Regional Health Integration to Enhance Services in Northern Uganda (RHITES-N, Acholi Activity)

Overview

USAID/Uganda’s health and HIV/AIDS portfolio focuses on an integrated health system strengthening approach for primary health care, in line with Uganda’s Health Sector Strategic and Investment Plan. RHITES-N, Acholi Activity is one of five USAID/Uganda activities focused on comprehensive regional health and HIV/AIDS programs. The RHITES-N, Acholi Activity seeks to increase the access and utilization of quality health services in the Acholi region of northern Uganda, strengthen the supported districts’ health systems, and encourage healthy behavior. The five-year activity targets eight districts (Amuru, Nwoya, Gulu, Pader, Lamwo, Kitgum, Omoro, and Agago) in Northern Uganda with an estimated total population of 1.2 million. Since inception in 2017, the Activity has supported 331 health facilities.

By strengthening the capacity of districts and communities to increase access to and utilization of quality, integrated health services, this activity aims to have a significant, measurable, and lasting impact on lives of Ugandans. Ultimate success will be based on improvements in key indicators related to HIV and malaria prevalence; maternal, neonatal, and child mortality; modern method contraceptive use; and child development outcomes.

 

The Challenge

Increase the effective use of integrated health services in the Acholi region of Northern Uganda and strengthen health systems to sustain these gains. The region faces a variety of unique challenges affecting the health of the population and the implementation of the Activity.

  • Has one of the highest burdens of HIV and malaria in the country
  • Has not yet achieved the 95% target for viral load suppression for people living with HIV, especially among children
  • In 2018-2019 it had the 2nd highest rate of institutional maternal mortality in the country
  • Low levels of antenatal care visits among pregnant women
  • Fertility rate of 6.3 compared to the, already high, national average of 6.2
  • Recent civil conflict and ongoing security challenges
  • Refugee population (from South Sudan), along with high numbers of key and priority populations

 

Objectives

  • Increase access to and utilization of quality health services
  • Strengthen district health systems for delivery of quality services
  • Increase adoption of healthy behaviors

 

Achievements

  • Scaled up interventions that target high-risk populations including key and priority populations, with HIV testing services, including HIV self-testing services in Gulu and Kitgum.
  • From 2017-2019, carried out voluntary medical male circumcision  for 44,409 adolescent boys and men with as a prevention intervention; 94% of circumcised clients were reached with follow-up care within 48 hours of circumcision.
  • Implemented index client testing and assisted partner notification, achieving a yield rate of 41%, an improvement from 15.5%. Overall, the program supported initiation of 22,236 new HIV-positive individuals on antiretroviral therapy (ART).
  • As of December 2019, 60,949 people living with HIV were receiving ART in Acholi sub-region, achieving 97% of the annual target, with viral load suppression at 89%. Activities are ongoing to improve viral load suppression including transitioning of children, adolescents, and adults to more optimal regimens and strengthening of viral load switch committees to support prompt switching of patients to optimal regimen.
  • TB case notification rate was 243/100,000 during year 2 of the activity with TB treatment success rate at 63%.
  • Supporting several interventions to provide quality, integrated, rights-based family planning (FP) services; a total of 47,333 FP users accessed services during from October 2019-December 2020, of whom 26,979 were new FP users (57%).
  • Results indicate that overall, malaria confirmation in Acholi sub-region as of 2019 stood at 91% an improvement from 89% in 2018, whereas 95% of the malaria cases were appropriately treated.
  • In Acholi sub-region, the proportion of pregnant women with at least one antenatal (ANC) visit increased from 93% to 99% from October 2018-September 2019. ANC4 coverage improved from 47% to 51%. Institutional delivery rates stood at 74%, close to the national target of 80% whereas the caesarian section rate stood at 6% during 2019, within the Ministry of Health’s acceptable range of 5-15%.
  • Newborn care interventions focused on prematurity as the leading cause of newborn death in the region. Efforts included setting up 14 special care nurseries at different levels of care. A notable increase in admissions and a reduction in pre-discharge newborn deaths such as in Gulu (from 11.4 to 9.1 deaths per 1,000 live births) and Omoro (4.7 to 2.8 deaths per 1,000 Live births) while others continue to improve.
  • At the facility level, mentorships on nutritional assessment, counseling, and support (NACS) led to improvement in the proportion of clients accessing NACS from 28% to 45%.
  • In terms of HIV laboratory external quality assurance, the Acholi region pass rate is currently at 94%, an improvement from below 90%.​
  • Improved malaria case management at 97% across supported districts
  • Testing 242,000 people for malaria during community outreaches over six months. 193,600 positives (80% positivity rate) and all given treatment.
  • Trained 116 cultural leaders and 120 Village health teams on malaria prevention sensitization.
  • Distributed 140,280 pieces of LLINs (66%) across eight districts of Acholi sub-region
  • Improved uptake of IPTp2 at 98% through establishment of Fansidar directly observed treatment (DOT) corners at 57% of supported health facilities.
  • Continuous data management through tracking malaria cases using malaria data channels to keep an eye on upsurges given Acholi region is an endemic region. This has helped us set up timely interventions in response to upsurges and kept mortality below 1%.

 

Resources

 

Duration
2017 to 2022
Funders 
US Agency for International Development (USAID)
Partners 
Infectious Diseases Institute (IDI)
Gulu Women’s Economic Development and Globalization (GWED-G)
Panagora Group
Regions/ Countries