Bridging the Gap

Treatment of children with acute malnutrition has failed to achieve high coverage and impact because of barriers in accessing health facilities where treatment services are usually located. This study, conducted in Turkana and Isiolo counties, Kenya, aimed to investigate the effectiveness and the cost of integrating treatment of acute malnutrition into integrated community case management (iCCM). The study shows that working with community health volunteers (CHVs) to treat children with acute malnutrition at the community level increased recovery rate, reduced defaulting rate, and reduced the length of time to recovery compared with treatment of children in health facilities. Most of the CHVs correctly managed children with acute malnutrition. The cost per child treated was lower in the intervention group than in the control group in both counties. The community and the CHVs were generally satisfied withthe intervention. Enabling factors for the intervention included community sensitization, CHV training and mentoring, use of simplified tools and protocols and proximity of CHVs to caregivers, among others. Challenges and barriers included low literacy levels of CHVs which affected their learning and reporting, reluctance among some caregivers to accept the new role of CHVs at the beginning, interrupted commodity supply, increased CHV workload, and inadequate financial incentives for CHVs among others. This intervention could accelerate access to treatment of acute malnutrition in areas with limited access to health services and contribute towards achieving the goal of the Kenya Health Policy 2014-2030 of attaining the highest possible standard of health for all Kenyans.