Category Archives: Uganda

Laying the groundwork for a successful field evaluation of the pneumonia diagnostics project

Copyright Malaria Consortium VHT preparing to use the RR respiratory rate counter while being observed by the research team

As Programme Coordinator for Malaria Consortium’s pneumonia diagnostics project, I visited Uganda last week to see the preparations underway for the final stage of the project: the field evaluation. During three months, our teams will study the usability and acceptability of previously selected devices to find the best one for diagnosing pneumonia – a major killer of children under five in sub-Saharan Africa.

I recently attended a training conducted by three master trainers in Mpigi town where seven village health team members (VHTs) were learning how to assess the first pair of devices: a respiratory rate phone application called RRate and a pulse oximeter called UTECH. The training went very well, with six out of seven assessors passing with a 90 percent competency score. We will now continue to train all 25 assessors who will be participating in the study for the next three months.

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VHTs focused on the consent process as part of their training Mpigi.

I then joined the Malaria Consortium research team who were conducting assessments in the field with previously trained VHTs. This was to support the research team with on the ground training on conducting this element of the study and on providing supervision to the VHTs to ensure they were able to assess the diagnostic devices.

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VHT preparing to use the RR respiratory rate counter while being observed by the research team

As sensitisation of key audiences before the field evaluation activity is key to the success of this phase, this part of the project was very well planned and executed by the Ugandan team.

Firstly, the team held a pneumonia diagnostics sensitisation meeting with 40 heads of health centres in Mpigi district at the Health Centre IV in the town. The objective was to inform these key stakeholders of the project and ensure they understood why and how patients might come their way during the three-month field evaluation period.

After my presentation on the overall project aims and objectives, I  received interesting comments on inclusion criteria, the rationale for the study and on how pulse oximetry is an unknown tool in Uganda. The master trainers then demonstrated the devices and had good questions on the background for the study and how referrals would be handled. It was agreed that Malaria Consortium would provide an oxygen concentrator to Mpigi Health Centre IV to ensure oxygen would be available for any referred patients if required.

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A master trainer demonstrates a fingertip pulse oximeter to a health centre manager in Mpigi.

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A master trainer demonstrates a fingertip pulse oximeter to health centre managers in Mpigi

On the following day, I attended a sensitisation meeting of 20 district health officials, including the District Health Officer (DHO) and their assistants, at the Mpigi District Health Office where I presented on the project and the implications for the district. The DHO confirmed the need for the study and while expressing his gratitude for the support to date. All attendants were very interested to see the devices and were happy to hear Malaria Consortium had supported the Health Centre with an oxygen concentrator.

The field evaluation started in Mpigi district in October and will continue running during the months of November and December 2015. The dissemination of results on the usability and acceptability of the devices is planned for January and February 2016.

Kevin Baker is the Pneumonia Diagnostics Programme Coordinator

Reducing the risk of malaria in pregnancy in Uganda – observations from the field

Alany and Majole are South Sudanese women living in refugee camps in West Nile province, Northern Uganda. Both are pregnant.

I met Alany and Majole as I travelled to a rural health facility, where they were attending their first antenatal care (ANC) visit.  The midwife sat with each of the women and gave them a basic health education lesson. Then there were the physical examinations, followed by the provision of required medicines for their stage of pregnancy – including intermittent preventive treatment in pregnancy (IPTp) to reduce the risk of malaria for themselves and their babies. Before they returned home under the shelter of their sun umbrella, they were each given a mosquito net to protect them further from malaria. These last two aspects of the ANC visit are especially important since pregnant women are at increased risk of malaria – as are their unborn babies.

Malaria in pregnancy (MIP) is a significant public health threat which affects more than 30 million pregnant women each year in malaria-endemic areas. It poses substantial risks to mother and unborn child, including maternal anaemia, stillbirth, miscarriage and low birth weight – a leading cause of child mortality. To prevent malaria infections among pregnant women living in areas of moderate or high transmission, the World Health Organization recommends IPTp, a full therapeutic course of antimalarial medicine given to pregnant women regardless of whether or not they are infected with malaria.

Uganda’s Malaria Control Strategic Plan identifies IPTp as one of three main elements to prevent MIP. It is delivered as part of the focused ANC package and has been implemented countrywide since 2002. Yet, despite having made significant progress, Uganda is far from meeting the government’s target of 85 percent of pregnant women receiving two doses of IPTp by the end of 2015. In 2014-15, less than half of pregnant women in Uganda received two or more doses of IPTp, despite overall one time ANC attendance being 94 percent in Uganda.

