Uganda is a country with a burgeoning economy and it has made significant strides in reducing poverty. It remains however, one of the world's most impoverished countries. Uganda also has an extremely high population growth rate, one of the largest in Africa, and a high rural population. The country faces one of the largest malaria burdens in the world.
You can watch specially produced films highlighting the need for community based agents in Uganda and the challenges they face as they try to provide villages with access to diagnostics and treatment for main childhood illnesses. For more information, click here.
|Uganda, population 32.7 million|
|Human Development Index Ranking (Source: UNDP HDI index)||143/177|
|Under five mortality rate/100,000||128|
|Neonatal mortality rate||30|
|% of population using improved drinking-water sources||67|
|% of population using improved sanitation facilities||48|
|Estimated number of children (aged 0-14) living with HIV, 2009||150,000|
|% of under fives with suspected diarrhoea receiving oral rehydration solution and continued feeding||39|
|% of under fives with suspected pneumonia receiving antibiotics||47|
|% of under fives sleeping under long lasting insecticidal nets||10|
|% of under fives with fever receiving anti-malarial drugs||61|
|Healthcare worker patient ratio (Source: WHO health workforce resource alliance)||1 to 1818|
Unless otherwise stated, all statistics from UNICEF State of the World's Children 2011
InSCALE in Uganda
InSCALE is operational in nine districts throughout Uganda, including Buliisa, Hoima, Kibaale, Kiboga, Kiryandongo, Kyankwanzi, Kyenjojo, Kyegegwa, and Masindi.
To enlarge map this map of the mid-west region Uganda, please click here.
Boosting VHT morale, performance levels, and satisfaction with job conditions is a priority for inSCALE in Uganda. From planning and synthesis of a number of document reviews, international and national stakeholder consultations, two innovative approaches have emerged:
Technology supported supervision approach for increased VHT motivation and performance
There is evidence to suggest that information and communication technology (ICT), in particular mobile phones, smartphones and affordable laptops can be used to increase the efficiency and effectiveness of data collection, submission and feedback. These can help in delivering health messages, spread of learning materials and clinical decision support tools, as well as promoting collective identity and peer support through virtual communities. However, little evidence exists on how ICT and mobile health applications can be used at scale, particularly when implementing in rural areas. To achieve the principles of good supervision without frequent face to face contact with a supervisor, we aim to utilise available technology and develop tools for the functions described above. Such an approach, from a theoretical perspective, will enhance positive personal and collective identity of VHTs. This should lead to increased motivation to perform, improved self efficacy, and more effective learning through the encouragement of reflection on their own and their peers' performance.
Community supported motivation approach for promoting collective identity and accountability
The importance of involving communities in the support and sustainability of community based programmes emerged overwhelmingly from the reviews. This emphasis goes back all the way to involving communities in the design of programmes; aligning community expectations with programme goals; involving communities in programme monitoring and decision making (such as who should be selected and deselected as VHTs); and encouraging both communities to feel accountable for the programme performance and programme personnel to feel accountable to the community. The need for VHTs to be 'embedded' in the communities they serve is frequently mentioned, yet there is little evidence-based data on community level interventions and their impact on VHT performance. The community supported motivation approach aims to increase retention and performance of VHTs by improving the perceived value of the VHT to the VHT themselves and the community they serve. It will make VHTs more visible and will contribute to sustainability of the VHT role. Activities to promote this will include empowerment of communities to participate in monitoring and decision making, which is a concept that has previously worked in Uganda for improving quality of care in health facilities.