A six-year, US$65 million program, RHITES-E worked with the government of Uganda to expand access to high-quality integrated health services for approximately 7.3 million Ugandans living in 30 districts and 2 cities in the Eastern Region and Karamoja subregion. The project used health systems strengthening as its approach for improving service delivery, building on strong collaborative relationships with districts, regional hospitals, and health facilities, and fostering data-based decision-making to strengthen their leadership in oversight of implementation. 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.

RHITES-E achieved results, ownership, and sustainability of outcomes through a combination of strategies as well as customizing support to accommodate districts’ cultural differences and adjusting to the impact of the COVID-19 pandemic on health service implementation. These strategies included:

• Aligning with government of Uganda goals and plans
• Promoting a “whole of district” approach to ensure the public sector engaged the private and private not-for-profit sectors to meet district goals
• Using data to build health facility and district capacity, ownership, and accountability
• Integrating services, management systems, and sectors across the continuum of care, from districts to communities
• Rewarding high quality services and health worker performance by helping districts, facilities, and community networks better use performance data and celebrate successes
• Applying digital solutions to improve data efficiency, transparency, and use.

Highlights of results included:

• Increased new users of family planning by 79% to 447,169 in 2022, along with a 575% increase in users of long-acting and reversible contraception
• Increased women delivering in a health facility from 57% to 81% and saw regional achievement of the national 90% expanded program on immunization target
• Provided over 70,000 clients with antiretroviral therapy (ART) for HIV
• Improved rates and timeliness of reporting into the national health management information system from 67% to 91%, and increased coverage of electronic medical records in ART sites from 12% to 60%. 
• Contributed to the region’s response to the COVID-19 pandemic and other threats, including supporting districts to fully vaccinate over 1,300,000 people against COVID-19 and establish two emergency operations centers in regional referral hospitals.