NATIONAL VILLAGE HEALTH TEAMS (VHT) ASSESSMENT IN UGANDA

Transcription

1 NATIONAL VILLAGE HEALTH TEAMS (VHT) ASSESSMENT IN UGANDA March 2015

2 Cover photo by Jake Lyell.

3 Table of Contents ABBREVIATIONS AND ACRONYMS... 1 FOREWORD... 2 ACKNOWLEDGEMENTS... 3 EXECUTIVE SUMMARY INTRODUCTION Definition of Village Health Teams and Functions The History of Community Health Worker Programmes around the World Evolution of VHTs in Uganda VHT Roles and Services Globally Selection of VHTs Performance Incentives Justification of the Assessment OBJECTIVES General Objective Specific Objectives METHODOLOGY Study Setting Study Design and Sampling Study Respondents Quality Control Data Management and Analysis Ethical considerations Limitations of the Assessment FINDINGS Introduction Number and Socio-demographics of VHTs in Uganda (Objective 1) Training provided to Village Health Teams (Objective 2) Partners Working with VHTs and the Activities VHTs are Currently Implementing (Objective 3) Extent to which the VHT Implementation Guidelines are Being Implemented by the Ministry of Health, the Districts and Partners (Objective 4) Approaches for Motivation Mechanisms and Arrangements (Objective 5) Functionality of the VHT Programme (Objective 6) DISCUSSION SUMMARY RECOMMENDATIONS Recommendations for Immediate Action Additional Recommendations... 63

4 7. 0 APPENDICES Appendix 7.1: Number of VHTs in the Districts Appendix 7.2: National Partners to Interview Appendix 7.3: List of Partners Working with VHTs in Districts Appendix 7.4: List of Partners Interviewed at District Level Appendix 7.5: Ministry of Health Key Informant Interviews Appendix 7.6: VHT Questionnaire Appendix 7.7: Questionnaire for Ministry of Health Officials Appendix 7.8: Partner Interview Guide Appendix 7.9: Health Centre Interview Guide Appendix 7.10: Community Interview Guide Appendix 7.11: District Key Informant Guide (LCV Chairman, CAO, RDC) REFERENCES DISTRICT-LEVEL ANALYSIS

5 Abbreviations and Acronyms AVSI Association of Volunteers in International Service AMREF African Medical Research Foundation ASARECA Association for Strengthening Agricultural Research in Eastern and Central Africa CAAIP Agricultural Infrastructure Improvement Programme CAO Chief Administrative Officer CDO Community Development Officer CHW Community Health Worker CIAT International Centre for Tropical Agriculture DG Director General DHT District Health Team GISO Gombolola Internal Security Officer FAWEU Forum for African Women Educationalists Uganda FGD Focus Group Discussion HC Health Centre HSSP Health Sector Strategic Plan IDC Ideal Development Consults Ltd IDI Infectious Disease Institute IP Implementing Partner KII Key Informant Interview LC Local Council MDG Millennium Development Goal MOH Ministry of Health MUAC Mid-upper Arm Circumference mtrac Mobile Tracking NAADS NCDs National Agricultural Advisory Services Non-communicable Diseases NGO Nongovernmental Organization NTDs Neglected Tropical Diseases ORS Oral Rehydration Solution RUFORUM Regional Universities Forum RDT Rapid Diagnostic Testing SACCO Savings and Credit Cooperative Organization SPSS Statistical Package for Social Scientists SPRING Strengthening Partnerships, Results and Innovations in Nutrition Globally SHSSPP Support to Health Strategic Sector Plan Project STAR EC Strengthening TB and HIV & AIDS Responses in East-Central Uganda TB Tuberculosis TEREWODE Association for the Rehabilitation and Re-Orientation of Women for Development TOT Training of Trainers UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children s Fund USAID United States Agency for International Development VHT Village Health Team WHO World Health Organization 1

6 Foreword Uganda s health indicators on maternal and child mortality and morbidity remain high despite continued investment in maternal, neonatal, and child health. According to the Health Sector Strategic Plan (HSSP) 2000/ /06, the key challenge for the health system was to extend basic health care services to the entire population, especially in rural areas where access to health care is limited. It was to address this challenge that HSSP I recommended the establishment of the Village Health Teams (VHTs) and HSSP II and HSSP III called for the VHT strategy s roll-out and consolidation, respectively. The Ministry of Health established Village Health Teams (VHTs) in 2001 as a means to close the gap in delivery of health services to the households. Strategy and implementation guidelines were developed and distributed to the development partners and the districts to utilize in establishing, training and motivating the VHTs to undertake their activities. A number of districts and partners have established and trained VHTs in their operational areas with and without the Ministry of Health s guidance. In some instances, partners have taken up VHTs, provided training on their programmatic areas without the basic/core training required of VHTs using the Ministry of Health VHT training manual. This therefore leaves a gap in the VHTs operational methods. The Ugandan Ministry of Health, with partners, commissioned a VHT assessment to establish and ascertain the number, coverage, and functionality of VHTs in the country in order to devise an improvement framework. We are confident that this document will provide guidance to the Ministry of Health and the stakeholders to revise the VHT strategy in Uganda. Dr Ruth Aceng Director General of Health Services Ministry of Health, Uganda 2

7 Acknowledgements The Ministry of Health would like to acknowledge the efforts of a number of organizations and individuals who contributed immensely to the success of the assessment. Financial assistance was provided by the United Nations Population Fund (UNFPA) and the GAVI HSS (Health Sector Support). The United Nations Children s Fund (UNICEF) and World Health Organization (WHO) provided technical support into the assessment. Pathfinder International Uganda coordinated the process of carrying out the entire assessment. We are grateful to all the implementing partners who have supported the VHT program and who contributed to the success of the assessment. We are grateful to Ideal Development Consults Ltd. for ably carrying out the assessment, particularly Prof. Christopher Orach, Mr. Julius Twinamasiko, Dr. Frank Kaharuza, Dr. Stella Neema, Mr. Richard Opio, and Ms. Alice Ladur. We are grateful for the efforts of officials at local government level who supported the assessment by providing the necessary data. We greatly appreciate all the hard work of field staff and, most importantly, the contributions of survey respondents whose participation was critical to the successful completion of this assessment. The Ministry of Health would like to particularly thank the following task force for participating in the different stages of the assessment, including reviewing the report: No Name Title Organization 1 Dr. Christopher Oleke National VHT Coordinator Ministry of Health 2 Ms. Roseline Achola NPO-Maternal Health- Reproductive Health CS 3 Mr. Benjamin Sensasi National Professional Officer (NPO)-Health Promotion and Communication UNFPA WHO 4 Ms. Lucy Shillingi Country Representative Pathfinder-Uganda 5 Ms. Caroline Nalwoga Ssekikubo Monitoring and Evaluation Specialist Pathfinder-Uganda 6 Mr. Charles Muhumuza Consultant Ministry of Health 7 Ms. Flavia Mpanga Health Specialist UNICEF 8 Ms. Margaret Waithaka Research and Metrics Advisor Pathfinder-HQ 9 Ms. Tara Acton Senior Programme Officer Pathfinder-HQ 10 Ms. Camille Collins Lovell Technical Advisor for Behaviour Change 11 Ms. Minal Rahimtoola Technical Advisor for Health Systems Strengthening Pathfinder-HQ Pathfinder-HQ 11 Dr. Fredrick Makumbi Researcher Makerere University School of Public Health 12 Dr Modibo Kassogue Chief, Child Health & Dev t UNICEF 3

8 Source: Uganda Bureau of Statistics,

9 Executive Summary Background Uganda adopted the Village Health Teams (VHTs) strategy in 2001 as a bridge in health service delivery between communities and health facilities. This assessment sought to determine the VHT programme s functionality in Uganda. The overall ojective of the assessment was to determine the national status and functionality of VHTs in Uganda in order to improve the planning and delivery of health services to households and communities. The specific objectives of the assessment were: 1) To establish the number and sociodemographic profiles of the VHTs in Uganda; 2) To establish the training that was provided to the VHTs (VHT training; duration of the training; the content, methods, and materials used for the training); 3) To establish the partners working with VHTs and the activities VHTs are currently implementing; 4) To review the extent to which the VHT implementation guidelines are being implemented by the Ministry of Health (MOH) and the districts and partners; 5) To identify approaches for VHT motivation mechanisms and arrangements; and lastly, 6) To assess the functionality of VHTs in Uganda. Methods The assessment employed a cross-sectional study design using qualitative and quantitative techniques of data collection. The assessment was conducted in all 112 districts in Uganda from November 2014 to January Individual interviews were conducted with a total of 2,610 VHT members, 224 health workers, and 112 VHT focal persons. Key informant interviews were conducted with 112 district partners and 200 district leaders, including Resident District Commissioners, Local Council V Chairpersons, and Chief Administrative Officers. Additionally, key informant interviews were conducted with seven Ministry of Health officials and 13 national partners. Focus group discussions were conducted with 112 District Health Team (DHTs) and 30 community groups. Results Objective 1: To establish the number and socio-demographic profiles of the VHTs in Uganda. Overall, we found a total of 179,175 VHT members in the country. Thirty percent of these do not have basic training. More than half (52%) of the VHTs had a minimum of O Level qualification. The highest level of education attained by VHT members (0.4%) is University. Slightly more than 1% (1.3%) of the VHTs interviewed had no formal education, of which 82% are VHTs in Karamoja region. Objective 2: To establish the training provided to VHTs. We found that the majority (84%) of the 112 districts had VHT trainers. Almost half (47%) of the districts had training of trainers (TOTs) in the last 4 years. TOTs were largely conducted by the Ministry of Health. Fifty percent of the districts have more than 75% active trainers. Most VHTs (91.1%) have had initial training. Overall, more than half of the VHTs were trained for 5-7 days. This duration is too short to accommodate the content of VHT training manual and the ever-increasing roles of VHTs. The main content of the basic trainings was: disease prevention, health education, community mapping, community registers, home visits, community mobilisation, and referrals. The initial trainings were conducted based on MOH guidelines. On average, VHTs received 6 refresher trainings after the basic training. The refresher trainings were varied in content, duration, and methodology. 5

10 Objective 3: To establish the partners working with VHTs and the activities VHTs are currently implementing. The roles VHTs play include mobilisation of communities to access health interventions such as immunization, mosquito net distribution, fistula services, and HIV and AIDS counselling and testing services. VHTs conduct community sensitization on disease prevention such as hygiene and sanitation practices (e.g. hand washing, construction of pit latrines, and drinking boiled water) and the importance of using health services (e.g. HIV testing, antenatal care, and family planning). They were also actively involved in treatment of common ailments like malaria and diarrhoea, and in promotion of health services (including immunization activities) and identifying patients suffering from neglected tropical diseases (NTDs) in their communities. VHTs were also involved in distributing contraceptives such as condoms. They were also instrumental in the distribution of drugs (mainly deworming tablets and anti-malarials) in the communities to population groups such as children under five. Partners The study established that 109 implementing partners (IPs) are working with districts to support VHT activities. These include the UN agencies UNFPA, WHO, UNICEF, and UNDP, implementing partners including Pathfinder International, World Vision, Malaria Consortium, PACE, AMREF, Baylor Uganda, and several community-based organisations (CBOs). These IPs provided financial, technical, and logistical support to the VHT programme. The partners were using the MOH VHT guidelines in the implementation of VHT activities. Although there are many partners supporting VHT implementation in the districts, they are not equitably distributed in geographically and with respect to their activities, as shown by the concentration of partners in some districts and not in the others. Even within districts, partner activities are concentrated in some sub-counties and not in others. Objective 4: To review the extent to which the VHT implementation guidelines are being implemented by the MOH, districts, and partners. Overall, there was adherence to the MOH guideline for VHT recruitment and selection in most districts. Supervision of VHT activities varied across the districts. What was however common was the involvement of the IPs, DHTs and the district leaders in supervising VHT activities either directly or indirectly. The assessment did not validate the extent of this supervision as no supervision reports were found. A general hierarchical VHT reporting from the village through the parish (health centre), sub-county to the district level exists as evident in some districts. In a few districts such as Otuke, Sheem, and Buhweju, there was practically no reporting due to the absence of a reporting format/tool and lack of training. It was also found that there is non-uniformity in reporting tools amongst IPs. Objective 5: To identify approaches for VHT motivation. Monetary and non-monetary forms of VHT motivation were identified. Financial motivation included lunch and transport allowances, activity, and monthly allowances. Non-monetary forms of motivation included verbal recognition and appreciation on media and during public events. Capacity building in the forms of educational short courses, trainings, and mentorship were cited as ways of motivating VHTs. Provision of tools and supplies such as uniforms, bags, gum boots, umbrellas, identity cards, bicycles, among others, and provision of special rewards for VHT were also mentioned. These forms of motivation were found to be non-uniform and irregular amongst IPs. This resulted into demotivation among some VHTs. Monetary motivation was largely provided by IPs. As a result, VHTs 6

11 efforts are concentrated more on IP programmes than on government programmes. This in effect lessened government ownership of the VHT programme. Objective 6: To assess the functionality of VHTs in Uganda. In terms of governance, the assessment found that there is a coordination office at the national level for the VHT programme. However, this office is incapacitated by lack of staff, logistics, and inadequate and/or inaccessible funding for VHT implementation, coordination, monitoring, and supervision of the entire programme. This is reflected in the ever-reducing government funds since the inception of the programme. At the district level, functionality of the VHT programme is weak due to lack of funding for the programme both from the centre and the districts. Districts do not have databases for the VHTs and lack evidence of monitoring, supervision, and coordination of the VHT programme. The districts reported that VHTs are being supervised by in-charges of health centres, Health Inspectors, Assistants, and Educators. However, these workers were found to lack facilitation in terms of transport and some of them were neither oriented to the VHT strategy nor formally mandated to monitor and supervise VHT activities. At community level, the programme was appreciated in the rural communities, whereas urban communities did not know or knew little about the programme. This calls for more sensitization of the urban communities on the roles of VHTs. At individual VHT level, although most of the VHTs reported having been supervised, there was no evidence of supervision in the form of reports at the nearest health facility or district. The VHTs reported multiple reporting requirements from partners, which is a burden to VHTs especially those with low or no education. Conclusion The assessment has shown that the VHT strategy has been implemented to varying levels across the districts. Funding of the programme by the government has been gradually reducing since its inception, leaving the IPs to fund most of the activities. Districts have different levels of capacity to coordinate, train, and supervise VHT activities but have been hampered by lack of funds. Coordination and supportive supervision to partners and districts by the MOH have not been conducted as desired due to funding constraints. Recommendations 1. There is need to review the entire VHT strategy including policy, selection, training, content, redefinition of roles and responsibilities of VHTs, and coordination structures at the national and district level. 2. The government should have a clear commitment to adequately financing and institutionalizing the VHT strategy and should ensure regular payments of VHTs for sustainability of the programme. 3. A strong VHT coordination structure as well as clear monitoring and supervision mechanisms should be established at all levels of government. Coordination of implementing partners should be part of the structure. 7

12 4. The Ministry of Health should establish an accurate database for VHTs at the national level to aid monitoring and supervision of the programme. Each district should also be helped to create a district-specific VHT database. 5. The Ministry of Health should streamline training and refresher courses for VHTs to ensure quality, equity in capacity building for all VHTs, and control over VHT activities. 6. Lastly, the government and all relevant stakeholders should make available a conducive working environment for VHTs. This should include efforts to improve working relationships between VHTs and health workers and supporting economic development opportunities for VHTs. Women Focus Group Discussion in Masaka district, Mixed Focus Group Discussion in Sembabule district,

13 1.0 Introduction 1.1 Definition of Village Health Teams and Functions According to the VHT Strategy and Operational Guidelines, the Village Health Team is a non-statutory community (village) structure selected by the people themselves to manage all matters related to health and cross-cutting issues. The Village Health Teams are chosen by their own communities to promote health and wellbeing of all village health members (MOH, 2009). The basic functions of VHTs articulated in the VHT Strategy and Operational Guidelines include community information management, health promotion and education, mobilisation of communities for utilization of health services and health action, simple community case management and follow-up of major killer diseases (malaria, diarrhoea, pneumonia and emergencies), newborn care, and distribution of health commodities (MOH, 2009). 1.2 The History of Community Health Worker Programmes around the World The concept of using community members to render certain basic health services to the communities from which they come has been in existence for at least 50 years. The Chinese barefoot doctor programme is the best known of the early programmes, although Thailand, for example, has also made use of village health volunteers and communicators since the early 1950s (Kauffman & Myers, 1997; Sringernyuang, Hongvivatana & Pradabmuk, 1995). The barefoot doctors were health auxiliaries who began to emerge in the mid-1950s and became a nationwide programme from the mid-1960s, ensuring basic health care at the brigade (production unit) level (Zhu et al., 1989; see also Hsiao, 1984; Sidel, 1972; Shi, 1993). Partly in response to the successes of this movement and partly in response to the inability of conventional allopathic health services to deliver basic health care, a number of countries subsequently began to experiment with the village health worker concept (Sanders, 1985). The early literature emphasizes the role of the village health workers (VHWs), which was the term most commonly used at the time, as not only (and possibly not even primarily) a health care provider, but also as an advocate for the community and an agent of social change, functioning as a community mouthpiece to fight against inequities and advocate for community rights and needs with government structures; in David Werner s famous words, the health worker as liberator rather than lackey (Werner, 1981). This view is reflected in the Alma Ata Declaration, which identified community health workers (CHWs) as one of the cornerstones of comprehensive primary health care. Examples of VHW initiatives in Africa driven by this rationale include Tanzania s and Zimbabwe s VHW programmes in their early phase. Both were set in the political context of wholesale systemic transformation (decolonization and the Ujamaa movement in Tanzania, and the liberation struggle in Zimbabwe), and both focused on self-reliance, rural development, and the eradication of poverty and societal inequities. The economic recession of the 1980s, which seriously jeopardized particularly the economies of developing countries, and brought shifts in the policy environment as the focus on liberation, decolonization, democratization, self-reliance, and the basic needs approach to development was replaced by World Bank-driven policies of structural adjustment and its successors. CHW programmes were the first to fall victim to new economic stringencies and most large-scale, national programmes collapsed (although numerous nongovernmental organizations (NGOs) and faith-based organizations 9

14 (FBOs) continued to invest in mostly small, community-based health care). The collapse was further facilitated by the fact that many large-scale programmes had suffered from a number of conceptual and implementation problems such as unrealistic expectations, poor initial planning, problems of sustainability, and the difficulties of maintaining quality (Gilson et al., 1989). While many policymakers turned their attention away from CHWs altogether, others, wanting to rescue the concept and practice, suggested subtle shifts, as the following quote from a WHO publication on CHWs illustrates: CHW programs have a role to play that can be fulfilled neither by formal health services nor by communities alone. Ideally, the CHW combines service functions and developmental/promotional functions that are, also ideally, not just in the field of health.perhaps the most important developmental or promotional role of the CHW is to act as a bridge between the community and the formal health services in all aspects of health development.the bridging activities of CHWs may provide opportunities to increase both the effectiveness of curative and preventive services and, perhaps more importantly, community management and ownership of health-related programs CHWs may be the only feasible and acceptable link between the health sector and the community that can be developed to meet the goal of improved health in the near term (Kahssay, Taylor & Berman, 1998). Although this concept of CHWs continues to focus on their role in community development and bridging the gap between communities and formal health services, their role as advocates for social change has been replaced by a predominantly technical and community management function. Over the years, and within the prevailing political climate, this pragmatic approach to CHWs has gained currency, and undoubtedly today constitutes the dominant approach, although the fundamental tension between their roles as extension worker and change agent remains. 1.3 Evolution of VHTs in Uganda In 200I, the Uganda Health Sector Strategic Plan 1 recommended the establishment of Village Health Teams to bridge the gap and increase equity in access to health services. The VHTs were charged with the responsibility to empower communities to take control of their own health and wellbeing and to participate actively in the management of the local health services (NHP, 1999). The decision to establish VHTs was in line with the Alma Ata (1978) and the Ouagadougou (2008) Declarations on primary health care. The roll-out of the VHT strategy during faced many challenges including ownership, sustainability, governance, motivation, selection and training. In addition, the VHT strategy relied heavily on the concept of volunteerism. 1.4 VHT Roles and Services Globally CHWs have participated in the provision of primary health care all over the world for several decades. There is evidence showing that VHTs can add significantly to the efforts of improving the health of the 10

15 population, particularly in those settings with the highest shortages of motivated and capable health professionals. 1 A review of CHWs across the globe provides a diverse picture of the current outreach services of health care workers. The review indicates that a wide range of services are offered by the CHWs to the community, including provision of safe delivery; counselling on breastfeeding; management of uncomplicated childhood illnesses; provision of health education on prevention and treatment of malaria, tuberculosis (TB), HIV and AIDs, sexually transmitted infections, and non-communicable diseases; and rehabilitation of people suffering from common mental health problems. The services offered by CHWs have helped in the decline of maternal and child mortality rates and have also assisted in decreasing the burden and costs of TB and malaria. However, the coverage by such programmes and the overall progress towards achieving the Millennium Development Goal (MDG) targets is very slow (WHO, Report Global Health Workforce Alliance Year). Given the broad role that many CHWs play in primary care, a programme must assure that a core set of skills and information related to the MDGs be provided to most CHWs. Therefore, the curriculum should incorporate scientific knowledge about preventive and basic medical care, yet relate these ideas to local issues and cultural traditions. They should be trained, as required, on the promotive, preventive, curative, and rehabilitative aspects of care related to maternal, newborn and child health, malaria, TB, HIV and AIDS, as well as other communicable and non-communicable diseases. Other training content and training duration may be added that is pertinent to the specific intervention the CHW is expected to work on. The CHW/VHT programmes should be coherently inserted in the wider health system, and CHWs should be explicitly included within the human resources for health strategic planning at country and local level. While CHWs may not replace the need for sophisticated and quality health care delivery through highly skilled health care workers, they could play an important role in increasing access to health care and services, and in turn, improved health outcomes, as an effective link between the community and the formal health system, and as a critical component in the efforts for a wider approach that takes into account social and environmental determinants of health. Successful examples are evident in the efforts of the Bangladesh Rural Advancement Committee (BRAC), Bangladesh, which set up a CHW programme based on cumulative experience and learning. 2 Brazil is another example where CHWs provide coverage to over 80 million people. 3 4 Ethiopia is currently training about 30,000 workers with an emphasis on maternal and child health, HIV, and malaria. Similar programmes are also being considered in other developing countries like India, Ghana, and South Africa. In Pakistan, a huge public sector programme for training and deploying Lady Health 1 WHO, Global Health Workforce Alliance. Global experience of community health workers for delivery of health related millennium development goals: A systematic review; country case study and recommendations for integration into national health systems. 2 Macharia CW, Kogi-Makau W, Muroki NM. Dietary intake, feeding and care practices of children in Kathonzweni division, Makueni district, Kenya East African Medical Journal 2004;81(8): Freedman LP, Waldman R, De Pinho H, Chowdhury M, Rosenfield A. Who s got the power? Transforming health systems for women and children. Earthscan/James & James, WHO, UNICEF, UNFPA, World Bank. Maternal Mortality in 2005 WHO, UNICEF, UNFPA, World Bank,

16 Workers has been in place since 1994 and has been expanded to cover over 70% of the rural population with a work force exceeding 90, Selection of VHTs CHW programmes should regulate a clear selection and deployment procedure. Ideally, the community should be engaged in planning, selecting, implementing, and monitoring, which reinforced the appointment of those who complete the course and pass the written or verbal exam at the end of training. The government should take responsibility for making a transparent system for selection and deployment and further quality assurance of the regulated system. When scaling up a CHW program, decision makers should consider how to link them up with the wider health system Performance For CHW programmes to perform effectively, it is vital to lay proper emphasis on training and supervision. Prior experiences have documented that low interest/use by the government, inconsistent remuneration, inadequate staff and supplies, and lack of community involvement are key factors that negatively impact the CHW program. These factors can be alleviated through certified training programmes and supportive supervision, along with offering other incentives (financial and nonfinancial) to keep CHWs satisfied and motivated to perform their duties well. Furthermore, efforts geared toward standardizing training and certification for CHW programmes, could further provide a career pathway and enable them to effectively contribute to their communities. A recent study by Kash et al. 7 concluded that certified CHWs are potentially an important force for improving access to health care and social services and improving utility of resources to the underserved. Equipment and supplies issues, such as the reliable provision of transport, drug supplies, and equipment, have been identified as another weak link in CHW effectiveness. 8 The result is not only that they cannot do their job properly, but also that their standing in communities is undermined. Failure to meet the expectations of these populations (with regard to supplies) erodes their image and credibility. If CHWs are used in programmes that have drug treatment at their core, such as TB DOTS or HAART, the situation becomes more critical, but regardless most programmes include the need for supply of drugs and/or equipment, including transport. 9 Ideally, supplies and equipment should be organized through district or regional dispensaries, and collected and delivered by CHWs.1 In cases where villages are very far from the central health centre, village dispensaries can be established to cater to the drug needs of the populations. 10 Equipment and supplies may be added as relevant to the specific intervention that the CHW is expected to work on. 5 Campbell OM, Graham WJ. Lancet Maternal Survival Series Steering Group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368: WHO, Global Health Workforce Alliance: Global experience of community health workers for delivery of health related millennium development goals: A systematic review; country case study and recommendations for integration into national health systems. 7 Kaseje MA, Kaseje DC, Spencer HC. The training process in community-based health care in Saradidi, Kenya. Annals of Tropical Medicine and Parasitology. 1987;81 (Suppl 1): WHO, Global Health Workforce Alliance. Global experience of community health workers for delivery of health related millennium development goals. 9 Wanda J and Tulenko K. Increasing community health worker productivityand effectiveness: a review of the influence of the work environment WHO, Global Health Workforce Alliance. Global experience of community health workers for delivery of health related millennium development goals. 12

17 1.7 Incentives Keeping in mind the dearth of health workers and the rising need for CHWs to meet the health care demands, it is imperative to prevent dropouts from training programmes. CHWs are poor people, living in poor communities, and thus require income. From the global and country case studies review we found that programmes pay their CHWs either a salary or an honorarium and almost no examples exist of sustained community financing of CHWs. 11 Even NGOs tend to find ways of financially rewarding their CHWs. Moreover, attrition can be controlled through offering regular and performance-based financial incentives and hiring CHWs as full-time employees rather than part-time volunteers. 12 They should be given a wage if they work full time, and those working part time should be given small incentives for their work. We would make a strong recommendation for ensuring the CHWs be paid adequate wages commensurate with their workload and hours. Performance-based incentives could be another compensation option, which can also motivate them to work with full determination. Moreover, in-kind rewards, such as an identification pin, can provide a sense of pride in their work and increased status in their communities. 13 In cases where possible, free health coverage for CHWs and for their families should be provided. In the end, we would recommend that CHWs should be given pay for performance to keep them motivation and engaged Justification of the Assessment A number of districts and partners have established and trained VHTs in their operational areas with or without the MOH s guidance. In some instances, partners have taken up VHTs, provided training on their programmatic areas without the basic/core training required of VHTs using the MOH VHT training manual. This therefore leaves a gap in VHTs operational methods. Currently, there are gaps in the information related to number, coverage, and functionality of VHTs. While the VHT strategy and implementation guidelines are in place, most partners implementing programmes in the communities do not follow the strategy as reflected in the Health Sector Strategy Investment Plan II (HSSIP II). Therefore, the Ugandan MOH, with partners, undertook a VHT assessment to establish and ascertain the number, coverage, and functionality of VHTs in the country to enable them to design an improvement framework. 2.0 Objectives 2.1 General Objective To establish the national status and functionality of VHTs in Uganda in order to improve the planning and delivery of health services to households and communities. 2.2 Specific Objectives i) To establish the number and socio-demographic profiles of the VHT in Uganda. ii) To establish the training that was provided to the VHT (VHT training, duration of the training, the content, methods, and materials used for the training) 11 Ibid. 12 Ibid. 13 Ibid. 14 Douthwaite M, Ward P. Increasing contraceptive use in rural Pakistan: an evaluation of the lady health workers programme Health Policy and Management. 2005;20(2):

