Volume 93, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Program managers, investors, and evaluators need real-time information on how program strategies are being scaled up and implemented. Integrated Community Case Management (iCCM) of childhood illnesses is a strategy for increasing access to diagnosis and treatment of malaria, pneumonia, and diarrhea through community-based health workers. We collected real-time data on iCCM implementation strength through cell phone interviews with community-based health workers in Malawi and calculated indicators of implementation strength and utilization at district level using consensus definitions from the Ministry of Health (MOH) and iCCM partners. All of the iCCM implementation strength indicators varied widely within and across districts. Results show that Malawi has made substantial progress in the scale-up of iCCM since the 2008 program launch. However, there are wide differences in iCCM implementation strength by district. Districts that performed well according to the survey measures demonstrate that MOH implementation strength targets are achievable with the right combination of supportive structures. Using the survey results, specific districts can now be targeted with additional support.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Bryce J, Gilroy K, Jones G, Hazel E, Black RE, Victora CG, , 2010. The Accelerated Child Survival and Development programme in west Africa: a retrospective evaluation. Lancet 375: 572582.
  2. Bryce J, Victora CG, Habicht JP, Vaughan JP, Black RE, , 2004. The multi-country evaluation of the integrated management of childhood illness strategy: lessons for the evaluation of public health interventions. Am J Public Health 94: 406415.
  3. Hazel E, Amouzou A, Park L, Banda B, Chimuna T, Guenther T, Nsona H, Victora CG, Bryce J, , 2015. Real-time assessments of the strength of program implementation for community case management of childhood illness: validation of a mobile-phone based method in Malawi. Am J Trop Med Hyg 92: 660665.
  4. Young M, Wolfheim C, Marsh DR, Hammamy D, , 2012. World Health Organization/United Nations Children's Fund joint statement on integrated community case management: an equity-focused strategy to improve access to essential treatment services for children. Am J Trop Med Hyg 87: 610.
  5. Chopra M, Sharkey A, Dalmiya N, Anthony D, Binkin N, UNICEF Equity in Child Survival, Health and Nutrition Analysis Team, , 2012. Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition. Lancet 380: 13311340.
  6. Nsona H, Mtimuni A, Daelmans B, Callaghan-Koru JA, Gilroy K, Mgalula L, Kachule T, Zamasiya T, , 2012. Scaling up integrated community case management of childhood illness: update from Malawi. Am J Trop Med Hyg 87: 5460.
  7. National Statistical Office Malawi, 2008. 2008 Population and Housing Census. Available at: http://www.nsomalawi.mw/images/stories/data_on_line/demography/census_2008/MainReport/CensusMainReport.pdf.
  8. StataCorp, 2009. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.
  9. United States Census Bureau, 2012. Census and Survey Processing System, (CSPro). Available at: http://www.census.gov/population/international/software/. Accessed November 13, 2013.
  10. Gilroy KE, Callaghan-Koru JA, Cardemil CV, Nsona H, Amouzou A, Mtimuni A, Daelmans B, Mgalula L, Bryce J, CCM-Malawi Quality of Care Working Group, , 2013. Quality of sick child care delivered by Health Surveillance Assistants in Malawi. Health Policy Plan 28: 573585.
  11. Miller NP, Amouzou A, Tafesse M, Hazel E, Legesse H, Degefie T, Victora CG, Black RE, Bryce J, , 2014. Integrated community case management of childhood illness in Ethiopia: implementation strength and quality of care. Am J Trop Med Hyg 91: 424434.
  12. Institute for International Programs Johns Hopkins University Bloomberg School of Public Health, Save the Children USA, Malawi Ministry of Health, 2014. Improving Data Use of Routine CCM M&E by Health Workers: Case Study in Malawi. Available at: http://www.jhsph.edu/research/centers-and-institutes/institute-for-international-programs/completed-projects/traction-translating-research-into-action/_documents/Data_use_package_report_FINAL_Clean_9Jan14.pdf. Accessed March 13, 2015.
  13. Batzilis D, Dinkelman T, Oster E, Thornton R, Zanera D, National Bureau of Economic Research, , 2010. New Cellular Networks in Malawi Correlates of Service Rollout and Network Performance. NBER working paper series working paper 16616. Cambridge, MA: National Bureau of Economic Research.

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  • Received : 11 Dec 2014
  • Accepted : 26 Jun 2015

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