Health Policy Planning and Management (HPPM) Department

The Community and District Empowerment for Scale-up project (CODES) is a five-year project funded by the Bill and Melinda Gates Foundation. It is implemented in two phases. The first phase (wave 0) was a proof of concept in five districts with high pneumonia and diarrhea morbidity and mortality. The project is led by UNICEF and implemented in partnership with district local governments and implementing partners. The CODES strategy has three pillars, namely:
1) Improved targeting of interventions to match disease burden at district level;
2) Evidence based management tools used to improve district health team performance; and;
3) Increased community oversight to strengthen demand, and exact accountability

Makerere University School of Public Health provides scientific oversight and technical assistance for research design and implementation of the study components for knowledge generation and management which is done through the following strategies:

i) Provide technical assistance to contractors.
ii) Document lessons learned in the project implementation by conducting district case studies
iii) Advising on implementation adjustments and dissemination activities.
iv) Provision of input to study stakeholders on implementation and interim results as a basis for decision scale-up
v) Supervision of scientific reporting of the knowledge generation and management in peer-reviewed publications.

Project/Study Design & Setting
Wave 0 was designed as a "proof of concept". The main aim was to assess the feasibility and perceived utility of CODES validity" and perceived utility. Wave 1 is an RCT with eight intervention districts and eight control districts. It aims to test and evaluate the effects of using an experimental design that hypothesizes that districts adopting the CODES package will perform better and demonstrate improvements in key protective, preventive, and curative quality coverage indicators for pneumonia, diarrhea, and malaria.

Results
The first phase (wave 0) period showed that the CODES approach was feasible and well perceived by the districts. There was evidence of the following five set benchmarks being met:
1) At least 3/5 Districts operationalized the complete CODES intervention package;
2) Wave 0 case studies indicated good perceived utility by stakeholders in 3/5 Districts;
3) At least 3/5 Districts completed prioritization of identified bottlenecks and inclusion of interventions in their District Health Operational work plans to address them;
4) 5/5 Districts implemented at least 2 key activities on their District Health Operational Work Plans, to address the identified priority bottlenecks;
5) 2/5 Districts demonstrated improvement in service coverage in the pneumonia, diarrhea and malaria interventions prioritized.

Based on these results, a decision was made by the steering committee to roll out the intervention into another phase (wave 1) with eight intervention and eight control districts as a randomized control trial for the next two years

Principal Investigator: Dr Peter Waiswa
Co-Investigators: Prof. Stefan Peterson, Prof. Anne Katahoire, Dr.Danstan Bagenda
Funder/s: Bill and Melinda Gates Foundation through UNICEF-Uganda
Collaborating Institutions

  • Karolinska Institutet (KI),
  • Child Fund International (CFI),
  • Liverpool School of tropical Medicine (LSTM),
  • Advocates Coalition for Development and Environment (ACODE)

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