Tawfik Youssef, Nsungwa-Sabitii Jesca, Greer George, Owor Joseph, Kesande Rosette, Prysor-Jones Suzanne
USAID, Washington DC 20523-3700, WA, USA.
Trop Med Int Health. 2006 Jun;11(6):967-73. doi: 10.1111/j.1365-3156.2006.01622.x.
In Uganda, formal and informal private practitioners (PPs) provide most case management for childhood illness. This paper describes the impact of negotiation sessions, an intervention to improve the quality of PPs' case management of childhood diarrhoea, acute respiratory infection and malaria in a rural district in Uganda.
Negotiation sessions targeted PPs working at private clinics and drug shops. The aim was to improve key practices extracted from the national Integrated Management of Childhood Illness Guidelines, and to measure the PPs' performance before and after the intervention.
Post-intervention the quality of case management for childhood diarrhoea, acute respiratory infection and malaria was generally better, although certain practices appeared resistant to change. We discovered various types of PPs who were mostly unregistered by the district authorities.
Results suggest the importance of maintaining ongoing monitoring and support to PPs to understand barriers to change and to encourage more practice improvement. Modifications to the intervention are needed to take it to scale and render it more sustainable. Getting local organizations and professional associations more involved could make it easier to establish and maintain contact with PPs. The government needs to simplify registration procedures and reduce associated fees to encourage PPs to register and thus be included in a large-scale intervention. Future interventions need to measure the impact on improving childhood case management at the community/household level.
在乌干达，正式和非正式的私人从业者为儿童疾病提供了大部分病例管理服务。本文描述了协商会议的影响，这是一项旨在提高乌干达一个农村地区私人从业者对儿童腹泻、急性呼吸道感染和疟疾病例管理质量的干预措施。
协商会议针对在私人诊所和药店工作的私人从业者。目的是改进从国家儿童疾病综合管理指南中提取的关键做法，并衡量干预前后私人从业者的表现。
干预后，儿童腹泻、急性呼吸道感染和疟疾的病例管理质量总体上有所提高，尽管某些做法似乎难以改变。我们发现了各类主要未在地区当局注册的私人从业者。
结果表明持续监测和支持私人从业者以了解变革障碍并鼓励更多实践改进的重要性。需要对干预措施进行调整，以扩大规模并使其更具可持续性。让当地组织和专业协会更多地参与进来，可能会使与私人从业者建立和保持联系更容易。政府需要简化注册程序并降低相关费用，以鼓励私人从业者注册并因此被纳入大规模干预措施。未来的干预措施需要衡量对改善社区/家庭层面儿童病例管理的影响。