What we are doing about it

To explore the factors that continue to impede IPTp uptake, Malaria Consortium is leading a research project to assess and address barriers to pregnant women taking IPTp in Uganda. The study is conducted through COMDIS-HSD, a Research Programme Consortium, and also through our programme partnership arrangement  with funding from the UK government.

We discovered a range of barriers. In particular, health workers were found to have mixed knowledge of IPTp guidelines with regard to dosage, timing, and frequency. They did not always offer IPTp and encourage pregnant women to take it, at times incorrectly judging them to be ineligible.

Based on these findings, we designed a pilot intervention to align with the Ministry of Health training programme on MIP. This pilot intervention is being implemented in West Nile province, complementing the standard training course on MIP by sending daily reminder text messages for five weeks, summarising the key points relating to IPTp of the training. The intervention is being implemented in eight health facilities. A neighbouring district acts as control with a further eight health facilities receiving the training but not the text messages.

How things are progressing

With the text messages having been sent out in June and July, I travelled to Uganda to check up on progress and to gain a better understanding of the project sites. I also visited health facilities in the study districts to observe how things are managed and the processes involved in an ANC visit.  This will feed into the evaluation of the pilot intervention in December, which will also look at data on ANC attendance, IPTp doses, IPTp stock levels, as well as follow up with a random sample of pregnant women who visited the health facilities for their ANC visits.  In preparation for this evaluation, I looked at all of the ANC registers and other records in close detail. I met with health facility staff to ask questions about their ANC clinics – roughly how many pregnant women they see, and how many midwives they have. I also met with some of the midwives to discuss ANC services they provide, specifically relating to malaria.

The visit was a great opportunity to see the hard work going into protecting pregnant women from malaria in West Nile. The pregnant women who visit these clinics return home better equipped to protect themselves and their babies from malaria.

By observing visits and discussing with staff at the ANC clinics, I could see first-hand some of the challenges and barriers to uptake of IPTp and other malaria control measures. For example, some steps of the process are not completed as they should be; medicines which should be taken at the health facility and in front of the midwife are being given to women to take at home at a later time; and shortages of some medicines and of ANC cards have led to difficulties administering the drugs and making sure women attend all of their ANC appointments on the correct dates.

However these obstacles are not insurmountable – and with further study and appropriate action they can be overcome. Obstacles such as these which get in the way of pregnant women receiving the best possible prevention and treatment from malaria are the motivation for studies such as the IPTp study in Uganda, as well as our other work in sub-Saharan Africa and Southeast Asia.

Georgia Gore-Langton is the COMDIS-HSD Research Officer at Malaria Consortium in London.

Malaria Consortium’s Edward Idenu receives best practice award

A child with severe malaria. Photo by William Daniels. 

In March, Malaria Consortium was invited to a meeting in Kampala, which brought together the partners of the Improving Severe Malaria Outcomes (ISMO) project. During this meeting I was delighted to receive an award for ‘Best Practice for Delivery’ in recognition of my work on the project.

A patient can make a complete recovery from severe malaria if it is caught in time and treated correctly. Unfortunately, however, of the estimated 216 million cases of malaria each year, approximately eight million of which are severe malaria cases, treatment is often too slow and makes use of incorrect drugs.

The ISMO project, comprising a consortium of partners: Medicines for Malaria Venture (MMV), Clinton Health Access Initiative and Malaria Consortium, aims to strengthen the market to accelerate access to, and uptake of, injectable artesunate – the World Health Organisation’s preferred treatment for severe malaria. However, market barriers have hampered its uptake. The treatment is expensive and buyers often have concerns due to there being only one World Health Organisation (WHO) already tested and trusted supplier.

Low uptake of injectable artesunate has affected its accelerated adoption, preventing potential new suppliers to delay in making major commitments to marketing the drug. The treatment has also not been readily accepted by providers and patients, due to a lack of advocacy, education and training at all levels.

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It is the role of the ISMO project to successfully create a stable and sustainable market for quality assured injectable artesunate with two or more suppliers, which will guarantee access to the treatment for severe malaria patients. This involves encouraging manufacturers to produce quality assured injectable artesunate and securing a commitment by donors to fund further production of the treatment.  The project is active in six countries, with Malaria Consortium focusing on implementation in Ethiopia, Nigeria and Uganda.

