FIRST CO-FINANCED PARTNERSHIP WITH GOVERNMENT LAUNCHED IN UGANDA

In collaboration with Ugandan MOH, Oyam District and Malaria Consortium, Living Goods launched our first public-private technical assistance partnership in Uganda in July 2020. Through this collaboration, Living Goods will support mHealth technology training for at least 500 government CHWs and 21 supervisors. The partnership will help standardize the quality of care for patients in Oyam District and provide government and supervisors with critical, real-time community-level data to enable quick decision-making and improve health outcomes. Owing to COVID-19-related challenges, we started with a smaller cohort of CHWs to enable us to assess how to best onboard others in this evolving environment.

In this co-financed program, the MOH provides an oversight role and technical guidance to the district to utilize its World Bank/Global Financing Facility-funded Uganda Reproductive Maternal and Child Health Improvements Project (URMCHIP) funding to compensate CHWs with a performance-based monthly incentive. This is calculated and paid out through a quarterly Results-Based Financing (RBF) allocation— which only pays for results that can be independently verified via district government structures. This is the first time that URMCHIP RBF funding is being used for to support community health work through CHWs. If successful, it could become a model throughout Uganda and other countries.  Learnings to-date include:

• District and health facilities need more support to plan better for the RBF funds they receive to drive performance and generate resources to support community health work.
• Continuous mentorship and capacity-building of district-based supervisors will better position them to support CHWs now and in the future. This will ensure sustainability of the program.
• It is important for all stakeholders to agree on the performance indicators and compensation plan and to transparently communicate the same to CHWs during training.
• Constitute a support structure team that will effectively drive the project implementation at all levels.
• Robust partner and government engagement is critical for collective leadership, implementation and shared success.

Before the end of 2020, we conducted in-person training for trainers of trainers (ToTs) and 200 CHWs. We provided them with smartphones loaded with the Smart Health app to help them standardize and improve their diagnosis and treatment protocols in the field. Along the way, we experienced a number of challenges related to conducting in-person trainings, such as delays in receiving COVID-19 test results of participants and longer training periods—as a result of convening small class sizes. To mitigate these issues, we added more lead time between testing and training, put in place service-level agreements with accredited labs, and increased the number of trainers on reserve in case someone tested positive prior to the start of activities. Safety remains our top priority and we will stop any trainings where there are suspected or positive COVID-19 cases.

In 2021, we will focus on training more CHWs and continue supporting those already trained to deliver health services in their respective communities, which we will subsequently measure against baseline data. Additionally, we shall continue to advocate for the inclusion of a community health budget line in the county health budget.