Implementation protocol for enhanced community case management of pneumonia treatment in post-conflict settings in Tigray, Northern Ethiopia

Background Pneumonia is a leading cause of morbidity and mortality in children under five years of age. The World Health Organization (WHO) advocates for managing pneumonia across all levels of the healthcare system, including the community level. Ethiopia has adopted this recommendation, and Health Extension Workers (HEWs) manage pneumonia in children. However, the scale of implementation is sub-optimal. Therefore, to improve childhood pneumonia treatment coverage in Ethiopia, the current implementation research (IR) aims to develop a scalable delivery model that achieves high population coverage of pneumonia management at the community level using evidence-based interventions. Methods The Integrated Community Management of Newborn and Childhood Illnesses (iCMNCI) is a healthcare strategy currently implemented in Ethiopia to enhance access to essential health services for newborns and children. The proposed IR includes a formative phase to identify barriers to pneumonia service delivery and community uptake, followed by co-design of a strengthened delivery model. The implementation phase will apply and iteratively refine this model within routine care. Evaluation will use a mixed-methods approach to assess feasibility, fidelity, acceptability, and early outcome trends. The target population is young infants aged 7–59 days and children aged 2–59 months with fast-breathing or chest-indrawing pneumonia, respectively. Discussion The IR will generate evidence on scalable, context-appropriate strategies to strengthen pneumonia management in a post-conflict setting. Findings will inform district- and national-level scale-up and provide lessons applicable to other resource-limited or disrupted health systems.