18 iii) To establish the partners working with VHTs and the activities VHTs are currently implementing. iv) To review the extent to which the VHT implementation guidelines are being implemented by the MOH, districts, and partners. v) To identify approaches for VHT motivation (mechanisms and arrangements). vi) To assess the functionality of VHTs in Uganda. 3.0 Methodology 3.1 Study Setting The study was conducted countrywide in all 112 districts in Uganda. The study was conducted from November 2014 to January Study Design and Sampling A cross-sectional, mixed-methods study was conducted, which included a structured survey of Village Health Teams, focus group discussions with district health teams, and in-depth interviews. The country was subdivided into 10 sub-regions (Table 1) following Uganda Bureau of Statistics criteria. A total of 10 teams consisting of 5-6 members were trained and deployed for data collection. Table 1: Districts in the different regions Region District No. of districts Karamoja Kaabong, Kotido, Abim, Napak, Moroto, Nakapiripirit, Amudat 7 Eastern Kween, Kapchorwa, Bukwo, Sironko, Bulambuli, Bududa, Manafwa, Mbale, Bukedea, Kumi, Ngora, Serere, Soroti, Tororo, 17 Amuria, Katakwi, Busia East Central Butaleja, Budaka, Kibuku, Pallisa, Buyende, Kaliro, Namutumba, Bugiri, Namayingo, Mayuge, Kamuli, Luuka, Jinja, Iganga 14 Central 1 Kalangala, Masaka, Rakai, Lwengo, Bukomansimbi, Kalungu, Butambala, Ssembabule, Lyantonde, Gomba, Mpigi, Mubende, 13 Mityana Central 2 Buikwe, Buvuma, Mukono, Wakiso, Kayunga, Luwero, Nakaseke, Nakasongola, Kiboga, Kyankwanzi 10 South Western Kiruhura, Mbarara, Ntungamo, Isingiro, Kabale, Kisoro, Kanungu, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, 13 Ibanda Western Rubirizi, Kasese, Kamwenge, Kabarole, Kyenjojo, Kyegegwa, Kibale, Bundibugyo, Ntoroko, Hoima, Masindi, Bulisa, 13 Kiryandongo North Amolatar, Kaberamaido, Dokolo, Apac, Lira, Oyam, Kole, Alebtong, Otuke, Agago, Kitgum, Lamwo, Pader, Gulu, Amuru, 16 Nwoya West Nile Nebbi, Zombo, Arua, Adjuman, Moyo, Yumbe, Koboko, Maracha 8 Kampala Kampala 1 14

19 3.3 Study Respondents Table 2 shows the data collection methods and the respondents who were interviewed. District leaders including Local Council V Chairman (LCV chairman), Resident District Commissioner (RDC) and the Chief Administrative Officer (CAO) were purposively selected. Members of the district health teams were mobilised in each district to participate in a focus group discussion. In each district, two sub-counties were selected at random by drawing from a hat. Health Centre II facilities in the sub-counties were also randomly selected. Health Centre III or higher facilities were selected if they were in the selected parishes. A minimum of 12 VHT members from the villages in a parish were selected with the help of parish VHT supervisors and health centre in-charges. Focus group discussions were held with members selected from community where the health centre under the assessment is located. Partner selection was done in consultation with the DHT. The criterion of selection was based on the most active partner in the district in terms of geographical coverage. This meant that the partner s contribution to the VHT programme in the district was significant. In districts where the partner had been interviewed before in the region by the research team, the second most active partner was then considered. Data were collected during this assignment through comprehensive review of available literature from: VHT manual/handbook, VHT Strategy and Operational Guidelines, VHT register, Situational Analysis of VHT 2009, and other documents deemed relevant. Teams also extracted reports for review to capture information on VHTs profile during data collection. Table 2: Respondents and data collection technique Data collection techniques Category of respondents Actual number Target number Desk review Reports and all relevant documents Focus group discussions District Health Teams Community Key informant interviews District VHT focal person Implementing partners (district level) District Key Informants MOH Officials Interview administered questionnaire 3.4 Quality Control VHT Health care workers % of respondents interviewed The research assistants were trained for 5 days in research methods and data collection tools. Data collection tools were also pretested for a day prior to data collection. All the tools were translated into the appropriate local languages. The central management team and partners including MOH, Pathfinder International and UNFPA conducted supervision of the data collection. Daily debrief meetings were held with data collectors/research assistants to review questionnaires. 15

20 3.5 Data Management and Analysis Data Management The quantitative data were checked for completeness prior to entry in an electronic database using Statistical Package for Social Scientists (SPSS) Version 20. Qualitative data were transcribed, cleaned, and entered into a master sheet. Under the guidance of the field supervisor, trained research assistants captured data, which were securely kept in password-protected files Data Analysis Descriptive data analysis was conducted using SPSS Version 20 to obtain frequencies distributions, graphs and cross tabulations for statistical association. The qualitative data were analyzed by reviewing the FGD transcripts several times while making notes in the transcripts. Any disagreements that required further clarity were resolved through discussions among the data analysis team and data triangulation. These data were then coded, grouped/sorted according to themes and relative occurrence of the responses. Extracted meanings were summarized according to key /important messages. Thematic and content analysis, summaries, scenarios were used. 3.6 Ethical considerations Permission to conduct the study was sought from the district leadership including District Health Officers, Chief Administrative Officers, and the Resident District Commissioners. Verbal consent to participate in the survey was sought from all respondents. In the event that consent was not granted, such respondents were at liberty not to participate in the study. Maximum confidentiality was observed at all levels of data collection and processing. Table 3: Team Composition Name of Consultant Qualifications Roles Prof Christopher Garimoi Orach PhD Public Health Team Leader Dr Frank M. Kaharuza PhD Epidemiology Field Coordinator Mr Julius Twinamasiko MSc Agricultural Economics Cert in Public Data Manager Health, Cert in Nutrition Research Methods Dr Stella Neema PhD Anthropology Qualitative Research Lead Mr Richard Ongom Opio MSc Public Health Qualitative Data Analyst Ms Alice Ladur MSc Public Health Qualitative Data Analyst 3.7 Limitations of the Assessment The timing of the assessment coincided with some major events such as the national immunisation days and World AIDS Day, which limited the availability of the key respondents hard. Some of the district officials could not be reached for this assessment. 16

21 4.0 Findings 4.1 Introduction The findings of the assessment are presented in six sections according to the specific objectives of the study. Section 4.2 addresses the socio-demographic profiles of VHTs. Section 4.3 focuses on the training provided to VHTs. Section 4.4 addresses activities VHTs are engaged in and partners supporting the VHT programme. Section 4.5 addresses the extent to which the VHT implementation guidelines were implemented. Section 4.6 presents VHT motivation mechanisms and arrangements and section 4.7 addresses the functionality of VHTs. 4.2 Number and Socio-demographics of VHTs in Uganda (Objective 1) The VHT focal persons reported an estimated total of 179,175 village health team members from all the 112 districts. The Eastern region had the highest number, followed by South Western and Western regions. These regions also happen to have the largest number of districts. Kampala region has the lowest number (351) of VHTs (Figure 1). Figure 1: Distribution of VHTs by region Age of VHTs The assessment established that the age of VHTs ranged from 18 years to 78 years, with an average of 40 years. Age was categorized into three groups (Figure 2). The majority of VHTs (59.3%) were in the age range of 31 to 49 years. 17

22 Figure 2: Age group by sex Sex of the VHTs The majority of the key informant interviews (KIIs) reported the existence of more female VHTs than male. For instance, in Mitooma district as well as in Kibaale district, this situation and challenges related to gender disparities affecting female VHTs were acknowledged. Many of the VHTs are women of which most men overlook them; they say it is a women`s thing, KII_ Mitooma district. Most VHTs are female, the married ones tend to be bullied by their husbands, tending to discourage them from that commitment, KII_ Kibaale district. While the majority of the sample of VHTs who attended the interviews were male (53.9%), it should be noted that this may not be a true reflection of the general gender composition of the VHTs. Rather, it is a reflection of the unbalanced male-female roles in the communities. The mobilisation of the VHTs was undertaken by the districts and it is possible that because the male VHT always have less domestic chores to do than female VHTs, the female VHTs could most likely not reach the interview venues on short notice due to the gender roles they play (Table 4). Table 4: Sex of the VHTs interviewed Gender Frequency Percent Male Female Total No data provided Level of Education of VHTs Of the VHTs interviewed, the majority (61.2%) had a qualification above primary level (Table 5). Overall, the study found that more than 52% of the VHTs had a minimum of O-level qualification. A few of the VHTs (2.9%) had attained tertiary level of education. 1.3% of the VHTs interviewed had no formal education, of whom 82% are VHTs in Karamoja region. 18

23 Table 5: Education level Level of education Frequency Percent No formal education P1-P P5-P O-level A-level Vocational Tertiary Total Overall, Karamoja region had the highest percentage of VHTs without formal education. Among VHTs with O-level education and above, Karamoja contributed the least (Table 6). Table 6: Percentage (row) distribution of level of education by region Region n No A- formal P1-P4 P5-P7 O-level level education Vocational Tertiary Northern Karamoja Eastern Central Central East Central West Nile Western South western Kampala However, the criterion of being able to read and write in the local language seems not to have been followed in some districts such as Kaabong, Napak, and Moroto, according to the key informants. A number of VHTs reported not knowing how to read and/or write. The general challenge is low literacy rate among VHTs., there are those who do not know how to read and write. So we use colours, numbers and pictures to help them identify (conditions such as) malnutrition, a bleeding woman to show certain aspects of a health condition or complication, FGD_DHT, Kaabong district. 19

24 4.2.4 VHT Education Level by Age Figure 3: Percentage of education distribution by age The figure above shows that the majority of the VHTs have attained O level as the highest level of education. Qualitative findings from various focus group discussions showed a general preference for more educated VHTs. The minimum level of education for VHTs should be O Level. But some of the things we are (assigning VHTs to do) require someone who has done A Level FGD_DHT, Lyantonde district. we appreciate the role VHTs have played but where the world has reached, when recruiting new VHTs, at least the person selected should have completed at least senior four. It will really help on the people s side, Community FGD (Men s Group), Luwero district. This finding underpins the need to invest in younger and more educated VHTs for effective health service delivery. The current National VHT guidelines do not stipulate the age and education level of VHTs Education and Occupation of VHTs Overall, a large percentage of both male (56.2%) and female (49.0%) VHTs had completed O-level. The assessment has shown that the education level among men and women is generally the same. A higher proportion of males (60.3%) as compared to females (50.6%) have attained post-primary education. A higher proportion of females (1.9%) than (0.8%) has no formal education. It was also noted that about 0.2% of female and 0.7% of male had tertiary education (Table 6). 20

25 Table 6: Relationship between level of education and sex Level of Education Male (n=1396) Female (n=1202) No formal education P1-P P5-P O-level A-level Vocational Tertiary University Total The majority (~85%) of VHTs are peasant farmers, and this does not vary by sex. No significant differences were observed in other categories of occupation. It should be noted that some VHT members are employees of NGOs (~1.5%) or local council (LC) members (~1%), which is inconsistent with the requirement for being a VHT member according to the recruitment guidelines. Table 7: Main Occupation of VHTs Occupation Male Female Overall 1313 (100%) 1151 (100%) Farmer Business/self employed Employed by NGO Student Fisherman/fisher flock LC member Boda boda Religious leader Cultural leader Marital Status of VHTs Nearly 4 in 5 VHT members are married suggesting a degree of stability within their respective communities (Table 8), and may be more acceptable because of the perceived respect accorded to such persons in this setting. Table 8: Marital Status of the VHTs Status Frequency Percent Single Cohabiting Married Separated Divorced Widowed

26 Discussion Although an estimated 179,175 village health team members were reported by focal persons for all the 112 districts, nearly one-third (30%) did not have basic training. These estimates could not be verified due to lack of other sources of data such as databases at the district level. This implies that they are not technically VHT members according to the VHT operational guidelines. This means that for 57,735 villages, there are an average of 3 VHT members serving a village. This figure, however, may be inaccurate since there are some districts (such as Kibuku and Kampala, among others) that have not carried out the basic VHT training. The number of VHTs are as reported by the districts and could not be independently verified. The regional imbalance in VHT distribution and coverage demands that the government conduct VHT training in districts that have not yet had their own trainings to ensure equitable delivery of health services. The assessment found that just over a half (52%) of VHTs were below 40 years of age. They are able to sensitize the communities on health promotion but also do other health related activities. This age bracket may be more susceptible to attrition as they are considered more mobile. Some of the VHTs were 50 years or older, a factor that may have led to inefficiencies with regards to report writing and swift movement during mobilisation activities. For example, administrators in districts such as Kalungu, Butambala, and Mpigi expressed dissatisfaction with the manner in which the older VHTs were performing in terms of reporting and drug distribution, as well as efficiency in movement during mobilisation. Some of the VHTs in this area are aged and cannot see well, FGD_DHT, Butambala district. Given the unique health challenges of the young people in Uganda, there is need to review the guidelines for eligibility and recruitment of people to be trained as VHTs to recruit more of 35 years and below to handle the needs of young people who are a majority in the population. While the majority of the VHTs interviewed (54%) were male, the assessment could not establish the exact sex composition of the VHTs in the country due to the absence of accurate VHT databases in the districts. Thus future revised recruitment guidelines should consider addressing the gender gap by having 50% male and 50% female targets for VHTs.. 22

27 The data shows that more than 50% of the VHTs have attained at least O-level education and can therefore read and write. This position was also supported by community data showing preference for people who have attained O-level education and above. This would imply that the government could consider the minimum level of education for a VHT member to be O-level. This would suit the expanding scope of responsibilities of VHTs such as administering antimalarial drugs, data gathering and reporting, and family planning. However, it should also be pointed out that there is a challenge of identifying people with O-level education in some places, especially in Karamoja region, where only about 20% of the VHTs had at least O-level education. VHTs are involved in various activities. Although majority of the VHT members were involved in farming, some are employed by NGOs and others work as Local Council members and students. Availability of such cadres to do VHT work may be limited, thus affecting their output. It is also important to note nonadherence of the guidelines regarding the participation of these cadres in VHTs, especially the LC members who may introduce political interferences. 4.3 Training provided to Village Health Teams (Objective 2) Retention and Training of District Trainers Of the 112 districts visited, 94 (84%) reported having VHT trainers in the district (Table 8). Almost half of the districts had training of district trainers in the last four years. The majority of the new districts did not have active district trainers. Trainings of district trainers were largely conducted by the Ministry of Health while 41% of the districts have more than 75% active trainers. Table 8: Year district trainers were trained TOT Training Number Percent Year Missing Total * Training of VHTs Of the 179,175 VHTs as reported by the VHT Focal Persons, only two-thirds had received basic training. While most of the VHTs had undergone the basic training, there were exceptions in the newly created districts such as Bulambuli, Amuria, Dokolo, Kibuku and Buikwe, among others where VHTs have not undergone the basic training. Kibuku as a district has never trained any VHT on comprehensive training apart from the trainings by NGOs (on specific projects), FGD_DHT, Kibuku district. 23

28 Figure 3: Distribution of trained and untrained VHTs by region No of VHTs Trained Not trained Region South Western region had the highest number of trained VHTs followed by Northern and Western regions. The Eastern region had the highest number of untrained VHTs. In Kampala district, VHTs did not receive basic training. Eastern, East Central, and Western regions had very high numbers of untrained VHTs. However, in the interviews with selected VHTs, the vast majority of the VHTs (91%) reported having received basic training. A few of the VHTs could not remember or did not know if they had received an initial training. This may be attributed to the multiplicity of trainings that the VHTs participated in, making it difficult for them to differentiate between basic and refresher training (Table 9). There have been various kinds of trainings conducted for the VHTs across all the districts. The basic training is based on the MOH guidelines and originally was designed to last 2 weeks. However, respondents explained that the length of training fell short of 2 weeks. The training days were compressed by the Ministry of Health from 14 to 5 days due to financial limitations (MOH 2009); however, the curriculum was not adjusted to fit this shortened timeframe due to financial constraints. In addition, supervision has not been adequately performed to ensure that training is the same across the board for all VHTs. Training of VHT is through the district partners but this is not standardized trainings are sometimes different without a properly laid out approach, KII_MOH. Programme-specific trainings have been conducted by various IPs. The programme areas included HIV and TB by STAR EC, malaria and HIV and AIDS by Malaria Consortium, family planning by Pathfinder International and Reproductive Health Uganda (RHU), hygiene and sanitation by Uganda Sanitation Fund, neglected tropical disease (NTDs), maternal, newborn and child health by World Vision, and nutrition by SPRING, among others. On average, these trainings lasted for 2-5 days. However, very few VHTs have been trained within each district and most often the same VHT members have been selected for the various trainings. Usually, the most active VHT members continue to receive these trainings to the disadvantage of those perceived to be inactive. However, the training of those perceived to be inactive proved successful with the NTD programme in Serere. 24

29 We tried this with NTD programme where we picked the ones regarded as inactive and they performed well, FDG DHT, Serere district. The majority of interviewed males (90.1%) and females (92.5%) received basic training as shown below. Table 9: Basic Training by Sex of the VHTs Response Males Females Frequency Percent Frequency Percent Had initial training Not had initial training Not sure if had initial training Total According to the Ministry of Health Operational Guidelines (MOH 2009), basic training of 5 days is recommended. The study established that the VHT basic training time ranged between 1 and 14 days. Overall, we established that just over half of the VHTs were trained for 5-7 days. Nearly a third was trained for 1-4 days. Figure 4 below shows period of training given to the VHTs. Figure 4: Duration of VHT Basic Training Duration of VHT basic training <1 Week (1-4 days) 1 Week (5-7 days) 2 Weeks (8-14 days) 51.8 Training Content The VHT training content, as per VHT Strategy and Operational Guidelines, is disease prevention and health promotion, identifying simple illnesses and provision of simple treatment, identification of danger signs, referral, maintenance of VHT registers, and community mapping. The most commonly recalled/mentioned content area for the VHT training was disease prevention (90.2%), while 63.2% reported having had training in health education, and home visits (62%) (Table 10). 25

30 Table 10: Reported content of the basic training Content Frequency Percent Disease prevention Health education Home visits Community mobilisation Referrals Community registers Community mapping Refresher Training Refresher training is any additional training conducted after the initial VHT training and is usually tailormade to the specific programme needs of the individual implementing partners. Refresher training is conducted for the various programme areas. It usually lasts 3-6 days and is conducted by implementing partners. They include training on communicable diseases (such as malaria, HIV, TB, Pneumonia), hygiene and sanitation, referrals, the roles of VHTs, among others. On average, the reported number of additional trainings were 6, but ranged from 1 to 30. Table 11: Category, content and duration of VHT training Category Training Content Duration Training Partners Basic training Community mobilisation, Record keeping, Health promotion, Prevention, Treating the sick, Referrals, and Home visits 1-14 days 5-7 days (MOH) MOH with support from Partners Refresher training (disease/ programme specific) Communicable diseases (Malaria, HIV, TB, Pneumonia), Diarrhoea, Hygiene and Sanitation promotion, emtct, Referral, Diagnostic Testing (RDT), Family Planning, community mobilisation for health care Varied 3-6 days Partners with MOH and District support The Ministry also apart from implementing partners should provide resources for refresher trainings because if a VHT was trained 3 years ago, things are changing. Something should be done in trainings, FGD_DHT, Lamwo district. VHTs should have refresher trainings to boost them to carry out their work most efficiently, FGD_DHT, Mubende district Who Conducts the Training? The initial VHT trainings are conducted by district trainers. District trainers are trained by MOH master trainers. The master trainers are Ministry of Health staff. Trainings such as refreshers or programmespecific trainings can be conducted by district health officials, health assistants, health centre in-charges, and some implementing partners Who Supports the Training? The MOH provided support to the VHT training through its master trainers and provision of guidelines for selecting and training the VHTs as articulated. 26

31 The Ministry of Health would coordinate training and provide guidelines and information, KII, MOH. Several implementing partners helped to support programme specific courses for the VHTs. These trainings included HIV and AIDS, TB, Malaria, Maternal and Child Health, Hygiene and Sanitation, Integrated Community Case Management, and Neglected Tropical Diseases. (Appendix 7.2) We trained them to recognize community members in need of rehabilitation and refer them especially those that need HIV testing and counselling and refer them to our clinic for services. We also trained them to do home visits and do follow up on patients to make sure they remind them to take and complete medication. We trained them on counselling and guidance and how to handle properly people living with HIV and AIDS. We trained them to encourage community members to go for HIV testing and to do community mobilisation in case of outreach. We trained them on how to write and what to capture in reports. We trained them on how to approach people, communicate and encourage them and how to link them to our clinics or to the nearest health centres, KII_Partner, Sheema district., we train them on specific programmes such as nutrition, immunization and general good health practices, KII_ Partner, Kiryandongo district. Discussion When new VHT Focal Persons in the districts are brought on board they have a difficult time understanding the effectiveness of the VHT programme due to a lack of information on what has happened in the programme in the previous years. The lack of a database to keep track of this information also results in not being able to accurately track the number of VHTs and the trainings they have attended. Despite the high number of VHTs in the Eastern region, the majority have not had initial VHT training. The high number of untrained VHTs in Eastern region is indicative of the disfunctionality of the VHT programme. People who did not receive initial training were considered VHT members in some districts. For example, in Kampala district where no initial training has taken place, 351 people were reported to be VHTs. These were only trained on programme-specific areas. In such districts, it is apparent that the VHT guidelines have not been followed with respect to training. It was noted that the content of the initial training reported by VHTs country-wide was largely consistent with the content stipulated in the VHT operational guidelines. However, this content may not have been fully covered in the short duration of the training (5-7 days) even when qualified trainers were used. The reduction of the training duration by the Ministry of Health from 10 to 5 days may have led to rushing of the trainings. The trainings may have been inadequate to equip the VHTs with appropriate knowledge and skills. This therefore could affect the quality of services VHTs provide to the community. At times, trainings are conducted directly by the IPs without notifying and involving the DHTs or using the district trainers. This indicates a problem of VHT programme coordination, streamlining, and training. Since IPs choose where to go and implement their programmes, it creates disparity in the capacity of VHTs since trainings are provided to some VHTs in some areas and not to others. This leads to differences in knowledge and skills levels among the VHTs. Such a situation may lead to demotivation of the VHTs and may result in drop out. 27

32 Poor IP coordination creates a problem for supervision of the programme and eventually in sustainability when the partners projects end. In areas with few or no implementing partners, it implies that the communities may not be benefitting from the VHT activities supported by such partners. While these multiple trainings can strengthen the capacity of VHTs to deliver services to the community and provide feedback to the health facility staff, it also means that the same VHTs receive multiple trainings, which increases their reporting burden. It may also mean there is inadequate time to have quality training given the low level of education of some of the VHTs. 4.4 Partners Working with VHTs and the Activities VHTs are Currently Implementing (Objective 3) 28

33 4.4.1 Partners supporting and working with VHTs Several development partners support VHT activities in the districts. These development partners include UNFPA, WHO, UNICEF, UNDP DFID, USAID, SIDA, and others (Appendix 7.2). They support the programme through the implementing partners that include: Pathfinder International, RHU, Baylor Uganda, World Vision, PACE, AMREF, and community-based organizations such as Mayanja Memorial, Kagum Development Organization, Uganda Sanitation Fund, and Community Connector, among others. However, there was no evidence to ascertain the criteria followed by the IPs in selection of the districts of operation. South Western region was found to have the highest number of IPs (Table 12). Table 12: Number of implementing partners by region Region Number of Partners Central 1 49 Central 2 41 Eastern 62 East Central 53 Kampala 12 Karamoja 31 Northern 64 South West 69 Western 60 West Nile 20 Development partners have made significant contributions to the overall implementation of the VHT programme through the provision of financial, technical and logistical support. They provide financial support to implanting partners to run the VHT programme related interventions. Such support is used to conduct training, logistics supplies, supervision and motivation. We support partners with money to go and do the work. Training has been done especially family planning and door to door mobilisation, pregnancy mapping and referrals. We work in Yumbe, Oyam, Kotido, Moroto, Kabong, Katakwi, Mubende and Kanungu. We give money to the Local Governments, Pathfinder International and Reproductive Health Uganda. On top of family planning, these partners support VHTs. CDFU radio health choice programme is one of the programmes supported by the partners. During radio shows, VHTs mobilise people to listen to the programme, KII_UNFPA, National Partner. We trained 125 VHTs and we give them UGX 25,000 per month for bicycle maintenance facilitation. They qualify for this facilitation upon the submission of a report and attending a monthly meeting. The health assistant is provided with a tracking system that he fills while supervising them KII_Baylor Uganda, Serere district. We also support VHT quarterly meeting with allowance of UGX 7,000 given to every VHT member. We usually support the health centre in-charges throughout the district through the provision of airtime of UGX 5,000 per month to enable them to easily coordinate with the VHT within their respective health facility, KII_Malaria Consortium, Mbale district. Improvement in the VHT programme has been reported in districts and or sub-counties where IPs have been operating as indicated by regular reporting, supervision, and activeness of VHTs. 29

34 Sub-counties that have implementing partners are performing so well as compared to those without partners, FGD_DHT Busia The VHTs getting support from partners have a stronger system and work better than those who are not getting any support or those working as volunteers, Community FGD_Masaka district. The presence of partners and VHT engagement in the districts is largely tailored to the specific programme interests of IPs as reported in this extract from Dokolo District Health Team. Most of these trainings have been conducted by partners. NUHITES support them (VHTs) in training and equipping them with what they call MUAC [mid-upper arm circumference] tapes, tape for measuring the upper arm circumference and then they use that for assessment of nutrition. There is Uganda Sanitation Fund that supports sanitation at homestead, some facilitation to make them do sensitization on sanitation in households. Then ABT Associates have come in now; they are training them to be pump operators, spray pump operators. If a partner comes for a particular disease that is there, another one comes like that, may be specifically for malaria, and may be for NTDs, it s not the same partners. FGD_DHT Dokolo. As reported by the district health teams during focus group discussions, implementing partners were not coordinated in offering their support to the VHTs. For example, they motivated VHTs differently, they had different reporting formats, and their programme training followed different methodologies and durations. This led some VHTs to be more motivated than others, which may have led to drop outs and reduced enthusiasm at work. Moreover, partners were concentrated in certain districts, leaving others with few or no partners. Different partners have different areas of interest, e.g. Marie Stopes focuses on family planning but again when they come in and they want VHTs we tell them to select VHTs already selected by the community and for the content we select and train using the manual. Partners come in with a specific agenda much as we are mandated to gate keep them and sometimes it isn t easy. So we just maybe say let s take what we can get, though the training is supposed to follow the guideline. We wish partners would give them the training for the entire package, but they say they can t afford that, FGD_DHT, Sheema district. The partners have no well-organized guidelines. For example, Crane Health Services has a different package, FGD_DHT, Otuke district. The VHTs were not trained on malaria. They were only trained on NTDs. FGD_DHT, Otuke district. As a district, it is hard to get information from the VHTs as data is submitted to partners directly as they have the capacity to facilitate and link up with them and by the time we ask for reports from them, it is long overdue. Thus we have to go partners for the information, yet it is the partners who are supposed to get these reports from the district. FGD_DHT, Kyejonjo district. The number of partners supporting the VHT programme varied across districts and regions. Reports from the District Health Teams showed that Sembabule district did not report the existence of an implementing partner supporting the VHT programme; Adjumani, Moyo, and Rakai districts have the least number of partners (1) and with Kampala Kyenjojo district having the highest number of 30

