Uganda Health Activity

The Challenge

Although Uganda’s health indicators have improved, implementation of family health high impact interventions at all levels of the health system are suboptimal and social norms and trust in the health system vary within subregions. The country’s new National Community Health Strategy provides an opportunity to strengthen Uganda’s community health services, staffed primarily by unpaid and overburdened volunteers. Barriers to quality of care include quality improvement approaches that are top-down and poorly utilized for family health services. Gender and social norms inhibit access to quality services, especially for vulnerable groups.

Overview and Objectives

The USAID Uganda Health Activity (UHA) will accelerate inclusive access to respectful, people-centered care for Ugandan families, propel the country across the finish line for sustainable HIV epidemic control, and ensure that family health and HIV interventions and outcomes are anchored in strong local health systems that use data to drive results and efficiently manage human, institutional, and financial resources.

URC and its partners will support Uganda to bridge the divide between national policymaking and local action by:

• Transforming existing human resources for health (HRH) at the community, facility, district, and regional levels into proponents, managers, and providers of respectful, people-centered care
• Bolstering the political stewardship, local ownership, private sector engagement (PSE), multi-sectoral collaboration, and community participation to achieve equity, sustainability, and accountability
• Introducing governance and health systems strengthening (HSS) interventions across 72 health districts in seven diverse sub-regions to ensure that local health service delivery (HSD) networks, through Uganda’s hub and spoke model, improve their performance and management systems to equitably deliver cost-effective, high quality health services in their catchment areas
• Saturating 30 of these districts with a robust program of direct HSD support that improves access to, demand for, and use of quality family health services at the community and facility levels

Achievements

• UHA advanced a robust program of quality improvement including training of regional and district QI coaches; development of QI guidelines and reporting tools; use of tele-mentoring to expand the reach of skill building; support for QI collaboratives to improve maternal and newborn outcomes, prevent and treat malaria during pregnancy and in children, improve access to and use of quality nutrition services, improve the reach and quality of family planning counseling and services – including for adolescents and hard-to-reach groups; and expand the clean clinic approach (CCA) as a priority WASH intervention. By the end of March 2024, the MoH continuous quality improvement database registered 362 site level QIprojects to address gaps in different health areas.
• UHA has scaled-up the high-risk pregnancy collaborative from 144 sites in 30 UHA districts to cover 466 sites in the 71 districts and 5 cities in the seven UHA implementation regions. The High-Risk Pregnancy Collaborative expanded nationally to cover 114 (78%) out of the 146 districts, covering 687 sites. Enrolment of high-risk pregnancies in specialized clinics rose to 51% in June 2024 from 37% in June 2023.
• UHA worked with the MoH to conduct regional launches and district level dissemination of the National Community Health Strategy (NCHS). All districts developed action plans to prioritize poorly performing indicators and use NCHS guidance to accelerate improvement. UHA also supported rollout of the Community Health Worker Registry (CHWR) which captures vital information including biodata, training, incentives, supervision, contact information and reports. The CHWR is expected to improve the collection and reporting of reliable community health data critical for effective management of community data for improved community health systems.
• To ensure all maternal and perinatal deaths are reviewed, audited, and reported, the Activity has oriented and provided technical and logistical support to districts to conduct MPDSR committee meetings in the 7 UHA regions. UHA also supports regions to improve implementation of MPDSR recommendations and conduct joint reviews of maternal deaths. Consequently, the proportion of maternal deaths reviewed in the 7 regions increased to 98.8% by end of June 2024 from 95% at the end of March 2023.
• ANC and facility delivery indicators have shown steady gains by June 2024 relative to the first quarter of project implementation. For instance, ANC1 coverage in the 7 regions has remained steady at 95%, ANC4 coverage at 58% (improvement from 53%), and institutional delivery rate at 73% (improvement from 67%).
• Increased coverage of the fully immunized children by 12 months across all 71 districts and 5 cities in the 7 UHA implementation regions from 83% (181,772/218,039) by the end of the first quarter of project implementation in March 2023 to 94% (210,194/223,582) one year later by the end of June 2024.
• Total FP users served has steadily increased from 491,604 FP users in March 2023 to 533,519 one year later by end of June 2024, 22% of whom were adolescents. A total of 7,277 HIV positive women received FP services. 21% of women who delivered received post-partum family planning (PPFP) within 6 weeks.
• Integrated community outreaches reached 57,620 people, with significant behavior change observed, particularly in increased immunization rates and mosquito net usage. These efforts, coupled with media campaigns and training sessions, contributed to notable improvements in health indicators, such as a decline in nutrition rehabilitation default rates from 21% in March 2023 to 14% by end of June 2024.
• By end of the first year of implementation, 2,523,574 children under-five years of age had a nutrition assessment with 65% of children receiving assessment. This proportion has remained steady across quarters. The outpatient therapeutic care cure rates for children under five years have improved over the past year from 65% in March 2023 to 75% in June 2024.
• With regards to Public Financial Management to improve health outcomes, UHA conducted on-site mentorships and trainings at 97% (1732 out of 1785) of health facilities in 76 LGs on financial management and effective utilization of RBF/primary health care (PHC) funds. These interventions have contributed to health budget absorption rates above 80% from a project baseline of 75% in December 2022.
• With regards to other health systems strengthening areas, technical assistance to Regional Referral Hospitals (RRHs) and District Health Departments enhanced quality improvement and performance reviews, while logistical support addressed service delivery bottlenecks in health systems. For example, by end of June 2024, HMIS reporting rates are consistently above 99%, and targeted interventions addressed data quality issues, further improving completeness. Interventions reduced health workforce absenteeism to 16% in June 2024 from 35% in June 2023, and the Human Resources for Health Resource Information System (HRIS) achieved 80% functionality, reflecting enhancements in staffing norms and workforce performance. Supply chain systems had achieved a 99% timely reporting rate to the National Medical Stores for public health facilities and a 96% rate to the Joint Medical Stores for private health facilities, with an average commodity availability of 70%.