Table 4 Key conclusions and recommendations

Targeting of iCCM implementation

When determining targeting of iCCM implementation, health planners should consider factors beyond geographic proximity and assess the broader health service landscape and user preferences (such as reliability of services, perceptions of quality and unmet demand), particularly where rapid population growth has put pressure on existing services.

Research should explore the cost-effectiveness of iCCM as a transitional strategy, and identify potential benchmarks for facility access and quality improvement that signify when the programme is no longer needed.

Peri-urban implementation

Develop tailored sensitization and community engagement approaches to facilitate community participation in the VHT selection process.

Establish or review norms for VHT density and geographic coverage in larger communities to ensure equitable distribution, considering population changes and expectations for service hours.

Potentially consider other delivery strategies for iCCM as an alternative to the VHT model, in high density peri-urban settings.

Develop peri-urban typologies in relation to the health care context in order to support appropriate health policy and planning.

Overall iCCM improvement design

Continued attention is needed to improve diagnostics availability, strengthen supply chains and improve access along the referral care pathway in order to maximise the benefits of iCCM service provision.

Explore options for increasing postnatal support in the community.

Even where transport facilities exist, organising and affording referral transport remains challenging and needs to be addressed in implementation strategies.

Sensitise communities on the health system and complementary roles of community and facility-based care, clarifying that VHT members are intended to serve as a first point of care rather than provide a comprehensive range of services.