Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods

Hector Tibeihaho,Joseph J Valadez,Charles Nkolo,Stephen Mucunguzi,Anthony K Mbonye,Zaccheus Sinabulya,Richard Musabe,Dorcus K Henriksson,John Odaga,Margaret Katusiime

doi:10.3402/gha.v9.30983

Abstract

BackgroundLocal health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions.DesignAlthough the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project.ResultsAll five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans.ConclusionsIn the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.

Highlights

In Uganda, local health system managers have the responsibility for health service delivery including setting priorities and managing resources [1]
Use of Lot Quality Assurance Sampling (LQAS)-based data helps in identifying the worst-performing areas such that resources are targeted to these areas
The ‘proof-of-concept’ phase of the Community and District Empowerment for Scale-up (CODES) project has shown that district health planners in Uganda can adopt and integrate the UNICEF set of tools for priority settings and be able to make decisions at the margin, as long as such methods are contextualised, user-friendly, and participatory. These methods could be scaled-up to other districts in Uganda, and similar developing countries

Summary

Introduction

In Uganda, local health system managers have the responsibility for health service delivery including setting priorities and managing resources [1]. Health managers in lowincome countries commonly base funding decisions on what has been funded previously, or what is prioritised by the ministry(s) of health or donors [3, 10] These priorities are often based on national or international indicator values, rather than on locally available evidence [11]. Design: the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. Conclusions: In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival

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Results

Discussion

Conclusion