Ensuring access to and appropriate use of medicines for integrated community case management (iCCM): It takes a system

iCCM aims to improve access to appropriate treatment for children under five who live far from health facilities by training and supervising community health workers (CHWs) and supplying them with essential commodities. The effectiveness of the CHWs depends on the availability and appropriate use of the commodities. CHWs are in hard-to-reach places, presenting greater challenges for distribution of supplies, reporting, and supervision. To address these challenges, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program implements a broader systems strengthening approach, beyond focusing only on the resupply system. For example, in DRC, SIAPS has helped revise the Essential Medicines List and treatment guidelines to include medicines for iCCM, which has created a more supportive policy environment. Information systems and the use of information for appropriate quantification have been the focus of work in DRC, Mali, and Guinea, and, in many other countries, SIAPS has developed capacity of quantification committees to provide more accurate forecasts. In Burundi and Guinea, training, job aids, and supervision has improved the ability of CHWs to practice rational use and assure availability of commodities. In a recent survey in Burundi, all 37 observed CHWs provided and administered the correct treatment and counseling, with 74% of CHWs observing the child after the first dose. SIAPS supported a costing exercise in Burundi which was utilized to mobilize resources for iCCM expansion. Although the recent inclusion of iCCM activities in Global Fund grants is a significant opportunity for ministries of health to scale-up iCCM to reduce child mortality and morbidity rates, it is also a serious coordination challenge that must be addressed if iCCM is to succeed.