A major obstacle for countries implementing this project is the procurement, shipment, clearance and distribution of injectable artesunate. The process is often complicated by delays which lead to drug expiration, stock outs and subsequent poor uptake from clients. The duty of ensuring that these commodities are received and documented at the airport or sea ports is facilitated by the project with support from National Malaria Elimination programme (NMEP) – the government agency responsible for malaria interventions in Nigeria.

One of the key causes of delay is the time it takes for government documentation in support of the commodities to be issued by the Budget Office of the Federation, within the Federal Ministry of Finance, at the request of the Federal Ministry of Health. This cumbersome task normally takes between 8-12 weeks.

However, because of the strong partnership between NMEP, Malaria Consortium, and our partners in the Federal Ministry of Health, I managed to obtain a duty waiver for UNITAID injectable artesunate, to be used as part of the ISMO project, in just 14 days. It is for this that I received my award.

The timely receipt of the duty waiter ensured that the artesunate was cleared and distributed to all health facilities as planned. One of my main recommendations to partners working on this project is for all malaria commodities to be included in countries’ malaria strategic plans. This gives ownership to the government and ease of reference for commodities at the port of entry.

The award demonstrated the results that this project and its staff can achieve when they build networks and partnerships with government stakeholders. Going forward, the network established with key government partners will ensure speedy movement and delivery of commodities required for the next phase of the project.

Preventing malaria through drama and performance

“Our main purpose is to educate communities about malaria – its effects, how it is transmitted and how to avoid it.” Mugoya Muzamir is one of over two thousand community members in Mbale who has been trained as part of the Mbale Malaria Control project.

Malaria is the most common cause of illness and death in children in Mbale district and, in 2011, at the start of the Mbale Malaria Control Project, the district had the highest malaria burden in Uganda. Now that Mugoya has been trained in malaria case management, it is his responsibility to communicate how to prevent malaria transmission to the communities throughout Mbale. One of the most effective ways of doing this, he has found, is through performance and drama.

Mugoya, and 24 other village health workers (VHTs) trained as part of the project, now travel from community to community, performing dramas that teach how to avoid getting malaria. When I met Mugoya, he told me this was an effective way of communicating to a wide range of people: “When you do something funny, many people will come.”

The method has been successful in conveying messages to people throughout Mbale. Community members told me their families had learnt the importance of sleeping under a mosquito net and that they now clear any stagnant water near their villages. The dramas also include messages of when to contact a VHT, and how to recognise a case of severe malaria.

“When you move round the communities, you notice there has been a change. We have seen that the number of malaria cases has fallen. Last month there was one case of malaria, whereas three months ago there were 27 cases of malaria in that month, so people are picking up on our messages.”

You can check out photos of the drama performance below:

pThe drama group begins by playing songs all of them about preventing malaria in order to attract a crowdp
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Patrick Lee is Communications Assistant at Malaria Consortium in London.

Providing mosquito nets for families through school distributions

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“When the rainy season comes, our children fall sick because of the weather. It’s malaria, flu, cough – even measles. It affects us because they miss lessons, and they can’t always catch up when they come back.”

Mary is a teacher at Iyolwa Primary School in Tororo, eastern Uganda. She teaches maths, English and social studies to a class of around 80 students, most of whom are no more than 10 years old. Her students study hard but, like in many parts of the country, their education can be severely disrupted by malaria and other illnesses.

During my visit to check up on Comic Relief’s Operation Health project in the same district, I was fortunate enough to be able to observe an activity from one of our projects that tackles this issue head-on: the distribution of long lasting insecticidal nets that would provide protection for over a thousand children and their families.

Whilst malaria mortality and morbidity in Uganda is generally high, Tororo is the worst hit by the disease. On average, residents are exposed to one to two infectious mosquito bites per night, with malaria accounting for more than 40 percent of patient visits to many health facilities. Sleeping under a long lasting insecticide treated mosquito net is one of the best ways to prevent malaria, but unfortunately they are not always available, or if they are, people don’t know how to use them properly.

