title: Integrated community case management for childhood illnesses: explaining policy resistance in Kenya.
abstract: BACKGROUND
  There has been a re-emphasis recently on community health workers to provide child health care services including integrated community case management for childhood illness (iCCM). This research analysed iCCM policy development in Kenya and in particular the types of decision-making criteria used by Kenyan policy-makers in considering whether to advance iCCM policy.
  
  
  METHODS
  Data were collected through document reviews (n = 41) and semi-structured interviews (n = 19) with key stakeholders in iCCM policy including government officials, development partners, bilateral donors, and civil society organizations. Initial analysis was guided by the policy triangle with further analysis of factors affecting policy decision-making drawing upon a simple framework developed by Grindle and Thomas (Policy makers, policy choices and policy outcomes: the political economy of reform in developing countries. 1989; Policy Sci 22: :213-48.).
  
  
  RESULTS
  Policy development for iCCM has been slow in Kenya, compared with other Sub-Saharan African countries. At the time of the study, the Government had just completed the Community Health Training Manual which incorporated iCCM as a module, but this was the only formal expression of iCCM in Kenya. We found technical considerations, notably concerns about community health workers dispensing antibiotics to be a key factor slowing iCCM policy development, but this also overlapped with bureaucratic considerations, such as how the development of community health worker cadres may affect clinicians, as well as initial concerns about how an integrated approach might affect vertically oriented programs. International actors through agreements such as the Millennium Development Goals helped to get child survival onto the national policy agenda and such actors were active promoters of iCCM policy change. However international funders had not committed funding to scale-up iCCM policy, and this probably constrained their influence over iCCM policy debate.
  
  
  CONCLUSIONS
  Kenyan actors' concerns about iCCM underline the importance of adapting global policies to local conditions, and also generating local evidence to inform decision-making.
authors.affiliation: African Population and Health Research Center, atienopma@yahoo.com pjuma@aphrc.org.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Juma
authors.affiliation: Kenya Medical Research Institute, Centre for Global Health Nairobi, Kenya and.
authors.forename: Karen
authors.initials: K
authors.lastname: Owuor
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Bennett
mesh_terms: D019090:Case Management; D002648:Child; D000067576:Child Health; D002662:Child Health Services; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D006291:Health Policy; D006801:Humans; D007630:Kenya; D012189:Retrospective Studies
keywords: Case management; Kenya; child health; policy analysis