Zambia community case management

Zambia adopted iCCM to target populations in rural communities and “hard-to- reach areas” with limited access to health facilities:

  • Currently 50% of the population in rural areas are within 5 kilometres of a health facility.
  • Initial prioritization of North-Western province and Eastern, Muchinga, Northern, and Luapula provinces where malaria burden is the greatest

Accomplishments:

  • Integrated Management of Childhood Illness (IMCI) Technical Working Group (TWG) meets regularly
  • iCCM as the national strategy for malaria case management has been incorporated in the National Malaria Strategic Plan
  • Community data monitoring and supervision tools have been developed
  • Over 500 facility-based staff have been trained to provide oversight to CHWs implementing iCCM activities

Coverage:

  • As of September 2019, just over 8000 community health workers (CHWs) had been trained, deployed, and were registered in District Health Information System 2 (DHIS2), which is approximately half the national need.
  • Not all are active and adequately supplied with commodities
  • The number of patients seen by CHWs may not be adequately captured in the Health Management Information System (HMIS). 
  • The national goal is to deploy CHWs at a ratio of 1:500 population, but in lower burden rural settings a ratio of 1:750 has been found to be acceptable.

Challenges:

  • Support to reach the necessary number of CHWs to population ratio
  • Reporting systems
  • Supervision
  • Logistics
  • Monitoring
  • Retention of CHWs and malaria agents operating at community level
  • Ad hoc systems of incentives
  • Ad hoc system to roll out of iCCM