HIV & AIDS

What’s Next for Health Workforce Investment in Uganda?

cbales — Fri, 03 May 2024 13:03:58 +0000

What’s Next for Health Workforce Investment in Uganda? cbales May 03, 2024

May 03, 2024

As the first Africa Health Workforce Investment Forum kicks off, William Mubiru highlights what's worked in Uganda and what he hopes future investments focus on.

Next week the World Health Organization is holding the inaugural Africa Health Workforce Investment Forum, and will convene African ministers, donors, and civil society to stimulate and align long-term investment in the health workforce. These key decision-makers and actors will come to consensus around the first-ever Africa Health Workforce Investment Charter—which aims to cut the continent’s critical health worker shortage in half—and hammer out details to protect existing health workforce funding and partner on new investments.

I sat down with William Mubiru, a health systems and workforce expert in Uganda. Most recently he led the USAID-funded Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) Activity and worked with the government of Uganda and partners to expand access to high-quality integrated health services in 30 districts in Eastern Uganda and Karamoja, home to over 7 million Ugandans.

Below he shares how his passion for improving the health workforce and access to health care is rooted in his childhood and home district, and what future investments should prioritize.

Read how IntraHealth International is supporting the Africa Health Workforce Investment Forum and Charter.

Q: Why did you decide to work in public health, and focus on health systems and health workforce strengthening?

I was born and grew up in a community in Luweero District, which was at the center of the National Resistance Army war from 1980-86. The violence caused disruptions in service delivery, including health services, and breakdown of systems. Many health facilities were destroyed, and many health workers were killed or forced to flee. Lack of access to health care and essential medicines and inadequate numbers of health workers led to a high prevalence of diseases like malaria and diarrhea in my community.

We had to walk 15 kms each way to reach any health care services.

Even after the war we had to walk 15 kilometers, or about 3 hours each way, to reach any health care services. As I got older, I felt I needed to help the most vulnerable in my community, including the many widows and orphans, access health services. I ventured into public health to raise awareness about preventable diseases and work closely with the local leaders in lobbying for increased funding for the health sector.

Q: What are some of the key health workforce challenges Uganda is currently facing with ensuring health equity and reaching its goal of universal health coverage (UHC)?

The availability of health workers is still scarce, especially in rural and hard-to-reach areas. The country needs tens of thousands of additional skilled health workers to meet even the minimum targets required for UHC. We have weak leadership and governance for health workforce management. Many managers are not accountable and there's a lack of responsiveness to health workforce issues limiting access to care, like high levels of absenteeism. Another key challenge is poor data management. Because we still use multiple paper-based health information systems, especially at the community level, leaders don't have complete and aggregated data to make informed decisions.

The availability of health workers is still scarce, especially in rural areas.

Uganda struggles with limited domestic funds allocated to the health sector, and therefore for the health workforce. The current health budget is just 7.7% of the national pie, just half of the Abuja Declaration target. We also have poor community health systems, often characterized by inadequately trained and facilitated village health teams [VHTs]. The government is shifting to a more formalized community health workforce by piloting the Community Health Extension Workers Strategy, but this is yet to be adopted across the country.

Q: As the former head of USAID's RHITES-E, a $65 million six-year program, what are some interventions you've seen work, and helped address these challenges in Eastern Uganda and Karamoja?

There are lots of achievements, which I recommend should be replicated or sustained.

Localization. RHITES-E built the capacity of local partners, including three Regional Referral Hospitals, which are going to be critical in sustaining the gains we achieved. We worked with these partners to create capacity development plans and used several approaches like joint planning, mentorships, technical assistance, and “Data to Action” meetings. RHITES-E transitioned HIV/TB service delivery to these local partners and districts, and I'm proud that some of the districts—like Budaka, Kaabong, Manafwa, Mbale, and Sironko—were best performers in the Annual Health Sector Performance Report for 2022/23.

Health workforce development. RHITES-E worked with the Ministry of Health and regional referral hospitals to build the capacity of health workers in family planning; nutrition; maternal, neonatal, and child health; and emergencies. For example, during the upsurge of COVID-19, we worked with the national emergency department at the Ministry of Health to build the capacity of frontline health workers, especially midwives and nurses, in the areas of case management and home-based care, and to administer COVID-19 vaccinations, and this helped in reducing the fatalities of COVID-19.

Digital solutions. We built on existing technologies and platforms to improve data efficiency, from the community to the national level. For example, we supported the rollout of electronic medical records for antiretroviral therapy across 571 facilities in Eastern Uganda, and this led to improved timely district reporting into the national health management information system. We supported districts to roll out the national iHRIS human resources information system to collect information for workforce planning, deployment, recruitment, and attendance monitoring. District leaders used the iHRIS data for timely recruitment, and to fill more than 10,000 posts, while also reducing absenteeism.

Several districts used RBF funds to recruit health workers and increased facility births.

Result-based financing. The project supported the districts and the government of Uganda to roll out results-based financing [RBF], one of the key health financing strategies the country is embracing to improve service delivery. We worked closely with the ministry to build the capacity of districts to implement RBF and several districts, like Namisindwa, Kapchorwa, and Tororo, used RBF funds to recruit health workers, specifically additional midwives, which has helped improve service-level indicators, including increasing facility births.

Q: In addition to scaling up those successful interventions, what do you think should be the priorities for the next phase of investment in health workers and systems in Uganda?

Performance management needs to be prioritized—especially for improving health worker productivity, attendance to duty, and motivation—and also for holding health managers accountable for their own performance.

We need to invest more in the capacity of health workers. The country has invested in several strategies for health worker capacity development, but this needs to be amplified in all regions. We know this works—RHITES-E built health workers’ skills in integrated service delivery, and we saw huge increases in contraception use and in HIV viral load suppression for example.

