USAID Regional Health Integration to Enhance Services in Eastern Uganda Activity

ANNUAL REPORT (FY22)

October 1, 2021 – September 30, 2022

AID‐617‐A‐17‐00002

Submitted: October 31, 2022

Submitted by:
William Mubiru
Chief of Party
USAID Regional Health Integration to Enhance Services in Eastern Uganda Activity
IntraHealth International
Table of Contents
ACRONYM LIST....................................................................................................................................................................................... I
EXECUTIVE SUMMARY ...........................................................................................................................................................................1
INTRODUCTION........................................................................................................................................................................................6

Overview............................................................................................................................................................................. 6

RESULT AREA 1: STRENGTHENED CAPACITY OF RRHS, DISTRICTS, AND FACILITIES ...................................................7

1. PROGRAM MANAGEMENT CAPACITY STRENGTHENING OF LOCAL PARTNERS .......................................................7

1.1 IntraHealth RHITES-E Approach to LIP Strengthening .............................................................................. 7

1.2 Local Partner Health Services Activity Karamoja (LPHS-K) ....................................................................... 7
1.3 Moroto Regional Referral Hospital System Strengthening Activity (Moroto RRHSA) ...................... 8
1.4 USAID Local Partner Health Services Eastern Uganda (LPHS-E) .............................................................. 9
1.5 USAID Local Service Delivery Activity (LSDA) ............................................................................................ 10
1.6 Cross-Cutting Technical Assistance to LIPs, Moroto RRHSA, and Mbale RRH ................................... 10

RESULT AREA 2: AN INSTITUTIONALIZED CULTURE OF HEALTH SERVICES QUALITY WITHIN THE RRHS,
DISTRICTS, AND LOCAL PARTNERS............................................................................................................................................... 14
2 CONTINUED HEALTH SYSTEM STRENGTHENING SUPPORT AT THE DISTRICT LEVEL ........................................... 14

2.1 Service Delivery and QI Support .......................................................................................................................... 14

2.2 Family Planning........................................................................................................................................................ 15
2.3 Family Health Quality of Care Initiative ............................................................................................................. 16
2.5 Nutrition .................................................................................................................................................................... 19
2.6 Water, Sanitation, and Hygiene ........................................................................................................................... 20
2.7 TB/HIV: ....................................................................................................................................................................... 21
2.8 Laboratory ................................................................................................................................................................. 23

RESULT AREA 3: INTEGRATED HEALTH SERVICES, MANAGEMENT SYSTEMS, AND SECTORS ............................... 25

3.1 IntraHealth Approach to Transition of Service Delivery Support to the Districts ............................. 25
3.2 Governance & Leadership/Coordination ..................................................................................................... 26
3.3 Optimized Human Resources for Health (HRH)/Health Worker Staffing ........................................... 27
3.4 Supply Chain Management ............................................................................................................................. 28
3.5 COVID-19 vaccination Response ................................................................................................................... 31

RESULT AREA 4: IMPROVED DATA SYSTEMS, DATA USE, AND EFFICIENCIES TO ENABLE HEALTH WORKER
PERFORMANCE ...................................................................................................................................................................................... 34

4.0 Strategic Information / M&E Support ................................................................................................................ 34

4.1 Scaling up the implementation of Point of Service (POS) Electronic Medical Records System ........... 34
4.2 Building capacity for effective data management and utilization .............................................................. 34
4.3 HIV Data use management and utilization ....................................................................................................... 35
4.4 Strategic geographic information system interventions ............................................................................... 35
4.5 Collaborating, Learning and Adapting During the Transition ...................................................................... 35

RESULT AREA 5: GENDER NORMS ADDRESSED AND CLIENT-FOCUSED- GENDER SENSITIVE SERVICES
OFFERED ................................................................................................................................................................................................... 38
5.1 Support implementation of high-quality health communication and behaviour change: ................. 38
5.2 Design and implement adolescent/youth-focused interventions: ........................................................ 40
5.3 Address GBV in communities: .................................................................................................................... 41
6.0 FINANCIAL MANAGEMENT & OPERATIONS ...................................................................................................................... 43
7. SUMMARY OF EMERGING LESSONS ......................................................................................................................................... 44

8. SUMMARY OF KEY ACTIVITIES FOR FY23 Q1 ...................................................................................................... 45

ANNEXES .................................................................................................................................................................................................... A

a. Performance Table FY22 ............................................................................................................................................ a

b. Success Story ................................................................................................................................................................ c
c: Annex D: Lab section Tables: 2- ................................................................................................................................ c
d: ANNEX: E Supply Chain Section ............................................................................................................................... c
F: ANNEX F: SBCC Section .............................................................................................................................................. d

FIGURE 5: GRAPH SHOWING EM, ART AND PFM SPARSSS ............................................................................................................................................... 29

FIGURE 6: CHART 1 SHOWING HMIS 105(6) REPORTING RATE AND COMPLETENESS ................................................................................................................. 30
FIGURE 7: GRAPH SHOWING THE INFECTION PREVENTION AND CONTROL ASSESSMENT SCORE .................................................................................................... 32

TABLE 1: GENERAL PERFORMANCE AGAINST THE 8 IPC CORE COMPONENTS OF THE IPCAF TOOL ................................................................................................. 21
TABLE 2: INFECTION PREVENTION AND CONTROL PRACTICES IN SELECTED HCIVS AND HOSPITALS ................................................................................................. 21
TABLE 3: STAFFING LEVELS FOR ANESTHETIC OFFICERS ....................................................................................................................................................... 28
TABLE 4: SUPPLY CHAIN UPDATE BY QUARTER ................................................................................................................................................................... C
TABLE 5: DATA FROM VHT REPORTS ON HOME VISITS ......................................................................................................................................................... D
ACRONYM LIST IPC Infection prevention and control
ITN Insecticide‐treated net
AHD Advanced HIV Disease KP/PP Key Population/Priority population
AMTSL Active management of the third stage LARC Long‐acting reversible contraceptive
labor LIP Local implementing partner
ANC Antenatal care LMIS Laboratory management information
ANECCA African Network for Care of Children system
Affected by HIV/AIDS LPHS‐E Local Partner Health Services‐East
APN Assisted partner notification LPHS‐K Local Partner Health Services‐Karamoja
ART Antiretroviral therapy LQMS Laboratory Quality Management Systems
ARV Antiretroviral LSDA Local services delivery activity
BEmONC Basic emergency obstetric and newborn LTAP Local Transition Award Partner
care M&E Monitoring and evaluation
CBO Community‐based organization MAT Medically assisted therapy
CD Capacity development MbRRH Mbale Regional Referral Hospital
CEmMONC Comprehensive emergency obstetric and MNCH Maternal, newborn, and child health
newborn care MDR Multi‐drug resistant
CHW Community health worker MEL Monitoring, evaluating, and learning
CLA Collaborating, Learning, and Adapting MMD Multi‐month dispensing
CME Continuing medical education MMS Medicines Management Supervisor
COP Chief of Party MOH Ministry of Health
CPD Continuing professional development MoRRH Moroto Regional Referral Hospital
CPHL Central Public Health Laboratories MPDSR Maternal and perinatal death surveillance
CSO Civil society organization and response
CSSP Client Self Service Portal NACS Nutrition Assessment and Counselling
CQI Continuous Quality Improvement Services
D2A Data to action NMS National Medical Stores
DATIM Data for Accountability, Transparency, NTLP National TB & Leprosy Program
and Impact NTRL National Tuberculosis Reference
DBM District‐based mentor Laboratory
DHIS2 District Health Information Software 2 PFM Pharmaceutical financial management
DHMT District Health Management Team PHC Primary health care
DHO District Health Officer PLHIV People living with HIV
DHSA District Health Supervisory Authorities PMTCT Prevention of mother‐to‐child
DHSD Director of Health Services Delivery transmission
DHSS Director, Health Systems Strengthening PNC Postnatal care
DHT District Health Team POC Point of care
DICs Drop In Centers PPE Personal protective equipment
DNAP District Nutrition Action Plan PPFP Postpartum family planning
DNCC District Nutrition Coordination PrEP Pre‐exposure prophylaxis
Committee QI Quality improvement
DOP District Operational Plan QoC Quality of care
DQA Data quality assessment RASS Real‐time ARV Stock Status
DTG Dolutegravir RBF Results‐based financing
EID Early infant diagnosis RH Reproductive health
EMR Electronic medical records RHU Reproductive Health Uganda
FH Family health RRH Regional Referral Hospital
FP Family planning RRHSA Regional Referral Hospital System
G2G Government‐to‐government Strengthening Activity
GBV Gender‐based violence RTLP Regional TB & Leprosy Focal Person
GIS Geographic information system SANAS South African National Accreditation
GOU Government of Uganda System
HC (I, II, III, IV) Health Center (I, II, III, IV) SBCA USAID Social Behavior Change Activity
HDR HIV drug resistance SBCC Social and behaviour change
HFQAP Health Facility Quality of Care communication
Assessment Programme SCM Supply chain management
HMIS Health management information system SGBV Sexual and gender‐based violence
HRH Human resources for health SLMTA Strengthening Laboratory Management
HRIS Human resources information system Toward Accreditation
HSS Health systems strengthening SNS Sexual network strategy
HTS HIV testing services SOP Standard operating procedure
HUMC Health Unit Management Committee SPARS Supervision, Performance, Assessment,
IFA Iron‐folic acid and Recognition Strategy
IIT Interruption in Treatment SRH Sexual and reproductive health
IP Implementing partner

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SSCS Strengthening Supply Chain Systems TWG Technical working group
Activity TX Tested Positive
STI Sexually transmitted infection UHSS Uganda Health Systems Strengthening
TA Technical assistance Activity
TASO The AIDS Support Organisation UVRI Uganda Virus Research Institute
TB Tuberculosis VHT Village Health Team
TDY Templary Duty VL Viral load
TLD Tenofovir, Lamivudine, and Dolutegravir VLS Viral load suppression
TLE Tenofovir, Lamivudine, and Efavirenz VMMC Voluntary medical male circumcision
TPT TB preventive therapy WASH Water, sanitation, and hygiene
WHO World Health Organization
WISN Workload Indicators of Staffing Need

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EXECUTIVE SUMMARY

This report covers the fiscal year (FY) October 1, 2021, to September 30, 2022, which also marks the
fifth year of implementation of the USAID Regional Health Integration to Enhance Services in
Eastern Uganda Activity (RHITES-E). RHITES-E focuses on strengthening health systems and
improving the quality of integrated HIV/AIDS, tuberculosis (TB), maternal, newborn and child health
(MNCH), reproductive health (RH), and nutrition services. This report is aligned to the new program
description as per Clause 7 of Mod 24, with key aspects of capacity development to the local
implementing partners (LIPs) and continued support to district health teams (DHTs) to deliver
quality health services. Below is a summary of the main FY22 results by results area. See Annex 1 for
details on performance indicators.

Capacity Building to Local Entities: This year, RHITES-E shifted its mandate from direct service
delivery support to technical capacity development (CD) for USAID local partner transition award
recipients (Local Health Partner Services-East (LPHS-E) and Local Health Partner Services-Karamoja
(LPHS-K)), two government-to-government (G2G) award recipients (Mbale and Moroto Regional
Referral Hospitals (MbRRH and MoRRH)), and one Local Services Delivery Activity (LSDA) partner
implemented by Uganda Protestant Medical Bureau (UPMB). RHITES-E worked with local partners to
develop technical capacity development plans tailored to specific technical areas/programs. Using
different capacity development approaches such as trainings, targeted on-site coaching, monitoring
and evaluation (M&E) support, and regular Data to Action (D2A) Meetings, RHITES-E was able to
facilitate real-time data reviews and granular site-level action planning to address outstanding gaps.
RHITES-E leveraged approaches and lessons learned from implementing HIV and TB CD deployed
for local partners to cascade operational implementation for the Family Health program for districts
that targeted the G2G partners (MbRRH and MoRRH) too. To date, their workplans have integrated
FH components.

Service Integration: In FY22, RHITES-E provided comprehensive health systems strengthening (HSS)
support for service delivery and integration leading to increased coverage and use of health services
in 30 districts and two cities of Eastern Uganda. In the Family Health program area, several
achievements have been registered, including a reduction in the teenage pregnancy rate from 25%
in Q1 to 22% in Q4 and an increase in maternal deaths reviews from 87% in Q1 to 98% in Q4.
Perinatal mortality reduced from 23 per 1,000 live births to 11 per 1,000 live births. The low
performing areas observed over the year include immediate postpartum family planning (PPFP) (<48
hours), perinatal death reviews (at 52% against the target of 95%), and a high teenage pregnancy
rate, which remains at 22% against the target of 16.6%.

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Quality Improvement Mechanism: In FY22, RHITES-E continued to use the Ministry of Health
quality improvement (QI) framework and approaches to improve performance gaps as part of
building the capacity of regional, district, and facility teams to own and address problems. The QI
focused on ensuring functionality of District Quality Improvement Committees to conduct
coordination meetings, holding district learning sessions as well as ensuring technical assistance (TA)
on data utilization to identify district-specific performance gaps. RHITES-E provided technical
support to districts to take up QI projects based on findings from mentorships, Site Improvement
through Monitoring Systems (SIMS) visits, data reviews and supportive supervision visits. To date,
District QI structure functionality has improved from three functional QI coordination structures to
18 in Eastern Uganda and Karamoja. Nine technical supportive supervision sessions were conducted
by the Mbale Regional Referral Hospital (RRH) to nine districts in Elgon region and two by Moroto
RRH in northern Karamoja.

Data Systems and Efficiencies at District Levels: To improve monitoring and data sharing,
RHITES-E supported the local implementing partners, including RRHs, in data extraction; HIBRID and
TB Info reporting, analysis, and presentation; and use of GIS in programming, including drawing of
maps. RHITES-E coached 48 health information assistants (HIAs) in the use of the family health auto
validation reporting tool in three high-volume health facilities per district. HIAs are better equipped
to identify errors during report compilation, leading to improved data quality and completeness.
Through D2A biweekly sessions, RHITES-E has coordinated data use systematically among the LIPs.
Extensive analysis of low performing indicators is done, and partners discuss mitigation measures on
closing performance gaps.

COVID-19 Vaccination and Emergency Response: RHITES-E continued to roll out an uninterrupted
vaccination agenda in eastern Uganda to reduce severe spread of COVID-19 disease and deaths and
protect health systems. RHITES-E adopted the accelerated mass vaccination campaign strategy
developed by the Ministry of Health (MOH) that included a set of pillar activities, such as
coordination, risk communication and social mobilization; logistics; and vaccine service delivery to
rapidly increase the uptake of the vaccines. With collaboration from other USAID partners and
district teams, the vaccination coverage for the region improved from 5% and 3% for 1st dose and
full dose coverage respectively to 82% and 63%, closer to the national target of 70% full dose
coverage. Additionally, RHITES-E participated in and gave technical guidance to the Bududa and
Kween emergency response to anthrax outbreak activities, including the task force meetings and
social behavior change interventions. RHITES-E is also part of the national-level infection and
prevention control (IPC) subcommittee for Ebola viral disease
Gender, Youth, and Social Inclusion: In FY22, RHITES-E coordinated and facilitated the MoH
national trainers to conduct trainings and continuing medical education (CME) in the LPHS-E, LPHS-
K, and Moroto G2G supported areas. The training was on the rollout of sexual assault kits, and CME
concentrated on issues like gender integration, completeness of entering data into the gender-
based violence (GBV) registers, data use and review reporting, post-GBV care and handling, clear
GBV referral pathways, and child safeguarding policy. RHITES-E collaborated with USAID’s Social
Behavior Change Activity (SBCA) to roll out digital tools geared towards addressing teenage
pregnancies in Kaberamaido District through improving parent-children communication about
sexual and reproductive health (SRH) issues including sexual reproductive health and risks
associated especially sexually transmitted infections (STIs).

