It is estimated that more than 150 million episodes of pneumonia occur every year among children under five in developing countries, accounting for more than 95 percent of all new cases worldwide. Each year across the world, two million children under five years of age die of pneumonia contributing to almost 20 percent of childhood mortality cases which is more than AIDS, measles and malaria combined. Afghanistan, each year, contributes two million episodes of pneumonia to the global estimate. Every day 550 children under five years of age die and of these 115 deaths occur due to pneumonia – this translates into 42,000 deaths due to pneumonia alone, annually. Experts agree that the lives of many children can be spared if we just deliver antibiotics for pneumonia and dysentery, and oral rehydration packets and zinc supplements for diarrhoea. The UNICEF’s State of the World’s Children Report 2009 estimates that only 38 percent children suffering from pneumonia were taken to a health facility for treatment. This was also reported by USAID Evaluation of BPHS in 2008 – for only 39 percent of children with pneumonia a treatment was sought from a skilled health professional.
Experts agree that the lives of many children can be spared if we just deliver antibiotics for pneumonia and dysentery, and oral rehydration packets and zinc supplements for diarrhea
The aim of this intervention is to build the capacity of Community Health Workers (CHWs) to provide quality care to sick children. This includes: 1) increasing CHWs’ knowledge so that they can decide how, why and when a skill should be used. For example, to be able to treat a child with pneumonia correctly, a CHW must know how to detect the clinical signs of pneumonia and the correct amount of antibiotic (co-trimoxazole) to give; 2) enhancing practical skills so that a CHW is able to count breath rates to diagnose pneumonia; correctly prepare ORS to treat dehydration in a child with diarrhea; or fill in pictorial referral forms; 3) enhancing decision making skills so that CHWs know how to evaluate a sick child. This includes identifying danger signs; being able to decide whether a child needs home treatment or a referral; and being able to recognize which health protective and preventive behaviours and practices of caregivers need to change; and 4) enhancing CHWs’ communication skills so that they are able to counsel caregivers to ensure quality home care. This includes training on the need for a return follow-up session, and an assessment of caregivers’ compliance with instructions, including referral instructions. To accomplish the objectives of this intervention, it is critical to follow this detailed implementation plan, indicators, frequency of data collection, sources of information, data collection tools, and quality measurement tools and tools for assessing CHW and CHS performance.