From research to national expansion: 20 years' experience of community-based management of childhood pneumonia in Nepal.
OBJECTIVE
Pneumonia is a leading cause of mortality of children aged under five in Nepal. Research conducted by John Snow Inc. in the 1980s determined that pneumonia case management by community-based workers decreased under-five mortality by 28%.


METHODS
Female community health volunteers were selected as the national cadre to manage childhood pneumonia at community level using oral antibiotics. A technical working group composed of government officials, local experts and donor partners embarked on a process to develop a strategy to pilot the approach and expand it nationally.


METHODS
High under-five mortality rates, low access to peripheral health facilities and severe constraints in human resources led Nepal's Ministry of Health to test this innovative approach.


RESULTS
Community-based management of pneumonia doubled the total number of cases treated compared with districts with facility-based treatment only. Over half of the cases were treated by the female community health volunteers. The programme was phased in over 14 years and now 69% of Nepal's under-five population has access to pneumonia treatment.


CONCLUSIONS
Community-based management of pneumonia provides a medium-term solution to address a leading cause of child mortality while the efforts continue to strengthen and extend the reach of facility-based care. Trained community health workers can significantly increase the number of pneumonia cases receiving correct case management in resource-constrained settings, with appropriate health systems' support for logistics, supervision and monitoring. Community-based management of pneumonia can be scaled up and provides an effective approach to reducing child deaths in countries faced with insufficient human resources for health.
John Snow Incorporated, Kathmandu, Nepal. pdawson@nfhp.org.np
P
P
Dawson
Yv
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Pradhan
R
R
Houston
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Karki
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D
Poudel
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S
Hodgins
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007857:Leadership; D009390:Nepal / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D016730:Program Development; D014801:Vitamin A / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014815:Vitamins; D014801:Vitamin A