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 a. Overview of the Transition of LIPs and the Districts
In FY22, RHITES-E strengthened the program management capacity of local partners as well as
offered HSS support to districts using different approaches, including Data to Action (D2A)
meetings, on-site coaching, tailored trainings, and joint performance review meetings. As part of
assessing the progress of the CD processes, RHITES-E engaged local partners by holding joint
partner coordination and performance review meetings with a focus on site-improvement actions,
cross-learning, and strengthened partnerships. USAID provided technical guidance on key
performance indicators and implementation modalities. Oversight structures like technical working
groups (TWGs) were used to guide transition of Family Health from USAID activities to LIPs. As a
result, LIPs started taking on leadership roles in strategic coordination of service delivery and
execution of focused activities

b. Analysis of Progress/Highlights of TA and Key Service Statistics Strategic Level

Milestones
In FY22, RHITES-E developed strategic milestones through collaborative arrangements with local
partners and executed joint action plans. While developing milestones, RHITES-E has supported
continued health systems strengthening using focused mentorships, alignment of operations,
reinforcement of implementation structures like district-based mentors (DBMs), cross-learning and
check-in sessions, strengthened partnerships, USAID guidance on key performance indicators, and
oversight structures like TWGs. Strategic coordination of service delivery, execution of focused
activities by the LIPs as well as appreciation of and adherence to USAID technical guidance and
implementation modalities all showed specific improvements during the reporting period.

Health Systems Outcomes

Continued health systems support and capacity development has been sustained and improved at
districts and service delivery sites.
 Supply chain: RHITES-E worked with local partners to support and coordinate supply chain
management (SCM) interventions to ensure availability, accessibility, and rational use and
management of medicines and health supplies. Key supply chain deliverables this year
included capacity development of four local partners and 20 districts to conduct all SPARS
interventions and strengthening electronic logistics management information systems, such
as NMS+ Client Self Service Portal and RX Solution system. This was achieved through
mentorships on quality ordering, storage, stock management, prescribing, dispensing, and
regular stock monitoring to improve medicines management in facilities.
 Laboratory services: RHITES-E provided logistical and technical support through technical
coaching and mentorships to the three South African National Accreditation System (SANAS)
accredited laboratories, and they managed to sustain their accreditation statuses. One hub
successfully underwent assessment for SANAS accreditation. Additionally, five non-
accredited Strengthening Laboratory Management Toward Accreditation (SLMTA) hub sites
were also supported to undergo national Laboratory Quality Management Systems (LQMS)
audits in preparation for the certification audits expected in the first quarter of COP23.
 Strategic information: RHITES-E continued to conduct data analytics. Huge data sets from
over five years of implementation were assembled and analysed for insights, highlights,
trends, and visuals. The visuals were transformed into PowerPoint slides which were shared in
various forums, such as learning sessions, Chiefs of Parties (COPs), TWGs, and review
meetings with districts, MOH, and USAID.

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  Quality Improvement (QI): RHITES-E strengthened district health systems using QI
approaches to improve family health and HIV service delivery. For family health, five districts
implementing WHO Quality of Care (QoC) for MNCH, family planning (FP) and nutrition
collaboratives were supported in the region while QI capacity for TB/HIV of LIPs was
developed through training, mentorship, and cross learning at the facility level with LIP staff.
Areas of focus for CD included TB-HIV, pre-exposure prophylaxis (PrEP), Interruption in
Treatment(IIT) , CaCx screening, community QI, viral load coverage and suppression, and
prevention of mother-to-child transmission and early infant diagnosis (PMTCT-EID) through
the respective collaborative platforms.
 Human resources for health: RHITES-E provided capacity development to the districts to
functionalize the National Human Resources for Health Information System (HRIS) through
mentorships of focal point persons to guide planning, recruitment, deployment, and
attendance to duty monitoring. To date, within the region, 10,288 (76%) positions are filled
compared to the approved 13,588 positions.
 COVID-19: RHITES-E collaborated with Epic (Epidemic Control), MOH, Uganda Health
Systems Strengthening Activity (UHSS), Strengthening Supply Chain Systems Activity (SSCS),
SBCA, and Regional Emergency Operation Center (EOC) in response to COVID-19 in eastern
Uganda. RHITES-E engaged in national level COVAX meetings and partner catch-up
meetings to share experiences, discuss challenges, and plan to improve vaccination status in
the region. RHITES-E supported the districts in the Elgon region to clear the data backlog
through boot camps, providing biostatistician with internet data bundles, airtime, and
logistical support. As a result, the vaccination data backlog was reduced by 33% during the
year.

Highlights on Service Delivery Indicator Performance

Out of the 19 core indicators selected in the health areas of integrated family health, HIV, TB, and
COVID-19 (ANNEX 1: Summary of FY22 results on select indicators), nine indicators registered
improved performance or maintained good performance. Five indicators were slightly below targets,
whereas 6 indicators were significantly below targets by Q4. The indicators that have been
consistently below target are: teenage pregnancy at 24% vs. 16.6% target, attendance of Natal Care
visit 4 during pregnancy at 50% vs. 70% target, perinatal deaths surveillance and response (PDSR)
reviews at 52% vs. 95% target, drug resistant TB notifications at 83 vs. 108, and treatment success
rate at 80% vs. 85% target. The number of persons who have been fully vaccinated for COVID-19
increased to 1,187,676 in Q4 from 35,320 in Q1; the annual cumulative is still below target at
1,222,996 vs. 2,045,205 target by September 2022. RHITES-E has documented these non-performing
indicators and has allocated program teams to oversee specific interventions to close these gaps.
The main strategy is through TA on program management to the DHTs and local partners.

c. Summary of Challenges/Constraints

Programmatic challenges during the year

 During the transition of activities to local partners, some districts were not well oriented in the
different obligations of each partner; however, meetings were conducted regularly to clarify the
obligations for each partner.
 Overall, all LIPs did not achieve their annual voluntary medical male circumcision (VMMC) targets.
This may be due to the reduced VMMC facilitation rates that the local partners are offering VMMC
teams coupled with limited funding earmarked for VMMC outreach activities. RHITES-E continued
to engage the district leadership (District Health Officers (DHOs) on the need to continue offering
VMMC services as well as engaging the LIPs to revise the facilitation rates.
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 There was some hesitancy in starting antiretroviral therapy (ART) by some newly diagnosed HIV
patients mainly due to high levels of stigma and discrimination. This hindered efforts towards
reaching 100% linkage of newly diagnosed HIV patients to care. RHITES-E worked with the LIPs to
rollout psychosocial support (PSS) guidelines to improve counselling at all ART sites.
 LPHS-E region continues to report sub optimally for the weekly epidemiological surveillance
reporting (HMIS 033B). RHITES-E in collaboration with the local partners has continued to provide
targeted support to the DHTs/facility teams to build their capacity for accurate and timely
reporting.
 The ripple effects of the COVID-19 pandemic continue to be felt in key service areas such as
uptake and overall outlook of vital indicators like viral load (VL) coverage and suppression.
Nonetheless, RHITES-E leveraged its experience to support the local partners to develop district-
specific approaches to address COVID-19 related challenges.
 Most of the hub sites continue to experience staffing shortages, thus curtailing efforts to realize
accreditation status and offer comprehensive services. RHITES-E has continually managed this
challenge through regular coaching and mentorships to enhance the capacity of available staff to
take on different tasks.
 Commodity management for vital services remains a challenge, especially in the lower facility
laboratories. In this respect, RHITES-E laboratory partnered with the Supply Chain docket to
support commodity management using the SPARS model with a focus on forecasting, ordering,
and stock management. This has resulted in progressive improvement over time.
 The release of PHC funds to districts was delayed during the July-September quarter. This affected
implementation of key activities, especially integrated outreaches. RHITES-E will support catch-up
activities, including integrated child health days and supplementary implementation activities such
as mass polio vaccination.

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INTRODUCTION

Overview

For the past five years (2017 to 2021) RHITES-E has contributed to the capacity development of
the Government of Uganda (GOU) and key stakeholders to increase availability and utilization of
high-quality health services in 30 districts (25 in Eastern Uganda and five in Karamoja) by
strengthening health systems and improving the quality of, access to, and demand for health
services with attention to equity and underserved populations.

Following guidance from USAID/Uganda, RHITES-E started transitioning direct service delivery for
TB and HIV to local entities in 2021. The local entities included Baylor and ANECCA as well as two
Government-to-Government (G2G) awardees—Moroto and Mbale Regional Referral Hospitals—
and one local services delivery activity (LSDA)—Uganda Protestant Medical Bureau (UPMB). This was
in keeping with USAID’s journey to localization and self-reliance. RHITES-E is pivoting this through
supporting technical assistance in 30 districts district and local partner level using the above site-
level capacity development approach.
The capacity development approach focuses on program management strengthening for local
partners, continued health system strengthening at the district level, ensuring the continuation of
services in the context of COVID-19, and coordination of all USAID local partners in the East region
to ensure a cohesive family health, HIV, and TB response. In addition, and consistent with the latest
GOU health guidelines, standards and policies, RHITES-E is building the capacity of and providing
TA to these five stakeholders to implement targeted, evidence-based approaches that promote
integration of service delivery; increase efficiencies; promote decentralization and sustainability;
strengthen district, facility, and community partnerships; and fully engage the private and the not-
for-profit health care sectors that provide vital health services in the 30 districts. RHITES-E will
leverage all available assets while transitioning leadership to government and local entities.

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RESULT AREA 1: STRENGTHENED CAPACITY OF RRHS, DISTRICTS, AND FACILITIES

1. Program Management Capacity Strengthening of Local Partners

1.1 IntraHealth RHITES-E Approach to LIP Strengthening

Beginning in FY22, RHITES-E transitioned direct service delivery support to the MOH at the district
level as well as strengthened several local recipients of direct USAID funding. RHITES-E
implemented data-driven and collaborative technical assistance, capacity building, and continuous
quality improvement approaches. RHITES-E develops the capacity of health workers by
establishing and maintaining technical working groups to review FH performance, identify service
quality and access gaps, and plan follow-up coaching and mentorship. RHITES-E strengthens
quality improvement in the region by ensuring functionality of District Quality Improvement
Committees through coordination meetings, district learning sessions, and technical assistance on
data utilization, prioritization of performance gaps, and use of relevant indicators to improve
tracking of corrective actions.

In FY23, RHITES-E will further contribute to strengthening the HSS building blocks of leadership
and governance, strategic information management, access to essential commodities, health
financing, and laboratory services operations across the 30 supported districts. Further emphasis
will be placed on implementing close-out activities, including holding close-out meetings with key
stakeholders, dissemination of change packages, and working with the RRHs to implement the
hub and spoke approach.

1.2 Local Partner Health Services Activity Karamoja (LPHS-K)

RHITES-E conducted joint sit-in mentorships with the
LPHS-K in Kacheri HC III, Rengen HC III, Nakapelimoru
HC III, and Lokitelebu HC III to strengthen use of the
(HIV testing services) HTS screening tool. Additionally,
RHITES-E in collaboration with MOH and Uganda
Virus Research Institute (UVRI) supported LPHS-K to
train 20 staff members at six sites in HIV recency
testing and mentored one previously trained site. All
seven sites were activated, increasing the number of
sites from four to 11.

Under lab systems strengthening, RHITES-E supported

Participants from LPHS‐K participating in the the regional and district training of four nationally
HTS recency training in Kotido selected phase one sites for POC EID/VL training.
More than 30 health workers were trained, and this
has helped improve timely diagnosis of EID and VL monitoring of pregnant and lactating mothers.
RHITES-E also supported service improvement initiatives by taking part in the integrated joint
supportive supervision in selected health facilities. Support was also offered to three laboratory hubs
to prepare for the national audit exercise; this resulted in maintenance of the star rating of these
sites and improvement by one step for one hub. Adequate and appropriate logistical support was
offered to the hub sites to ensure an uninterrupted sample transportation network and overall hub
operations.

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LPHS-K pediatric ART optimization: In COP 21, LPHS-K region had 40% pediatric dolutegravir
(DTG) transition coverage by end of Q2. RHITES-E, therefore, conducted data analysis with the team
accounting for every child that was not transitioned to DTG according to the national HIV
prevention and treatment guidelines. The RHITES-E team worked with the local partner and the
district logistic team to ensure accurate quantification and ordering of pediatric DTG and
redistributed drugs to the sites that had not received the drug from the national warehouses. The
local partner supported the health facilities to mobilize the children for transitioning, and, by end of
June 2022, LPHS-K had achieved 85% transition coverage and 90% by end of September 2022.

Cervical cancer screening and management: In COP 21, RHITES-E supported payment of mentors’
per-diems, while the local partner (LPHS-K) provided transportation to the mentors, ensured
availability of cervical cancer commodities at the sites, and mobilized the patients and ensured their
presence at the facilities. RHITES-E also worked with the local partners to establish weekly targets for
the health facilities and followed up with MOH/USAID to ensure availability of cervical cancer
screening commodities in the health facilities that had been allocated targets. LPHS-K achieved 55%
performance towards the cervical cancer screening target in Q4, an improvement from 2% in Q1
against the annual target.

1.3 Moroto Regional Referral Hospital System Strengthening Activity (Moroto RRHSA)

RHITES-E conducted joint supportive supervision visits with the

Moroto RRHSA prevention team to establish the challenges
impeding the VMMC team from offering VMMC services. It was
established that a lack of resources was the major reason the
partner had failed to offer VMMC outreach services, which
generate the majority of VMMC outputs. This was because
Moroto RRHSA did not budget adequately for the outreach
activities.

Under the hub operations, RHITES-E supported the Moroto

Regional Referral Hospital laboratory hub to develop a workplan
Participants from Moroto RRHSA
participating in the VMMC dorsal slit skills
and budget for COP22 under the G2G mechanism. RHITES-E training.
supported the sample transportation network, which ensured
effective sample and results linkages between the lower facilities and the hub. RHITES-E also
supported maintenance and necessary repairs of the automated hub. Additionally, RHITES-E
supported the training of the laboratory staff, midwives, and data assistants on Point of Care (POC)
EID and viral load testing for HIV-exposed infants and pregnant and lactating mothers, respectively.
This improved the results turn around time from 28 to 17 days and ensured timely management of
clients. The hub underwent a successful SANAS surveillance audit courtesy of the continuous
support and site preparation facilitated by RHITES-E.

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1.4 USAID Local Partner Health Services Eastern Uganda (LPHS-E)

RHITES-E supported LPHS-E to

conduct trainings on HIV self-
testing, Social Network
Strategy (SNS), and assisted
partner notification
(APN)/Index testing for 652
health facility staff from 163
ART sites. This training was
Participants from LPHS‐E region undergoing an HIV self‐testing, SNS, APN index training
aimed at scaling up high
yielding HIV-positive case identification strategies in the region which enabled LPHS-E to achieve
(4,750) 98% of their Tested Positive (TX ) new target and a yield of 2%.

RHITES-E supported LPHS-E to set up the

medically assisted therapy (MAT) clinic at
Mbale RRH, conducted MAT
stakeholder’s meetings, and facilitated
learning site visits for the Mbale RRHSA
MAT team to the Butabika National
LPHS‐E team participating in a MAT clinic site visit at Butabika national referral Referral Hospital MAT clinic. MAT
Hospital. mentorships also targeted 55 health
facility staff from the 11 key population (KP) sites. RHITES-E coordinated seven MAT weekly update
meetings with LPHS-E to discuss progress made towards setting up the MAT clinic at Mbale RRHSA.
During these meetings, a road map to set up the MAT clinic was developed and action points with
responsible people were recommended. This road map was reviewed regularly to keep track of
actions that had been implemented and to develop interventions to address the gaps for the
pending action points. Additionally, RHITES-E coordinated with MOH and Uganda Viral Research
Institute to conduct HTS recency testing trainings for 32 ART sites to improve HIV recency testing in
the region. To improve KP micro planning for the HIV interventions, RHITES-E supported LPHS-E to
conduct GIS mapping of all KP hotspots in the region to establish their exact locations and to
explore which partners we can leverage resources with to improve KP services.

