CDI Module 5: Community-Directed Interventions
to Deliver Malaria Plus Packages (MPPs)
©Jhpiego Corporation
The Johns Hopkins University
A Training Program on CommunityDirected Intervention (CDI) to Improve
Access to Essential Health Services
Overview
 Our training uses malaria as a foundation for
integrated community case management (iCCM)
and community-directed intervention (CDI), but
in other countries/areas other combinations of
package components may be more appropriate
for starting out
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Module 5 Objectives
By the end of this module, learners will:
 Name components of a Malaria Plus Package (MPP)
 Describe key household and community practices that
impact child growth promotion and development
 List steps and activities for disease prevention at the
home/community level to reduce illnesses and deaths
 Explain home management of malaria-related diseases
(e.g., diarrhea, chest infection, malnutrition, anemia)
 List activities to promote care seeking and compliance
with healthy practices
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A Malaria Plus Package …
… starts with preventing and treating malaria
services, but then:
 Strengthens the health system to improve delivery of
a variety of community interventions
 Expands the capacity of the Ministry of Health
(MOH) and the local government authorities in the
target states/municipalities, to deliver an integrated
package to the community
 Provides appropriately tailored support to the
states/municipalities to help them improve their
planning, implementation, coordination and
supervision capacities for the integrated package
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Malaria Plus Includes …
 Increasing access to, and utilization of, preventive
measures
 Expanding access to, and utilization of, effective
diagnostic and treatment services
 Strengthening community mobilization and
communication for behavior change
 Improving state-/municipality-specific monitoring and
evaluation (M&E) for evidence-based management
 Strengthening partnerships for resource mobilization
and implementation
 Enhancing capacity of the states/municipalities for
oversight and project coordination
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Three MPP Delivery Channels/Links
1. Family-oriented, community: Home management of
childhood illness; health-promoting activities like
exclusive breastfeeding, long-lasting insecticide-treated
net (LLIN) use, intermittent preventive treatment in
pregnancy (IPTp)
2. Population-oriented outreach and schedulable
services: Delivery of health services (e.g., through a
Child Health Week in collaboration with partners)
3. Individual-oriented clinical services: Facility-based
care available on a 24-hour basis to deliver routine
services and manage severe illness
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Our Focus in CDI
 We are focusing on the family/community channel
for CDI
 Key household and community practices are a set of
practices that—when combined—have the greatest
impact on child survival, growth and development
 These key practices can prevent a variety of health
problems, not just malaria
 Families play a very significant role in the growth
and development of their children as well as in the
well-being of mothers
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Role of Families and Communities
 Caregivers need knowledge and skills in key
household and community practices that have
the greatest impact on the well-being of mothers
and children
 The purpose of this module is to outline contents
for training community-directed distributors
(CDDs)/community-oriented resource persons
(CORPs) to promote the key household and
community practices
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Why Malaria Plus Packages?
 The majority of children die at home in spite of the
availability of health services
 Many children die from other malaria-related
diseases (e.g., diarrhea, chest infection,
malnutrition, anemia)
 Initial care (whether using orthodox or traditional
medicine) takes place in the family
 Formally trained health workers are usually either
inaccessible or unavailable
 Feasible interventions that can significantly reduce
illness and death exist, and can be practiced at
home/in the community
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Examples of Good Practices
 Appropriate
breastfeeding can
reduce childhood
illness by 10%
 Good hygiene practices
can reduce childhood
illness by 10%
 Improved
complementary feeding
can prevent death from
malnutrition, diarrhea,
measles, etc.
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Household Practices
The key household practices can be grouped into
four broad clusters:
 Growth promotion and development
 Disease prevention
 Home management
 Care seeking and compliance
Can you name these practices and the services
the community can provide to foster these
practices?
