Institutionalization of integrated community case management into national health systems in low- and middle-income countries: a scoping review of the literature

Figures & data

Figure 1. Flow chart of the search strategy results.

Table 1. Characteristics of included citations.

Characteristics of included records	Count N (%)
Year of publication	N = 91
2010–2011	3 (3)
2012–2014	32 (35)
2015–2017	41 (45)
2018	15 (16)
Publication type	(N = 91)
Journal article	39 (43)
Government document	7 (8)
Implementing partner report/study	32 (35)
Donor report	10 (11)
Meeting proceeding/conference proceeding	2 (2)
International guideline	1 (1)
Percentage representation of WHO Region of origin in literature*	(N = 88)*
East Africa	44 (48)
Central Africa	7 (8)
West Africa	29 (32)
South-central Asia	7 (8)
Central America	1 (1)
Summary of studies by study design (where applicable)	N = 50
Empirical qualitative	9(18)
Empirical quantitative	15 (30)
Empirical mixed and multiple method study designs	9 (18)
Literature reviews/synthesis	7 (14)
Case studies	5 (10)
Commentaries/Editorials/view points	5 (10)

* Values do not add to 100 due to double counting for citations that cover more than one region

Table 2. Summary of characterises of iCCM community health workers.

Payment	Receive salary or stipends	No payment
	Burkina Faso, Ethiopia, Ghana-CBAs, Madagascar, Malawi, Mali, Mozambique, Niger, Uganda-CHEWs, Zambia-CHAs, Pakistan	Cameroon, DRC, Ghana-CHOs, Nigeria, Rwanda, Senegal, South Sudan, Uganda-VHTs, Zambia-others CHWs, Nicaragua, Nepal
Incentives and motivation	Monetary	Non monetary
	Burkina Faso before 2014, Madagascar (drug sellers)	Cameroon, Mali, Nigeria, Senegal, South Sudan, Uganda (implementing partners and community tokens)
	Rwanda, Madagascar (performance based financing)	Malawi (support from village committee)
	Access to loans (Nepal)	All (event based motivation)
iCCM training	short iCCM training (5–14 days)	iCCM part of longer training
	Burkina Faso, Cameroon, DRC, Ghana-CBAs, Madagascar, Malawi, Mozambique, Niger, Nigeria, Rwanda, Senegal, South Sudan, Uganda	Ethiopia, Ghana-CHOs, Zambia, Nicaragua, Pakistan
Basic CHW training	Short courses (5–14 days)	longer courses (1–10 months)
	Madagascar, Senegal, Uganda, Nicaragua, Nepal	Ethiopia, Ghana-CHOs, Zambia, Malawi, Mali, Mozambique, Niger, Pakistan
Gender	One male and one female per community	No requirement
Gender balance required	Burkina Faso, Ghana, Rwanda, Uganda	Cameroon, DRC, Madagascar, Malawi, Mali, Mozambique, Niger
Gender restricted to only females	Ethiopia, Nepal, Pakistan
Location of work	Home	Health post, health huts and village health compound or clinics
	Burkina Faso, Cameroon, DRC, Pakistan, Nepal, Nicaragua, Ghana-CBAs, Madagascar, Mozambique, Nigeria, Rwanda, South Sudan, Uganda-VHTs, Zambia-other CHWs	Ethiopia, Ghana-CHOs, Malawi, Mali, Niger, Senegal, Uganda-CHEWs, Zambia-CHAs
Supervision	Supervision by health facility workers/health post nurses	Supervision by other
	Burkina Faso, Cameroon, DRC, Ethiopia, Ghana, Madagascar, Malawi, Mali, Mozambique, Niger, Rwanda, Senegal, Uganda, Zambia, Nicaragua,	Pakistan (lady supervisors attached to the health facility) DRC (site management committee, health zone staff, Malawi (senior health assistants), Ghana (zonal coordinators), Mali (local health committees), Nigeria (community health extension workers), Nepal (village health workers), Rwanda (cell coordinators), South Sudan (community recruited supervisors).

Table 3. Summary of iCCM procurement supply management models.

