Understanding Integrated Community Case Management Institutionalization Processes Within National Health Systems in Malawi, Mali, and Rwanda: A Qualitative Study.

IF 2.5 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Alyssa L Davis, Erica Felker-Kantor, Jehan Ahmed, Zachariah Jezman, Beh Kamate, John Munthali, Noella Umulisa, Oumar Yattara
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引用次数: 0

Abstract

Introduction: Since 2012, the World Health Organization (WHO) and UNICEF have recommended integrated Community Case Management (iCCM) of childhood illnesses as an intervention delivered by community health workers (CHWs) in areas with limited access to health facilities to increase access to lifesaving interventions for children younger than 5 years with malaria, pneumonia, or diarrhea. In recent years, the importance of institutionalizing iCCM and community health more broadly within national health systems has become increasingly recognized.

Methods: This qualitative study sought to identify and describe processes of iCCM institutionalization from the perspectives of health system actors. A total of 51 semistructured interviews were conducted with purposefully selected key informants in 3 countries: Malawi, Mali, and Rwanda. Thematic analysis of coded interview data was conducted, and country documentation was reviewed to provide contextual background for qualitative interpretation. The study was informed by a newly developed iCCM Institutionalization Framework, which conceptualizes the process of institutionalization through a maturity model of phases (i.e., awareness, experimentation, expansion, consolidation, and maturity) with 4 drivers: core values, leadership, resources, and policy.

Results: According to key informant narrative descriptions, processes of iCCM institutionalization reflected a progression of maturity phases, which were iterative rather than linear in progression. All 4 drivers of institutionalization as conceptualized within the iCCM Institutionalization Framework were described by key informants as contributing to the advancement of iCCM institutionalization within their countries. Key informants emphasized the need to continually strengthen or reinforce iCCM institutionalization for it to be sustained within the context of wider health system dynamics.

Conclusion: Overall, key informants viewed government ownership and integration within national systems to define the status of iCCM institutionalization. Further development of the iCCM Institutionalization Framework and other practical sensemaking models could assist health system actors in advancing institutionalization of iCCM and other health interventions.

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来源期刊
Global Health: Science and Practice
Global Health: Science and Practice Medicine-Health Policy
CiteScore
3.50
自引率
7.50%
发文量
178
审稿时长
22 weeks
期刊介绍: Global Health: Science and Practice (GHSP) is a no-fee, open-access, peer-reviewed, online journal aimed to improve health practice, especially in low- and middle-income countries. Our goal is to reach those who design, implement, manage, evaluate, and otherwise support health programs. We are especially interested in advancing knowledge on practical program implementation issues, with information on what programs entail and how they are implemented. GHSP is currently indexed in PubMed, PubMed Central, POPLINE, EBSCO, SCOPUS,. the Web of Science Emerging Sources Citation Index, and the USAID Development Experience Clearinghouse (DEC). TOPICS: Issued four times a year, GHSP will include articles on all global health topics, covering diverse programming models and a wide range of cross-cutting issues that impact and support health systems. Examples include but are not limited to: Health: Addiction and harm reduction, Child Health, Communicable and Emerging Diseases, Disaster Preparedness and Response, Environmental Health, Family Planning/Reproductive Health, HIV/AIDS, Malaria, Maternal Health, Neglected Tropical Diseases, Non-Communicable Diseases/Injuries, Nutrition, Tuberculosis, Water and Sanitation. Cross-Cutting Issues: Epidemiology, Gender, Health Communication/Healthy Behavior, Health Policy and Advocacy, Health Systems, Human Resources/Training, Knowledge Management, Logistics and Supply Chain Management, Management and Governance, mHealth/eHealth/digital health, Monitoring and Evaluation, Scale Up, Youth.
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