Using the Lives Saved Tool as part of evaluations of community case management programs

BACKGROUND: Integrated community case management (iCCM) has been recommended by the World Health Organization to reduce mortality among children in populations with limited access to facility–based health care providers. Although many countries have introduced iCCM, interpretation of the impact is difficult due to many other activities occurring in the community. This paper suggests a method for using the Lives Saved Tool to model the independent impact of iCCM on child mortality. MODEL: The Lives Saved Tool (LiST) is a multi–cause model of mortality which allows users to look at the potential impacts of one or many interventions on one or many causes of death without double counting their impact. LiST uses changes in intervention coverage and cause–specific effectiveness estimates on mortality and risk factors to model overall changes in mortality as well as to attribute mortality reduction to specific interventions. Collecting data on the source of the care seeking behaviors is critical to being able to model and interpret the changes observed. DISCUSSION: The complexity of implementation of iCCM in the environment of broader health changes requires modeling to understand the program specific impacts. Using LiST results as additional data in combination with observed coverage change and mortality reduction can help explain the isolated impact of a given iCCM program when other changes are ongoing. LiST is unable to determine why the changes in health care seeking behaviors occur, but can be useful in helping to explain whether or not the changes were beneficial.