Community Health

What’s Next for Health Workforce Investment in Uganda?

cbales — Fri, 03 May 2024 13:03:58 +0000

What’s Next for Health Workforce Investment in Uganda? cbales May 03, 2024

May 03, 2024

As the first Africa Health Workforce Investment Forum kicks off, William Mubiru highlights what's worked in Uganda and what he hopes future investments focus on.

Next week the World Health Organization is holding the inaugural Africa Health Workforce Investment Forum, and will convene African ministers, donors, and civil society to stimulate and align long-term investment in the health workforce. These key decision-makers and actors will come to consensus around the first-ever Africa Health Workforce Investment Charter—which aims to cut the continent’s critical health worker shortage in half—and hammer out details to protect existing health workforce funding and partner on new investments.

I sat down with William Mubiru, a health systems and workforce expert in Uganda. Most recently he led the USAID-funded Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) Activity and worked with the government of Uganda and partners to expand access to high-quality integrated health services in 30 districts in Eastern Uganda and Karamoja, home to over 7 million Ugandans.

Below he shares how his passion for improving the health workforce and access to health care is rooted in his childhood and home district, and what future investments should prioritize.

Read how IntraHealth International is supporting the Africa Health Workforce Investment Forum and Charter.

Q: Why did you decide to work in public health, and focus on health systems and health workforce strengthening?

I was born and grew up in a community in Luweero District, which was at the center of the National Resistance Army war from 1980-86. The violence caused disruptions in service delivery, including health services, and breakdown of systems. Many health facilities were destroyed, and many health workers were killed or forced to flee. Lack of access to health care and essential medicines and inadequate numbers of health workers led to a high prevalence of diseases like malaria and diarrhea in my community.

We had to walk 15 kms each way to reach any health care services.

Even after the war we had to walk 15 kilometers, or about 3 hours each way, to reach any health care services. As I got older, I felt I needed to help the most vulnerable in my community, including the many widows and orphans, access health services. I ventured into public health to raise awareness about preventable diseases and work closely with the local leaders in lobbying for increased funding for the health sector.

Q: What are some of the key health workforce challenges Uganda is currently facing with ensuring health equity and reaching its goal of universal health coverage (UHC)?

The availability of health workers is still scarce, especially in rural and hard-to-reach areas. The country needs tens of thousands of additional skilled health workers to meet even the minimum targets required for UHC. We have weak leadership and governance for health workforce management. Many managers are not accountable and there's a lack of responsiveness to health workforce issues limiting access to care, like high levels of absenteeism. Another key challenge is poor data management. Because we still use multiple paper-based health information systems, especially at the community level, leaders don't have complete and aggregated data to make informed decisions.

The availability of health workers is still scarce, especially in rural areas.

Uganda struggles with limited domestic funds allocated to the health sector, and therefore for the health workforce. The current health budget is just 7.7% of the national pie, just half of the Abuja Declaration target. We also have poor community health systems, often characterized by inadequately trained and facilitated village health teams [VHTs]. The government is shifting to a more formalized community health workforce by piloting the Community Health Extension Workers Strategy, but this is yet to be adopted across the country.

Q: As the former head of USAID's RHITES-E, a $65 million six-year program, what are some interventions you've seen work, and helped address these challenges in Eastern Uganda and Karamoja?

There are lots of achievements, which I recommend should be replicated or sustained.

Localization. RHITES-E built the capacity of local partners, including three Regional Referral Hospitals, which are going to be critical in sustaining the gains we achieved. We worked with these partners to create capacity development plans and used several approaches like joint planning, mentorships, technical assistance, and “Data to Action” meetings. RHITES-E transitioned HIV/TB service delivery to these local partners and districts, and I'm proud that some of the districts—like Budaka, Kaabong, Manafwa, Mbale, and Sironko—were best performers in the Annual Health Sector Performance Report for 2022/23.

Health workforce development. RHITES-E worked with the Ministry of Health and regional referral hospitals to build the capacity of health workers in family planning; nutrition; maternal, neonatal, and child health; and emergencies. For example, during the upsurge of COVID-19, we worked with the national emergency department at the Ministry of Health to build the capacity of frontline health workers, especially midwives and nurses, in the areas of case management and home-based care, and to administer COVID-19 vaccinations, and this helped in reducing the fatalities of COVID-19.

Digital solutions. We built on existing technologies and platforms to improve data efficiency, from the community to the national level. For example, we supported the rollout of electronic medical records for antiretroviral therapy across 571 facilities in Eastern Uganda, and this led to improved timely district reporting into the national health management information system. We supported districts to roll out the national iHRIS human resources information system to collect information for workforce planning, deployment, recruitment, and attendance monitoring. District leaders used the iHRIS data for timely recruitment, and to fill more than 10,000 posts, while also reducing absenteeism.

Several districts used RBF funds to recruit health workers and increased facility births.

Result-based financing. The project supported the districts and the government of Uganda to roll out results-based financing [RBF], one of the key health financing strategies the country is embracing to improve service delivery. We worked closely with the ministry to build the capacity of districts to implement RBF and several districts, like Namisindwa, Kapchorwa, and Tororo, used RBF funds to recruit health workers, specifically additional midwives, which has helped improve service-level indicators, including increasing facility births.

Q: In addition to scaling up those successful interventions, what do you think should be the priorities for the next phase of investment in health workers and systems in Uganda?

