Routine monitoring systems for integrated community case management programs: Lessons from 18 countries in sub-Saharan Africa.

Integrated community case management (iCCM) programs are expanding rapidly in many low– and middle–income countries, particularly in sub–Saharan Africa. Conclusions from the recent review of iCCM programs in Africa emphasized the critical importance of using routine data to assess program performance and to inform impact evaluations [1]. Yet monitoring systems often fail to deliver quality data (defined as relevant, complete, timely and accurate [2]) and program managers do not have the capacity or are not empowered to use data for decision–making and corrective action [3]. Monitoring systems for iCCM suffer from many of the same shortcomings of the broader routine health information systems (HIS), but extending these systems to the community level at scale presents unique challenges and constraints. While the literature highlighting results of iCCM programs has expanded, little has been published that explores the monitoring systems necessary to support successful implementation. This paper aims to synthesize lessons learned from recent experience developing and implementing systems for routine monitoring of large scale iCCM programs. These lessons were compiled from the primary partners supporting iCCM implementation across 18 countries in sub–Saharan Africa through interviews with monitoring focal persons and review of relevant documents and tools and informed by literature on strengthening routine health information systems more broadly [3–5]. We first outline the rationale for routine data and the challenges iCCM programs face to establish functional monitoring systems to generate such data. We then characterize the current state of routine monitoring systems for iCCM, summarize lessons learned and conclude with a way forward.