Community-directed interventions for integrated delivery of a health package against major health problems in rural Uganda: perceptions on the strategy and its effectiveness.

Despite growing interest at national and international levels to use community-directed interventions (CDI) for delivery of health interventions in Africa, inadequate information on its acceptability and effectiveness remains. This study aimed to examine community perceptions on CDI strategy and its effectiveness for integrated delivery of health interventions with different degrees of complexity (insecticide treated nets, vitamin A supplements to children, home management of malaria and direct observation treatment of tuberculosis), using community-directed treatment with ivermectin (CDTI) as an entry point, compared to conventional delivery channels. The interventions were implemented in an incremental manner and both qualitative and quantitative methods were used at evaluation, three years after implementation. Coverage was significantly higher in CDI arm, compared to conventional delivery channels for all interventions (P < 0.05), except for direct observation treatment of tuberculosis (P > 0.05). Community members expressed interest in CDI because it responds to their perceived health problems, actively engages them and improves access to health care services. CDI seemed to be appropriate for interventions that are relatively simple, intervention materials are available, the disease is perceived as a health problem affecting all sections of the community and can be easily integrated into their daily lives, and community structures with full community participation.