International conference on PHC and Health Systems in Africa, 28 th – 30 th April, 2008

1. Improving the quality of health service delivery at the community level through the VHT strategy, the experience of Mpigi District, Uganda International conference on PHC and Health Systems in Africa, 28th – 30th April, 2008 Ougadougou, Burkina Faso Dr. Ruth Nassanga District Health Officer Mpigi, Uganda.

2. Why VHT Strategy ? • Bring services nearer to the people - Geographical inaccessibility • Enhance community mobilization empowerment and participation in management of health services • Reduce the gap in health service provision between households and service providers • Form linkage between government with CBO involved in health service delivery

3. How ? (1/3) National level • Defined a package of interventions to be delivered at household level by VHT • Developed the implementation guidelines • Trained trainer of trainers/supervisors District level • Facilitated establishment of VHT • Mapped out and linked VHT to health units

4. How ? (2/3) • District focal person • Developed VHT register • Facilitated VHT/HF coordination • Encouraged collaboration with other departments/programmes • Oriented all health unit based staff • Provided job aides, drugs and supplies to health units

5. How ? (3/3) • Provided identification badge to each VHT • Provided 300 bicycles • Provided village pay phones At health facility • Quarterly coordination meetings between VHT and health unit staff • Replenish stock, update information, discuss problems • Supervise VHT • Compile information from VHT registers

6. What ? • Community mobilization: routine immunization, HIV/AIDS counselling and testing, inform community the available services at health units • Health education: during home visits and community gatherings • Community distribution of: 1st line antimalarials, Vitamin A, albendazole, ORS, condoms, ITNs • Data collection: Maintain registries on the cases seen. • Identify, notify and refer cases

7. Observed outcome • Decreasing numbers of malaria cases in the under five reporting at the health facilities • Decreasing cases of anaemia diagnosed among the under fives at health facilities • Increasing immunization coverage • Increasing new ANC attendances • Increasing institutional deliveries

8. Challenges (1/2) • Coordination of partners and programs -delivery of community based services in an integrated manner through the VHT structure • Meeting the demands of the community - stock outs of drugs - weak support from health facility to handle referrals: understaffing, lack of equipment

9. Challenges (2/2) • Ensuring quality of care provided by VHTs - Lack of translated job aides with key promotion messages - Lack of funds for reflesher courses - Lack of house registers - Irregular quarterly meetings • Sustaining service provision - Volunterism of the VHT/Loss of VHT - Irregular supply of drugs and supplies

10. Lessons learnt • Linking VHT to the nearest health facilities and conducting quarterly meetings create a sense of attachment and improves interaction and working relationship btn h/workers and VHT • Involvement of political leadership in meetings strengthens oneness and ownership • Flexibility at the district level on the use of vertical progam funds enhance program implementation and facilitate integrated service delivery

11. Recommendations • Functional health facilities to support the community based providers and to attend to referrals • Matching policy with resources: evidenced by fund allocation and actual provision of funds • Strong coordination by Government to ensure integration in delivery of intervention at community level by different programs and development partners

12. THANK YOU FOR YOURATTENTION