We need to strengthen data management and invest more in digitalization of paper-based health information systems and building the capacity of all health leaders from community to the national level to use data for decision-making.

We need to improve public financial management and invest more in community health systems.

It’s critical to improve public financial management. As a country, a lot of our funding, especially for the health sector, is donor driven. Right now, over 40% of our national budget comes from donors. This calls for innovative approaches for enhancing efficiency in terms of resource allocation. There is need for investment in public financial management to minimize cases of corruption of public funds.

Finally, we need to invest more in community health systems and roll out paid, trained, equipped, and supervised community health extension workers to oversee VHTs and reach every single family, woman, and child and end preventable diseases and deaths. Most Ugandans live in rural communities that are far from health facilities. And this will help us a lot in minimizing the costs we are incurring for management of diseases.

Approximately 75% of Ugandans live in rural areas like Moroto, in Karamoja Region. Many people must travel long distances to receive health care. Photo by Tommy Trenchard for IntraHealth International. (Source: https://www.indexmundi.com)

William Mubiru [center] led the USAID-funded RHITES-E Activity, which expanded access to integrated health services in Eastern Uganda and Karamoja. Growing up during the NRA war, he remembers having to walk for hours to reach any health care. Photo courtesy William Mubiru.

Mubiru says Uganda's critical shortage of health workers impedes equitable access. The country needs tens of thousands of additional skilled health workers to reach minimum targets for UHC. Photo by Esther Ruth Mbabazi for IntraHealth International.

Additional health workforce challenges, like absenteeism, also impact access, especially for people in remote areas and the most vulnerable like children, people living with disability, and people living with HIV. Photo by Tommy Trenchard for IntraHealth International.

Uganda still has disparate paper-based health information systems, especially at the community level, making it hard for health leaders to make informed health workforce decisions. Photo by Tommy Trenchard for IntraHealth International.

RHITES-E used health systems strengthening as its overarching approach to improving equitable access, building the capacity of local partners and fostering data-driven decision-making to strengthen local leadership. Photo by Esther Ruth Mbabazi for IntraHealth International.

High-quality integrated services improved through the project—including family planning; maternal, newborn, and child health; and HIV/AIDS—led to impressive results, such as increasing new users of family planning by 79%. Photo by Esther Ruth Mbabazi for IntraHealth International.

Smart investments in health workers work, says Mubiru. For example, RHITES-E provided over 70,000 HIV clients with antiretroviral treatment [ART] and achieved 93% viral load suppression among ART clients of 98%. Photo by Esther Ruth Mbabazi for IntraHealth International.

Mubiru has several recommendations for future health workforce investments, including focusing more on community health systems and paid and supported community health workers to reach every woman, child, and family. Photo by Tommy Trenchard for IntraHealth International.

By Carol Bales

Strategic communications manager

By William Mubiru

Former Chief of party, Uganda RHITES-E Activity

Family Planning HIV & AIDS COVID-19 Maternal and Newborn Health Community Health Digital Health Health workforce development Leadership and Governance Management and Performance Health Workers Uganda

Is In The Media

The USAID-funded RHITES-E Activity strengthened the capacity of health workers to provide high-quality integrated health services in Eastern Uganda and Karamoja. As a result, facility births increased significantly. Photo by Esther Ruth Mbabaz for IntraHealth International.

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Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan

rgoodwin — Wed, 27 Mar 2024 17:44:30 +0000

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan rgoodwin March 27, 2024

April 01, 2024

During World Health Worker Week we’re paying tribute to the wide range of #SafeSupportedHealth Workers who are making a difference in tough situations.

In South Sudan, community outreach volunteers (COVs) like Lawrence Monday play a key role in the HIV response—linking health facilities and communities to extend services and acting as peers to people living with HIV. Under the supervision of an adherence nurse, Lawrence supports 160 clients on HIV treatment, including 15 children.

One of the children Lawrence helps is Timo*, who had a rough start in life. He was born in 2017 into a low-income family in Juba. His biological father was never around to help him as a baby, and his 25-year-old single mother had no job to support him or his two older siblings. She often went to the market to dance with Timo wrapped on her back, and well-wishers would give her some money or food items, which would help feed them for a few days.

Diagnosis and struggle

Timo’s mother knew she was HIV-positive. Although she had been receiving antiretroviral therapy (ART) from Nyakuron Primary Health Care Center (PHCC), when she became pregnant with Timo in 2016, she refused to take treatment and didn’t attend antenatal appointments. She feared she would be stigmatized at the health facility because she knew people who worked there.

When it was time for Timo to be born, his mother had a home delivery without a skilled health care provider. When Timo was three months old, both he and his mother became very ill. He couldn’t breastfeed well, became restless, and started bleeding from the navel. His 60-year-old grandmother rushed him to Nyakuron PHCC where he was assessed and diagnosed with HIV, and immediately enrolled on ART.

With the help of his grandmother, Timo successfully attended treatment for the following year. However, his ailing mother was often intoxicated. She would leave the children with her mother and dash down to a local spree to drink.

Timo’s mother continued to refuse treatment, and in 2022 succumbed to complications of HIV. At the time, Timo and his siblings were already fully under his grandmother’s care and they largely depended on the support of well-wishers.

Home visits from a community outreach volunteer

Nyakuron PHCC is now one of 14 health facilities supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International building local capacity to provide comprehensive HIV services and free ART to people living with HIV in South Sudan. By partnering with the health facilities and local organizations, the South Sudanese government, and communities, AHEC helps train health workers to deliver high-quality HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

In 2021, early on in the project, AHEC trained 160 COVs, including Lawrence Monday. The project provides a stipend and mobile phone airtime for communication to the COVs. In 2013, AHEC attached Lawrence to Timo to monitor his treatment progress through home visits and offer emotional and psychological support.

