Recently, as parts of sub-Saharan Africa have undergone rapid urbanization, there has been increased attention to urban health. Many health programs, such as integrated community case management (iCCM), a package of services for malaria, acute diarrhea, pneumonia, acute malnutrition, and newborn survival, have been implemented extensively in rural areas, but there is little evidence regarding how these programs translate to urban settings. Proactive community management (ProCCM) is a model for not only delivering iCCM services but also implementing them at scale, taking into account a number of barriers. ProCCM includes the provision of free proactive outreach services by CHWs in patients’ homes. In 2008, ProCCM was implemented in periurban areas across Mali.¹ The five components of this program were:

• Proactive case detection where CHWs traveled door-to-door
• Doorstep care including counseling, diagnosis, treatment, and referral
• Monthly individual supervision and weekly group supervision of CHWs from a dedicated supervisor
• Removal of user fees for patients who reported to CHWs that they were unable to pay for services
• Improvements to the infrastructure of primary health care centers

CHWs received 36 days of pre-service training, were selected from the community, and were remunerated. A number of outcome measures improved following the implementation of ProCCM, including the percent of febrile children under 5 years who received effective antimalarial treatment within 24 hours, the percentage of children 0-59 months with all-cause febrile illness, and under-five mortality. Although the evaluation of ProCCM was not designed to conclude causation between the intervention and health outcomes, ProCCM has successfully brought proactive case management to many periurban communities that previously lacked access to care.