Regional Health Integration to Enhance Services-North, Acholi (RHITES-N, Acholi) Activity

The Challenge

The Acholi region of northern Uganda faces a variety of challenges affecting population health, including: one of the highest burdens of HIV and malaria in the country; lower-than-optimal viral load suppression for people living with HIV (especially children); the second-highest rate of institutional maternal mortality in the country; low levels of antenatal care visits among pregnant women; and recent civil conflict and ongoing security challenges.

Overview and Objectives

USAID/Uganda uses an integrated health system strengthening approach for primary health care, in line with Uganda’s Health Sector Strategic and Investment Plan. RHITES-N, Acholi is one of five USAID/Uganda activities focused on comprehensive regional health and HIV/AIDS programs. RHITES-N, Acholi is working to:

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

The five-year activity (2017-2022) is active in eight districts in northern Uganda – Amuru, Nwoya, Gulu, Pader, Lamwo, Kitgum, Omoro, and Agago – with an estimated total population of 1.8 million. Since inception in 2017, the activity has supported more than 330 health facilities.

Achievements

RHITES-N, Acholi has successfully impacted health practices and outcomes across several priority areas, including HIV/AIDS, tuberculosis, malaria, family planning, maternal and newborn health, nutrition, and COVID-19. Achievements include:

HIV/AIDS: The activity increased antiretroviral therapy coverage to people living with HIV and successfully increased the associated viral load suppression rates. We scaled up interventions targeting high-risk populations with HIV testing services, including HIV self-testing in Gulu and Kitgum. In 2021, the activity reached 96% of the target of adolescent girls and young women with a full package of services appropriate to their age and HIV risk. Since its inception, RHITES-N, Acholi has provided voluntary medical male circumcision to nearly 80,000 adolescent boys and men.

Malaria: The proportion of malaria cases confirmed by either rapid diagnostic tests or microscopy increased from 77% to 98% in the activity’s first three years. For the same period, the proportion of confirmed cases that were appropriately treated increased from 56% to 97%.

Family planning, maternal, and newborn health: RHITES-N, Acholi supported several interventions to provide quality, integrated, rights-based family planning (FP) services. A total of 145,017 FP users accessed services in the last year, more than half of which were new users. The number of women who attended four antenatal care visits increased from 42% to 67%. The activity procured essential equipment for the Kitgum General Hospital neonatal intensive care unit. In Pader and Kitgum districts, construction was completed on two new maternity units in three health facilities.

Nutrition: Mentorship to facility-based health workers on nutritional assessment, counseling, and support improved client access to these services from 28% to 82%.

COVID-19: The activity supported a blood donation drive to avert a shortage during COVID-19, contributing to a four-fold increase of blood supply, meeting 70% of the region’s demand.