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says. “I visit all my clients twice every six months, and I visit children at least once a week, because they easily forget to take their medication, to ensure that they adhere to medication. Within the last month, I’ve registered only 5 out of 160 clients with high viral loads, whom I’m closely following up for adherence counseling.”

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says.

Timo was one of those who needed extra follow-up. In February 2023, when Timo was five, he lost weight and became very weak. When health providers at Nyakuron PHCC assessed him, his viral load was too high and unsuppressed. He seemed traumatized by the absence of his mother, lacked enough food, and sometimes refused the bitter taste of the medicine. The health providers developed a monitoring action plan, and after four months of Enhanced Adherence Counseling, his viral load was suppressed. The health provider transitioned Timo from Lopinavir to Dolutegravir and guided his grandmother on how to prepare and give him the medication. Lawrence helped link Timo to a nutrition center within the health facility where he received food portions monthly until his health improved by June 2023.

However, in October 2023, Timo developed swollen lymph nodes and a cough and was losing weight. During a home visit, Lawrence noticed Timo’s symptoms and immediately rushed him to Nyakuron PHCC, where he was referred to Al-Sabah Childrens’ hospital. Health workers at the hospital diagnosed Timo with opportunistic infections, including tuberculosis (TB). Timo was put on anti-TB treatment for six months, which he successfully completed with the help of Lawrence.

Lawrence Monday walks to visit Timo. The Advancing HIV/AIDS Epidemic Control Activity (AHEC) trained 160 COVs like Lawrence to monitor HIV clients' treatment progress. Photo by Achan Gladys for IntraHealth International.

Timo's grandmother brought him to Nyakuron PHCC. It is now one of the facilities supported by the USAID-funded Advancing HIV/AIDS Epidemic Control Activity (AHEC). Photo by Achan Gladys for IntraHealth International.

Going the extra mile

Lawrence visited Timo’s home every two days while he was on anti-TB treatment. He walked two kilometers each way to Timo’s house to ensure he took his medications consistently. “I had to pay more frequent visits to monitor Timo’s treatment progress, especially because he was on both HIV and TB medications. I used to count the tablets to keep track of his medication consistency,” says Lawrence.

Timo is now TB-free and virally suppressed of HIV, following his last viral load test in October 2023. He now looks jolly, is playful, eats well, and weighs an impressive 23kgs. He is one of the 386 children receiving ART from AHEC-supported facilities in South Sudan, as of September 2023. Overall, AHEC currently supports 12,694 active clients on treatment. IntraHealth also linked Timo to Jhpiego, which enrolled him in their USAID Orphans and Vulnerable Children (OVC) program and plans to consider him for academic support in 2024.

“Timo is very healthy now and helps me around with minor chores, which makes me happy. I don’t want him to contract another disease. I’m doing everything it takes to ensure that he eats well and sticks to his medication,” Timo’s grandmother proudly concludes.

*Not his real name.

By Gladys Achan

Communications Officer

Advancing HIV & AIDS Epidemic Control Activity HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Community Health Community Health Workers South Sudan

Is In The Media

Lawrence Monday, a community outreach volunteer (COV), speaks with his young client, Timo, while Timo's grandmother looks on. Photo by Achan Gladys for IntraHealth International.

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

cbales — Mon, 19 Feb 2024 15:40:18 +0000

Uganda Sees Health Workforce Gains; Increases in Family Planning and Safe Deliveries at End of USAID Project cbales February 19, 2024 February 19, 2024

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.

Resources

Uganda Country Brief

Family Planning Overview Brief

Uganda Family Planning & Reproductive Health HIV & AIDS Digital Health Health Workforce & SystemsA 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.

How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS?

cbales — Fri, 01 Dec 2023 14:08:44 +0000

How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS? cbales December 01, 2023

December 01, 2023

Communities are at the forefront of progress in the HIV response.

The UNAIDS theme for World AIDS Day this year is Let Communities Lead. A new report highlights that communities living with, at risk of, or affected by HIV are at the forefront of progress in the HIV response, including connecting people to HIV services, and calls for more action to enable and support communities in their leadership roles.

We sat down with Yadira Villaseñor, IntraHealth’s Central America regional director and the head of one of our largest HIV programs, to find out how her team is collaborating with communities, community organizations, and community health workers (CHWs) to reach more clients with HIV services.

Villaseñor is the chief of party for the five-year USAID HIV Care and Treatment Project in El Salvador, Guatemala, Honduras, and Panama. According to 2022 data via UNAIDS, 103,000 people in these four countries are living with HIV and 31% are not on antiretroviral therapy (ART). The project focuses on training and equipping health workers to deliver high-quality HIV care and treatment, reducing stigma toward key populations (KPs) and people living with or at risk for HIV, and improving adherence to ART.

Q: How is the USAID-funded HIV Care & Treatment Project partnering with communities in Central America to increase access to stigma-free HIV services and help more people living with HIV receive treatment?

In Central America, the HIV epidemic is concentrated among KPs—men who have sex with men, transgender women, and sex workers. Stigma and discrimination, limited access to health care (including HIV prevention initiatives), and migration make the region vulnerable to a growing HIV epidemic. Our project provides technical and financial support to local community organizations that work with these KPs. This year we have sub agreements with five local NGOs, and we meet with them weekly.

Through the community organizations, we identify KP peers in these communities to be trained as CHWs and link them to facilities and implement community outreach activities.

For example, our previous USAID project in the region introduced health workers called adherence promoters to provide HIV counseling and testing and treatment support in health facilities. Adherence promoters immediately link people who are HIV positive to treatment, encourage HIV clients to attend routine medical appointments, identify clients at risk of dropping out of ART, link clients to other health or social services, including for treatment of opportunistic infections and co-infections, and follow up with people who don’t show up for their appointments. They work closely with community liaisons, who conduct home visits to clients who drop out of treatment.