35 implementing partners. These variations may be attributed to partner interests in particular districts and sub-counties or to budgetary constraints. (Appendix 6.1) Activities VHTs are Currently Implementing Implementing partners have incorporated VHTs into several community-based programmes on maternal and child health, Integrated Community Case Management, HIV and AIDS, TB, reproductive health, immunization, nutrition, and sanitation. VHTs are actively involved in conducting health education, community mobilisation, referrals, rapid diagnostic testing for malaria, distribution of drugs, condoms, mosquito nets and water guards, and linking communities to health facilities. When our partners come, we also introduce our structures to them including the VHTs. So when they come, they use them like recently we have been having a faith-based organization that was sub-contracted by Star-East; Caritas Tororo. It has done a lot of community work and wanted community linkage facilitators. It took up all our VHTs to do that linking up the village clients who are HIV positive to the clinic, linking up services in the health facilities to the community, and they have really done it for us. FGD_DHT Bukwo district. Village Health Team members have been active in playing their role of mobilising the community. This has been through home visits, village meetings, and during church events such as prayers. They teach us to go for family planning methods so that we can have a better life and at least we space the children, FGD_Community, Kamuli district. They are teaching people how to construct that system where you can wash hands without touching the Jerrycan (tippy tap). I have also seen them doing health education in church after service, FGD_DHT, Ibanda district. The VHTs have helped to mobilise their community members to access health interventions such as immunizations, mosquito nets distribution, fistula treatment, and HIV and AIDS counselling and testing services. They also conduct community health education and sensitization meetings. Recently we had a team from TEREWODE organization and they wanted mothers who had the problem of fistula and wanted to identify them and were not in town but in villages and it was the VHTs that mobilised these mothers and (they) very many came. If there is an activity for family planning and for using permanent methods, they mobilise. They are not technical per se but are given some skills to mobilise people to come for services, FGD_DHT, Namayingo. Village Health Team members sensitize community members on epidemic outbreaks and how to detect danger signs. They have also been contracted to provide edutainment through their VHT groups to deliver health education messages at public events. VHTs conduct community sensitizations on disease prevention strategies such as hygiene and sanitation practices, e.g. hand washing, construction of pit latrines, utensils stands, sleeping under mosquito nets, and drinking boiled water. What I have at my home has been as a result of VHT efforts. I have managed to construct a pit latrine, a drying rack, and a rubbish pit. I never used to have any of these things, FGD_Community, Butaleja district. 31

36 They teach people about the dangers of dirt like not having a latrine and this has helped people to be clean. Some years back, people did not find it important to dig deep latrines but now they dig deep latrines of about feet. VHTs have helped people to be clean in their homes, FGD_Community, Mbarara district. In addition, VHTs carry out community sensitizations on the importance of using health services (e.g. going for HIV tests, antenatal care and delivery at health facilities, safe male circumcision, immunization and family planning). They equally sensitize communities on collective social responsibility, e.g. building fences around boreholes and clearing bushes along village paths. They mobilise us to make fences for the boreholes and advise us to keep the jerrycans used for fetching water clean, FGD_Community, Butaleja. Due to their active roles in disease prevention, treatment, promotion of health services, and their prompt response and commitment, VHTs have earned the respect of the communities they serve. Those health workers are good and we admire them and personally, I would love to be part of them based on the way they conduct their work. When a VHT comes to your home, and it is dirty, he or she can help you clean your place and continually advise us to maintain hygiene in the homes, FGD_Community, Butaleja district. VHTs identify patients in the communities suffering from neglected tropical diseases. These include Onchocerciasis (river blindness), elephantiasis, and bilharzia. In addition, once VHTs have identified those who are sick in the communities, they ensure that they access health services. VHTs identify and notify health facilities on the outbreaks of epidemics such Marburg fever, Ebola, Polio, Hepatitis E, and nodding syndrome. Whereas VHTs can also provide basic treatment of some kinds of illnesses among patients in the community, they are encouraged to refer patients with danger signs or those who present with unknown conditions or conditions which they are unable to manage to the nearest health facilities. VHTs have been instrumental in the distribution of drugs in the communities to populations such as children under five. Such drugs are mainly deworming tablets and anti-malaria. In addition, VHTs have been involved in the distribution of the NTD drugs. Whilst it is true that the VHTs have played vital roles in distributing drugs to community members, it is however noted that this role has been constrained by the shortfalls in drug supply from the health facilities. This shortfall has been blamed on drug theft in some cases. Quite often community members were told by VHTs that there were no drugs whenever they wanted to be given the drugs. Some VHTs are also alleged to have been selling the drugs or only giving them to relatives and friends. VHTs have themselves also carried out immunization activities. Like right now we are doing this mass polio campaign. We are using the VHTs for immunisation and some of them are even immunising/vaccinating children. Bukwo FGD _DHT. In most instances, they have contributed in terms of mobilisation of community members for uptake of immunization services. Therefore, VHTs can be credited with ensuring their functionality in regards to the role of promoting immunization services uptake in the community. Discussion Implementing partners have made significant contributions to the overall implementation of the VHT programme through the provision of financial, technical, and logistical support. This support has 32

37 improved utilization of health care services provided by VHTs in the areas of immunization, sanitation, HIV and AIDS services, antenatal care, delivery, and family planning. However, there is inequitable distribution of partners among and within districts. This may be caused by the uncoordinated selection criteria of the districts of operation. This leads to inequitable distribution of skills among VHTs. Districts with many partners may have VHTs who are more skilled than those with few partners or none at all. This has implications for the quality of the health care services VHTs deliver to the community. The roles played by the VHTs as indicated by the community FGD data are reflective of the content of the VHT training. The most common roles played by VHTs are community mobilisation and this is consistent with the content and requirement of the basic VHT training guidelines. The community members are appreciative of the roles played by VHTs in health service delivery especially in hygiene and sanitation, drug distribution, antenatal care, HIV, and family planning. Although the Government of Uganda owns the VHT programme, VHTs pay more allegiance to the IPs who provided them with more facilitation than government. This is reflected in the VHTs willingness to participate in IP-related projects as opposed to those for the government, where there is less or no facilitation. 4.5 Extent to which the VHT Implementation Guidelines are Being Implemented by the Ministry of Health, the Districts and Partners (Objective 4) Introduction The VHT guidelines (2009) stipulate the modalities of the course of action regarding VHT recruitment/selection, training, reporting, and supervision. The review assessed the extent to which the Ministry of Health, districts, and partners were implementing the guidelines Selection of VHTs According to the MOH VHT operational guidelines, members of the Village Health Team should be selected by the community itself and not imposed by political structures, and selection should be gender sensitive. It is recommended that VHT members be selected from the communities that they will serve and that the communities should have a say in their selection. The common practice for VHT recruitment involves community mobilisation and sensitization by members of the District Health Team or a health worker from the nearest health centre; this health team member then facilitates the community to select a VHT often by popular vote based on the agreed-upon selection criteria. The following are the recommended VHT selection criteria according to the guidelines: Should be exemplary, honest, trustworthy, and respected Should be willing to serve as a volunteer Must be a resident of the village Should be available to perform specified VHT tasks Should be interested in health and development matters Should be a good mobiliser and communicator May already be a CHW traditional birth attendant, drug distributor or similar Ideally should be able to read and write at least the local language The assessment could only determine adherence to selection criteria on the components of being able to read and write and community participation in selection. Findings from the study indicate that only 4.4% of the VHTs are below upper primary, the level below which VHTs may not be able to read and write in the local language. This shows adherence to the guidelines in regards to selection. 33

38 As far as community participation was concerned, close to 10% of the VHTs were selected without following the selection guidelines. They were selected by community leaders or NGOs, or joined on their own (Table 13). Table 13: Recruitment of VHTs Modality of Recruitment Frequency Percent Recruited by the community Community leader Selected by the NGO Just joined independently Total In practice, while the guidelines for selection of VHTs were adhered to in most instances, they were flouted in others. The adherence is reflected in the community members participation in the selection of the VHT through village meetings. The chairman and community in the local council gathered and selected those that never leave the village and they were guided on how to select the VHTs. In selecting these VHTs, we considered those people who are always in the village, approachable, and those who have had some education. We also selected those who can take good care of our medicine and are clean, FGD_Community, Gomba district. As summarized in the above extract, there was adherence to the MOH guidelines for VHT recruitment and selection in most districts. Community members were mobilised and guided on whom to select based on their residential status, education level, inter-personal relations and integrity. However, some Local Council leaders were reported to have individually identified their relatives or themselves for the VHT positions. People choose their relatives and friends and also LCs impose themselves into these positions. Because of some small money and bicycles, someone wants to be both an LC1 and a VHT, KII, Alebtong district. We observed no significant regional variation in the selection of the VHT members. However, the central region had 15.7% of the VHT members selected by community leaders, which markedly deviates from the guidelines (Table 14). Conversely, Karamoja region had the highest community participation in the selection of the VHT members, largely attributable to UNICEF s guidance and support in this region. Table 14: Selection of VHTs by regions in percentage Selection criteria Northern n=549 Karamoja n=134 Eastern n=772 Central n=541 Western n=562 Overall Country N=2558 By the community Community leader Other Selection * *Other selections included selection by IPs or self The DHTs were instrumental in VHT selection by facilitating the process and the communities were empowered through this process to make informed decisions in the selection of their VHTs. The 34

39 assessment therefore found that to a large extent there was adherence to the VHT recruitment and selection criteria. Discussion The VHT selection guidelines are in place and have largely been used. This is evident in the involvement and participation of the communities in selecting VHTs. However, a small proportion of VHTs were not selected in accordance with the guidelines. This included selection by local leaders, IPs, and selfselection. This may imply that the quality of VHTs not selected according to the selection guidelines may not meet the selection criteria such as being able to read and write or trusted, committed to working, and permanent residents in the community Training VHT training includes the initial and continuing/refresher training. In the initial trainings, the content included, among others, disease prevention, community mapping, community registers, home visits, community mobilisation, health education, and referrals, which is in line with the stipulated guidelines. A third of VHTs (34%) did not receive initial training but are working as VHTs in the districts. The initial training is required to run for 5 days. The study established that the VHT initial training time ranged between 1 and 14 days. Overall, it was established that more than half of the VHTs were trained for 5-7 days. Among VHTs who received basic training, nearly a third were trained for only 1-4 days. The methodology of training has followed what is stipulated in the guidelines as it involves more participatory methods. These included brainstorming, group discussions, role plays, games, field visits, sharing of experiences, and practicum. Training manuals have been used to facilitate the cascade approach. This included the VHT participants manual; VHT facilitators guide; and VHT TOT guide. These training manuals are user friendly with pictorial illustrations relevant to the specific audience. The MOH VHT guidelines (2009) recommend that in addition to the initial training, continuing/refresher trainings should be conducted based on the health needs as defined by the community, DHT, and partners. The refresher training should target only the VHTs who completed basic training. The study established that 60,149 VHTs received programme-specific trainings from partners but did not receive the initial training. The length of time for the refresher courses varied. The content included: HIV and AIDS, malaria management, maternal health, nutrition, record keeping, family planning, and integrated community case management (ICCM) In this assessment, VHTs were asked about the number of additional trainings they have received. They reported the numbers ranging between 1 and 30. On average, VHTs had generally received 6 additional trainings after the basic training. While these trainings have been carried out, they have not been as regular in some of the districts. In fact, the call for more regular refresher trainings was expressed quite often in different districts such as Pader, Kamuli, Nakapiripirit, Kaliro, Tororo, Kapchorwa, Mukono, Sembabule, Kalangala, Maracha, Nebbi, Hoima, and Kamwenge among others. Discussion Whereas the guidelines and training manuals to support VHT trainings are in place, nearly a third of VHTs have not received initial training. This may have been as a result of a number of factors such as; lack of funds by districts to conduct initial trainings, self-appointed VHT members and selection by local leaders and by IPs, against the guidelines. Such tendencies to select VHTs without the community involvement could have been due to lack of supervision by the districts. Consequently, a substantial number of VHTs may lack adequate skills to perform their duties. 35

40 The one third VHTs who received initial training in only 1-4 days imply that the training duration according to the guidelines was flouted. This may have therefore lowered the quality of the training conducted, as the training period is too short to equip the VHTs with the necessary knowledge and skills. Though the training period of five days of basic training is in the guidelines, it is however too short for the trainees to comprehend all the content and apply it. Besides, the varying education levels of VHTs affect their ability to comprehend the content of the training. Programme-specific trainings by IPs are not harmonized in terms of standardized materials, content, duration and methods. This clearly is not in line with the guidelines on refresher training Supervision For the purpose of this assessment, supervision refers to the oversight function of the district and lower local governments over the VHTs to ensure that they execute their roles in the guidelines Structure of supervision Only 70% of VHT members reported having been supervised. Health assistants, in-charges of health centres and parish VHT supervisors, and some by NGOs and community development officers are reported to have conducted the VHT supervision. However, there were no reports to support this. The quarterly review meetings at the district and health centres are usually viewed as supervision activities. However, there was reported on-the-spot supervision conducted by district leaders including the Resident District Commissioners, District LC V Chairmen as well as implementing partners. Routine supervision is also carried out by the in-charges and health assistants at the health centres and within the community. We have been having review meetings where the VHTs meet at the health centres and we give them feedback. Then also we have been giving them supportive supervision where the health worker at the health facility (in-charge) goes and supervises them. FGD_DHT_Buliisa district At the national level, supportive supervision was found to be inadequate due to funding constraints. In some instances, development partners have taken the lead in VHT supervision. The districts and Ministry of Health were perceived as less involved in VHT supervision even though they own the VHT programme. The Ministry of Health has also relaxed towards follow-up of VHT activities in that they have left it into the hands of partners, KII_ partner_kiboga district. When we don t initiate the supervision programme, the district does not do it because they claim not to have resources to conduct monitoring and supervision. This in other words tells me that these VHTs have been left in the hands of the development partners, yet it was initiated by the Ministry of health as the government, KII_partner,_Kumi district. The Ministry of Health recognizes the problem of lack of supervision as stated in the quote below: Quarterly supportive supervision this is not happening. It happens only when funds are available this was last done three quarters(s) ago, KII_MOH Supervisors of VHTs according to the MOH (2009) VHT guidelines should come from Health Centre (HC) II and HC III to which the VHTs are attached or Community Development Officers (CDOs) or Health Assistants or Health Inspectors. 36

41 However, in addition to these listed supervisors, in this study we identified that VHTs are also supervised by other structures that include the DHTs, local councils, CDOs, VHT Coordinators, Peer Supervisors, and IPs deviating from the guidelines. The selection of supervisors largely did not follow the guidelines (Table 15) At grassroots level, we mobilise and actually visit activities that VHTs perform. Our local council III also helps as supervisors. They supervise VHT activities and report to us accordingly, KII_ Bukedea District. Table 15: Selection of VHT supervisors Selection criteria Frequency Percent No criteria One Criterion Two criteria Three criteria Four criteria 6 5 Many of the district leaders reported carrying out indirect but not much of direct supervision of the VHT activities. Indirect supervision involves mandating the District Health Officer/DHT to supervise the VHT activities and to report to the top district leaders such as Chief Administrative Officers (CAOs), LC.V and the Resident District Commissioners. Personally, I supervise the VHT activities and even monitor them. As a district, we have our technical people in the DHT, the political wing and the people in security all of whom monitor and supervise the activities of VHTs in different ways, KII_ Kumi district. When I go down to the villages, I ask them how they are working and even check their reports and when I go to monitor other partners work like boreholes, the element of sanitation is common and the VHTs are key, they are always elected as water source committees for the boreholes. So in that way, I supervise the VHT work, KII_ Apac district. At the community level, VHT supervision has also been undertaken by peer supervisors, the Local Council I chairpersons and the health assistants. Peer Supervisors are VHT members who support fellow VHTs on writing reports especially due to illiteracy among some of the VHTs. In Karamoja sub-region where illiteracy is very high among the VHTs, Peer Supervisors have been used to support the VHTs in documentation of the VHT activities such as in report writing. We created the peer supervisors to help illiterate VHTs to document reports. The peer supervisors work as supervisors to check what VHTs have done on issues of sanitation whether the community members have latrines, FGD_DHT, Kotido district. A peer supervisor supervises VHTs and the peer supervisors are being supervised by Health Assistants and Health Assistant are being supervised by VHT Focal Person. During support supervision stock taking is done and data management tools are checked, KII_Partner, Gulu district. Table 16 below indicates that most of the VHTs (46.5%) were supervised by the health assistants and 33.6% were supervised by health centre in-charge. This is line with the guidelines that stipulate that the central figure in supervision is a designated individual from the first referral level who has contact with 37

42 VHTs on a regular basis. VHTs are directly supervised and report to the health centres through the health assistants as indicated in the MOH VHT guidelines (2009) on supervision where the VHTs are to be supervised by the health assistants. In communities where IPs exist, it was found that the IPs conduct VHT activity supervision through the health assistants. However, some VHTs (7.6%, 3.4%) were supervised by NGOs and CDOs respectively, which is also not in line with the guidelines. Table 16: Supervision of VHTs Supervisor Frequency Percent Health Assistant In charge of the health centre Parish VHT Supervisor Direct supervision by NGOs Direct supervision by CDO Discussion The assessment revealed that VHTs are supervised at the health centre IIs or IIIs or IVs and at district level as stipulated in the guidelines. However, there were no supervision checklists or reports ascertained. Supervision of the VHTs was hampered by lack of resources including funds, transport, and technical capacity for supervision. Supervision was undertaken mainly by health assistants, in-charges of health centres and parish VHT supervisors and LC I chairpersons as well as by NGOs and CDOs. The selection of VHT supervisors was not rigorously followed in 95% of the cases. It was however difficult to ascertain whether these various supervisors and the VHT members themselves understood what supervision entails. Therefore, the lack of supervision tools, reports, and apparent understanding of what supervision entails leaves gaps in determining whether the supervision reported to have been carried out was in fact effective. The lack of reports suggests that supervision may not have taken place. The non-adherence to the VHT Supervisors selection guidelines therefore compromises the quality of VHT supervision Reporting by VHTs The assessment found that VHTs fill in their registers, collate data, and share their reports with the health centres to which they are attached. This is illustrated in narratives from two focus groups below. The 5 VHTs at village level sit and compile their monthly report and from there a representative from the village meets the parish supervisor with other representatives from other villages in the same parish, they compile the parish report. Then the sub-county supervisor calls the parish supervisors and they sit with their parish reports and compile one report for the sub-county which is later brought to the HMIS focal person at the district. A copy is sent to the partners. So the HMIS person sends the report to the Ministry and this is always done on time, DHT FGD Namutumba. VHTs make monthly reports to health assistants at the facilities to which they are attached, and then the health assistants take initiative to report to Plan Uganda and sometimes we support the health team during supervision, KII_Partner, Plan Uganda. Although there is a hierarchical reporting mechanism right from the village through the parish (health centre), sub-county to the district level, in some districts (such as Otuke, Sheema, and Buhweju) there 38

43 was practically no reporting due to the absence of a reporting format/tool and lack of training. The districts reported that they were awaiting training in order to start reporting. There are no reports because we are still waiting for a format to train and report, FGD_DHT, Buhweju. The mtrac reporting system is an SMS-based reporting system that combines both statistical data and some narrative. It is a government-led initiative to digitize the transfer of Health Management Information System (HMIS) data via mobile phones. In Gomba district, for instance, it is used to accompany the paper-based reporting system. They (VHTs) report weekly through mtrac. They report to the parish coordinator in the monthly meetings held at (the) parish headquarters, FGD_DHT, Gomba district. The frequency of reporting varied among IPs contrary to the quarterly reporting required by MOH as stated by Mpigi DHT. The most common frequency of reporting for most VHTs is monthly (as outlined in the guidelines) and quarterly. However, in a few cases, weekly reports are made. They report to the programme, let me say, Malaria Consortium. If they say they want to report every month, they bring the reports monthly to the focal person who will have been selected by that programme to do that. Mildmay may be working with them on HIV clinics and they report weekly. PACE is working with them to mobilise people for the positive living services, they report monthly. So it depends on the programme they are involved in. FGD_DHT, Mpigi district. It was also established that some districts were defaulting on their reporting roles to the Ministry of Health. This is because the VHT focal persons in such districts were failing to submit reports to the Ministry of Health. Some focal persons do not share reports with the centre, KII_MOH Reporting tools for VHTs A sample of a VHT register, Kabale district,

44 The study established that the tools used for reporting by VHTs include registers, summary sheets from HC IIs and districts, and computerized databases in which data are entered into a spreadsheet by health centre staff. Paper-based forms for reporting were found to be the most commonly used in most districts. Reporting tools were mostly found to be in use with implementing partners. The tools were tailored to suit the programmatic priorities of each respective IP. We give VHTs tools to use during field activities and then use the tools to evaluate the programme, for example, the number of mothers referred and tested and then those that have obtained nutrition counselling are obtained from the outreach tool, KII_partner, Namutumba district. The assessment revealed that IPs such as World Vision and, districts such as Butambala, Bukomansimbi, Gomba, Moroto, Kyankwanzi, Kiboga and Wakiso, have adopted and are using the mtrac SMS reporting system. Table 17: Level of VHT report submission Report submitted to: Frequency Percent Health Centre II Health Centre III Health Centre IV District Partner The vast majority of VHTs submit their reports to Health centre II and III. A few VHTs submit their reports to the districts and implementing partners (table 17). Discussion The assessment showed a hierarchical reporting from the village through the parish (health centre), subcounty to the district levels. However, in some districts such as Otuke, Sheema and Buhweju, there was practically no reporting due to various reasons including the lack of tools and lack of training. The study however did not determine whether the hierarchical reporting existed in every district. The absence of reporting tools and training on reporting constrained reporting and suggests the need for capacity development in this area. Various reporting formats and tools were used including mtrac. However, paper-based forms for reporting were found to be the most commonly used in most districts. Reporting tools were mostly found to be in use with IPs. This implies that reporting took place based on availability of tools in settings and programmatic priorities of implementing partners. It may also imply that VHT supervisors at health centre level could only exercise limited supervision on VHT reporting. The inadequate reporting tools, existence of various implementing partners and reporting formats, coupled with low education level of some VHTs therefore suggest that there was irregularity and poor quality in reporting Coordination of VHT Programme The assessment found that the District Health Officers have the overall mandate for coordinating the VHT programme within the district. They specifically assign a district VHT focal person to be responsible for VHT coordination, training, monitoring, and supervision. The District Health Educator was assigned that role in most districts. However, coordination meetings and supportive supervision at lower levels 40

45 have been irregular. Even at the national level, coordination was recognised as a gap in the VHT programme. There is a national committee that should meet quarterly but this has not been regular. These meetings incur costs and therefore need funds for the meeting, KII_MOH Coordination became poor, there was no steering committee in the MOH, we did not know who was training and where, there was weakness at the central level for effective training, monitoring and evaluation; there was no effective leadership at the Ministry of Health, KII_MOH Coordination is also a problem in some areas; you don t find health assistants who should be in touch with VHTs in terms of supervision, KII_Manafa district Discussion There are VHT operational guidelines in place to support coordination mechanisms. However, poor coordination has arisen due to human resource and financial constraints mainly at national and district levels. The irregularity of the quarterly national steering committee meetings could have led to an increasing gap in VHT coordination among and within districts. Lack of coordination led to poor supervision of IPs and their activities Referrals For a functional VHT programme, an efficient referral system should be in place to determine when a referral is needed, the logistics plan in place for transport and funds when required and finally a process to document and track referrals. The Ministry of Health guidelines identified two levels of referral. Routine referrals Non-urgent conditions include: All conditions without danger signs for which the VHT has received training/instructions to when and where to refer All conditions without danger signs for which the VHT has not received specific training, or if the VHT does not have the necessary medications Routine outpatient or outreach referrals for immunisation, antenatal care, post-natal care (mother and infant) Referral of children >6months with mid-upper arm circumference (MUAC) yellow All conditions which require rehabilitation e.g. after injury, patients with leprosy Clear guidance must be given to VHTs on where to refer non urgent cases Emergency referrals This should be to the nearest health facility. These include conditions that require urgent treatment such as: All pregnant women (obstetric emergencies), new-borns or children or other person with danger signs including red on the MUAC strap Anyone with sudden recent loss of visual acuity, or a painful red eye, or recent inability to close the eye Accidents or injuries 41

46 This assessment established that VHTs have played key roles in identifying and referring under-five children and sick community members to the health facilities. VHTs link communities to health centres through networking and referral systems for diseases like HIV and AIDS, maternal and reproductive health problems, for antenatal (care), immunisation, FGD_DHT Namayingo. They move in the community and give health education thus they come in contact with those who have had cough for like two weeks and refer them. TB and HIV patients who are on treatment are also referred. They also refer clients with diseases which they have never had prior training on or if he/she doesn t have the necessary medication for that particular disease, KII_In-charge HC III, Kisugu. VHTs also accompany sick patients to health facilities such as pregnant mothers, youths and dog bite patients, as reported in Bukwo district. Overall, VHTs have been trained on referral forms and are actively involved in the referral of patients to health facilities. However, in some health facilities, some health workers have had negative attitudes concerning the VHT role in referring patients as explained in Namutumba district. This concern was voiced in Soroti, Kween, Nebbi, Mubende, and Gulu districts. Some health workers have failed to understand the strategies of VHTs. Some even demotivate them by asking them, who are you? What did you study? And even throw away the referral forms, FGD_DHT, Namutumba district. Some health workers think VHTs want to take their work so they do not work hand in hand with VHTs. They do not appreciate VHTs, FGD_DHT, Mubende district. This negative perception could be due to the lack of sensitization of health workers on VHT roles and/or coordination amongst VHTs and health workers. Some community members also have similar negative attitudes towards VHTs. Some communities don t understand VHT roles and thus chase them away from their homes. Someone says, I know you, what do you also know about health, go away. They lack recognition, KII_Bududa district. Nearly 9 in 10 VHTs (91.4%) referred clients using the common approaches of filling out the referral forms (77.8%) and writing in the book (22.2%). VHT members following up on the referral to the health facilities were almost universal (97.2%). The most commonly reported referred conditions were pregnant women (42.5%), under-fives (31.8%) and clients on long-term treatment (17.0%), as shown in Table 18. Facilities where patients are referred were usually government (97.4%), with some private (2.6%). Table 18: Clients Referred by VHTs in the Last Six Months Support Frequency Percent Pregnant women Postnatal mothers Clients on long-term treatment Under fives

47 Discussion The assessment established that most of the VHTs referred clients to health facilities. However, the assessment also found out that health workers sometimes did not respect referrals made by VHTs. This emanated from the fact that VHTs are considered people of low education who are not competent in disease management as they are not medical personnel. It was not clear whether referrals made by VHTs were effective, nor if they were recorded by the service providers at the health facilities. In addition, the assessment found that there were other concerns that affected effective referrals, such as lack of medicines in and transport means to health centres. 4.6 Approaches for Motivation Mechanisms and Arrangements (Objective 5) Volunteerism in the VHT programme VHTs are known or perceived by the district leaders as volunteers and non-government employees. Thus they are not supposed to receive salary. This concept of volunteerism has been a demotivation factor as the VHTs now think that they should be paid for their services. This has attracted the attention of different stakeholders who think that VHTs should be paid. The VHTs have been voluntary; volunteerism can t continue forever, KII_MOH They will begin the work very well but they will see themselves not gaining because of volunteerism within the shortest time period. So they will also start comparing themselves with others and the work they do and say we are doing a lot of work for these people for nothing. And then they relax, FGD_DHT, Moyo district. Government should motivate VHTs, they should be given some monthly allowance, FGD_Community, Hoima district. Volunteerism is a problem. It has been over taken by events. It first worked because they first expected to be salaried employees over time, and other incentives such as scholarships and absorption in the civil service, KII_MOH. Due to the ineffective roll-out of the minimum package for VHT motivation mentioned above, some of the VHTs have lost enthusiasm and dropped out of the programme. However, their replacement was a problem as districts lacked funds to train the new recruits in their roles. Their contribution is fundamental. They are doing a good job and if we had resources, we would pay them. They are doing what we could not do in their villages, KII_Mbale district Motivation of VHTs MOH has defined this minimum motivation package for purposes of identity, cultivating a sense of achievement and recognition (MOH, 2009). Motivation entails instituting and reinforcing mechanisms that recognise and appreciate the contribution of VHTs to their communities. The 2009 Ministry of Health operational guidelines recommend a minimum package for VHT motivation (Box 1). 43

