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Health system effects of implementing modified integrated Community Case Management (iCCM) intervention in private retail drug shops in South Western Uganda.

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Health system effects of implementing modified integrated Community Case Management (iCCM) intervention in retail drug shops in rural Uganda

F E Kitutu1,2, C Mayora1, E W Johansson2, S Peterson2,3,1, H Wamani 1  M Bigdeli4, Z Shroff4

1 Makerere University, Uganda

2 Uppsala University, Sweden

3 UNICEF, NY, USA

4 WHO, Geneva, Switzerland

Background

•Acute febrile illness  is common  in children under-five
• More than half  seek care from private retail drug shops in Uganda.
• In a largely unregulated market, quality of fever-care in drug shops has been reported to be poor and potentially  harmful
•We examined the processes by which an intervention in drug shops achieved positive unintended effects and the dynamic interactions this entailed with the underlying health system

Methods

• A theoretical framework of health market systems by Bloom et al was used
•In-depth interviews with drug sellers (n=28) and government officials (regulators, district health managers, government health centre workers) (n=9) were conducted
• Focus group discussions with care-seekers who use drug shop fever-care (n=11) and  community health workers (n=8) in study area were conducted
• Content analysis to extract data to codes, themes and describe overall response patterns
 

The Intervention

 The integrated Community Case Management intervention recommended by WHO & UNICEF was adapted for implementation in drug shops
 
Results
Initial fears and perceptions
Interface with the regulatory framework
Information and communication
Linkage to formal health system
Provider incentives
 
Conclusions
•Implementing an intervention in drug shops affects multiple stakeholders, whose positions and influence should be taken into account, to mitigate  negative unintended effects.
• Understanding  incentives of different stakeholders is vital in co-creating the regulation of retail health markets
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