Table 1 Description of Optimizing Health Extension Program sick child health services quality improvement strategies

The Optimizing Health Extension Program comprised of three strategies. These were demand creation, capacity building, and district level accountability and ownership of child health services. Of these, the capacity-building strategy primarily focused on improving the quality of care for sick children. The strategy included gap filling training for health extension workers with no iCCM training, supportive supervision, and performance review clinical mentoring meetings. Quarterly supportive supervision was planned to be conducted jointly by staff from the district health system and implementing partners using standard checklists. The existing biannual performance review and clinical mentoring meetings were to be supported to take place by trained experts over the course of two days in the presence of health extension workers and their supervisors from their respective health centers and district-level health offices. The meetings aimed to review the six months integrated community case management performance of the health extension workers, analyze gaps, hold discussions on the identified gaps, provide mentoring, and develop action plans. Where missing, job aids were to be distributed which included registers, chart booklets (clinical guidelines), and health education aids such as posters and family health cards. Backpacks were to be introduced for use by the health extension workers to carry medicines and registers during their home-to-home services. As part of the district level accountability and ownership of child health services, implementing partners also aimed to advocate for: the integration of child health service indicators in the districts’ health planning and management system; use of ambulances for referral of very sick children; and, strengthening the linkages between health centers and health posts. The linkages and integration were intended to enable the health centers to provide a regular supportive supervision, as well as essential drugs and supplies to their catchment health posts. Although medicines were not directly supplied by the program under this strategy, activities were also planned to strengthen medicine supply to the health posts through the existing government system.