InSCALE Malaria Project

The overall goal of the project is to demonstrate that government led ICCM programmes in Mozambique and Uganda can be scaled up while maintaining a consistent level of quality care, resulting in more children with diarrhoea, pneumonia, and malaria being able to access standard case management. To achieve this goal, a number of steps are necessary, but the main assumption is that scale up of a sustainable strategy for ICCM requires community based agents (CBAs) who perform optimally, deliver quality services, and remain in position for longer periods.
During the course of the project, InSCALE is working to undertake the following:

• identify best practices in implementing ICCM at sub-national levels in Uganda and Mozambique, and identify innovations in ICCM with potential to increase coverage and improve the quality of ICCM through better performance and retention of CBAs;
• assess the feasibility of identified innovations and their acceptability among community members, CBAs, facility-based health workers, and sub-national and national health authorities;
• evaluate innovations with the potential to increase coverage of ICCM and improve its quality through better CBA performance and retention;
• cost the innovations which demonstrate effectiveness in improving ICCM coverage and quality through better CBA performance and retention and investigate the potential for economies of scale and scope;
• promote implementation spread of ICCM by collaborating with ministries of health, sub-national health authorities and stakeholders, experiences and findings that improve coverage of ICCM and improve its quality.

InSCALE has been working since 2010 to achieve its stated objectives. Key outputs to date of the project are:

• Literature and landscape reviews have been conducted to explore the contextual factors which have an impact on aspects of work motivation and satisfaction, such as supervision, data use in quality improvement, incentives, payment for performance, community monitoring, mHealth, and work aids for CBAs.
• Feasibility studies of selected innovations have begun. Activities include documentation of CBA selection, evaluation of training methods and materials and formative research with MOH stakeholders and end users on the acceptability and feasibility of the innovations.
• Ethical approval for formative research from respective national and international authorities has been sought and granted; research has begun in selected areas.
• A costing framework has been developed and costings for ICCM implementation as well as selected InSCALE innovations is ongoing.
• Seniour ministry of health officials from implementation countries, as well as relevant stakeholders, policy makers, and other globally influential partners have been engaged in project objectives and are being updated and consulted at regular intervals.
• A dissemination and advocacy strategy for project outputs and learnings has been conceived; the InSCALE microsite has been created and populated.
• Resource mapping for sustained national financing of ICCM at scale has also begun and will continue for the duration of the project.

InSCALE hopes to demonstrate that coverage and impact of government-led ICCM programmes can be extended if innovative solutions can be found for critical limitations, such as motivation and retention of community health workers. Once feasible and acceptable solutions are identified, these solutions can be used to increase the coverage of ICCM and improve its quality.

Malaria, Children

Several low income countries across Africa are incorporating scale-up of integrated community case management (ICCM) into their formal health plans as a way of counteracting weak health infrastructure and low levels of access to quality care in rural areas. Mozambique and Uganda are among these countries. Community-based agents (CBAs) are being used as the conduit for the provision of ICCM, however, according to InSCALE, poor supervision of CBAs by formal health authorities, a lack of motivation among CBAs, and low levels of availability and usage of data hamper the effective progression of CBA programmes.