Ugandan Families Continue to Prefer Community-Based Care

Living Goods-led operations in Uganda: Despite anecdotal reports of CHWs feeling a growing psychological toll from COVID, our performance in Uganda remains stable.  Retention is at an all-time high, with 4,670 active CHWs and an attrition rate of just 2% in Q2. Performance continues to be sustained by the revised incentive structure, free medicines and PPE support we put in place to respond to COVID, along with timely phone replacements.

Our comparison of Living Goods program data to government DHIS2 data shows that for U5 treatments, families are increasingly opting for community-based care over health facilities. U5 positive diagnoses remained significantly above target in Q2 at 33.9, maintaining the high levels we’ve seen since rolling out our COVID response in May 2020.  Issues with the application meant there were data flow issues affecting reporting on some indicators, including child assessments, treatments, and facility referral completion—though these have mostly been resolved. We hope to resume in-service trainings soon, after noting some instances of potential misdiagnosis of pneumonia or CHWs giving a presumptive malaria diagnosis rather than an mRDT test.

Among pregnant women registered by CHWs, 92% delivered at health facilities against the target of 85%. While on-time PNC visits were below the 75% target, they increased to 72% in Q2 following workflow improvements and refresher trainings focused on improving the timeliness of follow-ups for expected deliveries.

There was also strong FP and immunization performance in Q2, and unintended pregnancies averted reached a record high in May. Immunization metrics have also improved slightly throughout 2021, showing CHWs are reaching more under-vaccinated children. The percent of children under age 2 whose immunization statuses had been assessed by a CHW doubled from June 2020 to June 2021, driven by the integration of immunization and iCCM workflows in the Smart Health app.

BRAC: CHWs once again exceeded most of their targets in Q2, maintaining the positive trend that started at the end of 2020 with a widescale mHealth upgrade. A highlight of the quarter was the rollout of FP services. A total of 931 CHWs received FP training and conducted 17,154 related visits. BRAC will continue prioritizing FP scaleup in Q3, including exploring Sayana Press self-injection.

BRAC’s completed facility referrals were below target in Q2, but they are expected to increase now that they have stopped providing free medicines and CHWs are increasingly directing clients to facilities for treatment. The percent of on-time PNC visits increased in Q2 but remains below target. BRAC is working to improve its PNC workflow and hopes to incorporate learnings from Living Goods to track dates of conception, improve early identification of pregnancy, and enhance the rate of routine follow-up more accurately.

Oyam: In an exciting validation of our new co-financed experiment in Oyam district, Living Goods and the district local government signed an addendum to our partnership that extends the program through the end of 2022.

There were strong improvements in child assessments and positive diagnoses or treatments in Q2 as well as positive trajectory elsewhere, including on digital KPIs. Increased supervision activities and PPE support continue to drive performance.

Living Goods is focused on ensuring that CHWs are compensated and sufficiently stocked—challenges that have affected performance. In June, CHW stock levels were only 28%.  Since this partnership places responsibility for stocking CHWs in the hands of the local government, with support from Malaria Consortium, Living Goods is working to engage partners to bridge the gap, including through the MoH’s Pharmacy Division and UNICEF. Low commodities have been a challenge across the country, with COVID-19 supplies prioritized.

Watch: Client Rose shares how her CHW Roseline not only provides her with FP, but also helped sensitize her husband and involve him in the conversation.

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