Amid rapid urbanization throughout sub-Saharan Africa, many health systems face a multitude of barriers to providing equitable access to high-quality primary health care due to extreme poverty, a lack of basic infrastructure, and environmental degradation. These conditions have carried significant implications for health equity and disease burden among populations living in urban areas.¹² In health systems hindered by limited resources and infrastructure, leveraging community-based interventions to improve timely access to effective care is critical for increasing the utilization of vital services that improve health outcomes.³ Several governments in the sub-Saharan African region have worked to strengthen community-based care through the roll-out of integrated community case management (iCCM), a program that trains and supports community health workers (CHWs) to diagnose, treat, and refer children in their local communities.³ Currently, Mali is testing alternative models of iCCM delivery in peri-urban and rural areas through proactive community case management (ProCCM), a model for integrating iCCM into health systems at scale.¹

At its core, the ProCCM model is designed to remove individual, local, and system-level barriers to timely care through proactive population outreach and rapid access to detection and evidence-based treatment.¹ Reducing access barriers from the patient perspective improves utilization of services. CHWs conduct daily door-to-door screenings to identify new patients who need care followed by a free evaluation - including diagnostics, treatment, referral, and counseling and follow-up activities. Areas in sub-Saharan Africa that have implemented the ProCCM intervention have shown documented improvements in early access to care, an increase in patient-provider contacts, and a reduction in under-five child mortality.¹ In its current form, the ProCCM model focuses on the detection and early treatment of the leading causes of under-five child mortality (neonatal illness, malaria, pneumonia, and diarrhea) rather than comprehensive primary care services. However, the ProCCM model is an important demonstration of leveraging CHW-led interventions to improve population health outcomes and strengthen the capacity of health systems to promote early and equitable access and facilitate a usual source of care.