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.
Dawson
P
P
John Snow Incorporated, Kathmandu, Nepal. pdawson@nfhp.org.np
Pradhan
Yv
Y
Houston
R
R
Karki
S
S
Poudel
D
D
Hodgins
S
S
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