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Trials. 2016 Mar 11;17(1):135. doi: 10.1186/s13063-016-1241-4.

Community and District Empowerment for Scale-up (CODES): a complex district-level management intervention to improve child survival in Uganda: study protocol for a randomized controlled trial.

Author information

1
School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. pwaiswa2001@yahoo.com.
2
Karolinska Institutet, Solna, Sweden. pwaiswa2001@yahoo.com.
3
Economics and Finance, UNICEF NewYork, Three UN Plaza, New York, NY, 10017, USA.
4
School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
5
College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
6
Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
7
UNICEF NewYork, Three UN Plaza, New York, NY, 10017, USA.
8
Health Section, UNICEF Uganda Country Office, Box 7074, Kampala, Uganda.
9
Karolinska Institutet, Solna, Sweden.
10
Uppsala University, Uppsala, Sweden.
11
Child Health and Development Centre, Makerere University, Kampala, Uganda.
12
Director Health Services, Ministry of Health, Box 7272, Kampala, Uganda.

Abstract

BACKGROUND:

Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably.

METHODS:

The CODES strategy combines management, diagnostic, and evaluation tools to identify and analyze the causes of bottlenecks to implementation, build capacity of district management teams to implement context-specific solutions, and to foster community monitoring and social accountability to increase demand for services. CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. Implementation and all data collection will be by the districts teams or local Community-based Organizations who will be supported by two local implementing partners. The study will be evaluated as a cluster randomized trial with eight intervention and eight comparison districts over a period of 3 years. Evaluation will focus on differences in uptake of child survival interventions and will follow an intention-to-treat analysis. We will also document and analyze experiences in implementation including changes in management practices.

DISCUSSION:

By increasing the District Health Management Teams' capacity to prioritize and implement context-specific solutions, and empowering communities to become active partners in service delivery, coverage of child survival interventions will increase. Lessons learned on strengthening district-level managerial capacities and mechanisms for community monitoring may have implications, not only in Uganda but also in other similar settings, especially with regard to accelerating effective coverage of key child survival interventions using locally available resources.

TRIAL REGISTRATION NUMBER:

ISRCTN15705788 , Date of registration; 24 July 2015.

KEYWORDS:

Bottleneck analysis; Child survival; Community monitoring; District strengthening; Evidence-based; Health systems strengthening; LQAS; Management tools; Uganda

PMID:
26968957
PMCID:
PMC4788939
DOI:
10.1186/s13063-016-1241-4
[Indexed for MEDLINE]
Free PMC Article

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