Performance management needs to be prioritized—especially for improving health worker productivity, attendance to duty, and motivation—and also for holding health managers accountable for their own performance.

We need to invest more in the capacity of health workers. The country has invested in several strategies for health worker capacity development, but this needs to be amplified in all regions. We know this works—RHITES-E built health workers’ skills in integrated service delivery, and we saw huge increases in contraception use and in HIV viral load suppression for example.

We need to strengthen data management and invest more in digitalization of paper-based health information systems and building the capacity of all health leaders from community to the national level to use data for decision-making.

We need to improve public financial management and invest more in community health systems.

It’s critical to improve public financial management. As a country, a lot of our funding, especially for the health sector, is donor driven. Right now, over 40% of our national budget comes from donors. This calls for innovative approaches for enhancing efficiency in terms of resource allocation. There is need for investment in public financial management to minimize cases of corruption of public funds.

Finally, we need to invest more in community health systems and roll out paid, trained, equipped, and supervised community health extension workers to oversee VHTs and reach every single family, woman, and child and end preventable diseases and deaths. Most Ugandans live in rural communities that are far from health facilities. And this will help us a lot in minimizing the costs we are incurring for management of diseases.

Approximately 75% of Ugandans live in rural areas like Moroto, in Karamoja Region. Many people must travel long distances to receive health care. Photo by Tommy Trenchard for IntraHealth International. (Source: https://www.indexmundi.com)

William Mubiru [center] led the USAID-funded RHITES-E Activity, which expanded access to integrated health services in Eastern Uganda and Karamoja. Growing up during the NRA war, he remembers having to walk for hours to reach any health care. Photo courtesy William Mubiru.

Mubiru says Uganda's critical shortage of health workers impedes equitable access. The country needs tens of thousands of additional skilled health workers to reach minimum targets for UHC. Photo by Esther Ruth Mbabazi for IntraHealth International.

Additional health workforce challenges, like absenteeism, also impact access, especially for people in remote areas and the most vulnerable like children, people living with disability, and people living with HIV. Photo by Tommy Trenchard for IntraHealth International.

Uganda still has disparate paper-based health information systems, especially at the community level, making it hard for health leaders to make informed health workforce decisions. Photo by Tommy Trenchard for IntraHealth International.

RHITES-E used health systems strengthening as its overarching approach to improving equitable access, building the capacity of local partners and fostering data-driven decision-making to strengthen local leadership. Photo by Esther Ruth Mbabazi for IntraHealth International.

High-quality integrated services improved through the project—including family planning; maternal, newborn, and child health; and HIV/AIDS—led to impressive results, such as increasing new users of family planning by 79%. Photo by Esther Ruth Mbabazi for IntraHealth International.

Smart investments in health workers work, says Mubiru. For example, RHITES-E provided over 70,000 HIV clients with antiretroviral treatment [ART] and achieved 93% viral load suppression among ART clients of 98%. Photo by Esther Ruth Mbabazi for IntraHealth International.

Mubiru has several recommendations for future health workforce investments, including focusing more on community health systems and paid and supported community health workers to reach every woman, child, and family. Photo by Tommy Trenchard for IntraHealth International.

By Carol Bales

Strategic communications manager

By William Mubiru

Former Chief of party, Uganda RHITES-E Activity

Family Planning HIV & AIDS COVID-19 Maternal and Newborn Health Community Health Digital Health Health workforce development Leadership and Governance Management and Performance Health Workers Uganda

Is In The Media

The USAID-funded RHITES-E Activity strengthened the capacity of health workers to provide high-quality integrated health services in Eastern Uganda and Karamoja. As a result, facility births increased significantly. Photo by Esther Ruth Mbabaz for IntraHealth International.

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Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan

rgoodwin — Wed, 27 Mar 2024 17:44:30 +0000

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan rgoodwin March 27, 2024

April 01, 2024

During World Health Worker Week we’re paying tribute to the wide range of #SafeSupportedHealth Workers who are making a difference in tough situations.

In South Sudan, community outreach volunteers (COVs) like Lawrence Monday play a key role in the HIV response—linking health facilities and communities to extend services and acting as peers to people living with HIV. Under the supervision of an adherence nurse, Lawrence supports 160 clients on HIV treatment, including 15 children.

One of the children Lawrence helps is Timo*, who had a rough start in life. He was born in 2017 into a low-income family in Juba. His biological father was never around to help him as a baby, and his 25-year-old single mother had no job to support him or his two older siblings. She often went to the market to dance with Timo wrapped on her back, and well-wishers would give her some money or food items, which would help feed them for a few days.

Diagnosis and struggle

Timo’s mother knew she was HIV-positive. Although she had been receiving antiretroviral therapy (ART) from Nyakuron Primary Health Care Center (PHCC), when she became pregnant with Timo in 2016, she refused to take treatment and didn’t attend antenatal appointments. She feared she would be stigmatized at the health facility because she knew people who worked there.

When it was time for Timo to be born, his mother had a home delivery without a skilled health care provider. When Timo was three months old, both he and his mother became very ill. He couldn’t breastfeed well, became restless, and started bleeding from the navel. His 60-year-old grandmother rushed him to Nyakuron PHCC where he was assessed and diagnosed with HIV, and immediately enrolled on ART.

