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Child health and the implementation of Community and District-management Empowerment for Scale-up (CODES) in Uganda: a randomised controlled trial

Waiswa, Peter, Mpanga, Flavia, Bagenda, Danstan, Kananura, Rornald Muhumuza ORCID: 0000-0002-9915-1989, O'Connell, Thomas, Henriksson, Dorcus Kiwanuka, DIaz, Theresa, Ayebare, Florence, Katahoire, Anne Ruhweza, Ssegujja, Eric, Mbonye, Anthony and Peterson, Stefan Swartling (2021) Child health and the implementation of Community and District-management Empowerment for Scale-up (CODES) in Uganda: a randomised controlled trial. BMJ Global Health, 6 (6). ISSN 2059-7908

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Identification Number: 10.1136/bmjgh-2021-006084


Introduction 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. Methods 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. Results 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. Conclusion 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. Trial registration number ISRCTN15705788.

Item Type: Article
Official URL:
Additional Information: © 2021 The Authors
Divisions: International Development
Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
R Medicine > RA Public aspects of medicine
Date Deposited: 23 Jun 2021 16:09
Last Modified: 12 Jul 2024 17:06

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