Where We Work : Uganda : Health

BRAC takes a multifaceted approach to delivering essential health care in Uganda. We focus on the prevention of malaria, tuberculosis (TB) and HIV/AIDS and the reduction of infant and underfive mortality rates. We increase access to health care by taking health services to the doorstep of the people and improve utilisation of government health facilities.

At the centre of our approach are the Community Health Volunteers (CHVs), who are women selected from BRAC’s microfinance groups and trained to provide basic health care. Every day, 1,600 dedicated CHVs bring essential healthcare services to the doorsteps of communities throughout Uganda. Each CHV has overall responsibility for 150 to 200 households in her area that she will visit, all within one kilometre of her home.

During each visit, a CHV checks on the health of the household members, offers treatment for basic illnesses and checks to see if there are any pregnant women in the house, in which case she can refer her for an antenatal checkup. The CHVs earn a small income from selling health care products, such as insecticide-treated nets, contraception and some over-the-counter medicines. For serious cases, they refer patients to health facilities.

CHVs are supported and supervised by Community Health Workers (CHWs), who are staff members responsible for implementing the BRAC’s health programme at the branch level. One of their duties is to help CHVs conduct community health forums on topics such as sanitation, hygiene, HIV/AIDS and malaria.

Programme Description

BRAC’s Essential Health Care (EHC) programme is a scalable model of community health care. The overall goal of the programme is to provide basic health services in communities where BRAC has an established microfinance group. One member of each group is designated and trained as a Community Health Volunteer. CHVs serve the health needs of the entire community, with particular attention to poor women and children.

Programme Objectives

• To increase reproductive health care services by raising awareness, ensuring antenatal care (ANC) and post-natal care (PNC) visits, and facility based deliveries
• To reduce the incidence of malaria, especially among pregnant women and children, by enhancing control and prevention
• To bring positive behavioural change for prevention of HIV/AIDS and ensuring access to HIV/AIDS services through community sensitisation and participation
• To develop a community based approach to increase and sustain TB case detection and cure rate as per the Millennium Development Goals
• To improve basic sanitation and hygiene by bringing behavioural change and ensuring access to safe water and latrines
• To mobilise women and disseminate information through village meetings and home visits
• To collaborate with the government to further facilitate and strengthen the implementation of national tuberculosis, malaria and immunisation programmes

Programme Components

Reproductive Health Care

One of BRAC’s primary concerns is to improve reproductive health care awareness and service utilisation. To fulfil this objective, CHVs identify pregnant women during their household visits. CHWs make one or two in-home checkups and then refer the women to nearby government or nongovernment health facilities. The CHVs raise awareness on pregnancy care and ante-natal danger signs and follow up to ensure that ANC and PNC visits are made to health facilities.

CHVs also keep a check on whether clients have taken their Tetanus Toxoid (TT) doses and completed the Intermittent Presumptive Therapy (IPT) courses, which is a promising treatment against childhood malaria in Africa. They also raise awareness on the importance of Voluntary Counselling and Testing (VCT) for HIV/AIDS, and Preventing Mother to Child Transmission of HIV (PMTCT).

Malaria Control

During household visits, the CHV identifies suspected cases of malaria and refers the patients to the nearest government health centres. She follows up to determine test results and ensures that the patient is taking their anti-malarial medication. A relative of the patient is put in charge of supervising the drug intake according to their prescription. She then conducts a follow-up visit to check on the patient’s recovery and to make sure that the patient has not developed further complications. Records of this information are kept in her household visit register.

CHVs also sell Insecticide Treated Nets (ITN) in the community and promotes the concept of every family member sleeping under a net. She ensures that nets are treated every six months and sells K-O TABS, which are insecticides that are dissolved in water and sprayed on mosquito nets to restore potency. BRAC has received government permission to distribute ACT (Artemisinin Combination Therapies), a three-day malaria treatment that must be taken under the supervision of a CHV.

TB Control

CHVs implement a well tested community based approach for increasing and sustaining TB case detection and treatment. During household visits, CHVs ask simple questions related to suspected TB cases (based on symptoms). When a suspected TB victim is identified, the CHV motivates that person to be tested at a nearby government facility. She explains the dangers that TB can pose to the sick person as well as the rest of the family. She then follows up on the patient to determine the test results. If the patient tests positive, the CHV can also act as a Direct Observation Treatment Short Course (DOTS) agent. DOTS involves second party observation of a TB infected person taking a prescribed course of medication so that patients do not default on taking their medication, which results in drug resistance.

Family Planning

During regular household visits, the CHV mobilises and motivates women to use modern methods of contraception. She provides clients with birth control pills and condoms. For other temporary and/or permanent methods, couples are referred to government primary and secondary health care facilities.

Community Health Initiatives

BRAC takes a multi-pronged approach to community health education. In addition to establishing EKOs - Ekibina Kyobulamu Obulungi - or “good health community committees”, we offer community health forums on issues such as malaria, TB and HIV prevention, maternal health, family planning and sanitation.

Basic Curative Services

CHVs are trained to diagnose and treat some basic ailments such as diarrhoea, dysentery, common cold, helminthiasis, anaemia, ringworm, scabies, hyperacidity and angular stomatitis. They also sell Artemisinin Combination Therapies (ACT) to treat malaria. They refer individuals with more complicated conditions to local public and private health facilities. CHVs earn a small income by selling over-the-counter medicines to patients.