title: Policy challenges facing integrated community case management in Sub-Saharan Africa.
abstract: OBJECTIVE
  To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change.
  
  
  METHODS
  Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions.
  
  
  RESULTS
  Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change.
  
  
  CONCLUSIONS
  iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies.
authors.affiliation: Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Bennett
authors.forename: Asha
authors.initials: A
authors.lastname: George
authors.forename: Daniela
authors.initials: D
authors.lastname: Rodriguez
authors.forename: Jessica
authors.initials: J
authors.lastname: Shearer
authors.forename: Brahima
authors.initials: B
authors.lastname: Diallo
authors.forename: Mamadou
authors.initials: M
authors.lastname: Konate
authors.forename: Sarah
authors.initials: S
authors.lastname: Dalglish
authors.forename: Pamela
authors.initials: P
authors.lastname: Juma
authors.forename: Ireen
authors.initials: I
authors.lastname: Namakhoma
authors.forename: Hastings
authors.initials: H
authors.lastname: Banda
authors.forename: Baltazar
authors.initials: B
authors.lastname: Chilundo
authors.forename: Alda
authors.initials: A
authors.lastname: Mariano
authors.forename: Julie
authors.initials: J
authors.lastname: Cliff
mesh_terms: D017954:Africa South of the Sahara; D001294:Attitude to Health; D019090:Case Management / Q000191:economics / Q000458:organization & administration*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration; D003906:Developing Countries; D019468:Disease Management; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007391:International Cooperation; D019982:Organizational Case Studies; D009936:Organizational Innovation / Q000191:economics; D009937:Organizational Objectives; D011050:Policy Making; D036301:Qualitative Research; D012189:Retrospective Studies
keywords: child health services; community health services; health policy; politique de santé; política sanitaria; services de santé communautaires; services de santé de l'enfant; servicios de salud comunitarios; servicios de salud infantil
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