ICCM+
Action Against Hunger is an international leader in the treatment of severe acute malnutrition (SAM) by Comunity Health Workers (CHWs), thanks to the research and evidence generation work carried out over the last 10 years known as the ‘iCCM+ approach’.
CHWs are people, mostly women, with no medical training, who acquire general health knowledge and care for families in their own communities, treating certain childhood illnesses (diarrhoea, malaria and respiratory infections) through iCCM (Integrated Community Case Management) intervention. Based on this intervention, in 2014 Action Against Hunger proposed incorporating the treatment of acute malnutrition into the CHWs package of activities. Since then, this approach has been implemented through pilot projects in different countries in collaboration with other partner organizations, ministries of health and research institutions.
In June 2023, an important milestonr, the World Health Organisation published updated guidelines for treating child malnutrition, incorporating the ICCM+ approach. This action based on equity will contribute to reaching and cure millions of children around the world by bringing treatment closer and making it more accessible.
How does it work?
Acute malnutrition is a preventable and treatable disease. Today, there is a highly effective treatment for SAM: administering ready-to-use therapeutic foods (RUTF) for children for a period of 6 to 8 weeks. Thanks to CHWs, treatment is delivered in the communities, preventing families from having to travel to health facilities.
This is essential because, in many countries where we work, more than 50% of the population lives more than 5 km from one of these health facilities, and the roads are dangerous or impassable at certain times of the year. In addition, travelling to the health facilities on a weekly basis is difficult when mothers, who are most often responsible for taking the sick child, also have to ensure the family's livelihood and care for the rest of their children. CHWs break down geographical, economic, social and cultural barriers to accessing healthcare facilities.
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NEWS
2026. Relapse-inclusive costing of simplified CMAM protocols: Lessons from Mali
A relapse‑inclusive costing analysis of standard and simplified protocols in Gao, Mali, examining resource use across the full continuum of care, including post‑discharge relapse. The findings complement a recent cost‑effectiveness analysis in the same setting and highlight how improved relapse prevention and follow‑up can strengthen outcomes and cost‑efficiency.
2026. Last peer review. Pilot study about relapses health area emergency context with a simplified-combined protocol Mali
- The simplified protocol can reduce relapse rates following treatment for severe acute malnutrition (SAM), even with reduced doses of ready-to-use therapeutic foods (RUTF)
- Comorbidities were the most significant factor in relapse.
- These results were achieved at health facilities and by community health workers (CHW)
In 2025, WHO in its document about “The curriculum guide for Community Health Workers”, has said: “If adequate training and regular supervision are provided, community health workers (CHWs) had to do the screening and treat cases of moderate and severe acute malnutrition without complications, including administering ready-to-use therapeutic food (RUTF)”. It is the first time that treatment of severe acute malnutrition is included in the curriculum of Community Health Workers.
In 2023, Recommendation B17. Assessment, classification and management or referral of infants and children 6–59 months of age with wasting and/or nutritional oedema can be carried out by community health workers as long as they receive adequate training, and regular supervision of their work is built into service delivery.
RESOURCES
VIDEOS
PEER REVIEW
Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali.
Cichon, B et al.
BMC Public Health 25, 233 (2025)
Effectiveness of decentralizing outpatient acute malnutrition treatment with Community Health Workers and a simplified-combined protocol: noninferiority cluster randomized controlled trial in emergency settings in Mali.
López-Ejeda N et al.
Frontiers in Public Health, 12. 2024, Feb 21
Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation.
Cichon, B et al.
Glob Health Sci Pract. 2024 Jun 27;12(3):e2300431. (2024)
Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya.
Wambui, E et al.
PLOS Glob Public Health 2024 May 16;4(5):e0002564.
Using Machine Learning to Fight Child Acute Malnutrition and Predict Weight Gain During Outpatient Treatment with a Simplified Combined Protocol.
Sánchez-Martínez LJ et al.
HNutrients 2024 Dec 6;16(23):4213.
Effectiveness and Coverage of Severe Acute Malnutrition Treatment with a Simplified Protocol in a Humanitarian Context in Diffa, Niger.
Charle-Cuéllar P et al.
Nutrients 2023, 15, 1975.
Cost of Acute Malnutrition Treatment Using a Simplified or Standard Protocol in Diffa, Niger.
Cichon, B et al.
Nutrients 2023, 15, 3833.
Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger.
Sánchez-Martinez et al.
Frontiers in Nutrition.2023, Nov 30
Cost of Acute Malnutrition Treatment Using a Simplified or Standard Protocol in Diffa, Niger.
Cichon, B et al.
Nutrients 2023, 15 (17), 3833. 2023, Sept 1
Scaling severe acute malnutrition treatment with community health workers: a geospatial coverage analysis in rural Mali.
Charle-Cuéllar P et al.
Hum Resour Health 20, 74 (2022).
Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan.
Rogers E et al.
Public Health Nutr. 2018 Feb;21(2):385-390.
Cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by community health workers compared to treatment provided at an outpatient facility in rural Mali.
Rogers, E et al.
Hum Resour Health 16, 12 (2018).
The effectiveness of treatment for Severe Acute Malnutrition (SAM) delivered by community health workers compared to a traditional facility based model.
Alvarez Morán et al.
BMC Health Serv Res 18, 207 (2018)
Quality of care for treatment of uncomplicated severe acute malnutrition delivered by community health workers in a rural area of Mali.
Alvarez Morán JL et al.
Matern Child Nutr. 2018 Jan;14(1):e12449
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