Improving Health Service Delivery in Northern Uganda
At the end of a heavily rutted, red dirt road in desperate need of repair, stands the Koch Goma Health Center III. At this health center in northern Uganda, there are always patients waiting to be seen, and the clinic staff are eager to provide the best possible service, despite the obstacles they face.
The head of the health center, Eunice Laker, describes the challenges her staff tackle daily an encouraging smile on her face. Eunice is a 15-year veteran of the nursing profession and has been at the Koch Goma Center for the last two and a half years. After a career of working in hospitals, she says the change has been significant.
“In the hospital, I normally did clinical work, but here I am doing a variety [of duties] like maternity, antenatal, community services and administration,” Eunice explains. “The biggest challenge in executing our duties is the overwhelming [number of] patients. The patients are too many, and we are very few staff onboard.”
Hard hit by the armed conflict, northern Uganda still lags behind in infrastructure and systems that would allow Eunice and her staff to provide the patients with the best possible care. A shortage of staff, a shortage of drugs, testing kits and other commodities and a lack of capacity are common obstacles health workers in the region face every day.
In an effort to improve the quality and access to health care in some of the most remote and hard-to-reach communities of northern Uganda, USAID is funding the Northern Uganda – Health Integration to Enhance Services (NU-HITES) project. The project is being implemented by a consortium led by Plan International including Communication for Development Foundation Uganda, IntraHealth International, The AIDS Support Organization, Tulane University School of Public Health and Uganda Health Marketing Group.
In collaboration with the Ugandan Ministry of Health, the project seeks to increase the use of health services at integrated, community-level facilities and strengthen health systems for effective and sustainable delivery of quality health services.
Since NU-HITES began last year, Eunice has benefited from several trainings in programs and administration offered to clinic staff. One of the trainings she received was in the implementation of Option B , a cost-effective, life-long antiretroviral treatment option recommended by the World Health Organization for pregnant women who are HIV positive.
“The training was good. Personally, I didn’t know much about Option B , though I had heard about it, but from the training we were able to implement Option B ,” she says. “We have an antenatal care clinic twice a week and we have noticed a difference since we began implementing it.” Option B has been benefiting the mothers and families who visit the clinic.
“The patients have definitely been healthier since Option B has started. They are looking better, and there is one thing which Option B has also brought- that is, male involvement,” Eunice explains. “It is improving because once you start a mother on the medication, you counsel her to bring her partner in case they don’t get tested together. If the father has tested positive, we enroll them on chronic care.”
Eunice says her administration skills have also improved since the additional training she received from the NU-HITES project.
"I had little knowledge about managing patients, but from the mentorship NU-HITES brought to us, I am confident. The [patient] registers are in much better condition than they were before,” said Eunice. “In the past, we gave the patients drugs and it might or might not be recorded. Now when the patients come in, you record what they are given, so you know for the next time, and it gets updated.”
Capacity building of clinical staff like Eunice is a critical component of the NU-HITES project. Another component is increasing health-seeking behaviors of people in northern Uganda. One way the project is achieving this objective is through health camps. Health camps provide a festive atmosphere where camp-goers receive messages encouraging them to seek services, as well as providing easy access to those services.
To commemorate the 10th anniversary of President's Emergency Plan for AIDS Relief (PEPFAR), on December 9, NU-HITES sponsored a health camp in collaboration with the Gulu Municipality Health Office. The ten-day camp provided HIV testing/counseling, voluntary male medical circumcision, maternal and child health services including cervical cancer screening, antenatal care and immunization and nutritional assessment for children under five and, among others services. Since the camp started on December 7th, over 400 cervical screenings and the same amount of circumcisions have been performed.