48 Box 1. Incentives for VHTs in Uganda Basic requirements to carry out VHT function (Standardised VHT uniform, ID, standardised bag and kit using MOH VHT logo. Lunch and travel allowance whilst carrying out outreach and visits to health centre) Health worker supervision and mentoring technical support Activity and performance related incentives Recognition by authorities and their own communities Advocate and support for VHT to access government programmes, income generating schemes and other microfinance and credit schemes Community reward such as community digging, seeds, livestock Source: MOH Operational Guidelines for establishment and scale up of village health teams To motivate VHTs, the districts and IPs have used a combination of monetary and non-monetary incentives. The most commonly used motivation were provision of allowances; official recognition; capacity building; provision of supplies, medicines, and equipment to facilitate VHT work; certificates; and income generation activities. Monetary Incentives: Financial incentives have been provided in the form of allowances mainly given during activities or events for transport, lunch provision, and bicycle maintenance. Partners provided forms of motivation that included transport and feeding allowances. The allowances ranged from as low as 2,000 Ushs to 25,000 Ushs per activity. On the other hand, some of the allowances are provided on monthly or quarterly basis ranging from between 25,000 Ushs to around 100,000 Ushs. However, it was not possible to establish the proportion of VHTs who were getting allowances. Financial support has also been provided to VHTs in the form of educational support to the children of VHTs who cannot continue going to school because of lack of school fees. VHTs have been encouraged to form their own savings and credit cooperative societies (SACCOs) and VHT associations for income generation. In some districts, VHT associations have been contracted to provide edutainment from which they can earn some payments. Some districts rely on implementing partners to provide financial and other forms of motivation to the VHTs. The district simply relies on NGO support. But as a district, there is no budget for VHTs which makes it impossible for the district to fund VHT activities. The district cannot even afford to print t-shirts to identify them NUHITES also uses the VHTs and currently it is the only NGO that actively supports them, KII_Nwoya district. Motivation comes from partners through the district. While Yumbe district is really willing to give their total support to VHTs, the only challenge is lack of fund from the District KII_CAO, Yumbe district. We train VHTs, give them transport refund when they come for any activity, feed them and provide VHTs with accommodation also so that they don t spend their money, KII_LC.V, Nwoya district. Non-monetary Incentives: Logistical forms of motivation have been provided either through MOH support to the districts or through IPs operating in the districts. The logistics provided to the VHTs 44

49 included among others, bicycles, t-shirts, torches, gum boots, rain coats, lunch, and transportation as well as handbags. The district has no specific budget for the VHTs but we have given them bicycles to facilitate their transport. We also give them t-shirts and small allowances when new projects are brought to the district by the different partners KII, Lamwo district. A sample of VHT T-shirt, Kibuku district, Gum boots and umbrellas for VHTs in Butalejja district,

50 In some districts such as Kaabong and Soroti, the community members reported having provided food to VHTs while conducting community mobilisation. Sometimes, I cook tea for VHTs or roast ground nuts for them as they pass around while on mobilisation tours. I have ever given one a hen after making for her orange juice because she was hungry. FGD_Community, Soroti district. In practice, the moral support have majorly been in the forms of appreciation by words of mouth, giving titles to VHTs (e.g. Super VHT), priority in accessing health services, public recognition on mass media or at public events, and encouragements. We always tell them that they are the best at what they do KII_Otuke district. We recognise them on national occasions such as the Independence Day. We give speeches in honour of what they do for the community and appreciate them, FGD_DHT, Pader district. We give them simple recognition. We appreciate them at the end of the year e.g. we write an appreciation certificate so as to boost their morale. Also we recognize them during public functions and this makes them feel respected, KII_Mpigi district. The district encourages the VHTs to form groups and some of them have benefited from government programmes like poverty alleviation fund FGD_DHT, Masindi district. DHTs from Nakasongora, Kamuli, Luwero, and Lamwo districts reported that priority is given to patients referred by VHTs at health facilities, which motivated the VHTs in their work. VHT is the core. For us to improve on maternal and child health, we needed really to have functional VHTs. And for us to have functional VHTs there must be means to motivate them because that is where normally problems will come. So we should have really something in place right from the Ministry of Health since they are part of the system. To make the whole system function, there must be some budget, much as they are many there must be a budget maybe for monthly meetings. And then, they don t need much then we can get something once in a while maybe like T-shirts yearly to motivate them. Every year you can give them a T-shirt, the way we are doing it to LC1 s, like every year they get like 120,000 if we really want to improve the health system, FGD_DHT, Kitgum district. Capacity Building as Non-monetary Incentive: Various ways of capacity building were identified. These included: Supportive supervision, trainings, mentorship, exchange visits, meetings, involvement at health facilities Feedback from referrals from health facilities Participation in data collection and surveys Refresher trainings by the health department, DHI office and district partners. There is also a current support from Amatheone-Agric, an NGO which has come up to support famers but they are interested to link up with the VHTs to provide health services needed to their potential farmers, mainly in building the capacity of the VHTs to help in the hard to reach areas. Amatheone-Agric 46

51 support is directly to farmers and may support VHTs with transport but not money, KII_Nwoya district. We note that while these various forms of motivation have been provided to the VHTs, they have largely been irregular and none uniform as have been the case with financial and logistical forms of motivation. The motivation also varies from IP to IP and from district to district. Incentives were not well defined. It would depend on the donor or government programme. The incentives were not consistent; the system of distributing incentives was not organized. Turn over became so much and drop outs were very high, KII _MOH The motivation is lacking, (there are) no standard incentives that are given they vary, KII_Partner, Pathfinder. There is Mildmay Uganda, Profam, TASO and also Uganda Care. These IPs work in some regions. But most of the time you find it is the same VHTs that are picked repeatedly, so they are very motivated while others are not. Every partner wants a VHT that is literate and can write a report, not starting from scratch to train them, FGD_DHT, Masaka As such, the irregularity, non-uniformity, and variance in form and substance of motivation have been de-motivational rather than motivational to some of the VHTs. This has led to drop out and inactiveness as well as poor relations among the VHTs. Thus, to some extent, this fragmented way of motivation has impeded the functionality of VHTs. Different rates of facilitation of the VHTs i.e. Strides facilitated them with 12,000 UGX while the Local Government was giving them 6,500 UGX. They tend to run to partners who give better facilitation. Since not all of them are taken on by partners, they end up dropping out of the system, FGD_DHT, Kasese district....bicycles given did not go to all VHTs; only one VHT in every village. That also caused a challenge because it demotivated the other VHTs. A coordinator was almost beaten sometimes. He had to come up with a list of members who had not got bicycles, FGD_DHT, Ibanda district. While various kinds of logistics were provided to facilitate VHT work such as torches and bicycles, in some instances they were reported to be of poor quality, with no spare parts Suggested VHT Motivation Mechanisms and Arrangements Various VHT motivation mechanisms were suggested by the community members, VHTs, partners, district health teams, and district leaders. 1. Establishing a standardized and regular financial way of motivating VHTs 2. Recognition and appreciation of the contribution of VHTs by both the central and local governments 3. Capacity building in the form of educational short courses, trainings, and mentorship 4. Provision of a conducive working environment for the VHTs in terms of: a. Ensuring cordial relationship between VHTs and the formal health care workers b. Provision of essential supplies such as uniforms, bags, gum boots, umbrellas, identity cards, bicycles, among others c. Provision of special rewards for VHT work 5. Provision of planned and well-executed regular supervision 47

52 6. Engaging the VHTs in economic empowerment activities such as SACCOs 7. Ensuring safety and security of VHTs especially during epidemic outbreaks such as viral haemorrhagic fevers, e.g., Ebola and Marburg. This includes provision of protective gear. 8. Provision of appropriate transport means for hard-to-reach areas such as hilly and island areas. 9. Involvement and engagement of VHTs in the national activities e.g. National Immunization Days, Child Days Plus Discussion The provision of monetary and non-monetary incentives to VHTs contributes to motivation and retention of VHTs. While the VHT Operational Guidelines stipulate the various forms of motivation for VHTs, it does not explicitly describe how these should be equitably distributed and who should provide these incentives. For instance, the financial forms of motivation did not have the educational level required and yet the government does not pay workers without formal education. The minimum package did not stipulate a salary but a reimbursement of costs for transport or for meals. In addition the MOH guidelines did not provide clarity on what constitutes activity- and performance-related incentives. While there are economic and social benefits of volunteerism, the VHTs performance can be eroded over time if some basic needs are not met. Some VHTs who volunteered had high monetary expectations and if these were not met, some dropped out of the VHT programme. Some of the materials provided were just tools but were not meant for motivation. Although those materials were meant as materials to facilitate VHT activities, they provided motivation to VHTs. The study found that there are certain things beyond what was thought of as motivation to VHTs. Qualitative data showed that there is an overwhelming demand for a harmonized and regular financial form of motivation for the VHTs. The various means of motivation are not uniform, thus creating disharmony at the district level and among the VHTs, hence making coordination ineffective. Although the MOH, development partners and implementing partners are providing different kinds of motivation, there is no system for tracking the different motivation packages and support for VHTs, hence there is need for harmonizing motivation approaches and packages to address these anomalies. Various ways of motivating VHT members were suggested by different stakeholders including VHT members, as seen above. The proposed idea to establish a standardized and regular form of financial incentive for VHTs calls for the need to undertake a proper planning to prepare for it. The government and its implementing partners will need to consider the sustainability of these forms of motivation and their implications for the number of VHTs in place Existing Equipment and Supplies for VHT Forty-three percent (43%) of VHT members reported possessing all the supplies and equipment needed for use in their operations (Figure 5). An almost equal number reported possessing some of the supplies and equipment needed to perform their duties. 48

53 Figure 5: Possession of supplies and equipment The assessment results indicate that VHTs possessed more of material supplies and equipment than medicines/drugs (Table 19). Supplies and equipment such as registers, badges, t-shirts, bags, and bicycles were possessed by more VHTs compared to drug-related supplies, such as Coartem, oral rehydration solution (ORS), and NTD drugs, as well as family planning supplies like condoms. Table 19: Supplies and equipment possessed by VHT members interviewed Supplies and Equipment Frequency Percent Badges, T-shirts, Bags Register Bicycle Report book Condoms ORS Amoxicillin Zinc Coartem NTD drugs Respiratory timers RDT kit Gloves Information, education, & communication (IEC) materials Mobile phones Identity cards Tippy tap materials Solar chargers Wrist watches The majority of the VHT members interviewed kept their supplies in wooden boxes. They reported that this was one of the safest ways to keep the supplies. 49

54 Discussion Whereas a number of equipment and supplies have been made available to VHT members, they appear to have been more focused on the health promotion and community mobilisation roles of VHTs than on the treatment roles. This situation may imply that some of the treatment needs of the community members cannot be adequately addressed by the VHT members due to stock-outs. 4.7 Functionality of the VHT Programme (Objective 6) Functionality of the VHT programme was assessed at four levels: national, district, community and individual VHT members. The study defined VHT programme functionality at national and district levels as the capacity of the Ministry of Health and district health teams to plan, manage, and supervise VHT activities at national and district levels. At community level, functionality was defined as the frequency of interaction between the VHT members and the health facility to which they are attached, the existence of and knowledge about VHTs by the community members and the benefits that accrue to the community as a result of the VHT programme. At individual level, functionality was defined as the capacity and practice of the VHTs to perform duties assigned to them in accordance with the guidelines. Four indicators were used to assess functionality at individual level: participation in coordination meetings, reporting, referrals, and supervision Functionality of the VHT Programme at National Level At the national level, functionality was assessed using six indicators: policy environment, investment, governance, coordination, supervision, and training Policy Environment The concept of the VHT was conceived and included in the second Health Sector Strategic Plan (HSSP ). The VHT concept evolved from the WHO Primary Health Care Framework to optimize health services to communities through community health workers. In the Health Sector Strategic Plan, the VHT constituted the health centre I with no formal physical structure. The role of the VHTs was to mobilise communities and carry out health promotion. The role of the Ministry of Health was to coordinate training and provide guidelines and information. Although some policy instruments refer to community health, there is no clear policy that addresses VHTs. The lack of harmonization in motivation, trainings, and coordination is a result of the lack of clear policy that explains how each of these aspects should be operationalized Investment in VHT The Government of Uganda has made some efforts to invest in the VHT programme since its creation. This is reflected in the allocation of funds to the VHT programme. Over time, the Ministry of Health has provided a budget for VHT implementation. However, funding for the VHT programme has been declining, leaving the partners to fund most of the activities. There is a budget line since the creation of the VHT strategy. However, funding kept reducing from about UGX 800 million per year at the start of the programme to less than UGX200 million per year in the last two years. The Central funding allocation is to train VHTs, coordinate and supervise VHTs. The low funding thus constraints these roles, even the little money allocated is never accessed, KII_MOH. The assessment established that the money released by the government in a financial year to train VHTs in the country is not sufficient to train VHTs even in one district. As of January 2015, the VHT 50

55 coordination office had not accessed any money for VHT implementation for the financial year. However, the government has working arrangements that allow partners to contribute to the VHT programme. The partners are supposed to facilitate district staff to conduct VHT activities. Various partners have contributed financial, logistical, and technical resources to the VHT programme. These partners include, among others, the UN Agencies such UNFPA, UNICEF, WHO, UNDP, World Bank, Implementing agencies such as Pathfinder International, Plan International, World Vision Uganda, PACE, Marie Stopes, AMREF, AVSI. (Appendix 7.2). The extent of investments by partners into the VHT programme was reported to be significant. However the total package of partner-specific support could not be determined by the assessment. They provide financial support annually to various organizations to implement VHT activities. Such support is used to conduct training, logistical supplies, supervision, and motivation Governance In 2014, the VHT section of Ministry of Health was separated from health promotion and education division and made answerable directly to the Commissioner of Community Health. A coordinator was put in place to coordinate the strategy at national level. The coordinator reports to the Commissioner, Community Health. The Commissioner reports to the Director Clinical and Community Health. The Director Clinical and Community Health then reports to the Director General. This hierarchy is in place and functioning Coordination There is a national VHT coordination committee at the MOH comprising of Ministry of Health staff, UN agencies, and the major implementing partners. The committee is mandated to meet quarterly. The functions of the committee include: reviewing VHT technical guidance, information sharing by implementing partners, and getting to know who is doing what in the VHT strategy. The assessment indicates that this committee does not meet regularly as mandated. For example, since February 2014, the committee met only once in November The coordination office is not facilitated in terms of personnel and facilities to ensure regular meetings. The assessment established that though there is a revised VHT strategy (2011), it has not been rolled out to the districts and to the partners. The districts still rely on the 2009 draft guidelines Supervision The Ministry of Health is mandated to supervise the implementation of the VHT strategy in the country. The Ministry is also required to supervise implementing partners in terms of the activities and how they implement them. However, the assessment results indicate that due to lack of funding and inadequate personnel, such supervision has not been regular. For example, in the financial year 2014/15, no funds have been accessed for supervision Training According to the MOH, TOTs have been conducted in all the districts apart from Kampala district. During the TOTs, district trainers are trained who in turn train VHTs. Most of the TOTs were conducted in the first 10 years of the programme. However, due to financial constraints, the district trainers have not conducted basic training for all the VHTs. It could also be that those VHTs without basic training are those who were selected outside the selection guidelines. 51

56 Discussion Lack of funding is a major challenge to the VHT activities at national level. As a result, coordination, and supervision of VHT activities have not been adequately performed. Training of VHTs has not been completed in all the districts as a result of lack of funding. Lack of personnel in the coordination office has created a huge gap where the national coordinator is expected to do all the coordination work. The MOH does however have other opportunities for supervision such as the Area Team supervision where VHT activities have been supervised, but this is also irregular due to inadequacy of funding. Area team supervision is integrated health supervision in the Ministry of Health. The team looks broadly at health service provision and is under the mandate of the Quality Assurance Department in the Ministry of Health. Overall, at national level, the VHT national coordination office is poorly facilitated to enable it efficiently implement the strategy as stipulated in the guidelines. The lack of policy to guide implementation of the VHT strategy has complicated the operations of the programme in terms of adequate funding, supervision, and coordination. The lack of coordination has left gaps in the programme. For example, the MOH has failed to roll out the revised strategy (2011) and this has left districts relying on the draft one of Functionality of the VHT Programme at District Level Functionality of the VHT programme at district level was assessed using data generated from the interviews with VHT focal persons. Functionality was based on responses to the core areas of recruitment, training, coordination, supervision, financing, and documentation. The core indicators were: guidelines for recruitment of VHTs, availability of active VHT trainers and basic VHT training. In addition, coordination and supervision indicators were weighted more than the other indicators with each having a maximum of four points. As shown in Table 20, most of the districts (80%) that conducted the initial training for the VHTs were able to follow the guidelines for recruitment of VHTs. However, only two-thirds of the districts were able to conduct the VHT initial training and had active VHT Trainers. Although 44% of the districts reported supporting VHT activities financially, less than 20% of the districts committed funds in the district budget. It was unclear if the funds committed in the budget were later disbursed for VHT activities. Regular and consistent coordination meetings were held in only 40% of the districts. Table 20: Indicators of VHT functionality Indicators of functionality n Percent Selection following guidelines No Missing 3 3 Conducted VHT TOT No Missing 3 3 Have active VHT Trainers No

57 Indicators of functionality n Percent Missing 7 6 Ever conducted Refresher Courses No Missing 4 4 Districts funding VHT implementation No Missing 5 4 District that allocated funds for VHTs in their budget In Budget No Funds District that conducted Coordination Meeting No Missing 7 6 Regularity of Coordination Meetings in the last I year None meeting meeting meetings four or more Discussion Although the majority of the districts followed the guidelines in recruitment (84%), carried out TOTs (83%), have active VHT trainers (63%) and conducted refresher training (68%), the VHT programme is lacking district funding thereby making it less functional in coordination and supervision activities Functionality of the VHT Programme at Community Level A majority of communities interviewed reported the existence of VHTs in their villages with exceptions of urban areas such as Soroti and Mbarara municipalities and Kampala city. We do not know the work of VHTs; we just see them at the facility and if we want medicine they give us medicine and we go. But we basically do not know what they do there and what they are supposed to do. FGD_Community, Kampala district The communities commonly referred to VHTs as village doctors, community health workers, and health promoters arising from the roles and services performed by VHTs such as treating children under five years, immunization, distribution of drugs, and promotion of hygiene and sanitation. Those community health workers are good. They mobilise us to maintain hygiene, construct toilets, drying lines and rubbish pits and also distribute nets. FGD_Community, Butaleja district 53

58 Generally, the community perceived VHTs as committed and passionate about their work. In a number of instances, community members reported having provided VHTs with food, transport and free water from bore holes in appreciation of VHT work to the community. They are really so committed and helpful because you find them and tell them of the disease affecting your child and they take it as an initiative to come to your home to extend treatment to the child. They really work because they have record books and here at the health centre you find our names in those record books and this justifies how they work hard. FGD_Community, Kyankwanzi district Before we can inform the VHTs trust me they will have known. These people are very good at their work. FGD_Community, Hoima district VHTs are allowed to get water freely from the community boreholes in appreciation of their good work. FGD_Community, Moroto district To a large extent, the services provided by VHTs were considered commensurate to the needs of community members. Community members reported improvement in hygiene and sanitation, uptake of immunization, antenatal care and HIV services, and reduction of illnesses and deaths in the community as direct efforts made by VHTs I used to suffer a lot from typhoid because I never had to boil my water but now I boil my water and I do not fall sick anymore. Even my children do not fall sick of malaria anymore. FGD_Community Mbale district What VHTs have done initially, children used to suffer from measles and one thought it was witchcraft, however when these people came, they encouraged parents to take their kids for immunization, they have advised pregnant women to go for antenatal services. FGD_Community Gomba district Even those VHTs the big job I see them doing in the community is that people in the community used to fear to go for HIV tests because they would stay in the village and fear to disclose their sickness but when the VHTs find out about them they go down to them in the village, counsel them and create for them conducive grounds of which finally the people who have HIV come to the health centre to carry out tests. But now ever since that happened you find that people have gained courage and confidence and come to the health centre to get tested because of the counselling they got from VHTs. You see they are now better people compared to how they were before they came for testing. FGD_Community Luwero, district Although community members largely considered VHT roles as meeting community needs, there were instances where the services provided did not meet community expectations, as cited in the extracts below: They used to perform their duties but now these days we don t know if there was change in leadership at the top most because for sure drugs are no longer available at all. And if you go with a child you find they have no medicine and you bring the child to the health centre. FGD_Community, Kyankwanzi district Some people tell VHTs that you who did not go to school, how do you teach me about latrine construction, you come here for my wife. FGD_Community, Kamuli district 54

59 In town many people are wiseacres they do not mind about people who come to talk to them about health, they just wait till when their children are sick and they go to hospital so they do not give any attention to VHTs. FGD_Community, Kampala district Lack of drugs and low levels of education of some VHTs have contributed to negative perceptions of community members towards VHTs in communities. In addition, VHTs are largely existent and known in rural settings compared to urban settings. Discussion The majority of the rural community members interviewed reported the existence of VHTs in their communities. To a large extent, the services provided by VHTs were considered relevant to the health needs of community members. Community members reported improvement in hygiene and sanitation, uptake of immunization, antenatal care, and HIV services and reduction of some illnesses and deaths in the community as direct efforts made by VHTs. This therefore implies that the VHT programme is perceived to be functional by the rural communities. However in the urban setting, the communities did not know much about the programme since the VHTs do not visit their homes. This brings into question the functionality of the programme in the urban communities Functionality of Individual VHT Members The individual VHT member functionality was assessed based on the following criteria: access to equipment and supplies, VHT referral and follow up, supervision and reporting. Table 21: Functionality of VHT members Indicator of functionality n Percent VHT referral and follow-up Conduct referral and follow up No referral or follow-up VHTs being supervised No VHT submitting reports No VHT participation in coordination meetings No Table 21 indicates that majority of VHTs referred clients to health centres (68%), were supervised (70%) and were reporting (91%). The reporting tools were majorly provided by IPs. Less than 50% of the VHTs reported having all the equipment. However, there was no evidence of support supervision reports to the district. The VHTs also reported multiple reporting formats from partners which became a burden to VHTs especially those with low or no education. Discussion Although most of the VHTs reported having been supervised, there was no evidence of supportive supervision reports to the districts. VHTs reported being supervised by health workers at health centre 55

60 IIs. However, these health workers lack facilitation in terms of transport and may not be adequately trained for this purpose. The quality of supervision may therefore be low. The VHT members also have multiple reporting formats from partners which became a burden to VHTs especially those with low or no education VHT Drop Outs (Attrition) For a VHT to be considered as a drop out, he/she no longer carries out any role related to the VHT programme in the community where he or she was trained. The assessment found that of the 56 district VHT Focal Persons who provided information on VHT drop outs, there was about 30% VHTs who dropped out (Table 22). As noted, this is a reported figure and we did not have the necessary documentation to verify this. The Northern region had the highest attrition due to camp decongestion and resettlement of former Internally Displaced Persons, which led to relocation and eventual drop out of some VHTs. Other causes of the drop out were: change of residence, death, employment, low motivation, and marriage. In other cases, VHTs were trained but they drop out. Others shift to other areas such as Kampala and others die yet they haven t been replaced. We also need more VHTs. The ones we have are not enough. The district does not have funds specifically allocated to the VHT programme and therefore facilitation of VHTs is not easy, KII_Rukungiri district. The high attrition rate is due to volunteerism. The VHTs are not seeing this programme as motivating. Some VHTs prefer doing something where they get some money and so others have gone to South Sudan, FGD_VHT, Moyo district. Table 22: Number of districts that reported VHT dropout rate region Region Frequency Mean drop out percentage Northern Karamoja Eastern Central Western Total / Mean A 30% drop out rate is high and affects the functionality of the VHT programme in as far as the number of people to conduct community health activities and the costs of recruiting and training other replacements and performance of VHTs are concerned Sustainability of the VHT programme The VHT programme has had a quite significant effect on the improvement of the delivery of primary health care services to the communities in Uganda. Such activities include hygiene and sanitation improvement, immunization, indoor residual spraying, HIV and AIDS, TB and malaria, family planning, maternal and child health, and NTD services. These services have been appreciated by the some community members, the district leaders, and the health care workers. Moreover, the community members participate in the selection of VHT members, thereby creating a sense of ownership in the process hence providing a ground for sustainability. However, several challenges with sustainability of the VHT programme were reported as illustrated in the excerpts below; 56

61 The MOH does not have clear harmonized position for financial sustainability of the VHT program, KII_MOH. The Government should encourage partner to use VHT but the VHT should be controlled by the Government, KII_MOH. Funding is the root cause of all the challenges VHTs are facing because without funds activities like supervision capacity building and motivation would be hard or near impossible to implement, KII_Mbarara In its current form, the programme is not sustainable as it is highly dependent on IPs. There is a need to ensure that the VHT programme is not dependent on volunteerism and financing mechanisms are put in place, harmonized and sustained. Partners can come together and have a VHT fund. This VHT fund can be put in a basket and then we know that from this district for the VHTs, there is this fund and the districts can break it down to ensure that the whole district is covered, the tools are harmonized and all the VHTs are remunerated depending on how much money is available, FGD_DHT, Kamuli district. Discussion Drop out rates The high drop out in the North (38%) may be due to the fact that the camp situation brought many villages together and the trainings provided to VHTs then may only benefitted VHTs from some villages and not others. The VHT training started about 15 years ago in northern Uganda compared to other regions. The VHTs may have naturally dropped out due to other employment, death, or retirement. The high expectation of benefits from the programme may have caused high attrition when the expectations were not fulfilled. Low drop out rates in Karamoja region were reported by two districts. VHTs in Karamoja were trained in the last five years and that may be a reason why there is low drop out as compared to the Northern region where VHTs were trained over ten years ago. Secondly, there is more support being provided to VHTs in Karamoja region under ICCM programme by UNICEF. However, this study did not correlate the low drop out in Karamoja region and service delivery or health indices. Sustainability The VHT programme seems unsustainable due to heavy dependency on partners. The MOH does not have a clear harmonized position for financial sustainability of the VHT program. 5.0 Discussion Summary 5.1 Number and Socio-demographics The assessment revealed that there are a total of 179,175 village health team members in the 112 districts with only 119,026 who have had the basic training. These are estimates as reported by the District VHT Focal Persons. With 57, 735 villages in Uganda, this translates into 3 VHTs serving a village. This figure, however, may be inaccurate since there are some districts such as Kibuku and Kampala, among others, that have not carried out the basic VHT training. The number of VHTs are as reported by the districts and could not be independently verified. The regional imbalance in VHT distribution in VHT 57

62 coverage requires the government to conduct VHT training in districts that have not yet had their own trainings to ensure equitable delivery of health services. The assessment found that just over a half (52%) of VHTs were below 40 years of age. They are able to sensitize the communities on health promotion but also do other health related activities. This age bracket may be more susceptible to attrition as they are considered more energetic and mobile. Some of the VHTs were 50 years or older, a factor that may have led to inefficiencies with regards to report writing and swift movement during mobilisation activities. For example, administrators in districts such as Kalungu, Butambala and Mpigi expressed dissatisfaction with the manner in which the older VHTs were performing in terms of reporting and drug distribution as well as efficiency in movement during mobilisation. Some of the VHTs in this area are aged and cannot see well, FGD_DHT, Butambala district. Given the unique challenges of the young ones less than 40 and the old one ones more than 40 years of age, there is need to review the guideline for eligibility and recruitment of people to be trained as VHTs. While the majority of the VHTs interviewed (54%) were male, the assessment could not establish the sex composition of the VHTs in the Country due to the absence of VHT databases in the districts. The data shows that more than 50% of the VHTs have attained at least 0-Level education and can therefore read and write. This position was also supported by community data showing preference for people who have attained 0-Level education and above. This would imply that Government could consider the minimum level of education for a VHT could be 0-Level. This would suit the expanding scope of responsibilities of VHTs such as administering antimalarial drugs, data gathering and reporting, family planning. However, it should also be pointed out that there is a challenge of identifying people with 0-Level education in some places, more especially in Karamoja region, where about 20% of the VHTs had at least O Level education as compared to the rest of the Country. VHTs are involved in various activities. The majority of the VHTs (86.2% males) and 85.6% females were engaged in farming. However, the findings indicate that some VHTs are employed by NGOs; some are students while others are LCs. These categories of VHTs may not have sufficient time to do VHT work and it is inconsistent with the VHT selection guidelines. Some of these individuals could have joined VHT work due to high expectations as noted in the interviews. It is therefore observed that the VHT selection guidelines have not been adhered to. 5.2 Training of VHTs The study found that there are no training databases for the VHTs in the districts and at the national level. Some of the VHT Focal Persons in the districts are new and because they lack VHT databases in the district, they therefore may lack information on what has happened in the programme in the previous years. This result may also mean that the number of VHTs may not be accurately known at the national level. Despite the high number of VHTs in the Eastern region, the majority have not had basic VHT training. The high number of untrained VHTs in Eastern region shows disfunctionality of the VHT programme. People who did not receive basic training were considered VHT members in some districts. For example, in Kampala district where no basic training has taken place, 351 people were reported to be VHTs. These 58

