CCM Central Indicators & Benchmarks

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Integrated community case management programs have been implemented in various forms throughout the developing world, ranging from disease-specific pilots to nationwide integrated treatment programs. Early data from successful CCM pilots speak to the necessity of key components such as quality assurance/supervision schemes and an interrupted drug supply, while data from less successful programs cite the omission of other key components, such as community sensitization and dialogue, as contributing to program failure and/or dissolution.

Taken together, the literature suggests that successful CCM programming depends on careful design and monitoring of CCM from a health systems perspective. To provide guidance on how to approach CCM programming from this angle, the CCM Benchmarks Matrix provides an overview of eight components that program managers must take into account when designing, implementing, monitoring, and evaluating CCM. The matrix outlines benchmarks per component for each stage of programming, according to three phases: advocacy and planning, pilot and early implementation, and expansion and scale-up. Overall, the tool is meant to provide normative guidance on how to approach CCM, with the goal of improving quality, functionality, and sustainability across the life of the program.

iCCM Benchmarks
Global Indicators
Country Indicators
Expanded Results Framework

Component name	Advocacy and Planning	Pilot and Early Implementation	Expansion/Scale-up
Component One: Coordination and Policy Setting	Mapping of CCM partners conducted Technical advisory group (TAG) established including community leaders, CCM champion & CHW representation Needs assessment and situation analysis for package of services conducted Stakeholder meetings to define roles and discuss current policies held National policies and guidelines reviewed	MOH leadership to manage unified CCM established Discussions regarding ongoing policy change (where necessary) completed	MOH leadership institutionalized to ensure sustainability Routine stakeholders meetings held to ensure coordination of CCM partners
Component Two: Costing and Financing	CCM costing estimates based on all service delivery requirements undertaken Finances for CCM medicines, supplies, and all program costs secured	Financing gap analysis completed MOH funding in CCM program invested	Long-term strategy for sustainability and financial viability developed MOH investment in CCM sustained
Component Three: Human Resources	Roles of CHWs, communities and referral service providers defined by communities and MoH Criteria for CHW recruitment defined by communities and MOH Training plan for comprehensive CHW training and refresher training developed (modules, training of trainers, monitoring and evaluation) CHW retention strategies, incentive/motivation plan developed	Role and expectations of CHW made clear to community and referral service providers Training of CHWs with community and facility participation CHW retention strategies, incentive/motivation plan implemented and made clear to CHW; community plays a role in providing rewards, MoH provides support	Process for update and discussion of role/expectations for CHW in place Ongoing training provided to update CHW on new skills, reinforce initial training CHW retention strategies reviewed and revised as necessary. Advancement, promotion, retirement to CHWs who express desire offered
Component Four: Supply chain management	Appropriate CCM medicines and supplies consistent with national policies (inclusion of RDTs where appropriate) and included in essential drug list Quantifications for CCM medicines and supplies completed Procurement plan for medicines and supplies developed Inventory control and resupply logistic system for CCM and standard operating procedures developed	CCM medicines and supplies procured consistent with national policies and plan Logistics system to maintain quantity and quality of products for CCM implemented	Stocks of medicines and supplies at all levels of the system monitored (through routine information system and/or supervision) Inventory control and resupply logistics system for CCM implemented and adapted based on results of pilot with no substantial stock-out periods
Component Five: Service Delivery and Referral	Plan for rational use of medicines (and RDTs where appropriate) by CHWs and patients developed Guidelines for clinical assessment, diagnosis, management and referral developed Referral and counter referral system developed	Assessment, diagnosis and treatment of sick children by CHWs with rational use of medicines and diagnostics Review and modify guidelines based on pilot Referral and counter referral system implemented: community information on where referral facility is made clear, health personnel also clear on their referral roles	Timely receipt of appropriate diagnosis and treatment by CHWs made routine Regular review of guidelines and modifications as needed CHWs routinely referring and counter referring with patient compliance, information flow from referral facility back to CHW with returned referral slips
Component Six: Communication and Social Mobilization	Communication strategies including prevention and management of community illness for policy makers, local leaders, health providers, CHWs, communities and other target groups developed Development of CSM content for CHWs on CCM and other messages (training materials, job aids etc) Materials and messages for CCM defined, targeting the community & other groups	Communication and social mobilization plan implemented Materials and messages to aide CHWs CHWs dialogue with parents and community members about CCM and other messages	Communication and social mobilization plan and implementation reviewed and refined based on monitoring and evaluation
Component Seven: Supervision & Performance Quality Assurance	Appropriate supervision checklists and other tools, including those for use of diagnostics developed Supervision plan, including number of visits, supportive supervision roles, self-supervision etc. established Supervisor trained in supervision and has access to appropriate supervision tools	Supervision visit every 1-3 months, includes reviewing of reports, monitoring of data Supervisor visits community, makes home visits, provides skills coaching to CHWs CCM supervision included as part of the CHW supervisor's performance review	CHWs routinely supervised for quality assurance and performance Data from reports and community feed-back used for problem solving and coaching Yearly evaluation that includes individual performance and evaluation of coverage or monitoring data
Component Eight: M & E and Health Information Systems	Monitoring framework for all components of CCM developed and sources of information identified Standardized registers and reporting documents developed Indicators and standards for HMIS and CCM surveys defined Research agenda for CCM documented and circulated	Monitoring framework tested & modified accordingly Registers and reporting documents reviewed CHWs, supervisors and M&E staff trained on the new framework, its components, and use of data	Monitoring and evaluation through HMIS data performed to sustain program impact OR and external evaluations of CCM performed as necessary to inform scale-up and sustainability