Community liaisons coordinate with other community testing partners to improve linkage rates for referrals, so recently diagnosed users can be greeted and accompanied by them to clinical services. Community liaisons also provide direct service delivery such as counseling in the home, bringing ART medications when they can´t be picked up, providing emotional support when needed, helping patients recover when they have interrupted their treatment, and service reminders via WhatsApp. They deliver services in a culturally respectful manner that’s language appropriate and tailored to the users’ needs.

Wilfredo Esquivel is an adherence promoter working in Hospital de Puerto Barrios, Izabal, Guatemala. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel (third from left), an adherence promoter, is a key part of the team of health workers at Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel meets with an HIV patient, Nancy Bermudez, in Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

HIV client Nancy Bermudez is then attended by Doctor Hector L. Romero at Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel also goes out into communities to provide HIV services. Here he boards a boat from Puerto Barrios to Livingston Izabal to conduct home visits. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel travels from from Puerto Barrios to Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel locates the home of HIV clients in Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel delivers groceries and provides counseling to clients in Livingston Izabal, a small village in Guatemala only reachable by boat. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel visits another HIV client outside her home in Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Q: How does the project invest in and support these community health workers?

There are now 41 adherence promoters and 46 community liaisons across the four countries. The project pays these CHWs and provides other support.

We provide training and technical assistance to develop and strengthen CHW competencies. To do this, we analyze available evidence-based information and summarize it in culturally sensitive and appropriate print and audio/visual materials that are easy for CHWs to use.

We invest in digital health tools and capacity for CHWs. For example, during COVID-19 shutdowns and other emergencies like hurricanes, we supported community liaisons to use surveillance tools and alerTAR, a mobile phone tool that sends text reminders, to identify and reach HIV clients who missed HIV appointments and connect them to services at facilities and carry out home treatment.

We support CHWs’ mental and physical health. For example, when we saw the toll the COVID pandemic was taking on them, we offered them mental health support to help reduce and manage their work-related stress. We also ensured all health workers had information about and access to COVID-19 vaccines, which helped them safely vaccinate other people in their communities and address vaccine hesitancy.

Q: How does the project advocate for local governments to invest in CHWs as part of their HIV response?

While recognition of the importance of CHWs has grown, challenges persist related to formal recognition, compensation, training, and integration into the formal health care system. Addressing these challenges and further strengthening the role of CHWs is essential for increasing access to HIV services. We are working with local and national policymakers to formalize the role of CHWs at the community and facility level.

We encourage local health authorities to analyze their context and identify key actors—including local NGOs and community members and health workers—to implement the health agenda. At the same time we work with national government officials, in coordination with ministries of health and social security institutes (a parallel system in Central America for health services for workers) to obtain their endorsement of community health workers to be linked to HIV clinics under their authority.

In addition, we document and share results obtained through CHW efforts with key decision-makers. For example, during the first year of our project, we documented and shared that community liaisons reengaged 1,841 (39%) HIV patients lost to follow-up, and adherence promoters provided counseling and 83% of their clients reached viral load suppression. I’m proud to now share that as of September 2023, our project and health workers we support provide HIV services to 43,104 people living with HIV and 95% have achieved viral load suppression.

Q: What advice do you have for how other implementers and development programs should partner with and invest in local communities and community health workers?

IntraHealth, as well as many other international NGOs, is moving to a locally led development strategy. This will allow us to expand our mentorship and facilitating role with many community-based organizations who provide the CHWs that are much needed to improve access to services. I think other implementers and development programs should:

Advocate with authorities at central and local levels to gain political support for CHWs and accept them as key local actors in the development of their communities.
Highlight the contribution of CHWs through fact sheets, success stories, and “situation rooms.” Situation rooms are regular meetings at sites, like HIV clinics, where data is analyzed by a diverse team with an eye on improving performance, utilization of HIV services, and access to HIV services and treatment as part of a comprehensive package. In other words, use data and tell the story of impact in a personal way.
Listen to CHWs and understand their needs.
Invest in training CHWs and strengthening their capacities. Provide in-person coaching to empower them and ensure that they develop and maintain the desired skills.
Sensitize health workers and personnel at the facility level to accept a range of support services from CHWs to reach the most marginalized and vulnerable communities, and recognize that community outreach interventions are key to reaching the United Nations 95-95-95 goals.
Materially and financially support the development of their work.

It is not always easy to do this through a project-based cycle, though we have demonstrated some great successes through our projects. In the future, we need more programmatic approaches for other actors, funders, donors, the private sector, and impact investors to form partnerships with community organizations and communities to hire CHWs between the larger projects that come and go.

Yadira Villaseñor spoke about partnering with communities during a Clinton Global Initiative event at the UN General Assembly. Click on the link and register to watch the event, then navigate to the session titled "Innovations in Access: How to Expand Our Health Care Workforce Through Diverse Community Stakeholders."

By Carol Bales

Strategic communications manager

By Jenny Alcázar

Communications Specialist

By Yadira Villaseñor

Chief of party, Central America HIV Care and Treatment Project and regional director, Central America

HIV & AIDS Community Health Health workforce development World AIDS Day Community Health Workers

Is In The Media

Yadira Villaseñor (right), chief of party for the USAID HIV Care and Treatment Project, stands with health workers outside of Hospital de Puerto Barrios in Izabal, Guatemala. The project works with teams of health workers, including community health workers identified by community organizations we partner with, to deliver high-quality HIV services to more people in Central America. Photo by Levi Dieguez for IntraHealth International.

