Last Updated

23 Oct 2018

Assessing the effect of strengthening the referral of children from the private health sector and its impact on child survival in Uganda


The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.

The primary objective is to assess the effect of strengthening the referral system on timely uptake of referral of sick children who seek care in the private sector.

The secondary objectives are: 1) to assess appropriate case management for malaria, pneumonia and diarrhoea; 2) to explore factors which influence the referral or non-referral of sick children from the private sector; and 3) to assess the cost-effectiveness of uptake of referral of sick children who seek care in the private sector.

Principal Institution(s)

Principal Investigator
Rationale and Abstract

Uganda's under-five mortality is high, currently estimated at 90/1000 live births (Uganda Bureau of Statistics 2011). Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics).

The project will be implemented in Mukono district, central Uganda selected because a recently concluded trial in the district showed that drug shop vendors (DSVs) adhere to diagnostic test results, treat appropriately and refer sick children; although uptake of referral is poor. The main reasons attributed to the observed poor referral were negative attitude towards referral forms from drugs shops by the health workers at referral facilities, perceptions of poor quality of care at referral facilities and costs involved (Hutchinson. 2012; Hutchinson et al. 2013 in press).

Thus the proposed project is a follow up to address these factors with the aim to improve uptake of referral. This project is in line with Uganda's Health sector and USAID Mission's health priorities of strengthening the health system. Critical barriers in the implementation of child survival interventions are poor quality of care in the private sector and timely referral and uptake of referral advice at community level. These barriers may be attributed to inadequate training of providers in the private sector (in diagnosis and management of childhood illnesses); inadequate supervision and regulation; poor linkages and collaboration between the public and private sectors; and non-existent linkages between community structures and the private sector. The barriers will be addressed through an intervention with three components; i) VHTs will be trained to do community sensitization and initiate community discussions aimed at identifying community support mechanisms for financial hardship (to be community led and managed) - e.g. communities to be encouraged to establish community credit/insurance schemes for referral VHTs will register children and facilitate follow up of sick children ii) supervision of providers in the private sector to diagnose, treat and refer sick children, iii) regular meetings between the public and private providers (convened by the district health team) to discuss the referral system. Identifier: NCT02450630

Study Design
Study Type : Interventional  (Clinical Trial)
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Thematic Categories


2014 Oct - 2017 Sep

Total Project Funding

Project Site