Component name

Advocacy and Planning

Pilot and Early Implementation

Expansion/Scale-up

Component One:

Coordination and Policy Setting

Mapping of CCM partners conducted

Technical advisory group (TAG) established including community leaders, CCM champion & CHW representation

Needs assessment and situation analysis for package of services conducted

Stakeholder meetings to define roles and discuss current policies held

National policies and guidelines reviewed

MOH leadership to manage unified CCM established

Discussions regarding ongoing policy change (where necessary) completed

MOH leadership institutionalized to ensure sustainability

Routine stakeholders meetings held to ensure coordination of CCM partners

Component Two:

Costing and Financing

CCM costing estimates based on all service delivery requirements undertaken

Finances for CCM medicines, supplies, and all program costs secured

Financing gap analysis completed

MOH funding in CCM program invested

Long-term strategy for sustainability and financial viability developed

MOH investment in CCM sustained

Component Three:

Human Resources

Roles of CHWs, communities and referral service providers defined by communities and MoH

Criteria for CHW recruitment defined by communities and MOH

Training plan for comprehensive CHW training and refresher training developed (modules, training of trainers, monitoring and evaluation)

CHW retention strategies, incentive/motivation plan developed

Role and expectations of CHW made clear to community and referral service providers

Training of CHWs with community and facility participation

CHW retention strategies, incentive/motivation plan implemented and made clear to CHW; community plays a role in providing rewards, MoH provides support

Process for update and discussion of role/expectations for CHW in place

Ongoing training provided to update CHW on new skills, reinforce initial training

CHW retention strategies reviewed and revised as necessary.

Advancement, promotion, retirement to CHWs who express desire offered

Component Four:

Supply chain management

Appropriate CCM medicines and supplies consistent with national policies (inclusion of RDTs where appropriate) and included in essential drug list

Quantifications for CCM medicines and supplies completed

Procurement plan for medicines and supplies developed

Inventory control and resupply logistic system for CCM and standard operating procedures developed

CCM medicines and supplies procured consistent with national policies and plan

Logistics system to maintain quantity and quality of products for CCM implemented

Stocks of medicines and supplies at all levels of the system monitored (through routine information system and/or supervision)

Inventory control and resupply logistics system for CCM implemented and adapted based on results of pilot with no substantial stock-out periods

