District Health Teams’ Readiness to Institutionalize Integrated Community Case Management in the Uganda Local Health Systems: A Repeated Qualitative Study

Abstract

Despite 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. n 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.

Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda

“…In Uganda, the VHTs are community volunteers chosen by community members to provide healthcare services to their communities [39] and are regarded as HC I [36,37,39]. Each VHT serves about 1000 people or 25 households in a village [35,40,41], and they provided linkage between the community and the HCs [36,39,40,42]. In addition to other functions, the VHTs are to raise awareness about and mobilise community members to participate in cervical cancer prevention activities [7].…”

Institutionalization of Projects Into Districts in Low- and Middle-Income Countries Needs Stewardship, Autonomy, and Resources

“…The article by Nanyonjo et al 4 in this issue of GHSP reports the findings of an evaluation of their efforts to institutionalize iCCM in 9 districts of Western Uganda. Designed by the United Nations Children's Fund and the World Health Organization, iCCM is a strategy that relies on community health workers (CHWs) using simple algorithms to offer health promotion, disease prevention, and curative services for uncomplicated diarrhea, malaria, and pneumonia.…”

Institutionalizing a Regional Model for Improving Quality of Newborn Care at Birth Across Hospitals in Eastern Uganda: A 4-Year Story

“…In most general hospitals in Uganda, newborns are managed in the pediatric unit, which is typically located some distance away from the maternity unit. 12 This is problematic for several reasons. First, precious time may be lost when transferring a newborn to the pediatric unit, which delays care and could be fatal.…”

“…This approach avoided the pitfalls of some past projects, which could not be sustained because they were too costly or conducted at a pace that the system could not maintain. 11,12,18 The networking of facilities within the region also improved access to care by vulnerable families, as newborn care services were expanded from 1 health facility to 6. The project also helped free up the NCU at the regional referral hospital.…”

“…11 Key contributing factors to the lack of sustainability include high resource intensity and too many simultaneous interventions overwhelming the local health system. 11,12 Considering sustainability challenges that have hindered past large-scale maternal and newborn project interventions, we designed and implemented a low-cost, limited-intensity package to improve care at birth. This report describes the implementation experiences and lessons learned to inform maternal and newborn health policy formulation and implementation of similar initiatives in Uganda and elsewhere.…”