Community case management of childhood illness in Nicaragua: Transforming health systems in underserved rural areas

Asha George, Elaine P. Menotti, Dixmer Rivera, Irma Montes, Carmen María Reyes, David R. Marsh

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


While social factors broadly determine health outcomes, strategic health workforce innovations such as community case management (CCM) can redress social inequalities in access to health care. Community case management enables trained health workers to assess children, diagnose common childhood infections, administer medicines, and monitor life-saving treatment in the poor, remote communities where they reside. This article reports on research that combined focus group discussions and key informant interviews to examine the perceptions of multiple stakeholders, with monitoring data, in order to assess programmatic results, limitations, and lessons learned in implementing CCM in Nicaragua. We found that CCM increases the use of curative services by poor children with pneumonia, diarrhea, or dysentery by five to six-fold over facility-based services. Apart from dramatically increasing geographic access to treatment for underserved groups, our qualitative research suggests that Nicaragua's CCM model also addresses the managerial challenges and social relations that underpin good quality of care, care-giver knowledge and awareness, and community mobilization, all health system-strengthening factors that are central to equitably and effectively improving child health. While our findings are promising, we suggest areas for further operational research to strengthen CCM program learning and functioning.

Original languageEnglish (US)
Pages (from-to)99-115
Number of pages17
JournalJournal of Health Care for the Poor and Underserved
Issue number4 SUPPL.
StatePublished - Nov 2009
Externally publishedYes


  • Adherence
  • Community case management
  • Community health workers
  • Diarrhea
  • Nicaragua
  • Pneumonia
  • Quality of care
  • Supervision

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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