Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
BMC health services research
Abstract
Integrated community case management (iCCM) strategies aim to reach poor communities by
providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age.
Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be
effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate
strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver
and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.
Methods: A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area
in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements
experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately
with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms
for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT
members. Thematic analysis was based on the ‘Health Access Livelihoods Framework’.
Results: iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban
settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health
service providers, caregivers valued VHTs’ free, proximal services, caring attitudes, perceived treatment quality,
perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived
to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence –
factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of
referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM
strategy was widely perceived to result in economic savings and other livelihood benefits.
Conclusions: In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both
VHT attributes and gaps in existing health services. Depending on health system resources and organisation,
iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should
consider tailored community engagement strategies, adapted selection criteria, and assessment of population
density to ensure sufficient coverage.
Description
Keywords
Child health, Integrated community case management (iCCM), Peri-urban health care, Health care access
Citation
Altaras, R., Montague, M., Graham, K., Strachan, C. E., Senyonjo, L., King, R., ... & Tibenderana, J. (2017). Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda. BMC health services research, 17, 1-17.DOI 10.1186/s12913-017-2723-0