Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda

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dc.contributor.authorAltaras, Robin
dc.contributor.authorMontague, Mark
dc.contributor.authorGraham, Kirstie
dc.contributor.authorStrachan, Clare E.
dc.contributor.authorSenyonjo, Laura
dc.contributor.authorKing, Rebecca
dc.contributor.authorCounihan, Helen
dc.contributor.authorMubiru, Denis
dc.contributor.authorKällander, Karin
dc.contributor.authorMeek, Sylvia
dc.contributor.authorTibenderana, James
dc.date.accessioned2023-06-20T20:10:58Z
dc.date.available2023-06-20T20:10:58Z
dc.date.issued2017
dc.description.abstractIntegrated 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.en_US
dc.identifier.citationAltaras, 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/s12913-017-2723-0en_US
dc.identifier.other10.1186/s12913-017-2723-0
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/8953
dc.language.isoenen_US
dc.publisherBMC health services researchen_US
dc.subjectChild healthen_US
dc.subjectIntegrated community case management (iCCM)en_US
dc.subjectPeri-urban health careen_US
dc.subjectHealth care accessen_US
dc.titleIntegrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Ugandaen_US
dc.typeArticleen_US
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