Component Five:

Service Delivery and Referral

Plan for rational use of medicines (and RDTs where appropriate) by CHWs and patients developed

Guidelines for clinical assessment, diagnosis, management and referral developed

Referral and counter referral system developed

Assessment, diagnosis and treatment of sick children by CHWs with rational use of medicines and diagnostics

Review and modify guidelines based on pilot

Referral and counter referral system implemented: community information on where referral facility is made clear, health personnel also clear on their referral roles

Timely receipt of appropriate diagnosis and treatment by CHWs made routine

Regular review of guidelines and modifications as needed

CHWs routinely referring and counter referring with patient compliance, information flow from referral facility back to CHW with returned referral slips

Component Six:

Communication and Social Mobilization

Communication strategies including prevention and management of community illness for policy makers, local leaders, health providers, CHWs, communities and other target groups developed

Development of CSM content for CHWs on CCM and other messages (training materials, job aids etc)

Materials and messages for CCM defined, targeting the community & other groups

Communication and social mobilization plan implemented

Materials and messages to aide CHWs

CHWs dialogue with parents and community members about CCM and other messages

Communication and social mobilization plan and implementation reviewed and refined based on monitoring and evaluation

Component Seven:

Supervision & Performance Quality Assurance

Appropriate supervision checklists and other tools, including those for use of diagnostics developed

Supervision plan, including number of visits, supportive supervision roles, self-supervision etc. established

Supervisor trained in supervision and has access to appropriate supervision tools

Supervision visit every 1-3 months, includes reviewing of reports, monitoring of data

Supervisor visits community, makes home visits, provides skills coaching to CHWs

CCM supervision included as part of the CHW supervisor's performance review

CHWs routinely supervised for quality assurance and performance

Data from reports and community feed-back used for problem solving and coaching

Yearly evaluation that includes individual performance and evaluation of coverage or monitoring data

Component Eight:

M & E and Health Information Systems

Monitoring framework for all components of CCM developed and sources of information identified

Standardized registers and reporting documents developed

Indicators and standards for HMIS and CCM surveys defined

Research agenda for CCM documented and circulated

Monitoring framework tested & modified accordingly

Registers and reporting documents reviewed

CHWs, supervisors and M&E staff trained on the new framework, its components, and use of data

Monitoring and evaluation through HMIS data performed to sustain program impact

OR and external evaluations of CCM performed as necessary to inform scale-up and sustainability

