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ORIGINAL ARTICLE
Open Access

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 and Karin Källander
Global Health: Science and Practice June 2020, 8(2):190-204; https://doi.org/10.9745/GHSP-D-19-00318
Agnes Nanyonjo
aMalaria Consortium Uganda, Kampala, Uganda.
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  • For correspondence: nyonjoagie@gmail.com
Edmound Kertho
aMalaria Consortium Uganda, Kampala, Uganda.
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James Tibenderana
bMalaria Consortium, London, UK.
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Karin Källander
cDepartment of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Figures & Tables

Figures

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  • Figure1
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    A village health team member counts the respiratory rate of a child who has a cough with fast breathing. Photo credit: © 2013 Edmound Kertho

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    A supervisor shows village health team members how to fill in the iCCM register during a quarterly review meeting. Photo credit: © 2013 Edmound Kertho

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    FIGURE 1.

    Uganda’s Health and Administrative System Structure

Tables

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    TABLE 1.

    Profile of District Health Team and Local Government Members Interviewed on Institutionalizing Integrated Community Case Management, 9 Districts in Uganda

    Readiness Study Group Interview ParticipantsBuliisaKibaaleKibogaKyankwanziKyenjojoKyegegwaKiryandongoMasindiHoima
    District health officerXXXXXXXXX
    District drug inspectorXXXXXX
    District health inspectorXXXXXXX
    District health educatorXXXXXXXXX
    District surveillance focal personXXX
    Health facility in-chargeXXXXXXXXX
    Health management information focal personXXX
    Malaria focal personXXXXXXX
    Medical superintendentXX
    District biostatisticianXXXX
    Key informant follow-up studyab
    District health officerNYNYYYYYY
    Malaria focal personYYNYYYYYY
    District biostatistician/HMIS focal personYYYYYYYYY
    District plannerN/AN/AN/AN/AN/AN/AN/AN/AN/A
    • Abbreviation: HMIS, health management information system.

    • ↵a Y means a person was district health team member in 2010 and 2015 and participated in the study.

    • ↵b N means person was not a district health team member in 2010.

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    TABLE 2.

    World Health Organization Health System Building Blocks (Functions) Explored in 9 Districts in Uganda

    Attributes Probed for in the Interview Guide
    Health financing
    • Sources of funding for health care in general and specifically for iCCM

    • Percentage of the district budget allocated to iCCM

    • Type of providers of child health care services

    • Range of health services provided by both public and private providers and coverage of the health costs at the point of use

    • Most significant change in health financing for children

    Service delivery
    • Scope of child services offered within the district-by whom and when and presence of any performance linked payments

    • The most significant change in health service delivery

    Health workforce
    • Scope of health staffing levels and turnover in the district

    • Scope of VHT coverage and turning over

    • Scope of training, implementation partners, remuneration, motivation. and supervision for CHWs

    • Presence and awareness of iCCM guidelines

    • Most significant in the health workforce

    Governance
    • Extent to which health decisions are made by the DHTs

    • Budget priority setting exercises

    • Health worker and health technology regulation

    • Community participation in health decision making

    • Most significant changes in health governance

    Medical products and technologies
    • Available medicines and supplies for treatment of common childhood illnesses

    • Distribution of the medicines and supplies specifically iCCM medicines

    • Most significant change in distribution of medicines

    Information
    • Management of health data at the local and district level

    • Availability of standardized registers for collecting and submitting community level data

    • Available data submission platforms

    • Community-level indicators fitted into the national HMIS

    • Use of data for decision making at local and district level

    • Key challenges in reporting data at the local and district level

    • Most significant change in the HMIS

    • Abbreviations: CHW, community health worker; DHT, district health team; HMIS, health management information system, iCCM, integrated community case management; VHT, village health team.

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Global Health: Science and Practice: 8 (2)
Global Health: Science and Practice
Vol. 8, No. 2
June 30, 2020
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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
Global Health: Science and Practice Jun 2020, 8 (2) 190-204; DOI: 10.9745/GHSP-D-19-00318

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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
Global Health: Science and Practice Jun 2020, 8 (2) 190-204; DOI: 10.9745/GHSP-D-19-00318
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