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

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

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.

Suggested Citation

  • Sarriot, Eric & Morrow, Melanie & Langston, Anne & Weiss, Jennifer & Landegger, Justine & Tsuma, Laban, 2015. "A causal loop analysis of the sustainability of integrated community case management in Rwanda," Social Science & Medicine, Elsevier, vol. 131(C), pages 147-155.
    • Handle: RePEc:eee:socmed:v:131:y:2015:i:c:p:147-155
    DOI: 10.1016/j.socscimed.2015.03.014
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    References listed on IDEAS

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    1. John H. Miller & Scott E. Page, 2007. "Social Science in Between, from Complex Adaptive Systems: An Introduction to Computational Models of Social Life," Introductory Chapters, in: Complex Adaptive Systems: An Introduction to Computational Models of Social Life, Princeton University Press.
    2. repec:mpr:mprres:7320 is not listed on IDEAS
    3. John H. Miller & Scott E. Page, 2007. "Complexity in Social Worlds, from Complex Adaptive Systems: An Introduction to Computational Models of Social Life," Introductory Chapters, in: Complex Adaptive Systems: An Introduction to Computational Models of Social Life, Princeton University Press.
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    Cited by:

    1. Abbott, Pamela & Sapsford, Roger & Binagwaho, Agnes, 2017. "Learning from Success: How Rwanda Achieved the Millennium Development Goals for Health," World Development, Elsevier, vol. 92(C), pages 103-116.
    2. Abeda Muhammad Iqbal & Narayanan Kulathuramaiyer & Adnan Shahid Khan & Johari Abdullah & Mussadiq Ali Khan, 2022. "Intellectual Capital: A System Thinking Analysis in Revamping the Exchanging Information in University-Industry Research Collaboration," Sustainability, MDPI, vol. 14(11), pages 1-15, May.
    3. Dimitri Renmans & Nathalie Holvoet & Bart Criel, 2017. "Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda," IJERPH, MDPI, vol. 14(9), pages 1-20, September.

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