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USAID/ RHITES-EC PROGRAM.

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USAID/ RHITES-EC:

University Research Co., LLC (URC), a US-based public health organization working in Uganda since 2005, is implementing the USAID Regional Health Integration to Enhance Services in East Central Uganda activity (USAID RHITES-EC). The purpose of this project is to support the implementation of a comprehensive, integrated investment in regional health, HIV/AIDS and nutrition assistance. This five-year activity targets 12 districts in East Central Uganda with an estimated total population of 4.1 million through a district-based integrated package of quality health services.

Uganda Development and Health Associates (UDHA)

UDHA was established in 2003 to empower, promote and strengthen health and development among needy communities. In 2005, UDHA was registered as a national NGO under the Uganda NGO Act, CAP 113 with registration number 5531. Since then, UDHA has expanded its operations to cover East central Uganda. At UDHA, we envision a society in which people are fully empowered to manage their health and development needs. Our work is guided by a mission, ‘to engage a multi-sectoral and professional approach with strong community participation and ownership for health, rights, and development’. 

Purpose:

UDHA will work with USAID/ RHITES-EC, districts and partners to plan, implement, monitor and evaluate community and facility-based interventions that address gaps in uptake of critical services and behaviors HIV, MNCH, TB, Malaria, WASH and Nutrition. The various activities will be implemented to achieve the following objectives:

  1. , mobilize various target audiences for uptake of promoted health services and behaviours.
  • Strengthen linkage and referral systems between the community and health facilities.  
  • Quality Improvement approaches to address gaps identified.

Tasks for UDHA:

Under this grant UDHA will work with USAID/ RHITES-EC, DHTs, community structures and audience representatives in Banda and Mutumba sub counties and Namayingo town council in Namayingo district to execute the following activities:

Objective 1: Identify and address social determinants and barriers andmobilize various target audiences for uptake of promoted health services and behaviours.

Activity 1.1: Work with RHITES-EC, DHT and health facilities to enlist 53 community mobilizers including VHTs, adolescent and youth peers, and other community resource persons in each of the sub counties that will be deployed to mobilize audiences for services and promote desired behaviors.  The breakdown of community mobilizers to be enlisted for each sub county are shown in the table below:

Sub County Health Facility Parish No. of community mobilizers
Banda subcounty Banda Health Centre III Lutolo 4
  Busiro Health Centre III Buchumba 3
    Bujwanga 4
    Buwoya 3
    Lugala 3
       
Namayingo Town Council Buyinja HC IV Budidi 3
    Nasinu 3
    Nambugu 3
    Namayingo Central 4
    Bulamba 3
       
Mutumba Subcounty Bugali Health Centre II Bulule 3
  Mutumba Health Centre III Lubira 4
    Mutumba 4
    Mwema 3
    Buchimo 3
    Lubango 3
       
Total     53

Activity 1.2: Using guidance provided by USAID/RHITES-EC, DHTs, health assistants, and health facilities UDHA will conduct one 2-day orientation for the 53 enlisted community mobilisers attached to the 5 health facilities. The orientations will be convened at 3 project focus sub counties. The orientation will ensure that the community mobilizers are equipped with appropriated skills and tools to mobilize communities for the uptake of the promoted health services and behaviors. The orientations will cover the following topics:

  1. Audience profiling/ mapping/ targeting
    1. Mobilization skills.
    1. Referral and linkages.
    1. Introduction to various SBCC approaches that will be deployed to mobilize audiences including: home and station visits, Stepping Stones, Wheel of Practices for Better Living, and Family Life Schools among others.
    1. How to use available client- provider job aides.
    1. Documentation and reporting.

Activity 1.3: This activity will be conducted in two parts: 1.3A (April – May 2019) and 1.3B (June – July 2019). Using guidance provided by USAID/RHITES-EC, DHTs, health assistants, and health facilities deploy, facilitate and supervise the oriented 53 community mobilizers to identify and address barriers and mobilize the most affected community members to practice the promoted health behaviors/ actions and refer them to facilities for services. The community mobilizers will be deployed at least 4 days a month to implement the following activities between March 1 and July 30, 2019: 

Activity 1.4: Work with RHITES-EC and DHTs to identify and orient 8 peer facilitators on the Stepping Stones curriculum. The 5-day orientation will take place at Namayingo Town Council offices in March 2019.

