Regional Health Integration to Enhance Services in East Central Uganda Activity (RHITES-EC)

Overview

​USAID RHITES-EC is supporting Uganda’s Ministry of Health (MOH) to improve regional health outcomes by increasing the utilization of high-quality health care services within 12 districts in East Central Uganda. The five-year project (2016-2021) focusing on HIV/AIDS, tuberculosis (TB), malaria, maternal, newborn, and child health (MNCH), reproductive health, family planning, nutrition, and water and sanitation, aims to:

  • Increase demand, access, and availability of health services
  • Improve the quality of services
  • Increase the availability of resources for public sector health services
  • Strengthen management, information and health service delivery systems
  • Increase the adoption of healthy behaviors and practices within households and communities

 

The Challenge

The East Central (EC) region of Uganda is home to 4.4 million people. The region faces unique challenges due to its waterside geography, and years of redistricting have created ‘newer’ and often more rural districts lacking basic infrastructure and access to quality health care. The burden of key health issues including HIV, HIV/TB co-infections, and malaria varies greatly amongst districts though malaria remains a leading cause of morbidity and mortality for children under 5, pregnant women and people living with HIV/AIDS (PLHIV). Furthermore, immunization coverage for children 12-23 months is low and prevalence of moderate to severe anemia is high. To improve health service delivery and increase access to and utilization of quality health services, RHITES-EC is working with partners and district health teams to strengthen health worker competencies and health management information systems, enhance supply chain management and laboratory services, promote uptake of healthy practices, and facilitate linkages between facilities and communities.

 

Objectives

URC and its partners share the vision that improved quality and increased utilization of services in the East Central region is achievable through an integrated service delivery approach that prioritizes gender and youth-friendly services, local capacity development for sustainability, learning and adaptation, and improved district stewardship. Some of the key strategies to achieve improved, sustainable health outcomes include:

  • Quality services at all levels of care, progressively and appropriately integrated at facility and community levels
  • Targeted service delivery mechanisms to reach marginalized vulnerable and under-served populations
  • Effective linkages and referrals at all levels
  • Quality Improvement methods and approaches institutionalized at district, sub-district, and facility levels
  • Improved/expanded diagnostic capabilities of laboratories
  • Improved healthcare infrastructure and equipment
  • Engaged national, district, and community leadership
  • Improved transparency and accountability in managing decentralized service delivery

 

Achievements

USAID RHITES-EC is building district capacity to manage and deliver quality health services at both facility and community levels. USAID RHITES-EC has consistently surpassed annual targets for HIV case finding and treatment initiation bringing Uganda closer to its goal of achieving epidemic control of HIV. The project has also increased household access to improved water and sanitation through Home Improvement Campaigns, improved malaria diagnosis and treatment by supporting health facilities to implement test and treat policies and supported national efforts to decrease HIV/TB coinfection by successfully rolling out TB Preventative Therapy to eligible patients.

  • An increase in adherence to the Uganda Ministry of Health malaria guidelines on “test and treat” from 55% at the start of project in October 2016 to 98% in March 2020;
  • An increase in the proportion of malaria cases treated for malaria based on positive malaria results from 60% at the start of the project in October 2016 to 93.7% in March 2020;
  • A decrease in patients with negative malaria being wrongly treated for Malaria using Artemisinin-based combination therapy (ACT) from 70% at the start of the project in October 2016 to 3.6% in March 2020. This has reduced waste of ACT that was arising from irrational use;
  • A reduction in the malaria burden in Bugiri district in East Central Uganda from 41% in October 2016 to 24% in March 2020 owing to the collaboration with USAID-PMI Vector Link Project that conducts indoor residual spraying that supplements other malaria intervention measures implemented by USAID RHITES-EC;
  • An increase in pregnant women receiving two or more doses of Fansidar for the intermittent presumptive treatment of malaria from 30% at the start of the project in October 2016 to 60% in March 2020;
  • Disseminated of long-lasting insecticide-treated nets (LLINs) dispensing logs to all health care facilities that provide antenatal services to ensure proper accountability for LLINs procured by USAID-PMI;
  • Distributed LLINs to over 300,000 pregnant women attending antenatal care at 350 health care facilities that offer antenatal care;
  • Routine onsite mentorships on quantification and ordering of health workers has resulted in maintenance of order submission by health care facilities for malaria commodities that is above 95%. This has ensured on-time last mile delivery leading to the availability of malaria commodities at health care facilities.
  • The activity supports districts and facilities to implement national TB program strategies, resulting in: an improvement in the TB case notification rate from 92/100,000 at project start to 100/100,000 every quarter beginning in 2018; increased TB treatment success rates from 74% at project start to an average of 80% per quarter; and TB cure rates that increased from 50% to 61% in early 2020.

 

Resources

Feature Stories

Reports & Briefs

Case Studies

Success Stories

 

Duration
2016 to 2021
Funders 
US Agency for International Development (USAID)
Partners 
The AIDS Support Organization (TASO)
Communication for Development Foundation Uganda (CDFU)
Youth Alive
Children’s AIDS Fund Uganda (CAFU)
Jinja Regional Referral Hospital
St. Benedict Health Centre III
St. Francis Hospital, Buluba
Iganga Islamic Medical Center (IIMC)
Regions/ Countries 
Geographic Scope 
12 Districts in the East Central region, including: Bugiri, Busia, Buyende, Iganga, Jinja, Kaliro, Kamuli, Luuka, Namayingo, Namutumba, Mayuge