With the help of his grandmother, Timo successfully attended treatment for the following year. However, his ailing mother was often intoxicated. She would leave the children with her mother and dash down to a local spree to drink.

Timo’s mother continued to refuse treatment, and in 2022 succumbed to complications of HIV. At the time, Timo and his siblings were already fully under his grandmother’s care and they largely depended on the support of well-wishers.

Home visits from a community outreach volunteer

Nyakuron PHCC is now one of 14 health facilities supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International building local capacity to provide comprehensive HIV services and free ART to people living with HIV in South Sudan. By partnering with the health facilities and local organizations, the South Sudanese government, and communities, AHEC helps train health workers to deliver high-quality HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

In 2021, early on in the project, AHEC trained 160 COVs, including Lawrence Monday. The project provides a stipend and mobile phone airtime for communication to the COVs. In 2013, AHEC attached Lawrence to Timo to monitor his treatment progress through home visits and offer emotional and psychological support.

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says. “I visit all my clients twice every six months, and I visit children at least once a week, because they easily forget to take their medication, to ensure that they adhere to medication. Within the last month, I’ve registered only 5 out of 160 clients with high viral loads, whom I’m closely following up for adherence counseling.”

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says.

Timo was one of those who needed extra follow-up. In February 2023, when Timo was five, he lost weight and became very weak. When health providers at Nyakuron PHCC assessed him, his viral load was too high and unsuppressed. He seemed traumatized by the absence of his mother, lacked enough food, and sometimes refused the bitter taste of the medicine. The health providers developed a monitoring action plan, and after four months of Enhanced Adherence Counseling, his viral load was suppressed. The health provider transitioned Timo from Lopinavir to Dolutegravir and guided his grandmother on how to prepare and give him the medication. Lawrence helped link Timo to a nutrition center within the health facility where he received food portions monthly until his health improved by June 2023.

However, in October 2023, Timo developed swollen lymph nodes and a cough and was losing weight. During a home visit, Lawrence noticed Timo’s symptoms and immediately rushed him to Nyakuron PHCC, where he was referred to Al-Sabah Childrens’ hospital. Health workers at the hospital diagnosed Timo with opportunistic infections, including tuberculosis (TB). Timo was put on anti-TB treatment for six months, which he successfully completed with the help of Lawrence.

Lawrence Monday walks to visit Timo. The Advancing HIV/AIDS Epidemic Control Activity (AHEC) trained 160 COVs like Lawrence to monitor HIV clients' treatment progress. Photo by Achan Gladys for IntraHealth International.

Timo's grandmother brought him to Nyakuron PHCC. It is now one of the facilities supported by the USAID-funded Advancing HIV/AIDS Epidemic Control Activity (AHEC). Photo by Achan Gladys for IntraHealth International.

Going the extra mile

Lawrence visited Timo’s home every two days while he was on anti-TB treatment. He walked two kilometers each way to Timo’s house to ensure he took his medications consistently. “I had to pay more frequent visits to monitor Timo’s treatment progress, especially because he was on both HIV and TB medications. I used to count the tablets to keep track of his medication consistency,” says Lawrence.

Timo is now TB-free and virally suppressed of HIV, following his last viral load test in October 2023. He now looks jolly, is playful, eats well, and weighs an impressive 23kgs. He is one of the 386 children receiving ART from AHEC-supported facilities in South Sudan, as of September 2023. Overall, AHEC currently supports 12,694 active clients on treatment. IntraHealth also linked Timo to Jhpiego, which enrolled him in their USAID Orphans and Vulnerable Children (OVC) program and plans to consider him for academic support in 2024.

“Timo is very healthy now and helps me around with minor chores, which makes me happy. I don’t want him to contract another disease. I’m doing everything it takes to ensure that he eats well and sticks to his medication,” Timo’s grandmother proudly concludes.

*Not his real name.

By Gladys Achan

Communications Officer

Advancing HIV & AIDS Epidemic Control Activity HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Community Health Community Health Workers South Sudan

Is In The Media

Lawrence Monday, a community outreach volunteer (COV), speaks with his young client, Timo, while Timo's grandmother looks on. Photo by Achan Gladys for IntraHealth International.

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How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS?

cbales — Fri, 01 Dec 2023 14:08:44 +0000

How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS? cbales December 01, 2023

December 01, 2023

Communities are at the forefront of progress in the HIV response.

The UNAIDS theme for World AIDS Day this year is Let Communities Lead. A new report highlights that communities living with, at risk of, or affected by HIV are at the forefront of progress in the HIV response, including connecting people to HIV services, and calls for more action to enable and support communities in their leadership roles.

We sat down with Yadira Villaseñor, IntraHealth’s Central America regional director and the head of one of our largest HIV programs, to find out how her team is collaborating with communities, community organizations, and community health workers (CHWs) to reach more clients with HIV services.

Villaseñor is the chief of party for the five-year USAID HIV Care and Treatment Project in El Salvador, Guatemala, Honduras, and Panama. According to 2022 data via UNAIDS, 103,000 people in these four countries are living with HIV and 31% are not on antiretroviral therapy (ART). The project focuses on training and equipping health workers to deliver high-quality HIV care and treatment, reducing stigma toward key populations (KPs) and people living with or at risk for HIV, and improving adherence to ART.

