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

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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

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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 Participants	Buliisa	Kibaale	Kiboga	Kyankwanzi	Kyenjojo	Kyegegwa	Kiryandongo	Masindi	Hoima
District health officer	X	X	X	X	X	X	X	X	X
District drug inspector	X		X	X	X	X			X
District health inspector	X	X	X	X	X	X			X
District health educator	X	X	X	X	X	X	X	X	X
District surveillance focal person	X	X							X
Health facility in-charge	X	X	X	X	X	X	X	X	X
Health management information focal person	X				X	X
Malaria focal person	X	X	X	X			X	X	X
Medical superintendent			X	X
District biostatistician					X	X	X	X
Key informant follow-up study^a ^b
District health officer	N	Y	N	Y	Y	Y	Y	Y	Y
Malaria focal person	Y	Y	N	Y	Y	Y	Y	Y	Y
District biostatistician/HMIS focal person	Y	Y	Y	Y	Y	Y	Y	Y	Y
District planner	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/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.