A Case Study on the Efficacy of Integrated Community Case Management for Childhood Illnesses in Conflict-Affected Mali (2021-2026)

This case study evaluates the implementation and efficacy of integrated community case management (iCCM) for childhood illnesses in conflict-affected regions of Mali between 2021 and 2026. It addresses the critical problem of sustaining essential child health services for malaria, pneumonia, and diarrhoea amidst severe access barriers caused by protracted insecurity. A convergent mixed-methods design was employed, analysing routine health management data from 42 community health worker (CHW) sites across Mopti and Segou, triangulated with 58 qualitative interviews with CHWs, caregivers, and health district supervisors. Findings demonstrate that a supported iCCM model maintained high service coverage. CHWs correctly assessed and managed 87% of cases, contributing to a 40% reduction in under-five mortality in intervention areas against pre-implementation baselines. This outcome is attributed to robust mobile supervision and adaptive, conflict-sensitive supply chains. Significant operational challenges were also identified, including CHW attrition due to displacement and recurring commodity stock-outs. The study concludes that iCCM is a resilient, life-saving strategy in fragile settings. It underscores the necessity for increased, sustained investment in African-led community health systems as a cornerstone of health security. To advance Universal Health Coverage, programming must be adaptive, prioritising the protection, training, and incentivisation of frontline health workers in conflict zones.