African Journal of Public Health and Health Systems | 20 January 2022
Navigating the Waters: A Case Study of Operational Barriers to iCCM Implementation in Lake Chad's Hard-to-Reach Island Communities
M, a, h, a, m, a, t, A, b, d, e, l, k, e, r, i, m
Abstract
The integrated community case management of childhood illness (iCCM) strategy is critical for reducing child mortality in remote areas. Its implementation in geographically isolated settings, such as the island communities of Lake Chad in Chad, faces distinct operational challenges that are poorly documented. This case study aimed to identify and analyse the primary operational barriers hindering effective iCCM implementation within these hard-to-reach island communities. A qualitative case study design was employed. Data were collected through in-depth interviews with health programme managers, community health workers, and caregivers, supplemented by direct observation of iCCM activities in selected island communities. Thematic analysis was used to synthesise the findings. Major barriers were identified across logistical, human resource, and community engagement domains. A predominant theme was the severe and routine disruption of medical supply chains due to the aquatic environment and seasonal variations, leading to prolonged stock-outs of essential medicines. Inadequate training and supervision of community health workers, alongside low community awareness of iCCM services, further compromised service delivery. Operationalising iCCM in Lake Chad’s island communities is significantly constrained by interconnected systemic and environmental barriers. These challenges underscore a critical gap in adapting standard iCCM delivery models to the realities of hard-to-reach aquatic settings. Adapt iCCM planning to include context-specific logistics for aquatic transport and seasonal forecasting. Strengthen training for community health workers on supply management and case management in isolated conditions. Develop targeted community dialogue strategies to improve health-seeking behaviour and programme ownership. integrated community case management, iCCM, hard-to-reach populations, Lake Chad, operational barriers, child health, Chad This case study provides programme planners and policymakers with evidence on the specific operational constraints to iCCM in a hard-to-reach aquatic context, informing more adapted and resilient child health strategies.