Case Management and Care-seeking for malaria, pneumonia and diarrhoea in Six African Countries after an Integrated Health Systems Strengthening Intervention

Objective: Assess coverage of selected case management and care-seeking indicators of diarrhoea, malaria and pneumonia, after an integrated health system strengthening (IHSS) intervention in six African countries – Ethiopia, Ghana, Malawi, Mali, Mozambique and Niger.

Methods: Fixed mixed-methods evaluation were utilised. Baseline data and secular trends from large, population-based household surveys (DHS, MICS, LQAS conducted from 2005 to 2013) for key indicators were examined to assess changes in coverage during the IHSS intervention. Contextual factors were described using data from document reviews and databases. Contextual data were also collected during key informant interviews with national stakeholders, district personnel, community health workers, supervisors, and beneficiaries.  Data were analysed and triangulated.  

Results: There was large variation in coverage post IHSS for case management interventions: with ORS coverage ranging from 24% in rural Ethiopia to 52% in Malawi; care-seeking for fever 50% in rural Ethiopia to 74% in Malawi, care-seeking for pneumonia 25% in rural Ethiopia to 72% in Malawi, and malaria treatment 32% in rural Mozambique to 37% in 3 Northern Regions of Ghana. Coverage generally increased from baseline to endline, ranging from a 12 percentage point increase in ORS coverage in 3 Northern Regions of Ghana to a 35 percentage point increase in fever care-seeking in Ethiopia.  Qualitative data highlighted the contextual influences impacting on intervention receipt and implementation.

Conclusion: Across these six African countries IHSS supports to facility-based and community-based case management contributed to improved care-seeking and treatment coverage for pneumonia, diarrhoea and malaria, however substantial barriers to implementation remain.