Innovative integrated case management programs to reduce death and severe diseases among children under five due to, pneumonia, diarrhea, malaria, and malnutrition through evidence based behavior change and social marketing approaches in Rwanda.
Our Idea is to establish a platform for combating the major killers of malaria, pneumonia, diarrhoea and acute malnutrition that will seek to address how a caregiver can acquire affordable and accessible products, convenient information and services that can be trusted and easily understood. SFH will incrementally build on existing Government interventions to increase caregivers knowledge and ability to prevent these diseases, to recognize danger signs, and to immediately go to a trained provider (informed demand), improve skills of providers for effective case management and referral skills, increase an affordable supply of diagnostic tools and quality assured medicines, known to treat a sick child and prevent future illness.
So what is integration and what does it mean for SFH? The WHO defines integration as “…the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.”
SFH already works with a number of service delivery and commodity distribution channels such as pharmacy networks, private clinics, community health workers, and other providers. SFH is constantly striving to scale up these networks to increase their health impact by providing services to caretakers to prevent and treat the largest killers of children; namely malaria, pneumonia, diarrheal and acute malnutrition.
Too often, effective treatment for these huge killers is not available, which is why SFH has put scaling up integrated case management (ICM) at the heart of its Malaria and Child Survival strategy. SFH approaches ICM by incrementally building on existing interventions. Caregivers often seek treatment from a preferred channel or trusted provider when their child is sick, irrespective of their child’s illness or symptoms. SFH will strengthen those preferred channels and the knowledge and skills of trusted providers so they can offer quality services and commodities where caregivers access them.
SFH finds integration as a maximum bandwidth of provider networks to offer the high quality services and commodities that caregivers require. Realistically, a semi-literate community health worker will not provide the same level of service as a trained doctor, but each level of the service provision network has a role to play. Networked levels that provide a package of options, both accessible and valued by caregivers, is the goal of any integrated intervention at SFH.
This idea of integrating case management of malaria, pneumonia, diarrheal and acute malnutrition begins by putting ourselves in the shoes of a caregiver with a sick child. She may go to a public or private clinic or a pharmacy, or she may go to an outlet without trained providers. She may even access a community health worker in her village. Irrespective of the channel she chooses, SFH team will work to ensure her child is assessed correctly and receives effective care. No matter which channel SFH is strengthening, key activities will be focused on improving access to effective prevention, treatment, quality of care, and informed demand among children’s caregivers to seek prompt and effective prevention and treatment from trained providers.
The direct behaviour change interventions will target caregivers of children under five, we will focus on the poorest quintiles and hard to reach areas. We will pilot this in 2 districts in Rwanda and then scale this up as a model of changing behaviours. The behaviours we will focus on are those that are most important for children under 5. Sleeping under the bed net every day, ,treating household water using point of use products, hygiene and the importance of washing hands with soap, avoidance of open defecation, clean latrine/toilet and other sanitation behaviours, importance of breastfeeding, complimentary feeding, eating the nutritious diet and its importance and gender relations in the house hold. Then we will focus on health seeking behaviours, sexual health and birth/pregnancy health as well as ensuring the young parents is ready for what happens in the first years of a child’s life.
Using the peer networks we will set up peer education sessions and have buddying systems for young parents to ensure the networks of support are there. We will use mobile video units (MVU) to get crowds together and then through the videos, theatre and discussions we will then deliver the target messages. Here we will also train peer educators and ensure they are in the communities delivering the change through peer support. Coupled with the direct behaviour change interventions we plan to implement radio and media behaviour change across the districts. Using saturation methods through community radio stations we will deliver targeted messages and plays. What is unique about this is that we have a scientific method that can actually calculate the impact of the behaviour change messages and say precisely the effect on the population.
Finally we aim to deliver social marketing of products such as water purifiers (sachets), condoms, family planning products and nutrition sprinkles to ensure the products are there in the districts, are available and can be sustained as well as creating employment opportunities.
Who will benefit from this idea and where are they located?
Care givers from two districts –Burera in the North and Nyabihu in the Western part of Rwanda where stunting, acute respiratory infections due to the cold weather and poor hygiene rates are unacceptably high.
How could you test this idea in a quick and low-cost way right now?
• Conduct a focus group discussion among care givers of children under five in the two districts
• Refer to the latest secondary data available such as the Rwanda Demographic Health Survey (RDHS) 2010 and other Health Management Information System (HMIS) and other evaluation reports.
• Conduct a small baseline survey in the two districts.
What kind of help would you need to make your idea real?
Expert advice would be very useful and appreciated as well as feedback from OpenIDEO.
Is this an idea that you or your organization would like to take forward?
Yes. I am ready and interested in testing this idea and making it real in my community.