RHITES-E offered support in periodic workplan and

USAID team giving SIMS feedback to the staff of Tirinyi
HCIII in Kibuku district. The facility attained an overall
score of 86%.
budget development, including the workplan and budget
for COP23. RHITES-E also took part in the integrated joint
supportive supervision visits in selected health facilities. As
a result, RHITES-E has registered sustenance of the
accreditation status of two accredited laboratory hub sites
in the region, a successful accreditation assessment of one
laboratory hub (Pallisa general hospital hub) by the South
African National Accreditation Society (SANAS), and
successful national audits for two non-accredited
9
laboratory hubs. Further, RHITES-E supported the national rollout of POC EID/VL training and surge
activities for the 12 selected phase one sites. This has resulted in an improved rate of diagnosis for
EID and VL monitoring for pregnant and lactating mothers. RHITES-E also supported capacity
building of personnel from three hubs by undergoing four cycles of nationally organized training
aimed at strengthening Quality Management System implementation and sustainability.

1.5 USAID Local Service Delivery Activity (LSDA)

Above site technical assistance

RHITES-E conducted a performance review meeting with the LSDA to identify the causes of the poor
linkage to care, which had dropped from 88% in Q2, to 83% in Q3. Poor documentation was
identified as the major cause of the poor linkage especially in Budaka, Mbale, Pallisa, Kibuku,
Sironko, Moroto, and
Kaabong districts. It was
observed during compilation
of monthly reports that
clients already in care were
being captured as new
positive clients in the HTS
register. This creates a false
impression that the new
clients are not linked to care,
The manager AIC Mbale giving opening remarks during the USAID KP TDY visit. yet they are already linked.
RHITES-E conducted joint
supportive supervision visits with the LSDA prevention team to orient the data assistants on how to
document known positives in the HTS register to avoid duplication of numbers at reporting.

Additionally, RHITES-E conducted joint preparation site visits with LSDA staff to prepare AIDS
Information Center Mbale, The AIDS Support Organization ( TASO) Mbale, and Mooni Drop-in
Center for the USAID KP Templary Duty( TDY) Y visit that was conducted in July/2022 to review the
performance of the KP program in the eastern region. RHITES-E provided technical assistance to the
LSDA laboratory team to ensure efficient and effective management of the LSDA supported
laboratory sites in the region. This involved reviewing and providing feedback on performance data,
logistic support where and when needed, and workplan and budget development.

1.6 Cross-Cutting Technical Assistance to LIPs, Moroto RRHSA, and Mbale RRH

RHITES-E supported the Mbale RRH laboratory hub to develop a workplan and budget in
preparation for the transition to the G2G mechanism. The sample transportation network was also
supported. This network ensured effective sample and results linkages between the lower facilities
and the hub. This was done by providing fuel, airtime, and data bundles; servicing and repairing
motorcycles; replacing one old motorcycle; and servicing equipment, including providing assorted
stationary for printing results. Additionally, RHITES-E supported the laboratory hub with site
preparations for the SANAS audit that led to the hub sustaining its accreditation status.

10
 Mbale RRH lab staff receiving a debrief after the SANAS audit. Sputum samples in the fridge collected from the
community during the national TB CAST campaign.

RHITES-E, in collaboration with the MOH Safe Male Circumcision (SMC) Monitoring Unit, conducted
VMMC site accreditation exercises for all 30 VMMC sites in the eastern region and Karamoja during
which all achieved full accreditation to offer VMMC services. RHITES-E spearheaded negotiations
with the district VMMC teams on behalf of the local partners to offer VMMC services at a lower cost
compared to previous COP years due to the limited budget the local partners have been allocated.
This consequently improved VMMC performance during the year since more facilities were now
offering VMMC services.

Six monthly meetings were held through the laboratory technical working group (TWG) platform to
ensure planning, implementation, and activity monitoring which has resulted in the continuous and
uninterrupted hub operations. This includes facilitating the sample transportation network and
coordination among the hub teams. RHITES-E offered support to the respective regions to ensure
timely transition to the regionalization plans through the G2G mechanisms. This aspect has a
cascading effect that ensures support to the laboratory hubs affiliated with the respective regional
referral hospital hubs. RHITES-E supported LPHS-E and LPHS-K to prepare for the USAID KP TDY visit
that took place in July 2022. During the TDY, 20 People who inject drugs (PWIDS), two civil society
organizations (CSOs), two Drop-in centers (DICs), and two KP facilities were visited in the LPHS-E
and LSDA regions.

11
LPHS-E, LPHS-K, LSDA & Moroto RRH Strengthening Activity

Functionalization of regional 3rd line ART meetings: In COP 21, RHITES-E collaborated with the
MOH to train the regional HIV Drug Resistance trainers/mentors, then worked with LPHS-E, LPHS-K,
Moroto RRHSA, and LSDA to kick start the regional third line ART meetings in Mbale and Moroto
RRHs. RHITES-E mobilized the trained regional mentors, identified cases for discussion, agreed on
the meeting schedule, and built the capacity of the regional trainers/mentors and the local partners.
This was done with the support of the MOH to utilize the national HIV drug resistance (HDR)
dashboard to identify patients that need to be discussed and the facilities serving them.

To build the capacity of regional mentors and local partners, RHITES-E collaborated with health
trainers based at Mbale Regional Referral Hospital to conduct coaching and mentorships at selected
high-volume sites which had patients eligible for HDR. The local partners mobilized the health
workers at these health facilities and identified key district-based mentors and their staffs to
participate in the exercise with the plan that after the coaching and mentorships at these sites, the
local partners would support the district-based mentors to conduct coaching and mentorships at
the remaining sites in their respective districts. RHITES-E was able to conduct mentorships in ten
health facilities (three in Bukedi and seven in Bugisu).

The national HDR dashboard revealed that no samples from HDR had come from the Sebei districts;
RHITES-E, therefore, worked with MOH trainers to conduct district-based orientations of health
workers from the districts of Sironko, Bulambuli, Kapchorwa, and Kween. This was followed by
district-based case discussions to further build the capacity of the districts to conduct HDR
management in their districts.

Retention in care and treatment: To address the challenge of treatment interruption at health
facilities of LPHS-K, LPHS-E, LSDA and Moroto RRHSA, which occurred during COP 21, RHITES-E
collaborated with the MOH and conducted a care and treatment QI learning session focused on
optimizing retention. The local partners identified causes of treatment interruptions and developed
QI projects to improve TX-CURR performance. As a result, in FY22, 6,327 patients were newly
identified and enrolled on ART. Of these, 104 were from G2G, 4,750 from LPHS-E, 1,090 from LSDA,
and 383 from LPHS-K. RHITES-E has achieved current treatment of 68,178 (85% of the target of
80,085), with G2G contributing 59% (647/1,100), LPHS-E 91% (45,079/49,586), LPHS-K 53%
(2945/5609), and LSDA 82% (19,507/23,667).

Learning sessions for care and treatment: In COP 21, RHITES-E collaborated with the MOH to
conduct regional learning sessions for all the local partners. Learnings were drawn about the
following indicators: retention in care and treatment, viral load coverage and suppression, MMD,
and ART optimization among children and adolescents. Lessons drawn from health facilities/districts
that are performing well were shared with poorly performing facilities/districts; DHOs/ART in
charges from districts/facilities that are not performing attended this meeting. The districts, with the
support of the local partners, developed action plans targeting the poorly performing indicators of
the districts.
12
Providing TA through cross learning platforms
To ensure a smooth transition, sustain quality, and achieve HIV care and treatment targets in COP21,
RHITES-E supported the establishment of the HIV Care and Treatment Technical Working Group as a
strategy for providing clinical, technical, and programmatic technical assistance to the HIV care and
treatment technical leads of the local transition partners of G2G Moroto, LPHS-K, LPHSE, and LSD-
UPMB. Local partners, however, complained about too many meetings that interfered with their
planning, field work, and support to health facilities/districts.

The complaint was expressed across the different program areas and resulted in the merging of TB
and Eliminating Mother to Child Transmission (EMTCT) into the HIV Care and Treatment TWG, and
the team members met biweekly. Three meetings were conducted; however, there was low
attendance for the first two meetings, during which the local partners shared performance along the
different indicators. At the third meeting, the local partners were provided with four key indicators
(interruption of treatment (IIT, TX_ML); cervical cancer prevention; viral load coverage/suppression;
and TB preventive therapy (TPT)) that are lagging. The technical working group meetings were
eventually merged into the USAID RHITES-E/RHITES-EC local partners meetings which were initially
happening bi-weekly. By end of COP21, the local partners meetings replaced TWGs, these were
conducted on a monthly to draw lessons and improve the performance in the region.

13
RESULT AREA 2: AN INSTITUTIONALIZED CULTURE OF HEALTH SERVICES QUALITY WITHIN
THE RRHS, DISTRICTS, AND LOCAL PARTNERS.

2 Continued Health System Strengthening Support at the District Level

IntraHealth International’s approach to supporting districts to build a culture of health service

quality uses several CD approaches, including the establishment of FH Technical Working Groups,
routine mentorship and supervision, revision of the staffing structure (attaching key staff to districts)
as well as conducting a district matrix to establish priority districts (i.e., light touch and intense
touch). RHITES-E uses other existing opportunities, especially participating in DHT meetings, partner
coordination meetings, and functionalization of the multi-sectoral platforms—especially the District
Nutrition Coordination Committee (DNCC) and integrated supportive supervision activities—to
deliver tailored support to districts in partnership with RRHs. Working with other implementing
partners. IntraHealth, through RHITES-E, advocates for increased budgetary allocation for critical FH
technical areas like primary health care (PHC) and efficient utilization of available resources.

2.1 Service Delivery and QI Support

In year five, RHITES-E continued with its mandate of strengthening the regional and district QI
structures and ensuring their functionality. RHITES-E supported the quarterly regional QI
coordination meetings for both Karamoja and East. The district QI structure improved functionality
from three functional district QI coordination structures to the current 18 districts in Eastern Uganda
and Karamoja. As part of the regional mandate, RHITES-E supported Mbale and Moroto RRHs to
conduct supportive supervision for QI and integrated supportive supervision and technical
supportive supervision to nine districts in Eastern Uganda and two districts from Karamoja region.

Pallisa and Kotido hospital teams demonstrating use of service gap identifier to identify services
PBFW are eligible for

14
 I. For family health, the WHO Quality of Care (QoC) for MNCH, FP, and nutrition was supported
in a total of ten sites in the five collaborative districts of Pallisa, Mbale, Kapchorwa,
Kaberamaido, and Amuria and three non-collaborative districts of Serere, Tororo, and
Bududa. This was done to beef up district capacity to offer quality health services given that
family health implementation was transitioned to and is fully supported by the districts while
RHITES-E provides above site technical support to the districts. Eighteen District Based
Mentors (DBMs)/Coaches participated in capacity development through orientation
trainings; two rounds of coaching were supported in 13 selected health facilities in these
districts; and harvest/learning meetings were conducted to share best practices.
II. For TB/HIV, capacity of LIPs and district/regional mentors were developed through
orientation trainings, mentorship, and cross-learning and sharing at both physical and virtual
learning events. Joint mentorship and coaching were also conducted at the facility level with
LIP staff. Areas of focus for CD included TB-HIV, PrEP, IIT, CaCx screening, community QI, viral
load coverage and suppression, and PMTCT-EID through the respective collaborative
platforms.

Formulation of QI Technical Working Group

RHITES-E supported the formation of the Quality Improvement TWG as part of its mandate to
support the transition process to the local transition partners, Baylor LPHS-E, ANECCA/LPHS-K,
Moroto RRH/G2G, and UPMB/LSDA. Terms of reference (TORs) were developed and shared with all
the above-mentioned implementing partners detailing the various processes of the TWG, TWG
objectives, team composition, scope of work, and activities to be done.

Development of change packages, QI tracking tools & mentorship guide

RHITES-E supported the development of QI change packages, innovated QI tracking tools (e.g., QI
functionality dashboard and client scheduler for community contacting) and developed a
mentorship guide/checklist. These were shared with the LIPs and the districts as part of RHITES-E’s
mandate to conduct capacity assessment and technical capacity building of the LIPs and the district
health team.

Technical working group meetings and supportive supervision

RHITES-E worked with the districts to establish district-level family health technical working groups
across all the 25 districts and two cities. These are led by the DHOs and composed of the different
district technical focal persons and district-based mentors. The district based TWGs have provided
an opportunity for district teams to routinely share performance of key FH indicators and identify
poor performing indicators and health facilities which are supported for improvement using the data
driven supportive supervision. RHITES-E has also collaborated with the RRHs to implement the hub
and spoke model through facilitating RRH consultants to build capacity of districts and health
facilities especially on maternal, newborn, and child health service delivery.

2.2 Family Planning

During the transition phase, RHITES-E continued to build on the success of current USAID
investments in Eastern Uganda and leveraged partnerships and strong synergies with the districts to
improve family planning. In Q4, 108,472 new users received an FP method and 99,058 returning
users continued use of FP. There was a 24% increase in total FP users in FY22 (851,282) compared to
FY21 (687,142). The proportion of adolescent FP users aged 10- 19 years increased from 19% (Q3) to
22% (Q4), with an associated decrease in the teenage pregnancy rate from 24% in Q3 to 22% in Q4.
The annual teenage pregnancy rate in FY22 stagnated at 24% compared to FY21 (25%). There is an
15
improvement in postpartum FP (PPFP) uptake from 37% in Q3 to 42% in Q4. PPFP uptake in the
extended postpartum period increased from 36% in Q3 to 40% in Q4. Though still low, there is a
slight improvement in immediate PPFP uptake (from 1.1% acceptance rate in Q3 to 1.8% in Q4). The
annual PPFP uptake increased to 40.6% in FY22 from 36.9% in FY21. The stock-out rate of FP
commodities declined from 53% in Q3 to 51% in Q4. However, the annual stock-out rate increased
from 40% in FY21 to 49% in FY22.

To achieve the above results, RHITES-E supported the districts and developed the capacity of 216
district-based mentors (DBMs), through the established family health TWGs, to offer and integrate
FP in HIV, MNCH, and nutrition both at the community and facility levels. Through a family planning
monitoring visit with the USAID team in May 2022 to selected health facilities, we identified
knowledge gaps among some health workers on PPFP, the updated medical eligibility criteria, and
the understanding of new users and revisits. Through the established family health TWGs, we
oriented the 216 DBMs across 25 districts and two cities on PPFP, the timings, contraceptive
eligibility for immediate and extended postpartum period, proper data capture and utilization, and
USAID FP policies and compliance. The FP DBMs rolled out the same updates to health facilities
through mentorship, supportive supervision, and continuous medical education. A total of 540
health workers across 135 high volume health facilities were mentored and supported to offer
quality and integrated FP services. We printed postpartum contraceptive method eligibility charts
and Tiahrt amendment standard operating procedures (SOPs), and the DBMs distributed them to all
these health facilities. The DBMs also mentored village health teams (VHTs), satisfied users, and
community-based FP providers on community interventions to address myths and misconceptions,
to conduct community awareness campaigns with a focus on adolescents and young women, and to
create demand for FP services.

The high stock-out rates of FP commodities at 49% are attributed to low order fulfilment rates by
National Medical Stores (NMS) and notable delays in effecting inter-warehouse commodity transfers
from Joint Medical Stores (JMS). To address these gaps, the RHITES-E supply chain team worked
closely with the districts and NMS/JMS to support redistributions and follow-up on orders to bridge
the gaps. The supply chain team also mentored the medicines management supervisors on bi-
monthly ordering and monthly stock surveillance.

RHITES-E also collaborated with other implementing partners like Marie Stopes, Reproductive
Health Uganda, AMREF, Living Goods, and Jhpiego to conduct community activities addressing
myths and misconceptions and to offer FP methods. The implanting partners were engaged during
the district-level TWG, regional partner coordination, and performance review meetings.

