A causal loop analysis of the sustainability of integrated community case management in Rwanda

Social Science & Medicine
Eric SarriotLaban Tsuma

Abstract

Expansion of community health services in Rwanda has come with the national scale up of integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhea. We used a sustainability assessment framework as part of a large-scale project evaluation to identify factors affecting iCCM sustainability (2011). We then (2012) used causal-loop analysis to identify systems determinants of iCCM sustainability from a national systems perspective. This allows us to develop three high-probability future scenarios putting the achievements of community health at risk, and to recommend mitigating strategies. Our causal loop diagram highlights both balancing and reinforcing loops of cause and effect in the national iCCM system. Financial, political and technical scenarios carry high probability for threatening the sustainability through: (1) reduction in performance-based financing resources, (2) political shocks and erosion of political commitment for community health, and (3) insufficient progress in resolving district health systems--"building blocks"--performance gaps. In a complex health system, the consequences of choices may be delayed and hard to predict precisely. Causal loop analysis and scenario mapping make explicit comple...Continue Reading

References

Nov 1, 2003·Archives of Clinical Neuropsychology : the Official Journal of the National Academy of Neuropsychologists·B N AxelrodL C Ward
Apr 6, 2004·The International Journal of Health Planning and Management·Eric G SarriotMichel C Pacqué
Apr 26, 2011·Lancet·Dominic Montagu, Gavin Yamey
Oct 4, 2012·Health Policy and Planning·Taghreed Adam, Don de Savigny
Oct 4, 2013·Implementation Science : IS·David A ChambersKurt C Stange
Aug 12, 2014·Health Research Policy and Systems·Agnes Semwanga RwashanaTaghreed Adam
Aug 28, 2014·Health Research Policy and Systems·Taghreed Adam
Oct 3, 2014·Global Health, Science and Practice·Catherine MugeniAgnes Binagwaho

❮ Previous
Next ❯

Citations

Jan 13, 2018·Annual Review of Public Health·Rachel C SheltonShannon Wiltsey Stirman
Jul 2, 2017·International Journal for Equity in Health·Jin Xu, Anne Mills
Jul 12, 2017·Global Public Health·Anne Paxton, Laura J Frost
Jul 6, 2019·Journal of Global Health·Jennifer YourkavitchIbrahim Ndaliman
Feb 12, 2017·BMC Health Services Research·Sachiko OzawaMary Qiu
Apr 28, 2021·BMC Health Services Research·Muhammad OsmanMarian Loveday
Aug 28, 2021·Globalization and Health·Catherine DecouttereNico Vandaele

❮ Previous
Next ❯

Related Concepts

Related Feeds

Antimalarial Agents (ASM)

Antimalarial agents, also known as antimalarials, are designed to prevent or cure malaria. Discover the latest research on antimalarial agents here.

Antimalarial Agents

Antimalarial agents, also known as antimalarials, are designed to prevent or cure malaria. Discover the latest research on antimalarial agents here.