TY - JOUR T1 - District Health Teams’ Readiness to Institutionalize Integrated Community Case Management in the Uganda Local Health Systems: A Repeated Qualitative Study JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 190 LP - 204 DO - 10.9745/GHSP-D-19-00318 VL - 8 IS - 2 AU - Agnes Nanyonjo AU - Edmound Kertho AU - James Tibenderana AU - Karin Källander Y1 - 2020/06/30 UR - http://www.ghspjournal.org/content/8/2/190.abstract N2 - Key FindingsDespite district health teams reporting readiness and preparation to incorporate integrated community case management (iCCM) into their district health systems, they were unable to institutionalize most components into district-specific work plans.Barriers to institutionalization included the lack of stewardship from both Ministry of Health and implementing partners on how to transition from a partner-supported to a locally-run program, lack of agreement of national guidelines on community-level drug distribution, lack of integration of some iCCM indicators in the national health management information system, and limited central government funding.Key ImplicationsDistrict health teams and other local government administrative structures should work together to increase community acceptance, engagement, and ownership of interventions.National and local health systems and implementing partners should collaborate to complement community engagement and encourage local ownership and effective institutionalization.Central government authorities should increase capacity building of district health teams by providing training, delegating power, and providing tools and technologies for implementing iCCM.Implementing partners should collaborate with the Ministry of Health and other relevant policy makers to put into place an effective phaseout and eventual exit plan that will ensure program sustainability.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. 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.Methods: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.Findings: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.Conclusion:Successful institutionalization of iCCM requires local ownership with increased coordination and cooperation among governmental and nongovernmental actors at both the national and district levels. ER -