Journal article
The role of integrated community case management projects in strengthening health systems: case study analysis in Ethiopia, Malawi and Mozambique
Health policy and planning, Vol.36(6), pp.900-912
06/25/2021
DOI: 10.1093/heapol/czaa177
PMID: 33930137
Abstract
Abstract Integrated community case management (iCCM) has now been implemented at scale globally. Literature to-date has focused primarily on the effectiveness of iCCM and the systems conditions required to sustain iCCM. In this study, we sought to explore opportunities taken and lost for strengthening health systems through successive iCCM programmes. We employed a systematic, embedded, multiple case study design for three countries—Ethiopia, Malawi and Mozambique—where Save the Children implemented iCCM programmes between 2009 and 2017. We used textual analysis to code 62 project documents on nine categories of functions of health systems using NVivo 11.0. The document review was supplemented by four key informant interviews. This study makes important contributions to the theoretical understanding of the role of projects in health systems strengthening by not only documenting evidence of systems strengthening in multi-year iCCM projects, but also emphasizing important deficiencies in systems strengthening efforts. Projects operated on a spectrum, ranging from gap-filling interventions, to support, to actual strengthening. While there were natural limits to the influence of a project on the health system, all successive projects found constructive opportunities to try to strengthen systems. Alignment with the Ministry of Health was not always static and simple, and ministries themselves have shown pluralism in their perspectives and orientations. We conclude that systems strengthening remains ‘everybody’s business’ and places demands for realism and transparency on government and the development architecture. While mid-size projects have limited decision space, there is value in better defining where systems strengthening contributions can actually be made. Furthermore, systems strengthening is not solely about macro-level changes, as operational and efficiency gains at meso and micro levels can have value to the system. Claims of ‘systems strengthening’ are, however, bounded within the quality of evaluation and learning investments.
Details
- Title: Subtitle
- The role of integrated community case management projects in strengthening health systems: case study analysis in Ethiopia, Malawi and Mozambique
- Creators
- William T Story - Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USASusannah Pritchard - Formerly Save the Children, Health Department, 1 St. John's Lane, London EC1M 4AR, UKEmily Hejna - Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USAElijah Olivas - Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USAEric Sarriot - Formerly Save the Children, Department of Global Health, 899 North Capitol St NE #900, Washington, DC 20002, USA
- Resource Type
- Journal article
- Publication Details
- Health policy and planning, Vol.36(6), pp.900-912
- DOI
- 10.1093/heapol/czaa177
- PMID
- 33930137
- NLM abbreviation
- Health Policy Plan
- ISSN
- 1460-2237
- eISSN
- 1460-2237
- Grant note
- name: Save the Children USA’s Department for Global Health
- Language
- English
- Date published
- 06/25/2021
- Academic Unit
- Community and Behavioral Health
- Record Identifier
- 9984215115302771
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