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Implementing integrated community case management during conflict in Yemen.

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Community health workers provided essential services in Yemen despite conflict challenges. Integrating programs and using mobile tech can improve access and safety in humanitarian health efforts.

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Area of Science:

  • Global Health
  • Public Health
  • Health Systems Strengthening

Background:

  • Yemen's health system is devastated by conflict, with millions lacking access to care.
  • Save the Children implemented an integrated Community Case Management (iCCM) program in rural Lahj and Taiz Governorates.
  • A qualitative study aimed to identify and address bottlenecks in iCCM service delivery within conflict-affected areas.

Purpose of the Study:

  • To document challenges faced in delivering integrated Community Case Management (iCCM) services in rural Yemen.
  • To identify strategies for overcoming service delivery bottlenecks in conflict-affected regions.
  • To inform future community health program design in protracted emergencies.

Main Methods:

  • Qualitative data collected through 23 in-depth interviews (IDIs) and 6 focus group discussions (FGDs).
  • Stakeholders at all levels of the iCCM program were engaged.
  • Data collection occurred in Aden City, Lahj Governorate, and Taiz Governorate.

Main Results:

  • iCCM faced challenges due to lack of integration into the national health system and short-term emergency funding.
  • Reduced service access occurred when community health workers (CHWs) were based in different communities, hindering travel during conflict.
  • Supervision, supply chain, and monitoring were hampered by conflict-related travel difficulties; mobile technology and buffer stocks were proposed solutions.
  • CHW and supervisor safety was a primary concern, with strategies including limiting travel, safety training, and mobile communication.

Conclusions:

  • Community health workers successfully delivered iCCM services amidst significant challenges posed by a weak health system and ongoing conflict.
  • Adaptations for service delivery, including mobile technology and localized supply chains, were identified to overcome bottlenecks.
  • The study highlights the inadequacy of short-term humanitarian funding models for addressing long-term health needs in protracted emergencies, exemplified by program closure.