2.3 Family Health Quality of Care Initiative

Integrated Family Health WHO Quality of Care Collaborative Activities: In FY20 and FY21,
RHITES-E oriented and supported 10 CEmONC/BEmONC facility staff across five districts of
Kapchorwa, Mbale city, Katakwi, Kaberamaido, and Pallisa to implement the WHO MNH quality of
care interventions. In FY22, we scaled up the WHO standards of integrated nutrition, maternal,
neonatal, family planning, and child health collaborative to two additional districts of Serere and
Tororo and 11 additional health facilities. In collaboration with the MOH, the MCHN Activity and the
quality improvement officer of the eastern region, RHITES -E conducted a three-day orientation for
28 regional coaches across Teso, Sebei, Bugisu, and Bukedi clusters on the nutrition, MNH, FP and

16
child health collaborative standards and indicators. The coaches were then supported to conduct
coaching visits based on the gaps identified and data collected in the 21 health facilities. The
collected data was entered into the nutrition, MNH, FP and child health collaborative dashboards,
and it showed satisfactory performance in key high-impact process indicators over an eight-month
period. For example, active management of the third stage of labor (AMTSL) registered a
maintenance above 90% (95%, 94% and 93%) and 100% of children under five years of age
presenting with diarrhea were appropriately treated.

In June 2022, the regional coaches were supported to conduct a two-day harvest meeting for the
family health QI activities. The coaches identified QI projects that had consistently showed
improvement for six plottable points, which were submitted and presented through panel
discussions, poster, or power point presentations. A total of 16 tested changes were harvested in the
areas of partograph use, review of perinatal deaths, management of postpartum hemorrhage,
prevention of puerperal sepsis, increasing ANC 1 in the first trimester, and postnatal care (PNC)
coverage at six weeks.

2.4 Maternal, Newborn, and Child Health

2.4.1 Family Health Technical Working Group coordination meetings and supportive
supervision.

The main strategy used to sustain the achievements made over the previous years in the MNCH
thematic area was FH TWGs; the others being quality of care collaboratives and maternal and
perinatal death surveillance and response (MPDSR). Out of an average of 15 members of the TWG,
three are district-based mentors of MNCH tasked with supporting the maternal, newborn, and child
health activities and are drawn from either midwifery or medical officers’ cadres. In each of the four
quarters of FY22, one meeting was conducted with support from RHITES E in at least 24 of the 27
districts and cities to share performance, celebrate successes, brainstorm causes/challenges for the
gaps in performance, and lay strategies to address those challenges.

Across the 24 districts and cities, the TWG picked five key indicators to track performance. These
indicators were ANC in the 1st trimester, ANC 4 visit coverage, health facility deliveries, postnatal
care at six weeks, and measles and fully immunized coverage for children under one year of age.
Other indicators were also tracked alongside the continuum of care, including process indicators of
partograph use, supplementations in ANC/PNC, screening in ANC/PNC, and prophylactic treatments
in ANC, while other antigens for child health and IMCI strategy were also tracked. Data driven
supportive supervision was then conducted in each of the 24 districts/cities based on the gaps
identified. Health facilities performing below the MOH targets were prioritized as well as those with
specific challenges. The districts were supported to reach at least five health facilities per quarter.
Supervision findings were shared at the DHT meetings, performance review meetings, and in the
next TWG meeting. Based on the gaps identified, the tools used for supervision were not uniform.
The Health Facility Quality of Care Assessment Programme (HFQAP) tool, MOH supportive
supervision tool, SIMS FH tool were among the tools used, while others innovated checklists to
address the local challenges.

17
Figure 1: Graph showing the Maternal Cascadeperformance FY22

As seen in in the figure above, ANC in 1st trimester has been maintained at 44% in Q1 and 45% in
Q4, just below the national target of 50%. ANC 4 coverage is at 50% and deliveries coverage at 79%
across the RHITES E region.

Using collaboration, RHITES-E worked with MOH to implement the Malaria In Pregnancy (MIP)
mentorship in six select facilities in each of the 25 districts with the HEROES/AMREF project in the
areas of sexual and gender-based violence (SGBV) and RH/MNCH. To increase demand for services
and improve health-seeking behavior, radio talk shows, public service announcements, and VHT
strategies were used to mobilize and educate the communities on behaviour change and disease
prevention.

In the next FY, RHITES-E shall continue the above strategy using the FH TWG and strengthen
collaboration with other stakeholders supporting service delivery.

2.4.3: Integrated Maternal and Perinatal Death Surveillance and Response (MPDSR):
The analysis of FY21 MPDSR at Mbale and Soroti RRHs revealed most deaths were referrals from
lower health facilities. In FY22, RHITES-E supported the RRHs and district teams to conduct
orientations and strengthen the district and hospital MPDSR committees to perform their roles in
supporting lower-level facilities in case management, appropriate referral, and ensuring availability
of human resources, equipment, and supplies at these facilities. The regional referral consultants
oriented 14 district MPDSR committees—four in Teso, three in Sebei, four in Bugisu, and two in
Bukedi sub-regions—on their roles and responsibilities to prevent maternal and perinatal deaths.
The committees developed their teams and started conducting quarterly review meetings and
confidential inquiries whenever necessary.

The RRH teams—including consultant obstetricians, medical officers, nursing officers, and
anesthetists from Mbale and Soroti RRHs—mentored a total of 122 health workers from ten
hospitals and Health Center IV (HCIVs) across the region on management of postpartum
hemorrhage, premature labor, pre-eclampsia, neonatal resuscitation, and partograph use.

RHITES-E facilitated the MPDSR committees of Bukedea and Katakwi districts to conduct community
dialogues as a response strategy in areas that reported maternal deaths attributed to delays
associated with seeking care from traditional birth attendants. One dialogue was conducted in
Bukedea district with 30 Participants. In Katakwi, two dialogues were conducted in Aparasia and

18
Atira sub-counties, attracting 60 participants composed of TBAs, VHTs, community and local leaders
together with health facility staff and DHT.

As a result, 99% of maternal deaths and 51% perinatal deaths were reviewed throughout the year.
The number of maternal deaths decreased from 163 to 142, and perinatal deaths decreased from
2,943 to 2,513. This represents a maternal mortality ratio reduction from 68.9/100,000 births to
61.5/100,000 births and perinatal mortality rate of 12.4/1000 births to 10.9/1000 births.

2.5 Nutrition

District Level Family Health Technical Working Groups and Supportive Supervision to Improve
Nutrition
During the reporting period, RHITES-E continued to support districts to ensure prevention and
management of malnutrition and strengthen district nutrition governance. During FY22, RHITES-E
supported nutrition service delivery at district and community levels for the first quarter and later
above site technical support to nutrition implementation at the district level. Through the district-
level FH technical working groups, RHITES-E supported the districts to review nutrition performance
and integrate supportive supervision to improve poor performing indicators, including nutrition
assessment, iron and folic acid supplementation, and vitamin A supplementation. As a result of the
targeted supportive supervision, nutrition assessment has improved from 47% in FY21 to 56% in
FY22, against the annual target of 85%, with 50% of children 6-59 months receiving nutrition
assessment compared to 52% in FY21 against the 50% target as shown in figure 2 below.

Figure 2: Quarterly and Annual trends in nutrition assessment in the region

During FY22, RHITES-E in collaboration with USAID MNCH and World Vision Uganda, supported the
rollout of sub-regional training of trainers (ToT) on maternal, infant, young child, and adolescent
nutrition (MIYCAN). A total of 87 ToTs were trained, including RHITE-E and World Vision officers.

To improve the breastfeeding practices in the region and the quality of nutrition support during the
first 1000 days of life, RHITES-E supported MOH district-based mentors to conduct quarterly
mentorship at 48 high-volume health facilities implementing the Baby Friendly Health Facility
Initiative (BFHI) and supported the MOH to conduct a BFHI internal assessment of 28 qualifying
health facilities of which 11 are ready for external BFHI accreditation.

HMIS data shows an improvement in the number of pregnant and children 0-59 months reached
with nutrition-specific interventions in FY22. A total of 174,535 (65%) pregnant women received iron
19
and folic acid at ANC1, and at 36 weeks 107,104 (67%) as compared to 182,410(63%) in FY21. See
figure 3 below. A total of 1,439,257 (96%) children 0-59 months were given a first dose of vitamin A
and 1,083,479 (73%) received a second dose against the annual target of 254,170. This was an
overachievement against the target due to the extended integrated Child Health Days in Q1. The
proportion of infants breastfed in the first hour of birth improved from 90% to 92% against the
annual target of 95%.

Figure 3: Pregnant women and children 0‐59 months reached with nutrition specific interventions

RHITES-E also supported community interventions to

promote MIYCAN using the family care group (FCG)
model with integration of WASH and key family care
MCH practices. The family care group model has been
implemented in 20 districts and 35 sub-counties. A
total of 15,612 children 0-23 months were reached with
nutrition specific interventions, and 13,853
pregnant/breastfeeding mothers and caretakers of Care group review in Mulanda SC, Tororo

children 0-23 months were reached through 1,562 care

groups.

Support to District Nutrition Coordination Committees: During the FY, RHITES-E continued to
support all the 25 districts to strengthen multisectoral nutrition planning and governance by
conducting a final review of their District Nutrition Action Plan (DNAP) in line with the Uganda
Nutrition Action Plan 2. These districts have moved to have their plans approved by the district
councils. RHITES-E will continue to support printing and implementation follow-up.

2.6 Water, Sanitation, and Hygiene

In FY22, RHITES-E continued to support districts to promote appropriate water sanitation and
hygiene (WASH) and infection prevention and control (IPC) practices at community and health
facility levels. Through the district-level Family Health Technical Working Groups, WASH
performance is reviewed and health facilities with poor performance are identified for continued
support. During FY22, functionalization of the health facility level IPC committees was a key area of
focus for supportive supervision, and it was found that all health facilities in the region have IPC
committees. However, more effort is still required to ensure their functionality.

20
Community-level promotion of WASH practices: RHITES-E supported community WASH
promotion and sensitization activities were conducted through media and home visits, integrated
into COVID-19 sensitization efforts and nutrition care groups, and celebrated during Sanitation
Week in Manafwa, Sironko, Budaka, and Bulambuli to promote practices that prevent diarrhea,
especially among children under five years of age. These activities focused on cholera prone
communities while also emphasizing continued routine reporting. By the end of FY22, 25 districts
reported on community data. DHIS2 data showed a total of 684,241 households were visited by
VHTs in FY22. Of these household, 68% have a latrine, 22% have an improved latrine, 25% have
handwashing facilities with soap and water, and 73% have safe drinking water.
Health facility WASH/infection, prevention, and control: During FY22, RHITES-E continued to
support districts to conduct health facility WASH/IPC audits, and, in Q1, nine health facilities had
improved IPC practices (>80%) out of the annual target of 20. As RHITES-E transitioned to above site
TA to the districts, an assessment was conducted using a WHO Infection Prevention and Control
Assessment (IPCAF) tool in 21 HCIVs and hospitals. They were assessed against the eight IPC core
components. The assessment showed that over 70% had IPC programs and guidelines, were trained
on IPC, and had health care associated infections (HAI) surveillance; however, there is a need for
more frequent monitoring of the health facilities for IPC/WASH improvement.

Table 1: General performance against the 8 IPC core components of the IPCAF tool

7. Workload, staffing,
Associated Infections

8. Built environment,
6. Monitoring of IPC

equipment for IPC at

3. IPC education and

and bed occupancy

(HAI) surveillance
1.IPC Programme

2. IPC guidelines

the facility level

COMPONENT

5. Multimodal

materials, and
4. Health Care

and feedback
IPC CORE

strategies
training

Median
78% 70% 70% 68% 55% 28% 50% 63%
Score

The assessment showed that five hospitals and 14 HCIVs scored intermediate and advanced on IPC
practices according to WHO standards, giving a total of 28 health facilities with improved IP
practices (>80%) against an annual target of 20. There is a need for continued support for
improvement as none of the hospitals had advanced IPC practices.

Table 2: Infection prevention and control Practices in selected HCIVs and hospitals
IPC Practices Total score Hospitals (5) HCIV (16)
Inadequate 0-200 0 (0%) 1 (6%)
Basic 201-400 0 (0%) 1 (6%)
Intermediate 401-600 4 (80%) 14 (88%)
Advanced 601-800 1 (20%) 0 (0%)

2.7 TB/HIV:

In COP21, RHITES-E focused on building local partner capacity and coordination to deliver a
sustainable and TB-HIV response to the burden of TB and TB-HIV in Eastern and Karamoja regions.

21
TB HIV and TB/HIV Cascade: The RHITES-E project team with local implementing partners adopted
and scaled up the national TB and TB/HIV clinical cascade QI collaborative as a systematic approach
to address the bottlenecks affecting TB performance in both TB and TB/HIV clinical care cascades in
Eastern and Karamoja regions. The project facilitated the implementation of initial activities on the
road map for this collaboration, including two regional and eight district coaches’ trainings and
entry meetings, baseline data collection, and site coaching visits. As part of its mandate, RHITES-E
has provided follow-on above site support to eight selected districts in the supported regions in
collaboration with the LIP regional implementing mechanisms. RHITES-E facilitated regional coaches
working together with district teams to identify the bottlenecks affecting TB and TB/HIV clinical
cascade and support site teams to systematically address identified gaps using the QI approach. This
activity builds upon the continued support given to TB and TB/HIV cascade improvement initiatives
at sites by regional implementing mechanisms (IM). Consequently, there is a progressive shift in TB
and TB-HIV QI indicator reporting by districts in the national Continuous Quality Improvement (CQI)
dashboard from 40% to 70% by September 2022.

Overall, in year five, 85% of new and relapsed TB cases (820) had a documented HIV status; 820 TB.
HIV co-infected people were identified and 70% (574/820) of the TB-HIV co-infected initiated ART in
both regions. Further, 95% of patients active on ART were screened for TB compared to 91% in FY22.
Low TB-HIV yield is attributed to poor quality of TB screening and limited HCW knowledge of
Advanced HIV Disease (AHD) screening and management. This will be addressed through the
planned AHD trainings of frontline health care workers.

TB preventive therapy (TPT)

TB preventive therapy treatment is a critical component of the WHO End TB strategy and effort to
eliminate TB. The project provided logistical and financial facilitation to the regional trainer for the
programmatic management of latent TB infection (PMLTBI). As part of phased scale up of use of
alternative regimens for TB prevention, sixty-six (66) health workers at Karenga HC IV, Kaabong
General Hospital, Kotido General Hospital, and Abim General Hospital in the northern Karamoja
region were trained on use of cost-effective once weekly Rifapentine/Isoniazid for three months
(3HP). This improved health worker knowledge on use of alternative therapies for TB prevention.
TPT achievement in year five was 54%
(1,098/2,042) against the annual target of
86%— 9,260/10,718 for Karamoja (Five
districts)/Eastern Uganda (16 districts)
respectively. The performance is attributed
to improved knowledge through
collaborative support provided during the
virtual TWG meetings and site-level
mentorship and mop up activities by LIPs. .
despite the high COP targets versus actual
Capacity building training for Programmatic Management of Latent low TPT targets as per the TPT audit
TB in Abim Hospital, Abim District findings. The unmet TPT need from the
audit was 232 and 2,416 for LPHS-K & E.
However, the overall achievement also includes under 5(U5) and 5 years+ reached for TPT as per the
United Nations high-level meeting targets assigned to Uganda.

Programmatic management of multi-drug resistant TB (PMDT)

The project team continued to provide monthly supportive supervision to two MDR TB treatment
initiation sites in Moroto and Mbale RRHs and, consequently, regular support to district structures to
22
conduct quality TB screening and contact investigation, to improve drug resistant case finding
through expanded and optimal utilization of GeneXpert, to increase private sector involvement, and
to build capacity of health care workers and community actors. Direct TA t was provided to improve
drug resistant TB documentation and reporting through regular review of reporting tools and
systems. In kind support (transportation) was provided to Mbale RRH for drug resistant TB patient
linkage, follow up, and contact investigation.

12-month outcomes for drug resistant TB patients enrolled 15 months ago: Mbale RRH started
nine patients and Moroto RRH started 4 patients on second line TB treatment 12 months ago; (8/13)
62% are currently retained in care with negative cultures.

