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

Abstract

BackgroundIntegrated 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.MethodsA 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’.ResultsiCCM 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.ConclusionsIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2723-0) contains supplementary material, which is available to authorized users.

“From Experts to Locals Hands” Healthcare services Planning in Sub-Saharan Africa: Insight from the Integrated Community Case Management of Ghana

“…Communities blamed financial incapacity and irregular provision of medicines from the district health centres as factors limiting their zeal to support CBHVs. Whiles earlier studies showcased the enormous capacities of community health actors in the act of advocating and mobilizing support for community programs [41,48,49]. Such capabilities were visible across the communities in the context of local governance, but never translated materially and financially in support for the iCCM.…”

“…The qualitative approach was useful in exploring key variables postulated in the Spider-gram, framework on community participation in healthcare services planning [16]. To adequately situate the framework with the result of the study, we reviewed related literature from articles on community participation in healthcare planning in Sub-Saharan Africa [35,36,40,41], and health policy documents, reports and articles in Ghana [3,12,14,25,33,38]. We then collected qualitative data on Community health, the actors involved, the conduct of the need's assessment, the selection of the CBHVs, and how that influenced community-driven monitoring of the process, resources mobilization and leadership for sustainability.…”

“From experts to locals hands” healthcare service planning in sub-Saharan Africa: an insight from the integrated community case management of Ghana

“…1 ). Locals awareness was created on the health program towards utilization [ 41 ]. More caregivers participated in the decision-making process in selecting CBHVs.…”

“…The qualitative approach was useful in exploring key variables postulated in the Spider-gram, framework on community participation in healthcare service planning [ 16 ]. To adequately situate the framework with the result of the study, we reviewed related literature from articles on community participation in healthcare planning in Sub-Saharan Africa [ 35 , 36 , 40 , 41 ], and health policy documents, reports and articles in Ghana [ 3 , 12 , 14 , 25 , 33 , 38 ]. We then collected qualitative data on Community health, the actors involved, the conduct of the need’s assessment, the selection of the CBHVs, and how that influenced community-driven monitoring of the process, resources mobilization and leadership for sustainability.…”

Management of Childhood Infections in Poorly Planned Urban Settlements in Kampala and Wakiso Districts of Uganda

“…It has been previously shown in the study area that iCCM was perceived to facilitate timely access to treatment and improved child health in peri-urban settings. In addition, caregivers valued VHTs’ free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services 31 a justification to scale up iCCM to these areas.…”