ICCM of Common Childhood Diseases: Mozambique and Uganda
- Conditions
- DiarrhoeaPneumoniaMalaria
- Interventions
- Other: Technology supported supervisionBehavioral: Community supported supervisionOther: Integrated community case management
- Registration Number
- NCT01972321
- Lead Sponsor
- Malaria Consortium
- Brief Summary
The aim of the inSCALE project is to test the effect of innovative approaches to increase coverage of integrated community case management, which provides community based-care for diarrhoea, pneumonia and malaria, resulting in more children receiving timely and appropriate care for these three most common childhood illnesses
- Detailed Description
The Innovations at Scale for Community Access and Lasting Effects (inSCALE) project is identifying and documenting limitations to national scale up of Integrated Community Case Management (ICCM) and aims to demonstrate that coverage and impact of government-led ICCM programmes can be extended if innovative solutions can be found for critical limitations. Based on research, three main constraints have been found to limit coverage of community based management of childhood diseases: supervision, motivation and information flow
Potential solutions to the identified constraints have been formulated based on current knowledge and experiences from Malaria Consortium ICCM implementation and other relevant community-based initiatives in both project countries and elsewhere. Extensive formative research was conducted to support the design of innovations aimed to improve motivation and performance of community health workers.
Innovations which have potential to address the project's aims but lack sufficient evidence of impact are being formally evaluated in a randomised control trial. In Mozambique, a technology based intervention is being tested where community health workers (CHWs) are provided with smart phones to programmed with a tool for decision support, immediate feedback and multimedia audio and images to improve adherence to protocols. The tool will also allow CHWs to send key indicators to a server and to keep a register of patients who can be tracked over time. The indicators submitted will be used for performance monitoring of the CHWs by providing automated timely, digestible reports with targeted follow-up actions for CHW supervisors. In Uganda, one technology and one community based intervention are being evaluated over a 12 month period. In the technology intervention, CHWs are given a Java enabled mobile phone through which they can send their weekly reports and drug stocks, receive immediate feedback based on data submission and monthly motivational messages. The phones in both countries also contain innovative tools such as a respiratory timers to support the CHWs in their work. CHWs and their supervisors are on closed user groups in order to increase communication and support. The community intervention is focused on the running of Village Health Clubs. These are designed to be highly participatory with the CHWs in the role of facilitator, aimed at increasing awareness about the CHW role and improving motivation through the support of the community.
Continuous Ministry of Health support for health facilities to provide referral care and equip community health workers with medicines, tools, supervision and training are critical for the success of the project.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 2289
CHWs in districts with ICCM implementation
CHWs in districts without ICCM implementation
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Community supported supervision Integrated community case management The community supported supervision intervention will set up village health clubs with the aim to improve child health through a community led forum with the CHW as the main focus point. Village health club meetings will provide a forum where CHWs and community members who are part of the club can work together to identify child health and CHW challenges. They will use village networks, knowledge, creativity and other assets. Technology supported supervision Technology supported supervision The technology supported supervision intervention will support the CHWs in providing quality case management for the under-fives who suffer from diarrhea, pneumonia and malaria through unlimited communication with their health facility supervisors and colleagues through closed-user-groups. It will enhance timely reporting of patient data and targeted support supervision on the CHWs who need support from their supervisors. With the CHWs receiving the above support and feedback messages, this will potentially increase CHW motivation, performance and retention. Data reported by CHWs can be used by the district planners to forecasting of medicine procurements and react to drug stock-outs or unusual data trends (e.g. disease outbreaks). Technology supported supervision Integrated community case management The technology supported supervision intervention will support the CHWs in providing quality case management for the under-fives who suffer from diarrhea, pneumonia and malaria through unlimited communication with their health facility supervisors and colleagues through closed-user-groups. It will enhance timely reporting of patient data and targeted support supervision on the CHWs who need support from their supervisors. With the CHWs receiving the above support and feedback messages, this will potentially increase CHW motivation, performance and retention. Data reported by CHWs can be used by the district planners to forecasting of medicine procurements and react to drug stock-outs or unusual data trends (e.g. disease outbreaks). Community supported supervision Community supported supervision The community supported supervision intervention will set up village health clubs with the aim to improve child health through a community led forum with the CHW as the main focus point. Village health club meetings will provide a forum where CHWs and community members who are part of the club can work together to identify child health and CHW challenges. They will use village networks, knowledge, creativity and other assets. Control arm Integrated community case management The CHWs in the control arm will be receiving the standard Ministry of Health designed package to integrated community case management support and supervision.
- Primary Outcome Measures
Name Time Method Appropriate treatment of malaria, pneumonia and diarrhoea in children under five years of age 1 year Proportion of children under five years of age with symptoms of malaria, pneumonia and diarrhoea who received appropriate treatment
- Secondary Outcome Measures
Name Time Method Community health workers with medicine stock-out <1 week each quarter 1 year The proportion of community health workers with medicine stock-out \<1 week each quarter
Trial Locations
- Locations (2)
26 Sub-Counties
🇺🇬Hoima, Please Select, Uganda
6 Districts
🇲🇿Inhambane, Mozambique