Child health and the implementation of Community and District-management Empowerment for Scale-up (Codes) in Uganda

A randomised controlled trial

Bibliographic Data

ID21879149
AuthorsPeter Waiswa (0000-0001-8221-902X, Karolinska Institutet, corresponding author), Flavia Mpanga (0000-0002-8890-8325, World Health Organization - Uganda), Danstan Bagenda (0000-0002-3308-2562, University of Nebraska Medical Center), Rornald Muhumuza Kananura (0000-0002-9915-1989, Makerere University), Thomas O’Connell (0000-0002-6003-008X, World Health Organization), Dorcus Kiwanuka Henriksson (0000-0002-2359-9891, Karolinska Institutet), Theresa Diaz (0000-0001-5063-8078, World Health Organization), Florence Ayebare (0000-0002-3343-146X, Makerere University), Anne Katahoire (0000-0003-3520-070X, Makerere University), Anne Ruhweza Katahoire (Child Health and Development Centre, Makerere University, Kampala, Uganda), Eric Ssegujja (0000-0002-7732-1019, Makerere University), Anthony K Mbonye (Makerere University), Anthony Mbonye (Makerere University), Stefan Peterson (0000-0001-7203-3096, United Nations Children's Fund), Stefan Swartling Peterson (Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda)
Year2021
Volume6
Issue6
Pagese006084
Publication date2021-06-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-006084
PMID34103326
OpenAlexW3170651687
LanguageEN
Citations received2
References cited29

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

Community health · Economic growth · Economics · Empowerment · Environmental health · Health facility · Health services · Malaria · Population · Psychological intervention · Public health · Randomized controlled trial · Child Nutrition and Water Access · Global Maternal and Child Health · Health Policy Implementation Science · Medicine · Nursing · Surgery

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