title: Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods.
abstract: BACKGROUND
  Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions.
  
  
  METHODS
  Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project.
  
  
  RESULTS
  All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans.
  
  
  CONCLUSIONS
  In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.
authors.affiliation: Liverpool School of Tropical Medicine, Kampala, Uganda.
authors.forename: John
authors.initials: J
authors.lastname: Odaga
authors.affiliation: Health Systems and Policy (HSP) Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|International Maternal and Child Health Department, Uppsala University, Uppsala, Sweden; Dorcus.Kiwanuka@ki.se.
authors.forename: Dorcus K
authors.initials: DK
authors.lastname: Henriksson
authors.affiliation: Liverpool School of Tropical Medicine, Kampala, Uganda.
authors.forename: Charles
authors.initials: C
authors.lastname: Nkolo
authors.affiliation: ChildFund International, Kampala, Uganda.
authors.forename: Hector
authors.initials: H
authors.lastname: Tibeihaho
authors.affiliation: ChildFund International, Kampala, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Musabe
authors.affiliation: ChildFund International, Kampala, Uganda.
authors.forename: Margaret
authors.initials: M
authors.lastname: Katusiime
authors.affiliation: ChildFund International, Kampala, Uganda.
authors.forename: Zaccheus
authors.initials: Z
authors.lastname: Sinabulya
authors.affiliation: ChildFund International, Kampala, Uganda.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mucunguzi
authors.affiliation: Ministry of Health, Kampala, Uganda.|School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Mbonye
authors.affiliation: Liverpool School of Tropical Medicine, Kampala, Uganda.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Valadez
mesh_terms: D002648:Child; D002662:Child Health Services / Q000592:standards*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D055810:Lot Quality Assurance Sampling / Q000379:methods*; D009936:Organizational Innovation; D011209:Power, Psychological; D058996:Quality Improvement; D040841:Resource Allocation; D011795:Surveys and Questionnaires; D014454:Uganda
keywords: Bottleneck analysis; CODES; LQAS; priority setting