Uganda

Providing Critical Health Services through our Direct Operations

At least 76 percent of Uganda’s population lives in rural areas and has very poor access to quality health care. Despite significant efforts to improve the health system, the country is still far from the goal of achieving universal health coverage, and the Government of Uganda recognizes the need to design and develop a highly effective, localized health care delivery system. However, extending basic health care services to the entire population remains a challenge—especially given the shortage of health workers.

With only one doctor for every 25,000 people, Uganda falls significantly short of the World Health Organization’s (WHO) recommendation of one doctor for every 1,000 people. Consequently, the system is stretched, and health facilities are heavily overburdened, drastically reducing both the motivation of health workers and quality of services. In 2001, Uganda introduced community health workers, known as Village Health Teams (VHTs), to reduce the burden at health facilities and increase promotive and preventative health behaviors. While VHTs have contributed to improved health outcomes, 75 percent of the disease burden largely remains due to preventable diseases.

Since 2007, Living Goods has worked closely with Uganda’s Ministry of Health (MOH) and district-level local governments to strengthen the health system by recruiting, training, and supporting a network of community health workers (CHWs) who serve as government VHTs to deliver essential, high-quality services. Additionally, Living Goods has provided technical and financial assistance to the MOH and District Health Teams and partners like BRAC. At the end of 2018 we were supporting 3,200 digitally empowered CHWs in 20 districts, while our partner BRAC was supporting 3,850 CHWs in 75 districts.

Elizabeth, a Living Goods-supported CHW near Jinja, Uganda, checks in on a pregnant mother in her community using her smart phone.

By providing education and counseling support on nutrition, water and sanitation, the integrated treatment of malaria, diarrhea, and pneumonia, family planning, supporting immunization counseling and referrals, and the health of pregnant women and mothers, Living Goods pays special attention to the child’s first 1,000 days of life. This is a unique and critical period that establishes a child’s foundation for optimal health, growth, and mental development. And Living Goods continuously adapts its programming and approaches to drive greater impact.

By 2021, we aim to support and digitally empower at least 13,000 CHWs who will provide health care to more than 10.5 million Ugandans. To make this goal a reality, we work closely with national and district government partners to provide technical assistance and support for community health programming. By providing strategy support, technical expertise in areas such as mobile technology, use of data or performance management analytics, and financing, we enabled more than 5.6 million people in Uganda to live healthier lives in 2018.

Partnering with government to deliver community health

Beyond our direct operations, Living Goods’ overarching goal is to support the Government of Uganda in developing a sustainable integrated community health system that its Ministry of Health can operate, manage, and fund to ensure the delivery of high-quality community health services. 

Living Goods’ community health approach leverages digital health technology to improve supervision, performance, and motivation of CHWs and to, in turn, drive positive health outcomes. We lend our digital health expertise to inform Uganda’s eHealth efforts through the nationally convened eHealth technical working group (TWG) and health information systems TWG. We also support the Ministry’s goal of establishing a functional community health management system.

We support the government through a wide variety of approaches, beyond direct technical assistance and financial support. We actively participate in national TWGs—forums convened by the government for technical public and nonprofit sector officers to contribute to policy processes at the national and district levels—and government advisory committees—critical channels for sharing best practices and providing expertise.  

• Supporting the development of the National Community Health Extension Worker Policy. Living Goods supported the MOH to conduct a Regulatory Impact Assessment for the community health extension worker (CHEW) program, a cabinet prerequisite needed prior to the approval of any new policy, bill, or regulation for evidence-based policymaking. We also provided financial and technical assistance to finalize the assessment and supporting documentation for submission to the cabinet.
• Supporting MOH to improve community-level data. Living Goods is supporting the MOH Division of Health Information and Community Health Department to ensure that all the data collected by our supported CHWs is in line with community health priorities. Harmonizing data collection tools reduces the workload of health workers, biostatisticians, and the MOH, and also strengthens evidence-based decision making.
• Launching district dashboards to improve evidence-based decision making. We developed district dashboards and trained local government officials in Mukono and Mayuge districts. The dashboards provide real-time data, showing a graphical representation of the historical and present status of key community health indicators.
• Community results-based financing (RBF) in Kyotera and Masaka. In 2018, with funding from the Deerfield Foundation, we launched a community results-based financing (RBF) scheme in partnership with the Government of Uganda.