Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda

Malaria Journal

Research

Shem Bwambale¹  Rapheal Mbusa¹  Michael Matte²  Edgar Mulogo²  Moses Ntaro²  Palka Patel³  Jessica Kenney³  Geren S. Stone³  James S. Miller⁴  Lacey English⁵ 

[1] Bugoye Health Centre III, Bugoye, Uganda;Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;Global Primary Care Program, Massachusetts General Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;

关键词: Africa;    Child mortality;    Case management;    Referral;    Paediatric malaria;   

DOI  :  10.1186/s12936-016-1300-z

 received in 2016-01-26, accepted in 2016-04-19,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundIn Uganda, over half of under-five child mortality is attributed to three infectious diseases: malaria, pneumonia and diarrhoea. Integrated community case management (iCCM) trains village health workers (VHWs) to provide in-home diagnosis and treatment of these common childhood illnesses. For severely ill children, iCCM relies on a functioning referral system to ensure timely treatment at a health facility. However, referral completion rates vary widely among iCCM programmes and are difficult to monitor. The Bugoye Integrated Community Case Management Initiative (BIMI) is an iCCM programme operating in Bugoye sub-county, Uganda. This case study describes BIMI’s experience with monitoring referral completion at Bugoye Health Centre III (BHC), and outlines improvements to be made within iCCM referral systems.MethodsThis study triangulated multiple data sources to evaluate the strengths and gaps in the BIMI referral system. Three quantitative data sources were reviewed: (1) VHW report of referred patients, (2) referral forms found at BHC, and (3) BHC patient records. These data sources were collated and triangulated from January–December 2014. The goal was to determine if patients were completing their referrals and if referrals were adequately documented using routine data sources.ResultsFrom January–December 2014, there were 268 patients referred to BHC, as documented by VHWs. However, only 52 of these patients had referral forms stored at BHC. Of the 52 referral forms found, 22 of these patients were also found in BHC register books recorded by clinic staff. Thus, the study found a mismatch between VHW reports of patient referrals and the referral visits documented at BHC. This discrepancy may indicate several gaps: (1) referred patients may not be completing their referral, (2) referral forms may be getting lost at BHC, and, (3) referred patients may be going to other health facilities or drug shops, rather than BHC, for their referral.ConclusionsThis study demonstrates the challenges of effectively monitoring iCCM referral completion, given identified limitations such as discordant data sources, incomplete record keeping and lack of unique identifiers. There is a need to innovate and improve the ways by which referral compliance is monitored using routine data, in order to improve the percentage of referrals completed. Through research and field experience, this study proposes programmatic and technological solutions to rectify these gaps within iCCM programmes facing similar challenges. With improved monitoring, VHWs will be empowered to increase referral completion, allowing critically ill children to access needed health services.

【 授权许可】

CC BY   
© English et al. 2016