Component	Indicator	Definition	Metric	Type	Framework Level	Data Source	Frequency
Component 1: Coordination and Policy Setting	CCM policy	CCM is incorporated into national MNCH policy/guideline(s) to allow CHWs to give: ●low osmolarity ORS and zinc supplements for diarrhea ● antibiotics for pneumonia ● ACTs (and RDTs, where appropriate) for fever/malaria in malaria-endemic countries	Yes: National policy guidelines adopted to allow CCM in line with WHO recommendations for all relevant conditions (diarrhea, pneumonia and malaria in countries with malaria) Partial: National policy guidelines adopted to allow CCM in line with WHO recommendations for at least one relevant condition No: No national policy guidelines that support CCM in line with WHO recommendations	Input	IR1-Policy	MOH policy, strategy or guideline document	Annual
Component 2: Costing and Financing	Annual CCM costed plan	Costed plan for CCM exists and is updated annually	Yes: Costed plan for CCM for all relevant conditions (as specified by country policy or implementation status) exists and updated annually Partial: a) Updated costed plan exists for CCM including at least one relevant health condition OR b) Costed plan exists but not updated No: No costed plans for CCM available for any relevant health condition	Input	Process	Administrative and budget documents	Annual
Component 3: Human Resources	Targeted CHWs providing CCM	Proportion of CHWs targeted for CCM who are trained and providing CCM according to the national policy	Numerator: # of CHWs targeted for CCM that are trained and that can provide evidence of providing CCM services in the last 3 months Denominator: # CHWs targeted for CCM	Output	IR2-Access	Administrative and budget documents/ Registers	Annual
Component 4: Supply chain management	Medicine and diagnostic availability	Percentage of CCM sites with all key CCM medicines or diagnostics in stock during the last visit OR last day of reporting period. whichever is most recent (Key products defined by country policy)	Numerator: # of CCM sites with all key CCM medicines or diagnostics in stock during the last visit OR last day of reporting period. (Key products defined by country policy or implementation status) Denominator: # of CCM sites	Output	IR2-Access	Supervision reports; direct observation: day of visit; surveys, routine reporting	Annual/quarterly
Component 5: Service Delivery and Referral	Treatment coverage	Percentage of sick children receiving appropriate treatment	Numerator: # of children under five with CCM condition receiving appropriate treatment Denominator: # of children under five with CCM condition (fever/malaria, diarrhea or suspected pneumonia)	Outcome	SO-Use	Survey	Episodic
Component 5: Service Delivery and Referral	Treatment ratio	Ratio of treated cases to expected cases by CCM condition in a given catchment area stratified by point of service	Numerator: 1. # of treatments for children under five provided through CCM by disease in one year period in a given catchment area -- 2. # of treatments for children under five provided by health facility by disease in one year period in a given catchment area Denominator: # of illnesses expected in a given catchment area (by disease) in one year period	Outcome	SO-Use	CHW and HF treatment registers with denominator from CHERG model estimates	Annual
Component 6: Communication and Social Mobilization	Caregiver knowledge of illness signs	Proportion of care givers who know 2 or more signs of childhood illness that require immediate assessment	Numerator: # of caregivers of children under five interviewed who can correctly state 2 or more signs of childhood illness that require immediate assessment Denominator: # of caregivers of children under five interviewed	Outcome	IR4-Demand	HH survey	Episodic
Component 7: Supervision & Performance Quality Assurance	Routine supervision coverage	Proportion of CHWs who received at least 1 supervisory contact in the prior 3 months during which registers and/or reports were reviewed	Numerator: # of CHWs who received at least 1 supervisory contact in the prior 3 months during which registers and/or reports were reviewed Denominator: # of CHWs trained in and deployed for CCM or # of CHWs interviewed	Output	IR3-Quality	Supervisory records	Quarterly
Component 7: Supervision & Performance Quality Assurance	Correct case management practice	Proportion of sick children who receive correct case management from a trained CHW	Numerator: # of sick children who were correctly treated/referred for all conditions Denominator: # of sick children assessed requiring treatment	Outcome	IR3-Quality	Direct observation	Episodic
Component 8: Monitoring & Evaluation and Health Information Systems	CCM in HMIS	One or more CCM indicators incorporated into HMIS	Yes: One or more CCM indicator collected and monitored through national HMIS Partial: One or more CCM indicator included in national HMIS No: No recommended CCM indicators included in national HMIS	Process	IR1-Policy	HMIS	Annual

