National scale-up of integrated community case management in rural Ethiopia: implementation and early lessons learned.

BACKGROUND: Although under-five mortality in Ethiopia has decreased 67% in the past two decades, many, children still die from preventable or treatable conditions, mainly pneumonia, newborn problems, diarrhea, malaria and malnutrition. Most of these deaths can be avoided with timely and appropriate care, but access to and use of treatment remains inadequate. Community health workers, appropriately trained, supervised, and supplied with essen- tial equipment and medicines, can deliver case management or referral to most sick children. In 2010, Ethiopia added pneumonia to diarrhea, malaria and severe acute malnutrition, targeted for treatment in the integrated community case management (iCCM) strategy.
PURPOSE: This article describes the national scale-up of iCCM implementation and early lessons learned.
METHODS: We reviewed data related to iCCM program inputs and processes from reports, minutes, and related documents from January 2010 through July 2013. We describe introduction and scale-up through eight health system components.
RESULTS: The government and partners trained and supplied 27,116 of the total 32,000 Health Extension Workers and mentored 80% of them to deliver iCCM services to over one million children. The government led a strong-iCCM partnership that attracted development partners in implementation, monitoring, evaluation, and research. Service utilization and weak supply chain remain-major challenges.
CONCLUSION: Strong MOH leadership, policy support, and national partnerships helped successful national iCCM scale-up and should help settle remaining challenges.