End of treatment outcomes (24 months) evaluation: 8 MDR TB patients were enrolled in Mbale
RRH. Four (50%) were cured, three completed (38%) and one died (12.5%). In Moroto RRH, four
patients were enrolled and two (50%) were cured and 2 (50%) completed. Both drug resistant TB
clinics conducted monthly onsite clinics and panel and cohort review meetings.

TB community awareness, sensitization, and testing (TB CAST)

RHITES-E, in collaboration with other partners, provided logistical and technical supportive
supervision for the implementation of intensified
community and health facility TB sensitization, screening
& testing. The project provided tools for screening
650,000 household members and sustained hub
operations in Karamoja and Eastern Uganda.
Collaborations and partnerships
In COP 21, RHITES-E collaborated with the LPHS-TB
activity to conduct a capacity building and joint coaching
activity for regional- and district-based mentors in the RHITE‐ E Project vehicle supporting
Eastern and Karamoja regions for the TB, TB-HIV CQI redistribution of TB CAST Logistics
collaborative.

2.8 Laboratory

During year five, RHITES-E supported systems strengthening in all 11 hub sites to ensure quality
service delivery. This was done through several efforts, including focusing on enhancing the hub
sample transport network, building Quality Management Systems (QMS), strengthening laboratory
quality management systems, improving EID, TB, and HIV viral load testing services by strengthening
efforts towards multiplex disease testing, and ensuring preparedness and responsiveness to disease
outbreaks, especially of a resurgence of COVID-19 in the country and lately, an Ebola outbreak.
RHITES-E ensured uninterrupted hub operations and maintained compliance with Quality
Management Systems (QMS) at all hub sites.

Through RHITES-E support, three SANAS accredited laboratories managed to sustain their
accreditation status and one hub successfully underwent assessment for SANAS accreditation.
Additionally, five non-accredited SLMTA hub sites were supported to undergo national laboratory
Quality Management System (LQMS) audits in preparation for the certification audits expected in
the first quarter of COP23 as shown in table 2 in Annex D. Uninterrupted hub operations were

23
attained by meeting the necessary logistical and technical needs of all hub sites and POC sites in the
region. This involved prompt and sufficient provision of airtime and data bundles to the hub teams
for coordinating the sample transportation network, assorted stationary for results printing, fuel for
hub riders, servicing and repair of hub motorcycles, replacement of old hub motorcycles, procuring
personal protective gear for hub riders, and servicing of laboratory equipment

24
RESULT AREA 3: INTEGRATED HEALTH SERVICES, MANAGEMENT SYSTEMS, AND SECTORS

3.1 IntraHealth Approach to Transition of Service Delivery Support to the Districts

IntraHealth has been providing health systems strengthening (HSS) support to the district health
team to help the team strengthen and have more ownership of district performance. The approach
to this transition is focused on collaborating with different stakeholders, especially the national level
partners, including SSCS, UHSS and ULA, to address leadership, governance and financing, human
resource capacity, supply chain logistics, strategic information management, and quality
improvement. RHITES-E uses several CD approaches including the establishment of FH technical
working groups, routine mentorship and supervision, revision of the staffing structure as well as
conducting a district matrix to establish priority districts (i.e., light touch and intense touch). RHITES-
E leverages other existing opportunities, especially participating in DHT meetings, partner
coordination meetings, and integrated supportive supervision activities to deliver tailored support to
districts in partnership with RRHs as part of service delivery support to the districts.

Stakeholder and resource mapping

In year five, RHITES-E has been planning and implementing a seamless transfer of direct service
delivery components of its family health scope (FP/RH, MNCH, malaria, nutrition) to district health
authorities. This is in line with the USAID principle of sustainability and local ownership of
interventions. Key strategies include:
 Stakeholder and resource mapping within districts and the region where RHITES-E has been
operating.
 Participation in key district meetings to influence resource allocation to the health sector.
 Utilizing data to prioritize activities for funding using results-based financing (RBF), primary
health care (PHC), and other grants.

Partnerships and collaborations with districts and regional partners

RHITES-E conducted a partner coordination meeting in Mbale with participation of the MOH
planning department where targets were clarified. Partners’ roles at the national, regional, and
district levels and RHITES-E transition mandate were also highlighted. RHITES-E will follow up and
document commitments to supporting priority areas in districts and RRHs. RHITES-E also supported
Soroti RRH to conduct their first annual regional performance review meeting. The meeting was
attended by over 80 participants in the categories of Resident District Commissioners; District
Chairpersons; Chief Administrative Officers; District Health Officers; ADHO-MCH; and implementing
partners, including WHO, IDI, TASO and Uganda Cares. It was officiated by the MOH Senior Health
Planner and Soroti RRH Director. Key challenges highlighted included the lack of substantive DHOs
(nine out of 11 DHOs are still acting), lack of a blood bank, and delayed operationalization of
upgraded HFs. The RRH Director will follow-up and support recruitment processes for District Health
Officers (DHOs) and implementation of the meeting action plans. RHITES-E and other implementing
partners will jointly facilitate quarterly regional performance review meetings.

Technical working groups

RHITES-E worked closely with the DHOs to establish FH TWGs across 25 districts and two cities
under the leadership of the DHOs, which fostered district ownership and accountability. The TWGs
provided an opportunity for district teams to share performance on key FH indicators, enabling the
TWG to conduct targeted supportive supervision in poorly performing health facilities.
Consequently, improvement in key FH indicators has been registered by the districts.
25
3.2 Governance & Leadership/Coordination

Strengthening leadership and governance in human resources for health

To sustain gains in HRH, RHITES E used the “whole-of-district approach,” involving different health
minded stakeholders to identify barriers, and thus, collectively develop contextualized interventions
to address the barriers with a clear monitoring tool using a QI approach. Relatedly, RHITES E
collaborated with districts and local partners to have a central coordinating unit of iHRIS in all the 30
districts to optimally manage HRH data to guide recruitment, retention, deployment, trainings, and
attendance to duty tracking. As a follow-on to MOH guidance to increase health worker productivity
through improved staff attendance, reporting, and utilization of HRH data for decision-making, six
districts of Mbale, Tororo, Manafwa, Moroto, Abim, and Kaabong were selected and conducted
district-led accountability meetings. Key objectives of this activity were to.
 Increase the proportion of health workers who attend at least 95% of their scheduled work
time.
 Increase the proportion of health facilities that submit staff attendance summary reports to
the district to 85%.
 Increase the proportion of health facility attendance summary reports entered in iHRIS to
95%.
 Increase the proportion of districts with updated staff files with performance plans, schedule
of duties and appraisal forms.
 Revitalize the rewards and sanctions committees at all levels.
High-profile district officials like RDC, LC V, CAO, district planner, selected heads of departments,
DHTs, selected Senior Assistant Secretaries, and facility in-charges participated in this one-day event.
As a key output, an action plan was developed to guide the next steps. Crosscutting issues
highlighted in all districts included: improving timely documentation; reporting and data use at all
levels; rejuvenation of the rewards and sanctions committees at all levels; building capacity of facility
staff to manage HRIS improving responsiveness of the sub-county chiefs to support the functions of
health service delivery within their catchments and improving the feedback loop at all levels.
Relatedly, RHITES-E focused on enhancing systems thinking in supportive supervision through
reactivating supportive supervision focal persons structures, disseminating and aligning to the draft
MOH supportive supervision guidelines, to 20 districts in the region, emphasizing planning and
reporting mechanisms. Ten district health teams were provided with logistical support to conduct
integrated supportive supervision to lower-level health facilities. During the supportive supervision
visits, all service areas were visited, and respective facility teams were supported to review their
performance data with remedial focus on areas with suboptimal performance noted. All findings
were documented in the facility supportive supervision books to fast track and also guide the
subsequent visits.

26
3.3 Optimized Human Resources for Health (HRH)/Health Worker Staffing

In line with the Ministry of Health Human Resources for Health Strategic Framework 2020/2030,
RHITES-E continued to work closely with the districts and local partners (LPHS K/E, Moroto RRHSA
and LSDA) during the financial year to plan, develop, and deploy both PEPFAR seconded staff and
GoU staff, and utilize the health workforce for complementarity and synergies. This data-driven
approach facilitated the local government units and local partners to use iHRIS in addition to
locally contextualized interconnected interventions like WISN and HRH inventory analysis data to
have the right number of health workforce, in the right place, at the right time, with the right skills
and attitude, doing the right work to optimally match the health needs of the population in
Eastern Uganda.

Ensure enhanced functionality and use of iHRIS in 30 districts:

RHITES-E worked with existing structures to facilitate district HRIS focal point persons with logistics
and phone call reminders to strengthen iHRIS data update and use in 30 Districts. The functionality
indicators measured included staff completeness, data quality, usage, updated staff list, generating
reports, and presence of focal person. With all these efforts, some districts like Mbale used HRH data
(wage analysis and recruitment plans) to support recruitment of an additional 100 health workers.
RHITES-E continued to provide tailored capacity to DHTs to routinely discuss HRH data to guide
decision-making during DHT meetings and performance reviews.

In collaboration with UHSS, RHITES-E facilitated the repair of Bududa Hospital biometric machine,
including installation and oriented Moroto RRH key staff, like the Hospital Director, Principal
Hospital Administrator, Project Coordinator, Human Resource Officer, and M&E team, on the basics
of iHRIS. With this support, all staff records were entered in iHRIS. This improved staff
responsiveness while on duty.

Due to the continued mismatch between the need for, demand for, and supply of health workers in
the rural areas of eastern Uganda, the average staffing levels for critical health workers remained at
77%. This was lower than the 85% national target with reasons attributed to limited wage bill and an
increase in health facilities elevated from level II to level III without clear budget support. However,
the staffing levels for medical officers was at 93%, enrolled midwives at 72%, enrolled nurses at 74%,
clinical officers at 80%, pharmacists at 75%, and laboratory technicians at 68%. The staffing levels
differed by region and by district for a clear reason that health workers prefer being posted to urban
locations in Mbale district and some parts of Teso region, while the acceptability of posting to
remote rural districts in Karamoja that are perceived to be hard-to-reach and hard-to-stay is low.
This was a major cause of high vacancy rates of 80% for specialized cadres like the anesthetic
officers in Karamoja compared to 48% in Teso region as indicated in table 3 below.

27
Table 3: Staffing levels for Anesthetic Officers

Improve work climate for health workers:

A good work climate is essential for the attraction and retention of health workers. Key elements of
a good work climate include supportive leadership, non-discrimination, and a conducive work
environment. RHITES-E continued to implement interventions to improve health facility leadership
and governance during the reporting period. Anecdotal evidence demonstrates that facilities with
strong leadership will perform better at health service delivery than facilities with feeble leadership
systems. RHITES-E continued to advocate for improved housing for staff. In the same vein, RHITES-E
facilitated the engagement of human resources officers in the 30 districts with safari day allowances
and transportation to visit health facilities, interact with health workers, and address HR issues
related to delayed payments and accession to payroll, among other issues which would otherwise
encumber a conducive work environment. In addition, through COVID-19 efforts, RHITES-E
rejuvenated the IPC committees at all the PEPFAR-supported facilities as one of the means to
improve occupational health and safety at the workplace. Relatedly, RHITES-E will continue to work
with existing structures to functionalize Health Unit Management Committees, focusing on their
roles and responsibilities. DHTs continued to provide technical assistance to the Health Unit
Management Committees during their quarterly supportive supervision visits to facilities and
reminded them of their core roles and responsibilities in monitoring health service delivery at their
respective facilities.

3.4 Supply Chain Management

Quality, affordable essential medicines, and health supplies are available and used rationally
In FY22, RHITES-E partnered with local partners, LPHS E, LPHS K and LSDA, to support and
coordinate Supply Chain Management (SCM) interventions to ensure availability, accessibility,
rational use, and management of medicines and health supplies in the region. The Key SCM
deliverables during the year included: ensuring that local implementing partners support districts to
conduct all Supervision Performance Assessment and Recognition Strategy (SPARS) interventions
(Essential medicines SPARS, Laboratory SPARS, ART SPARS and PFM SPARS); mentorships on quality
ordering, storage, stock management, prescribing, dispensing, and regular stock monitoring to
improve medicines management in facilities; trainings to build capacity of health workers in
quantification; and laboratory commodity management.

The specific approaches included: Conduct SPARS led by the Medicines Management Supervisors
(MMS); supervision and monitoring of health facility stock management activities through
operationalization of the weekly real time ARV stock status monitoring system (RASS) and RHITES-E
digital dashboard; internal assessments using SIMS to improve supply chain reliability; supporting
HMIS105(6) monthly reporting and completeness; technical supportive supervision to health facility
28
teams on quantification, ordering, and reporting for essential medicines and health supplies (EMHS)
and ARVs; and supporting functionalization of Rx Solution for stock management.

Implementation of SPARS (EM, ART, LAB, and PFM District Support Package)

In year five, USAID RHITES-E in collaboration with LPHS-E Baylor, LSDA and LPHS-K ANNECA
assessed and identified facilities which were due for supportive supervision by the MMS in their
respective districts. RHITES-E supported and built capacity of local mechanisms to develop quarterly
concepts and supervision schedules for these facilities.

The local partners recruited SCM Officers in each of the three clusters to manage SCM activities
therein. As a result, there were improved supportive supervision visits made by the MMS, thus
improving performance efficiently and effectively. By the end of the year 1,031 visits had been
conducted at 523 health facilities.

Figure 1: Graph showing EM, ART and PFM SPARS

RHITES-E region scored 12.1 against the national target of 15 for Pharmaceutical Financial
Management (PFM), increasing from 9.9 to 12.1 out of 15. This was due to targeted scheduling of
supervision visits during the quarter, especially in Bukedi and Karamoja clusters. ART SPARS
decreased from 17.3 to 14 out of the total average score of 20 because of stocked-out pediatric
regimens like DTG10 and DTG 50mg that had expired. The region is slightly above national EM
SPARS target score (20). However, fluctuations were registered in the score for all SPARS
interventions. The EM SPARS had a good improvement of one average score (from 20.7 to 21.7). In
Q1 FY23, RHITES-E will focus support on all local partners in the region and ensure that Bukwo,
Kween, and Bududa districts, which are still scoring below the national average score of 80%, are
prioritized while striving to maintain districts whose scores are above the national average (80%).

LAB SPARS

In year five, Laboratory SPARS quality scores continued to improve when we compare the baseline
total average scores with the current total average scores. There was an increase from 14.2 to 15
with Mbale, Budaka, and Namisindwa performing well while Bulambuli, Kween, Moroto, Butaleja,
and Kibuku performed poorly following their national positions as 62, 65, 56, 64, and 57 respectively.
These districts will require more support from the laboratory supervisor and LPHS mechanisms.

During FY23 Q1, facilities will be supported to improve their current scores to improve on the
national average positions.

Stock monitoring for increased availability of EMHS

During FY22, USAID RHITES-E, through LPHS mechanisms, continued to support utilization of
electronic logistics management information systems (eLMIS) for stock reporting through platforms
at facilities for weekly (Real Time Commodity Stock Status Monitoring and MTRAC) and monthly
(DHIS2 and RHITES-E digital platforms) monitoring to improve availability and reliability of supplies
at the supported health facilities. Tracer medicines availability and reporting has steadily improved
29
during the year. LPHS-E, LSDA and LPHS-K supply chain officers working through district structures
conducted onsite mentorships on use of the HMIS 105(6) data tool and submission into eLMIS,
stressing reporting rate and completeness and accuracy of reports submitted. Overall, by the end of
the year, the HMIS105(6) reporting rate was at 95% and the completeness was at 67%.
Figure 2: Chart 1 showing HMIS 105(6) reporting rate and completeness All facilities in Budaka, Kibuku,
and Manafwa districts and Mbale
City had 100% completeness in
HMIS 105(6) reporting.

RASS Reporting: The RASS

weekly reporting drastically
improved during FY22 (year five)
throughout the region. This is
because RHITES-E worked
together with the LPHS
mechanisms and engaged
experienced RASS users in each district to mentor others and share daily updates. The facility staff
were mentored on reporting.

