LAUSR

The current state of iCCM Acknowledging a shortage of clinicians and inequitable access to basic health care for many communities in lowand middle-income countries (LMICs), the World Health Organization and United Nations Children’s Fund developed integrated Community Case Management (iCCM)1. iCCM is a paper-based clinical decision rule that is deployed by frontline community health workers (CHWs) in hard-toreach locations. The components of the decision rule are sufficiently simple for CHWs who are educated to secondary school level (with 6 days statutory iCCM training)2 to be able to manage uncomplicated illnesses in the community, and urgently refer seriously ill children to higher-level facilities for more comprehensive medical attention. Rolled out in the early 2000s3 across Asia and sub-Saharan Africa, iCCM (and its related decision rule, Integrated Management of Childhood Illness (IMCI)) contributed to notable progress towards achieving Millennium Development Goal 44. Despite significant reductions in under-5 morbidity and mortality between 1990 and 20155, the overall impact of iCCM on childhood survival in LMICs is undermined by a variety of factors. These include poor CHW adherence to guidelines6,7, incomplete patient recording, cumbersome monthly aggregation and reporting of cases to district health offices, as well as infrequent training opportunities to retain and develop skills, and irregular supervisory support8. This has prompted innovative strategies in attempts to optimize iCCM delivery.