Malaria Clinical Trial
Official title:
Integrated Community Case Management of Common Childhood Diseases: Mozambique and Uganda
The aim of the inSCALE project is to test the effect of innovative approaches to increase coverage of integrated community case management, which provides community based-care for diarrhoea, pneumonia and malaria, resulting in more children receiving timely and appropriate care for these three most common childhood illnesses
The Innovations at Scale for Community Access and Lasting Effects (inSCALE) project is
identifying and documenting limitations to national scale up of Integrated Community Case
Management (ICCM) and aims to demonstrate that coverage and impact of government-led ICCM
programmes can be extended if innovative solutions can be found for critical limitations.
Based on research, three main constraints have been found to limit coverage of community
based management of childhood diseases: supervision, motivation and information flow
Potential solutions to the identified constraints have been formulated based on current
knowledge and experiences from Malaria Consortium ICCM implementation and other relevant
community-based initiatives in both project countries and elsewhere. Extensive formative
research was conducted to support the design of innovations aimed to improve motivation and
performance of community health workers.
Innovations which have potential to address the project's aims but lack sufficient evidence
of impact are being formally evaluated in a randomised control trial. In Mozambique, a
technology based intervention is being tested where community health workers (CHWs) are
provided with smart phones to programmed with a tool for decision support, immediate
feedback and multimedia audio and images to improve adherence to protocols. The tool will
also allow CHWs to send key indicators to a server and to keep a register of patients who
can be tracked over time. The indicators submitted will be used for performance monitoring
of the CHWs by providing automated timely, digestible reports with targeted follow-up
actions for CHW supervisors. In Uganda, one technology and one community based intervention
are being evaluated over a 12 month period. In the technology intervention, CHWs are given a
Java enabled mobile phone through which they can send their weekly reports and drug stocks,
receive immediate feedback based on data submission and monthly motivational messages. The
phones in both countries also contain innovative tools such as a respiratory timers to
support the CHWs in their work. CHWs and their supervisors are on closed user groups in
order to increase communication and support. The community intervention is focused on the
running of Village Health Clubs. These are designed to be highly participatory with the CHWs
in the role of facilitator, aimed at increasing awareness about the CHW role and improving
motivation through the support of the community.
Continuous Ministry of Health support for health facilities to provide referral care and
equip community health workers with medicines, tools, supervision and training are critical
for the success of the project.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
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