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Policy challenges facing integrated community case management in Sub-Saharan Africa

OBJECTIVE: To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. METHODS: Qualitative retrospective case st...

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Autores principales: Bennett, Sara, George, Asha, Rodriguez, Daniela, Shearer, Jessica, Diallo, Brahima, Konate, Mamadou, Dalglish, Sarah, Juma, Pamela, Namakhoma, Ireen, Banda, Hastings, Chilundo, Baltazar, Mariano, Alda, Cliff, Julie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BlackWell Publishing Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282431/
https://www.ncbi.nlm.nih.gov/pubmed/24750516
http://dx.doi.org/10.1111/tmi.12319
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author Bennett, Sara
George, Asha
Rodriguez, Daniela
Shearer, Jessica
Diallo, Brahima
Konate, Mamadou
Dalglish, Sarah
Juma, Pamela
Namakhoma, Ireen
Banda, Hastings
Chilundo, Baltazar
Mariano, Alda
Cliff, Julie
author_facet Bennett, Sara
George, Asha
Rodriguez, Daniela
Shearer, Jessica
Diallo, Brahima
Konate, Mamadou
Dalglish, Sarah
Juma, Pamela
Namakhoma, Ireen
Banda, Hastings
Chilundo, Baltazar
Mariano, Alda
Cliff, Julie
author_sort Bennett, Sara
collection PubMed
description OBJECTIVE: To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. METHODS: Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. RESULTS: Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. CONCLUSIONS: iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies.
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spelling pubmed-42824312015-01-15 Policy challenges facing integrated community case management in Sub-Saharan Africa Bennett, Sara George, Asha Rodriguez, Daniela Shearer, Jessica Diallo, Brahima Konate, Mamadou Dalglish, Sarah Juma, Pamela Namakhoma, Ireen Banda, Hastings Chilundo, Baltazar Mariano, Alda Cliff, Julie Trop Med Int Health Health Policy OBJECTIVE: To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. METHODS: Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. RESULTS: Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. CONCLUSIONS: iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies. BlackWell Publishing Ltd 2014-07 2014-04-18 /pmc/articles/PMC4282431/ /pubmed/24750516 http://dx.doi.org/10.1111/tmi.12319 Text en © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Health Policy
Bennett, Sara
George, Asha
Rodriguez, Daniela
Shearer, Jessica
Diallo, Brahima
Konate, Mamadou
Dalglish, Sarah
Juma, Pamela
Namakhoma, Ireen
Banda, Hastings
Chilundo, Baltazar
Mariano, Alda
Cliff, Julie
Policy challenges facing integrated community case management in Sub-Saharan Africa
title Policy challenges facing integrated community case management in Sub-Saharan Africa
title_full Policy challenges facing integrated community case management in Sub-Saharan Africa
title_fullStr Policy challenges facing integrated community case management in Sub-Saharan Africa
title_full_unstemmed Policy challenges facing integrated community case management in Sub-Saharan Africa
title_short Policy challenges facing integrated community case management in Sub-Saharan Africa
title_sort policy challenges facing integrated community case management in sub-saharan africa
topic Health Policy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282431/
https://www.ncbi.nlm.nih.gov/pubmed/24750516
http://dx.doi.org/10.1111/tmi.12319
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