Stock monitoring for increased availability of EMHS: Stock monitoring was done by means of
regular follow-ups via phone calls, weekly reports of RASS (real time ARVs stock monitoring system),
and monthly submissions of stock status by medicine management supervisors. All this was to
ensure availability of key health commodities. The regional quarterly reporting rates of the stock
status of adult and pediatric ARVs and TB medicines and the Rapid test kits, including the
Determine, stat Pak, SD Bio line, HIV/Syphilis Duo and TB Lam, improved from 35% in Q1 to 50% in
Q4. The low reporting rate is attributed to frequent reporting system failure. In FY23 Q1, focus will
be put on improve reporting rates in the region.

RX Solution Stock monitoring system support: USAID RHITES-E, in collaboration with above site
implementing partner SSCS, built capacity of local partners to continue providing internet data and
ensure improved synchronization rates at the facility level. The reporting rates have been steadily
improving due to joint support visits conducted with SSCS, LPHS-K, and RHITES-E in Q3 and the
number of reporting sites increased because USAID SSCS procured and distributed 75 computers for
the RHITES-E region to ensure efficient and effective utilization. However, the performance slowed
down in Q4 because of changes in the supply chain staff at LPHS-E as two LPHS-E supply chain
officers moved away from the region. RHITES-E directly engaged facilities to improve
synchronization during that period.

Supporting quantification and ordering for commodities: In FY22, RHITES-E worked with LIPs to
train 460 facility staff working at ART clinics and stores in the use of the new electronic ordering
system (NMS+ CSSP). RHITES-E facilitated district-based MMS and facility staff while LIPs trained the
staff. RHITES-E through LPHS mechanisms conducted onsite mentorships to guide cycles 1 and 2,
quantification and ordering, focusing on order accuracy and timeliness and ensuring that all lower-
level facilities submitted orders in the Client Self Service Portal.

In year five, RHITES-E liaised with National Medical Stores and the USAID Strengthening Supply
Chain Systems Activity to create facility user credentials and coordinated with local partners to
30
ensure they reached the users and were used to submit timely cycle one and two orders. The region
managed to achieve 100% and 99% respectively in LPHS-K and LPHS-E for HC2s and HC3s. The
RHITES-E region has continued to maintain commodity security because of timely quantification
support to all ordering sites. Local partners have been supported in line with program items like
VMMC, HTS, and PrEP ordering, and quarterly orders have been prepared and submitted to JMS and
Beyond logistics in a regular manner.

MMD handling and optimization: RHITES-E, in collaboration with LIPs, has supported multi-
month dispensation through quality ordering, mentorships, and distribution of MMD guidelines,
ensuring that clients are transitioned and maintained on optimal regimens given the need to
decongest facilities. RHITES-E continued to work with NMS and alternative drug store (JMS) to
ensure health facilities’ requisitions for optimal stocks of multi-month Tenofovir, Lamivudine,
Dolutegravir (TLD) and Tenofovir, Lamivudine, Efavirenz (TLE) packs were met. Facility-based
mentorships were conducted throughout the quarters and ensured that each item was recorded on
a different stock management tool. RHITES-E conducted assessments on the number of children
kept on legacy and obsolete regimens and conducted mentorships on new guidelines regarding
optimization of children to DTG-based regimens. Optimization data has improved as can be seen
from the care and treatment report, and the region has adequate stock of DTG 10mg. RHITES-E also
supported 15 districts to make emergency orders for DTG 10mg and supported the collection and
distribution to the facilities. These orders from NMS and JMS warehouses stabilized optimization
stocks.

COVID-19 SCM support: In year five, RHITES-E facilitated the redistribution of short dated Covid-19
vaccines across the different regimens within the supported districts. Consequently, there was a
marked improvement in the number of people fully vaccinated from 58% to 64% in Q4. RHITES-E
supported and facilitated district staff to conduct COVID-19 outreach as well as timely reporting of
vaccination data. Additionally, RHITES-E supported LPHS mechanisms to strengthen regular
vaccine’s stock status reporting and monitoring expiry dates for the region. Overall, the district
vaccine store’s weekly COVID-19 vaccines reporting rate was 100%, and the facility reporting rate
was 94%

Other support to districts: RHITES-E supported districts’ collection of antimalarial back orders for
20 supported districts from NMS 15 for LPHS-E and five for Soroti sub-region, and local partners
supported facility-level distributions from DHO’s stores. RHITES-E also supported the transportation
of TB CAST campaign commodities from NMS to all districts and ensured that they reach sites.

3.5 COVID-19 vaccination Response

Results of Support to District Implementation Response to COVID-19: Vaccine Rollout Update

RHITES-E has continued to support the GOU to ensure the vaccination agenda is rolled out
uninterrupted in eastern Uganda and five districts of Karamoja region to reduce severe spread of
COVID-19 disease and deaths, protecting health systems. This has been done through the new
strategy of Accelerated Mass Vaccination Campaigns that involves a series of activities, namely
regional technical planning meetings, district technical micro-planning meetings, regional launches,
and actual vaccination implementation. Actual vaccination implementation involves community
mobilization, demand creation, mobile vaccination campaigns, and static sites. In year five, RHITES-E
supported the 15 districts and one city of Bugisu, Bukedi, and Sebei. Through this strategy, the
COVID-19 vaccination coverage for the region improved from 5% and 3% for 1st dose and full dose
coverage respectively to 82% and 63%, closer to the national target of 70% full dose coverage.

31
IPC and PPE Support
RHITES-E actively participated in the annual IPC and hand hygiene survey conducted in 13 regions of
the country, including the RHITES-E region of operation. To eliminate the possibility of bias during
the survey, different implementing partners were tasked with assessment of regions other than their
base of operations in an exchange program. The data collection was based on the WHO
standardized and validated tools.

Figure 3: Graph showing the Infection Prevention and Control Assessment Score As seen in the table,
SCORE
the Infection
Prevention and
700 592 569 558
600 518 491 481 Control Assessment
470 463 440
500 402 394
333 292 Framework (IPCAF)
400
300 was used to assess the
200 health facilities with
100 Score
0 none of the regions in
the country attaining
the targeted
Advanced IPC level
(601-800). Ten out of
13 regions registered
intermediate capacities including Bugisu and Karamoja region which attained scores of 481 and 463
respectively. The performance within the regions is partly attributed to the intensive phase of the
rollout of the IPC mentorship as part of response efforts to COVID-19. A total of 16 districts in the
RHITES-E region comprising a total of 41 health facilities were assessed. These facilities included two
regional referral hospitals, eight general hospitals, seven HCIVs, 18 HCIIIs and six HCIIs for balance
and even representation.

RHITES-E collaborated with WHO,

MOH, IDI, SBCA Regional Emergency
Operation Center (EOC), and Regional
IPC mentors in response to COVID-19
in eastern Uganda. The collaboration
included the regional level
Accelerated Mass Vaccination
Campaign technical planning
meetings, launches, resource
mobilization, microplanning, and
actual vaccination implementation.
RHITES-E distributed a total of 12,480
liters of liquid soap, 82,000 medical masks, 9,000 N95 Masks, 4,340 liters of hand sanitizer, 12,500
pairs of surgical gloves, 20 isolation tents for the holding center, and 20 oxygen cylinders for case
management. to the PEPFAR sites, cities, municipalities, district local governments, and general
hospitals in the entire region.
Other Support (Cold Chain, Community Sensitization/SBC, HRH, Monitoring)
In year five, RHITES-E supported the districts of Bugisu, Bukedi, Sebei, and Teso with COVID-19
vaccine redistribution, specifically from Soroti District to the districts of Pallisa, Butebo, Mbale,
Manafwa, Butaleja, Namisindwa, and Tororo. The vaccines were redistributed to the districts based
on demand from the DHOs of the respective districts as shown in table 3 below.

32
Table 3: Showing vaccines redistribution to the RHITES-E districts

Quantity of vaccines and associated supplies

District Vaccination Auto Disable
Moderna AstraZeneca *(J&J)
Cards syringes (0.5 ml)
Pallisa 5,040 5,000 2,385 10,040 8,240
Butebo 560 1000 0 1,560 1,800
Mbale 2240 3000 0 2,000 2,000
Tororo 3,920 8,000 0 0 3,600
Namisindwa 1,400 2,000 0 3,400 3,400
Butaleja 3,780 2,000 0 6000 6000
Manafwa 420 0 0 420 420
17,360 21,000 2,385 23,420 25,460

The main achievements here were vaccines and assorted supplies distributed to the districts as
shown in the table above with a total of 17,360 and 21,000 doses of Moderna and AstraZeneca
respectively redistributed. The District Cold Chain Technician, District Health Officers and Assistant
District Health Officers were very supportive during the redistribution, and the Mbale and Soroti
Regional Emergency Operations Centers team were also very supportive in the redistribution
process accounting for an established sustainable system for the region.

33
RESULT AREA 4: IMPROVED DATA SYSTEMS, DATA USE, AND EFFICIENCIES TO ENABLE
HEALTH WORKER PERFORMANCE

4.0 Strategic Information / M&E Support

In FY22, RHITES-E continued to conduct data analytics. Huge data sets from over five years of
implementation were assembled and analysed for insights, highlights, trends, and visuals. The visuals
were transformed into PowerPoint slides which were shared in various forums such as learning
sessions, COPs, TWGs, and review meetings with districts, MOH, and USAID. LIPs were also
supported to identify non-performing indicators, conduct appropriate analysis, and present the data
in technical meetings (D2A) so that strategies are derived to improve performance, such indicators
included PMTCT-EID and viral load suppression. This was all geared to inform progress on
performance, share best practices, and target support to districts.

4.1 Scaling up the implementation of Point of Service (POS) Electronic Medical Records
System

In FY22, RHITES-E continued to support LIPs to sustain functionalization of Uganda EMR system and
POS in health facilities in the Eastern Region. Prior to the transition, 121 health facilities had Uganda
EMR and 118 had a functional system. RHITES-E supported the functionalized of 20 Uganda EMR
sites and eight POS health facilities through the provision of hardware equipment such as
computers and electronic cables. Currently 145 sites have EMR, and 138 sites are functional; 25 sites
use POS. Furthermore, eight POS sites were functionalized in the region through provision of
hardware to the LIPs. Uganda EMR has been instrumental in ensuring consistent reporting,
turnaround time for data for monitoring, and real time capture of patient data. RHITES-E has
continued to support the LIPs and regional referral hospitals to maintain functional Uganda EMR
POC at all hospitals and Health Center IVs in the region. Additional hardware (laptops) was given to
data assistants under LPHS-E/K and Moroto RRH; specifically, under LPHS-E, 11 laptops were given
for key population program data management and data assistants were oriented on KP combination
tracker.

4.2 Building capacity for effective data management and utilization

In FY22, RHITES-E continued to support the LIPs in data extraction, analysis, presentation, and use of
GIS in programming. Moroto and Mbale RRH teams were trained in different M&E packages,
including DHIS data extraction, PEPFAR Uganda data management system and TB Info reporting,
and GIS. This hands-on activity was geared to increase data use and presentation at the hospital
level to improve indicator performance, guide implementation and decision making. DATIM report
writing support was given to local partners, especially Moroto RRH throughout FY22. As a result of
these trainings, there has been registered improvements in reporting rates from 78% in FY22 Q1 to
100% in FY22 Q4.

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4.3 HIV Data use management and utilization

RHITES-E has continued to support the LIPs to monitor HIV performance through weekly
dashboards and orientation on key indicators such as MER 2.6. LPHS-E teams were trained on the
key population tracker, and customized dashboards were developed to track key population
cascades and monitor both prevention and treatment indicators. This led to improved achievement
of key Population viral load suppression (KP_PVLS) from 77 to 88% and linkage to care from 85% to
95% in Q4. Through these trainings and meetings with LIPs, action points and key poorly performing
indicators were identified to guide site level implementation. HIV data use training also focused on
geospatial data analysis using GIS and data management system orientation (TBinfo, GIS, Teams &
PIRS).

4.4 Strategic geographic information system interventions

Strategic Geographic Information System Development, Dissemination and Scale-up

In FY22, as part of its above site technical support role, RHITES-E built the capacity of district
biostatisticians and USG implementing partners on the development of geospatial datasets and
spatial analytics. Knowledge on geospatial analytics, resources, and data was availed to support HIV,
reproductive, maternal, newborn, child, and adolescent health analyses. RHITES-E supported the
training of district biostatisticians and implementing partners alongside USAID SITES to present and
build capacity on how to navigate the ArcGIS desktop software and ArcGIS Online platform.

In FY22 Q2, the GIS activity disseminated 15 health facility catchment GIS maps in the Teso Cluster
and continued with scale-up in the clusters of Bukedi with 15 maps, Bugisu with 15 maps, and Sebei
with nine maps. The activity will continue scale-up, supporting the DHTs with design, development,
printing, and dissemination of 39 GIS maps for 39 health facilities.

RHITES-E will also continue supporting and providing TA to districts and local partners in using the
cardboard reusable GIS maps for daily programming.

As part of the digital health investment, RHITES-E provided TA and minimal logistics to scale up GIS
catchment maps in 15 districts in 55 health facilities. The TA included physical drawing of maps with
designated health teams, their transformation into digital formats, and mentorship on map usage.
The logistical support involved specialized printing of the maps on hard covers to permit longevity.
The cover of GIS maps at high volume sites in the 30 districts of RHITES-E has increased from 15%
pre-transition to 40% by Q4. Interactions with facilities indicate growing usage of the maps for
planning of community outreach activities, visualization of performance, and lobbying, a key
component of the Results Based Financing RBF funds. Owing to the critical application of GIS,
RHITES-E will liaise with the LIPs to scale up GIS in other lower-level facilities to increase coverage,
targeting 50% in the year ahead.

4.5 Collaborating, Learning and Adapting During the Transition

Knowledge Management and CLA

At the start of this year’s implementation, RHITES-E provided above site technical support to the
local partners to set up the data management systems, particularly, facilitating the two partners to
prepare their Activity Monitoring Evaluation and Learning Plan, Branding and Marking Plan. Further,
the RHITES-E supported them in adapting quarterly reporting templates for quarterly report
35
documentation. As a result, the team was able to refine the Agencies MEL strategy, improve their
knowledge on MER 2.5 indicators, and identify innovative ways to conduct data collection in an
efficient and effective manner.

Further, RHITES-E collaborated with its various

RHITES‐E submitted 7 abstracts on the best practices and
stakeholders through the weekly virtual progress
innovations in improving family health indicators at the
various international conferences like IAS and ICFP meetings at cluster level to learn, adapt, and
improve performance. The weekly virtual
Illustrative examples of how RHITES‐E collaborated with its
various stakeholders to learn, adapt, and improve sessions were data reviews focused on
performance in Y5. Key topics of the learning showcase struggling indicators, and teams produced
from these collaboratives include:
various strategies and action plans. The
 Using data to action meetings with local partners to
improve HIV cascade indicators learnings were used to develop abstracts for
 Cross collaboration and partnerships with family various conferences such as the National Quality
health partners to improve MCH outcomes Improvement Conference, International AIDS
Society , International Conference on Family
Planning , International Maternal Newborn
Health Conferences, and the safe motherhood conferences to promote and share proven practices
from the RHITES-E region. RHITES-E conducted documentation visits in the region where a series of
impact stories were documented and published as a blog. In year five, RHITES-E continued to use
the CLA and knowledge management approaches to make strides in improving results and health
outcomes.

A series of photo essays were also documented where RHITES-E best practices were compiled and
featured on various social media platforms for IntraHealth and the USAID Mission in Uganda.
Further, RHITES-E hosted the team from USAID’s Office of Health & HIV/AIDS in the Mbale District
in June 2022. The USAID team was hosted at the DHO forum together with MoH and DHOs where
they were able to learn of the impact and achievements of RHITES-E in the process of the transition.
RHITES-E participated in World Health Day, where it showcased its health program implementation
and support in the region. The local partners were able to provide services to walk-in clients and
others.
Best practices and changes package dissemination
As part of RHITES-E’s FH transition approaches, family
health (FP/RH, Malaria, Nutrition & MNCH) best
practices packages were disseminated to key project
stakeholders, including district health representatives,
USAID, MOH officials, and implementing partners.
The best practices focus on strategies and
innovations to adapt while implementing the FH
technical areas.