The Malaria Control Culture project in Tororo focuses on developing ‘routine’ net distributions, ensuring nets reach those that need them most and encouraging people to use them. At the health facility level, we provide nets for pregnant women (who are at an increased risk of contracting malaria) when they go for antenatal check-ups. We also help ensure good net coverage through annual distribution campaigns for school children in years one and four.

It was one of the school net distributions that I visited, arriving in time to enjoy a lively drama about malaria prevention performed by a group of village health workers and primary school pupils. While the drama was going on, Malaria Consortium staff were speaking with teachers about the logistics of the distribution, while parents and relations gathered in the shade to hear from district officials and other experts about how to use the nets.

“Today we are going to show you exactly what Malaria Consortium has done for the people in the village, and what good things are going on there,” said Saul, head village health team member (VHT) of the sub-county. “We are going to show you through song, and at the same time we are going to make a drama so you can see exactly what is happening.” He told me that he was there with other VHTs to teach the school children how to protect themselves and their families from malaria. This way, children not only bring home a net but can also pass along the lessons they have learnt on preventing malaria, he explained.

When the drama ended, children in Y1 and Y4 began to gather outside the school building, where teachers read out their names from class registers Abbo Kevin, mother of six year-old daughter Stella who received a net that day, told me: “I came to this school when I was younger, but I didn’t receive nets. This is the first time. Before, malaria was so high, but it is now decreasing because of the nets.”

Mary said she and the other teachers are also happy to see a drop in the number of absences: “Since the nets, it has changed. Many have been falling sick, but as of now the numbers have been reduced.”

Take a look at the photo gallery below to see some of the photos from the net distribution:

pStudents teachers parents and community health workers VHTs gather near Iyolwa Primary School for a drama performance that teaches children how to protect themselves and their families from malarianbspp
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Ilya Jones is Communications Officer at Malaria Consortium in London.

Barriers to IPTp uptake in Uganda

Pregnant women are particularly susceptible to malaria partly because of their reduced immunity to the disease, but also because of their vulnerable social and economic status. Their unborn babies are also at high risk, with malaria potentially leading to spontaneous abortion and low birth weight. Babies born with low birth weight will often be weak and more likely to get sick. However, malaria in pregnancy is preventable. The World Health Organization recommends a combination of three interventions for the prevention and treatment of malaria in pregnancy: the use of long-lasting insecticidal nets, prompt diagnosis and effective treatment of malaria infections, and the administration of intermittent preventive treatment in pregnancy (IPTp).

It is this last method that we have been concerned with at Malaria Consortium. IPTp is low-cost, safe and generally acceptable to pregnant women, and can be provided at antenatal check-ups. However, despite generally high antenatal care (ANC) attendance, most countries in sub-Saharan Africa do not come close to meeting the targets set by organisations like Roll Back Malaria, which advocate for universal coverage.  In Uganda, for example, current surveys suggest that only about a quarter of pregnant women receive two doses of IPTp (IPT2, the indicator commonly used to assess IPTp uptake). This suggests that many opportunities for the provision of IPTp are being missed.

Research results

We have coordinated a study conducted in 2014, which explored the barriers that continue to impede IPTp uptake in Uganda. This has involved carrying out in-depth interviews with pregnant women and mothers who attended ANC, health workers, district health officials and community leaders.  Conducted through COMDIS-HSD, a research programme consortium funded by UK aid from the UK government, the study looked at both the supply side (i.e. the health system, including health workers) and demand side factors (i.e. women’s and communities’ perceptions).

The research concluded that, despite a range of minor concerns (for example with regard to taking IPTp on an empty stomach), women and communities have largely positive views of ANC and IPTp. Refusal rates of IPTp are low and given the high ANC attendance figures, the main obstacles to the provision of IPTp are therefore likely to be supply-side challenges. In the past, many health facilities struggled with frequent stock-outs of the drug used for IPTp, although this has been improving thanks to recent efforts from the Ministry of Health. Private facilities on the other hand have to buy their own supplies, which means stock-outs are still a problem.

Another major barrier to the provision of IPTp is health workers’ inadequate knowledge with regard to when and how to provide IPTp. This is compounded by the incoherent and out-of-date information provided in many policy documents and job aids that are supposed to guide health workers. Moreover, the policies in use are not in line with the most recent WHO policy recommendations for the provision of IPTp.

What next?

