Analysis of the institutionalisation of Integrated Community Case Management and its implications for access to community healthcare since 2019 in Sub-Saharan Africa: a systematic review

Abstract

The Integrated Community Case Management (iCCM) is a priority in Sub-Saharan Africa though its implementation has been hampered by several obstacles. Following the 2019 Addis Ababa technical consultations, strengthening its institutionalisation was recommended. We conducted a systematic review to assess the institutionalisation of Integrated Community Case Management in Sub-Saharan Africa and the results obtained. We conducted a systematic review by searching electronic databases for original scientific articles from studies conducted in Sub-Saharan Africa (2020–2025). Quality was assessed using the Mixed Methods Assessment Tool (MMAT). The selection of studies was carried out in two stages by HSO, PN and AK. Data were extracted and synthesised narratively, focusing on the health system governance and the essential components of Universal Health Coverage (resources used, services offered, geographical and financial access, and impact on morbidity and mortality). Twelve studies were selected and analysed. All identified political commitment to adopting iCCM, and four showed full integration into the national health system. Two studies showed that these countries were able to ensure the effective expansion and availability of services nationwide while respecting the initial spirit of community-based curative care. Challenges such as shortages in the supply of medicines, equipment and materials, as well as insufficient funding, were reported. Three articles show that the utilisation of community-based healthcare services has remained low. Although two articles provided results suggesting reductions in morbidity and mortality related to diseases targeted by the strategy (malaria, diarrhoea and pneumonia), the Sustainable Development Goals targets have not been met. Proactive visit initiatives and improved integration with other primary health care services improve utilisation and reduce costs. Our findings indicate the need to accelerate the institutionalisation of iCCM so that it becomes a service that effectively meets the needs of communities and is actively used by them.