63 were only trained on programme-specific areas. In such districts, it is apparent that the VHT guidelines have not been followed with respect to training. It was noted that the content of the basic training reported by VHTs was largely consistent with the content stipulated in the VHT operational guidelines. However, this content may not have been fully covered in the short duration of the training (5-7 days) even when qualified trainers were used. The reduction of the training duration by the Ministry of Health from 10 to 5 days may have led to rushing of the trainings. The trainings may have been inadequate to equip the VHTs with appropriate knowledge and skills. This therefore could affect the quality of services VHTs provide to the community. At times, trainings are conducted directly by the IPs without notifying and involving the DHTs or using the district trainers. This indicates a problem of VHT programme coordination, streamlining and training. Since IPs choose where to go and implement their programmes, it creates disparity in the capacity of VHTs since trainings are provided to some VHTs in some areas and not to others. This leads to differences in knowledge and skills levels among the VHTs. Such a situation may lead to demotivation of the VHTs who have missed the training and may result into drop out. Poor IP coordination creates a problem in supervision of the programme and eventually in sustainability when the partners projects end. In areas with few or no implementing partners, it implies that the communities may not be benefitting from the VHT activities supported by such partners. While these multiple trainings can strengthen the capacity of VHTs to deliver services to the community and provide feedback to the health facility staff, it also means that the same VHTs receive multiple trainings which increase their reporting burden. It may also mean there is inadequate time to have quality training given the low level of education of some of the VHTs. 5.3 Partners Supporting VHT Programme and Activities the VHTs are Implementing Implementing partners have made significant contributions to the overall implementation of the VHT programme through the provision of financial, technical and logistical support. This support has improved utilization of health care services provided by VHTs in the areas of immunization, sanitation, HIV and AIDS services, antenatal care, deliveries and family planning services. However, there is inequitable distribution of partners among and within districts. This may be caused by the uncoordinated selection criteria of the districts of operation. This leads to inequitable distribution of skills among VHTs. Districts with many partners may have VHTs who are more skilled than those with few partners or none at all. This has implications on quality of health care services VHTs deliver to the community. The roles played by the VHTs as indicated by the Community FGD data are reflective of the content of the VHT training. The most common roles played by VHTs are community mobilisation and this is consistent with the content and requirement of the basic VHT training guidelines. The community members are appreciative of the roles played by VHTs in health service delivery especially in hygiene and sanitation, drug distribution, antenatal care, HIV and family planning. Although the VHT programme is owned by the Government of Uganda, the assessment established that VHTs pay more allegiance to the IPs who provided them with more facilitation than government. This is 59

64 reflected in the VHTs willingness to participate in IP related projects as opposed to those for the government where there is less or no facilitation. 5.4 Extent to which Implementing Guidelines are Being Followed Selection The VHT selection guidelines are in place and have largely been used. This is evident in the involvement and participation of the communities in selecting VHTs. However, a small proportion of VHTs were selected not in accordance with the guidelines in place. This included selection by local leaders, selfselection and selection by IPs. This may imply that the quality of VHTs not selected according to the selection guidelines may not meet the selection criteria such as being able to read and write or being trusted, committed to working, and permanent residents in the community. Training Whereas the guidelines and training manuals to support VHT trainings are in place, nearly a third of VHTs have not received basic training. This may have been as a result of a number of factors such as: lack of funds by districts to conduct basic trainings, self-appointment and selection by local leaders and by IPs. Such tendencies to select VHTs without the community involvement could have been due to lack of supervision by the districts. Consequently, a substantial number of VHTs may lack adequate skills to perform their duties. The one-third VHTs who received basic training in only 1-4 days imply that the training duration guidelines were flouted. This may have therefore lowered the quality of the training conducted as the training period is too short to equip the VHTs with the necessary knowledge and skills. Though the training period of 5 days of basic training is in the guidelines, it is however too short for the trainees to comprehend all the content and apply it. Besides, the varying education levels of VHTs affect their ability to comprehend the content of the training. Programme-specific trainings by IPs are not harmonized in terms of standardized materials, content, duration and methods. This clearly is not in line with the guidelines on refresher training. Supervision The assessment revealed that VHTs are supervised at the health centre IIs or IIIs or IVs and at district level as stipulated in the guidelines. However, there were no supervision checklists and reports ascertained. Supervision of the VHTs was hampered by lack of resources including funds, transport and technical capacity for supervision. Supervision was undertaken mainly by Health Assistants, In-charges of health centres and Parish VHT supervisors and LC I Chairpersons as well as by NGOs and CDOs. The selection of VHT Supervisors was not rigorously followed except in only 5% of cases. It was however difficult to ascertain whether these various supervisors and the VHT members themselves understood what supervision entails. Therefore, the lack of supervision tools, reports and apparent understanding of what supervision entails leaves gaps in determining whether the supervision reported to have been carried out was effective. The lack of reports suggests that supervision may not have taken place. The non-adherence to the VHT Supervisors selection guidelines therefore compromises the quality of VHT supervision. 60

65 Reporting The assessment showed a hierarchical reporting from the village through the parish (health centre), subcounty to the district levels. However, in some districts such as Otuke, Sheema and Buhweju, there was practically no reporting due to various reasons including the lack of tools and lack of training. The study however did not determine whether the hierarchical reporting existed in every district. The absence of reporting tools and training on reporting constrained reporting and suggests the need for capacity development in this area. Various reporting formats and tools were used, including mtrac. However, paper-based forms for reporting were found to be the most commonly used in most districts. Reporting tools were mostly found with implementing partners. This implies that reporting took place based on availability of tools in settings and programmatic priorities of implementing partners. It may also imply that VHT supervisors at health centre levels could only exercise limited supervision of VHT reporting. The inadequate reporting tools, existence of various implementing partners and reporting formats, coupled with low education level of some VHTs, therefore suggest that there was irregularity and poor quality in reporting. Coordination There are VHT operational guidelines in place to support coordination mechanisms. However, poor coordination has arisen due to human resource and financial constraints mainly at national and district levels. The irregularity of the quarterly national steering committee meetings could have led to increasing gap in VHT coordination among and within districts. Lack of coordination led to poor supervision of IPs and their activities. Referrals The assessment established that most of the VHTs referred clients to health facilities. However, the assessment also found that health workers sometimes did not respect referrals made by VHTs. This emanated from the fact that VHTs are considered people of low education who are not competent in disease management as they are not medical personnel. It was not clear whether referrals made by VHTs were effectively handled by the service providers at the health facilities. In addition, the assessment found that there were other concerns that affected effective referral, such as lack of medicines in and transport means to health centres. Approaches for motivation The provision of monetary and non-monetary incentives to VHTs contributes to motivation and retention of VHTs. While the VHT Operational Guidelines stipulate the various forms of motivation for VHTs, it does not explicitly describe how these should be equitably distributed and who should provide these incentives. For instance, the financial forms of motivation did not have the educational level required and yet government does not pay workers without formal education. The minimum package did not stipulate a salary but a reimbursement of costs for transport or for meals. In addition the MOH guidelines did not provide clarity on what constitutes activity- and performance-related incentives. While there are economic and social benefits of volunteerism, maintaining the VHTs to perform their functions can be eroded over time if some basic needs are not met. Some VHT who volunteered had high monetary expectations and if these were not met, some dropped out of the VHT programme. Some of the materials provided were just tools but were not meant for motivation. Although those materials were meant as materials to facilitate VHT activities, they provided motivation to VHTs. The study found that there are certain things beyond what was thought as motivation to VHTs. Qualitative data showed 61

66 that there is an overwhelming demand for a harmonised and regular financial form of motivation for the VHTs. The various methods of motivation are not uniform thus creating disharmony at the district level and among the VHTs hence making coordination ineffective. Although the MOH, development partners and IPs are providing different kinds of motivation, there is no system for tracking the different motivation packages and support for VHTs, hence there is need for harmonising motivation approaches and packages to address these anomalies. 5.5 Functionality of VHT Programme National level Lack of funding is a major challenge to the VHT activities at national level. As a result, coordination and supervision of VHT activities have not been adequately performed. Training of VHTs has not been completed in all the districts as a result of lack of funding. Lack of personnel in the coordination office has created a huge gap where the national coordinator is expected to do all the coordination work. The MOH does however have other opportunities for supervision such as the Area Team supervision where VHT activities have been supervised, but this is also irregular due to inadequacy of funding. Overall, at national level, the VHT national coordination office is poorly facilitated to enable it efficiently implement the strategy as stipulated in the guidelines. District level Although the majority of the districts followed the guidelines in recruitment, carried out ToTs, have VHT trainers and conduct refresher training, the VHT programme is none functional on district funding to the programme, coordination and supervision. This is mainly due to lack of funds to finance these activities in the districts. Community level The majority of the rural community members interviewed reported the existence of VHTs in their communities. To a large extent, the services provided by VHTs were considered relevant to the health needs of community members. Community members reported improvement in hygiene and sanitation, uptake of immunization, antenatal care and HIV services, and reduction of some illnesses and deaths in the community as direct efforts made by VHTs. This therefore implies that the VHT programme is perceived to be functional by the rural communities. However, in the urban setting, the communities did not know much about the programme since the VHTs do not visit their homes. This brings into question the functionality of the programme in the urban communities. Individual VHT functionality Although most of the VHTs reported having been supervised, there was no evidence of supportive supervision reports to the districts. VHTs reported being supervised by health workers at health centre IIs. However, these health workers lack facilitation in terms of transport and may not be adequately trained for this purpose. The quality of supervision may therefore be low. The VHT members also have multiple reporting formats from partners which became a burden to VHTs, especially those with low or no education. 62

67 6.0 Recommendations 6.1 Recommendations for Immediate Action 1. There is a need to review the whole strategy of VHT including policy, selection, training, contents, definition of roles and responsibilities of VHTs, and coordination structures at the national and district level. 2. The government should have a clear commitment to adequately financing and institutionalizing the VHT strategy and ensuring regular payments of VHTs for sustainability of the programme. 3. A strong VHT coordination structure as well as clear monitoring and supervision mechanisms should be established at all levels of government. Coordination of implementing partners should be part of the structure. 4. The Ministry of Health should establish an accurate database for VHTs at the national level to aid monitoring and supervision of the programme. Each district should also be helped to create district specific VHT database. 5. The Ministry of Health should streamline training and refresher courses for VHTs to ensure quality, equity in capacity building for all VHTs, and control over VHT activities. 6. Lastly, government and all relevant stakeholders should make available conducive working environment for VHTs. This should include efforts to improve working relationships between VHTs and health workers and supporting economic development opportunities for VHTs. 6.2 Additional Recommendations Numbers and Socio-demographics 1. The MOH should include stipulation in the selection criteria to Increase the number of VHTs under the age of 35 to more effectively reach young people in the communities. Selection criteria should be revised in a way that takes into consideration communities cultural values while also encouraging a greater number of younger VHTs within the overall selection. 2. The minimum education level for VHTs should be specified at O level. However, consideration should be made for the differences in education levels between the regions. In urban centres, there is a need to recruit VHTs of higher levels of education to match the population that lives in these areas. 3. Engage more female VHTs in recruitment to handle specific female health needs, such as reproductive health issues, that women may feel uncomfortable discussing with male VHTs. Training and supervision of VHTs 1. Given the increasing expectations for the roles of VHTs, the duration, content, and methodology of the VHT training should be reviewed and revised with the intention of making it commensurate with the skills to be developed. In addition, inclusion of content around gender and values clarification for serving young people (e.g., addressing myths and misconceptions about family planning use by young people and nulliparous couples) is needed to address VHTs attitudes and ability to effectively deliver services. 63

68 2. The VHT programme should be coherently inserted in the wider health system, and should be explicitly included within the human resources for health strategic planning at country and local level. 3. The MOH should put in place clear, measurable mechanisms of VHTs role in primary health care, to ensure that a core set of skills and information related to MDGs be provided to VHTs. The proposed revised VHT curriculum should incorporate scientific knowledge about preventive and basic medical care, and how they relate these ideas to local social issues and cultural traditions. They should be trained, as required, on the promotive, preventive, curative and rehabilitative aspects of care related to maternal, newborn and child health, malaria, tuberculosis, HIV and AIDS, as well as other communicable and non-communicable diseases. 4. There is need to establish a VHT database at the district level to track all district level VHT trainings and other activities. However, this needs control and coordination of all district level VHT trainings and other activities by the MOH and the District Local Governments. 5. The MOH should ensure that all VHTs in the districts undergo VHT basic training, especially in Kampala and the newly created districts. 6. There should be coordination of refresher training by the MOH and the District Health Teams and IPs to ensure uniformity of the VHT training with regard to standardized materials, content, duration and methods based on VHT roles and functions and fair coverage and should be more inclusive of the content of the basic training since the current training is more programmedriven. The refresher training should only target VHT who have completed the basic training. 7. Considering the ever-changing roles of VHTs, it is recommended that their roles and responsibilities be reviewed and updated, stipulating suitable duration of days for training. There is need to identify other innovative ways of training to ensure content is covered and skills are acquired. 8. The MOH and districts in close collaboration with IPs should ensure reliable provision of transport, drug supplies, and equipment for VHT effectiveness in implementing their activities. Supplies of drugs and related commodities should be brought to the Health Centre IIs for the VHTs to easily access them. 9. The MOH and Districts should revise the training curriculum for supervisors and ensure that VHT supervision checklists exist and are put to use by VHT supervisors. The MOH and DHTs should revise supervision tools, report formats/tools for VHTs, and checklists for understanding what supervision entails to ensure effective supervision of VHTs as well as harmony with IPs expectations. The MOH and districts should enforce adherence to the set criteria for selection of VHT supervisors and build their capacity to perform that role. The MOH should ensure that VHT supervision checklists are developed and disseminated to the districts. The districts should ensure that VHT supervision checklists are put to use by the VHT superviors. Reports of VHT supervision should be written and submitted by supervisors to appropriate offices as stipulated in the VHT operational guidelines. The MOH and districts should revise the training and supportive supervision activities to ensure positive attitudes of health workers towards VHTs. 10. The MOH and districts should ensure that VHTs have appropriate tools for regular reporting feeding into respective district HMIS. The MOH and districts should ensure that VHTs have the right skills and tools to undertake effective data collection, report writing and timely report submission. 64

69 11. Indicators that specifically track VHT interventions (e.g. VHT trainings) should be developed in the HMIS so as to track effectiveness and performance of VHT members work. The VHTs should be oriented on the importance of tracking, collecting, and reporting these indicators using the revised VHT reporting formats during the VHT trainings. Partners supporting the VHT programme 1. The MOH and the district leadership should play a role to ensure a more equitable distribution of implementing partners among and within districts. In addition, the MOH should regulate partners working within the same district but working in the same programme area. 2. The MOH should use district-based VHT and IP mapping to coordinate and harmonise the VHT activities in the districts. This will improve the inequity of VHT coverage and service delivery. It will also strengthen government leadership and ownership of the programme. 3. The government should create a national fund where partners financial contribution to the VHT programme should be kept. This helps in equitable distribution of funds for the different VHT activities. Implementation of the guidelines 1. The DHT and district leaders should ensure thorough supervision a clear selection and deployment procedure for VHTs and their supervisors. Ideally, they should engage community in planning, selecting, implementing, and monitoring that reassures appointing those who certify the course completion and pass the writing or verbal exam at the end of training. The MOH and local leadership should take responsibility for designing a transparent system for selection and deployment and further quality assurance of the regulated set system. 2. The MOH and districts should streamline reporting structure to ensure compliance with the VHT operational guidelines on reporting. 3. The government should provide adequate funding for the Ministry of Health to have an efficient national steering committee and for coordination of VHT activities nationally and at district level, as well as at the community level. 4. There is a need to sensitize health workers in the health centres and the communities at large about the mandate of the VHTs. This will create harmony and good working relationships between the VHTs and the health workers. 5. The MOH should advocate with/lobby Parliament to provide adequate funding and annual budgets for VHT activities nationally, as well as at district and community levels. 6. In the revision of training and support supervision guidelines, the MOH should develop an effective tracking system to ensure that patient referrals are effective and can be evaluated. 7. The MOH should develop and use effective checklists to assess attitudes of health workers and communities towards VHTs work. Motivation mechanisms 1. There is a need to provide a standardised, harmonised, regular, and equitable financial form of motivation to VHTs and to ensure equitable distribution of non-monetary incentives to all VHTs. 2. The MOH should lobby Parliament to establish Performance-Based Financing system (PBF model) in which a base salary is paid for core activities, and an additional bonus can be earned for excellent performance for additional activities. 65

70 3. Non-monetary recognition of VHTs as a formal health worker cadre, integrated into the public health system, with all that that entails (payment, rights, supervision and assessment). 4. The government should review the number and level of education of VHTs if a standardised remuneration systems is introduced, such as wages or salaries. 5. The MOH should develop career path development plans for VHTs as a motivational function. 6. Government should take lead in clarification and provision of the motivations and incentives mentioned in the VHT operational guidelines. 7. Revise the HMIS to include household data on basic public health indicators collected by the VHT system. 8. Establish use of mhealth tools such as the routine messaging tool for household health data collection that feeds into district HMIS and for monitoring VHT performance. 9. For motivation to be effective there is a need to have a database of VHTs with their full names and photographs. This helps in tracking the existence of the VHTs and the authenticity of these VHTs if they have to be introduced to a remuneration payment system. 10. The government and IPs need to undertake proper planning on the proposed financial mechanisms of VHT motivation prior to adopting such suggestions. The government and IPs should undertake a cost-benefit analysis of these suggested motivation mechanisms to come up with the most suitable mechanisms that are within government means to motivate the VHT members Functionality 1. A VHT Policy should be formulated to guide the strategy development, which should be costed and funded. 2. The MOH and the district health offices should coordinate the IPs in terms of activities implemented and geographical coverage in order to reduce the concentration of IPs in some areas. 3. There is a need to empower the VHT department at the MOH with adequate funding and to increase personnel to enable them to efficiently implement the strategy. 4. A national basket fund should be established to which donors contribute and which can be used to pay VHT salaries and any other additional costs such as training, supervision, supplies, etc. 5. The MOH should routinely monitor district-based databases for VHTs and their activities to ensure coordination of all IPs targeting VHTs. This will help in equitable geographical distribution of service delivery as well as skills and knowledge among VHTs. 6. The districts should include in their annual workplans and budgets VHT activities and the MOH should ensure timely disbursement of funds. 7. The MOH should develop an urban-specific strategy that prioritizes parishes or villages with the worst public health indicators, such as slum areas, and the lowest service provider to population ratios. The most underserved parts of the cities/towns should be addressed first, with later expansion to the rest of the city as budget permits. 66

71 7. 0 Appendices Appendix 7.1: Number of VHTs in the Districts District Number of VHTs ABIM 718 Adjumani 826 AGAGO 1969 Alebtong 1210 Amolatar 870 AMURU 720 Apac 3500 Arua 200 Dokolo 958 Gulu 1561 Kitgum 1534 Kole 1114 Lamwo 1198 Lira 210 Maracha 1184 Moyo 1642 Nebbi 879 Nwoya 874 Otuke 790 Oyam 4976 Pader 1300 Yumbe 1272 Zombo 1669 Koboko 120 AMUDAT 244 Kaabong 920 KOTIDO 365 Moroto 365 Nakapiripirit 343 Napak 60 Amuria 3630 Budaka 798 Bududa 1902 Bugiri 2285 Bukedea

72 Bukwo 1054 Bulambuli 2820 Busia 1710 Butaleja 1000 Buyende 1615 Iganga 715 Jinja 1930 Kaberamaido 82 Kaliro 1465 Kamuli 3456 Kapchorwa 1484 Katakwir 1540 Kibuku 492 Kumi 871 Kween 968 Luuka 1275 Manafa 3031 Mayuge 2500 Mbale 3214 Namayingo 1250 Namutumba 1815 Ngora 665 Palisa 1712 Serere 1480 Sironko 2570 Soroti 1398 TORORO 4375 Buikwe 1870 bukomansimbi 1016 BUTAMBALA 640 Buvuma 300 GOMBA 1018 kalangala 480 kalungu 1140 Kayunga 1875 Kiboga 1143 kyakwanzi 62 Luwero 2980 lwengo 1802 lyantonde 150 masaka

73 MITYANA 150 MPIGI 1354 MUBENDE 309 Mukono 2547 Nakaseke 656 Nakasongola 1405 rakai 4500 sembabule 1500 WAKISO 2880 Buhweju 1235 BULIISA 418 Bundibunjo 2548 Bushenyi 1713 Hoima 1124 ibanda 1750 Isingiro 3325 kabale 4437 Kabarole 3000 Kamwenge 2560 Kanungu 1760 Kasese 1023 Kibaale 7620 kiruhura 3408 KIRYANDONGO 412 Kisoro 2200 Kyegegwa 1430 Kyenjojo 5246 MASINDI 1328 Mbarara 2582 Mitooma 1198 Ntoroko 1312 Ntungamo 3695 Rubirizi 1020 Rukunguri 1119 Sheema

74 Appendix 7.2: National Partners to Interview PARTNER KEY INFORMANT COMMENTS PACE Amon Done World Vision Geofrey Babugirana Done UNFPA Roseline Achola Done Pathfinder International Uganda Karamagi Charles Done Marie Stopes Uganda Dr. Herbert Muhumuza Done AMREF Dr. Kagurusi Done UNICEF Charles Loada Done Malaria consortium Denis Mubiru Done Reproductive Health Uganda Kansiime Doreen Done Uganda Health Marketing Group Eva Kaggwa Done FHI 360 Done POPSEC Done 70

75 Appendix 7.3: List of Partners Working with VHTs in Districts DISTRICT PARTNER AREA OF OPERATION KARAMOJA REGION Moroto UNICEF Nutrition UNFPA Malaria International Rescue Committee PMTCT CAUMM ICCM Nakapiripirit UNICEF Nutrition International Rescue Committee HIV CAUMM ICCM WAP CONCERN Amudat International Rescue Committee PMTCT Vision Care ICCM FOREF HIV UNICEF Nutrition Pilgrim Uganda Malaria, HIV, diarrhea Marie Stopes Maternal health CAUMM ICCM Napak UNICEF Nutrition International Rescue Committee PMTCT CAUMM ICCM Sight Savers Samaritan Purse Sanitation and hygiene Katakwi Baylor Uganda HIV, Malaria UNFPA Malaria LWF TASO HIV/AIDS Kaabong World Vision Nutrition UNICEF Nutrition International Rescue Committee PMTCT Community Action for Health Nutrition Abim UNICEF Nutrition, support review meetings World Vision Nutrition Community Action for Health Nutrition Baylor Uganda HIV reporting 71

76 GOAL Kotido Community Action For Health Nutrition World Vision HIV International Rescue Committee PMTCT UNICEF Nutrition Amuria World Vision Nutrition TASO HIV/AIDS Baylor Uganda HIV/AIDS Pilgrim Malaria, HIV, diarrhea Uganda Cares HIV Eastern Soroti World Vision Malaria AMREF TB AIC Malaria Uganda Cares HIV Baylor Uganda HIV/AIDS Mental Health Project Serere Baylor Uganda HIV/AIDS AMREF Reproductive Health Partners For Children World Wide Livelihood And Sanitation And Reproductive Health Staying Alive Fistula and supporting households with equipments Health Need Reproductive sanitation HOW Uganda Reproductive Health Hope for OVC Uganda Pentecostal Assembly of God Pilgrim Management of malaria SORUDA Uganda Reproductive health and sanitation Ngora Baylor Uganda HIV/AIDS Pilgrim Malaria, HIV, diarrhea THETA PMTCT PACE Malaria Uganda Sanitation Fund Hygiene and Sanitation Bukwo PACE HIV,TB,PMTCT CARITAS HIV and AIDS,TB Star Ec HIV/AIDS,TB Strengthening Decentralization Systems(SDS) Health system strengthening Kween 72

77 Kapchorwa Bukedea Bulambuli Manafwa Kumi Sironko Mbale Bududa PACE Star E PACE Star E Pilgrim Baylor Uganda Maritza international PACE Salvation army TASO PACE Salvation Army Mbale Cap Baylor Uganda Pilgrim PACE Strides Star E Friends of Kumi Private Sector Training PACE Buyobo Development Association Salvation Army Star EC PACE World Vision Malaria Consortium SPOT LIGHT ON AFRICA PACE UMODA HIV/AIDS, Malaria, TB HIV/AIDS,TB Malaria HIV, TB Management of malaria Referral, community linkage, HIV/AIDS, sanitation Malaria control and prevention Reproductive health HIV/AIDS, Referrals, maternal health Family planning, malaria and nutrition Family planning Maternal health HIV/AIDS, maternal health Reproductive health and family planning malaria and nutrition Maternal, Newborn and Child Health HIV/AIDS Malaria, HIV/AIDS and Reproductive health Micro finance and soft loans Family planning HIV/AIDS,TB HIV/AIDS Girl child and Child upbringing Malaria prevention and control Water source treatment, H/C construction Malaria, HIV/AIDS and TB HIV/AIDS 73

78 SCORE Family planning DATA Maternal health PATH Family planning PONT Uganda Capacity building Tororo Plan Uganda ICCM World Vision Nutrition East Central Mayuge Star EC TB/HIV Strides Maternal, Newborn and Child Health Family Life Education Program family planning Makerere SPH New born care Paliisa MANIFEST Maternal and Newborn Health Star ec TB, HIV Kagum Development Maternal health Organization Kibuku Uganda Sanitation Fund Hygiene and Sanitation MANIFEST Maternal and Neonatal Health Kagum Development Maternal Health Organization Kadama Widows Association HIV/AIDS Star EC TB, HIV TASO HIV/AIDS Budaka KADO Maternal Health Salvation Army Reproductive Health Child Fund Maternal, Newborn and Child Health Star e HIV/AIDS Strengthening Decentralization Health system strengthening Systems(SDS) Butaleja World Vision Maternal, Newborn and Child Health Child Fund Child Health Salvation Army Reproductive health Namutumba Star EC HIV/AIDS and TB Marie Stopes Family planning Spring Nutrition Kagum Development Organization Malaria, TB, HIV Envision 74

79 Busia Namayingo Bugiri Luuka Buyende Kamuli Kaliro Accelerating Nutrition Intervention(ANI) World vision PACE Salvation army Child fund Star EC Family health international(fhi) Star ec PACE GOAL Mother To Mothers Star EC World vision Strides PACE Link up project ACCORD Star EC Kagum development organization PACE Star EC MANIFEST Community vision Kagum Development Organization Plan Uganda MANIFEST Star EC Strides Strengthening Decentralization Systems(SDS) Star EC PACE Strides Kagum Development Nutrition Maternal, neonatal and child health Malaria Family planning Livelihood and child health TB Family planning HIV/TB Malaria WASH HIV in pregnancies and lactating mothers HIV, TB MNCH MNCH Malaria HIV and TB Long lasting nets, pregnant mothers and children Malaria TB, HIV and Malaria Maternal and child health Livelihood HIV, TB Malaria ICCM MNCH TB, HIV, Malaria MNCH Health System strengthening TB, HIV Malaria MNCH HIV, TB, Malaria 75

80 Organization Central 2 Nakasongola AMREF Malaria Save the children Reproductive health PREFA Prevention of transmission from mother to child World vision Nutrition and sanitation Strides MNCH Save foundation UNICEF Family health days Nakaseke Busoga Trust HIV and malaria Mild may HIV Kiboga Malaria consortium Drug distribution World Vision Nutrition and sanitation Kyakwanzi Malaria consortium ICCMs World Vision Nutrition and Sanitation AMREF Malaria Luwero PLAN ICCM UNHCO CORDI Busoga Trust HIV and malaria AMREF Malaria PACE Malaria Caritas Health Wine Mbuya Outreach Abagala Uganda Kayunga FHI 360 Family planning PACE HIV and TB Strides MNCH Joint Action for Health Buvuma PACE Health communication and education Makerere University Walter Export clients from communities Reed Project Envision Train in mass treatment of bilharzia Jinja TASO HIV/AIDS PACE HIV and TB 76

81 Sustain project Data collection for health information Mukono Omni-med Training VHTs PACE HIV and TB World Vision Nutrition and sanitation Buikwe World Vision HIV testing UNICEF Family health days Walter reed project PACE Malaria THETHA Iganga PACE Malaria Star EC TB, HIV, Malaria South Western Kisoro SPRING Nutrition AMREF Maternal and family based health care Muhabura HIV/ Sanitation Mayanja memorial hospital HIV, Malaria Water School Project Kisoro Doctors of Global Health Mitooma Global fund Distribution of mosquito nets Star SW HIV and TB Church of Uganda HIV Buhweju Star SW HIV, TB Malaria Consortium ICCM UNICEF Registration Ntungamo Star SW HIV UNICEF Immunization Health child Maternal health Kabale PACE HIV World Vision AIM project Mayanja Memorial Hospital HIV, Malaria Reproductive Health Uganda Reproductive health, Maternal health, HIV management, Star SW HIV Community Connector Nutrition Kanungu UNFPA Family planning ACLAIM Nutrition 77