Q: How is the USAID-funded HIV Care & Treatment Project partnering with communities in Central America to increase access to stigma-free HIV services and help more people living with HIV receive treatment?

In Central America, the HIV epidemic is concentrated among KPs—men who have sex with men, transgender women, and sex workers. Stigma and discrimination, limited access to health care (including HIV prevention initiatives), and migration make the region vulnerable to a growing HIV epidemic. Our project provides technical and financial support to local community organizations that work with these KPs. This year we have sub agreements with five local NGOs, and we meet with them weekly.

Through the community organizations, we identify KP peers in these communities to be trained as CHWs and link them to facilities and implement community outreach activities.

For example, our previous USAID project in the region introduced health workers called adherence promoters to provide HIV counseling and testing and treatment support in health facilities. Adherence promoters immediately link people who are HIV positive to treatment, encourage HIV clients to attend routine medical appointments, identify clients at risk of dropping out of ART, link clients to other health or social services, including for treatment of opportunistic infections and co-infections, and follow up with people who don’t show up for their appointments. They work closely with community liaisons, who conduct home visits to clients who drop out of treatment.

Community liaisons coordinate with other community testing partners to improve linkage rates for referrals, so recently diagnosed users can be greeted and accompanied by them to clinical services. Community liaisons also provide direct service delivery such as counseling in the home, bringing ART medications when they can´t be picked up, providing emotional support when needed, helping patients recover when they have interrupted their treatment, and service reminders via WhatsApp. They deliver services in a culturally respectful manner that’s language appropriate and tailored to the users’ needs.

Wilfredo Esquivel is an adherence promoter working in Hospital de Puerto Barrios, Izabal, Guatemala. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel (third from left), an adherence promoter, is a key part of the team of health workers at Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel meets with an HIV patient, Nancy Bermudez, in Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

HIV client Nancy Bermudez is then attended by Doctor Hector L. Romero at Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel also goes out into communities to provide HIV services. Here he boards a boat from Puerto Barrios to Livingston Izabal to conduct home visits. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel travels from from Puerto Barrios to Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel locates the home of HIV clients in Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel delivers groceries and provides counseling to clients in Livingston Izabal, a small village in Guatemala only reachable by boat. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel visits another HIV client outside her home in Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Q: How does the project invest in and support these community health workers?

There are now 41 adherence promoters and 46 community liaisons across the four countries. The project pays these CHWs and provides other support.

We provide training and technical assistance to develop and strengthen CHW competencies. To do this, we analyze available evidence-based information and summarize it in culturally sensitive and appropriate print and audio/visual materials that are easy for CHWs to use.

We invest in digital health tools and capacity for CHWs. For example, during COVID-19 shutdowns and other emergencies like hurricanes, we supported community liaisons to use surveillance tools and alerTAR, a mobile phone tool that sends text reminders, to identify and reach HIV clients who missed HIV appointments and connect them to services at facilities and carry out home treatment.

We support CHWs’ mental and physical health. For example, when we saw the toll the COVID pandemic was taking on them, we offered them mental health support to help reduce and manage their work-related stress. We also ensured all health workers had information about and access to COVID-19 vaccines, which helped them safely vaccinate other people in their communities and address vaccine hesitancy.

Q: How does the project advocate for local governments to invest in CHWs as part of their HIV response?

While recognition of the importance of CHWs has grown, challenges persist related to formal recognition, compensation, training, and integration into the formal health care system. Addressing these challenges and further strengthening the role of CHWs is essential for increasing access to HIV services. We are working with local and national policymakers to formalize the role of CHWs at the community and facility level.

We encourage local health authorities to analyze their context and identify key actors—including local NGOs and community members and health workers—to implement the health agenda. At the same time we work with national government officials, in coordination with ministries of health and social security institutes (a parallel system in Central America for health services for workers) to obtain their endorsement of community health workers to be linked to HIV clinics under their authority.

In addition, we document and share results obtained through CHW efforts with key decision-makers. For example, during the first year of our project, we documented and shared that community liaisons reengaged 1,841 (39%) HIV patients lost to follow-up, and adherence promoters provided counseling and 83% of their clients reached viral load suppression. I’m proud to now share that as of September 2023, our project and health workers we support provide HIV services to 43,104 people living with HIV and 95% have achieved viral load suppression.

Q: What advice do you have for how other implementers and development programs should partner with and invest in local communities and community health workers?

IntraHealth, as well as many other international NGOs, is moving to a locally led development strategy. This will allow us to expand our mentorship and facilitating role with many community-based organizations who provide the CHWs that are much needed to improve access to services. I think other implementers and development programs should:

Advocate with authorities at central and local levels to gain political support for CHWs and accept them as key local actors in the development of their communities.
Highlight the contribution of CHWs through fact sheets, success stories, and “situation rooms.” Situation rooms are regular meetings at sites, like HIV clinics, where data is analyzed by a diverse team with an eye on improving performance, utilization of HIV services, and access to HIV services and treatment as part of a comprehensive package. In other words, use data and tell the story of impact in a personal way.
Listen to CHWs and understand their needs.
Invest in training CHWs and strengthening their capacities. Provide in-person coaching to empower them and ensure that they develop and maintain the desired skills.
Sensitize health workers and personnel at the facility level to accept a range of support services from CHWs to reach the most marginalized and vulnerable communities, and recognize that community outreach interventions are key to reaching the United Nations 95-95-95 goals.
Materially and financially support the development of their work.