Component	Indicator	Definition	Metric	Type	Framework Level	Data Source	Frequency
Component 1: Coordination and Policy Setting	CCM MOH focal point	CCM focal point/unit within MOH in place	Yes: Focal point/unit for CCM established for all relevant conditions (diarrhea, pneumonia and malaria in countries with malaria) Partial: Focal point/unit for CCM established for at least one relevant condition No: No CCM focal point/unit established for any relevant condition"	Input	Process	TORs / MOH administrative document/ verbal communication with central MoH official	Annual
Component 1: Coordination and Policy Setting	CCM coordination	MOH-led CCM stakeholder group, working group or task force established and meeting regularly	Yes: MOH-led CCM stakeholder group established and meeting as outlined in terms of reference (or more frequently) or ad hoc (twice a year minimum) Partial: MOH-led CCM stakeholder group established but meets irregularly (less than terms of reference) or ad-hoc (less than twice per year, 0-1 meeting) No: MOH-led CCM stakeholder group not established	Input	Process	Established TOR and meeting minutes	Annual
Component 1: Coordination and Policy Setting	CCM partner map	List of CCM partners, activities and locations available and up to date	Yes: List/map of CCM partners, activities and locations available and updated within the last year Partial: List/map of CCM partners, activities and locations available but not updated within the last year No: List/map of CCM partners, activities and locations not available "	Input	Process	MOH Administrative document	Annual
Component 1: Coordination and Policy Setting	CCM target areas defined	Target areas for CCM defined based on country-specific criteria	Yes: Target areas for CCM defined based on country-specific criteria* No: Target areas for CCM not defined	Input	Process	MOH Administrative document	Annual
Component 2: Costing and Financing	CCM national financial contribution	Balance between national public sources and donor funding for CCM	Percentage of national public sources (MoH, provincial, municipal budgets) within the CCM total budget	Input	Process	Administrative and budget documents	Annual
Component 2: Costing and Financing	Expenditure (1): CCM proportion of disease program	Average annual recurrent expenditure for CCM per child under five in target area by disease type as a percentage of total average expenditure per child under five by disease type	Numerator: Annual recurrent expenditure for CCM per child by disease type (Indicator 9) Denominator: Total annual recurrent expenditure per child in target area by disease type	Output	IR1-Policy	Costing study	Episodic
Component 2: Costing and Financing	Expenditure (2): Average per child	Average annual recurrent expenditure per child under five in target area by disease type as per point of service	Numerator: Annual recurrent expenditure by disease type by point of service Denominator: population under five each year in target area	Output	IR1-Policy	Costing study	Episodic
Component 2: Costing and Financing	Expenditure (3): Average per contact	Average expenditure per contact by disease type as per point of service	Numerator: Annual expenditure by disease type by point of service Denominator: Number of contacts each year by disease type	Output	IR1-Policy	Costing study	Episodic
Component 3: Human Resources	Annual CCM CHW retention	Proportion of CHWs trained in CCM who are providing CCM one year after initial training and deployment	Numerator: # of CHWs providing CCM services one year after initial CCM training and deployment (time frame can be modified) Denominator: # of CHWs trained and deployed to provide CCM services	Output	IR2-Access	MOH monitoring data and supervisor checklist	Annual
Component 3: Human Resources	CCM CHW density	Number of CHWs deployed for CCM per 1000 children under-five in target areas	Numerator: # of CHWs deployed in CCM Denominator: Total children under five per 1000 in target communities	Output	IR2-Access	MOH monitoring data	Annual
Component 3: Human Resources	Target area coverage	Proportion of targeted catchment areas for CCM who have a CHW trained and deployed in CCM	Numerator: # of targeted catchment areas with CHW trained and deployed for CCM as per country protocol Denominator: # of targeted catchment areas	Output	IR2-Access	MOH administrative data	Annual
Component 3: Human Resources	Training strategy	Comprehensive CCM training strategy that is competency based	Yes: strategy has all the critical components: A time frame that corresponds to/fits with the CCM implementation Strategy; Includes training of sufficient cadres (master trainers, supervisors, CHWs, others) at the different level of services (community, facility, district, regional, national); Includes X% of the training time devoted for actual clinical training including examining and treating actual cases (competency based); Includes refresher training to update/upgrade the skills of all the CCM cadres at the different levels; and Includes the development/adaptation of the up-to-date training and supervision modules, examination and treatment protocols and job aids. Partial: Strategy has some of the critical components No: Strategy has no critical components or there is no written training strategy	Input	Process	Training strategy document, implementation guideline	Annual
