Resource Details

Resource Name:A causal loop analysis of the sustainability of integrated community case management in Rwanda
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Resource Type:Peer-reviewed publication
Short Desc: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. The team used a sustainability assessment framework as part of a large-scale project evaluation to identify factors affecting iCCM sustainability (2011). They then (2012) used causal-loop analysis to identify systems determinants of iCCM sustainability from a national systems perspective. This allowed them to develop three high-probability future scenarios putting the achievements of community health at risk, and to recommend mitigating strategies. Their 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.
Resource Date:07-Mar-15
Contact Person:Eric Sarriot
Related Topics:  Track 1: Sustain. in Community Health
 Track 3: Complex Systems
 Community Capacity
 Health systems strengthening
 Maternal and Child Health