SciELO - Scientific Electronic Library Online

vol.86 issue5Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series studyImplementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi author indexsubject indexarticles search
Home Page  

Services on Demand




Related links


Bulletin of the World Health Organization

Print version ISSN 0042-9686


DAWSON, P et al. From research to national expansion: 20 years' experience of community-based management of childhood pneumonia in Nepal. Bull World Health Organ [online]. 2008, vol.86, n.5, pp.339-343. ISSN 0042-9686.

PROBLEM: Pneumonia is a leading cause of mortality of children aged under five in Nepal. Research conducted by John Snow Inc. in the 1980s determined that pneumonia case management by community-based workers decreased under-five mortality by 28%. APPROACH: Female community health volunteers were selected as the national cadre to manage childhood pneumonia at community level using oral antibiotics. A technical working group composed of government officials, local experts and donor partners embarked on a process to develop a strategy to pilot the approach and expand it nationally. LOCAL SETTING: High under-five mortality rates, low access to peripheral health facilities and severe constraints in human resources led Nepal's Ministry of Health to test this innovative approach. RELEVANT CHANGES: Community-based management of pneumonia doubled the total number of cases treated compared with districts with facility-based treatment only. Over half of the cases were treated by the female community health volunteers. The programme was phased in over 14 years and now 69% of Nepal's under-five population has access to pneumonia treatment. LESSONS LEARNED: Community-based management of pneumonia provides a medium-term solution to address a leading cause of child mortality while the efforts continue to strengthen and extend the reach of facility-based care. Trained community health workers can significantly increase the number of pneumonia cases receiving correct case management in resource-constrained settings, with appropriate health systems' support for logistics, supervision and monitoring. Community-based management of pneumonia can be scaled up and provides an effective approach to reducing child deaths in countries faced with insufficient human resources for health.

        · abstract in French | Spanish     · text in English     · English ( pdf )