District Health Teams' Readiness to Institutionalize Integrated Community Case Management in the Uganda Local Health Systems: A Repeated Qualitative Study.

Agnes Nanyonjo,Edmound Kertho,James Tibenderana,Karin Källander

doi:10.9745/ghsp-d-19-00318

Agnes Nanyonjo, Edmound Kertho + Show 2 more

Open Access

https://doi.org/10.9745/ghsp-d-19-00318

Copy DOI

Abstract

Several countries have adopted integrated community case management (iCCM) as a strategy for improved health service delivery in areas with poor health facility coverage. Early implementation of iCCM is often run by nongovernmental organizations financed by donors through projects. Such projects risk failure to transition into programs run by the local health system upon project closure. Engagement of subnational health authorities such as district health teams (DHTs) is essential for a smooth transition. We used a repeated qualitative study design to assess the readiness of and progress made by DHTs in institutionalizing iCCM into the functions of locally decentralized health systems in 9 western Uganda districts. Readiness data were derived from structured group interviews with DHTs before iCCM policy adoption in 2010 and again in 2015. Progressive institutionalization achievements were assessed through key informant interviews with targeted DHT members and local government district planners in the same areas. In the readiness study, DHTs expressed commitment to institutionalize iCCM into the local health system through the development of district-specific iCCM activity work plans and budgets. The DHTs further suggested that they would implement district-led training, motivation, and supervision of community health workers; procurement of iCCM medicines and supplies; and advocacy activities for inclusion of iCCM indicators into the national health information systems. After iCCM policy adoption, follow-up study data findings showed that iCCM was largely not institutionalized into the local district health system functions. The poor institutionalization was attributed to lack of stewardship on how to transition from externally supported implementation to district-led programming, conflicting guidelines on community distribution of medicines, poor community-level accountability systems, and limited decision-making autonomy at the district level. Successful institutionalization of iCCM requires local ownership with increased coordination and cooperation among governmental and nongovernmental actors at both the national and district levels.

Highlights

Several countries have adopted integrated community case management as a strategy for improved health service delivery in areas with poor health facility coverage
The United Nations Children’s Fund and the World Health Organization (WHO) recommend integrated community case management of childhood illnesses as a strategy for equitable access to treatment in areas with formal health facility deficiency.[6] iCCM relies on community health workers (CHWs) using simple algorithms to offer health promotion, disease prevention, and curative services for uncomplicated diarrhea, malaria, and pneumonia.[6]
In the pre-iCCM policy adoption readiness study, we found that the district health team (DHT) reported being ready to www.ghspjournal.org

Summary

Introduction

Several countries have adopted integrated community case management (iCCM) as a strategy for improved health service delivery in areas with poor health facility coverage. Implementation of iCCM is often run by nongovernmental organizations financed by donors through projects Such projects risk failure to transition into programs run by the local health system upon project closure. The DHTs further suggested that they would implement district-led training, motivation, and supervision of community health workers; procurement of iCCM medicines and supplies; and advocacy activities for inclusion of iCCM indicators into the national health information systems. Uganda District Health Teams’ Institutionalization of Integrated Community Case Management www.ghspjournal.org despite making remarkable improvements.[1,2] Disparities in under-5 mortality persist among sub-Saharan countries and between the richest and the poorest households.[3] Infectious diseases continue to account for a sizable proportion of the region’s under-5 mortality. In 2002, Uganda adopted the Home-Based Management of Fever policy for management of malaria, and, in 2010, adopted the iCCM policy that introduced CHW training in integrated management of pneumonia and diarrhea within the community.[7]

Methods

Results

Discussion

Conclusion