Health system effects of implementing integrated community case management (iCCM) intervention in private retail drug shops in South Western Uganda: a qualitative study.
Health system effects of implementing integrated community case management (iCCM) intervention in private retail drug shops in South Western Uganda: a qualitative study.
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DOI：
10.1136/bmjgh-2017-000334
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发表时间：
2017
影响因子：
8.1
通讯作者：
Shroff ZC
中科院分区：
文献类型：
--
作者：
Kitutu FE;Mayora C;Johansson EW;Peterson S;Wamani H;Bigdeli M;Shroff ZC
干预私营药店以提高护理质量和加强监管监督可能会对卫生系统产生影响，在扩大任何此类干预措施之前需要了解这些影响。我们研究的过程中，通过药店的干预最终在积极的意外影响和其他动态的相互作用，在基本的卫生系统。在乌干达西南部的药店实施了一项多方面的干预措施，包括药品销售人员培训、提供诊断和补贴药品、使用治疗算法、每月监督和社区宣传，以改善儿科发热管理。2013年9月至2015年9月期间，在基线、中点和终点与利益攸关方（药品销售商、政府官员和社区卫生工作者）进行了焦点小组讨论和深入访谈。使用卫生市场和系统的透镜，从访谈的成绩单进行了分析，以确定卫生系统的影响与干预措施的明显成功。利益攸关方最初对干预对质量、公平和与监管框架的接口的影响表示谨慎和担忧。随着时间的推移，这些利益相关者接受了干预措施。大多数答复者指出，干预措施提高了药店的标准，使药店能够接受病人记录保存、基于寄生虫的疟疾治疗和适当的药物使用。支持性监督也得到了改善，更好地遵守了许可证和其他监管要求。从社区和客户的角度来看，药品销售商的合法性得到了加强，从而提高了对药店的信任。该研究表明，有效地使用卫生技术和感知的药物功效如何有助于提高利益相关者对药店的合法性和信任。该研究还表明，使用适当的激励措施和消费者赋权战略相结合，可以帮助协调与药品法规的共同做法，并保障公众健康，特别是在混合健康市场环境中。
Intervening in private drug shops to improve quality of care and enhance regulatory oversight may have health system effects that need to be understood before scaling up any such interventions. We examine the processes through which a drug shop intervention culminated in positive unintended effects and other dynamic interactions within the underlying health system. A multifaceted intervention consisting of drug seller training, supply of diagnostics and subsidised medicines, use of treatment algorithms, monthly supervision and community sensitisation was implemented in drug shops in South Western Uganda, to improve paediatric fever management. Focus group discussions and in-depth interviews were conducted with stakeholders (drug sellers, government officials and community health workers) at baseline, midpoint and end-line between September 2013 and September 2015. Using a health market and systems lens, transcripts from the interviews were analysed to identify health system effects associated with the apparent success of the intervention. Stakeholders initially expressed caution and fears about the intervention’s implications for quality, equity and interface with the regulatory framework. Over time, these stakeholders embraced the intervention. Most respondents noted that the intervention had improved drug shop standards, enabled drug shops to embrace patient record keeping, parasite-based treatment of malaria and appropriate medicine use. There was also improved supportive supervision, and better compliance to licensing and other regulatory requirements. Drug seller legitimacy was enhanced from the community and client perspective, leading to improved trust in drug shops. The study showed how effectively using health technologies and the perceived efficacy of medicines contributed to improved legitimacy and trust in drug shops among stakeholders. The study also demonstrated that using a combination of appropriate incentives and consumer empowerment strategies can help harmonise common practices with medicine regulations and safeguard public health, especially in mixed health market contexts.