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USAID and IntraHealth to Expand Locally Led Development in Zambia

cbales — Tue, 08 Aug 2023 16:07:29 +0000

USAID and IntraHealth to Expand Locally Led Development in Zambia cbales August 08, 2023 August 08, 2023

Through a new contract from the US Agency for International Development (USAID), IntraHealth International will implement the Zambia Leading Organizational Capacity and Localization Development (LOCAL) Activity. This project will build on IntraHealth’s 24-year history in Zambia, and our successful local capacity-strengthening work, to enable local implementing partners (LIPs) to independently secure, manage, and monitor USAID programs to carry out the country’s development agenda and deliver results for the Zambian people.

Locally led development is the best path toward sustained improvements in health and development outcomes around the world. In Zambia, USAID has made tremendous progress in establishing direct awards with local organizations to lead HIV programs. Yet gaps in local partners’ organizational capacity must be addressed to strengthen their operations and ensure sustainability.

Since 2019, IntraHealth has worked with 101 local implementing partners in 18 countries.

As implementer of the USAID Accelerating Support to Advanced Local Partners (ASAP) and ASAP II contracts in sub-Saharan Africa, IntraHealth brings extensive expertise in rapidly preparing local organizations and government entities to develop the capabilities and resources to serve as prime partners for USAID programming. Since 2019, IntraHealth has worked with 101 LIPs in 18 countries, including Zambia, with 98% of LIPs documenting capacity improvements.

Through the five-year Zambia LOCAL activity, IntraHealth and partners SustainAbility Solutions and Ku-Atenga Media will provide LIPs the support they need for success in operations, income generation, and advocacy, building on lessons learned from ASAP and other local partner capacity-strengthening initiatives. Specifically the project will:

increase LIPs’ capacity for risk identification, mitigation, and compliance to financial and operational best practices
enhance LIPs’ resource mobilization and funding diversification capacity for the purpose of organizational sustainability
increase networking opportunities; improve communication, monitoring, evaluation, and learning capacities; and enhance understanding of integrated programming.

The activity will initially focus on health-related LIPs that are expected to greatly expand in scope and implement development programs at national and provincial levels. It will also support LIPs that implement non-health-related program activities.

Zambia LOCAL will incorporate local voices into all aspects of its work—a key for successful localization—and create space for local leadership and for local communities.

Annie Banda, a Zambian global public health professional, will serve as chief of party. Banda has significant experience assessing and strengthening the capacity of local organizations. She will manage a pool of Zambian experts and technical advisors to provide technical assistance that meets LIPs’ needs.

"I am so grateful and excited for the opportunity that IntraHealth has given me to lead and champion USAID Zambia's agenda of empowering local organizations to sustainably deliver health services to targeted communities," says Banda.

"IntraHealth is a longstanding partner of USAID in Zambia," says Maqsoda Maqsodi, president and CEO of IntraHealth. "Since 1999, we've partnered with the Zambian government and others. Together we've strengthened the Zambian health workforce and improved health services for Zambian communities. Now we're honored to be helping local organizations prepare to lead USAID programs and drive the country's development agenda."

Also read: Toward Sustainable Locally Led Development, IntraHealth's 2022 annual report

IntraHealth partnered with 6,616 local entities worldwide in 2022, including health facilities, governments, civil society groups, religious leaders, youth advocates, and more.

Family Planning & Reproductive Health HIV & AIDS Maternal, Newborn, & Child Health Noncommunicable Diseases Health workforce development Health Workers

In South Sudan, Antiretroviral Therapy Gives Man a Second Chance to Live

cbales — Tue, 01 Aug 2023 13:24:41 +0000

In South Sudan, Antiretroviral Therapy Gives Man a Second Chance to Live cbales August 01, 2023

August 01, 2023

Thanks to his brother and health workers, John is thriving.

Twenty-five-year-old John thinks he may have lived with HIV for over three years before taking a blood test in December 2021. After several failed over-the-counter malaria treatments, John’s older brother Ojok took him to Munuki Primary Health Center in Juba, where he tested HIV positive.

Although health workers immediately enrolled John on antiretroviral therapy (ART), he refused medication and lived in denial for another year.

John’s health deteriorated and in December 2022, Ojok returned him to Munuki Primary Health Center. After health workers at the center performed another positive HIV test, and provided a radiological tuberculosis (TB) diagnosis, he began receiving HIV and TB treatment.

Munuki is one of 14 health centers supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International providing comprehensive HIV services—including Pre-Exposure Prophylaxis (PrEP), an HIV prevention method—and free ART to 11,345 people living with HIV in South Sudan. By partnering with local health facilities and organizations, the South Sudanese government, and local communities, AHEC helps train health workers to provide HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

This time, AHEC attached John to Agnes, one of 161 community outreach volunteers the activity trained to help HIV clients adhere to treatment. Agnes visits John twice a month to assess and understand the challenges he is facing, suggest appropriate recommendations, provide psychological support, and, when needed, accompany him to the health facility for ART refills or counseling.

Galla Moses, a physician and AHEC’s deputy chief of party, examines John during a visit to the orphanage in December 2022. Photo by Gladys Achan for IntraHealth International

During the first visit, John was wasted, weighing just 35.5 kilograms, and had grade 1 oedema. His eyes sunk, his hair was falling out, and he could barely walk without support. AHEC coordinated with ACROSS to assess and enroll John in the nutritional support program at its service point in Munuki health facility. Because John was bedridden and couldn’t access the services by himself, Agnes collected and delivered food portions to him at the orphanage until March 2023, when John was back on his feet and started visiting the health facility.

