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.
In districts where there is support, VHTs carry out iCCM
Village Health Teams (VHTs) serve an average of 100 households of approximately 500 peopleEach 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
- 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
- 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.
- 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
- 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