Volume 94, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We conducted a prospective evaluation of the “Rapid Scale-Up” (RSU) program in Burkina Faso, focusing on the integrated community case management (iCCM) component of the program. We used a quasi-experimental design in which nine RSU districts were compared with seven districts without the program. The evaluation included documentation of program implementation, assessments of implementation and quality of care, baseline and endline coverage surveys, and estimation of mortality changes using the Lives Saved Tool. Although the program trained large numbers of community health workers, there were implementation shortcomings related to training, supervision, and drug stockouts. The quality of care provided to sick children was poor, and utilization of community health workers was low. Changes in intervention coverage were comparable in RSU and comparison areas. Estimated under-five mortality declined by 6.2% (from 110 to 103 deaths per 1,000 live births) in the RSU area and 4.2% (from 114 to 109 per 1,000 live births) in the comparison area. The RSU did not result in coverage increases or mortality reductions in Burkina Faso, but we cannot draw conclusions about the effectiveness of the iCCM strategy, given implementation shortcomings. The evaluation results highlight the need for greater attention to implementation of iCCM programs.

[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.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization, UNICEF, 2009. WHO/UNICEF Joint Statement: Home Visits for the Newborn Child: A Strategy to Improve Survival. Geneva, Switzerland: World Health Organization.
  2. World Health Organization, UNICEF, 2012. WHO/UNICEF Joint Statement: Integrated Community Case Management. Geneva, Switzerland: World Health Organization.
  3. Department of Foreign Affairs, Trade and Development Canada, 2007. The Initiative to Save a Million Lives. Available at: http://www.pm.gc.ca/eng/news/2007/11/26/initiative-save-million-lives. Accessed May 3, 2014.
  4. World Health Organization, 2015. Rapid Access Expansion 2015 Programme (RAcE 2015). Available at: http://www.who.int/malaria/areas/rapid_access_expansion_2015/en/. Accessed July 25, 2015.
  5. de Sousa A, Tiedje KE, Recht J, Bjelic I, Hamer DH, , 2012. Community case management of childhood illnesses: policy and implementation in Countdown to 2015 countries. Bull World Health Organ 90: 183190.[Crossref]
  6. United Nations Development Programme, 2014. Human Development Report 2014: Sustaining Human Progress: Reducing Vulnerabilities and Building Resilience. New York, NY: United Nations Development Programme.
  7. United Nations Inter-Agency Group on Mortality Estimation, 2015. Child Mortality Estimates, Burkina Faso. Available at: http://www.childmortality.org/index.php?r=site/graph#ID=BFA_BurkinaFaso. Accessed July 25, 2015.
  8. World Health Organization, 2014. Trends in Maternal Mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva, Switzerland: World Health Organization.
  9. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, For the Child Health Epidemiology Reference Group of WHO and UNICEF; , 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 21512161.[Crossref]
  10. Ministère de la Santé du Burkina Faso, 2008. Requête du Burkina Faso auprès du partenariat pour la santé de la mère, du nouveau né et de l'enfant. Ouagadougou, Burkina Faso: Government of Burkina Faso.
  11. Bennett S, George A, Rodriguez D, Shearer J, Diallo B, Konate M, Dalglish S, Juma P, Namakhoma I, Banda H, Chilundo B, Mariano A, Cliff J, , 2014. Policy challenges facing integrated community case management in sub-Saharan Africa. Trop Med Int Health 19: 872882.[Crossref]
  12. Institut Supérieur des Sciences de la Population, Institute for International Programs, Johns Hopkins University, 2014. Evaluation independante du projet d'accélération de la réduction de la mortalité maternelle, néonatale et infanto-juvénile dans les régions sanitaires du Nord et Centre-Nord au Burkina Faso: Enquête communautaire. Ouagadougou, Burkina Faso: ISSP and IIP-JHU.
  13. Ministère de la Santé du Burkina Faso, 2014. Profil de l'agent de santé à base communautaire. Ouagadougou, Burkina Faso: Government of Burkina Faso.
  14. Bryce J, Victora CG, Boerma T, Peters DH, Black RE, , 2011. Evaluating the scale-up for maternal and child survival: a common framework. Int Health 3: 139146.[Crossref]
