Work

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

Year: 2015

Type: review

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 complex cause-and-effects relationships and high probability risks, which need to be anticipated and mitigated.

Source: Social Science & Medicine

DOI: 10.1016/j.socscimed.2015.03.014

Authors: Eric Sarriot, Melanie Morrow, Anne Langston, Jennifer Weiss, Justine Landegger, Laban Tsuma

Institutions: ICF International (United States), International Rescue Committee, Association of Maternal and Child Health Programs

Language: English

Topic: Healthcare Systems and Practices

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,800