Assessing the Effect of Strengthening Referral of Sick Children From the Private Health Sector and Its Impact on Referral Uptake in Uganda.

Summary

Uganda's under-five mortality is high, currently estimated at 90/1000 live births (Uganda Bureau of Statistics 2011). Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics).

The project will be implemented in Mukono district, central Uganda selected because a recent concluded trial in the district showed that drug shop vendors (DSVs) adhere to diagnostic test results, treat appropriately and refer sick children; although uptake of referral is poor. The main reasons attributed to the observed poor referral were negative attitude towards referral forms from drugs shops by the health workers at referral facilities,perceptions of poor quality of care at referral facilities and costs involved (Hutchinson. 2012; Hutchinson et al. 2013 in press)..

Thus the proposed project is a follow up to address these factors with the aim to improve uptake of referral. This project is in line with the Uganda's Health sector and USAID Mission's health priorities of strengthening the health system. Critical barriers in the implementation of child survival interventions are poor quality of care in the private sector and timely referral and uptake of referral advice at community level. These barriers may be attributed to inadequate training of providers in the private sector (in diagnosis and management of childhood illnesses); inadequate supervision and regulation; poor linkages and collaboration between the public and private sectors; and non-existent linkages between community structures and the private sector. The barriers will be addressed through an intervention with three components; i) VHTs will be trained to do community sensitization and initiate community discussions aimed at identifying community support mechanisms for financial hardship (to be community led and managed) - e.g. communities to be encouraged to establish community credit/insurance schemes for referral VHTs will register children and facilitate follow up of sick children ii) supervision of providers in the private sector to diagnose, treat and refer sick children, iii) regular meetings between the public and private providers (convened by the district health team) to discuss the referral system.

Conditions

• Malaria

Interventions

BEHAVIORAL

Strenghtened referral of children

Community awareness on referral+ trained private providers in using RDTs/ICCM to treat and refer sick children + supervision and regular meetings between the private and public sector.All health workers in the intervention arm will be trained on how to recognize and distinguish uncomplicated \& severe malaria, supplying unit-dose packaged Coartem® to customers with uncomplicated malaria, and administration of rectal artesunate pre-referral treatment and referral for sick children with severe and complicated malaria, diarrhoea and pneumonia.Private outlets in intervention arm will be trained to improve diagnosis, treatment and referral of children. The intervention will thus contribute to better health seeking practices at a community level and improved quality of care in the private sector

Sponsors & Collaborators

• Makerere University

  collaborator OTHER

• Columbia University

  collaborator OTHER

• London School of Hygiene and Tropical Medicine

  collaborator OTHER

• University of Copenhagen

  collaborator OTHER

• Ministry of Health, Uganda

  lead OTHER_GOV

Principal Investigators

• Anthony K Mbonye, PhD · Minstry of Health Uganda

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Max Age

5 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2015-05-31

Primary Completion

2016-12-31

Completion

2017-05-31