Activity 1.5: This activity will be conducted in two parts: 1.5A (April  – May 2019) and 1.5B (June  – July2019). Facilitate the 8 peer facilitators to facilitate 4 Stepping Stones groups; 2 groups in Namayingo TC, a group in Banda sub county and a group in Mutumba sub county targeting 100 vulnerable AGYW aged 15 – 24 (25 per group). The identified 100 AGYW will be expected to attend 10 Stepping Stones sessions between March and July 2019. The AGYW will also be referred for the relevant HIV and pregnancy prevention services. UDHA will also use this opportunity to identify sexual partners of the AGYW and mobilize them for health services including HTS, VMMC and condom use among others. 

Objective 2: Strengthen linkage and referral systems between the community and health facilities. 

Activity 2.1:Work with health assistants and DHTs to support the community-based mobilizers to facilitate referrals and use linkage tools and processes. Mobilizers will be introduced to the health facility staff including health workers, linkage facilitators, expert clients, HMIS focal persons, and health facility in-charges. The goal is to improve completion of community referrals and ensure good working relationships between communities and health facilities. Cost leveraged by UDHA.

Objective 3: Improve reporting, monitoring and evaluation of community-based interventions to promote ongoing learning and adaptation.

Activity 3.1: This activity will be conducted in two parts: 3.1 A (March- April 2019) and 3.1B (May – July 2019). UDHA will work with USAID/RHITES EC staff, DHTs, health facilities, health assistants and peer leaders to convene quarterly performance review meetings for the 53 community mobilizers in April and July2019. During the meetings held at health facilities:

  1. The community mobilizers will submit activity reports for months preceding meeting.
    1. The gaps identified among the community mobilizers identified through supportive supervision will be addressed.
    1. The community mobilizers will be oriented on any new tools and approaches.
    1. The facility will share the overall monthly performance of the facility with the community mobilizers. This will focus on the areas for which community mobilizer activities are centred.

Activity 3.2: This activity will be conducted in two parts: 3.2A (March- April 2019) and 3.2B (May – July 2019). UDHA will support its staff to attend weekly and monthly performance review meetings at the health facilities being supported. UDHA staff will also attend any other critical meetings convened at the district level.

Activity 3.3: This activity will be conducted in two parts: 3.3A (March- April 2019) and 3.3B (May – July 2019). To ensure fidelity of the activities implemented UDHA will facilitate staff to conduct supportive supervision visits to the community mobilizers. The supportive supervision visits will be used to mentor community mobilizers on various aspects of their work and address any challenges they are facing during activity implementation.  Each community mobilizer will be supervised at least once a month for the entire implementation period. Cost leveraged by UDHA.

Activity 3.4: This activity will be conducted in two parts: 3.4A (March- April 2019) and 3.43B (May – July 2019). UDHA will convene monthly performance review meetings with RHITES-EC. The meetings will be used to:

  1. Review implementation of planned activities.
  2. Review completed milestones.
  3. Address emerging needs and challenges.
  4. Plan for monthly activities.
  5. Document and compile successes and learnings from the activities implemented.

Cost leveraged by UDHA.

Activity 3.5: This activity will be conducted in two parts: 3.5A (March- April 2019) and 3.5B (May – July 2019). UDHA will compile and submit weekly activity updates and monthly reports to USAID/RHITES-EC detailing activities implemented during each of the performance periods. UDHA will compile and share activity reports regularly as detailed above to ensure there is adequate and frequent support from the technical team at RHITES EC. Cost leveraged by UDHA.

Objective 4: Implement quality improvement approaches to address gaps identified.

Activity 4.1:This activity will be conducted in two parts: 4.1A (March – April 2019) and 4.2B (May – July 2019). Conduct monthly quality improvement team meetings to plan, review and monitor QI activities. UDHA will implement quality improvement projects to address gaps for underperforming indicators in selected communities across various thematic areas as guided by USAID/RHITES-EC. UDHA will collect, update, document and report improvement data and experiences using standard QI tools.

Activity 4.2: This activity will be conducted in two parts: 4.2A (March- April 2019) and 4.2B (May – July2019). With support from RHITES EC, UDHA will conduct two collaborative/mentorship meetings in March and May 2019 with selected community mobilizers, gate keepers and staff. The meetings will be used to mentor the community mobilizers and staff on various areas where gaps are identified.

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