title: Valuing and Sustaining (or Not) the Ability of Volunteer Community Health Workers to Deliver Integrated Community Case Management in Northern Ghana: A Qualitative Study.
abstract: BACKGROUND
  Within the integrated community case management of childhood illnesses (iCCM) programme, the traditional health promotion and prevention role of community health workers (CHWs) has been expanded to treatment. Understanding both the impact and the implementation experience of this expanded role are important. In evaluating UNICEF's implementation of iCCM, this qualitative case study explores the implementation experience in Ghana.
  
  
  RESULTS
  Data were collected through a rapid appraisal using focus groups and individual interviews during a field visit in May 2013 to Accra and the Northern Region of Ghana. We sought to understand the experience of iCCM from the perspective of locally based UNICEF staff, their partners, researchers, Ghana health services management staff, CHWs and their supervisors, nurses in health facilities and mothers receiving the service. Our analysis of the findings showed that there is an appreciation both by mothers and by facility level staff for the contribution of CHWs. Appreciation was expressed for the localisation of the treatment of childhood illness, thus saving mothers from the effort and expense of having to seek treatment outside of the village. Despite an overall expression of value for the expanded role of CHWs, we also found that there were problems in supporting and sustaining their efforts. The data showed concern around CHWs being unpaid, poorly supervised, regularly out of stock, lacking in essential equipment and remaining outside the formal health system.
  
  
  CONCLUSIONS
  Expanding the roles of CHWs is important and can be valuable, but contextual and health system factors threaten the sustainability of iCCM in Ghana. In this and other implementation sites, policymakers and key donors need to take into account historical lessons from the CHW literature, while exploring innovative and sustainable mechanisms to secure the programme as part of a government owned and government led strategy.
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Daniels
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, South Africa; School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Daviaud
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health, University of the Western Cape, Bellville, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
mesh_terms: D001291:Attitude of Health Personnel; D019090:Case Management; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D005869:Ghana; D006297:Health Services Accessibility; D036301:Qualitative Research; D014838:Volunteers