TY - JOUR
T1 - Child health and the implementation of Community and District-management Empowerment for Scale-up (CODES) in Uganda
T2 - A randomised controlled trial
AU - Waiswa, Peter
AU - Mpanga, Flavia
AU - Bagenda, Danstan
AU - Kananura, Rornald Muhumuza
AU - O'Connell, Thomas
AU - Henriksson, Dorcus Kiwanuka
AU - DIaz, Theresa
AU - Ayebare, Florence
AU - Katahoire, Anne Ruhweza
AU - Ssegujja, Eric
AU - Mbonye, Anthony
AU - Peterson, Stefan Swartling
N1 - Publisher Copyright:
©
PY - 2021/6/8
Y1 - 2021/6/8
N2 - Introduction Uganda's district-level administrative units buttress the public healthcare system. In many districts, however, local capacity is incommensurate with that required to plan and implement quality health interventions. This study investigates how a district management strategy informed by local data and community dialogue influences health services. Methods A 3-year randomised controlled trial (RCT) comprised of 16 Ugandan districts tested a management approach, Community and District-management Empowerment for Scale-up (CODES). Eight districts were randomly selected for each of the intervention and comparison areas. The approach relies on a customised set of data-driven diagnostic tools to identify and resolve health system bottlenecks. Using a difference-in-differences approach, the authors performed an intention-to-treat analysis of protective, preventive and curative practices for malaria, pneumonia and diarrhoea among children aged 5 and younger. Results Intervention districts reported significant net increases in the treatment of malaria (+23%), pneumonia (+19%) and diarrhoea (+13%) and improved stool disposal (+10%). Coverage rates for immunisation and vitamin A consumption saw similar improvements. By engaging communities and district managers in a common quest to solve local bottlenecks, CODES fostered demand for health services. However, limited fiscal space-constrained district managers' ability to implement solutions identified through CODES. Conclusion Data-driven district management interventions can positively impact child health outcomes, with clinically significant improvements in the treatment of malaria, pneumonia and diarrhoea as well as stool disposal. The findings recommend the model's suitability for health systems strengthening in Uganda and other decentralised contexts. Trial registration number ISRCTN15705788.
AB - Introduction Uganda's district-level administrative units buttress the public healthcare system. In many districts, however, local capacity is incommensurate with that required to plan and implement quality health interventions. This study investigates how a district management strategy informed by local data and community dialogue influences health services. Methods A 3-year randomised controlled trial (RCT) comprised of 16 Ugandan districts tested a management approach, Community and District-management Empowerment for Scale-up (CODES). Eight districts were randomly selected for each of the intervention and comparison areas. The approach relies on a customised set of data-driven diagnostic tools to identify and resolve health system bottlenecks. Using a difference-in-differences approach, the authors performed an intention-to-treat analysis of protective, preventive and curative practices for malaria, pneumonia and diarrhoea among children aged 5 and younger. Results Intervention districts reported significant net increases in the treatment of malaria (+23%), pneumonia (+19%) and diarrhoea (+13%) and improved stool disposal (+10%). Coverage rates for immunisation and vitamin A consumption saw similar improvements. By engaging communities and district managers in a common quest to solve local bottlenecks, CODES fostered demand for health services. However, limited fiscal space-constrained district managers' ability to implement solutions identified through CODES. Conclusion Data-driven district management interventions can positively impact child health outcomes, with clinically significant improvements in the treatment of malaria, pneumonia and diarrhoea as well as stool disposal. The findings recommend the model's suitability for health systems strengthening in Uganda and other decentralised contexts. Trial registration number ISRCTN15705788.
KW - child health
KW - cluster randomised trial
KW - health systems
KW - public health
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U2 - 10.1136/bmjgh-2021-006084
DO - 10.1136/bmjgh-2021-006084
M3 - Article
AN - SCOPUS:85107930338
SN - 2059-7908
VL - 6
JO - BMJ Global Health
JF - BMJ Global Health
IS - 6
M1 - e006084
ER -