It is not always easy to do this through a project-based cycle, though we have demonstrated some great successes through our projects. In the future, we need more programmatic approaches for other actors, funders, donors, the private sector, and impact investors to form partnerships with community organizations and communities to hire CHWs between the larger projects that come and go.

Yadira Villaseñor spoke about partnering with communities during a Clinton Global Initiative event at the UN General Assembly. Click on the link and register to watch the event, then navigate to the session titled "Innovations in Access: How to Expand Our Health Care Workforce Through Diverse Community Stakeholders."

By Carol Bales

Strategic communications manager

By Jenny Alcázar

Communications Specialist

By Yadira Villaseñor

Chief of party, Central America HIV Care and Treatment Project and regional director, Central America

HIV & AIDS Community Health Health workforce development World AIDS Day Community Health Workers

Is In The Media

Yadira Villaseñor (right), chief of party for the USAID HIV Care and Treatment Project, stands with health workers outside of Hospital de Puerto Barrios in Izabal, Guatemala. The project works with teams of health workers, including community health workers identified by community organizations we partner with, to deliver high-quality HIV services to more people in Central America. Photo by Levi Dieguez for IntraHealth International.

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Placement of Dedicated Family Planning Providers to Broaden Method Choice and Increase Contraceptive Access and Uptake: Experience from South Sudan

ihadmin2 — Mon, 27 Mar 2023 19:49:38 +0000

Placement of Dedicated Family Planning Providers to Broaden Method Choice and Increase Contraceptive Access and Uptake: Experience from South Sudan 2023 ihadmin2 March 27, 2023

To improve access to family planning in South Sudan, IntraHealth International implemented a “dedicated provider” model based on evidence that with time, skills, and materials, dedicated providers can serve more women with family planning, meet unmet need, and expand contraceptive choice.

Between October 2019 and December 2020, with funding from USAID under the Evidence to Action for Strengthened Family Planning and Reproductive Health for Women and Girls (E2A) project, IntraHealth recruited and placed nurses and community health workers in nine public-sector health facilities and adjacent communities to address health workforce limitations, expand clients’ method options, increase access to provider-dependent methods, and stimulate further demand to help meet high levels of unmet need for family planning.

This technical brief offers details on the approach and results of this effort.

Download

Countries South Sudan

Projects Evidence to Action (E2A) Project

Topics Family Planning & Reproductive Health Community Health Health workforce development Community Health Workers Nurses

Publisher IntraHealth International

By Eva Canoutas, Patrick Buruga, Lou Eluzai Loponi, Juru Joyce Romano, Anne Kinuthia, Roy Jacobstein

In Eastern Uganda, One District’s COVID-19 Vaccination Preparedness and Response Strategies Exceeded Expectations

ihadmin2 — Thu, 12 Jan 2023 20:53:46 +0000

In Eastern Uganda, One District’s COVID-19 Vaccination Preparedness and Response Strategies Exceeded Expectations ihadmin2 January 12, 2023

October 24, 2022

The Bududa District used several approaches to improve vaccine uptake in the region—and saw great success.

Uganda is working hard to prevent COVID-19 by encouraging its citizens to get vaccinated. Today, the country’s cumulative positive cases are over 170,000, including 3,600+ deaths and over 100,000 recoveries. While Uganda has sustained a low COVID-19 transmission rate at 2%, not all of its eligible population is fully vaccinated, and the Ministry of Health is trying to change that.

One district in Uganda, the Bududa District, took advantage of Uganda’s vaccination efforts to make sure its key populations received jabs, achieving a 100% vaccine coverage rate for the first dose and a 98% full dose rate by June 2022.

Bududa District is situated in the Bukedi region of Uganda and has a population of 270,000. It’s considered a hard-to-reach area due to its poor terrain and multiple landslides that affect both lives and livelihoods. Because of this, the district struggles to provide easy access to health services. As a result, the district has a 26% teenage pregnancy rate, low uptake of modern contraceptives (14%), poor client attendance for antenatal care visits, and low male involvement in family planning decisions. Additionally, many expectant mothers prefer to deliver at home instead of in a health facility. The COVID-19 pandemic has further burdened the already struggling health system.

Like the rest of the country, the Bududa District embraced vaccination efforts and its health team was proactive on the district task force. And Bududa collaborated with IntraHealth’s Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) project, which helped them conduct continuous reviews, correct course when needed, and design and implement several helpful strategies.

Demand creation

First, the district needed to inform the local population about the benefits of the COVID-19 vaccine. They did this through mass vaccination drives and radio talk shows spearheaded by health experts, and by deploying volunteer health teams to communities to talk about the importance of vaccination, which helped address myths and misconceptions about the vaccine.

Influential district leaders, including chief administrative officers, members of Parliament, the resident district commissioner, and religious leaders all received their vaccines publicly, which played a key role in allaying people’s fears.

Partnerships with health workers

Second, RHITES-E trained 180 health workers on COVID-19 risk communication and vaccine storage and management. The district created and worked with subcounty taskforces to help manage COVID-19 response. Continuous engagement with the subcounty, village, and lower-level stakeholders, such as community elders and leaders, improved service delivery in hard-to-reach areas, especially since the district chose to administer the Johnson and Johnson vaccine, which only required a single jab.