John lives in an orphanage founded by his brother, which houses 64 orphans, including adolescent girls and young women. IntraHealth collaborated with Jhpiego to assess and screen children at the orphanage for tuberculosis and HIV, whose results all turned out negative, and enrolled 17 adolescent girls and young women in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program. DREAMS, led by Jhpiego in South Sudan, works to reduce HIV infection among adolescent girls and young women through comprehensive HIV services, PrEP, youth-friendly reproductive health care, economic strengthening, post-violence care for survivors of gender-based violence, and psychological support.

Caring community members, health workers, and local organizations are making a difference for people living with, or at risk of, HIV. These partnerships are critical for controlling and ending HIV in the country.

“My brother is my hero,” says John. “He encouraged me to go and get tested for HIV when everyone believed I was bewitched. Now I’m on medication and my life is back to normal. What is more relieving is that I was told at the health facility during adherence counseling that even with my HIV status, I can get married in future and have children who are not HIV positive.”

John poses for a photo with Agnes, his treatment supporter, during a facility visit for ART refill in June 2023. Photo by Achan Gladys for IntraHealth International

Agnes, the AHEC-supported community outreach volunteer, continues visiting John at the orphanage to assess and monitor his health progress and provide coping mechanisms. He now weighs an impressive 50kgs. His viral load is also suppressed and he’s thriving on treatment.

In the 14 AHEC-supported facilities, viral load testing has increased significantly and 87% of HIV clients are virally suppressed.

“I’m grateful to the health workers who have been very supportive and helped me get on treatment,” says John. “Now I sell merchandise at my cousin’s shop. I will use my daily commission to start up my own business soon.”

By Gladys Achan

Communications Officer

HIV & AIDS Health Workers Community Health Workers South Sudan

Is In The Media

John shares a light moment with the ART clinician and his treatment supporter during a medication refill at Munuki Primary Health Care Center in June 2023. Photo by Gladys Achan for IntraHealth International.

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IAS 2023, the 12th IAS Conference on HIV Science

cbales — Fri, 14 Jul 2023 14:54:15 +0000

IAS 2023, the 12th IAS Conference on HIV Science cbales July 14, 2023

July 23, 2023 - July 26, 2023

The most influential meeting on HIV research and its applications, the IAS Conference on HIV Science presents critical advances in basic, clinical, and operational HIV research that move science into policy and practice. IntraHealth staff will present work of the USAID-funded HIV Care and Treatment Project.

International AIDS Society

https://www.iasociety.org/conferences/ias2023

Our Participation

Poster Presentation

Implementing cervical cancer screening tools to identify serotypes of human papillomavirus (HPV) among women living with HIV, Cuilapa, Guatemala, 2022

Date(s):	July 25, 2023 12:00pm - 01:00pm AEST (July 24, 2023 10:00pm - 11:00pm EDT)
Location:	Poster Exhibition Area
Presenter(s):	Leonel Leon

Assisted partner notification acceptance advances at the speed of trust: Lessons learnt from a skills-development workshop implementation from 10 clinics in Honduras

Location:	Virtual
Presenter(s):	Linda Suazo

Implementation of active surveillance for histoplasmosis in sentinel sites in an endemic area of Honduras, Central America

Location:	VIrtual
Presenter(s):	Luis Aguirre

Participants

Luis Aguirre

Monitoring and Evaluation Officer

Leonel Leon

Technical programs coordinator, IntraHealth/Guatemala

Linda Suazo

Technical advisor, IntraHealth/Honduras

HIV & AIDS

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Brisbane, Australia

Big Milestones for Me and All Community Health Workers in Kenya

cbales — Fri, 30 Jun 2023 16:00:49 +0000

Big Milestones for Me and All Community Health Workers in Kenya cbales June 30, 2023

June 30, 2023

Last week USAID’s assistant administrator for Global Health visited and Kenya’s president announced a new commitment.

I was thrilled to receive Dr. Atul Gawande, Assistant Administrator for Global Health at USAID, last week at Mathare North Health Center–my link facility.

I told him about how I, and my fellow community health workers (CHWs) in Kenya, support the Introducing New Tools Project to strengthen tuberculosis (TB) care. I go house to house to educate community members about TB. I screen for TB, and when I identify a person who may have TB, I bring the patient to this facility for further testing and treatment, which can now be done using new technologies.

CHWs have made significant strides in ensuring early detection of TB. I’m a link between my community and the facility, and I connect them to essential health services–not just for TB, but HIV, family planning, maternal health, vaccination services, and more.

CHWs have made significant strides in early detection of TB.

I have gone to extraordinary lengths to become this visible, representing the impact of thousands of CHWs to the largest donor to global health.

My journey began with my own challenges accessing quality and appropriate primary health care services. I became a community health volunteer, or “CHV,” and gained knowledge and understanding of what my community’s health needs are. I continued to work as an unpaid CHV for years and realized I needed to advocate for fair pay for myself and other CHVs. I completed advocacy training and decided to co-create, with my colleague Margaret Odera, the CHW - Champions Network–a national movement for CHWs to advocate as a block for the interests and needs of all CHWs in Kenya, encourage greater leadership opportunities for us, and rally our community behind actions to improve all of our health and wellbeing.

CHWs demonstrate a deep passion for mentoring and guiding residents and fellows in achieving health for all. CHWs willingness to share their knowledge and expertise has undoubtedly shaped the next generation of health care professionals, fostering a culture of innovation and excellence.

Dr. Gawande listens to other health workers at Mathare North Health Center. Photo courtesy Sheringham Elisha.

Dr. Gawande’s visit was a remarkable recognition and testament to all frontline health workers’ exceptional contributions and groundbreaking work in the community. During his visit, different kinds of health workers at the health center discussed the gaps in TB and HIV response. We focused on promoting innovation and access to quality, safe, and affordable health care services for community members.

Dr. Gawande’s visit was a remarkable recognition.