Component 3: Human Resources	Human resource strategy	CHWs are recognized within Human Resources for Health Development Plans and supported (with motivation, retention, rotation - where applicable - performance issues addressed)	Yes: Plan recognizes CHWs and specifies performance elements to support their role (e.g. training strategies, supportive supervision structures in place, attention to motivation, provides a career path for the CCM cadres (where appropriate; e.g. offers future additional training for CWHs to promote them as Supervisors). Partial: Plan recognizes CHWs but does not specify all performance elements to support them No: Plan does not recognize CHWs or there is no HRH plan	Input	Process	MOH documents	Annual
Component 4: Supply chain management	Medicine and diagnostic registration	CCM medicines and diagnostics are registered with National Regulatory Authority (NRA) ACTs and RDTs for malaria Zinc and low osmolarity ORS for diarrhea Antibiotics for pneumonia	Yes: CCM medicines and diagnostics appropriate for use with children for all relevant conditions registered with NRA Partial: CCM medicines and diagnostics for some CCM conditions registered with NRA No: CCM medicines and diagnostics not registered with NRA	Input	Process	Drug registration lists	Annual
Component 4: Supply chain management	Medicine and diagnostic adequate availability	Percentage of CCM sites with all key CCM medicines and diagnostics adequately stocked on the day of visit OR last day of reporting period whichever is most recent	Numerator: # of CCM sites with all key CCM medicines or diagnostics in adequate stocks, between a country defined maximum and minimum stock level, on the last visit OR last day of reporting period. Denominator: # of CCM sites	Output	IR3-Quality	Supervision reports, surveys, routine reporting	Annual/quarterly
Component 4: Supply chain management	Medicine and diagnostic storage	Percentage of CCM sites with medicines and diagnostics stored appropriately	Numerator: # of CCM sites with medicines and diagnostics stored in an appropriate manner; appropriate to be locally defined, and may include: Storage area free of rodents or insects; Storage area secured with a lock and key, access limited; Medicines are protected from direct sunlight; Medicines are stored at appropriate temperature; Space is sufficient for the quantity of products that should be stored; and Space should be dry, free from flooding. Denominator: # of CCM sites	Output	IR3-Quality	Survey and/or supervisor checklist	Annual/quarterly
Component 4: Supply chain management	Medicine and diagnostic validity	Percentage of CCM sites with no expired or damaged medicine or diagnostics on the day of observation	Numerator: # of CCM sites with no expired medicine, RDTs or non-functional timers/thermometers on the day of observation Denominator: # of CCM sites	Output	IR3-Quality	Survey and/or supervisor checklist	Annual/quarterly
Component 5: Service Delivery and Referral	CCM treatment coverage by CHW	Proportion of overall treatment coverage being provided by CCM by CHW	Numerator: # of children under five with CCM condition receiving appropriate treatment from CHW Denominator: # of children under five with CCM condition (fever/malaria, diarrhea or suspected pneumonia)	Outcome	SO-Use	Survey	Episodic
Component 5: Service Delivery and Referral	Treatment coverage by income quintile	Percentage of sick children receiving appropriate treatment by income quintile by point of service	Numerator: # of children under five with CCM condition receiving appropriate treatment by income quintile by point of service Denominator: # of children under five with any CCM condition (fever/malaria, diarrhea or suspected pneumonia) by point of service	Outcome	SO-Use	Survey	Episodic
Component 5: Service Delivery and Referral	Treatment rate	Number of CCM conditions treatments per 1000 children under five in target area in a given period by point of service and disease	Numerator: 1. # of treatments for children under five provided through CCM by disease in given time period in target area by point of service -- 2. # of treatments for children under five provided by health facility by CCM disease in a given time period in target area by point of service Denominator: # of children under five in target area by point of service at a given time divided by 1000	Outcome	SO-Use	CHW and HF treatment registers	Annual/quarterly