We had to quickly find solutions to avoid further COVID-19 spread.

“At first, it was really a problem,” says Dr. Ntegeka Sylvia Enid from the Bududa District Health Office. “Being a hard-to-reach district with many porous borders made the pandemic uncontainable. We had to quickly find solutions to avoid further COVID-19 spread.”

The district also established 96 vaccination teams with clear roles and responsibilities. Comprised of a nurse, health information assistant, community health workers, and health assistants, the teams ensured that vaccines were provided at all vaccination health centers and that data was adequately captured.

These teams identified any available opportunities to administer vaccines, including at busy trading centers, markets, schools, and religious and political gatherings. In the initial phase, the district prioritized the most at-risk community members, such as health workers, teachers, persons with underlying health conditions, and those above 50 years.

Goal-setting

Third, the district established targets for vaccination. With guidance from the Ministry of Health, the Bududa District set a goal of 136,924 vaccinations. To achieve this, vaccination service points were expanded up to health center IIIs in addition to hospitals and health center IVs. Vaccination teams conducted outreach services and reduced their team sizes from six to four members to increase coverage at the subcounty level. Health workers were asked to establish their clients’ COVID-19 vaccination status through routine care and to talk to those who hadn’t been vaccinated about getting their jab.

Regular review

Lastly, deliberate coordination mechanisms were built to allow for regular reviews and informed decision-making. At the lower level, health facility in-charges began providing daily updates on vaccinations through a WhatsApp group. This platform helped health facilities share information and address challenges together in real-time. For example, vaccines were redistributed from districts with low demand to the facilities in need.

At the national level, RHITES-E continues to engage in COVAX and partner catch-up meetings to share experiences and discuss challenges and plans to improve vaccination uptake in the region. RHITES-E is currently helping data assistants and biostatisticians in Bududa with monthly internet data bundles and entry fees to ensure prompt reporting and avoid vaccination data backlogs.

These vaccination strategies in the Bududa District vaccination have drastically changed the vaccination rate in the region, not only for key populations but for everyone. In November 2021, the rate for the first dose was at 9% and the rate for the full dose was 2%. By September the Summer 2022, that rate had improved to 78% and 63% respectively.

RHITES-E is funded by the US Agency for International Development.

By Irene Mirembe

Knowledge management manager, IntraHealth International

Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-East) Infectious Diseases COVID-19 Community Health Health Workers Uganda

Photos

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Community Outreach Volunteers Help Clients Navigate HIV Prevention, Care, and Treatment in South Sudan

kseaton — Fri, 29 Jul 2022 16:03:32 +0000

Community Outreach Volunteers Help Clients Navigate HIV Prevention, Care, and Treatment in South Sudan kseaton July 29, 2022

August 02, 2022

How tracing changes health outcomes in Juba.

Rose,* a 54-year-old widow and mother of five in Juba, South Sudan, is HIV-positive. She started antiretroviral therapy (ART) as soon as she was diagnosed with HIV in 2018 but did not disclose her status to her children right away—she knew her family might be at risk of contracting HIV and recognized that her children should be tested, but she felt a lot of self-stigma, which held her back from talking about it with them.

Rose was also part of a religious community that preached against modern medicine and after listening to healing testimonies from others, she was convinced that she could be healed of HIV through prayer. She stopped taking ART for over two years and her health deteriorated. She lost weight and suffered from other infections related to HIV.

Luckily, Rose met Sarah,* a community outreach volunteer working with IntraHealth International’s Advancing HIV/AIDS Epidemic Control (AHEC) Activity, a USAID-funded project. Sarah is also HIV-positive and, as a community health worker, she conducts outreach in her community. She shares her experiences with her clients and encourages them to test and know their HIV status, to adhere to ART treatment, and to visit health facilities regularly for viral load sample collection to attain viral load suppression.

Sarah's support encouraged me to adhere to my treatment.

Sarah met Rose while doing community outreach and Rose became one of Sarah’s clients. Sarah provided her with psychological support, such as providing ways Rose can focus on her health and well-being, and adherence monitoring, making sure Rose maintains her medication regimen to achieve viral load suppression. She also talked to Rose about the importance of disclosure and how to live positively without passing on the infection to others.

“The community outreach volunteer assigned to me was an evidence-based example that even with HIV, one can live a long healthy life while on ART,” Rose says. “Her support encouraged me to adhere to my treatment.”

Sarah talked to Rose about restarting her HIV medication and the importance of disclosing her status to her family. Rose was hesitant at first, but eventually took her children to the Munuki Primary Health Care Center, an AHEC supported health facility. While at the facility, all five of her children tested HIV negative. The ART provider at the facility counseled Rose on the importance of adherence to care and treatment, and she was reinstated on ART.

Rose is now a community outreach volunteer champion who visits clients in her community and helps refill ART prescriptions for those who are unable to visit their health facilities. She shares her knowledge and experiences with other HIV-positive members of her community and encourages clients to continue with their treatment.

The AHEC project has given us a second chance to live.

“Community outreach has helped us reach many people, including men, who have then been diagnosed with HIV and linked to ART,” Rose says. “I’m very happy because IntraHealth, through the AHEC project, has given us a second chance to live. We’re looking forward to the start of PrEP intervention in the country that will protect those at high risk of HIV from acquiring new HIV infections.”

