inSCALE - Integrated Community Case Management of Common Childhood Diseases: Mozambique and Uganda


2010 - 2015


Community based agents (CBAs) can deliver lifesaving treatment to children. However, scale-up can be problematic in terms of low motivation, attrition and poor performance of CBAs. The Innovations at Scale for Community Access and Lasting Effects (inSCALE) project will identify and document limitations to national scale up of Integrated Community Case Management (ICCM) in terms of its geographical distribution and quality.


The aim of the project is to demonstrate that coverage of government-led integrated community case management programmes can be increased to cover up to 33 percent of the districts, primarily resulting in more children with diarrhoea, pneumonia and malaria accessing appropriate care.


Potential innovations to improve supervision and motivation were identified through literature reviews, observations, stakeholder interviews together with country-level contextual data. Promising interventions were selected through a workshop, and their feasibility and acceptance among stakeholders, CBAs, community members and health workers were assessed using formative research methods.

Selected innovations identified will be pre-tested, piloted and evaluated through:A cluster randomized controlled trial

  1. Household interviews with caretakers of children with diarrhoea, pneumonia and malaria appropriately treated by CBAs
  2. Periodic CBAs surveys for information on retention, motivation and performance
  3. Process evaluation using in-depth interviews and focus group discussions with CBAs, CBA supervisors, community members and national stakeholders
  4. Routinely collected program data
  5. Cost and cost effectiveness analysis based on data from caretakers, CBAs, health facilities, districts, national offices and project data

The findings to inform and refine national implementation strategies to promote scale up of ICCM will be done through advocacy activities including live radio shows, dissemination of reports, stakeholder workshops, policy briefs and newsletters.

Preliminary results

Based on literature reviews and stakeholder interviews, 18 activities that potentially can improve supervision and motivation among CBAs were identified. These activities were categorized into either a technology supported approach or a community supported approach. Using a pile sorting exercise with stakeholders, a short list of activities to be taken forward to the intervention trial was created and formative research started to inform innovation design.


Funded by Bill & Melinda Gates Foundation.


Contact person

Adjunct senior lecturer

Karin Källander

Organizational unit: Global health (IHCAR)

Global HealthPublic Health