In 2006, Save the Children commited to establish Hasta el Último Rincón: Community Case Management (CCM) in order to reduce mortality among children under five living in impoverished remote communities in Nicaragua. The project aims to reduce mortality by increasing families' use of community-based curative services, and by helping them to recognize and respond to danger signs of common childhood infection.
Save the Children will use the following strategies to achieve results: (1) training, equipping and supporting existing community health workers, called brigadistas, to provide evidence-based CCM; (2) training Ministry of Health (MOH) partners to support and supply brigadistas; (3) training families to recognize and label danger signs, seek appropriate care, and comply with advice; (4) mobilizing communities to support brigadistas and increase household-level recognition and response to danger signs; (5) partnering with MOH and NicaSalud Federation to ensure sustainability and advocate for community-level curative services.
Existing strategies to deliver curative care to the world's sick children are effective where access to health facilities is good. But many areas, particularly those that are home to the'lowest socio-economic quintile,' are without services. CCM is a delivery strategy to bring simple, curative interventions to under-served communities for common life-threatening infant and childhood infections, such as diarrhea, pneumonia, malaria, and newborn sepsis. Key interventions are inexpensive and include oral rehydration solution and zinc for diarrhea; antibiotics for pneumonia, dysentery and newborn sepsis; and antimalarials.
Hasta el Último Rincón is Phase One of a national and ultimately regional strategy to reduce infant and child mortality. The Project will complement the current, largely preventive, maternal and infant health strategy of the MOH (called 'PROCOSAN') by strengthening the curative skills of existing brigadistas and their supporting MOH partners.
Save the Children (SC) has prioritized CCM as a global strategy to achieve the Millennium Development Goal for children. SC has advanced the state-of-the-art in CCM in Mali, Nepal, India, and Bangladesh, and aims to transfer and adapt lessons learned to appropriate settings in Latin America, starting with Nicaragua, the second poorest country in the hemisphere.
SEEKING: partnership with governments, NGOs, donors, academics and advocates. Seeking $800,000 to support the final four years of this project and $45,000,000 to adapt, test, and implement similar models at large scale in Ethiopia, Indonesia, Mali, Malawi, Pakistan, and India.