There are currently 8,825 clients on care and treatment in all AHEC-supported facilities. Through community outreach volunteer tracing efforts, 932 clients (66% of those who stopped treatment between October 2021 and May 2022) have returned to the health facility as of May 2022.

AHEC is funded by the US Agency for International Development.

*Not her real name.

By Gladys Achan

Communications Officer

Advancing HIV & AIDS Epidemic Control Activity HIV & AIDS Community Health Community Health Workers South Sudan

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IntraHealth Reached 317,443 Health Workers in 2021, Extending Health Care to Millions

kseaton — Wed, 29 Jun 2022 15:11:35 +0000

IntraHealth Reached 317,443 Health Workers in 2021, Extending Health Care to Millions kseaton June 29, 2022 June 29, 2022 Chapel Hill, NC

During 2021, the second year of the COVID-19 pandemic, IntraHealth International reached 317,443 health workers in 42 countries, helping to make high-quality health care available to more people around the world. Our programs led to:

$33,399,555 in financial aid provided for student health workers through IntraHealth programs
2,524,424 COVID-19 vaccines distributed through IntraHealth programs
223,677 men provided with voluntary medical male circumcision to prevent HIV infection
2,264,216 messages sent to and from health workers via mHero, WhatsApp, or other digital health tools
898,190 individuals tested for HIV and received results
8,231,279 family planning users through IntraHealth programs
1,389,009 new users of contraception
504,185 children under 5 treated for malaria

Even before the pandemic, the World Health Organization estimated a shortfall of 18 million health workers by 2030. Now, 15 million more health workers are needed in low and lower-middle income countries alone to respond to the needs of the health system and achieve universal health coverage.

IntraHealth International reached 317,443 health workers in 42 countries.

“The difficulties many countries have faced in responding to COVID-19 and rapidly delivering vaccines, tests, treatment, and supportive care have shone a spotlight on vulnerabilities in health systems and workforces around the world,” says Polly Dunford, IntraHealth’s president and CEO. “But we know that by investing in and supporting health workers—including and especially community health workers, nurses, and midwives—we can make great strides in COVID-19 response and in achieving universal health coverage.”

In 2021, IntraHealth focused on expanding digital health tools, responding to global health security threats, and training and supporting local health organizations. We expanded our iHRIS software to 25 countries, who now use it to manage their health worker personnel records, trained 9,000+ health workers on COVID-19 response, and worked with 74 local organizations to help them prepare to receive funding from USAID and PEPFAR.

See more 2021 results in our full annual report.

IntraHealth believes everyone everywhere should have the health care they need to thrive. Our mission is to improve the performance of health workers and strengthen the systems in which they work.

Banner photo: Jeanne Uwimana is a gender-based violence officer at the Isange One Stop Center at the Nyanza District Hospital. Photo by Innocent Ishimwe for IntraHealth International.

Health Areas Family Planning & Reproductive Health HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Mental Health Noncommunicable Diseases Nutrition Community Health Digital Health Education & Performance Health workforce development Gender Equality Global health security Health Workforce & Systems Health WorkersNamuwaya Nsabu weighs her 9 month old baby before receiving immunization services at Nakaloke Health Center III in Mbale, Uganda. Photo by Esther Ruth Mbabazi for IntraHealth International.

Engaging Communities to Improve Health Care Quality through the Citizen Voice and Action Approach

kseaton — Fri, 13 May 2022 19:32:12 +0000

Engaging Communities to Improve Health Care Quality through the Citizen Voice and Action Approach 2022 kseaton May 13, 2022

Read about how IntraHealth International's Ingobyi project applies the Patient Voice Program-Citizen Voice and Action approach to enhance non-confrontational dialogue, accountability, and citizen participation and engagement in the process of improving services. The approach enables joint action planning to address structural, policy, and service delivery gaps.

Download

Supporting Rwanda’s COVID-19 Response and Mitigating Its Impact on Maternal, Newborn, and Child Health and Malaria Service Delivery

Piloting an eLearning Course for Community Health Worker Training

Strategies to Improve Infection Prevention and Control in Health Facilities

Enhancing Provider Competencies through the Low-Dose, High-Frequency Training Approach

Strengthening Health Provider Competencies through Clinical Mentorship

Preventing and Managing Obstetric Fistula in Rwanda

Engaging Communities and Promoting Health-Seeking Behavior through Strategic Social and Behavior Change

Building Capacity of Health Workers through Supportive Supervision

Countries Rwanda

Projects Ingobyi

Topics Community Health Health Workers

By Betty Murerwa, Assumpta Kayinamura Mwali

Engaging Communities and Promoting Health-Seeking Behavior through Strategic Social and Behavior Change

kseaton — Fri, 13 May 2022 19:17:39 +0000

Engaging Communities and Promoting Health-Seeking Behavior through Strategic Social and Behavior Change 2022 kseaton May 13, 2022

Read about a key evidence-based intervention employed by IntraHealth International's Ingobyi project. The implementation of social and behavior change messaging engages communities to play an active role in promoting their optimal health and positive health-seeking habits and practices.

Ingobyi’s social and behavior change messages are aimed at increasing knowledge, awareness, and demand for RMNCH and malaria services at the 26 district hospitals and 323 health centers it supports and other facilities nationwide.

