In many parts of Africa, the difference between life and death for a child can depend on how well local health systems function. District health teams must make difficult decisions with limited resources, while communities often have little voice in how services are delivered.

The Community and District Empowerment for Scale-up (CODES) project was created to address this challenge. Implemented as a three-year randomized study in Uganda, the initiative explored how empowering local health managers and communities could strengthen health systems and improve survival for children under five.

Through his leadership in health systems research, Peter Waiswa contributed to advancing approaches that place data, local decision-making, and community participation at the center of improving healthcare delivery.

Strengthening Local Health Leadership

A key focus of CODES was empowering District Health Teams with better tools and evidence to guide their decisions. Using data collected through Lot Quality Assurance Sampling (LQAS), district teams were able to identify gaps in health services and prioritize solutions.

By analyzing bottlenecks and developing evidence-based action plans, local health leaders could focus their efforts where they were most needed.

The project worked closely with partners including ChildFund International and the Liverpool School of Tropical Medicine to support districts in strengthening management and planning.

Giving Communities a Voice

CODES also emphasized the importance of community participation in improving health services. Working with the Advocates Coalition for Development and Environment, the project introduced Community Dialogues and Citizen Report Cards.

These tools allowed community members to share feedback about health services, highlight problems, and work together with health providers to find solutions. By creating space for dialogue and accountability, communities became active partners in strengthening local health systems.

Focus on the Leading Causes of Child Death

The project focused on improving treatment and care for three major illnesses affecting children under five:

• Malaria

• Pneumonia

• Diarrhea

These conditions remain among the leading causes of child mortality in many low-resource settings, yet they are often preventable and treatable when health systems function effectively.

Measurable Improvements

The results of the CODES intervention showed clear improvements in the coverage of curative care for children:

• Malaria treatment increased by 23%

• Pneumonia treatment increased by 19%

• Diarrhea treatment increased by 13%

These improvements demonstrate how better use of data, stronger local leadership, and community accountability can translate into tangible health gains for children.

Lessons for Health Systems

Beyond improving specific health indicators, CODES demonstrated that local solutions driven by data and community engagement can strengthen decentralized health systems. District teams gained greater capacity to develop evidence-based plans, while communities became more involved in monitoring and improving the services they rely on.

Initiatives like CODES reflect the broader commitment of Peter Waiswa to bridging research, policy, and practice—ensuring that evidence leads to practical improvements in the health and wellbeing of children and families.