Factors Affecting Implementation of Integrated Community Case Management Of Childhood Illness In South West Shoa Zone, Central Ethiopia

Abstract

Introduction: Integrated community case management is a program that allowed Health Extension Workers treat the three most common Childhood illnesses; pneumonia, Diarrhea and malaria through delivering closer and accessible care to community. In Ethiopia, this proven strategy is on stage of preparation for expansion, but few researches were done to assess the challenges encountered in the ongoing implementation. Objective: The objective of the study was to assess factors affecting implementation of community case management of childhood illnesses in the health posts of selected woredas of South West shoa Zone, Central Ethiopia. Methods and materials: Facility based cross-sectional study were employed. All functional health posts (99) and HEWs trained in ICCM (157) of four districts were included in the study. Pre-tested structured questionnaires and observation checklist was deployed to collect data on the study variables. Data was entered in to Epi data v.3.1 and transported to SPSS v.21.0 for analysis .Descriptive statistical methods were done to indicate the frequency of the variables and bivariate and multiple binary logistic regression analysis were used to determine independent effects of factors affecting ICCM implementation status. Results: - based on mean percentage coverage of all health posts 39(39.4%) them were in good implementation category and the ret majority in poor category. During the survey, 24(15.3%) of kebelles were found lacking two HEWs, 26.8% had recommended three CHAs and 26(16.6%) lacking any CHAs. Only 39(39.5%) received supportive supervision by either of woreda or health center. Essential ICCM commodities were available in 87.93% of Health posts. After Multivariate regression analysis number of CHAs per kebelle (AOR3.63,95%CI[1.16-6.41]),average hours of open health post per day(AOR 2.74,95%CI[1.38-5.61]),sessions community mobilization (AOR 4.26,95%CI[1.98-9.18]),proper documentation of reports and files (AOR0.041,95%CI[0.008- 0.216])and onsite mentoring (AOR3.14,95%CI[1.65-6.52]) had disentangled independent effect on implementation status of ICCM services. Conclusion: Inadequacy of HEWs and CHAs in kebelles as per the standard, irregular supervision, monitoring, lower hours of health posts and lower sessions of community sensitization were major challenges to better implementation of the program. Construction of shelters for HEWs by either of government or community was also crucial for optimal functioning of the ICCM services.