Special Supplement on integrated Community Case Management
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The Government of Malawi (GoM) initiated activities to deliver treatment of common childhood illnesses (suspected pneumonia, fever/suspected malaria, and diarrhea) in the community in 2008. The service providers are Health Surveillance Assistants (HSAs), and they are posted nationwide to serve communities at a ratio of 1 to 1,000 population. The GoM targeted the establishment of 3,452 village health clinics (VHCs) in hard-to-reach areas by 2011. By September of 2011, 3,296 HSAs had received training in integrated case management of childhood illness, and 2,709 VHCs were functional. An assessment has shown that HSAs are able to treat sick children with quality similar to the quality provided in fixed facilities. Monitoring data also suggest that communities are using the sick child services. We summarize factors that have facilitated the scale up of integrated community case management of children in Malawi and address challenges, such as ensuring a steady supply of medicines and supportive supervision.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. UN Interagency Group for Child Mortality Estimates, 2011. Levels and Trends in Child Mortality. New York: UNICEF. [Google Scholar]
  2. UNICEF, 2011. Countdown to 2015 Decade Report (2000–2010): Tracking Stock of Maternal, Newborn and Child Survival. New York: UNICEF. [Google Scholar]
  3. WHO, 2005. World Health Report Making Every Mother and Child Count. Geneva, Switzerland: World Health Organization. [Google Scholar]
  4. WHO, UNICEF, 2004. Joint Statement on Management of Pneumonia in Community Settings. New York: UNICEF. [Google Scholar]
  5. UNICEF, 2012. Countdown to 2015: Tracking Progress in Maternal, Newborn and Child Survival. Progress Report 2012. New York: UNICEF. [Google Scholar]
  6. UNICEF, 2010. Community Case Management of Diarrhoea, Malaria and Pneumonia of Sick Children for Sub-Sahara Africa in 2010: Data Report of a Desk-Based Survey of UNICEF Country Offices. New York: UNICEF. [Google Scholar]
  7. Bhutta ZA, Lassi ZS, Parito G, Huicho L, , 2010. Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems. Geneva, Switzerland: Global Health Workforce Alliance. [Google Scholar]
  8. Haines A, Sanders D, Lehman U, Rowe AK, Lawn JE, Jan S, Walker DG, Bhutta Z, , 2007. Achieving child survival goals: potential contribution of community health workers. Lancet 369: 21212131.[Crossref] [Google Scholar]
  9. WHO, 2011. World Health Statistics. Geneva, Switzerland: World Health Organization. [Google Scholar]
  10. UNICEF and Malawi National Statistics Office, 2008. Malawi Multiple Indicator Cluster Survey 2006. Final Report. Lilongwe, Malawi: UNICEF and Malawi National Statistics Office. [Google Scholar]
  11. Joint United Programme on HIV/AIDS, 2010. Malawi HIV, Monitoring AIDS, and Evaluation Report: 2008–2009. UNGASS Country Progress Report, 2010. Geneva, Switzerland: Joint United Programme on HIV/AIDS. [Google Scholar]
  12. Ministry of Health Malawi, 2004. A Joint Programme of Work for a Health Sector-Wide Approach (SWAP), 2004–2010. Lilongwe, Malawi: Government of Malawi. [Google Scholar]
  13. National Statistics Office, Malawi, 2008. Population and Housing Census Main Report. Available at: http://www.nso.malawi.net/. Accessed July 25, 2012. [Google Scholar]
  14. Gilroy KE, Callaghan-Koru JA, Cardemil CV, Nsona H, Amouzou A, Mtimuni A, Daelmans B, Mgalula L, Bryce J on behalf of the CCM-Malawi Quality of Care Working Group, , 2012. Quality of sick child care delivered by Health Surveillance Assistants in Malawi. Health Policy Plan: first published online October 13, 2012. doi:10.1093/heapol/czs095. [Google Scholar]
  15. Callaghan-Koru JA, Hyder AA, George A, Gilroy KE, Nsona H, Mtimuni A, Bryce J, , 2012. Health workers' and managers' perceptions of the integrated community case management program for childhood illness in Malawi: the importance of expanding access to child health services. Am J Trop Med Hyg 87 (Suppl 5): 6168.[Crossref] [Google Scholar]
  16. National Statistical Office, Malawi, 2011. Institute for International Programs—Johns Hopkins University, USA Measuring CCM Implementation Strength Report of Findings from a Pilot of Study Catalytic Initiative Rapid Scale-Up Program, Malawi. Lilongwe, Malawi: Government of Malawi. [Google Scholar]
  17. WHO/UNICEF, 2011. Caring for the Sick Child in the Community. Geneva, Switzerland: World Health Organization. [Google Scholar]
  18. Kelly JM, Osamba B, Garg RM, Hamel MJ, Lewis JJ, Rowe SY, Rowe AK, Deming MS, , 2001. Community health worker performance in the management of multiple childhood illnesses: Siaya District, Kenya, 1997—2001. Am J Public Health 91: 16171624.[Crossref] [Google Scholar]
  19. Rowe SY, Kelly JM, Olewe MA, Kleinbaum DG, McGowan JE, McFarland DA, Rochat R, Deming S, , 2007. Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya, Kenya. Trans R Soc Trop Med Hyg 101: 188202.[Crossref] [Google Scholar]
  20. Ministry of Health Malawi, 2010. Demographic and Health Survey. Lilongwe, Malawi: Government of Malawi. [Google Scholar]
  21. Ministry of Health Malawi, 2009. Survey to Evaluate the Quality of Care Provided to Sick Children Attending a Health Facility. Lilongwe, Malawi: Government of Malawi. [Google Scholar]
  22. Victora CG, Black RE, Boerma JT, Bryce J, , 2011. Measuring impact in the Millennium Development Goal era and beyond: a new approach for large-scale effectiveness evaluations. Lancet 377: 8595.[Crossref] [Google Scholar]
  23. McGorman L, Marsh DR, Guenther T, Gilroy K, Barat LM, Hammamy D, Wansi E, Peterson S, Hamer DH, George A, , 2012. A health systems approach to integrated community case management of childhood illness: methods and tools. Am J Trop Med Hyg 87 (Suppl 5): 6976.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 05 Dec 2011
  • Accepted : 12 May 2012
  • Published online : 07 Nov 2012

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