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Establishing Integrated Community Management of Malaria,

Pneumonia and Diarrhea in Two Selected Local Government Areas, Akwa Ibom State, NigeriaWilliam Brieger, Bright Orji, Emmanuel Otolorin, Eno Ndekhedehe, Jones Nwadike

MIS 2010 Revealed Inappropriate Large Problem, PoorResponse• Using the RDT, 52 percent of children age 6-59

months in Nigeria tested positive for malaria• Among children (

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Stakeholder Challenges • Manager’s skepticism

that communitymembers can performRDTs correctly

• Health workers’ pooracceptance of RDTsas opposed to using

their clinical judgment• Provider’s reluctance

to trust communities with antibiotics

Management Challenges • Procurement problems as

needed meds come fromdifferent funding sources

• Difficulty in sourcingRDTs that come withready to use components

• RDTs come with onebuffer bottle container for

25 tests, inadequate if there is wastage• Procurement and supplies of AMFm drugs delayeddue to cumbersome, delayed drug registrationprocess

• Sharps and waste disposal• Multiple statistics tracking registers, as no one register

captures all the indicators – burden M&E personnel

Community Challenges• Belief that 'blood of

someone alive cannotbe buried' – disposingof RDT cassette byburial would meanburying the personalive

• Perceptions thatperson has malaria even if RDT is negative

• Volunteers request for incentives and motivation asnew tasks included

Addressing StakeholderChallenges • Stakeholders consensus meetings

helped address reluctance by thehealth ministry to allow RDT useat the community level

• Consensus meetings createopportunity for programs tointegrate as IMCI, RH and Malariadepartments trained providers

Solving Management Challenges • We worked with other malaria partners to identify

reliable sources of RDTs• Joining local pharmaceutical company already

registered with AMFm helped fast tract supplies of ACTS

Community Dialogue• Community dialogue and agreed on incineration as an

acceptable method of disposal• Engaged communities to accept only positive RDT-

results need ACTs• Volunteers demands for incentives challenged by

leaders• Community self-monitoring: volunteer fined one-goat

for failing to provide services

Lessons Learned• Need for consensus building among partners on roles

and extent of services to be provided by volunteers• Community education and dialogue prior to the initial

start-up iCCM provision• Without attention to these start-up processes we

cannot expect to reach our endpoint coverageindicators

Acknowledgements• Funding for this project came from

 – The ExxonMobil Foundation – Ellicott Dredges (Baltimore)

• Partners – Community Partners for Development – Akwa Ibom State Ministry of Health

Contact:Bill Brieger: bbbrieger@yahoo.com; bbrieger@jhsph.edu