local evidence that demonstrates the effectiveness of
iCCM, and, critically, clear financial commitments that assure the
feasibility and sustainability of iCCM programmes.
Although the study participants in Kenya expressed their apprehensions
about iCCM with perhaps greater force than participants
in other countries included in the broader study, their concerns are
neither new nor unique to Kenya. Other analysts and researchers
have also underlined the health system challenges associated with
maintaining CHW programs, focussing particularly on CHW remuneration,
training and supervision, and critically financial sustainability
(Haines et al. 2007; Lehmann et al. 2009). Although it may
be tempting to view actors’ resistance to iCCM in Kenya as being
driven by a desire to protect the professional interests of qualified
health workers combined with a relatively weak commitment to primary
health care, this would be an over-simplification. In order to
advance the iCCM policy agenda in Kenya, and similar countries,
multiple interconnected health systems concerns will need to be
addressed and consideration should be given to how to adapt the
iCCM model to country health systems.