Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.

Rationale, aims, and objectives Appropriate treatment of pediatric fever in rural areas remains a challenge and maybe partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer‐supervision among drug sellers on the appropriate treatment of pneumonia symptoms, uncomplicated malaria, and non‐bloody diarrhea among children less than 5 years of age in the intervention (Luuka) and comparison (Buyende) districts, in East‐Central Uganda. Methods Data on pneumonia symptoms, uncomplicated malaria, and non‐bloody diarrhea among children less than 5 years of age was abstracted from drug shop sick child registers over a 12‐month period; 6 months before and 6 months after the introduction of peer‐supervision. Interrupted time series were applied to determine the effectiveness of the peer‐supervision intervention on the appropriate treatment of pneumonia, uncomplicated malaria, and non‐bloody diarrhea among children less than 5 years of age attending drug shops in East Central Uganda. Results The proportion of children treated appropriately for pneumonia symptoms was 10.84% ( P < .05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% ( P = .79, CI = [−10.43, 13.36]) higher, and for non‐bloody diarrhea was 4.00% ( P < .05, CI = [−7.95, −0.13]) lower in the intervention district than the comparison district, respectively. Post‐intervention trend results showed an increase of 1.21% ( P = .008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% ( P < .06, CI = [−1.95, 0.02]) in the proportion of children appropriately treated for non‐bloody diarrhea, respectively. Conclusions Peer‐supervision increased the proportion of children less than 5 years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non‐bloody diarrhea. Implementation of community‐level interventions to improve pediatric fever management should consider including peer‐supervision among drug sellers.

Background: Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for Class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. Without support supervision, inappropriate treatment of malaria, pneumonia and diarrhoea among children under 5 years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka District in East Central Uganda. Methods: Eight in-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellers at the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision. Transcripts were imported into Atlas.ti 7 qualitative data management software where they were analysed using thematic content analysis. Results: Initially, peer supervisors were disliked and regarded by drug sellers as another extension of drug inspectors. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria, respectively, among children under 5 years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop centre for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they may also gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and inadequate financial resources were the main peer supervision challenges mentioned. Conclusion: Drug sellers benefitted from peer supervision by developing a good relationship with peer supervisors. This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices. There is need to explore the minimum resources needed for peer supervision of drug sellers to further inform practice and policy.

Background: There is a growing number of urban refugees that may necessitate local government and humanitarian organizations to factor in when planning for the urban infrastructure as this has proved to be a planning blind spot. This study assessed factors influencing Somali refugee movement from Nakivale refugee settlement to Kampala, the capital city of Uganda. Methods: Six key informant interviews were held with the Principle Protection Officer-OPM, Legal Coordinator-NRC, Manager Access to Justice Program-RLP, Psychosocial Counsellor-JRS, Somali elder Nakivale settlement and the Chairperson-SCK. Three focus group discussions were conducted with one group of male and two groups of female Somali refugees. Transcripts were managed using Atlas ti version 7 (ATLAS. Ti GmbH, Berlin). Results: The need for better basic needs such as food, water, health care, education, employment, a better quality life and difficulties related to having a language barrier emerged in the first theme. Movement due to political and cultural persecution emerged as a combined theme of security. The need for better economic benefits, livelihood support and an enabling refugee policy were influencers. The study also revealed that Somali refugees are a well-knit society with a robust communication network that relies on Islamic religion and country background in exploiting connections that enable those who move from Nakivale settlement to quickly adapt to the situation in Kampala.Conclusion: Somali movement from Nakivale refugee settlement to Kampala is influenced by a need for better basic needs and security; economic benefits, livelihood support and an enabling refugee policy which guarantees freedom of movement. A communication network based on religion and country background are facilitators.

BackgroundPeer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than five years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.MethodsIn this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with one hundred and thirty drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.Results A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. Conclusion Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.