Download

Supporting Rwanda’s COVID-19 Response and Mitigating Its Impact on Maternal, Newborn, and Child Health and Malaria Service Delivery

Piloting an eLearning Course for Community Health Worker Training

Strategies to Improve Infection Prevention and Control in Health Facilities

Enhancing Provider Competencies through the Low-Dose, High-Frequency Training Approach

Strengthening Health Provider Competencies through Clinical Mentorship

Preventing and Managing Obstetric Fistula in Rwanda

Countries Rwanda

Projects Ingobyi

Topics Maternal, Newborn, & Child Health Community Health

By Assumpta Kayinamura Mwali

An Interactive Game Helps Men Start Family Planning Conversations in Eastern Uganda

kseaton — Wed, 06 Apr 2022 19:08:19 +0000

An Interactive Game Helps Men Start Family Planning Conversations in Eastern Uganda kseaton April 06, 2022 April 12, 2022

An interactive game for men that focuses on male engagement for family planning and culminates with a child-spacing planning card has increased family planning use in eastern Uganda. Facilitated by village health teams, the game—Together We Decide—is a collaboration between IntraHealth International and ideas42 as part of the Scale-up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services project (SupCap).

The project used behavioral science to design, test, and scale up an intervention that would help increase postpartum contraceptive uptake, improve communication about family planning between couples, and increase knowledge about modern contraceptive methods in eastern Uganda.

In Uganda, 28% of women have an unmet need for family planning. In the eastern region, unmet need is even higher, at 36%. The region has some of the highest fertility rates in the country, ranging from 5.6 children per woman to 7.9 children per woman. During the postpartum period, 41% of women need contraception to space their pregnancy and 27% of women need contraception to limit pregnancy.

SupCap found that the game and planning card led more men to believe that couples should decide contraceptive use together and that modern methods of contraception are good options for spacing children.

Based on these data, SupCap scaled up the intervention in six districts of eastern Uganda, which made a big difference in family planning services. During a five-month period (October 2021 to February 2022), SupCap:

Conducted 4,618 game sessions, reaching 20,576 men.
Distributed 19,271 child-spacing planning cards, 41% of which were returned to a health facility by a man, woman, or couple for counseling on family planning.
Connected clients to 7,434 contraceptive methods.
Contributed to 61.5% of total postpartum family planning uptake in the six project districts.
Helped increase the range of methods clients chose, including a significant increase in women choosing the permanent contraceptive method, bilateral tubal ligations.

One of the key components of the project was the child-spacing planning card, which referred men who played the game to a health facility. The planning cards helped promote family planning conversations between partners and, as a result, women and men came to health facilities together with a plan. Of the clients who brought planning cards to a facility, 94.7% chose a family planning method.

“It’s exciting to see that the project is achieving what it intended to: improving postpartum family planning uptake through male engagement,” says Susan Tino, SupCap project manager. “Registering over 7,000 women who have taken up modern contraceptive methods in just a few health facilities over five months is commendable work by the district, health facility, and project teams.”

Components of "Together We Decide," a game played by male partners of postpartum women and facilitated by local volunteer health teams.

A family planning referral card, which players received after playing Together We Decide.

Keys to success and unexpected outcomes

SupCap worked closely with district health officials, health workers, religious and traditional leaders, and village health teams throughout each stage of the project. Including a wide range of stakeholders from the beginning of the project was crucial to ensuring project buy-in, success, and sustainability.

“We must thank SupCap for this intervention,” says Sister Susan Akora, an assistant district health officer. "Before, we would only see a woman come to the health facility, never the man. Now they come together.”

The project aimed to increase contraceptive uptake and knowledge about contraceptive methods and improve couples’ communication and help inform women of all their available options. For example, facilities in the Pallisa and Amuria Districts saw a significant increase in women opting for the permanent contraceptive method, bilateral tubal ligations. In the Pallisa District, the average number of monthly bilateral tubal ligations increased by 175% and in the Amuria District, the average monthly number increased by 400%.

“We kept struggling to get clients who opted for bilateral tubal ligations, but SupCap made it easier,” says Jenifer Amuge, a midwife at the Gogonyo Health Center III in the Pallisa District.

“The games brought a change. Even those who did not know about bilateral tubal ligations or other methods got the information and understood their importance.”

There were several additional positive outcomes. Over the course of the project, SupCap helped:

Decrease cases of gender-based violence, thanks to the project’s focus on male engagement and increased communication between partners.
Improve postpartum family planning reporting in DHIS2—an open-source software platform for reporting, analyzing, and disseminating data for health projects—by training health workers to document family planning uptake in the health management information system.
Increase demand for contraceptive methods. When stockouts happened in several district facilities, the SupCap team worked with supply chain advisors to redistribute supplies and ensure district health facilities had adequate supplies to meet the increase in demand.
Increase results-based financing funds to districts, thanks to their improvement in family planning indicators.

Resources

Tested Solutions for Engaging Men in Family Planning

Supporting Couples to Make Active Joint Decisions About Childbearing: An interactive game on family size, child spacing, and contraceptives in Uganda

Uganda Family Planning & Reproductive Health Community HealthMen play Together We Decide at Kaserem subcounty in Kapchorwa, Uganda. Photo by Esther Ruth Mbabazi for IntraHealth International.Scale-Up and Capacity Building in Behavioral Science to Improve the Uptake of Family Planning and Reproductive Health Services (SupCap)