Component 5: Service Delivery and Referral	Case load by site	Proportion of CCM sites treating at least X cases per month (to be defined locally)	Numerator: # of CCM sites treating at least X cases per month Denominator: # of CCM sites	Output	IR3-Quality	CHW registers	Annual/quarterly
Component 5: Service Delivery and Referral	Appropriate RDT use	Use of rapid diagnostic tests (for child presenting with fever where RDTs are part of the package)	Numerator: # of children tested with an RDT Denominator: # of children presenting with fever	Outcome	IR3-Quality	Record review, observation	Monitoring: Quarterly, Evaluation: 3 years
Component 5: Service Delivery and Referral	Appropriate prescribing practice for positive RDTs	Appropriate prescribing practices based on results of rapid diagnostic tests (where RDTs are part of the package)	Numerator: # of children that receive an ACT Denominator: # of children with a positive RDT RDT	Outcome	IR3-Quality	Record review, observation	Monitoring: Quarterly, Evaluation: 3 years
Component 5: Service Delivery and Referral	Appropriate prescribing practice for negative RDTs	Appropriate prescribing practices based on results of rapid diagnostic tests (where RDTs are part of the package)	Numerator: # of children with negative RDT who do not receive ACT Denominator: # of children with a negative RDT	Outcome	IR3-Quality	Record review, observation	Monitoring: Quarterly, Evaluation: 3 years
Component 5: Service Delivery and Referral	First source of care	Proportion of caregivers of children under five in CCM target areas who sought CHWs as first source of care for the sick child	Numerator: # of sick children under five whose caregivers sought care from CHWs as first source of care for the child Denominator: # of sick children under five	Outcome	IR4-Demand	HH survey	Episodic
Component 5: Service Delivery and Referral	Complete and consistent case registration	Proportion of CHWs whose registers show completeness and consistency between classification and treatment	Numerator: # of CHWs whose registers show completeness and consistency between classification and treatment for at least 4 of 5 cases reviewed for each condition Denominator: # of CHWs supervised	Output	IR3-Quality	CHW registers/ Supervision reports	Quarterly
Component 5: Service Delivery and Referral	Follow up rate	# and proportion of cases followed up after receiving treatment from CHW according to country protocol	Numerator: # of cases followed up after receiving treatment from CHW Denominator: total number of cases receiving treatment from CHW	Output	IR3-Quality	Monitoring: CHW registers Evaluation: HH survey	Monitoring: Quarterly, Evaluation: 3 years
Component 5: Service Delivery and Referral	Referral rate	Proportion of cases who are recommended for referral by the CHW	Numerator: # of cases seen by CHW who are recommended for referral Denominator: # of cases seen by CHW	Output	IR3-Quality	Monthly reports/ Registers	Annual/quarterly
Component 5: Service Delivery and Referral	Successful referral	Proportion of children recommended for referral received at the referral facility	Numerator: # of children received at referral facility Denominator: Total # of children recommended for referral	Outcome	SO-Use	Special study/ survey/ CHW Registers and facility reports	Annual
Component 6: Communication and Social Mobilization	Communication strategy	Communication strategy for childhood illness includes CCM	Yes: Childhood illness communication strategy includes CCM for all relevant conditions (pneumonia, malaria, diarrhea) Partial: Communication strategy for childhood illness includes CCM for at least one relevant condition No: National childhood illness communication strategy does not exist OR does not mention CCM at all	Input	Process	National strategy document; BCC materials, modules, job aids, and training curriculum	Annual
Component 6: Communication and Social Mobilization	Caregiver knowledge of community health worker	Proportion of care givers who know the presence and role of CHW	Numerator: # of caregivers of children under five interviewed from target communities who can name location and services provided by their CHW Denominator: total # of caregivers of children under five interviewed from target communities	Output	IR4-Demand	HH survey	Episodic
Component 7: Supervision & Performance Quality Assurance	Supervision strategy	Supervision strategy available and outlines designated cadres, job descriptions and standardized supporting materials (i.e. checklists, training materials)	Yes: National supervision strategy for CCM available and includes designated cadres, job description and standardized supervision checklists, guidelines and training materials Partial: Supervision strategy for CCM available but does not include all required components and materials No: Supervision strategy and supporting materials for CCM are not available	Input	IR3-Quality	Supervisory tools and plans	Annual