Dr. Gawande said his visit to Kenya and specifically Mathare North Health Center was influenced by the positive outcomes for the fight against TB and HIV/AIDs. “Your accomplishments are a source of inspiration and motivation to the entire community health effort,” he said. “Your work should be replicated in other parts of the country and even in the world at large. I do not doubt that your future endeavors will continue to contribute immensely to the field of community health, improving the lives of countless individuals."

The same week Kenya’s President Ruto committed to hiring 103,000 CHWs, and said community health volunteers will now be known as community health promoters, will be equipped with modern equipment and deployed in communities across Kenya, and that USAID will help train them. I’m impressed by this bold step, and I am looking for our stipends to be changed to fair salaries.

I’ll continue to advocate for funders to invest in me and other CHWs.

Sheringham Elisha is a long-time advocacy partner of the Frontline Health Workers Coalition and has participated in several of the coalition's campaigns, including the recent "Invest in Me" campaign.

While the global community has pledged to end AIDS and TB by 2030, there is still urgent work to be done, including by CHWs and for supporting CHWs. With new approaches and technologies for detecting and treating TB we can make faster progress to end this disease, and new TB vaccines on the horizon could be a major boost to TB prevention. But to reach everyone in need, policy-makers must invest in the health workforce and follow through on funding commitments. That’s why I’ll continue to advocate for USAID and other funders, including national governments, to invest in me and other CHWs.

I am also asking the drafters of the UN Declaration on TB now being negotiated to not forget me and the role we CHWs play in the fight to end TB and to be sure to include strong commitments for our professionalization and remuneration.

By Sheringham Elisha

Community health worker and advocate

HIV & AIDS Tuberculosis Policy & Advocacy Community Health Workers Kenya

Is In The Media

Sheringham Elisha discusses his work to end tuberculosis with Dr. Atul Gawande outside of Mathare North Health Center. Photo courtesy Sheringham Elisha.

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Female Community Health Workers Can Unlock Health For All

ihadmin2 — Tue, 30 May 2023 13:25:53 +0000

Female Community Health Workers Can Unlock Health For All ihadmin2 May 30, 2023

May 24, 2023

Let’s give them platforms to share their recommendations and pay them fairly.

The global health community is in Geneva this week for the 76th World Health Assembly (WHA). With this year’s theme “Saving lives, driving health for all,” it is critical for the conversations to be laser-focused on turning words into action to deliver for the more than half a billion people across the African continent who still do not have access to basic health care.

For us at mothers2mothers, an African Primary Health Care NGO and member of the Frontline Health Worker Coalition, this focus should especially hone in on the vital and life-saving role that female community health workers (CHWs) are playing in unlocking health for all for their peers.

More needs to be done to ensure local female CHW voices are represented in global fora.

I was in New York earlier this month for the Multi-Stakeholder Hearings on Tuberculosis, Pandemic Preparedness and Response, and Universal Health Coverage (UHC), where I delivered an intervention from the floor and highlighted the contribution of CHWs. But it struck me how much more needs to be done to ensure that local female CHW voices are represented in global fora to truly improve the working conditions and guarantee the fair recognition and remuneration they deserve. Too few of the conversations still do not include the voices and point of views from the people who experience the reality of working on the frontlines, and that needs to change.

Why? Because no genuine talk of achieving UHC by 2030 would be complete without thoughtfully considering and integrating CHW solutions and responses. UHC depends on quality primary health coverage (PHC), which in turn relies on paid, professional, skilled, and supported CHWs—in other words: CHWs + PHC = UHC. And we know that scaling up primary health care interventions across low- and middle-income countries could deliver the kind of gains that will firmly set the world on the path to achieving health for all by 2030—from saving 60 million lives to increasing life expectancy by 3.7 years.

With CHWs’ proven ability to save lives and improve health, we must unlock the full potential of this remarkable group to deliver health for all.

12,000 Mentor Mothers reached over 15 million people across Africa with life-saving services.

For m2m, this potential lies in particular with female CHWs. As a former m2m CHW myself in South Africa, and now a passionate advocate for the recognition of and investment in this critical element of the health system, I have experienced first-hand what can be achieved when we invest in female grassroots leadership. m2m’s model of training and employing local women living with HIV as CHWs—known as Mentor Mothers—across ten African countries has created a ripple effect of health and hope for the communities we work with, as well as the women we employ. Since our creation in 2001, nearly 12,000 Mentor Mothers have reached over 15 million people across a dozen African nations with life-saving health services, including maternal and child health, reproductive health, and HIV services; and helped to keep more than two million women and children alive, who would otherwise have been at risk of maternal and child mortality.

Female CHWs like m2m Mentor Mothers have a unique ability to build relationships with their clients, especially women, children, and adolescent girls, and understand what they are going through thanks to their lived experiences. We have also found that engaging men in their homes is often more effective than other spaces. Owing to the insights and skills that training alone cannot provide, and their tireless work in facilities and door-to-door in their communities, Mentor Mothers are ensuring that their peers access, and crucially, stay in care. In 2021, 100% of our clients who tested positive for HIV accessed antiretroviral therapy, compared to an 85% benchmark for Eastern and Southern Africa.

The time to invest in female CHWs is now. Not “tomorrow.”

This is what has made m2m’s impact so meaningful and long-lasting—our investment in, and employment of, African women living with HIV as CHWs.

Yet only 14% of CHWs in sub-Saharan Africa are salaried, and the health sector faces a 24% gender pay gap, despite women making up almost 70% of the total workforce. This is simply unacceptable.

The time to invest in female CHWs is now. Not “tomorrow” or “soon.” Now.

What should this investment be directed towards? Equal and fair pay, and formal recognition of the status and qualifications of female CHWs through certification and accreditation. Those are all things that motivate CHWs to work harder, build the confidence of their community in them as professionals, and show that their work is valued. This is how we help set CHWs up for success and unlock their potential to help us reach the Global Goal of Health for All. I know that this is true because this is what my own employment and remuneration as a CHW meant to me.

