Process evaluation of implementation of integrated Malaria community case management in Muleba district in Kagera region

Abstract

ABSTRACT Background: Malaria is a major public health challenge in Tanzania, particularly affecting pregnant women and children under five. In June 2022, Tanzania launched Integrated Community Case Management (iCCM) in hard-to-reach areas to enable community-based testing and treatment of uncomplicated malaria, with referrals for severe cases. Although evidence is available on the impact and challenges of iCCM intervention, little remains to be known about the effectiveness of implementation. This study evaluates the effectiveness of iCCM implementation, despite existing evidence on its impact and challenges Objective: This study aimed to evaluate the implementation of integrated Malaria Community Case Management (iCCM) in the villages that implement iCCM strategies in Muleba District Council Methodology: This study employed a case study design with an explanatory qualitative approach. A total of twenty-five participants were purposively selected, including five iCCM providers, five health facility in-charges, five Village Executive Officer (VEO), and ten community members from the villages that implement iCCM in Muleba District Council. The sample size was determined by theoretical saturation. Data was transcribed verbatim, and a content analysis approach was used for data analysis. Findings: Availability of essential commodities and tools for iCCM was ensured through collaborative efforts between linked health facilities and iCCM providers, despite occasional stockouts. Capacity building through training and supervision was crucial for enhancing service delivery. Community engagement, facilitated by local leaders and Community Health Workers, promoted awareness and utilization of iCCM services, despite existence of challenges such as geographical barriers and financial constraints. Conclusion: The study found that iCCM implementation faces challenges in resource availability, logistics, equipment functionality, and transportation. Despite effective training and community engagement, stockouts and financial constraints disrupt service delivery. Improved communication, collaboration with community leaders, significantly enhanced iCCM services. Recommendation: NMCP and malaria implementing partners, should ensure continuous availability of essential commodities, enhance capacity-building efforts, promote community engagement, optimize logistical systems, improve transportation support, and address systemic challenges through collaboration between linked health facilities, local leaders, and communities.