The remote district of Kaberamaido in Eastern Uganda is full of praise now that the district has adequate essential drugs especially those needed to treat malaria. This is attributed to the on-going integrated Community Case Management of malaria, pneumonia and diarrhoea (iCCM) and the indoor residual spraying (IRS) programmes. The two programmes have been instrumental in the control of malaria, the leading cause of illnesses and deaths in the district.
Now Kaberamaido has become a donor to other districts, giving them part of its medicines from the central National Medical Stores that it no longer needs. Dr. James Odongo, the District Health Officer, recalls with a grimace, the lowest point of his professional career last year during the presentation of the national health performance review, when Kaberamaido was ranked among the bottom eight districts with the worst health indicators, coming in at number 119 of the country’s 127 districts.
Following the retraining of 882 Village Health Team (VHT) members which was completed in December 2018 and are now serving the district’s eleven sub counties, things are looking up and Dr. Odongo is quite optimistic with the state of the people’s health in the district, especially children under five years and referring expectant mothers.
The 882 VHTs who were all equipped with the VHT kit that has basic equipment, printed job aides (manuals) and medicines are now soldiering on the health frontline, entering into homesteads to assess people’s health, making referrals of cases that are beyond their mandate to the health centres and keeping proper records of everything they do, following the guidelines provided.
“The outcome of the iCCM approach in Kaberamaido in 2019 is already visible and is likely to be confirmed by the official reports when they are made later in the year. Because of rapid testing for malaria of children who present with fevers for example, a lot of medicine has been saved from being wastefully administered.”
Today, Kaberamaido has excess stock of medicines supplied by the central National Medical Stores, and it is donating them to needy districts of Nwoya, Kole and Katakwi. By mid-May 2019, Kumi District had also heard about the drugs bounty in Kameramaido and made their request for medicines, which the Kaberamaido administration accepted.
Dr. Odongo is not even anxious about wherever the next ranking by the national review will place Kaberamaido; what matters is that the people are healthier with malaria incidence now down from 43 per cent to 13 per cent and other poorly performing districts are now being helped by Kaberamaido. The DHO is explicitly grateful to iCCM, IRS, FamilyConnect, UNICEF and USAID for the big turnaround. The iCCM interventions are funded by UKaid under the Strengthening of Uganda’s Response to Malaria (SURMA) programme implemented by UNICEF and Malaria Consortium.
In Ogerai Village, we find VHT Joseph Ewaru conducting some tests on a two-year-old child. She has neither, malaria, diarrhoea nor pneumonia, three of the major killers of children under five years. He reassures the mother with some counselling and instructions and then turns to us to explain his work. Ewaru shows us his VHT kit which has an array of medicines including oral rehydration salts (ORS), equipment like RDT for malaria and a Respiratory Timer for pneumonia assessment, reporting tools like consumption log a Sick Child job Aid (manual) and the iCCM register.
It is of course still early days to celebrate. The district of Kaberamaido is coming from the bottom in health service delivery and there are still serious challenges to be tackled. Male involvement in maternal and child health is still quite low yet without it, issues like elimination of mother to child transmission of HIV cannot be tackled effectively, nor can diseases that affect both partners be effectively treated.
But Dr Odongo, who had been DHO for just over one year is hopeful that with intensification of education and VHT activities, things will improve sooner than later. Already, at Otuboi (sub county) Health Centre III where special focus on education has been made, a promising 83 per cent male involvement has been registered.
The Malaria Consortium regional coordinator for SURMA based in Lira, that overseas northern Uganda’s implementation of iCCM and other malaria interventions, Dr. Musa Odongo has also already noted the turning of events for the better in Kaberamaido. He points to the increase in health seeking behaviour especially in women of reproductive age, thanks in part to FamilyConnect, and reduction in morbidity and deaths of children under five, made possible by iCCM.
But Dr. Musa bluntly points out that the iCCM programme requires enormous resources and there are no shortcuts for now, with every VHT requiring a complete kit to be effective. Yet trust also takes long to build, as most people cannot believe that a VHT, whom they have been seeing all along amongst them, can after “only” six days of training manage the malaria wracking their child. Such delays in letting the VHT take charge can be disastrous and taking the sick child to a health centre many kilometres away without first immediately having it attended to at home complicates the treatment, besides clogging the system of course. This necessitates heavier investment in communication and education.