The under-representation of women’s voices and needs in the health care sector, and under-recognition of female CHWs is still too rife and needs to change. That is why our work with the Frontline Health Workers Coalition to ensure fair remuneration and full recognition and accreditation of female CHWs in national and global policy frameworks remains so timely and vital—and why, this week, we will be urging United Nations Member States at the WHA to embrace our ask for fairer pay and better recognition for female CHWs, and to create more opportunities to hear from more CHWs at upcoming global gatherings.

This post was originally published on the Frontline Health Workers Coalition Blog. IntraHealth International leads the secretariat for the coalition.

By Babalwa Mbono

Strategic Project Officer, mothers2mothers

HIV & AIDS Policy & Advocacy World Health Assembly Community Health Workers Africa

Is In The Media

Babalwa Mbono, Strategic Project Officer for mothers2mothers and former Mentor Mother, delivers an intervention at the United Nations Multi-Stakeholder Hearing on Universal Health Coverage in New York, May 2023.

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These Adapted Approaches Are Helping Improve HIV Care during COVID-19 in South Sudan

ihadmin2 — Wed, 01 Feb 2023 20:43:50 +0000

These Adapted Approaches Are Helping Improve HIV Care during COVID-19 in South Sudan ihadmin2 February 01, 2023 December 08, 2022

After COVID-19 began to spread, IntraHealth International used two strategies to improve HIV services in South Sudan. The strategies achieved great success and IntraHealth is transitioned them to South Sudan’s Ministry of Health for implementation across the country.

In collaboration with the US Centers for Disease Control and Prevention (CDC) and the International Centre for AIDS Care and Treatment Program (ICAP), IntraHealth used the Incident Management System and Granular Site Management strategies, which fostered teamwork and built data analysis and problem-solving skills among health workers.

By late 2020, COVID-19 had already affected both access to and the quality of health services. And in South Sudan, it was no different. IntraHealth’s Strengthening National Capacity for Integrated HIV/AIDS Health Data Collection, Use, and Dissemination in Support of an Evidence-based Response team saw that the number of adults and children with HIV who were receiving antiretroviral therapy was down to 56%, but because of COVID-19 restrictions, the team wasn’t able to conduct site improvement or joint supportive supervision, and inadequate coordination made implementation with partners at health facilities difficult.

In response to these challenges, CDC, IntraHealth, and ICAP partnered to roll out two different approaches across IntraHealth-supported health facilities: the Incident Management System (IMS) and the Granular Site Management (GSM) strategy.

“The GSM initiative has had many positive impacts on the health facility.”

IMS was originally developed to coordinate and manage responses to World Health Organization-designated public health emergencies of international concern. But Nigeria decided to adopt the IMS approach to manage their HIV programs and saw improved outcomes at high-volume facilities. So South Sudan followed suit to grow their HIV program.

GSM is an intensive approach for onsite program data review and quality improvement that helps improve health workers’ performance, grow HIV programs, and improve the quality of HIV services. Field officers work with teams of health workers to collect data daily. Then they submit data every week to project staff who generate dashboards that are used to review performance and create improvement plans.

After a core team of CDC, IntraHealth, and ICAP members formed in early 2021, they created a three-tiered structure to improve collaboration, streamline communication, and implement IMS:

The organizational unit (CDC, IntraHealth, and ICAP)
Three regional levels led by teams from IntraHealth, ICAP, and RTI International
Facility-level granular site management teams led by field officers.

After the GSM strategy underwent pilot testing, the team rolled it out across 28 high-priority facilities. IntraHealth provided six Zoom accounts to support the GSM calls across the selected sites, developed the schedule, and trained facility staff to use the continuous quality improvement (CQI) methodology to analyze data from the weekly dashboard and implement interventions.

Embedding the CQI approach within the GSM rollout helped 25 field officers and 45 facility staff build their knowledge and skills to provide improved HIV services. It also increased health workers’ confidence because they were participating in calls together with the Ministry of Health, PEPFAR, implementing partners, and other health facility staff.

“The introduction of the GSM initiative to the HIV/AIDS and TB program has had many positive impacts on the facility,” says Tabu Richard Lokeri, a clinician at the Saint Theresa Mission Hospital-Isohe. “Our facility team members are now able to generate and analyze facility data to make informed decisions at the facility levels and we are able to make significant improvements in HIV case identification through index testing.”

The GSM approach allowed space for everyone to attend the same meeting to discuss issues affecting program growth, which led to quick decision-making, easier acceptability of the interventions proposed in the meeting, and close follow-up. Unlike when data is used only at the national level, the GSM approach allowed facility staff to analyze and interpret weekly dashboards and make decisions based on evidence.

The GSM approach allowed facility staff to make decisions based on evidence.

“Through GSM we were able to raise performance issues affecting the facility,” says Olori Thomas, an antiretroviral therapy clinician and the Nyong Primary Health Care Center. “As a result, our facility is now renovated, which has created more space for maintaining clients’ privacy and confidentiality. We were also able to learn and understand our facility gaps and mutually agree on interventions to address them. Through GSM, there has always been room for discussion and learning how different facilities in the region have achieved their targets.''

The GSM methodology has fostered teamwork and built data analysis and problem-solving skills among project teams. Because of its success, the IMS is now transitioning to the Ministry of Health to scale up and introduce to all facilities across the country.

Merekaje Grace and Wole Moses contributed to this news item.

South Sudan HIV & AIDS COVID-19 Strengthening National Capacity for Integrated HIV/AIDS Health Data Collection, Use, and Dissemination in Support of an Evidence-based Response in South Sudan