Comprehensive Health Support in Northern Uganda

Ken Banks,

“To keep you healthy while on your medication, always remember to eat well to boost your immunity, by including vegetables like malakwang, nakati, boo, and protein-rich foods like fish, meat, and eggs in your diet.”

In the Acholi region of Northern Uganda, phone reminders like these are helping people living with HIV take their anti-retroviral treatment on time. With correct adherence to treatment, HIV can be a manageable condition that can be prevented from spreading to others. This is the hope for Acholi, which faces one of the highest burdens of HIV in Uganda. Acholi has the added burden of ongoing conflict that presents security and transportation challenges to people living with HIV.

RHITES-N, Acholi was one of five USAID activities in Uganda focused on comprehensive regional health and HIV/AIDS programs that used an integrated health system strengthening approach for primary health care. We are proud of our role providing high-quality learning, training of health workers, and revitalization of systems for health facilities and our technical assistance for HIV/AIDS, TB, malaria, family planning (FP), and nutrition services to improve health and wellbeing in Acholi. 

URC implemented the USAID RHITES-N, Acholi activity to increase access to and utilization of health services, strengthen district health systems, and increase adoption of healthy behaviors. Over the course of the activity, RHITES-N, Acholi supported more than 330 health facilities in eight districts.

A commitment to localization drove the activity’s success. Through local systems, leadership, and resources, RHITES-N, Acholi was implemented through local systems, resources, leadership, and continuous learning.

Supporting Local Partners

The activity worked closely with three local partners to integrate a collaborating, learning and adapting (CLA) approach throughout their work and processes. The three organizations, the Local Partner Health Service (LPHS) Ankole and Acholi, Gulu Women Economic Development and Globalisation (GWED-G), and Gulu Regional Referral Hospital, participated in a CLA orientation, a CLA maturity self-assessment, and action plan development process.

CLA is an approach that guides organizations implementing development projects to collaborate strategically, identify key learnings throughout implementation, and adapt project implementation accordingly to optimize project outcomes. RHITES-N, Acholi used CLA to continuously strengthen technical approaches and interventions toward achieving improved health outcomes.

The CLA capacity strengthening initiative aimed to strengthen local partners’:

  • Skills and knowledge to assess progress for continuous learning and adaptive change
  • Technical learning
  • Collaboration and adaptive management

Village health teams and community health workers were essential partners throughout the activity. RHITES-N, Acholi provided training and educational resources for health workers across the spectrum of services including TB treatment follow up, testing for sexually transmitted infections (STIs), contraception counseling, identification of clients for HIV pre-exposure prophylaxis (PrEP), and referrals, to name a few. A better-resourced community health workforce helps communities access more convenient and affordable health services. This is critical for women seeking services like contraception or HIV services.


Health Activity Highlights

Messaging and Mentorship to Address HIV/AIDS

To address Acholi’s high communicable disease burden, the activity developed interventions for HIV/AIDS, TB, COVID-19, and malaria. Social and behavior change (SBC) communication was the foundation for much of the support, particularly to promote healthy behaviors related to HIV prevention and treatment. The activity used a variety of knowledge gathering methods including root cause analyses and mapping of 124 HIV hotspots to design evidence-based approaches targeting key populations.

Panagora supported the design and implementation of interactive phone messages through the Viamo platform to promote HIV testing and adherence to antiretroviral therapy (ART) including keeping clinic appointments, picking up medication, and nutrition education. Clients could choose their preferred language for the messages – English, Luo (Acholi), or Kiswahili – the region’s three most spoken languages. The subsequent evaluation of this intervention found almost half of the respondents (49 percent) said that the messages motivated them to take their medicine on time and 23 percent said that they took their partner/family members for an HIV test as a result of listening to the phone messages.

To help prevent HIV transmission, the activity developed and provided materials to peer counselors and health workers to reach young people, commercial sex workers, and intravenous drug users with education and resources on PreP. Health care providers were trained on identification and referral of clients for PrEP, and identification of victims of gender-based violence for support service referral. This contributed to more than 6,368 individuals adopting PrEP between 2018 and 2021.

A Curated Approach for Key Populations

To better reach key populations with HIV services, the activity provided outreach workers, including community health workers and peer outreach teams, with a message matrix to guide their distribution of self-testing kits at the community level. Panagora supported the activity integrating key population (KP)-specific indicators into its overall activity monitoring and evaluation dashboard. RHITES-N, Acholi-supported interventions reached 8,896 individuals over the course of the activity. More than 95 percent of KPs engaged by outreach workers or clinical staff went for an HIV test and ART initiation among KPs increased by 94 percent October 2020 and September 2021 during which the peer navigation system, adherence clubs, and the Community Client-Led Antiretroviral Delivery system were in place. These outcomes reinforced the value of formative research in developing targeted interventions that effectively reach marginalized people.

Community-Centered Family Planning Support

Community health workers played a major role in the activity’s FP interventions in rural areas. Panagora contributed to this component of the activity by developing a FP SBC strategy, gap assessment, and counseling guide for the community health workers. The activity trained 654 community-based voluntary health workers in 25 rural sites of Acholi using these tools. FP uptake in these sites reached 59 percent, surpassing the national target. A total of 145,017 individuals accessed FP services in the last year of the activity, more than half of which received services for the first time.

Community dialogues for families, first-time parents, young people, and cultural and religious leaders identified practices including early marriage, polygamy, children as heritage, unemployment, and the importance of girl child education as factors affecting FP uptake in the area. The activity implemented community health campaigns and identified community influencers to engage communities in these dialogues to discuss sociocultural factors, myths, and misconceptions about FP to increase the acceptability of FP.

The RHITES-N Success Story

To learn more about RHITES-N, Acholi and its achievements, explore URC’s project page.