The resilience of integrated community case management in acute emergency: A case study from Unity State, South Sudan
The resilience of integrated community case management in acute emergency: A case study from Unity State, South Sudan
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DOI：
10.7189/jogh.08.020602
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发表时间：
2018-12-01
影响因子：
7.2
通讯作者：
Miller, Nathan P.
中科院分区：
文献类型：
--
作者：
Kozuki, Naoko;Ericson, Katja;Miller, Nathan P.
2013年底至2014年初，南苏丹爆发了一场持续数月的冲突，导致约200万人流离失所。2015年5月，国际救援委员会和儿童基金会开展了一项混合方法案例研究，研究这一严重紧急情况对联合州佩因贾尔县儿童疾病方案综合社区个案管理的影响。目的是记录一个iCCM项目在严重危机期间的运作情况，并评估项目继续运作的能力。这项混合方法案例研究包括半结构化访谈和焦点小组，主要利益相关者包括政策制定者、项目实施者、社区卫生工作者（chw）和护理人员，了解他们在这段时间内参与iCCM规划的经验。还分析了常规方案数据，以评估危机对关键健康指标的影响。Payinjiar的国内流离失所者人数几乎增加了一倍。一些流离失所的卫生保健员继续提供治疗。当他们能够随身携带物资时。尽管iCCM项目没有正式的社区动员工作，但许多国内流离失所者在他们流离失所的社区找到了卫生工作者，并得到了他们的照顾。据报告，国内流离失所者的护理人员更愿意接受卫生保健员的护理，而不是冒着不安全的风险前往卫生设施。在严重危机期间，保健员每月提供的治疗总数有所下降，但在六个月内恢复到危机前的水平。CHW监督员试图通过利用其网络追踪流离失所的CHW并在访问前评估安全状况来继续监督。月度监管率在2014年2月降至77%的最低水平，但到2014年8月回升至91%。一些卫生工作者和社区领袖定性地证实了这种持续监督的说法。结论：卫生保健工作者，包括国内流离失所者，在严重紧急情况下继续为儿童疾病提供治疗，服务提供比正规卫生部门更快地恢复到危机前的水平。国际捐助方和人道主义行为体应认识到iCCM是一种可能具有高影响力的人道主义对策。捐助者提供的灵活资金将有助于进一步形成关于综合治理、方法和改进的证据，从而在严重危机中维持和加强规划。
Background An active conflict in South Sudan in late 2013/early 2014 displaced approximately 2 million people over the course of several months. In May 2015, the International Rescue Committee and UNICEF conducted a mixed-methods case study of the impact of that acute emergency on integrated community case management (iCCM) of childhood illness programming Payinjiar County, Unity State. The objective was to document the operations of an iCCM program during an acute crisis and to assess the program's ability to continue operations.Results This mixed-methods case study is comprised of semi-structured interviews and focus groups with key stakeholders such as policymakers, program implementers, community health workers (CHWs), and caregivers on their experience with iCCM programming during this time period. Routine program data were also analyzed to assess the effect of the crisis on key health indicators.Findings Internally displaced persons (IDPs) nearly doubled the population in Payinjiar. Some displaced CHWs continued to provide treatment. in host communities when they were able to take supplies with them. Despite no formal community mobilization effort by the iCCM program, many IDPs identified CHWs in the communities they were displaced to and obtained care from them. Caregivers who had been internally displaced reported preferring care from CHWs especially in contrast to risking an insecure journey to health facilities. The total number of treatments provided per month by CHWs dropped during the acute crisis, but recovered to pre-crisis levels with in six months. CHW supervisors attempted to continue supervision by utilizing their networks to track down displaced CHWs and assess the security situation prior to visits. The monthly supervision rate dropped to the lowest level of 77% in February 2014, but rebounded to 91% by August 2014. Several CHWs and community leaders qualitatively validated this claim of sustained supervision.Conclusions CHWs, including those who were internally displaced, continued to provide treatment for childhood illnesses during an acute emergency, and service provision recovered faster to pre-crisis levels than the formal health sector. International donors and humanitarian actors should recognize iCCM as a potentially high-impact humanitarian response. Flexible funding from donors would enable further evidence generation on iCCM, approaches and improvements that could both sustain and enhance programming in acute crisis.