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Growth Promotion and Development
 Exclusive breastfeeding: Feeding a baby with
only breast milk, not even water, from birth until
six months of age
 Complementary feeding: Feeding children with
freshly prepared energy- and nutrient-rich
complementary foods, beginning at six months
of age, while continuing to breastfeed up to two
years or longer
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Growth Promotion and Development
(continued)
 Micronutrients and diet supplementation:
Ensuring that children receive adequate
amounts of micronutrients (vitamin A, iron,
iodine and zinc in particular), either in their diet
or through supplementation
 Growth monitoring: A process of weighing a
child at intervals, charting the weight on a child
health card and showing the mother whether the
child is doing well or not
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Growth Promotion and Development
(continued)
 Promoting mental and
psychosocial
development:
Providing children with
a stimulating
environment to achieve
optimal development
later in life
 Birth registration: The
official recording of the
birth of a child with the
National Population
Commission
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Disease Prevention
 Proper feces disposal and handwashing:
Disposing of feces, including children’s feces, safely;
and washing hands with soap after defecation,
before preparing meals and before feeding children
 Protecting children and pregnant women in
malaria-endemic areas, by ensuring that they sleep
under insecticide-treated nets
 Preventing HIV and caring for people living with
HIV/AIDS (PLWHA): Providing appropriate care for
HIV/AIDS-affected people, especially orphans, and
taking action to prevent further HIV infections
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Disease Prevention (continued)
 Preventing child
abuse and neglect,
and taking
appropriate action:
 Taking action to
prevent child abuse
 Recognizing child
abuse when it has
occurred and taking
appropriate action
16
Home Management
 Preventing and managing child injuries by
taking appropriate action:
 Keeping the home environment tidy and free of
objects that may cause accidents among children
 Preventing and providing appropriate treatment for
child injuries
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Home Management (continued)
 Giving appropriate home treatment for infection:
 Beginning appropriate home management of diarrhea
immediately to prevent dehydration
 Giving salt sugar solution or drinking water in addition to
breast milk if the child is still exclusively breastfed
 Continuing to feed and offering more food and fluid when
the child is sick, including breast milk
 Taking the child to a health facility immediately if the child
has any of the following signs:
–
–
–
–
Is not able to drink
Develops a fever
Is getting worse
Passes blood in stool
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Home Management (continued)
 Taking all children with a cough to a health
facility where the cough will be properly
assessed and treated
Also, taking all children to a health facility for
assessment if they develop any of these signs:
 Breathing is fast
 Breathing becomes difficult
 Child is not able to drink
 Child is getting worse
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Care Seeking and Compliance
 Immunization: Ensuring that
every child completes the full
course of routine
immunization five times
before the child’s first
birthday
 Also, ensuring that, from the
age of six months, a child
receives vitamin A
supplementation and
deworming tablets every six
months until the child reaches
five years of age
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Care Seeking and Compliance
(continued)
 Recognizing when a
child needs treatment
outside the home, and
seeking care from
appropriate providers:
 Taking the child with
severe illness to the
health facility
immediately to save the
child’s life
 Following the health
worker’s advice on
treatment, follow-up
and referral
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Care Seeking and Compliance
(continued)
 Birth preparedness and complication
readiness: Getting ready for a baby’s birth and
possible problems/dangers that may arise during
labor, and taking care of emergencies when they
arise
If a woman is well prepared for normal childbirth and
possible complications, she is more likely to receive the
skilled and timely care she needs to protect her overall
health and the health of her baby
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Care Seeking
 Family planning using appropriate methods
 Families that plan and space their children
ensure that the pregnant woman:
 Regains her strength between pregnancies
 Avoids frequent exposure to health risks
 Gives birth to children who are strong and healthy
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Avoiding Delays
Three ways of wasting
time (delays) may lead
to complications and
death of a woman and
her child:
 Delay in seeking care
 Delay in reaching care
 Delay in receiving care
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Care Seeking and Compliance
(continued)
 Essential community newborn care:
 Identifying danger signs in newborns and advising to take
baby immediately to nearest health facility
 Ensuring that mother and baby go back to the health
facility within the first week and at six weeks of delivery—
and if she delivered at home, ensuring that mother and
baby go to the health facility within 24 hours
 Active participation of men in child care and
reproductive health: Ensuring that men actively
participate in the provision of child care and are
involved in reproductive health
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MPP-Driven Commodities
Examples of commodities that will drive the MPP
implementation strategy are:





Folic acid
Ferrous sulfate
Anti-helminthics
Oral rehydration salts
Antibiotics that are already in the work plan/procurement plan
of the participating states/municipalities
 LLINs for mop-up phase
 Vaccines
Not all commodities will be available through the
community channel
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In Your Country
 What is the package of services and health
promotion activities that are provided at the
community level through community efforts?
 How were the components of this package decided?
 Are there other services that could be added?
 We have discussed many services (20); so, how do
we decide:
 Which ones to start delivering first?
 Which ones to train CDDs on first?
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Planning for Malaria Plus
Key practices
Resources
needed
Source of
assistance
Growth promotion and
development
Disease prevention
Home management
Care seeking and
compliance
As a group exercise, fill out this chart—you may substitute a different set of
services relevant to your country
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Integration Challenges
 How can we integrate these additional areas into
the training and work of the CDDs/CORPs?
 What are the cost implications for CDD training
and CDD kits?
 How can we provide integrated supportive
supervision for CDDs to implement MPP?
 What other concerns do you have?
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Summary and Conclusion
 Key household and community practices have a
potential impact on child survival, growth and
development
 The key household and community practices are
deployed as part of an integrated maternal, neonatal and
child health strategy
 Improving knowledge about key household and
community practices will:
 Promote survival, growth and development of newborns, children
under five years of age and their mothers
 Strengthen the community management of malaria and related
illnesses
 Reduce maternal and child deaths
 Each MPP must be decided by the country and district
concerned
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