Over the year, RHITES-E drew from its experience USAID FH Team at the DHO Forum’s
developing the capacity of districts and local partners showcase
to deliver quality health services and improve results to share proven practices and strategies
adapted to its specific contexts. These best practices provide insights for LIPs and DHTs on what has
worked to improve performance within family health service delivery in eastern Uganda. This series
of briefs highlights activities and approaches with innovative features that have produced
outstanding results in improving the quality of services and have the potential for replication or
adaptation. As a result of the above interventions, RHITES-E submitted a winning CLA Case
36
competition for the year 2022 organized by USAID. “Using Data for Adaptive Management to
Successfully Transition Programs” has been selected as one of twenty finalists out of 124
submissions and is publicly recognized on USAID's Learning Lab website. This year's case described
the role of D2A in improving HIV performance by integrating CLA practices into RHITES-E work to
strengthen development outcomes.

Examples of CLA During the Transition

Use of D2A Approach to promote the culture of learning: In FY22, as part of its performance
improvement plan, IntraHealth RHITES-E organized D2A meetings, a systematic and collaborative
process of linking HIV program data to action (D2A), which includes analysing, interpreting,
reviewing, and putting into motion lessons learned from HIV program implementation through
continuous review of data and weekly course correction action plans. Stakeholders in this D2A
included all the local partners, UPMB-LSDA, LPHS-K/E, and Moroto Regional referral hospital to
discuss poorly performing indicators.

The weekly D2A meetings feed into larger meetings involving MOH representatives and the USAID
team. At the meetings, local partners present their performance improvement plans, and the MOH
and USAID provide guidance from their perspectives. The progress seen through this collaborative
approach is a testament to the intentional use of the Data to Action approach, which seeks to
register impact in a short time and navigate adaptive management to rapidly transition PEPFAR
program implementation to local partners.

To date, RHITES-E has experienced improvement in key PEPFAR indicators that were once
challenging for local partners. The target for multi-month dispensing of ART increased from 78% in
October 2021 to 87% in September 2022. The indicator measuring the percentage of HIV-positive
women on ART screened for cervical cancer improved from 29% in December 2021 to 85% in
September 2022. The VMMC uptake increased from 9% in December 2021 to 97% in September
2022, and the local partners also improved the number of individuals who were newly enrolled on
pre-exposure prophylaxis (PrEP) from 45% in December 2021 to 169% in September 2022.

37
RESULT AREA 5: GENDER NORMS ADDRESSED AND CLIENT-FOCUSED- GENDER SENSITIVE
SERVICES OFFERED

5.1 Support implementation of high-quality health communication and behaviour change:

During FY22, the RHITES-E social and behavior change communication (SBCC) interventions focused
on building the capacity of the local districts and LPHS to create awareness and promotion of
healthy behaviors and mobilize adolescents and youth (20-24), KPs, and men and women of
reproductive age for services across the 30 districts in the region. The SBCC team utilized different
approaches, including interpersonal communication through home visits and one-on-one sessions,
male- and female-focused discussions, community drives and activations, dialogue meetings, and
targeted radio talk shows. During the SBCC TWG meetings, USAID SBCA rolled out the HIV/TB
campaign to LPHS-E and LPHS-K, and a database of community resource persons was shared. The
database included VMMC community mobilizers from the circumcision sites.

Access to and use of quality maternal, newborn, and child health (MNCH); family planning
(FP)/reproductive health (RH)

RHITES-E supported the districts to engage 1,545 trained VHT champions to support the
interpersonal communication component. These supported activities addressed barriers to FP,
MNCH uptake, HTS coverage, adherence to ART, referrals from the community to the facility, and
improved nutrition and WASH practices. Through the home visits, the VHTs were able to follow up
and mobilize their communities. Results from HMIS 097b reports generated by the VHT
coordinators show 76,963 HIV clients were followed up with in the community, 5,212 TB cases were
identified, and 408,401 clients were followed up for FP and using it. Following the home visits,
70,087 women attended at least four ANC and 32,245 attended at least eight ANC visits. A total of
2,151,682 adolescents and young people were reached, and 5,145,717 household members sleep
under LLIN as shown in table 6 in Annex F: SBCC Section.

Nutrition; and water, sanitation, and hygiene (WASH) health services at community- and
health facility-levels

Meetings to support community reporting

In FY22, RHITES-E conducted 25 meetings of the targeted 27 in various districts in Bugisu, Bukedi,
Teso, and Sebei clusters. The major discussion points from these meetings were on community
reporting, especially the 097b reports that are the responsibility of the supervisors of the VHTs. As a
way forward, the health assistants give priority to the 097b HMIS reports and take full responsibility
to ensure they are submitted to the biostatistician for entry on the third of every month after the
quarter ends. RHITES-E will support the distribution of 097B HMIS tools, biostatisticians conducting
WASH data review meetings, and tracking of the new community health services indicators. As a
follow-on, RHITES-E organized meetings with the supervisors of the VHTs and other community
support teams. The meetings focused on supporting the continuity of services at the health facility
level and included district health educators, Assistant DHO-Environmental Health, health assistants,
health inspectors, and biostatisticians to support community reporting.

38
Scale up of innovative models of SBC

Support Karamoja Community Engagement Strategy

Community Engagement Strategy Karamoja and Moroto Regional Referral Hospital
This strategy was developed based on
information gathered through consultations
with cultural and religious leaders, health
workers, members of Village Health Teams
(VHTs)/Interpersonal Communication (IPC)
Agents; HCT mobilizers, HIV and AIDS clients,
and community members. Most discussions
were conducted at the community level at
venues provided by health facilities. In other
instances, consultations were conducted at
venues near testing sites. Males and females as
well as young people participated in the
discussions to ensure their concerns were
addressed. Areas to reach those at risk were
identified and mapped. Community HTS will
take place at the locations mapped to ensure
those at risk are reached with services while
addressing challenges linked to access to
services.

Supporting Accelerated Mass Vaccination for

COVID-19
To increase awareness about COVID-19 vaccination, RHITES-E conducted 324 community
mobilization and sensitizations in the Elgon region. During the sensitization meetings, VHTs
conducted house-to-house mobilization and a community drive using the public address system in
sub-counties with low vaccine uptake. These mobilization drives were conducted to mobilize,
sensitize, and increase awareness of the importance of COVID-19 vaccination. RHITES-E supported
mass vaccination for COVID-19 launches in Manafwa District and Tororo for the first round of the
accelerated campaign. For the second round, RHITES-E supported Kapchorwa District for the
regional launch. Overall, 36 radio talk shows were held on regional radios to educate the masses on
the need for COVID-19 vaccination. These talk shows were interactive with a call-in session to
answer and give instant feedback to the callers on vaccination venues.

Support CAST TB activities to commemorate TB Day

USAID RHITES-E carried out sensitizations and community dialogues to create awareness about TB
and created demand for screening of TB cases in selected health facilities. The main channels for
communication were radio talk shows and community sensitization drives with a public address
system for catchment community penetration. Six districts and 24 sub counties were reached with
the community drive as well as TB hot spots identified by the health facility. Village Health Teams
participating in the modified TB CAST were also educated on case identification and health
communication to educate the community on TB detection on a one-to-one basis. These included
Bulambuli, Sironko, Mbale, Namisindwa, Butebo, and Kibuku.

39
Supporting anthrax and other climate disasters
RHITES-E supported the districts affected by the climatic disaster, including Mbale city, Mbale
district, Sironko, and Bulambuli, with risk communication and psychosocial support through radio
talk shows and public address system drives in the most affected sub counties. Information given
was on climate change and the possible negative outcomes, including the likelihood of a cholera
outbreak in the lowlands. RHITES-E also supported mobilization for an anthrax outbreak in the
districts of Kween, Bududa, and Namisindwa by facilitating VHT trainings on case identification and
follow up. Six talk shows were organized, and 660 spots ran on the radio with the main messages
focused on anthrax treatment, signs and symptoms, and prevention. Mobilization also called on the
community to report all suspected cases to the nearest veterinary officer or to go to the nearest
health facility for appropriate medical support. It also called for support ensuring youth adhere to
treatment.

Supporting Sanitation week

Four districts were supported to conduct sanitation week commemoration activities. These districts
were Bulambuli, Sironko, Manafwa, and Budaka. During the sanitation week, the VHTs conducted
house-to-house visits, mobilizing communities to improve hygiene and sanitation practices by
putting in place hand washing with soap facilities and ensuring food hygiene, safe disposal of
human faeces, and treatment and safe storage of household drinking water. RHITES-E implemented
community mobilization drives using the public address system in key hot spots identified by the
environmental health staff as leading in poor latrine coverage. The activity was led by the ADHO-
Environmental Health together with District Health Officer, Health Inspectors, Health Assistants and
Village Health Teams.

Scaled-up gender-sensitive and transformative interventions to address underlying health

inequities

Support districts to commemorate International Women’s Day

RHITES-E supported Mbale District to commemorate International Women’s Day with celebrations in
Bumasobo subcounty, Mbale District. The district was supported with a community mobilization and
sensitization drive a day prior to the event and on the day of the event. RHITES-E further supported
the event with a talk show on Open Gate FM in Mbale. This was attended by Lillian Anasho Enwaku,
nursing officer from Namatala HCIV, and Esther Watsikwi, the chairperson, Mbale Women’s Council.
Issues discussed included the GBV referral pathways and mobilization for the International Women’s
Day celebrations. During the event, there was cervical cancer screening available, and 68 clients were
screened, two positive and 66 negatives. A legal clinic by FIDA Uganda attracted four GBV cases.

5.2 Design and implement adolescent/youth-focused interventions:

In FY22, RHITES-E supported LPHS-E, LPHS-K, and Moroto G2G in Gender, Youth and Social
Inclusion in SGBV TWG meetings. Among the issues discussed were completeness of filling data in
the GBV registers, data use, and review reporting. This created an opportunity to share SOPs and
policies, including those on alcohol and drug use, child- or adolescent-centered first line support,
child protection protocols, child safeguarding policy, emergency contraceptive use, ethical principles
and human rights standards for reporting child or adolescent sexual abuse, first line support after
sexual abuse, GBV screening tool, GBV screening tool for children and adolescents, pathways of care
for child and adolescent survivors of sexual abuse, post-exposure prophylaxis (PEP) after sexual
abuse, policies for adolescents living with HIV, preventing pregnancy in girls who have been sexually
abused, referral chart for GBV survivors, referral pathway for SGBV, and signs that a woman/girl may
40
be subjected to GBV. RHITES-E engaged the LPHS to utilize strategies like facility-based
mentorships, case review/conference meetings, and targeted community youth dialogues in the 225
sites located in Mbale, Budaka, Sironko, Manafwa, Namisindwa, Bulambuli, Tororo, Butebo, Pallisa,
Butaleja, Kibuku, Bududa, Kween, Bukwo, Kapchorwa, Kaabong, Karenga, Abim, Moroto, and Kotido
districts.

5.3 Address GBV in communities:

Improving GBV case identification through screening and onsite mentorships
In FY22, RHITES-E facilitated the Ministry of Health team, including the national and regional
trainers, to support LPHS-E, LPHS-K, and Moroto G2G to conduct GBV-focused mentorships at 225
sites located in Mbale, Budaka, Sironko, Manafwa, Namisindwa, Bulambuli, Tororo, Butebo, Pallisa,
Butaleja, Kibuku, Bududa, Kween, Bukwo, Kapchorwa, Kaabong, Karenga, Abim, Moroto, and Kotido
districts. These included both lower-level health facilities and high HIV sites. The GBV QI tool was
used for effective mentorship. Participants mentored included case managers, mentor mothers,
counsellors, nurses, midwives, and clinicians. GBV screening tools were used to facilitate routine
and/or clinical inquiry for GBV and IPV to enhance case identification, reporting, and management.
Improving post-GBV care services through GBV case review meetings/case conferences
In FY22, RHITES-E built the capacity of GBV focal persons in 25 health facilities to conduct SGBV case
review meetings/case conferences in ten districts of Butebo, Kibuku, Budaka, Pallisa, Butaleja,
Butebo, Namisindwa, Bududa, Manafwa, and Tororo. This was intended to support improvement in
post-GBV care interventions and establishing durable and sustainable solutions for survivors who
need both clinical and nonclinical services. During the case review meetings, 303 (139 males, 164
females) participants took part. Among the key issues discussed were GBV identification, screening,
management/response, follow up, referral, and documentation.

Capacity to respond to SGBV

To strengthen post-GBV care and management of survivors, RHITES-E supported a GBV training for
30 health facility staff (11 males and 19 females) on how to identify and manage GBV cases. The
training also identified participants’ strengths and weaknesses to produce an actionable way forward
to integrate and strengthen the health system on SGBV cases in Karamoja sub-region.

The support team was composed of national trainers from the MOH and the staff of Moroto RRH
and LPHSK-ANNECA. The participants included medical officers, clinical officers, nurses and
midwives, and orthopedic officers. The objectives of the training were to increase health workers’
skills on screening post-GBV cases, identifying GBV cases, examining the survivor/victim using the
evidence assault collection kit, improving the engagement of men in mitigating GBV, and increasing
health workers’ knowledge to report on GBV indicators as provided by the MOH. The training also
focused on improving health facility reporting using the GBV register on gender cases identified in
the facility.

Roll-out of the Sexual Assault Kits training

RHITES-E conducted capacity development through orientation of 14 Trainings of Trainers (TOT)

from LPHS-K and Moroto RRHSA on the use of sexual assault kits, sexual and gender-based violence
(SGBV) and post-GBV and provided them with 505 SGBV assault kits. The trained health workers will
roll out the training on use of the kits to other frontline health workers.

41
Status of youth friendly services at regional, districts and community

Youth were sensitized on available youth friendly services and corners at nearby health facilities
across 26 sub-counties. The key services emphasized included sexually transmitted infection (STI)
screening, preexposure prophylaxis (PEP,) and family planning services. Young men and women
were also taken through by the adolescent focal persons the GBV clinical care package and LIVES-
first line support. Twenty-seven teenage mothers shared their personal teenage pregnancy
experiences during the dialogue meetings across 26 high-burdened sub counties reached. These 27
teenage mothers used various dialogue meetings as avenues to discourage teenage pregnancies
and poor health seeking behaviours among the youth. This resulted in having teenage mothers as
advocates in the fight against teenage pregnancies within their communities.

Forty-five youth champions across all the districts were able to reach out to 675 (246 males, 429
females) young people through one-on-one discussion and, home visits on information on ASRH.
Young people were also taken through male condom demonstration sessions, how to store and
dispose of condoms, discussions on STIs/STDS, and dangers of teenage pregnancy.

42
6.0 FINANCIAL MANAGEMENT & OPERATIONS

1. Activity Financial Analysis

Life of Activity (start and end dates): May 22, 2017 - May 21, 2022
Total Estimated Contract/Agreement Amount: US$72,178,455
Total Amount Obligated to Date (Sept 30, 2022): US$ $64,989,773.33

Current Pipeline Amount: US$325,342.84

Actual Expenditure Through This Quarter: US$ 64,664,430.49

Estimated Expenditures Next Quarter: US$ 1,068,755

2. Contracts and Grants Management

Activities of the next quarter (Q1/FY23):

 Modification of the sub awards for TASO Consortium.

 Continuous monitoring of activities to ensure compliance with donor provisions. IntraHealth
guidelines on management of sub awards in FY23.
 The unit will also continue supporting the capacity of LIPs—Baylor Uganda, ANECCA plus
G2G, and Mbale and Moroto Regional Referral Hospitals—in supportive roles, including
programmatic implementations and financial reporting to the donor.

