The Global Fund New Funding Model: Lessons from Uganda on Integrating the Integrated Community Case Management Model (iCCM)

The system is designed to provide a hierarchical structure for the delivery of health services. However, despite this structure, child mortality and morbidity rates remain unacceptably high in Uganda. Pneumonia, diarrhea, and malaria are leading causes of mortality and morbidity among children under five years of age, contributing to 40% of deaths in this age group. According to the Uganda national iCCM guidelines, each year, 33 million cases of malaria, diarrhea, and pneumonia go untreated. Only half of the children with symptoms of acute respiratory infection receive antibiotics, and only 35% of children with diarrhea receive oral rehydration salts (ORS). Rural and urban disparities in health outcomes and in access to health services persist, with children in rural areas being less likely to receive antibiotics, seek advice and treatment for malaria, and receive oral rehydration therapy compared to those in urban areas. The health worker to population ratio in Uganda is 1.8 per 1,000 people, which is below the 2.3 per 1,000 people ratio recommended by the World Health Organization (WHO). Most of these health workers are based in urban areas, contributing to the low access to child health services in rural areas. Poor quality of services and the long distances many people need to travel to visit health facilities also hinder access to lifesaving treatment. The Ministry of Health (MOH) of Uganda has implemented the Village Health Team (VHT) program to improve access to health services in rural areas. VHTs are chosen by their community, based on gender balance, and ability to read and write. Each VHT has five volunteers, two of whom work on integrated community case management (iCCM), and the others work on social mobilization and health education. VHTs receive a basic health promotion training, which is five days in duration, and an iCCM hands-on training based on the VHT Register and Sick Child Job Aid. They also learn how to use respiratory timers and rapid diagnostic tests. The iCCM model is designed to provide community-based care for children with symptoms of malaria, pneumonia, and diarrhea. VHTs are trained to identify danger signs and refer newborns, and to treat malaria, pneumonia, and diarrhea. They receive non-monetary incentives, such as bicycles, T-shirts, and badges, for their work. The iCCM model has been integrated into the Global Fund New Funding Model (NFM) concept note for malaria, which aims to provide funding for the implementation of iCCM in Uganda.