Community case management of childhood illness in Nicaragua: Transforming health systems in underserved rural areas

Asha George, Elaine P. Menotti, Dixmer Rivera, Irma Montes, Carmen María Reyes, David R. Marsh

Research output: Contribution to journalArticle

Abstract

While social factors broadly determine health outcomes, strategic health workforce innovations such as community case management (CCM) can redress social inequalities in access to health care. Community case management enables trained health workers to assess children, diagnose common childhood infections, administer medicines, and monitor life-saving treatment in the poor, remote communities where they reside. This article reports on research that combined focus group discussions and key informant interviews to examine the perceptions of multiple stakeholders, with monitoring data, in order to assess programmatic results, limitations, and lessons learned in implementing CCM in Nicaragua. We found that CCM increases the use of curative services by poor children with pneumonia, diarrhea, or dysentery by five to six-fold over facility-based services. Apart from dramatically increasing geographic access to treatment for underserved groups, our qualitative research suggests that Nicaragua's CCM model also addresses the managerial challenges and social relations that underpin good quality of care, care-giver knowledge and awareness, and community mobilization, all health system-strengthening factors that are central to equitably and effectively improving child health. While our findings are promising, we suggest areas for further operational research to strengthen CCM program learning and functioning.

Original languageEnglish (US)
Pages (from-to)99-115
Number of pages17
JournalJournal of Health Care for the Poor and Underserved
Volume20
Issue number4 SUPPL.
StatePublished - Nov 2009
Externally publishedYes

Fingerprint

Nicaragua
Case Management
Health
Health Manpower
Dysentery
Health Services Accessibility
Qualitative Research
Quality of Health Care
Focus Groups
Research
Caregivers
Diarrhea
Pneumonia
Learning
Interviews

Keywords

  • Adherence
  • Community case management
  • Community health workers
  • Diarrhea
  • Nicaragua
  • Pneumonia
  • Quality of care
  • Supervision

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

George, A., Menotti, E. P., Rivera, D., Montes, I., Reyes, C. M., & Marsh, D. R. (2009). Community case management of childhood illness in Nicaragua: Transforming health systems in underserved rural areas. Journal of Health Care for the Poor and Underserved, 20(4 SUPPL.), 99-115.

Community case management of childhood illness in Nicaragua : Transforming health systems in underserved rural areas. / George, Asha; Menotti, Elaine P.; Rivera, Dixmer; Montes, Irma; Reyes, Carmen María; Marsh, David R.

In: Journal of Health Care for the Poor and Underserved, Vol. 20, No. 4 SUPPL., 11.2009, p. 99-115.

Research output: Contribution to journalArticle

George, A, Menotti, EP, Rivera, D, Montes, I, Reyes, CM & Marsh, DR 2009, 'Community case management of childhood illness in Nicaragua: Transforming health systems in underserved rural areas', Journal of Health Care for the Poor and Underserved, vol. 20, no. 4 SUPPL., pp. 99-115.
George, Asha ; Menotti, Elaine P. ; Rivera, Dixmer ; Montes, Irma ; Reyes, Carmen María ; Marsh, David R. / Community case management of childhood illness in Nicaragua : Transforming health systems in underserved rural areas. In: Journal of Health Care for the Poor and Underserved. 2009 ; Vol. 20, No. 4 SUPPL. pp. 99-115.
@article{9d6717b4a8ad4bda906c04464d9fa09b,
title = "Community case management of childhood illness in Nicaragua: Transforming health systems in underserved rural areas",
abstract = "While social factors broadly determine health outcomes, strategic health workforce innovations such as community case management (CCM) can redress social inequalities in access to health care. Community case management enables trained health workers to assess children, diagnose common childhood infections, administer medicines, and monitor life-saving treatment in the poor, remote communities where they reside. This article reports on research that combined focus group discussions and key informant interviews to examine the perceptions of multiple stakeholders, with monitoring data, in order to assess programmatic results, limitations, and lessons learned in implementing CCM in Nicaragua. We found that CCM increases the use of curative services by poor children with pneumonia, diarrhea, or dysentery by five to six-fold over facility-based services. Apart from dramatically increasing geographic access to treatment for underserved groups, our qualitative research suggests that Nicaragua's CCM model also addresses the managerial challenges and social relations that underpin good quality of care, care-giver knowledge and awareness, and community mobilization, all health system-strengthening factors that are central to equitably and effectively improving child health. While our findings are promising, we suggest areas for further operational research to strengthen CCM program learning and functioning.",
keywords = "Adherence, Community case management, Community health workers, Diarrhea, Nicaragua, Pneumonia, Quality of care, Supervision",
author = "Asha George and Menotti, {Elaine P.} and Dixmer Rivera and Irma Montes and Reyes, {Carmen Mar{\'i}a} and Marsh, {David R.}",
year = "2009",
month = "11",
language = "English (US)",
volume = "20",
pages = "99--115",
journal = "Journal of Health Care for the Poor and Underserved",
issn = "1049-2089",
publisher = "Johns Hopkins University Press",
number = "4 SUPPL.",