82 Star SW HIV UNICEF Nutrition Bushenyi Health Child Uganda Maternal health Star SW HIV and TB UNICEF Nutrition TASO HIV/AIDS Uganda Sanitation Fund Sanitation Sheema UNICEF Immunization Star sw HIV Marie stopes Family planning TASO HIV/AIDS Reproductive Health Uganda Reproductive health, Maternal health, HIV management Church Of Uganda tuberculosis and HIV UNHCO ICOB HIV Mbarara Health child Maternal health TASO HIV testing and counseling Uganda Sanitation Fund sanitation Coin Uganda ICOB HIV Reproductive Health Uganda Reproductive health, Maternal health, HIV management Isingiro UNHCR Child health Mayanja Memorial Hospital HIV, Malaria PACE ICCM Church Of Uganda tuberculosis and HIV Aids Information Centre HIV/AIDS Medical Teams Association Star Sw HIV ICOB HIV Rukungiri AMREF Saving lives at birth PACE HIV Star sw HIV Agape RUGADA Capacity building MCSP RODNET kiruhura UNICEF ICCM Star SW HIV and tuberculosis African Evangelism Enterprise malaria, tuberculosis and HIV 78

83 Ibanda Star SW HIV and tuberculosis community connector Mayanja Memorial HIV, Malaria African Evangelical malaria, tuberculosis and HIV Enterprise(COU) Western Hoima Malaria Consortium Malaria World Vision Immunization Care Uganda HIV Reproductive Health Uganda Reproductive health, Maternal health, HIV management Infectious Disease Institute Safe deliveries Kyegegwa UNICEF HIV Baylor Uganda Immunization Church of Uganda HIV Kabarole Baylor Uganda HIV International Development Initiative Reproductive Health Uganda Reproductive health, Maternal health, HIV management PACE Malaria Church Of Uganda Malaria, tuberculosis and HIV Community based ARV DOTS HIV/AIDS project Kibaale World Vision HIV Malaria Consortium Malaria Save Foundation Infectious Disease Institute Safe deliveries Uganda Rural Development Program EMESCO Kyenjojo Baylor Uganda HIV Strides Family planning UNICEF Child health program Samaritan Purse Sanitation and hygiene NGO Forum Capacity building PACE Malaria Marie Stopes Maternal health Kind Uganda Malaria Consortium Malaria Church Of Uganda tuberculosis and HIV 79

84 Bundibugyo Ntoroko Rubirizi Kamwenge NGO-CBO Baylor Uganda World Vision Save The Children PACE World Health Organization Belgian Technical Cooperation UNICEF Baylor Uganda UNICEF Save The Children Save Foundation Ride Africa Rwebisengo Post Test Association Karugutu people living with HIV/AIDS Health Child Uganda Church Of Uganda Mayanja Memorial Hospital COVOID World Vision Strides Mild May UNICEF Carter Centre PACE HIV Child survival Maternal/child health HIV Reproductive health and family planning and nutrition Capacity Buliding Immunization, Nutrition HIV Family health days and immunization Mother child health HIV/AIDS Maternal health TB HIV, Malaria Capacity building for VHTs Capacity building Capacity building Immunization, Nutrition Malaria Kasese UNICEF Immunization, Nutrition North Kaberamaido Pilgrim Africa Malaria, Baylor Uganda TB, HIV/AIDS PACE Malaria Oyam Communication For Development Foundation Uganda Uganda Health Marketing Group Family Health International Reproductive health Condom distribution Reproductive health and family planning 80

85 Nu-Hites HIV/AIDS and community mobilisation Marie Stopes Family planning World Vision Nutrition Transparency International Global Refugee International HIV Plan Uganda Malaria UNHCO GHN THETA Kole Nu-Hites Safe male circumcision, immunization, malaria Crane Health Services HIV, Malaria and TB World Vision HIV/AIDS, Sanitation, immunization, family planning UNICEF Immunization ABT associates Alebtong Plan Uganda Malaria Nu-Hites Malaria, TB, HIV Divine Waters Uganda PACE Malaria Dokolo Uganda Health Marketing Group Malaria Crane Health Services NTDs Nu-hites Malaria, TB, HIV PACE Malaria Uganda sanitation fund Sanitation and hygiene Community connector Nutrition ABT associates Apac Nu-Hites Malaria, TB, HIV LICODA HIV/ Family planning Lira Plan Uganda Adolescent Nu-Hites HIV, Malaria and TB Marie Stopes Reproductive health TASO HIV/AIDS PACE Malaria Reproductive Health Uganda Reproductive health, Maternal health, HIV management Otuke Crane Health Services Malaria, TB, HIV UNICEF Immunization Marie Stopes Reproductive health Amolatar 81

86 Agago CEPA JCRC Lango Samaritan Initiative Nuhites AVSI PACE HIV HIV/AIDS Malaria, TB, HIV ICCM ICCM Kitgum AVSI ICCM International Rescue Committee PMTCT Nuhites Malaria, TB, HIV UNICEF Child fund Maternal health AMREF Malaria and HIV World Vision Nutrition Pader AVSI ICCM SAVE The Children ICCM Nuhites Malaria, TB, HIV Carter Centre AMREF Malaria and HIV Lamwo International Rescue Committee ICCM AVSI ICCM KAMPALA Gomba Malaria Consortium Malaria Mild May HIV/AIDS Uganda health marketing group Family planning Bulisa Infectious Disease Institute HIV/AIDS Malaria Consortium ICCMs World Vision Reproductive health, nutrition and sanitation Masindi Malaria Consortium Malaria, diarrhea, Pneumonia SCIPHA HIV/AIDS TASO HIV/AIDS International Health Net Work Sight Savers CEDO Mubende World Vision Water and sanitation PACE Reproductive health UNFPA Reproductive health PATH Family planning SNV UNICEF Nutrition 82

87 Mild may HIV/AIDS Mityana FHI 360 Reproductive health SCIPHA HIV/AIDS Marie Stopes Reproductive health Mild May HIV/AIDS Strides Nutrition, child health Uganda Health Marketing Group Reproductive health Reproductive Health Uganda Reproductive health, Maternal health, HIV management Kiryandongo Child Fund Water/sanitation Action Against Hunger Nutrition International Rescue Committee Water and sanitation, reproductive health UNICEF Nutrition PACE HIV/AIDS Butambala Malaria Consortium Malaria prevention Mild May HIV/AIDS World Vision Nutrition Wakiso UNICEF Total funding Malaria consortium implementation Mild may HIV/AIDS AMREF Circumcision PACE Malaria Mpigi PACE Malaria Malaria Consortium ICCM Strides Reproductive health World vision Nutrition Mild May HIV/AIDS SCIPHA HIV/AIDS STOP MALARIA Malaria control WEST NILE Gulu Nu-hites Malaria, TB, HIV AVSI ICCM AMREF World vision Nutrition Nwoya AVSI ICCM PACE Malaria Amuru AVSI ICCM World Vision MCH 83

88 Nuhites Health facility based VHT meeting Koboko UNHCR Supports refugee VHTs Yumbe UNFPA Reproductive health Adjumani Baylor Uganda Nutrition assessment - Immunization Moyo New Life - Zombo Baylor Uganda HIV/AIDS Nebbi Baylor Uganda HIV/AIDS RTI Arua UNICEF Nutrition PREFA HIV/AIDS Baylor HIV/AIDS Care International Refugee settlement Concern Nutrition Maracha Baylor Uganda HIV/AIDS SNV(WASH) RICE(Agriculture) Nutrition CENTRAL 1 Rakai World Vision Nutrition Kalangala Strides Reproductive health Kalangala Comprehensive Health Malaria Service Masaka Uganda Cares HIV PREFA PMTCT Mild May HIV Red cross Reproductive health Kalungu Malaria Consortium All VHT activities TASO HIV/AIDS Mild may HIV Uganda cares HIV Lwengo PACE Malaria CDC TASO HIV/AIDS Malaria consortium Supply of drugs 84

89 Bukomanasimbi PACE Malaria Malaria Consortium Malaria Mild May HIV/AIDS Uganda Cares HIV Villa Maria Karitas MADDO Ssembabule - - Lyantonde PACE Malaria Mild may HIV/AIDS Care Uganda HIV 85

90 Appendix 7.4: List of Partners Interviewed at District Level District Arua Adjumani Bududa. Bukedea Bulambuli Bundibugyo Hoima Kibaale Ntoroko Rubiriizi Kaliro Oyam Kitgum Kumi Kyegegwa Maracha Masaka Mbale Mbarara Mityana Moyo Dokolo Kiryandongo Kamuli Butaleja Gomba Abim Amudat Amuria Kaabong Partner Baylor Baylor PONT (PERTENERSHIP OVERSEAS NETWORK TRUST Baylor PACE Save the Children International World Vision Infectious Diseases Institute RIDE AFRICA Health Child Uganda Envision World Vision Uganda AVSI Baylor Uganda Humura Archdeaconry, Church Of Uganda Baylor Uganda Cares Malaria Consortium Healthy Child Uganda Reproductive Health Uganda (RHU) Mityana Office Baylor NU-HITES Child Fund PLAN Uganda Mazimasa Community Development Association (Implementing for Child Fund) Gomba Aids Support and Counseling Organization {GASCO} Community action for Health (CAFH) Friends of Christ Revival Ministry (FOCREV) Partners for Children World Wide CUAAM (INGO) 86

91 Katakwi Kotido Moroto Nakapiripirit Napak Kibuku BUSIA Kiboga Luwero Palisa Nakaseke Nakasongola Kaberamaido Lira Buyende Budaka Kibuku Namutumba Sheema Mpigi Kabale Ntungamo Mubende Alebtong Sironko Soroti Kamwenge Kabarole Kapchorwa Serere Manafa LWF (Lutheran World Federation) International Rescue Commission (INGO) UNICEF Moroto Doctors With Africa- CUAAM (INGO) International rescue committee (IRC) Kagum Development Organization (KADO) World Vision Uganda World Vision Plan Uganda Maternal and Neonatal Implementation for Equitable Systems Busoga Trust World Vision Baylor Uganda Marie Stopes STAR EC Child Fund (Kadenge Children s Project) Kadama Widows Association USAID SPRING ICOBI (Integrated Community Based Initiatives) Mild May AMREF Uganda Red Cross Society PACE (Programme For Accessible Health Communication And Education) Plan International Buyobo Community Development Association World Vision World Vision Baylor Kapchorwa Integrated Community Baylor Uganda TASO 87

92 Appendix 7.5: Ministry of Health Key Informant Interviews 1. Director General 2. Assistant commissioner, Health Promotion and Education 3. Assistant commissioner, Community Health 4. Assistant Commissioner, Reproductive Health 5. VHT Coordinator 6. Director, Clinical and Community Health 88

93 Appendix 7.6: VHT Questionnaire General information 1. Date of interview (dd/mm/yyyy) 2. District 3. Sub-county 4. Parish 5. Village 6. Name of interviewer & contact 7. Name of the VHT member and contact 8. Age 9. Sex 1) Male 2) Female 10. Highest level of education attained (including M M vocational skills) 1)P.7 2) 0-Level 3) A-level 4)Tertiary 5)University 1. Marital status 1)Single 2)Married 3)Divorced 4)Widowed 2. Occupation (other than VHT work) 1)Farmer 2)Business 3)Employed by Govt 4)Employed by NGO 5)Student 6)Other specify 3. Name and level of Health facility the VHT is attached to 4. How were you selected to become a VHT member? 5. Have you been trained as a VHT member? 6. When were you trained as a VHT member? 7. How many times have you received training? 8. How long was the training? 9. Who conducted the training? 10. What was covered in the training 1)Disease prevention 2)Community mapping 3)Community registers 4)Home visits 5)Community mobilisation 6)Health education 7)Referrals 89

94 8) Others (specify) 11. How was the training done 1)Brain storming 2)Group discussions on specific issues 3)Role plays 4)Games 5)Field visits 6)Sharing experiences 7)Practicing what has been learned 8)Refresher sessions after training to strengthen weaknesses found during supervision 12. How long have you served as a VHT member? 1) 6 months to 1 year 2) 1 year to 2 years 3) 2-5 year 4) More than 5 years (specify) 13. What has kept you active? 14. What were your expectations as a VHT member? 15. Have the above expectations been met? 16. If no, suggest areas of improvement 17. What are your roles as a VHT member? 1) Mobilize the community for health action 2) Promote health to prevent disease 3) Treat simple illness at home 4) Checks for danger signs in the community 90

95 5) Report and refers community sickness to health workers 6) Keep village records up to date 7) Others specify 18. What activities have you done as a VHT member? 1) Disease prevention 2) Community mapping 3) Community registers 4) Home visits 5) Community mobilisation 6) Health education 7) Referrals 8) Treat simple illness at home 9) Checks for danger signs in the community Others (specify) 19. How many other VHT members are in your Village 20. In how many village(s) do you work? 21. Have you received any additional training following the basic training? YES/NO If yes, specify.. 1) 2)No Specify 22. Have you been supervised in the last 6 months? 1) 2)No If yes, by who? Specify. 23. What support did you get from your supervisor? 1) Observation of service delivery (use of Job Aids, RDT 2) Coaching and skill development 3) Hygienic practice 4) Trouble shooting (this is technical advice) 5) Problem solving (non technical) 6) Home visit 7) Record review (Register, stock cards) 8) Supply check (Medicines, ) Others (specify) 24. During your activities, have you ever received any 1) 2)No assistance from the Local Council? 25. If yes, which assistance? 1) Inform communites about 91

96 VHT 2) Advocacy for health at home 3) Mobilize communities for health 4) Supervision of VHT activities 5) Give financial support 6) Planning for VHT in district and village health plans 7) Attend and support health events 8) Others (specify) 26. Do you have the supplies and equipment you need to provide the services you are expected to deliver? 27. If yes which supplies and equipments do you have? (Please verify) 1) 2) No 3) Some 1) Condoms 2) Register 3) Report book 4) Badges, t-shirts, bags 5) Job Aids (flip charts, counselling cards, VHT manual, etc.) 6) IEC materials 7) Identity cards 8) Bicycle 9) Others (specify).. ADDITIONAL Amoxacilin Coartem ORS Zinc Lectoatersunate RDT kit Gloves Respiratory timers Mobile phones Solar chargers Wrist watch Tippy tap materials 28. How do you keep the supplies/medicines? 1. Wooden box 2. Plastic bag 3. Others (please specify) 29. What additional logistical support have you received 92

97 as a VHT member to facilitate your activities? 30. Who provided these supplies/equipment/medicines? Specify 31. In the last six months, have you participated in a VHT 1) review meeting? 2) No 32. Have you ever had a meeting/dialogue with the 1) community to give you feed back on your services? 2) No 33. If yes, who participated in the feed back meeting? 1) LC 1 2) Parish leaders 3) Health workers 4) Community members 5) Partners How does your community support you in work as a VHT? (please tick appropriately) Referral of patients 35. What do you do when you get clients who need health services that you can not provide? For example 1) Feed back 2) Support (financial or gifts in kind) 3) Guidance on your work 4) Formal recognition/ appreciation 5) Others (specify) 1) Referral 2) Others (specify) 36. If the answer above is referral how do you refer? 1) Fill out form 2) Write in the book 3) Other (specify) Do you have referral forms? If yes, verify availability of referral forms 1) 2) no 38. If yes, are they Ministry of Health referral forms? 1) 2) No 39. In the last one month did you refer any client to the 1) health facility? 2) No 40. If yes, where was the client referred? 1) Government health facility 2) Private health facility 3) Others (specify). 41. Did you follow up any of the referred clients? 1) 2) No 42. What category of clients did you follow up? 1) pregnant women 2) post natal mothers 3) clients on long term treatment 93

98 43. What challenges do you face during referral? (Health facility related) 4) new borne 5) Under fives 6) others (specify). 44. What challenges do you face during referral? (Client related) 45. Do you have a VHT/ICCM register? 1) 2) No 46. What do you record in the register? (please verify) How do you use the information you collect? Where do you submit your monthly and quarterly.. reports? Are these reports shared with the community? 1) 2) No 50. If yes in which ways do you share the reports If no, why? 52. What challenges do you find in the course of your work? 53. How do you think these challenges can be rectified? THANK YOU VERY MUCH FOR PARTICIPATING IN THIS INTERVIEW. 94

99 Appendix 7.7: Questionnaire for Ministry of Health Officials 1. DEMONSTRATION OF MOH COMMITMENT TO IMPLEMENT VHT STRATEGY Does the Ministry have a budget line to implement the VHT strategy? In the last two quarters what has the Ministry done with VHT allocation? What plans are in place for resource mobilisation for VHT strategy? What advocacy activities have been carried out to promote the roll out of the VHT strategy? (Influence policy, resource allocation, integration etc) What are the supervision mechanisms in place? What Quality control measures are in place and how is it done? 2. COORDINATION How are the VHT activities coordinated from national to community level? Are there any reports on coordination in the last two quarters? Who is the focal person for VHTs at the Ministry? What is the linkage between MOH and the districts in coordinating VHT interventions? Does VHT working group exist? If yes, explain its functionality. How can the coordination be strengthened? How does MOH work with other partners in supporting VHTs 3. POLICY FRAME WORK What policies and guidelines are in place to guide the VHT implementation? Are they available? Has there been any review of policies and guidelines to meet new challenges and innovations? Have policies and guidelines been disseminated to districts and partners? 4. SUSTAINABILITY What mechanisms are in place to ensure continuity of established VHTs? - How often are the VHT kits, tools, registers, T-shirts replenished? - Are there planned refresher courses for VHTs? If yes, verify. How has the Ministry utilized lessons and best practices learnt from other countries and other partners? 5. MOTIVATION Are there guidelines that define standard package for VHT motivation? Are these guidelines being adhered to by partners? What needs to be improved /harmonized to increase the morale of the VHTs to serve their community's health needs? 6. DATABASE ON VHTS Does the MOH have a data base for VHTs? If no, what are the plans for establishing the database? If yes, when was it last updated? Is the existing database adequate? 95

100 What plans do you have to improve/update the database? 7. CHALLENGES What challenges have you encountered in implementing the VHT strategy? (consider political, Technology, economics, social, legal, environment) What are the possible solutions to overcome these challenges? 8. RECOMMENDATIONS Suggest ways of improving the VHT implementation framework? What suggestions do have for improvement of VHT functionality? What suggestions do you have for sustainability of VHTs functionality? 96

101 Appendix 7.8: Partner Interview Guide General information Name of Organisation Name of respondent Position of respondent Phone number of respondent Name of interviewer 1. What activities does this organization do? When did you start supporting VHTs in Uganda? How have you been supporting VHTs in Uganda? a) Strengthening the national capacity to provide quality VHT strategy implementation b) Providing technical advice c) Funding for core activities d) Drugs and other supplies and logistics e) Advocacy f) Training VHTs g) Others (specify) 4. If funding, how much funds have you so far spent in regard to VHT support? How do you know how your resources have been utilized? How are you involved in the planning and evaluation processes? Has this organization been involved in training of VHTs? a) b) No 8. In which districts has this organisation carried out the training?... 97

102 9. What areas did you train on? a) Provide appropriate information about disease prevention and health promotion Correctly classify simple illnesses and give simple treatment b) Referring cases they cannot manage c) Referring cases with danger signs or complications d) Maintaining simple, village register and reporting e) Recognizing community members in need of rehabilitation and refer them to the appropriate services f) Skills such as direct observation of therapy or community case management (Fever, pneumonia,malnutrition g) Others (Specify). 10. What methods did you use to train the VHTs? a) Brain storming b) Group discussions on specific issues c) Role-plays d) Games e) Field visits f) Sharing of experiences. g) Practicing what has been learned h) Refresher sessions after training to strengthen weaknesses found during supervision i) Additional topics according to new developments or health needs of the community. j) Others (Specify) 11. How many trainings has this organization so far offered? What challenges do you think face VHT implementation in Uganda? 13. What do you think can be done to improve VHT operations? 98

103 Appendix 7.9: Health Centre Interview Guide General information District... Subcounty. Parish Village Name of health centre Name of respondent Position of respondent Phone number of respondent Name of interviewer 1. How long have you been working here?...years 2. How many villages does this health centre cover? How many households does this health centre cover? How many VHTs operate under this health centre? What are the functions of VHTs a) Community Information management, b) Health Promotion and Education c) Mobilization of communities for utilization of health services and health action d) Simple community case management and follow up of major killer diseases (Malaria, Diarrhoea, Pneumonia) and emergencies e) Care of the newborn f) Distribution of health commodities 6. What diseases do the VHTs treat in the communities? 1) Malaria 2) Diarrhea, 3)Pneumonia, 4)Malnutrition 7. Do VHTs usually refer community members to this health centre? 1) 2) No. 8. Under what circumstances do the VHTs refer community members to a health centre? a) ALL Pregnant women, newborns or children or other person with danger signs including red on the MUAC strap. b) Anyone with sudden recent loss of visual acuity, or a painful red eye or recent inability to close the eye c) Accidents or injuries. d) ALL conditions without danger signs for which the VHT has not received specific training, or if the VHT does not have the necessary medications e) Routine outpatient or outreach referrals for Immunisation, Antenatal Care, Post natal care (Mother and Infant) f) Referral of children >6months with mid arm circumference (MUAC) yellow. g) All conditions which require rehabilitation e.g after injury, patients with leprosy. h) Others (specify) What roles do VHTs play at this health centre? a) VHTs refer patients to HC II/III/IV. b) VHTs follow-up patients discharged from the health centres. 99

104 c) VHT members can serve as health management committee of Health Centre II. d) VHTs assist at clinics and outreach 10. How does this health facility help VHTs to perform their duties? a) The VHT benefit from the training facilities of HCII/III/IV b) The VHT receives training, support and supervision from Health Centres. c) Commodities e.g kits for use at community level are stored d) Supervision of the VHTs 11. What constraints do you think face VHT operations in communities around this health centre? How do you think VHT operations can be improved?

105 Appendix 7.10: Community Interview Guide General information District... Subcounty. Parish Village 1. How many households are in this village? 2. How many VHT members do you have in this village? 3. How were VHTs formed in this community (Guiding principles)? 4. What is the composition of the VHTs as regards to gender (how many men vs women) 5. Do you know the functions of VHTs? 6. What are they? 7. What diseases do VHTs usually work treat? 8. How do VHTs relate to LCs (what activities do they do together, how do LCs help VHTs to do their work?) 9. How do VHTs relate to health centres (what activities do they do together, how do health centres help VHTs to do their work?) 10. How do VHTs relate to households and communities (what activities do they do together, how do households and the communities help VHTs to do their work?) 11. Who monitors VHTs in this community? How is monitoring done? 12. Have you benefited from the existence of VHTs in this community? How? 13. How do you think VHTs can be improved to perform better? 101

106 Appendix 7.11: District Key Informant Guide (LCV Chairman, CAO, RDC) Name of the Key informant Title of the key informant Contact of the key informant What do you know about VHT? 2. Is there any mobilisation of district leadership about VHT program? 3. How is the district supporting VHT activities? 4. Do you sometimes supervise VHT activities? How? 5. What does the district do to motivate VHTs? 6. What do you feel about the contribution of VHTs in promoting health services 7. What challenges does the district find in implementing the VHT program? 8. Suggestions to improve the VHT program 102

107 8.0 References Ministry of Health (MOH) Uganda 2009a, Operational guidelines for establishment and scale up of village health teams. Ministry of Health (MOH) Uganda 2009b, Situation Analysis, Village Health Teams Uganda Ministry of Health (MOH) Uganda, Village Health Team, Facilitator`s Guide for Training Village Health Teams. Ministry of Health (MOH) Uganda, Village Health Team, Guide for Training the Training of Village Health Teams. World Vision Uganda 2014, Improving Maternal New born and Child Health through Village Health Teams in Uganda. A VHT AIM Functionality Assessment Report. Health Sector Strategic Plan 2000/ /05, Ministry of Health. Health Sector Strategic Plan 2005/ /10, Ministry of Health. 103

108 9.0 District-Level Analysis See the following report for analysis of each district s VHT. 104

109 MINISTRY OF HEALTH NATIONAL VILLAGE HEALTH TEAMS (VHT) ASSESSMENT IN UGANDA District-Level Analysis MARCH

110 CONTENTS CONTENTS District: ABIM District: ADJUMANI District: AGAGO District: ALEBTONG District: AMOLATAR District: AMUDAT District: AMURIA District: AMURU District: APAC District: ARUA District: BUDUDA District: BUDAKA District: BUGIRI District: BUHWEJU District: BUIKWE District: BUKEDEA District: BUKOMANSIMBI District: BUKWO District: BULAMBULI District: BULIISA District: BUNDIBUGYO District: BUSHENYI District: BUSIA District: BUTALEJA District: BUTAMBALA District: BUVUMA District: BUYENDE District: DOKOLO District: GOMBA District: GULU District: HOIMA District: IBANDA District: IGANGA District: Isingiro District: JINJA District: KAABONG District: KABALE District: KABAROLE District: Kaberamaido District: Kalangala District: KALIRO District: KALUNGU District: KAMPALA

111 District: KAMULI District: Kamwenge District: KANUNGU District: Kapchorwa District: KASESE District: Katakwi District: KAYUNGA District: KIBAALE District: KIBOGA District: KIBUKU District: KIRUHURA District: KIRYANDONGO District: KISORO District: KITGUM District: KOBOKO District: KOLE District: KOTIDO District: KUMI District: KWEEN District: Kyakwanzi District: Kyegegwa District: Kyenjojo District: LAMWO District: LIRA District: LUUKA District: LUWERO District: LWENGO District: LYANTONDE District: MANAFWA District: MARACHA District: MASAKA District: MASINDI District: MAYUGE District: MBALE District: Mbarara District: MITOOMA District: MITYANA District: MOROTO District: MOYO District: MPIGI District: MUBENDE District: MUKONO District: NAKAPIRIPIRIT District: NAKASEKE District: NAKASONGOLA District: NAMAYINGO District: NAMUTUMBA District: Napak

112 District: NEBBI District: NGORA District: NTOROKO District: NTUNGAMO District: NWOYA District: OTUKE District: OYAM District: PADER District: PALIISA District: RAKAI District: Rubirizi District: RUKUNGIRI District: SEMBABULE District: SERERE District: SHEEMA District: SIRONKO District: SOROTI District: TORORO District: WAKISO District: YUMBE District: ZOMBO

113 Summary This report summarizes the analysis by district. The assessment summarized the district data considering the following variables: 1. District demographics 2. Training of trainers (TOTs) 3. VHT training 4. Refresher training 5. Coordination, supervision and feedback 6. Functions/roles of VHTs 7. Partners supporting VHT activities 8. Support to VHTs by partners 9. Challenges faced in implementation of VHT programme 109

114 District: ABIM Status of VHT Implementation Number of sub-counties 6 Number of parishes 35 Number of villages 309 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 35 Number of villages with trained VHTs 309 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 40 How many are still in the district 40 How many are still active 40 Organization that conducted TOTs MOH, UNICEF VHT training Number of VHTs with basic training 718 Number of VHTs without basic training 0 Number of active VHTs 718 Number of VHTs that has dropped 0 Duration of basic training 6 Organization that funded the training UNICEF 110

115 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF, World vision, Baylor Uganda, Marie Stopes Content of the refresher training Malaria, HIV/AIDS, diarrhoea, family planning, Nutrition Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Mobilization of the community for health activities, ICCM Programs and nutrition project. What partners support VHT activities in the district? UNICEF, Community Action for Health, World Vision, Baylor Uganda Support to VHTs by partners Capacity building e.g. training Logistical supplies Funding e.g. transport allowance, meals, training Time and targeted counselling of mothers Technical advice Drug supplies Challenges faced in the implementation of VHT programme Lack of funds Voluntarism is killing their morale 111

116 District: ADJUMANI Status of VHT Implementation Number of sub-counties 10 Number of parishes 54 Number of villages 206 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 54 Number of villages with trained VHTs 206 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 5 How many are still active 5 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 826 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - 112

