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Summative evaluation of the WHO Rapid Access Expansion (RAcE) Initiative

Since 1990, the death rate of children under five has dropped by 56 per cent from 93 deaths per 1000 live births to 41 in 2016. Yet, much more is needed to meet the Sustainable Development Goal target of less than 25 deaths by 2030. In Sub-Saharan Africa, one child in 13 dies before his or her fifth birthday. The majority of these deaths, caused by pneumonia, diarrhoea and malaria, can be prevented by providing timely access to quality diagnosis and treatment.

In 2012 the government of Canada provided a grant to the WHO Global Malaria Programme (GMP) to support the scale-up of the diagnosis and treatment of children with pneumonia, diarrhoea and malaria by Community Health Workers, an approach known as integrated community case management (iCCM). The six-year programme, labeled the Rapid Access Expansion (RAcE) initiative, distinguished itself from other internationally funded iCCM programmes by aiming to achieve universal health coverage for all children in hard-to-reach areas within selected geographic boundaries. An estimated 1.9 million children were covered by the programme. WHO subcontracted five international NGOs to support the ministries of health of five African countries to deliver programmes in six regions:

  • Democratic Republic of the Congo (International Rescue Committee)
  • Malawi (Save the Children)
  • Mozambique (Save the Children)
  • Niger (World Vision)
  • Nigeria (two programmes) (Malaria Consortium and Society for Family Health)

Over the six years of the RAcE initiative, the programme partners supported the training, supervision and commodity supply to about eight thousand Community Health Workers who delivered more than eight million live-saving treatments to acutely ill children.

The evaluation of the RAcE Initiative was conducted by the hera team of Alice Behrendt, Josef Decosas, Marieke Devillé and Ingeborg Jille-Traas on behalf of the WHO Evaluation Office, supported by Abdon Mukalay in the DRC, John Phuka in Malawi, Sandra Manuel in Mozambique, Mahamane Karki in Niger, and Vivian Shaahu in Nigeria. Quality assurance for the evaluation was provided by Leo Devillé. The team visited all six RAcE programmes, prepared five country briefs, and consolidated the findings in a summative evaluation report.

The RAcE Initiative showed that iCCM can fill important gaps in national strategies for universal health coverage by creating access to essential health services to children who need timely treatment but who do not have easy access to primary health care facilities. It is an effective contribution to child survival when it is applied to overcome geographic barriers in access to care. The services are highly appreciated by caregivers of children. The key to effective iCCM is its link to health systems building blocks, particularly:

  • the uninterrupted supply of quality medicines
  • a human resources for health framework that includes Community Health Workers
  • a health management information system (HMIS) that includes community-level data
  • the integration of iCCM in the national health financing framework
  • effective community engagement and demand generation

You can read the full evaluation report here:

Photo credit: UNMEER/Simon Ruf