Malaria Consortium is about to implement a small-scale pilot intervention in collaboration with the Ministry of Health to address some of the key barriers to IPTp uptake in Uganda. The main focus of the intervention is to ensure adequate knowledge of IPTp guidelines among health workers. This will support the Ministry’s plans to roll out a country-wide classroom-based training programme on malaria in pregnancy, which will include updated IPTp guidelines that comply with current WHO recommendations.

However, it is unfortunately not feasible for everyone involved in ANC provision to attend traditional classroom training sessions. Therefore, in order to reinforce the guidelines and ensure all relevant health workers receive the necessary information, we will pilot the use of text messaging to communicate key messages. Following the classroom-based training, health workers providing ANC services at a number of health facilities in West Nile province will receive a series of text messages emphasising the importance of IPTp, explaining the new guidelines and the rationale behind the changes. This approach has recently been shown to be highly effective in communicating clinical recommendations to health workers in China, and we believe that the rapid spread of mobile technology in Africa means that the time is right to test this innovative solution in Uganda.

In order to assess the effect of the intervention, the pilot will also include health workers in a neighbouring district who will only receive the classroom-based malaria in pregnancy training. We will assess knowledge of IPTp at all facilities six months after the training. If text messaging works, we would expect to see better levels of knowledge among those health workers who attended the training and subsequently received the messages compared with those who only received the training. We would also expect that better knowledge of the IPTp guidelines will lead to fewer missed opportunities and hence an increase in IPTp coverage. The pilot is scheduled to start in May 2015 and evaluation results are expected to be available in 2016.

Christian Rassi is COMDIS-HSD Project Coordinator at Malaria Consortium

Connecting healthcare workers in rural Uganda with mobile technology

Malaria Consortium has encouraged the creation of parish coordinator roles as part of the integrated community case management (iCCM) programme in support of the Ugandan Ministry of Health’s village health team structure and as part of the inSCALE project in Uganda, which seeks to increase coverage of community health services. Acting as the link between village health team members (VHTs) and supervisors, the role of the parish coordinator facilitates the reporting, supervision and mobilisation processes, often through the use of mobile technology.

Bulega Abdul was elected as the coordinator for his parish of Kibugubya in Hoima district, Western Uganda. “Three VHTs were nominated for each parish, from which we elected the coordinator” said Abdul.  “I think they elected me because of the way I do my work. I was happy to be elected. I like it. I don’t mind that I don’t get paid.”

Abdul’s main responsibilities include collecting monthly reports from the 28 VHTs in his parish. “I make monthly home visits to all the VHTs to make sure they’re doing okay. We go through the register together; if I find any mistakes in how they give out drugs, or if there is a discrepancy in drug use and patients seen, we find and correct the mistakes together so that the next time, they can do it right.”

Traveling on his bicycle across the 18km wide parish, Abdul visits at least one VHT most days. “I call a day in advance to let them know I am coming. I used to have to spend my own money – maybe 5,000 shillings per month – making these calls. But now, I make them for free on the inSCALE CUG.” The CUG – or Closed User Group – is part of the inSCALE technology intervention where selected VHTs receive phones allowing free calls between VHTs and their supervisors, as well as functions for mobile submission of reports.

“The CUG really helps me,” Abdul said. “Before, when I was sacrificing my own money, it would be very tiresome. To limit the time on the phone I would call one VHT and ask him to notify his partner, and the calls would be so short – just a few words,” Abdul laughed, mimicking a clipped, abrupt conversation. “There would be misunderstandings and sometimes you would not find that person in the correct meeting place and would have to go back again later. And there would never be time for asking and answering questions on the phone. Now, it’s so much better. We can talk longer and the VHTs can call me if they have any problems with drugs or with their register and I can explain it properly. It really helps the VHTs in their performance.”

VHT performance is partly monitored through the weekly reports submitted on the inSCALE phones. “The reports are very good, because they are short,” Abdul said. “Before, with the written monthly reports, they were long and you could lose information or notes, so there would be more mistakes. The VHTs would often be reluctant to complete them because it would take so long. Now, with the weekly ones, they are quicker and more accurate. To me it is very important that we report exactly what is happening on the ground; it is very important when you deal with medicine that you can account for it.”

The phone software is designed to increase the VHTs level of motivation through regular messages of recognition and appreciation that, according to Abdul, are very important. “The reminders and the messages of thanks are very popular. It is really important to feel that you are working for someone, and to have regular contact with Malaria Consortium as our donors. I really appreciate that; I feel I am part of Malaria Consortium now because the phones have brought us closer.”

