Improving child survival through a district management strengthening and community empowerment intervention: early implementation experiences from Uganda
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
BMC public health
Abstract
Background: The Community and District Empowerment for Scale-up (CODES) project pioneered the
implementation of a comprehensive district management and community empowerment intervention in five
districts in Uganda. In order to improve effective coverage and quality of child survival interventions CODES
combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with
Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in
monitoring health service provision and to demand for quality services. This paper presents early implementation
experiences in five pilot districts and lessons learnt during the first 2 years of implementation.
Methods: This qualitative study was comprised of 38 in-depth interviews with members of the District Health
Teams (DHTs) and two implementing partners. These were supplemented by observations during implementation
and documents review. Thematic analysis was used to distill early implementation experiences and lessons learnt
from the process.
Results: All five districts health teams with support from the implementing partners were able to adopt the UNICEF
tools and to develop district health operational work plans that were evidence-based. Members of the DHTs
described the approach introduced by the CODES project as a more systematic planning process and very much
appreciated it. Districts were also able to implement some of the priority activities included in their work plans but
limited financial resources and fiscal decision space constrained the implementation of some activities that were
prioritized. Community dialogues based on Citizen Report Cards (CRC) increased community awareness of available
health care services, their utilization and led to discussions on service delivery, barriers to service utilization and
processes for improvement. Community dialogues were also instrumental in bringing together service users,
providers and leaders to discuss problems and find solutions. The dialogues however are more likely to be
sustainable if embedded in existing community structures and conducted by district based facilitators. U report as a
community feedback mechanism registered a low response rate.
Conclusion: The UNICEF tools were adopted at district level and generally well perceived by the DHTs. The limited
resources and fiscal decision space however can hinder implementation of prioritized activities. Community
dialogues based on CRCs can bring service providers and the community together but need to be embedded in
existing community structures for sustainability.
Description
Keywords
child survival, management strengthening
Citation
Katahoire, A. R., Henriksson, D. K., Ssegujja, E., Waiswa, P., Ayebare, F., Bagenda, D., ... & Peterson, S. S. (2015). Improving child survival through a district management strengthening and community empowerment intervention: early implementation experiences from Uganda. BMC public health, 15(1), 1-11.