From Crate to Community: Integrated Community Case Management (iCCM) and ColaLife

After almost a year of planning, the Integrated Community Case Management (iCCM) Evidence Review Symposium came to a close in Accra, Ghana last week. I’ve just returned to Toronto after having presented as part of the Supply Chain Management Panel and sharing our preliminary findings from the ColaLife Operational Trial in Zambia (COTZ). There was a tremendous amount of enthusiasm and interest in what we are doing.

We were in good company, as joining me on the Supply Chain Panel were:

  • Yasmin Chandani – Project Director for JSI’s Supply Chain for Community Case Management (SC4CCM) project;
  • Humphreys Nsona – from the Ministry of Health in Malawi who spoke about cStock;
  • Timoteo Chaluco – Village Reach, Mozambique who spoke about ODK Scan (the same software we used to collect our data); and
  • Patrick Nganji – SC4CCM, Rwanda on behalf of Catherine Mugeni from Rwanda’s Ministry of Health who spoke about community health worker motivation and problem solving teams

And what a great coincidence and pleasure it was to have the panel be moderated by Musonda Kasonde, a logistics and supply chain specialist at UNICEF (and the daughter of Dr. Joseph Kasonde, Minister of Health in Zambia, and a great supporter of our work).

The Symposium had two main objectives:

  1. To review the current state of the art of iCCM implementation by bringing together researchers, donors, government, implementers and partners to review the map of the current landscape and status of evidence in key iCCM program areas, in order to draw out priorities, lessons and gaps for improving child and maternal-newborn health; and
  2. To assist African countries to integrate and take action on key frontline iCCM findings presented during the evidence symposium.

iCCM is a strategy to deliver lifesaving interventions for the leading causes of childhood mortality to the community level, particularly where there is limited access to facility-based services. It is an essential approach in helping to achieve equity and to reaching those children most in need.

It’s well established that in most high-mortality countries, the services provided by health facilities alone do not provide adequate access to treatment (Schellenberg et al, 2003; Victora et al, 2003). In 2012, approximately three quarters of the 6.6M deaths in children under five were mainly due to preventable causes: neonatal conditions, pneumonia, diarrhea and malaria (the leading causes of death in children under 5).

iccm colalife slide

Many of these deaths could have been averted through the use of existing, low-cost, relatively basic interventions like antibiotics, ORS & Zinc, and ACTs (antimalarials). Bringing these treatments closer to home is a crucial challenge that needs to be addressed – and our model is breaking new ground. By providing an alternative point of access (to an innovative combination therapy product) through rural retailers at the community level, we were able to significantly increase utilization of ORS and Zinc at the household level. This can relieve pressure on already over-burdened health centres, and help overcome key access challenges including distance to access treatment, stock-outs, quality of treatment, and treatment delay.

The Symposium was organized into ten cross-cutting thematic areas, many of which clearly overlap with key themes addressed/considered by the ColaLife model:

  • Coordination, Policy Setting and Scale-Up
  • Costs, Cost-Effectiveness, and Financing
  • Demand Generation and Social Mobilization
  • Human Resources and Deployment
  • iCCM for Newborn Health
  • Innovations
  • Monitoring and Evaluation
  • Private Sector Partnerships
  • Supervision and Performance Quality Assurance
  • Supply Chain Management

At the end of each panelist’s presentation, we were asked to leave the audience with some key points for consideration. Here’s some from our work:

  • With appropriate stakeholder development, a private sector ORSZ product seems to be acceptable at all levels.
  • Linking messaging around treatment with a specific product – can improve uptake. Wilson and colleagues (J of Glob Hlth, 2013) note that one of the main differentiators between countries that have been successful in scaling up ORS and those that haven’t was the decision to promote a clear, unambiguous message about the treatment of choice (in Bhutta et al, Lancet, 2013).
  • Multi-sectoral partnerships and integrated innovation (social, technical/scientific, & business innovation) can improve impact and chances for achieving scale.
  • Demand-driven vs. supply-led distribution: the concept of developing value-chains for simple public health commodities (vs. supply-chains) can complement existing systems.
  • Leveraging existing local networks, as opposed to developing parallel systems, has numerous advantages.
  • The need for task shifting from primary health facilities to the community level has the potential of being partially fulfilled by private shops (at least for simple commodities).
  • To address issues of affordability in remote/rural, under-served markets, some level of subsidy (e.g. through vouchers) may be required until product costs are sufficiently low.
  • Application of this model to other simple PH commodities?

I’ll leave you with the following link to a video that was put together by the organizers of the iCCM Symposium.

In other news, it was also great to see Chelsea Clinton Tweet about ColaLife on Friday:

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Till next time.