Developing innovative approaches to improve treatment provision for childhood infection in peri-urban settings: A pilot study in accredited drug shops. (360G-Wellcome-110311_Z_15_Z)

Aim: To develop a health systems strategy and community-based mechanism to deliver integrated Community CaseManagement (iCCM) services to increase access to prompt effective treatment for childhood infections in peri-urban areas Objectives: i. Investigate the feasibility of two alternative community-based mechanisms (community health workers or licensed private sector drug retail outlets) to deliver iCCM in peri-urban areas ii. Develop mechanisms for governance, quality assurance, regulation, linkage with public health system (supervision, referral, health management information system) and financial sustainability, that are acceptable to treatment providers, patients, local and national authorities and regulators iii. Explore the acceptability and perceptions of a private sector delivery strategy amongst providers, users, national authorities and policy makers iv. Assess quality of iCCM services provided by trained drug retailers through a small pilot study, with focus on accuracy of diagnosis and adherence to treatment guidelines Methods: Formative research, key informant interviews, and stakeholder consultations to adapt iCCM approach and explore mechanisms to support two alternative community-based mechanisms (community health workers or drug retail outlets) to deliver iCCM services in peri-urban settings. To be followed by a small pilot study in which 10 licensed drug shops will be trained to diagnose and treat pneumonia, malaria and diarrhoea according to iCCM guidelines. The ability of drug vendors to diagnose and treat children will be evaluated through a mix of methods including: record review, clinical vignettes, participant observation, and re-assessment of a sample of patients by a qualified health worker. Participant observation and focus group discussions will explore the effects of the pilot intervention from the perspective of drug vendors, and exit interviews will examine acceptability to patients and costs incurred by households.