Amid the many uncertainties our world faces as a result of the novel coronavirus, Muso and our partners continue to make progress toward our collective goal of universal health care for all. More than half of the world’s population does not receive essential health services. Together with our government partners, we are working to build a reality where fewer people fall gravely ill to serious diseases, and fewer children die as a result of preventable deaths caused by poverty. In order to develop the most effective methods for delivering quality, rapid care at the community level to the global population, Muso tests everything we do. Along with our research partners, we have spent the last five years designing and conducting a Randomized Controlled Trial that tests a core aspect of care delivery by Community Health Workers: proactive case detection.
When Community Health Workers (CHWs) go door-to-door, proactively searching for disease and providing care, do they save more lives?
Now, Muso has reached a new milestone in our efforts to answer this pressing and timely question. Last month, our Research, Monitoring and Evaluation team completed the third and final year of data collection for the Proactive Community Case Management and Child Survival Trial (the ProCCM Trial), conducted in the rural district of Bankass, Mali.
Under the best circumstances, collecting data for one of the world’s largest global health studies would present challenges, and requires acute attention to detail. Muso’s data collection for the ProCCM Trial took place under a unique set of circumstances. Violent conflict in the district of Bankass, where the ProCCM Trial took place across eight Muso sites, posed a significant threat to our patients’ lives. Muso health workers worked to create mobile clinics and developed other creative approaches in making sure patients were still able to access care normally provided at the clinic level even when they didn’t feel safe making such a trip. On top of all these obstacles, the COVID-19 pandemic arrived in Mali during the final month of data collection, which would have terminated the survey early had cases of COVID-19 arrived in the region prior to the completion of data collection. In order to complete the final round of data collection, our Research team extended daily surveying hours while adhering to security precautions and curfews in the region. We trained surveyors in infection control measures, provided them with alcohol hand sanitizer, and disseminated training on how to respect necessary distance measures from survey participants. Fortunately, we completed data collection prior to the arrival of COVID-19 in Bankass. Despite these many obstacles, Muso CHWs and government clinical staff provided uninterrupted care throughout the duration of the Trial, and continue to do so, committing to serve patients while developing much-needed answers to important global questions for community case management and child survival.
Bankass ProCCM Trial surveyors gather for a group photo
The ProCCM Trial is a Randomized Control Trial designed to detect a relative difference in under-five mortality between the WHO-recommended integrated Community Case Management (iCCM) package of care for CHWs, and the intervention of CHWs providing that same care through Proactive Community Case Management (ProCCM). The trial will measure efficacy of care; cost-effectiveness of care; and equity of door-to-door proactive case detection. For more on the ProCCM Trial, read the study protocol published in BMJ Open.
The study was designed and implemented in partnership with the Malian Ministry of Health from day one. Our government partners were key partners in identifying Bankass as the region for the trial. Planning and implementation of the intervention were executed in partnership with the Ministry of Health and district health officials, including operating through government primary health centers. We are thankful for our partners at the Ministry of Health for their expertise and collaboration.
Finalizing data collection would not have been possible without coordination from surveyors, Muso’s Research, Monitoring, and Evaluation team, and our Program team in Bankass. Buy-in at the community level was also key. We are grateful to the communities that welcomed us and for our continuing partnerships with village chiefs, local authorities, religious leaders, and other representatives. These relationships made it possible to conduct a study that will not only directly benefit the care delivered in their own communities, but many others in the future.
The intent of the ProCCM Trial is not to prove the validity of Muso’s model, but to be of use to implementing organizations and governments globally. The results of the Trial will be used by the Malian government, who has committed to integrating its findings into Mali’s national strategies for community health. Beyond Mali, Muso will share findings with our global partners and decision-makers to increase momentum towards reaching the Sustainable Development Goals and improving health outcomes for women and children worldwide. Our team will continue to provide technical assistance to support the implementation of evidence-based strategies found from the Trial’s results in Mali and beyond. iCCM, paired with door-to-door proactive case detection, has the potential to significantly improve the impact of CHWs on their communities, driving positive health outcomes for tens of millions of patients. We look forward to sharing what the ProCCM Trial’s data tells us about how best to design health systems that reach every patient with the care they need, when they need it.