Government led iCCM PSM plan	Present	Absent
	Burkina Faso, Ethiopia, Ghana, Madagascar, Malawi, Mozambique, Rwanda, Senegal, Uganda, Zambia, Nicaragua, Nepal, Pakistan	Cameroon, DRC, Mali, Nigeria, Niger, South Sudan
iCCM drugs supplied at the community level	All countries supply iCCM drugs. In Burkina Faso drugs for Malaria are supplied at the community level and inclusion of drugs for pneumonia is underway.
System used	Parallel partner run system	Integrated pull and push-pull mechanism	Integrated push mechanism
	DRC, Cameroon, Mali, Niger, Nigeria, South Sudan	Ethiopia, Ghana (CHOs may push medicines to CBAs), Madagascar, Senegal, Uganda (higher levels may push to lower levels), Zambia, Nepal (pull-push), Pakistan	Malawi, Mozambique, Rwanda, Burkina Faso
PSM improvement tools and approaches	Forecasting and quantification	ehealth interventions	providing large stocks to hard-to-reach areas
	Ethiopia, Ghana	Malawi (cStock), Mozambique (APE App), Rwanda (m’Ubuzima programe), Zambia.	South Sudan

*The integrated systems in all countries are partially supported by implementing partners.

Table 4. Service delivery models for iCCM and stage of implementation.

Stage of implementation	Early	Expansion
	Cameroon, South Sudan	Burkina Faso, DRC, Ethiopia, Ghana, Madagascar, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda, Senegal, Uganda, Zambia, Nicaragua, Nepal, Pakistan
Health promotion responsibilities	Allocated to separate cadre of CHWs	Not allocated to separate cadre of CHWs	Mandatory partitioning of time
	Cameroon, DRC, Ethiopia-HDAs, Zambia (only after obtaining a critical mass of CHAs), Niger (only in some areas), and Senegal	Burkina Faso, Ghana, Madagascar, Malawi, Mali, Nigeria, Rwanda, South Sudan, Uganda, Nicaragua, Nepal and Pakistan.	Ethiopia-mandatory time partitioning, Mozambique- 80% CHW work must be on health promotion
Provision of curative services	Free services for malaria, pneumonia and diarrhea	Free services for malaria, pneumonia and diarrhea but with user charges	Paid for services
	Burkina Faso (recently transitioned from paid services), Cameroon, Ethiopia, Malawi, Mali (only for pneumonia), Mozambique, Niger, Nigeria, Rwanda, South Sudan, Uganda, Zambia, Nicaragua, Nepal and Pakistan	DRC, Ghana, Mali, and Senegal	Madagascar (subsidised Medicine charges), Mali (diarrhea and pneumonia)

Table 5. Compliance with iCCM benchmark components by low to middle-income countries.

	Benchmark components of integrated community case (iCCM)
*Countries	Coordination and policy setting	Costing and financing;	Human resources (CHWs)	Supply chain management	Service delivery and referral	Communications and social mobilization	Supervision and performance quality assurance	Monitoring, evaluation and integration into health information systems
East Africa
Ethiopia	☑	☑	☑	☑	✓	✓	✓	☑
Madagascar	✓		✓	☑	✓		✓
Malawi	☑	☑	☑	☑	✓	☑	✓	☑
Mozambique			☑	☑	✓	✓	✓	✓
Rwanda	☑	☑	☑	☑	✓	✓	✓	☑
Uganda	✓		☑	☑	✓	✓	✓	☑
Zambia	✓	☑	☑	☑	✓	✓	✓	✓
South Sudan		☑	✓	✓	✓	✓	✓	✓
Central Africa
Cameroon	✓	☑	✓	✓	✓	☑	✓
DRC	✓	☑	✓	✓	✓	☑	✓	✓
West Africa
Burkina Faso	✓		☑	☑	✓	☑	✓
Ghana	☑	☑	☑	☑	✓	✓	✓	☑
Mali	✓		✓	✓	✓	☑	✓	✓
Niger	✓		✓	✓	✓	☑	✓	☑
Nigeria	✓	☑	✓	✓	✓		✓	☑
Senegal	✓	☑	✓		✓	☑
Asia
Nepal	✓		☑	☑	✓		✓	✓
Pakistan			☑	✓	✓		✓	✓
Central America
Nicaragua	✓		✓	☑	✓		✓	✓

☑Best practice examples, ✓Otherwise