title: Community-directed interventions strategy enhances efficient and effective integration of health care delivery and development activities in rural disadvantaged communities of Uganda.
abstract: The community-directed interventions (CDI) strategy achieved a desired coverage of the ultimate treatment goal (UTG) of at least 90% with ivermectin distribution for onchocerciasis control, and filled the gap between the health care services and the communities. However, it was not clear how its primary actors--the community-directed health workers (CDHW) and community-directed health supervisors (CDHS)--would perform if they were given more responsibilities for other health and development activities within their communities. A total of 429 of 636 (67.5%) of the CDHWs who were involved in other health and development activities performed better than those who were involved only in ivermectin distribution, with a drop-out rate of 2.3%. A total of 467 of 864 (54.1%) of CDHSs who were involved in other health and development activities also maintained the desired level of performance. They facilitated updating of household registers (P<0.05), trained and supervised CDHWs, and educated community members about onchocerciasis control (P<0.001). Their drop-out rate was 2.6%. The study showed that the majority of those who dropped out had not been selected by their community members. Therefore, CDI strategy promoted integration of health and development activities with a high potential for sustainability.
authors.affiliation: The Carter Center, Atlanta GA 30306, USA. mkataba@emory.edu
authors.forename: M N
authors.initials: MN
authors.lastname: Katabarwa
authors.forename: P
authors.initials: P
authors.lastname: Habomugisha
authors.forename: F O
authors.initials: FO
authors.lastname: Richards
authors.forename: D
authors.initials: D
authors.lastname: Hopkins
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003906:Developing Countries; D006801:Humans; D009855:Onchocerciasis / Q000517:prevention & control; D019035:Rural Health Services / Q000458:organization & administration*; D014454:Uganda