Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
Makerere University Centre of Excellence for Maternal Newborn & Child Health, Makerere University School of Public Health, Kampala, Uganda.
BMJ Glob Health. 2021 Jun;6(6). doi: 10.1136/bmjgh-2021-006084.
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.
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.
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.
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.
ISRCTN15705788.
乌干达的地区级行政单位为公共医疗体系提供支持。然而，在许多地区，当地的能力与规划和实施高质量卫生干预措施所需的能力并不相称。本研究调查了一种由当地数据和社区对话提供信息的地区管理策略如何影响卫生服务。
一项为期 3 年的随机对照试验（RCT）由 16 个乌干达地区组成，测试了一种管理方法，即社区和地区管理赋权以扩大规模（CODES）。每个干预和比较区随机选择了 8 个区。该方法依赖于一套定制的、数据驱动的诊断工具，以确定和解决卫生系统的瓶颈。作者采用差异法对五岁以下儿童疟疾、肺炎和腹泻的预防、保护和治疗做法进行了意向性治疗分析。
干预区报告说，疟疾（+23%）、肺炎（+19%）和腹泻（+13%）的治疗以及粪便处理（+10%）有显著的净增加。免疫和维生素 A 消费的覆盖率也有类似的改善。通过让社区和地区管理人员共同努力解决当地的瓶颈问题，CODES 促进了对卫生服务的需求。然而，有限的财政空间限制了地区管理人员实施通过 CODES 确定的解决方案的能力。
以数据为驱动的地区管理干预措施可以对儿童健康结果产生积极影响，在疟疾、肺炎和腹泻的治疗以及粪便处理方面有显著的临床改善。研究结果表明，该模式适合乌干达和其他权力下放背景下的卫生系统加强。
ISRCTN86113424。
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