Uganda community case management

Community Health Services

Uganda adopted the integrated community case management (iCCM) strategy in 2010, which is built on National Village Health Team (VHT) strategy. 

VHT:

  • In districts where there is support, VHTs carry out iCCM

  • Village Health Teams (VHTs) serve an average of 100 households of approximately 500 people

    Each VHT has five community health workers selected by community members
  • Community leaders responsible for coordination, overseeing VHTs and administrative supervision of VHT activities in their areas
  • ~89 out of 112 districts have VHT systems
    • Functionality of districts where the VHTs have been introduced still sub-optimal.
  • Comprehensive mapping of VHTs underway

iCCM:

  • Two of five VHT members are trained on ICCM Implementation Guidelines
  • Health facilities to track clients referred and supervise the VHT and the private drug shops within their catchment area

Community Health Extension Workers (CHEWs):

  • In development: Community Health Extension Worker (CHEW) model, likely to be implemented in 2-3 years.

    • CHEWs positioned at the parish level (about 10 villages, 1000 households and 5000 people) and will have conventional health posts.
    • Will be paid and will receive comprehensive training prior to deployment
    • VHTs will remain at villages and will receive supervision from CHEWs
      • Implementation of iCCM will continue to be at the village level by VHTs

Training:

  • By the end of 2017, ~4,000 health workers were planned to be trained in integrated management of malaria (IMM) by PMI, which includes management of severe malaria.

Challenges

  • High attrition of the VHT members due to lack of incentives 
    • Efforts are ongoing to motivate VHTs (short term: bicycles, T shirts, medicine boxes and torches; long term: government is negotiating stipends) 
  • Mainstreaming iCCM: Currently supported by partners, limited in coverage
    • In the Uganda Malaria Reduction Strategic Plan (UMRSP), funding will be mobilised from government and partners to scale up and improve national ownership 
  • Supervisory system and reporting from the VHTs including supervisory visits, data quality and reporting tools, transmitting and  incorporation of data in HMIS
    • Efforts for provision of VHT registers, incorporation VHT data into HMIS and increased supervision to strengthen the reporting systems

Implementation challenges:

  • 2015 assessment: VHT strategy has been implemented to varying degrees across the districts.
    • Governmental funding has been decreasing since its inception and is now largely donor funded
    • Coordination, training, and supervision of VHT activities have been affected by a lack of funds.
    • VHT coverage is limited because of a lack of tools, resources, motivation, and regular supervision, which has resulted in high attrition
    • VHT reporting has not yet been integrated into the DHIS-2 system, however ongoing efforts with the MOH aim to incorporate it by the end of 2017
    • VHTs receive and iCCM 6-day training on the management and referral of children under 5