117 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs Community mobilization, Referrals, Home Visits, Health Education, Immunization, Routine outpatient or outreach referrals What partners support VHT activities in the district? Baylor Uganda Support to VHTs by partners Funding e.g. transport allowance, meals, training Provision of monthly bicycle repair allowance VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in the implementation of VHT programme Inadequate monitoring Inadequate means of transport Inadequate knowledge and skills Lack of proper coordination between the VHTs and the DHTs Inadequate supplies 113

118 District: AGAGO Status of VHT Implementation Number of sub-counties 16 Number of parishes 78 Number of villages 912 Number of sub-counties with trained VHTs 16 Number of parishes with trained VHTs 78 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 8 How many are still in the district 5 How many are still active 5 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 1969 Number of VHTs without basic training - Number of active VHTs 1337 Number of VHTs that has dropped 632 Duration of basic training 7 Organization that funded the training MOH, UNICEF 114

119 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Ministry of health Content of the refresher training Malaria, pneumonia, sanitation Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Health education, Immunization, Community Mobilization, Referrals What partners support VHT activities in the district? PACE, AVSI Challenges faced in the implementation of VHT programme Inadequate funding No transport refund for the DHI Reporting tools are lacking Some VHTs are inactive due to lack of motivation No transport means for VHTs 115

120 District: ALEBTONG Status of VHT Implementation Number of sub-counties 10 Number of parishes 45 Number of villages 605 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 45 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs - TOT Training TOT Training Has TOT training been carried out NO How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 1210 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - 116

121 Refresher training Has there been any refresher training in the district NO Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities NO Functions of VHTs Referrals, Home Visits, Community mobilization What partners support VHT activities in the district? Plan Uganda, PACE, divine waters Uganda Support to VHTs by partners Capacity building e.g. training, Funding e.g. transport allowance, meals, training Challenges faced in the implementation of VHT programme Lack of funding The issues of VHTs working with partners they demand a lot High dropout rate There is no proper coordination among VHTs The new villages are not in our data and there are no VHTs for those villages 117

122 District: AMOLATAR Status of VHT Implementation Number of sub-counties 11 Number of parishes 58 Number of villages 435 Number of sub-counties with trained VHTs 11 Number of parishes with trained VHTs 58 Number of villages with trained VHTs 435 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out NO How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 820 Number of VHTs without basic training 50 Number of active VHTs 870 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training Nuhites Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - 118

123 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Referrals, Community Mobilization, Community Sensitization, Home Visits, Administering of NTDs drugs What partners support VHT activities in the district? Nuhites, Lango Samaritan Initiative Organization Challenges faced in the implementation of VHT programme Inadequate funding for VHT activities Inadequate training for VHTs because 5days are not enough for that basic training Selection criteria is a challenge because community leaders put their relatives expecting to gain Lack of motivation No follow up supervision for VHTs 119

124 District: AMUDAT Status of VHT Implementation Number of sub-counties 4 Number of parishes 12 Number of villages 122 Number of sub-counties with trained VHTs 4 Number of parishes with trained VHTs 12 Number of villages with trained VHTs 122 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 40 How many are still in the district 35 How many are still active 35 Organization that conducted TOTs International Red Cross VHT training Number of VHTs with basic training 244 Number of VHTs without basic training 0 Number of active VHTs 237 Number of VHTs that has dropped 7 Duration of basic training 5 Organization that funded the training International Red Cross 120

125 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF, MOH Content of the refresher training ICCM, drug management, reporting Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Mobilization, treatment of simple illnesses, drug distribution, treatment of malaria What partners support VHT activities in the district? Vision care, UNICEF, FOREF, CAUMM Support to VHTs by partners Providing technical advice Funding for core activities Drugs and other supplies and logistics Challenges faced in the implementation of VHT programme Delay in supplies Inadequate funds Illiteracy of the VHTs Transport is a problem Mobilize community 121

126 District: AMURIA Status of VHT Implementation Number of sub-counties 16 Number of parishes 98 Number of villages 605 Number of sub-counties with trained VHTs 2 Number of parishes with trained VHTs 12 Number of villages with trained VHTs 40 % of sub-counties covered by VHTs 13 % of parishes covered by VHTs 12 % of villages covered by VHTs 7 TOT Training Has TOT training been carried out How many TOTs were trained 30 How many are still in the district 30 How many are still active 30 Organization that conducted TOTs MOH, World vision VHT training Number of VHTs with basic training 80 Number of VHTs without basic training 3550 Number of active VHTs 3630 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training World vision 122

127 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Mobilization for pregnant mothers, Mobilization for immunization, health education of the community, referrals What partners support VHT activities in the district? World vision Support to VHTs by partners Funding e.g. transport allowance, meals, training, etc. Technical advice Drugs, other supplies and logistics Advocacy Challenges faced in the implementation of VHT programme No meetings, Lack of funds, Illiteracy, No reporting tools, little motivation No refresher trainings &quarterly meetings Community looks down upon the VHT 123

128 District: AMURU Status of VHT Implementation Number of sub-counties 5 Number of parishes 32 Number of villages 67 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 32 Number of villages with trained VHTs 67 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 3 How many are still active 3 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 720 Number of VHTs without basic training - Number of active VHTs 420 Number of VHTs that has dropped 300 Duration of basic training 10 Organization that funded the training World health organization, UNICEF, church of Uganda, 124

129 Refresher training Has there been any refresher training in the district Organization that supported the refresher training World vision, AMREF, AVSI Content of the refresher training ICCM, Adolescent sexual and reproductive health, family planning, sanitation and VHT strategy 2010 Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs All pregnant women, new-borns or other persons with danger signs, Community mobilization, Community Sensitization, Health Education, Administering of NTDs drugs, Routine outpatient or outreach referrals What partners support VHT activities in the district? AVSI, World Vision, Nuhites Support to VHTs by partners Capacity building e.g. training Drugs, other supplies and logistics, Funding e.g. transport allowance, meals, training Challenges faced in the implementation of VHT programme Few VHTs in some areas Partners are supporting very limited number of VHTs No few registers Transport for supervisors Conflicting policy statements like households versus 2 VHTs per village 125

130 District: APAC Status of VHT Implementation Number of sub-counties 9 Number of parishes 64 Number of villages 715 Number of sub-counties with trained VHTs 9 Number of parishes with trained VHTs 64 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 9 How many are still in the district 9 How many are still active 9 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 2860 Number of VHTs without basic training 640 Number of active VHTs 1900 Number of VHTs that has dropped 1600 Duration of basic training - Organization that funded the training - 126

131 Refresher training Has there been any refresher training in the district Organization that supported the refresher training NUMAT, UNICEF Content of the refresher training Malaria, diarrhoea Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Immunization, Referrals, Administering of NTDs drugs, Home Visits, Community Mobilization What partners support VHT activities in the district? Nuhites, LICODA Challenges faced in the implementation of VHT programme Low budget allocation for VHTs Some VHTs are not trained so it affects the quality of work Some VHTs are not willing to volunteer Health workers do not want to involve the VHTs in some of the activities because they are so demanding Some leaders do not recognise VHTs work The LCs do not support VHTs yet VHTs are members of their community 127

132 District: ARUA Status of VHT Implementation Number of sub-counties 28 Number of parishes 169 Number of villages 1382 Number of sub-counties with trained VHTs 28 Number of parishes with trained VHTs 169 Number of villages with trained VHTs 1382 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 31 How many are still in the district 27 How many are still active 27 Organization that conducted TOTs MTI, UNICEF, CHC VHT training Number of VHTs with basic training - Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training UNICEF Refresher training Has there been any refresher training in the district Organization that supported the refresher training Content of the refresher training MOH, UNICEF, Baylor Uganda, CHC HIV/AIDS, malaria, TB 128

133 Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Community mobilization, Immunization, Referrals, Distribution of NTDs drugs, Home Visits What partners support VHT activities in the district? UNICEF, PREFA, Baylor Uganda, Care international Support to VHTs by partners Logistical supplies, Support supervision, Advocating for VHT supervision from the District Challenges faced in the implementation of VHT programme Lack of financial motivation to the VHTs Conflicting roles when many agencies use them at the same level Poor record keeping by the VHTs due to low level of education In adequate stationary In adequate personal protective equipment for VHTs Some VHTs were demotivated and dropped out 129

134 District: BUDUDA Status of VHT Implementation Number of sub-counties 16 Number of parishes 94 Number of villages 915 Number of sub-counties with trained VHTs 16 Number of parishes with trained VHTs 94 Number of villages with trained VHTs 951 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 400 Number of VHTs without basic training 1502 Number of active VHTs 1902 Number of VHTs that has dropped 00 Duration of basic training 5 Organization that funded the training World health organization 130

135 Refresher training Has there been any refresher training in the district Organization that supported the refresher training PATH, PACE,PONT, SCORE Content of the refresher training Maternal child health, malaria, Malaria, HIV/AIDS, TB, Family planning Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Referrals, Community Mobilization, Home Visits, Health Education What partners support VHT activities in the district? PACE, UMODA, SCORE, DATA Support given to VHTs by partners Capacity building for example training Provision of mobile phones Support supervision Challenges faced in the implementation of VHT programme There is no transport for the deployment of VHTs Only 400 out of 1902 are trained VHTs No motivation for these VHTs No working tools 131

136 District: BUDAKA Status of VHT Implementation Number of sub-counties 13 Number of parishes 59 Number of villages 266 Number of sub-counties with trained VHTs 13 Number of parishes with trained VHTs 59 Number of villages with trained VHTs 266 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 8 How many are still in the district 8 How many are still active 8 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 798 Number of VHTs without basic training 0 Number of active VHTs 796 Number of VHTs that has dropped 2 Duration of basic training 5 Organization that funded the training MOH, TASO 132

137 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Kagum Development Organization, Salvation army, Content of the refresher training Malaria management, TB, HIV/AIDS, family planning Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities yes No Functions of VHTs They refer sick community members to health centre, They also collect data from villages on health programs like latrine coverage, hand washing facilities, They also distribute drugs for Neglected Topical Diseases for elephantiasis and deworming tablets, They also carry out home visiting doing counselling for HIV/AIDS, They carry out immunization with other health workers in case of outreaches What partners support VHT activities in the district? Salvation Army Support to VHTs by partners Award of best performing VHTs, Capacity building e.g. training, Logistical supplies, Provision of mobile phones Challenges faced in the implementation of VHT programme No budget allocated to facilitate VHT activities MOH provided bicycles without readily available spare parts on market A considerable number of VHTs don't have bicycles making their work hard Because VHTs are working voluntarily they cannot be engaged throughout the week 133

138 District: BUGIRI Status of VHT Implementation Number of sub-counties 11 Number of parishes 65 Number of villages 457 Number of sub-counties with trained VHTs 11 Number of parishes with trained VHTs 54 Number of villages with trained VHTs 398 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 83 % of villages covered by VHTs 87 TOT Training Has TOT training been carried out How many TOTs were trained 15 How many are still in the district 15 How many are still active 15 Organization that conducted TOTs Star E, World vision VHT training Number of VHTs with basic training 1990 Number of VHTs without basic training 295 Number of active VHTs 2185 Number of VHTs that has dropped 100 Duration of basic training 5 Organization that funded the training Star E, World vision, Strides 134

139 Refresher training Has there been any refresher training in the district yes Organization that supported the refresher training Star E, Strides, World vision, PACE Content of the refresher training HIV, TB, Malaria, infant and young child feeding, immunization, PMTCT Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Mobilise and sensitise the people during health related events, They help during immunization for instance during polio immunization, they help to weigh children, They conduct health education during special clinic days like postnatal care They collect data and do monthly reports that are submitted at the health centre Conduct hygiene/sanitation and health education in communities Refer patients to the health centre especially those family planning issues, pregnant mothers They help in mobilization of community members especially during immunization, HIV testing outreaches What partners support VHT activities in the district? Star EC, World vision Challenges faced in the implementation of VHT programme VHTs do not have the required tools e.g. reporting tools The district core team lacks capacity to supervise VHTs Inadequate facilitation for VHTs Some selected VHTs are working yet untrained The number of VHTs with transport means (bicycles) is very few 135

140 District: BUHWEJU Status of VHT Implementation Number of sub-counties 8 Number of parishes 37 Number of villages 227 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs 37 Number of villages with trained VHTs 255 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 92 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training - Number of VHTs without basic training 255 Number of active VHTs 255 Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training Health partners Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - 136

141 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs They do community mobilization, They do home visiting and sensitize the communities, They do health education for example in churches. They help me during child days when we are giving vitamin A and albendazole to children under 14 years They do health education Refer clients to us Do treatment of minor infections/sickness What partners support VHT activities in the district? None Challenges faced in the implementation of VHT programme None 137

142 District: BUIKWE Status of VHT Implementation Number of sub-counties 12 Number of parishes 65 Number of villages 483 Number of sub-counties with trained VHTs 12 Number of parishes with trained VHTs 65 Number of villages with trained VHTs 483 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training - Number of VHTs without basic training 1890 Number of active VHTs 924 Number of VHTs that has dropped 966 Duration of basic training - Organization that funded the training - 138

143 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Health education programs are handled at times with their support Perform mobilization of communication for health out reaches Referral 0f the patient they cannot handle during visits and tracking lost clients in the art clinic What partners support VHT activities in the district? World vision, UNICEF Challenges faced in the implementation of VHT programme Inadequate funding Poor transport means No refresher courses No recognition of VHTs 139

144 District: BUKEDEA Status of VHT Implementation Number of sub-counties 6 Number of parishes 71 Number of villages 163 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 71 Number of villages with trained VHTs 163 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 4 How many are still in the district 4 How many are still active 4 Organization that conducted TOTs Star EC, world vision VHT training Number of VHTs with basic training 489 Number of VHTs without basic training 193 Number of active VHTs 652 Number of VHTs that has dropped 30 Duration of basic training 5 Organization that funded the training Malteserational 140

145 Refresher training Has there been any refresher training in the district Organization that supported the refresher training THETA, Baylor Uganda, stop malaria Content of the refresher training Malaria, referrals, HIV/AIDS,PMTCT, TB management Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Community mobilization, Home Visits, Community Sensitization, Reporting to the facility, Referrals, Immunization What partners support VHT activities in the district? AMREF, Baylor Uganda, pilgrims Support to VHTs by partners Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Retention care to VHTs Challenges faced in the implementation of VHT programme Sustainability of VHTs is hard since partners take the lead. Voluntary work is hard, they should be facilitated High turnover of the VHTs hence many trainings which are expensive 141

146 District: BUKOMANSIMBI Status of VHT Implementation Number of sub-counties 5 Number of parishes 25 Number of villages 254 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 25 Number of villages with trained VHTs 254 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 8 How many are still active 5 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 1006 Number of VHTs without basic training 10 Number of active VHTs 1011 Number of VHTs that has dropped 5 Duration of basic training 5 Organization that funded the training Malaria consortium Refresher training Has there been any refresher training in the district Organization that supported the refresher training Malaria consortium Content of the refresher training Roles of VHTs, roles of health worker, identifying danger signs Duration of refresher training (days) 5 142

147 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Administering NTDs, Health Education, Community Mobilization, Home visits What partners support VHT activities in the district? Mild May, Malaria Consortium Challenges faced in the implementation of VHT programme Lack of transport No support from ministry of health Inadequate funding 143

148 District: BUKWO Status of VHT Implementation Number of sub-counties 12 Number of parishes 66 Number of villages 527 Number of sub-counties with trained VHTs 0 Number of parishes with trained VHTs 0 Number of villages with trained VHTs 0 % of sub-counties covered by VHTs 0 % of parishes covered by VHTs 0 % of villages covered by VHTs 0 TOT Training Has TOT training been carried out How many TOTs were trained 2 How many are still in the district 2 How many are still active 2 Organization that conducted TOTs Global fund VHT training Number of VHTs with basic training 0 Number of VHTs without basic training 1054 Number of active VHTs 1054 Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - Refresher training Has there been any refresher training in the district Organization that supported the refresher training PACE, CARITAS, Content of the refresher training HIV, TB Duration of refresher training (days) 2 144

149 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Community mobilization, Immunization, Reporting to the facility, Referrals, Health Education What partners support VHT activities in the district? PACE, CARITAS Challenges faced in the implementation of VHT programme Lack of motivation of these VHTs They have not been trained There is neither supervision nor support supervision being done They have not been empowered and no certificates are given as VHTs Some VHTs did not receive bicycles 145

150 District: BULAMBULI Status of VHT Implementation Number of sub-counties 17 Number of parishes 121 Number of villages 1410 Number of sub-counties with trained VHTs 0 Number of parishes with trained VHTs 0 Number of villages with trained VHTs 0 % of sub-counties covered by VHTs 0 % of parishes covered by VHTs 0 % of villages covered by VHTs 0 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 00 Number of VHTs without basic training 2820 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - Refresher training Has there been any refresher training in the district Organization that supported the refresher training PACE, Salvation army Content of the refresher training Malaria, hygiene, TB, family planning Duration of refresher training (days) 5 146

151 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No yes Functions of VHTs Community mobilization, Community Sensitization, Referrals, Reporting to the facility, Home Visits, Health education What partners support VHT activities in the district? PACE, Salvation Army Challenges faced in the implementation of VHT programme Transport is a problem Lack of motivation and the resources to support the system Lack of VHT register No any basic trainings for VHTs has been done No sub county and parish VHT structures in place 147

152 District: BULIISA Status of VHT Implementation Number of sub-counties 7 Number of parishes 30 Number of villages 125 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 26 Number of villages with trained VHTs 89 % of sub-counties covered by VHTs 71 % of parishes covered by VHTs 87 % of villages covered by VHTs 71 TOT Training Has TOT training been carried out How many TOTs were trained 6 How many are still in the district 3 How many are still active 3 Organization that conducted TOTs Ministry of Health, Malaria consortium VHT training Number of VHTs with basic training 418 Number of VHTs without basic training 0 Number of active VHTs 275 Number of VHTs that has dropped 143 Duration of basic training 6 Organization that funded the training Ministry of Health 148

153 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings - Have any feedback reports been provided to sub-counties in the - last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Administering NTDs drugs, reporting to the facility, Health Education, Home Visits, Community Mobilization, Community Sensitization What partners support VHT activities in the district? Infectious disease institute, malaria consortium, world vision Challenges faced in the implementation of VHT programme LIMITED SUPPORT FROM LEADERS Limited funding to support VHT activities Low literacy level of VHTs Lack tools for reporting Inadequate supervision and feed back High dropout rate of VHTs New villages created after VHT training 149

154 District: BUNDIBUGYO Status of VHT Implementation Number of sub-counties 15 Number of parishes - Number of villages 1274 Number of sub-counties with trained VHTs 15 Number of parishes with trained VHTs - Number of villages with trained VHTs 1274 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs - % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 7 How many are still in the district 6 How many are still active 6 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 2548 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 10 Organization that funded the training UNICEF, BTC Refresher training Has there been any refresher training in the district Organization that supported the refresher training Content of the refresher training HIV, family planning Duration of refresher training (days) 3 150

155 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs Health education, Referrals, Home Visits, Community Mobilization, Immunisation, Administering of NTDs drugs What partners support VHT activities in the district? Baylor Uganda, world vision, UNICEF, World Health Organization Support to VHTs by partners Capacity building e.g. training Logistical supplies Funding e.g. transport allowance, meals, training Challenges faced in the implementation of VHT programme High level of drop out Lack of motivation Not able to read and write Have no reporting tools 151

156 District: BUSHENYI Status of VHT Implementation Number of sub-counties 12 Number of parishes 65 Number of villages 565 Number of sub-counties with trained VHTs 12 Number of parishes with trained VHTs 65 Number of villages with trained VHTs 565 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 38 How many are still in the district 31 How many are still active 31 Organization that conducted TOTs Health child Uganda VHT training Number of VHTs with basic training 1713 Number of VHTs without basic training - Number of active VHTs 1628 Number of VHTs that has dropped 85 Duration of basic training 5 Organization that funded the training Health child Uganda 152

157 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Global fund, health child Uganda Content of the refresher training HIV, Nutrition Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs They do home visits to monitor hygiene and help in child days to give tablets to children Do health education to people Compiling physical tally reports They refer clients and report to us. They give first aid to people before referring them to us They support us in community mobilization especially during immunization What partners support VHT activities in the district? Health child Uganda, Star SW, Challenges faced in implementing the VHT programme Motivation of VHTs to do their work Lack of trainings to get them refreshed No regular supportive supervision due to Lack of funds 153

158 District: BUSIA Status of VHT Implementation Number of sub-counties 16 Number of parishes 60 Number of villages 570 Number of sub-counties with trained VHTs 4 Number of parishes with trained VHTs 16 Number of villages with trained VHTs 137 % of sub-counties covered by VHTs 25 % of parishes covered by VHTs 27 % of villages covered by VHTs 24 TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 11 How many are still active 10 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 460 Number of VHTs without basic training 1250 Number of active VHTs 1590 Number of VHTs that has dropped 120 Duration of basic training 5 Organization that funded the training World vision, Friends of Christ Revival Ministries 154

159 Refresher training Has there been any refresher training in the district Organization that supported the refresher training World vision Content of the refresher training PD health, TTC, Maternal health, CLTS Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No yes Functions of VHTs Mobilise for immunization and outreaches Make referrals to the health centre of children with malnutrition, pregnant mothers and other patients They also do health education in the community circled around hygiene and sanitation and other health They collect primary data for sanitation and hygiene at household level Visit pregnant mothers to detect any danger signs, ANC follow up and reminders What partners support VHT activities in the district? World Vision, Child Fund, FHI 360, Salvation Army Support to VHTs by partners Funding e.g. transport allowance, meals, training Capacity building e.g. training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme Lack of funds to carry out training and support supervision VHTs are not equipped with the necessary tools VHT identification at village level is a problem as they are identified and selected on political ground 155

160 District: BUTALEJA Status of VHT Implementation Number of sub-counties 12 Number of parishes 64 Number of villages 423 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs 67 % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 30 How many are still in the district 20 How many are still active 8 Organization that conducted TOTs Ministry of health, world vision VHT training Number of VHTs with basic training 1000 Number of VHTs without basic training - Number of active VHTs 870 Number of VHTs that has dropped 130 Duration of basic training 10 Organization that funded the training UNICEF, world vision, child fund 156

161 Refresher training Has there been any refresher training in the district Organization that supported the refresher training World vision, salvation army, child fund Content of the refresher training PD health, reproductive health, family planning Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs Referring sick community members to the facility Health education during community gatherings VHTs mobilize for outreach activities and distribute NTD drugs in the community We also use them to alert communities about disease outbreaks for example Marburg What partners support VHT activities in the district? World Vision, Child Fund, Salvation Army Support to VHTs by partners Funding for core activities of VHTs Supplying them with drugs especially deworming tablets Training VHTs in relation to maternal and child health Challenges faced in implementing the VHT programme There is no budget line for the VHT program and is totally dependent on partner support No support supervision of VHTs is carried out at the district level 157

162 District: BUTAMBALA Status of VHT Implementation Number of sub-counties 6 Number of parishes 25 Number of villages 142 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 25 Number of villages with trained VHTs 142 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 5 How many are still in the district 5 How many are still active 5 Organization that conducted TOTs Ministry of Health VHT training Number of VHTs with basic training 640 Number of VHTs without basic training 0 Number of active VHTs 640 Number of VHTs that has dropped - Duration of basic training 6 Organization that funded the training UNICEF, Ministry of health 158

163 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Mild may, malaria consortium Content of the refresher training ICCM, DISEASE SURVIALLENCE, REFFERALS Duration of refresher training (days) 6 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They do referral of under children five years with danger signs and pregnant mothers. They do mobilize community members for health talks and immunization They report any outbreak of diseases to the health facility VHTs encourage pregnant mothers to go for antenatal care and continuously discourage them from going to traditional birth attendants VHTs give counselling services to the youth for example how they can overcome the youthful stage challenges They carry out health education for example personal hygiene and sanitation in a home, boiling drink What partners support VHT activities in the district? Malaria Consortium, Mildmay Challenges faced in implementing the VHT programme Stock out of medicines, Bad weather affects VHTs movement, No transport means Faulty equipment like respiratory timers were given Old VHTs do not want to leave the system 159

164 District: BUVUMA Status of VHT Implementation Number of sub-counties 9 Number of parishes 38 Number of villages 213 Number of sub-counties with trained VHTs 9 Number of parishes with trained VHTs 38 Number of villages with trained VHTs 148 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 69 TOT Training Has TOT training been carried out NO How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - 160

165 VHT training Number of VHTs with basic training 300 Number of VHTs without basic training - Number of active VHTs 300 Number of VHTs that has dropped - Duration of basic training 2 Organization that funded the training PACE Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No - No Functions of VHTs They help in drug distribution especially NTDs, Health Education, Community mobilization, Referrals, Reporting on monthly basis, and Help in following up HIV/AIDs patients and bring ARTs close to them What partners support VHT activities in the district? PACE, MUWRP Challenges faced in implementing the VHT programme Lack of coordination Lack of proper communication system Expensive water transport Inadequate skills and knowledge among VHTs Inadequate motivation of VHTs 161

166 District: BUYENDE Status of VHT Implementation Number of sub-counties 6 Number of parishes 38 Number of villages 340 Number of sub-counties with trained VHTs 4 Number of parishes with trained VHTs 7 Number of villages with trained VHTs 61 % of sub-counties covered by VHTs 67 % of parishes covered by VHTs 18 % of villages covered by VHTs 18 TOT Training Has TOT training been carried out How many TOTs were trained 11 How many are still in the district 11 How many are still active 11 Organization that conducted TOTs Ministry of health, star etc. 162

167 VHT training Number of VHTs with basic training 220 Number of VHTs without basic training 1395 Number of active VHTs 1615 Number of VHTs that has dropped 00 Duration of basic training 5 Organization that funded the training Star EC Refresher training Has there been any refresher training in the district Organization that supported the refresher training Star EC Content of the refresher training TB, HIV, Nutrition, HMIS/Records, Family planning Duration of refresher training (days) 1 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Mobilize community members for outreaches and other health activities Refer sick community members to the health facility as well as pregnant mothers for ANC Fill client medical forms with the general information hence reducing the health worker workload What partners support VHT activities in the district? STAR EC, MANIFEST, Kagum development organization, Community vision Support to VHTs by partners Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Technical advice Challenges faced in implementing the VHT programme Inadequate funding for the VHT program, Do not have transport means to supervise VHTs Biggest number of VHTs is not trained Inadequate incentives to motivate VHTs 163

168 District: DOKOLO Status of VHT Implementation Number of sub-counties 11 Number of parishes 60 Number of villages 479 Number of sub-counties with trained VHTs 7 Number of parishes with trained VHTs 36 Number of villages with trained VHTs 350 % of sub-counties covered by VHTs 64 % of parishes covered by VHTs 60 % of villages covered by VHTs 73 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 700 Number of VHTs without basic training 258 Number of active VHTs 616 Number of VHTs that has dropped 342 Duration of basic training 5 Organization that funded the training UPHOLD Refresher training Has there been any refresher training in the district Organization that supported the refresher training NUMAT Content of the refresher training Malaria Duration of refresher training (days) 2 164

169 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs Community mobilization, Immunization, Administering NTDs drugs, Counselling, Home Visits, Referrals, Health Education What partners support VHT activities in the district? Crane health services, UHMG Support to VHTs by partners Funding e.g. transport allowance, meals, training Provision of refreshments such as soda, tea, etc. during field work Challenges faced in implementing the VHT programme Poor performance due to inadequate training of the VHTs Some activities come with little funding thus the VHTs lack facilitation Transport is a huge problem only 50% of the VHTs received bicycles There is no district budget for VHTs so the work relies on development partners 165

170 District: GOMBA Status of VHT Implementation Number of sub-counties 5 Number of parishes 37 Number of villages - Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 27 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 73 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 8 How many are still active 8 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 1018 Number of VHTs without basic training 00 Number of active VHTs 1018 Number of VHTs that has dropped 00 Duration of basic training 3 Organization that funded the training Ministry of health 166

171 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They provide health education They distribute de worming tablets in the community They do follow up in case there is something the health centre wants to follow up They do maternal and health reproductive counselling They help in mobilizing people in case of any health activity They identify cases that need referral within the community and they immediately send them to the health facility What partners support VHT activities in the district? Malaria Consortium, Mild may Support to VHTs by partners Technical advice, Drugs supplies and logistics, Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme The VHTs are not given salary Transport is a problem since they lack means as bicycles and motor cycles Substandard items given to VHTs such as bicycles No harmony between VHTs and health staff at health centre 167