Component 7: Supervision & Performance Quality Assurance	Clinical supervision coverage	Proportion of CHWs who received at least 1 supervisory contact during the prior 3 months where a sick child visit or scenario was assessed and coaching was provided	Numerator: # of CHWs receiving at least 1 supervisory contact in the prior 3 months where a sick child visit was observed or scenario was assessed and coaching provided Denominator: # of CHWs trained in and deployed for CCM or # of CHWs interviewed	Output	IR3-Quality	Supervisory records; survey and CHW interviews	Define Locally (during prior 3 month or as determined locally)
Component 7: Supervision & Performance Quality Assurance	CCM supervisor training	Proportion of supervisors assigned to CCM (at all levels of health system) that have been trained in CCM	Numerator: # of supervisors assigned to CCM (at all levels of the health system) that have been trained in CCM Denominator: # of supervisors assigned to CCM (at all levels of the health system)	Output	IR3-Quality	Administrative records	Annual
Component 7: Supervision & Performance Quality Assurance	CHW to supervisor ratio	Ratio of CHWs deployed for CCM for each assigned CCM supervisor in the same target area	Numerator: # of CHWs trained in CCM Denominator: # of supervisors assigned to CCM supervision	Output	IR3-Quality	District reports; survey	Annual/episodic
Component 7: Supervision & Performance Quality Assurance	Case management knowledge	Proportion CHWs (or proportion of cases) who correctly manage sick child case scenarios	Numerator: (a) # of CHWs who correctly manage case scenarios OR (b) # case scenarios correctly managed Denominator: (a) # of CHWs assessed OR (b) # case scenarios presented	Output	IR3-Quality	Supervision reports; direct observation	Should be measured quarterly for 1st year of service bi-annual or episodic in subsequent years
Component 7: Supervision & Performance Quality Assurance	Respiratory rate	Proportion of CHWs who correctly count respiratory rate	Numerator: # of CHWs who correctly count (+/- 2 breaths per minute) the respiratory rate of live case, supervisor, community infant, or video Denominator: # of CHWs assessed	Output	IR3-Quality	Direct Observation	Monitoring: Quarterly, Evaluation: episodic
Component 7: Supervision & Performance Quality Assurance	First dose	First dose of treatment received in presence of CHW	Numerator: # of children given first dose of treatment in the presence of CHW Denominator: # of children treated by CHW	Evaluation: Outcome	IR3-Quality	Special study/ Direct observation	Annual/episodic
Component 7: Supervision & Performance Quality Assurance	Correct referral	Proportion of cases with danger signs or severe disease recommended for referral	Numerator: # of cases with danger signs or severe disease recommended for referral according to protocol Denominator: # of cases with danger signs who should be referred according to protocol	Output	IR3-Quality	Special study/ surveys	Annual or less
Component 7: Supervision & Performance Quality Assurance	Counseling quality	Proportion of CHWs who provide proper counseling during sick child visits	Numerator: # of CHWs who provide proper counseling to caretakers of sick children (dose, duration, frequency and follow-up) Denominator: # of CHWs assessed	Output	IR3-Quality	Direct observation	Episodic
Component 8: Monitoring & Evaluation and Health Information Systems	Classification consistency	Registers and reports for case management of children under five at facility and community levels align with standard WHO or national classifications	Yes: Registers and reports for case management of children under five at facility and community levels follow the same standard WHO or national classifications for malaria, pneumonia and diarrhea Partial: Registers and reports for case management of children under five at facility and community levels follow the same standard WHO or national classifications for only some conditions No: Registers and reports for case management of children under five at facility and community levels do not follow the same standard WHO or national classifications	Input	Process	Registers and reporting documents	Episodic
Component 8: Monitoring & Evaluation and Health Information Systems	District monitoring	Proportion of implementing districts using monitoring data on case management at community and facility levels	Numerator: # of implementing districts using monitoring data for planning on case management at community and facility levels Denominator: # of districts implementing CCM	Process	Process	HMIS records and reports (gold standard); other CCM reporting where relevant	Quarterly

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