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Sustaining iCCM in Uganda: medicine redistribution

May 6, 2014

The integrated community case management (iCCM) programme is being implemented by the Ministry of Health in approximately 30 districts in Uganda. Two Village Health Team members (VHTs) have been trained in each village of these districts to diagnose and treat malaria, pneumonia and diarrhoea as well as to refer sick newborns and severe cases to the nearest health facilities

In the past, health facilities across Ugandan districts faced a common problem of regular stock outs of malaria medicines. Today, however, many districts are facing the opposite problem of these medicines expiring on the shelves. VHTs have significantly increased the number of children being seen in the community and receiving appropriate treatment for malaria, pneumonia and diarrhoea therefore allowing health facility staff to attend to more urgent and severe cases.

Health facilities currently receive medicines on a ‘push system’ not based on actual consumption, meaning that often certain health facilities have too many medicines, while others (including VHTs, who are considered the first level of health facility, HC1, in Uganda) face stock-outs.

Sub-counties in two districts of the mid-Western Uganda have taken the necessary action to ensure that VHTs are receiving the correct amount of medicines in order to meet the demand in their communities and treat children with malaria in a timely and appropriate way. Kiryadongo and Masindi districts have started re-distributing medicines from their health facilities to their VHTs and have put a system in place in order to easily track the medicines from the health facility through the VHT to the end user and make it as transparent as possible. 

Amayo Cyril, In-Charge at Kaduku Health Centre II, in Masindi district says he was reluctant to start the process because of the risk. “Our active VHTs kept asking for more drugs, and it makes sense that what we have at the facility should be used to help. So when we decided on the authorisation process in consultation with the DHO we went ahead. We have done two rounds through a pull system, supplying according to individual VHTs’ needs. We really needed the system to be designed together with the Malaria Focal Person and the District Health Officer, and for us, it is now working well.”

Malaria Consortium believes strongly, that with the right mechanisms in place in order to safeguard the medicines and ensure all commodities can be tracked at all levels, redistribution can have a huge impact on the sustainability of the iCCM programme in the country. By reducing the number of medicines that are expiring at health facility level, VHTs can access more medicines without an increase in cost at central level and treat more children. In this way, districts are able to support their VHTs and sustain their iCCM programmes.

Find out more about Masindi and Kiryadongo’s experience, in our case study and interviews with key people.

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