RT Journal Article
SR Electronic
T1 Child health and the implementation of Community and District-management Empowerment for Scale-up (CODES) in Uganda: a randomised controlled trial
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e006084
DO 10.1136/bmjgh-2021-006084
VO 6
IS 6
A1 Peter Waiswa
A1 Flavia Mpanga
A1 Danstan Bagenda
A1 Rornald Muhumuza Kananura
A1 Thomas O’Connell
A1 Dorcus Kiwanuka Henriksson
A1 Theresa Diaz
A1 Florence Ayebare
A1 Anne Ruhweza Katahoire
A1 Eric Ssegujja
A1 Anthony Mbonye
A1 Stefan Swartling Peterson
YR 2021
UL http://gh.bmj.com/content/6/6/e006084.abstract
AB 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.Data are available upon request. Data access for further research can be freely shared with researchers after a formal request through the corresponding author.