UGANDA: CHWs Sustain Strong Service Delivery in Year 2 of COVID

We are proud to have continued innovating and sustaining key health services in our Uganda learning site in 2021, despite a big COVID surge in June and ensuing lockdown measures that affected household coverage and commodity supplies at the CHW level. 

We saw strong performance on child assessments and treatments, referrals, facility delivery, and supervision, which were driven by various program adjustments. These included free medicines and personal protective equipment (PPE) for CHWs, improved supervision resulting from bug fixes to the Supervisor App, and weekly data review meetings.

That said, results were lower in H2 than H1 due to tech challenges. Though we pushed out fixes that improved CHW phone syncing and the overall user experience in Q4, in 2022 we’ll be prioritizing finding a long-term solution that can handle our massive amount of historical data from Uganda.

We scaled family planning to an additional 400 CHWs in 2021 despite COVID and will train 1,280 more in 2022 to reach 100% coverage. Based on our learnings from a recent evaluation of our family planning work, we’ll do a deep dive in Q1 2022 on the optimal ratio of family planning visits to drive couple years of protection (CYPs). We’ll focus on strengthening family planning coverage, referrals, refills, and conversion rates, and closing the loop with facilities to drive increased uptake of long-term methods. Other areas of focus will be on stabilizing CHW stock levels, strengthening on-time PNC, and driving COVID vaccinations among CHWs.

We made a strategic decision not to scale our work in Oyam—a project co-financed with the district government and Malaria Consortium—but continue to operate it as a pilot to influence the national community health strategy and policies. Performance on most KPIs was inconsistent and below target throughout the year, mainly due to low stock levels of essential commodities at the CHW level, and unreliable compensation for CHWs.

On a positive note, CHW supervision was consistently above the target of 90%. We are pleased to see growing district government support and buy-in from the MoH—which is leading a newly formed Technical Advisory Committee that will provide oversight in Oyam. In 2022, priorities include working with the committee on ensuring commodity availability at the community level, documentation and sharing of lessons, and advocating for CHW compensation.

Our partner BRAC sustained strong performance throughout 2021, achieving most targets, including pregnancy registrations, sick child assessments, and treatments/referrals, thanks to effective CHW supervision, a simplified incentive structure, and stability of the Smart Health app. They are working on improving results on ANC visits by working with Medic to intensify task reminders for CHWs.

Looking ahead to 2022, with its mHealth upgrade completed, BRAC will continue building the capacity of CHWs to provide quality-driven services, focus on more frequent visits to high-risk patients, and scaling the peer supervision approach we initially developed. We also plan to reactivate cross-learning visits and engagement between Living Goods and BRAC programs, which were curtailed due to COVID lockdown measures.

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