And, as Abdul noted, this benefit is mutual. “I think it also helps Malaria Consortium. If they need something urgent, they can just call the VHTs directly. I think it positively affects the success of the programme because they know what is going on at ground level. Surely, these phones are cheaper than the fuel they would need to see us all?”

Just as the phones are helping to connect the VHTs with each other and with Malaria Consortium, they have also improved relations with supervisors and health workers. “Before, many of us VHTs had an inferiority complex with our supervisors and the health workers; there would be a big gap between us. But now that feeling is no longer there. Because of the frequent communication we are more familiar with them. We feel equal; that we are all health workers and all have the same goal. These phones have really done so much good.”

Malaria Consortium has been implementing iCCM projects in Mozambique, South Sudan, Uganda, and Zambia since 2009. To date, over 14,000 community health workers have been trained, providing close to three million treatments for over 2.4 million cases.

Health care starts at home

A community dialogue led by a community health worker takes place under a tree in central Uganda

Effective health care starts at home and in the community. Leila Noisette, Malaria Consortium’s Advocacy Officer in Uganda, explains how Malaria Consortium works with communities, providing training and tools that they can use to improve their own health and that of their children

Though close to Kampala – the capital city of Uganda – and close to a major highway, Kiboga District is essentially rural and the main means of income are from crops and livestock. Most of the local residents rely on subsistence agriculture. Malaria has been a major cause of child mortality here and has affected the productivity of adults working in the fields.

Adera Nakato, a young grandmother explained that falling sick from malaria used to be common in the area: “I could hardly work for money and had limited food for my children. I used to buy nets but they were not effective because they were not treated; it gave us false confidence and we continued to suffer from malaria.”

Three years ago, Malaria Consortium distributed long-lasting insecticidal nets in the area. Adera received nets through the distribution for her family:

“Ever since we started using them, none of us here has suffered from malaria fever,” she told us.

Every household in four districts of mid-western Uganda benefited from the net distribution, a universal coverage campaign undertaken by Malaria Consortium through the Pioneer project funded by Comic Relief.

Tumusiime Mildred, a 32 year old mother of five children also benefited from the distribution of nets: “What can I say about the nets? It is just evident when you look at my children playing. They look happy and healthy.”

Mildred’s husband is a teacher but she had to stop work after a complication during the birth of her youngest child. She explains that nets have helped to reduce the amount of money her family have to spend on health care: “Treating the whole family was costly. Now, we no longer frequent hospitals due to malaria. My last born is two years old and she has never suffered from malaria yet. When the older ones get sick, they are taken to Ssunna, the village health team member, and they get better in a few days,” Mildred adds.

Ssunna is one of a number of community members who have been trained by Malaria Consortium to act as village health team members (VHTs), providing basic health care to young children in the community. He learnt to diagnose and treat malaria, as well as other leading causes of child death including pneumonia and diarrhoea in children under the age of five.

“I am glad that I am here to serve my community as a VHT,” Ssunna explains.

As well as diagnosis and treatment, VHTs also actively work with communities to share information about disease prevention and basic sanitary measures that families can follow to stay healthy. Ssunna received training to conduct community dialogues. The dialogues, part of a community outreach initiative supported by Malaria Consortium and the District Health Authorities, encourage communities to express their views and share experiences related to health, sanitation and hygiene. “With the village chairperson, we organise community dialogues every month where we discuss prevention of diseases such as malaria. These dialogues have yielded good results. In fact I can now spend a whole month without seeing a child suffering from malaria, diarrhoea or pneumonia.”

Catherine Nassiwa, a senior nursing officer, is the Malaria Focal Person in Kiboga District Health Team. A lot has improved as a result of the partnership between the district health team and Malaria Consortium, she explains: “Awareness of malaria has increased… sanitation, hygiene and care-seeking behaviour have improved, which, combined with the use of nets has reduced the morbidity in the district. Thanks to reduced expenditure for treatment, families can invest their money elsewhere. The relationship between community members and health workers has also improved. This has built health workers confidence and increased community members trust in the public health services.”

As the Pioneer project draws to a close, Ssunna talks about the lasting impact the project will have on the area. He hopes that, with support from active residents like himself, the community will continue taking care of their health without relying on support from partners.

“I am looking at a strategy to continue working with the community without waiting for support form Malaria Consortium.”

