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Policy Challenges Facing the Scale Up of Integrated Community Case Management (iCCM) in Uganda
Phyllis Awor1, Joan Nakayaga Kalyango2,3, Cecilia Stålsby Lundborg4
1School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
Insights
Integrated Community Case Management (iCCM) in Uganda faces challenges like low funding and weak coordination. Strengthening the program requires increased domestic investment, better coordination, and a focus on monitoring and evaluation for improved child healthcare access.
Area of Science:
- Public Health
- Health Policy Analysis
- International Development
Background:
- Integrated Community Case Management (iCCM) is an equity-focused strategy to improve access to care for common childhood illnesses in rural areas.
- Community health workers (CHWs) are trained to diagnose and treat malaria, pneumonia, and diarrhea in children under five.
- Uganda has a policy for iCCM, implemented through public sector CHWs, necessitating an evaluation of its 10-year trajectory.
Purpose of the Study:
- To conduct an iCCM policy analysis in Uganda.
- To identify challenges, enablers, and priorities for scaling up the iCCM strategy.
- To understand the barriers and facilitators affecting iCCM policy implementation.
Main Methods:
- Qualitative case study research.
- Document review of 52 relevant documents.
- Key informant interviews with 15 Ugandan stakeholders conducted in 2017.
Main Results:
- The iCCM policy process in Uganda has been largely driven by international agencies with limited government ownership.
- Key implementation challenges include insufficient government funding, fragmented coordination, and conflicting policies, hindering program scale-up.
- Enablers for scaling up iCCM include strong community engagement, existing policy frameworks, and the potential involvement of the private sector.
Conclusions:
- The iCCM program in Uganda requires enhanced domestic funding and improved coordination.
- A stronger focus on monitoring, evaluation, and operational research is crucial for program strengthening.
- Harnessing existing enablers is essential for successful iCCM scale-up in Uganda.
Background:
Integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhoea is an equity focused strategy, to increase access to care for febrile illness in children under-5 years of age, in rural communities. Lay community members are trained to diagnose and treat malaria, pneumonia and diarrhoea in children, and to identify and refer very ill children. Today, many low-income countries including Uganda, have a policy for iCCM which is being rolled out through public sector community health workers (CHWs). Ten years after the introduction of the iCCM strategy in Uganda, it is important to take stock and understand the barriers and facilitators affecting implementation of the iCCM policy.
Methods:
We conducted an iCCM policy analysis in order to identify the challenges, enablers and priorities for scale-up of the iCCM strategy in Uganda. This was a qualitative case study research which included a document review (n=52) and key informant interviews (n=15) with Ugandan stakeholders. Interviews were conducted in 2017 and the desk review included literature up to 2019.
Results:
This paper highlights the iCCM policy trajectory since 2010 in Uganda and includes a policy timeline. The iCCM policy process was mainly led by international agencies from inception, with little ownership of the government. Many implementation challenges including low government funding, weak coordination and contradicting policies were identified, which could contribute to the slow scale up of the iCCM program. Despite the challenges, many enablers and opportunities also exist within the health system, which should be further harnessed to scale up iCCM in Uganda. These enabling factors include strong community commitment, existing policy instruments and the potential of utilizing also the private sector for iCCM implementation.
Conclusion:
The iCCM program in Uganda needs to be strengthen through increased domestic funding, strong coordination and a focus on monitoring, evaluation and operational research.
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