3. Construction
 Remodeling at Kapchorwa Hospital to increase floor area as per approved layout and
improve laboratory infrastructure. Scope of work was to be within available funds. Hospital
Management was advised to source for alternative funding to address outstanding items.
The scope of work was executed as outlined in the contract documents at the site. These
included:
o Window openings in pharmacy were sealed off at the rear and a second window to
the front was created instead. Burglar proofing was provided to existing window
sections with glass panes.
o Steel instead of concrete sills for external windows, maintained aluminum for internal
windows.
o Provided sliding door between reception and data room.
o Reused old doors in alternative locations.
o Extra worktop lengths were provided in automation room.
o Cleaned old terrazzo; provided new terrazzo in toilet. Deferred epoxy floor finish.
Repaired sections of existing toilet wall tiles.
o Electrical-mechanical services to the remodeled laboratory and the entire OPD block
needed to be upgraded to cater for the anticipated laboratory equipment loads.
 List of outstanding items was shared with the Hospital administration. Among projected
outstanding works at handover in the current scope of work were : a panic exit device,
signage, changing room lockers, fire extinguishers, fire alarm system, installation of smoke
detectors, additional day lighting through existing roof, additional granite, additional
plumbing and drainage fittings, elbow operated taps, air conditioners, eye wash station,
emergency shower/drench hose, ceiling works, furniture, cyclone roof ventilators, and
biometric access system for restricted access.
 Any gaps to accreditation standards would be addressed by the Hospital, soon after handing
over the current scope of work.
43
  Works were executed within the agreed contract sums (or as modified in the addenda issued
later).

Major Achievements
 Laboratory infrastructure improvement at Kapchorwa hospital was successfully completed
and handed over.

4. HR and Administration
In the period Oct 1, 2021-Sept 30, 2022, four staff were recruited. Total number of RHITES-E staff
stood at 50, and these include IntraHealth (45) and TASO (5). We also recruited eight Program
Volunteers to support various activities. Four staff voluntarily left the RHITES-E Activity, and 74
were involuntarily laid-off during year.

7. SUMMARY OF EMERGING LESSONS

 LIPs have not effectively scaled up and implemented high yielding HIV testing strategies like
APN/index and SNS, therefore, resulting in over-testing and achievement of a low HTS yield,
especially in the LPHS-K region. The reasons for this are high stigma in Karamoja, terrain, and
inefficient implementation of high-yield interventions. RHITES-E continues to build the
capacity of LIPs to improve performance
 This has been the reason LPHS-K has failed to achieve its TX new annual target.
 RHITES-E needs to continue offering technical support and guidance to the LIPs and
encourage uptake of best practices like facility and community VL campaigns to ensure
consistent and improved indicator performances, e.g., VL coverage and suppression, AHD
management, EQA response, and pass rates.
 RHITES-E should also actively support the G2G sites with strengthening transition efforts
since their start-up has not been satisfactory.
 RHITES-E will help LIPs to build a stronger relationship with MOH.
 More effort needs to be demonstrated to encourage the LIPs to strengthen district and
health facility partnerships to guarantee activity uptake and ownership.
 RHITES-E should also encourage the LIPS to ensure integrated technical supportive
supervision exercises are held regularly to guide subsequent site mentorships.
 Weekly above site data review sessions with local partners provide an avenue to coach and
build the capacity of staff on utilization of data/dashboards to facilitate performance
improvement.
 Continuous district engagements are key to strengthening working relationships and
collaboration with other IPs.
 Utilization of data/dashboards by the program is key towards informed targeted facility
implementation.
 Technical assistance efforts should be followed up to assess progress on the practices
deriving from transferred skills and knowledge. This facilitates compliance with standards,
guidelines, and definitions.
 The training of health workers in post-GBV care and management has increased the number
of cases being managed by the trained health workers in different clinics.

44
  Most trained GBV focal persons based at the health facilities need reminders through CME
and mentorships. These mentorships are cost efficient, providing on-the-job training that do
not require resources.
 Youth champions in collaboration with other community structures in high teenage
pregnancy burden districts have supported community responses to sexual violence cases.
 Involvement of stakeholders from the community department at the district facilitates deep
community entry regarding GBV case identification, referral, and management.
 Male action groups (MAGs) engagement has led to increased number of clients for MNCH
services.
 There is limited financial capacity to equip adolescent girls and young women with various
materials to help them in economic empowerment. RHITES-E has leveraged other partners
with livelihood programs by referring those in need to relevant support like the Parish
Development Model and Emyoga funds.

8. SUMMARY OF KEY ACTIVITIES FOR FY23 Q1

RHITES-E will actively engage the local partners and DHTs to conduct the following:

Monitoring, Evaluation and Learning

 Provide technical support on data processes (collection, cleaning, and reporting) in line with
the district reporting mandate.
 Work with the districts’ DHT to conduct DQA on FH, on COVID-19 response data.
 Roll out the new HMIS SOPs and oversee reporting of reporting systems.
 Implement the CLA through D2A and communities of practices on broad questions that relate
to transition processes and capacity building outcomes.

Family Health
 Facilitate district EPI microplanning in category 3 and 4 districts.
 Conduct quarterly district-level FH TWG meetings.
 Facilitate DBMs to conduct integrated data-driven supportive supervision.
 Conduct regional multi-sectoral performance review meetings.
 Support quarterly MPDSR district-level review meetings.
 Print and distribute health facility and community referral SOPs and DNAPs.
 Support the 52 regional QI coaches to conduct monthly coaching and mentorship at the 26
QI collaborative facilities in seven districts.

COVID-19 Vaccination Response

 Clear and clean the COVID vaccination data backlog.
 Re-orientation meeting for the District Task Forces.
 Weekly coordination meetings at district level.
 Support districts to formulate preparedness and response plans for pandemics, including
COVID-19 upsurges.
 Facilitate routine supervision visits to the districts.

45
 HIV TB activities
 Provide coaching and mentorships to the local partners to scale up MMD, especially among
children, and ART optimization/DTG transitioning.
 Conduct hands on coaching and mentorships on HDR management.
 Conduct regional care and treatment QI meetings with district health teams and PLHIV
networks to improve retention in care and treatment.
 Hold regional meetings for ART in-charges and district DSD/HIV focal persons together with
the local partners to improve DSD implementation in the districts.
 Supportive supervision/mentorship to improve the TB, TB-HIV Clinical cascade.
 Conduct coaching for TB, TB-HIV CQI collaborative.
 District data validation/harmonization meetings.
 Coordinate the implementation of the AP3 program with the region.

HIV Prevention
 Support LPHS-E and LSDA to enhance PrEP continuity through supporting approaches like
DSDM (DICs) and targeted peer-led approaches and trainings.
 Support LPHS-K, LPHS-E, LSDA, and Moroto RRHSA to conduct the annual VMMC adverse
event management and resuscitation trainings.
 Conduct joint sit-in mentorships at all high-volume sites in LPHS-E, LPHS-K, Moroto RRHSA,
and LSDA to strengthen the use of the HTS screening tool to improve yield.
 Support LPHS-K, LPHS-E, LSDA, and Moroto RRHSA to conduct re-assessment of all ART sites
in index testing proficiency.
 Support LPHS-E to start offering MAT therapy services to PWIDS from the eastern region,
Karamoja, and east central region by end of October 2022.
 Support the local partners to collect VMMC COP22 Q1 data on adverse events and VMMC
standards for the national QI dashboard.

Laboratory System Strengthening

 Annual SANAS surveillance audits (Tororo and Mbale Labs).

HIV Care and Treatment

 Conduct orientation of health workers from Sebei cluster districts of Bulambuli, Kapchorwa,
Kween, and Bukwo on HDR, sample removal, and management of patients failing on second
line drugs.

Prevention of Mother to Child Transmission (PMTCT)

 Supporting LIPs and Districts to roll out Accelerated Progress in PMTCT and Pediatrics (AP3)
Initiative.

Gender Youth and Social Inclusion

 Organize community stakeholder meetings.
 Conduct community engagements with AGYW for prevention of HIV.
 Support the LPHS to refine and customize their child protection and safeguarding policies.

SBCC

46
  Support Moroto G2G to develop a demand generation strategy.
 Support demand creation for COVID-19 vaccination using radio.

Human Resources for Health

 Logistical support to five districts to hold accountability meetings.
 Conduct monthly supportive supervision to 25 districts to sustain iHRIS functionality and
strengthen HRH data analysis.

Supply Chain
 Improve district level systems and activities for planning, managing, and monitoring the
availability and utilization of health commodities through quality quantification and ordering.
 Implementation of EMHS Supervision Performance Assessment and Reward Strategy (SPARS)
in LPHS-E.

47
ANNEXES

a. Performance Table FY22

Table 1. Summary of FY22 results on select FH indicators area

Annual Cumulative FY22

AREA Link to CDCs Select Indicators for FY22
Target Actual
Q1 Q2 Q3 Q4
Percentage of women attended at least four times for
CHL.6.1-1 70% 50% 49% 52% 50% 49%
antenatal care (ANC) during pregnancy

Number of women giving birth in a HF with USG 116,034 253,347 62,011 64,860 64,394 62,082
HL.6.2-X
support
79% 80% 77% 80% 79%

Number of women giving birth who received 110,232 234,747 56,859 58,406 61,080 58,402
HL.6.2-1 uterotonics in the third stage of labor (or immediately
after birth) through USG-supported programs 95% 92% 98% 94% 95%

Maternal Deaths Surveillance and Response (MDSR)

95% 98% 87% 107`% 100% 98%
reviews reported
INTEGRATED CHL.6.8-1
FAMILY HEALTH Perinatal Deaths Surveillance and Response (PDSR)
95% 52% 55% 49% 57% 48%
reviews reported
Percentage of mothers who attended postnatal care
CHL.6.2-2 80% 66% 67% 66% 66% 66%
(PNC) visit within 6 weeks postpartum
Percentage of children under one year of age who are
CHL.6.4-1 90% 94% 93% 94% 97% 89%
fully immunized
Number of children who received their first dose of 110,232 277,280 71,949 67,381 71,030 66,920
HL.6.4-X measles-containing vaccine (MCV1) by 12 months of
age in USG-assisted programs 97% 98% 96% 100% 94%
CHL.7-3 Teenage pregnancy rate 16.6 24% 25% 24% 24% 22%
Couple-Years of Protection in USG-supported
HL.7.1-1 252,047 334,157 546,090 265,695 268,048 256,796
programs

CHL.9-1 Early initiation of breastfeeding 95% 92% 91% 94% 90% 95%
WASH AND
NUTRITION Percentage of Children 6-59 months who received
CHL.9-3 nutritional assessment and categorization at facility 50% 50% 53% 50% 50% 47%
level
a
 Number of children under five (0-59 months) reached 254,170 1,439,257 500,787 288,222 359,422 290,826
HL.9-1 with nutrition-specific interventions through USG-
supported nutrition activities 96% 131% 100% 85% 73%

108 83 13 25 29 16
HL2.4-1 Drug-Resistant TB Notifications
HIV AND TB 77% 48% 93% 107% 59%

HL2.4-4 Drug-Resistant TB treatment Success Rate 85% 80% 65% 75% 93% 92%

Number of people who received a first dose of an 2,045,206 1,449,613 227,918 944,722 149,182 127,791
CV.1.4-6 approved COVID-19 vaccine (COV-1) with USG direct
support 71% 11% 57% 65% 71%

Number of people who have been fully Immunized for 2,045,206 1,222,996 35,320 982,173 106,575 98,928
COVID 19
COVID 60% 2% 50% 55% 60%
Number of people who received a recommended 2,045,206 73,535 1,242 4,880 31,042 36,371
CV.1.4-8 booster dose of an approved COVID-19 vaccine (COV-
4% 0.1% 0.3% 2% 4%
2,3,4) with USG direct support
Number of people who received a recommended 2,045,206 73,535 1,242 4,880 31,042 36,371
CV.1.4-8 booster dose of an approved COVID-19 vaccine (COV-
2,3,4) with USG direct support 4% 0.1% 0.3% 2% 4%

Slightly Behind Significantly Behind

Key On Target
Target Target

b
b. Success Story

Using data for adaptive management to successfully transition programs on USAID's Learning Lab
website.

c: Annex D: Lab section Tables: 2-

RHITES-E SANAS Status for the period 2021- 2022

Sn Hub Site Status in 2021 Current status
1 Mbale Regional Referral hospital SANAS Sustained
Accredited
2 Moroto Regional Referral SANAS Sustained
hospital Accredited
3 Tororo General Hospital SANAS Sustained
Accredited
4 Pallisa General Hospital SANAS Due for audit in COP23
Accredited
5 Kapchorwa General Hospital STAR 3 STAR 3
6 Busolwe General Hospital STAR 4 Audit deferred to a later date
7 Abim General Hospital STAR 2 STAR 2
8 Kaabong General Hospital STAR 1 STAR 2
9 Bududa General Hospital STAR 1 Under supplementation program
10 Kotido HCIV STAR 3 STAR 2
11 Budadiri HCIV STAR 1 STAR 2

d: ANNEX: E Supply Chain Section

Table 4: Supply Chain Update by quarter

Supply Chain Update by quarter

SCM_ Reporting rate Stock _ Status

District FY 22 FY 22 FY 22 FY 22 Average FY FY FY 22 FY 22 Average
Q1 Q2 Q3 Q4 22 22 Q3 Q4
Q1 Q2
Bududa 80% 98% 98% 98% 94% 76% 68% 85% 78% 77%
Bulambuli 88% 89% 95% 95% 92% 66% 62% 78% 68% 69%
Manafwa 89% 95% 94% 94% 93% 77% 78% 69% 65% 72%
Mbale 88% 89% 91% 91% 90% 69% 66% 59% 64% 65%
Namisindwa 91% 95% 98% 98% 96% 49% 68% 77% 65% 65%

Sironko 98% 97% 100% 100% 99% 78% 69% 52% 71% 68%
Bukwo 98% 99% 100% 100% 99% 59% 55% 77% 45% 59%
Kapchorwa 98% 100% 100% 100% 100% 69% 89% 63% 66% 72%
c
 Kween 91% 94% 100% 100% 96% 89% 71% 55% 60% 69%
Budaka 97% 81% 98% 98% 94% 91% 78% 71% 77% 79%
Butaleja 99% 93% 95% 95% 96% 86% 78% 88% 69% 80%
Butebo 88% 89% 91% 91% 90% 45% 51% 89% 61% 62%
Kibuku 81% 89% 95% 95% 90% 78% 68% 69% 55% 68%
Pallisa 86% 89% 88% 88% 88% 69% 59% 74% 64% 67%
Tororo 80% 86% 84% 84% 84% 69% 79% 69% 73% 73%
Abim 98% 95% 97% 97% 97% 77% 69% 79% 81% 77%
Kaabong 79% 80% 89% 89% 84% 41% 59% 78% 65% 61%
Karenga 81% 97% 91% 91% 90% 53% 81% 70% 61% 66%
Kotido 94% 89% 91% 91% 91% 81% 85% 71% 65% 76%
Moroto 98% 99% 100% 100% 99% 89% 66% 69% 63% 72%
Total 90% 92% 95% 95% 93% 71% 70% 72% 66% 70%

Source DHIS2 2022

F: ANNEX F: SBCC Section

Table 5: Data from VHT reports on home visits

SN Parameter Qtr1 Qtr2 Qtr3 Qtr4 Cumulative
Total
VH20 Number of HIV positive patients 22,206 26,258 26,846 1653 76,963
seen in the community
VH22 Number of TB cases identified in 1,189 1,605 2,290 128 5,212
the community
VH24 Number of people using FP 111,268 124,268 16,0817 12048 408,401
services (information & methods)
VH25 Number of deliveries at home 2,251 2,298 3,094 276 7,919
0
VH26 Number of women who died 26 36 48 0 110
during pregnancy
VH27 Number of women who attended 20,339 21,926 26,546 1276 70,087
at least 4 ANC visits
VH28 Number of women who attended 9,034 10,331 12327 553 32,245
at least 8 ANC visits
VH29 Number of adolescents and young 612,125 639,433 830411 69713 2,151,682
people (10-19 & 20-24 years)
VH32 Total number of Household 1,531,419 1,643,549 1861240 109509 5,145,717
members using LLIN