  15. Hayes RJ, Moulton LH, , 2010. Cluster Randomized Trials. Boca Raton, FL: Chapman and Hall/CRC.
  16. United States Census Bureau, 2010. Census and Survey Processing System (CSPro) 4.0. Available at: http://www.census.gov/ipc/www/cspro/. Accessed July 27, 2015.
  17. SPSS Inc, 2009. SPSS, Version 17. Chicago, IL: SPSS Inc.
  18. QSR International Pty Ltd, 2012. NVivo Qualitative Data Analysis Software, Version 10. Doncaster, Victoria: QSR International Pty Ltd.
  19. Direction générale de l'information et des statistiques sanitaires du Ministère de la Santé, 2009. Annuaire Statistique 2008. Ouagadougou, Burkina Faso: Government of Burkina Faso.
  20. Direction générale de l'information et des statistiques sanitaires du Ministère de la Santé, 2011. Annuaire Statistique 2010. Ouagadougou, Burkina Faso: Government of Burkina Faso.
  21. Direction générale de l'information et des statistiques sanitaires du Ministère de la Santé, 2014. Annuaire Statistique 2013. Ouagadougou, Burkina Faso: Government of Burkina Faso.
  22. Burkina Faso Ministry of Mines and Energy, 2014. 2012 Statistical Handbook for the Ministry of Mines and Energy. Ouagadougou, Burkina Faso: Government of Burkina Faso.
  23. 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.[Crossref]
  24. Pendragon Software Corporation, 2011. Pendragon Forms VI. Buffalo Grove, IL: Pendragon Software Corporation.
  25. StataCorp, 2013. Stata Statistical Software, Version 13. College Station, TX: StataCorp LP.
  26. Department of Child and Adolescent Health and Development, World Health Organization, 2003. Health Facility Survey: Tool to Evaluate the Quality of Care Delivered to Sick Children Attending Outpatient Facilities. Geneva, Switzerland: World Health Organization.
  27. Institut pour la Recherche en Sciences de la Santé, 2012. Evaluation de la qualité des soins prodigués aux enfants de moins de 5 ans dans les formations sanitaires des régions du Nord et du Centre-Nord du Burkina Faso. Ouagadougou, Burkina Faso: Government of Burkina Faso.
  28. Institut National de la Statistiqe et de la Démographie, 2008. Recensement General de la Population et de l'Habitation de 2006, Résultats Définitifs. Ouagadougou, Burkina Faso.
  29. StataCorp, 2011. Stata Statistical Software, Version 12. College Station, TX: StataCorp LP.
  30. Binder DA, , 1983. On the variances of asymptotically normal estimators from complex surveys. Int Stat Rev 51: 279292.[Crossref]
  31. UN Commission on Information and Accountability for Women's and Children's Health, 2014. Available at: http://www.everywomaneverychild.org/accountability/coia. Accessed April 23, 2015.
  32. UNICEF, 2014. UNICEF Statistics and Monitoring: Multiple Indicator Cluster Survey. Available at: http://www.unicef.org/statistics/index_24302.html. Accessed May 3, 2014.
  33. Walker N, Tam Y, Friberg IK, , 2013. Overview of the Lives Saved Tool (LiST). BMC Public Health 13 (Suppl 3): S1.[Crossref]
  34. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, Sankar JM, Blencowe H, Rizvi A, Chou AB, Walker N, for the Lancet Newborn Interventions Review Group and the Lancet Every Newborn Study Group; , 2014. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 383: 13331354.[Crossref]
  35. Nsungwa-Sabiiti J, Burnham G, Pariyo G, Uganda IMCI Documentation Team; , 2004. Implementation of a National Integrated Management of Childhood Illness (IMCI) Program in Uganda. J Health Popul Dev Ctries, doi: 10.12927/whp.2004.17643.
  36. Sauerborn R, Nougtara A, Hien M, Diesfeld HJ, , 1996. Seasonal variations of household costs of illness in Burkina Faso. Soc Sci Med 43: 281290.[Crossref]
  37. Hazir T, Begum K, El Arifeen S, Khan AM, Huque MH, Kazmi N, Roy S, Abbasi S, Rahman QS, Theodoratou E, Khorshed MS, Rahman KM, Bari S, Kaiser MM, Saha SK, Ahmed AS, Rudan I, Bryce J, Qazi SA, Campbell H, , 2013. Measuring coverage in MNCH: a prospective validation study in Pakistan and Bangladesh on measuring correct treatment of childhood pneumonia. PLoS Med 10: e1001422.[Crossref]
  38. Amouzou A, Morris S, Moulton LH, Mukanga D, , 2014. Assessing the impact of integrated community case management (iCCM) programs on child mortality: review of early results and lessons learned in sub-Saharan Africa. J Glob Health 4: 020411.[Crossref]

Data & Media loading...

Supplementary Data

Supplementary PDF

  • Received : 11 Aug 2015
  • Accepted : 29 Sep 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error