iCCM Recommended Indicators Dyness Kasungami Senior Child Health Adviser, Maternal and Child Survival Program Eric Swedberg Senior Director Child Health Department of Global Health, Save the Children Session 4 February 16, 2016

Presentation Content Indicator Guide for M&E of iCCM Review of routine monitoring indicators in 10 countries Proposed set of high-value indicators

Indicator Guide for M&E of iCCM iCCM Task Force published an Indicator Guide for M&E of iCCM in 2013 Lists indicators across programme components and phases to “encourage the consistent use of standardized definitions and metrics 48 indicators spanning the 8 components of the Benchmark Framework [periodic, routine and special studies]

Indicator Guide for M&E of iCCM Many indicators initially adapted from sub-national programs; few had been used by national iCCM programs Not intended as a prescriptive set of indicators for all programmes but rather a menu that MOH and partners can use to identify the most appropriate for their programmes and contexts Guide is intended to evolve and incorporate experience and learning from national iCCM programs

Review of routine monitoring indicators in 10 countries Monitoring iCCM: a feasibility study of the indicator guide for monitoring and evaluating integrated community case management Timothy Roberton, Dyness Kasungami, Tanya Guenther and Elizabeth Hazel Health Policy and Planning, January 2016 Purposive sample from 10 countries of tools and protocols for iCCM Analyzed 18 routine monitoring indicators reviewing four types of tools: (1) tools used by CHWs; (2) tools used to aggregate and report data from CHWs; (3) tools used by CHW supervisors to record data during supervision visits; and (4) tools used to aggregate and send information from health facility level to higher levels in the health system

Review of routine monitoring indicators in 10 countries (2) Countries are already collecting the data needed to calculate many of the routine monitoring indicators In general data is most available for human resources, service delivery and referral and M&E and health information systems. Data is less available for supply chain management and supervision and performance quality assurance. Although countries are collecting the data, most remains only available at the health facility level, not district and national levels. Countries may rightfully decide that certain data only needs to be available at the health facility of district level

Review of routine monitoring indicators in 10 countries (3) Suggested Next Steps: Some indicators in their current form may be overly difficult to measure and need revising e.g. supply chain management and performance quality assurance Other indicators require up-to-date CHW deployment data. This is currently lacking in many countries but should be feasible. Countries should choose 3-5 high-value routine monitoring indicators based upon these criteria: (1) effort required for data collection, aggregation and computation; (2) reliability of measurement and interpretation; and (3) utility for all stakeholders.

Next steps The Monitoring and Evaluation sub group of the global CCM Task Force started a process of reviewing the current indicators list and defining data needs at every level of iCCM implementation The sub group has proposed a set of 12 indicators to be collected through routine health information systems and 6 through special studies The sub group urges countries to identify opportunities to include these high value iCCM indicators in the DHIS or other national HMIS.

Proposed set of high-value indicators Human Resources: (to be collected annually) Under-five catchment population per CCM site: # of children under five per CCM site Geographic access to CCM: % of target population (or target communities) with access to CCM services (countries to define eligibility for CCM and definition of active CHW) CCM CHW density: Number of CHWs trained and deployed for CCM per 1000 children under five in target areas (3.2) CHW to supervisor ratio: Ratio of CHWs deployed for CCM to CCM supervisors (7.3)

Proposed set of high-value indicators (2) Service Delivery: Case load by CHW: # cases treated by CHW by reporting period (total and disaggregated by disease) CCM treatment rate: Number of CCM conditions treated per 1000 children under 5 in target areas in a given time period (5.1) Percent of expected cases treated: Number of CCM conditions treated/Number of expected cases for population and time period RDT positivity rate: % of fever cases presenting to CHW who were tested with RDT and received a positive result

Proposed set of high-value indicators (3) Supply chain/logistics: Medicine and diagnostic continuous stock (1): % of CCM sites with no stock out of each CCM commodity over the period (disaggregated by commodity) (recommended by the SCM group/optional) Medicine and diagnostic availability (2): % of CCM sites with all key CCM medicines and diagnostics in stock on last day of reporting period (more common because easier to collect) (4.2)

Proposed set of high-value indicators (4) Referrals: Referral rate: # cases referred per 100 cases seen by CHWs (5.3) Reporting: 1. Reporting: % of CHWs/HFs/districts submitting report on iCCM during time period (disaggregated by level) (8.3)

Proposed set of high-value indicators (5) Supervision: Completed versus expected supervision activity: proportion of expected supervision activities (to be defined locally) completed during reported period (similar to 7.4)

Proposed set of high-value indicators (6) Outcome Indicators (from household surveys every 3-5 years) Diagnosis: % of children under 5 years old with fever in the last 2 weeks who had a finger/heel stick for malaria testing Treatment malaria: % of confirmed outpatient malaria cases that received firstline antimalarial treatment according to national policy Treatment Diarrhea: % of diarrhea cases among children under five that received ORS according to national policy

Proposed set of high-value indicators (7) Outcome Indicators (from household surveys every 3-5 years) Treatment Diarrhea: % of diarrhea cases among children under five that received zinc according to national policy (5.4) Treatment Pneumonia: % of suspected pneumonia cases among children under five that received antibiotics according to national policy (similar to 5.4) Treatment Pneumonia: Percentage of suspected pneumonia cases among children under five who sought care from an appropriate provider

Next Steps These are proposed indicators. Please send your comments on these proposed indicators to Dyness at dkasungami@jsi.com Thank you!