Although we were concerned that our KPIs would see decreases under these difficult working conditions, we are thrilled that they have not. While the pandemic has made some fearful of going to health facilities, we are ensuring women and children do not fall through the cracks.

In our Uganda direct operations, we believe Q2 achievements were likely driven by the introduction of free medicine in early May, increased compensation packages for CHWs, and a reluctance among the population to visit health facilities. Monthly under-five (U5) assessments per CHW reached a record of 36 in Q2, surpassing the target of 32. U5 positive diagnoses and treatments per CHW also reached a record 31 in Q1—a nearly 30% increase from Q1 and almost double the target of 16. This increase is largely attributed to the presumptive treatment of malaria in our current adjusted low/no-touch protocols, which restrict Ugandan CHWs from doing malaria rapid diagnostic tests (mRDTs) and treating all fevers as presumptive malaria. We may see a reduction in Q3, as we are considering reintroducing mRDTs, given our current reliable supply of personal protective equipment (PPE).

CHWs are also becoming increasingly engaged in their work; we have seen previous low-performers significantly step up their level of effort. The adjusted COVID-19 CHW incentive scheme launched in April, being equipped with PPE and additional training have helped increase CHW reporting and motivation. CHW average income rose from $12.50 in March to $19.70 in June, showing a 58% increase. Remote supervision has also led to increased engagement with CHWs. However, certain services like immunization are challenging without more in-person contact, as child health cards cannot be seen remotely. Immunization activities have seen a steady growth pattern, but there is still significant opportunity to reach more children, particularly given the worrisome drop in vaccinations across the country. We will focus on improving immunization supervision, tracking statuses, and integrating workflows and SMS reminders into the Smart Health app. CHWs are also reaching out to more new women of reproductive age on a monthly basis and an increasing number have received family planning (FP) services. CHWs in Uganda are continuing to provide the Sayana Press injectable contraceptives to women using low-touch services. We will also begin a pilot to test self-injection of Sayana Press in Q3 to increase access to FP in the midst of service disruptions at facilities. 

BRAC’s performance was generally stable but remains below target. BRAC halted field activities in April following the COVID-19 lockdown, resuming operations in May using remote supervision and adjusted no-touch protocols. From Q1 to Q2, monthly under-1 (U1) assessments per CHW fell 8% and pregnancies registered per CHW fell 10%, while positive diagnoses and treatments per CHW increased 18%. On-time postnatal care (PNC) visits also jumped from 49% in Q1 to 68% in Q2, and supervision and CHW in-stock levels improved significantly. BRAC remotely recruited 457 new CHWs who were deployed in March; however, they were not given full in-person basic training due to COVID-19, so are currently only doing some education and awareness-raising activities. BRAC is preparing to potentially resume replacement and refresher training in Q3. We are supporting BRAC to further adapt their ways of working, which will enable them to ensure continuity of services at this critical time.