Uganda Sees Health Workforce Gains; Increases in Family Planning and Safe Deliveries at End of USAID Project

A health worker in Uganda weighs a baby before administering immunizations at Nakaloke Health Center III in Mbale, Uganda. Photo by Esther Ruth Mbabazi for IntraHealth International.

Between 2017 and 2023, Uganda strengthened its health workforce and systems, improved health services, and championed locally led development in collaboration with IntraHealth’s Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) Activity.

Led by IntraHealth in partnership with The AIDS Support Organization (TASO), Communication for Development Foundation Uganda (CDFU), Malaria Consortium, and Medic, the USAID-funded project worked closely with the government at the national and local levels to expand access to high-quality health services. RHITES-E also supported Uganda’s response to the COVID-19 pandemic and an outbreak of Ebola Virus Disease and helped the Eastern region to be better prepared to respond to future threats through the establishment of public health emergency operations centers at the Mbale and Moroto Regional Referral Hospitals.

Focus on health systems strengthening

IntraHealth used health systems strengthening as its overarching approach for RHITES-E, building on strong collaborative relationships with districts, regional hospitals, health facilities, and communities, and fostering data-driven decision-making to strengthen local leadership in oversight of implementation. Key systems improvements include:

  • Through training and mentorships, built district capacity to use IntraHealth’s iHRIS human resources information system to guide health workforce planning, recruitment, deployment, and monitoring of attendance to duty. As a result, project districts used iHRIS data to fill 10,288 health worker positions, 76% of the approved positions in the region, while also reducing absenteeism.
  • Improved timely district reporting into the national health management information system from 67% to 91%, increased coverage of electronic medical records in antiretroviral therapy (ART) sites from 12% to 60%, and strengthened data quality and monitoring through digital health tools.
  • Strengthened laboratory services, including regular external quality assessments and faster turnaround times, leading to the first four labs in the region achieving international accreditation status.
  • Through mentorships, strengthened district capacity to coordinate supply chain management interventions to ensure availability, accessibility, and rational use of quality, affordable medicines and health supplies. Achievements included increasing the real-time ARV stock status weekly reporting rate from 13% to 61% from 2022-23 and maintaining multi-month dispensing of ARVs at 90% to reduce HIV clients’ need for clinic visits.

Integrated services for expanded access

Through a “whole of district” mindset, RHITES-E worked with district leaders, local partners, health workers, and community groups to expand access to health care in 30 districts in Eastern Uganda and Karamoja, home to over 7 million Ugandans. High-quality integrated services improved through the project encompass family planning; maternal, newborn, and child health; HIV/AIDS and tuberculosis; malaria; nutrition; and water, sanitation and hygiene. Highlights of results include:

  • Increased new users of family planning by 79%, from 249,351 to 447,169
  • Expanded users of long-acting and reversible contraception by 575%, from 47,059 to 317,726
  • Improved the percentage of women delivering their babies in a health facility from 57% to 81%
  • Achieved the 90% national target for childhood immunization through the essential program on immunization 
  • Provided over 70,000 clients with ART for HIV
  • Achieved viral load coverage and suppression rates among ART clients of 98% and 93%, respectively
  • Increased the percentage of households with improved latrines (69% to 89%), safe drinking water (58% to 83%), and proper handwashing facilities (57% to 91%)
  • Through the Mbale Emergency Operations Center, implemented an intensive COVID-19 testing approach that improved result turnaround time from 14 days to 2 and achieved vaccination of 60% of the regional population by May 2023.

Engaging men in family planning

As part of RHITES-E, IntraHealth collaborated with ideas42 with funding from the William and Flora Hewlett Foundation on an initiative in six districts to improve the health and well-being of women of reproductive age, in particular by engaging the male partners of postpartum women in the benefits of child spacing. The “SupCap” project used a four-stage behavioral science methodology to co-design solutions with community members, including 1) an interactive game played by male partners of postpartum women, facilitated by village health teams; 2) a child spacing/referral card received by game participants to fill out with their partners and take to a health facility; and 3) text messages sent to game players, village health teams, and health workers. This project:

  • Reached over 20,500 male partners of postpartum women
  • Contributed to 61.5% of total postpartum family planning uptake in the six project districts
  • Tracked individuals who brought a child spacing planning card to the health facility: 100% received family planning counseling and 95% chose a method.

Transition to local partners

During its last two years, RHITES-E provided technical assistance in transitioning HIV service delivery to local implementing partners and family health services to the districts in alignment with IntraHealth’s and USAID’s focus on local capacity strengthening and locally led development. These local partners include Baylor Uganda, ANECCA, the Uganda Protestant Medical Bureau, and the Mbale and Moroto Regional Referral Hospitals, all of which received capacity development support from IntraHealth.