Access to health care for rural communities in Mbale, Uganda

Children in Lubaale viilage, Bumasikye sub-county

In Mbale district, eastern Uganda, Malaria Consortium is working with the District Health Team with funding from Comic Relief on a project that aims to help reduce child deaths from malaria and other severe childhood illnesses. Malaria is the most common cause of death in Mbale for children and adults, accounting for over 20,000 hospital admissions a year and over 30 percent of all admissions in the district.

In this audio interview, Malaria Consortium speaks to a village chief from Lubaale Parish, an area comprising six villages in Bumasikye sub-county, Mbale. He describes the impact that malaria has on life in his community.

Click here to read more about this project.

How malaria control can strengthen the health system

Dr John Baptist Waniaye, District Health Officer in Mbale, Eastern Uganda, presents on the Mbale Malaria Control Project

Leila Noisette, Malaria Consortium’s Advocacy Officer in Uganda, interviews Dr John Baptist Waniaye, District Health Officer in Mbale, Eastern Uganda, on how support for malaria control in the region, through Malaria Consortium’s Mbale Malaria Control Project – funded by Comic Relief – is benefitting the health system as a whole and how to sustain these benefits.

The Mbale Malaria Control Project started two years ago. What impact have you seen on the delivery of health services and on health more broadly in the district?

The Mbale Malaria Control Project has led to a change in our community. The health seeking behaviour of our people has improved a lot. We recently did a quality assurance survey which indicated that 86.5 percent of people are seeking health services within 24 hours of becoming sick. This has largely been due to the system of village health teams, which aim to help people seek (health) care in time before they get complications.

An addition to that has been the availability of medicines; National medical stores has improved in its quantity and quality of supplies to about 70/80 percent of the needs of the people of Mbale and Malaria Control Project has also been buffering, filling up those gaps. So right now we are talking about availability of essential medicines at 92 percent. Most of the patients who reach our facilities are now able to get the medicines. For those who don’t know, it is very important for us to remind them that the medicines are available and they should be able to use the public health facility if possible.

Another contribution has been the availability of diagnostic equipment. This has improved the way health workers treat the patients, because they feel more confident and are able to diagnose accurately and offer proper medication based on the diagnosis. Because we have received microscopes, wing scales and so on, so we have improved a lot. All these are aimed at diagnosing mainly malaria. But as you know, malaria is an entry point for over 40 percent of health services required in the health sector and this equipment is also used for other common illnesses which cause death in children, so all this is tackled on a more holistic level.

Recently, we also had a citizen satisfaction survey conducted by Strengthening Decentralisation for Sustainability (SDS), a USAID funded project implemented in partnership with the district. Interestingly, it has shown that in the last two to three years, the citizen satisfaction with health services delivery has improved. Three years ago, we were at four percent satisfaction. The recent survey shows that now we are at 64 percent satisfaction with health services delivery. So we think that if we continue with the current trust levels we are going to improve significantly the services to our people.

What do you see as the best way to sustain these results?

In terms of sustainability, the first thing is ownership by the district. We would like to take on this intervention seriously by seeing to it that we plan and budget for some of these activities, like supporting the community referral system, or sustaining the meetings for the village health team members, and how to plan for this at all our levels, district level, sub-county level and village level.

On the side of the community, we also think that in order to sustain this, there should be community contribution at household level. Assessments done by our Community Development Officers indicates that there is some household will to contribute towards sustaining these good achievements. Our job now remains how to sensitise people to take this on, from the district level with the District Council to sub-county and village councils, so that they also go out there and bring people to support sustainability.

The other thing is increasing partnership, networking. We would like to work more closely with partners. We believe that through coordination and networking with other service providers we will be able to sustain the current achievements in the health sector.

What is your personal opinion about this project, as a District Health Officer (DHO), but also as a member of the Mbale community?

I think this is a great project which has touched the real needs of the people and it has satisfied most of our needs. As a DHO I feel very proud to be associated with this project because it has been able to make me fulfil some of my mandates and assignments as a DHO. Then as a citizen from here and a villager from this place, I really feel happy that we can go to a health facility and get diagnosed and receive the drugs largely due to the contribution by this project. I used to receive so many phone calls from my village mate telling me there is no medicine here and there but now I don’t receive these phone calls anymore so I feel there has been a change in the community.