By Goodluck Musinguzi
Uganda has made great strides in the fight against Mosquitoes that cause malaria disease compared to 20 years. According to World Health Organization, Global Health Observatory Data Repository/World Health Statistics report.
Malaria cases reached maximum value of 441.87 per 1000 population that were at risk in the year 2000. The Minimum value has reduced to 80, 90 per 1000 population in 2020.
Dr Diana Atwine, Permanent Secretary Ministry of Health says they provide leadership for the health sector and are responsible for overseeing the delivery of curative, preventive, palliative, and rehabilitative services to the people of Uganda.
“We are using the structures created to reach out with 27 million Long Lasting Mosquito Nets and treat those with Malaria Disease. Apart from Mosquito Nets there are other strategies being deployed to fight Malaria the leading cause of death in Uganda”, said Dr Diana Atwine.
The provision of health services in Uganda has been decentralized with districts and health sub-districts playing a key role in the delivery and management of health services at each respective level.
Health services are structured into national referral hospitals and regional referral hospitals, general hospitals, and health center (HC)
levels IV, III, and II. HC IIs provide the first level of interaction between the formal health sector and communities.
HC IIs only provide outpatient care and community outreach services, and health assistants are key to the provision of comprehensive services and links with the Village Health Teams.
HC IIIs provide basic preventive and curative care, while also providing supportive supervision to the community and HC IIs under their jurisdiction.
HC IVs sometimes serve as headquarters for health sub-districts that provide day to-day management and technical oversight of lower-level health facilities (III and II) in a jurisdiction.
HC I does not have a physical structure but rather consists of a team of people—VHTs—who link health facilities with the community.
VHTs in Uganda provide the lowest level of care at the village level, classified as HC-I, and serve an average of 100 households or approximately 500 people.
VHTs provide a range of preventive health services and, in some districts where there is support, VHTs carry out iCCM as well.
The MoH has been working on developing a community health extension worker (CHEW) model, which is likely to be implemented in the next five years.
Under this model, CHEWs will be positioned at the parish level (about 10 villages, 1000 households, and 5000 people) and they will have conventional
health posts. CHEWs will be paid and will receive comprehensive training prior to deployment.
During the recent Commonwealth Heads of Government Meeting malaria summit, the Government of Uganda (GoU) committed to have 15,000 CHEWs recruited and fully supported by 2023.
When the CHEWs program is implemented, VHTs will remain active at the village level but will receive supervision from the envisioned CHEWs. The implementation of iCCM will continue to be at the village level by VHTs.
These VHT networks also facilitate health promotion, service delivery, and community participation in access and utilization of health services. In 2015, the MoH carried out an assessment to determine the national status and functionality of VHTs in Uganda to improve the planning and delivery of health 15 services to households and communities.
The assessment indicates that the VHT strategy has been implemented to varying degrees across the districts. Funding of the program by the government has been gradually decreasing since its inception, leaving donors to fund most of the activities.
Districts have different levels of capacity to coordinate, train, and supervise VHT activities but have been hampered by a lack of funds. Coordination and supportive supervision by the MoH have not been conducted as desired
due to funding constraints.
Overall, VHT coverage is still limited because of challenges surrounding lack of tools, resources, motivation, and regular supervision, which has resulted in high attrition among VHTs.
The assessment recommended that the government should have a clear commitment to adequate financing and institutionalization of the VHT strategy and should ensure regular payment of VHTs for the
sustainability of the program.