1. Community case management RBM CMWG, 8-9 th July 2009

2. Purpose What are the operational/implementation issues that need attention, if nation wide delivery of community case management is to be feasible and achievable? How can we address these issues?

3. Categorisation of the issues Health system Health worker Community based Health facility based Community Policy Private sector

4. Health systems Availability of malaria treatments; in the hands of CHWs – right treatment, right dosages, right time How does community-based case management fit/integrate into the “formal” health system? Use of regular supervision to sustain good practices and behaviour; models and funding

5. Health systems Record keeping and use of data for decision making; registers, data flow, feedback Resource mobilisation Using defined indicator/s to measure progress; reliably

6. Health worker – community-based Quality of services; assessing CHW performance and improving it, adherence to guidelines CHW motivational approaches; why volunteer? What is the right package, i.e. financial and non-financial?

7. Health worker – facility based Supervision of CHWs? Perceptions of CCM? Extension of the health system or “competition”?; resources to community not matched by resources to health facilities.

8. Community Treatment adherence; what is the status now and how can it be improved? Pre-packs, packaging Effective approaches for demand creation for treatment (and diagnosis); what is community mobilisation/ sensitisation? where is the evidence of what works?

9. Policy environment Rationale of community case management (malaria); (presumptive) treatment close to home? what about health facilities? Treatment and diagnosis=case management? Introduction of integrated community case management (malaria, pneumonia, diarrhoea); how will this affect current malaria case management approaches?

10. Private sector Is this a continuum of community case management? Acceptability-both sides How to engage? Policies, training, treatments, diagnosis, reporting, quality control

11. How can we address these issues? Distill the operational evidence (& experiences) to highlight what works – best practices, implementation models what has not worked and why Harness current funding opportunities to support feasible implementation models – link to operational research to inform future improvements Identify the gaps that have not be addressed and how to go about finding solutions

12. How can we address these issues? Recommendations CCM is a delivery approach that should complement health facility delivery approach Health facility delivery should be strengthened in tandem with CCM; health facility delivery should be the ideal approach CCM is not a permanent delivery approach and there should be guidelines on “phasing in” and “phasing out” – changing role of CHWs?