}

TY - JOUR

T1 - Community case management of childhood illness in Nicaragua

T2 - Transforming health systems in underserved rural areas

AU - George, Asha

AU - Menotti, Elaine P.

AU - Rivera, Dixmer

AU - Montes, Irma

AU - Reyes, Carmen María

AU - Marsh, David R.

PY - 2009/11

Y1 - 2009/11

N2 - While social factors broadly determine health outcomes, strategic health workforce innovations such as community case management (CCM) can redress social inequalities in access to health care. Community case management enables trained health workers to assess children, diagnose common childhood infections, administer medicines, and monitor life-saving treatment in the poor, remote communities where they reside. This article reports on research that combined focus group discussions and key informant interviews to examine the perceptions of multiple stakeholders, with monitoring data, in order to assess programmatic results, limitations, and lessons learned in implementing CCM in Nicaragua. We found that CCM increases the use of curative services by poor children with pneumonia, diarrhea, or dysentery by five to six-fold over facility-based services. Apart from dramatically increasing geographic access to treatment for underserved groups, our qualitative research suggests that Nicaragua's CCM model also addresses the managerial challenges and social relations that underpin good quality of care, care-giver knowledge and awareness, and community mobilization, all health system-strengthening factors that are central to equitably and effectively improving child health. While our findings are promising, we suggest areas for further operational research to strengthen CCM program learning and functioning.

AB - While social factors broadly determine health outcomes, strategic health workforce innovations such as community case management (CCM) can redress social inequalities in access to health care. Community case management enables trained health workers to assess children, diagnose common childhood infections, administer medicines, and monitor life-saving treatment in the poor, remote communities where they reside. This article reports on research that combined focus group discussions and key informant interviews to examine the perceptions of multiple stakeholders, with monitoring data, in order to assess programmatic results, limitations, and lessons learned in implementing CCM in Nicaragua. We found that CCM increases the use of curative services by poor children with pneumonia, diarrhea, or dysentery by five to six-fold over facility-based services. Apart from dramatically increasing geographic access to treatment for underserved groups, our qualitative research suggests that Nicaragua's CCM model also addresses the managerial challenges and social relations that underpin good quality of care, care-giver knowledge and awareness, and community mobilization, all health system-strengthening factors that are central to equitably and effectively improving child health. While our findings are promising, we suggest areas for further operational research to strengthen CCM program learning and functioning.

KW - Adherence

KW - Community case management

KW - Community health workers

KW - Diarrhea

KW - Nicaragua

KW - Pneumonia

KW - Quality of care

KW - Supervision

UR - http://www.scopus.com/inward/record.url?scp=77249177059&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77249177059&partnerID=8YFLogxK

M3 - Article

C2 - 20168036

AN - SCOPUS:77249177059

VL - 20

SP - 99

EP - 115

JO - Journal of Health Care for the Poor and Underserved

JF - Journal of Health Care for the Poor and Underserved

SN - 1049-2089

IS - 4 SUPPL.

ER -