172 District: GULU Status of VHT Implementation Number of sub-counties 16 Number of parishes 70 Number of villages 290 Number of sub-counties with trained VHTs 14 Number of parishes with trained VHTs 58 Number of villages with trained VHTs 245 % of sub-counties covered by VHTs 88 % of parishes covered by VHTs 83 % of villages covered by VHTs 84 TOT Training Has TOT training been carried out How many TOTs were trained 35 How many are still in the district 33 How many are still active 32 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 1351 Number of VHTs without basic training 210 Number of active VHTs 1550 Number of VHTs that has dropped 11 Duration of basic training 5 Organization that funded the training UNCEF, DIOSCESE OF NORTHERN UGANDA, VSO, AMREF, NUHITES 168

173 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities yes No Functions of VHTs Community mobilization, Routine outpatient or outreach referrals, Administering NTDs drugs, Counselling, Health Education, Reporting to the facility What partners support VHT activities in the district? AVSI Support to VHTs by partners Capacity building e.g. training Drugs, other supplies and logistics, Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme Reporting forms are not supplied regularly, Lack of funds for coordination meetings, Motivation of the VHTs, Funds for basic and refresher trainings, Protective equipment, Inconsistent supply of drugs, Transport for both supervisors and VHTs (bicycles) 169

174 District: HOIMA Status of VHT Implementation Number of sub-counties 16 Number of parishes 62 Number of villages 589 Number of sub-counties with trained VHTs 16 Number of parishes with trained VHTs 62 Number of villages with trained VHTs 589 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 1o How many are still in the district 10 How many are still active 10 Organization that conducted TOTs Malaria consortium VHT training Number of VHTs with basic training 1124 Number of VHTs without basic training 00 Number of active VHTs 1124 Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training Malaria consortium Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - 170

175 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the yes last one year Do you do a regular supportive supervision of the VHT activities - Functions of VHTs Administering NTDs drugs, Health Education, Community Mobilization, Home Visits What partners support VHT activities in the district? Malaria Consortium, World Vision Support to VHTs by partners Capacity building e.g. training in areas of Nutrition and child care Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme Capturing VHT reports is a challenge because it is not regular, Drug stock outs, Lack of constant supervision, Transport challenges, Dropouts due to lack of financial motivation 171

176 District: IBANDA Status of VHT Implementation Number of sub-counties 15 Number of parishes 57 Number of villages 590 Number of sub-counties with trained VHTs 15 Number of parishes with trained VHTs 57 Number of villages with trained VHTs 590 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 15 How many are still in the district 13 How many are still active 13 Organization that conducted TOTs star south west, mayanja memorial VHT training Number of VHTs with basic training 1750 Number of VHTs without basic training 0 Number of active VHTs 1750 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training MOH, ICOBI 172

177 Refresher training Has there been any refresher training in the district Organization that supported the refresher training mayanja memorial, star south west, community Africanor, African evangelical enterprise( COU) Content of the refresher training ROLES OF VHTs, danger signs, TB, HIV, and malaria care skills Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Referrals, Community sensitization, Health education, Mosquito net distribution, Follow up on antenatal mothers, VHTs help on child health days What partners support VHT activities in the district? Community connector, star south west, mayanja memorial, African evangelical enterprise (COU) Challenges faced in implementing the VHT programme Lack of regular meetings Lack of enough report books No medicines to supply at the moment Lack of logistical supplies like bicycles 173

178 District: IGANGA Status of VHT Implementation Number of sub-counties 16 Number of parishes 89 Number of villages 413 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 7 Number of villages with trained VHTs 27 % of sub-counties covered by VHTs 31 % of parishes covered by VHTs 8 % of villages covered by VHTs 7 TOT Training Has TOT training been carried out How many TOTs were trained 5 How many are still in the district 4 How many are still active 3 Organization that conducted TOTs Star EC VHT training Number of VHTs with basic training 715 Number of VHTs without basic training - Number of active VHTs 715 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training Pace, Star EC Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - 174

179 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Mobilization of community members for health concerns like immunization, attending antenatal programs Health education, this has been through encouraging families to at least have an operation pit latrine Home visits Providing information on the existing activities taking place for example disease prevention Sensitize people about health related issues like sanitation and hygiene What partners support VHT activities in the district? PACE, STAR EC Support to VHTs by partners Capacity building e.g. training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme There are no incentives for motivation, Using VHTs who are not trained, No continuous reporting tools like registers, Transport, Low sensitization about VHT responsibilities 175

180 District: Isingiro Status of VHT Implementation Number of sub-counties 17 Number of parishes 93 Number of villages 786 Number of sub-counties with trained VHTs 17 Number of parishes with trained VHTs 69 Number of villages with trained VHTs 550 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 74 % of villages covered by VHTs 70 TOT Training Has TOT training been carried out How many TOTs were trained 63 How many are still in the district 50 How many are still active 13 Organization that conducted TOTs Ministry of health VHT training Number of VHTs with basic training 2009 Number of VHTs without basic training 1316 Number of active VHTs 2321 Number of VHTs that has dropped 1004 Duration of basic training 5 Organization that funded the training MOH, ICOB, UNHCR 176

181 Refresher training Has there been any refresher training in the district Organization that supported the refresher training church Uganda Content of the refresher training ICCM Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities YES - Functions of VHTs Sensitization on health, hygiene and general sanitation They are also involved in hygiene and sanitation in the community. They help to distribute drugs during child days and other busy health activity days at the health centre What partners support VHT activities in the district? Church of Uganda, UNHCR, ICOBI Challenges faced in implementation of VHT programme We don`t have funds allocated to VHTs program VHTs don`t have tools to use e.g. registers and referral books 177

182 District: JINJA Status of VHT Implementation Number of sub-counties 12 Number of parishes 46 Number of villages 381 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 24 Number of villages with trained VHTs 150 % of sub-counties covered by VHTs 50 % of parishes covered by VHTs 52 % of villages covered by VHTs 39 TOT Training Has TOT training been carried out How many TOTs were trained 24 How many are still in the district 24 How many are still active 20 Organization that conducted TOTs Ministry of Health VHT training Number of VHTs with basic training 879 Number of VHTs without basic training 1051 Number of active VHTs 1880 Number of VHTs that has dropped 50 Duration of basic training 6 Organization that funded the training TASO, Sustain project 178

183 Refresher training Has there been any refresher training in the district Organization that supported the refresher training TASO Content of the refresher training disease prevention, drug distribution, how to treat simple illness Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities - No Functions of VHTs Educate members about family planning Sensitize the members about health improvement, HIV/AIDS patients through counselling They have gone ahead and setup a nutrition demonstration garden at the health Centre They link health services to the community like simple medications that is to say deworming. What partners support VHT activities in the district? TASO, PACE, SUSTAIN PROJECT Support to VHTs by partners VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Capacity building e.g. training Challenges faced in implementing the VHT programme Limited trainings Limited funds Monitoring and reporting is difficult Health behaviour changes 179

184 District: KAABONG Status of VHT Implementation Number of sub-counties 14 Number of parishes 84 Number of villages 848 Number of sub-counties with trained VHTs 14 Number of parishes with trained VHTs 84 Number of villages with trained VHTs 374 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 44 TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 12 How many are still active 12 Organization that conducted TOTs UNICEF, MOH VHT training Number of VHTs with basic training 760 Number of VHTs without basic training 160 Number of active VHTs 920 Number of VHTs that has dropped 00 Duration of basic training 5 Organization that funded the training UNICEF, MOH 180

185 Refresher training Has there been any refresher training in the district YES Organization that supported the refresher training UNICEF, MOH Content of the refresher training Nutrition Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Immunization, distribution of drugs, referring cases What partners support VHT activities in the district? UNICEF Support to VHTs by partners Providing technical advice Funding for core activities Drugs and other supplies and logistics Advocacy Training VHTs Challenges faced in implementation of VHT programme High illiteracy Demand for better pay for VHTs Lack of budget vote in district 181

186 District: KABALE Status of VHT Implementation Number of sub-counties 25 Number of parishes 141 Number of villages 1441 Number of sub-counties with trained VHTs 25 Number of parishes with trained VHTs 141 Number of villages with trained VHTs 1441 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 36 How many are still in the district 24 How many are still active 16 Organization that conducted TOTs MOH, SHHSSPII VHT training Number of VHTs with basic training 4437 Number of VHTs without basic training - Number of active VHTs 3328 Number of VHTs that has dropped 1109 Duration of basic training 3 Organization that funded the training MOH Refresher training Has there been any refresher training in the district Organization that supported the refresher training MCHIP Content of the refresher training Maternal health Duration of refresher training (days) 3 182

187 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Community mobilization about health services They refer patients to the HC The report to the HC monthly quarterly and annually They carry out home visits and sometimes help us in following up for example pregnant women They also do health education like in churches What partners support VHT activities in the district? PACE, world vision Challenges faced in implementing the VHT programme VHTs lack tools, registers and reporting format No motivation e.g. salary Transport not enough since we were give 2 bicycles Basic training is incomplete 183

188 District: KABAROLE Status of VHT Implementation Number of sub-counties 27 Number of parishes 94 Number of villages 750 Number of sub-counties with trained VHTs 24 Number of parishes with trained VHTs 19 Number of villages with trained VHTs 735 % of sub-counties covered by VHTs 89 % of parishes covered by VHTs 20 % of villages covered by VHTs 98 TOT Training Has TOT training been carried out How many TOTs were trained 42 How many are still in the district 35 How many are still active 35 Organization that conducted TOTs Baylor Uganda VHT training Number of VHTs with basic training 1000 Number of VHTs without basic training 2000 Number of active VHTs 3000 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training Baylor Uganda 184

189 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Baylor Uganda Content of the refresher training Causes of malaria, TB, Post-natal trainings Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Health education, Home Visits What partners support VHT activities in the district? Baylor Uganda Support to VHTs by partners Training VHTs- tools in community data, Logistical support and specific needs of the project Support districts to hold meetings with the health facilities Gave Phones to VHTs under the saving mothers giving life Equipped VHTs with Bicycle, bags, T-shirts, and books Trained health assistant at sub counties Support Radio talk shows Bicycle maintenance of 30,000/= per quarter Challenges faced in implementing the VHT programme District leadership has not embraced the VHT concept Not having all the VHTs trained Not having regular follow-ups Lack of financial motivation 185

190 District: Kaberamaido Status of VHT Implementation Number of sub-counties 12 Number of parishes 42 Number of villages 435 Number of sub-counties with trained VHTs 12 Number of parishes with trained VHTs 42 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 7 How many are still in the district 2 How many are still active 2 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1015 Number of VHTs without basic training - Number of active VHTs 825 Number of VHTs that has dropped 190 Duration of basic training 5 Organization that funded the training MOH 186

191 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Health education, Home Visits, Administering of NTDs drugs, Community Mobilization, Referrals What partners support VHT activities in the district? Pilgrim Africa, Baylor Uganda Support to VHTs by partners Capacity building e.g. training Funding e.g. transport allowance, meals, training Provision of tokens for VHT motivation e.g. plates, cups Challenges faced in implementing the VHT programme No specific funding for VHT program High drop out of VHTs coz not all programs can incorporate them No facilitation for VHTs. 2 VHTs handling a village of 170 households is a very big number 187

192 District: Kalangala Status of VHT Implementation Number of sub-counties 6 Number of parishes 17 Number of villages 106 Number of sub-counties with trained VHTs 3 Number of parishes with trained VHTs 9 Number of villages with trained VHTs 46 % of sub-counties covered by VHTs 50 % of parishes covered by VHTs 53 % of villages covered by VHTs 43 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 8 How many are still active 3 Organization that conducted TOTs Strides VHT training Number of VHTs with basic training 180 Number of VHTs without basic training 300 Number of active VHTs 180 Number of VHTs that has dropped 300 Duration of basic training 7 Organization that funded the training USAID 188

193 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UHMG Content of the refresher training - Duration of refresher training (days) 7 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No - No Functions of VHTs Mobilization, Referrals, Home visits, Health talks, Community sensitization, they do counselling, Treatment of diseases What partners support VHT activities in the district? Strides Challenges faced in implementing the VHT programme Transport i.e. movement of the VHTs is difficult Untrained VHTs Aggressive community 189

194 District: KALIRO Status of VHT Implementation Number of sub-counties 6 Number of parishes 34 Number of villages 396 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 7 How many are still active 7 Organization that conducted TOTs MOH, Star EC VHT training Number of VHTs with basic training 1110 Number of VHTs without basic training 355 Number of active VHTs 1465 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training STAR EC 190

195 Refresher training Has there been any refresher training in the district Organization that supported the refresher training STAR EC, PACE, STRIDES, ENVISION Content of the refresher training Malaria, TB, HIV/AIDS, NTD Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They follow up patients after referral They mobilize the community in case of any outreach program They also sensitize the community in case of any strange disease outbreak. What partners support VHT activities in the district? Strengthening Decentralization System, Kagum Development Organization Support to VHTs by partners Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme Inadequate funding, inadequate logistics like transport, supervision tools at the district Some VHTs have not been trained 191

196 District: KALUNGU Status of VHT Implementation Number of sub-counties 6 Number of parishes 36 Number of villages 285 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 36 Number of villages with trained VHTs 285 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs Malaria consortium VHT training Number of VHTs with basic training 1140 Number of VHTs without basic training - Number of active VHTs 1128 Number of VHTs that has dropped 12 Duration of basic training 7 Organization that funded the training Malaria consortium 192

197 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Malaria consortium, TASO Content of the refresher training roles of VHTs, drug handling, maternal and new borne, MTRAC Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities - Functions of VHTs Drug distribution, Follow-up on community members about mosquito nets, Mobilization during immunization, Community sensitization about prevention of malaria What partners support VHT activities in the district? Malaria consortium Challenges faced in implementing the VHT programme Drug stock outs, Lack of a budget for VHTs, Lack of allowances, Very little transport refund, Most VHTs are illiterates, Densely populated villages 193

198 District: KAMPALA Status of VHT Implementation Number of sub-counties 5 Number of parishes 108 Number of villages 796 Number of sub-counties with trained VHTs 0 Number of parishes with trained VHTs 0 Number of villages with trained VHTs 0 % of sub-counties covered by VHTs 0 % of parishes covered by VHTs 0 % of villages covered by VHTs 0 TOT Training Has TOT training been carried out 0 How many TOTs were trained 0 How many are still in the district 0 How many are still active 0 Organization that conducted TOTs None VHT training Number of VHTs with basic training 0 Number of VHTs without basic training 1219 Number of active VHTs 1219 Number of VHTs that has dropped 0 Duration of basic training None Organization that funded the training None 194

199 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Plan Uganda, AMICAL,KCCA, UHMG, MOH Content of the refresher training Immunization, Sanitation awareness, Polio campaign Duration of refresher training (days) 3 Coordination,supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Community sensitization in health issues like hygiene and sanitation, Mobilization of the communities during health programs Home visits, Follow ups Disease prevention and awareness and coordination between the VHTs with the health centre for effective service delivery. Conduct outreaches to create awareness of emerging diseases and also ongoing campaigns such as immunization. They also refer clients who need medical attention to the HC What partners support VHT activities in the district? Division Rubaga Nakawa Central Partners Uganda Health Marketing Group UNICEF CIDI Track TB Infectious Disease Institute Uganda Health Marketing Group Baylor Uganda CIDI AMICAL KIDIP KACHEPA Water Aid 195

200 Support to VHTs by partners Capacity building e.g. training Advocacy, Technical advice, Funding e.g. transport allowance, meals, training Drugs, other supplies and logistics Challenges faced in implementing the VHT programme The VHTs want to assume the responsibility of health workers yet they don t have the necessary training Some have low levels of education and can t express themselves well in English Sometimes the facility lacks money to facilitate them in some activities in terms of some allowances Inadequate supplies to be given to the VHTs Gumboots, Bags for keeping materials, drugs The VHTs lack proper form of Identification for instance Identity cards, T-shirts, Lack of communication skills some VHTs are not reliable 196

201 District: KAMULI Status of VHT Implementation Number of sub-counties 13 Number of parishes 76 Number of villages 756 Number of sub-counties with trained VHTs 12 Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs 92 % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 17 How many are still in the district 17 How many are still active 17 Organization that conducted TOTs MOH, STRIDES, STAR EC, PLAN VHT training Number of VHTs with basic training 1327 Number of VHTs without basic training 2129 Number of active VHTs 3456 Number of VHTs that has dropped 00 Duration of basic training 5 Organization that funded the training STRIDES, STAR EC, PLAN 197

202 Refresher training Has there been any refresher training in the district Organization that supported the refresher training PLAN, STAR EC, STRIDES Content of the refresher training ICCM, Maternal, New-born and Child Health, PMTCT, TB, Malaria management Duration of refresher training (days) 1 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities - Functions of VHTs Referrals, Routine outpatient or outreach referrals, Health Education What partners support VHT activities in the district? PLAN, MANIFEST, STAR EC, Support to VHTs by partners Capacity building e.g. training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme There is no transport means in place to monitor the VHT program Do not have funds to meet the stationery needs for the VHT program We do not have funds to motivate and train VHTs Most of the VHTs are not trained in the basic strategy 198

203 District: Kamwenge Status of VHT Implementation Number of sub-counties 15 Number of parishes 75 Number of villages 647 Number of sub-counties with trained VHTs 15 Number of parishes with trained VHTs 75 Number of villages with trained VHTs 636 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 98 TOT Training Has TOT training been carried out How many TOTs were trained 40 How many are still in the district 25 How many are still active 25 Organization that conducted TOTs UNICEF VHT training Number of VHTs with basic training 2536 Number of VHTs without basic training 24 Number of active VHTs 824 Number of VHTs that has dropped 1736 Duration of basic training 5 Organization that funded the training UNICEF 199

204 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Strides, malaria consortium Content of the refresher training Family planning Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Health education, Community Mobilization, Referrals, Home Visits What partners support VHT activities in the district? Strides, World Vision Support to VHTs by partners Capacity building e.g. training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Support supervision Challenges faced in implementing the VHT programme Work over load of VHTs, Lack of logistics like stationary, High dropout rate because of minimal incentive, Illiteracy among VHTs- not able to read, High expectations of VHTs 200

205 District: KANUNGU Status of VHT Implementation Number of sub-counties 17 Number of parishes 18 Number of villages 518 Number of sub-counties with trained VHTs 16 Number of parishes with trained VHTs 8 Number of villages with trained VHTs 518 % of sub-counties covered by VHTs 94 % of parishes covered by VHTs 44 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 34 How many are still in the district 25 How many are still active 25 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1750 Number of VHTs without basic training 10 Number of active VHTs 1750 Number of VHTs that has dropped 10 Duration of basic training 6 Organization that funded the training UNFPA, SHHPPII Refresher training Has there been any refresher training in the district Organization that supported the refresher training Star SW Content of the refresher training HIV Duration of refresher training (days) 3 201

206 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs They sensitive people in case of an epidemic Give families simple family planning methods They teach people personal hygiene They also help the health facility in health education They also participate in community outreaches The VHTs distribute ORS and family planning tablets What partners support VHT activities in the district? UNFPA, ACLAIM, STAR SW, UNICEF Challenges faced in implementing the VHT programme Limited/no funding is the biggest challenge for supervision and training 202

207 District: Kapchorwa Status of VHT Implementation Number of sub-counties 15 Number of parishes 85 Number of villages 642 Number of sub-counties with trained VHTs 15 Number of parishes with trained VHTs 85 Number of villages with trained VHTs 642 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 15 How many are still in the district 15 How many are still active 15 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1284 Number of VHTs without basic training 200 Number of active VHTs 1484 Number of VHTs that has dropped 00 Duration of basic training 14 Organization that funded the training MOH 203

208 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Star E, PACE Content of the refresher training HIV, TB, Malaria, Community mobilisation Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Community mobilization, Referrals, Health Education, Reporting to the facility, Immunization, Administering of NTDs drugs, Community Sensitization What partners support VHT activities in the district? PACE, Star E Challenges faced in implementing the VHT programme Inadequate funding, limited logistics like stationary and storage facilities, Lack of equipment like raincoats, Lack of transportation and follow-ups 204

209 District: KASESE Status of VHT Implementation Number of sub-counties 29 Number of parishes 153 Number of villages 762 Number of sub-counties with trained VHTs 26 Number of parishes with trained VHTs 150 Number of villages with trained VHTs 743 % of sub-counties covered by VHTs 90 % of parishes covered by VHTs 98 % of villages covered by VHTs 98 TOT Training Has TOT training been carried out How many TOTs were trained 69 How many are still in the district 69 How many are still active 30 Organization that conducted TOTs MOH 205

210 VHT training Number of VHTs with basic training 153 Number of VHTs without basic training 870 Number of active VHTs 1023 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training UNICEF Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF Content of the refresher training HIV, Family planning, Malaria Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No - Functions of VHTs Community mobilization, Home Visits, Health Education, Reporting to the facility What partners support VHT activities in the district? UNICEF, Save the Children, Strides Challenges faced in implementing the VHT programme They are not well equipped Limited finances 206

211 District: Katakwi Status of VHT Implementation Number of sub-counties 10 Number of parishes 58 Number of villages 338 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 58 Number of villages with trained VHTs 338 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 10 How many are still active 8 Organization that conducted TOTs MOH 207

212 VHT training Number of VHTs with basic training 1290 Number of VHTs without basic training 250 Number of active VHTs 1540 Number of VHTs that has dropped 00 Duration of basic training 6 Organization that funded the training MOH Refresher training Has there been any refresher training in the district Organization that supported the refresher training Global Fund, Pathfinder Content of the refresher training HIV/AIDS Malaria, sanitation, family planning Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No no Functions of VHTs Mobilization, referrals & maternal ANC, family planning, drug distributions What partners support VHT activities in the district? LWF, TASO, BAYLOR UGANDA, NEPA Support to VHTs by partners Strengthening the national capacity to provide quality VHT strategy implementation Funding e.g. transport allowance, meals, training Drugs and other supplies and logistics, Advocacy, Monthly bicycle repair allowance, Providing technical advice Challenges faced in implementing the VHT programme No salary, which is a demotivation Illiteracy of VHTs which affects reporting Favouritism by some leader in selecting VHTs No fund for supervision 208

213 District: KAYUNGA Status of VHT Implementation Number of sub-counties 8 Number of parishes 61 Number of villages 375 Number of sub-counties with trained VHTs 2 Number of parishes with trained VHTs 15 Number of villages with trained VHTs 108 % of sub-counties covered by VHTs 25 % of parishes covered by VHTs 25 % of villages covered by VHTs 29 TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 12 How many are still active 10 Organization that conducted TOTs Strides VHT training Number of VHTs with basic training 540 Number of VHTs without basic training 1335 Number of active VHTs 1875 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training Strides 209

214 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Health education, immunization, community for outreaches, hygiene and sanitation activities are done through home visits. What partners support VHT activities in the district? FHI360, Challenges faced in implementing the VHT programme Lack of transport facilitation No funds to support supervision 210

215 District: KIBAALE Status of VHT Implementation Number of sub-counties 35 Number of parishes 220 Number of villages 1099 Number of sub-counties with trained VHTs 35 Number of parishes with trained VHTs 220 Number of villages with trained VHTs 1099 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 35 How many are still in the district 5 How many are still active 5 Organization that conducted TOTs Malaria consortium VHT training Number of VHTs with basic training 3810 Number of VHTs without basic training 3810 Number of active VHTs 6910 Number of VHTs that has dropped 710 Duration of basic training 5 Organization that funded the training Malaria consortium, World vision, Save mother giving life (SMGL) 211

216 Refresher training Has there been any refresher training in the district Organization that supported the refresher training World vision Content of the refresher training HIV Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Health education, Administering of NTDs drugs, Referrals What partners support VHT activities in the district? World Vision, Infectious Disease Institute, Malaria Consortium Support to VHTs by partners Capacity building e.g. training Logistical supplies, Support supervision, Time and targeted counselling of mothers, Mentorship Challenges faced in implementing the VHT programme Financial constraints from the district Lack of working materials Lack of continuous trainings 212

217 District: KIBOGA Status of VHT Implementation Number of sub-counties 8 Number of parishes 41 Number of villages 237 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs 41 Number of villages with trained VHTs 237 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 18 How many are still in the district 11 How many are still active 11 Organization that conducted TOTs Ministry of Health, AMREF VHT training Number of VHTs with basic training 1143 Number of VHTs without basic training - Number of active VHTs 1143 Number of VHTs that has dropped - Duration of basic training 6 Organization that funded the training AMREF 213

218 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They do distribution of drugs when availed to them and also home visits. Sensitization on health related issues Supervise sanitation To treat children under 5 years What partners support VHT activities in the district? Malaria Consortium, World Vision Support to VHTs by partners VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Capacity building e.g. training Challenges faced in implementing the VHT programme Limited funding No supervision Refresher courses not emphasized to empower VHTs with skills and ideas Some consider themselves to be Doct0rs Illiteracy levels are high No equipment like MUAC tapes 214

219 District: KIBUKU Status of VHT Implementation Number of sub-counties 10 Number of parishes 44 Number of villages 246 Number of sub-counties with trained VHTs 0 Number of parishes with trained VHTs 0 Number of villages with trained VHTs 0 % of sub-counties covered by VHTs 0 % of parishes covered by VHTs 0 % of villages covered by VHTs 0 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 0 Number of VHTs without basic training 492 Number of active VHTs 492 Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - 215

220 Refresher training Has there been any refresher training in the district Organization that supported the refresher training MANIFEST, Uganda Sanitation Fund, Kagum Development Organization, Kibuku Widows Association Content of the refresher training maternal and Neonatal Health, Hygiene and Sanitation, Malaria management, HIV/AIDS Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs VHTs do home visits under the supervision of the in charge They help in management of malaria at community level by distributing medicines and mosquito nets They do counselling of the sick even to the people prevented by cultural beliefs from visiting the homes They refer patients to the health facility especially those referred for HIV/AIDS counselling and testing They follow up patients who have been discharged from the health centre or on long term treatment They sensitize the community about health What partners support VHT activities in the district? Kibuku Widows Association, Kagum Development Organization, MANIFEST, Sanitation Fund Support to VHTs by partners Capacity building e.g. training Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme VHTs don't have a guaranteed motivation in place (no pay) VHTs keep on dropping out of the programme Selection at community level is based on political grounds ignoring capability and education level 216

221 District: KIRUHURA Status of VHT Implementation Number of sub-counties 18 Number of parishes 92 Number of villages 565 Number of sub-counties with trained VHTs 18 Number of parishes with trained VHTs 92 Number of villages with trained VHTs 565 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 40 How many are still in the district 40 How many are still active 40 Organization that conducted TOTs UNICEF 217

222 VHT training Number of VHTs with basic training 1649 Number of VHTs without basic training 1759 Number of active VHTs 1759 Number of VHTs that has dropped 1649 Duration of basic training 3 Organization that funded the training UNICEF Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Mobilization in case of any health activity, Health education, Referrals, Help patients with chronical diseases What partners support VHT activities in the district? Star South West, African Evangelism Enterprise, UNICEF Challenges faced in implementing the VHT programme Lack of support in absence of donors Supply of faulty and substandard logistics like bicycles and torches Very low allowance in form of transport refund Political intervention in the implementation of the VHT PROGRAMME Lack of total ownership of the programme 218

223 District: KIRYANDONGO Status of VHT Implementation Number of sub-counties 7 Number of parishes 19 Number of villages 242 Number of sub-counties with trained VHTs - Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs - % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - 219

224 VHT training Number of VHTs with basic training - Number of VHTs without basic training 412 Number of active VHTs 412 Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - Refresher training Has there been any refresher training in the district - Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Referrals, Community Mobilization, Administering of NTDs drugs, reporting to the facility, Health Education What partners support VHT activities in the district? CHILD FUND, PACE, UNICEF/CONCERN, ACTION AGAINST HUNGER Support to VHTs by partners Capacity building e.g. training Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme No motivation for VHTs in form of salaries There is no sustainability when implementing partners wind up programmes Provision of refresher trainings 220

225 District: KISORO Status of VHT Implementation Number of sub-counties 14 Number of parishes 36 Number of villages 390 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 13 Number of villages with trained VHTs - % of sub-counties covered by VHTs 36 % of parishes covered by VHTs 36 % of villages covered by VHTs TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 7 How many are still active 7 Organization that conducted TOTs MOH, SHHSSPII 221

226 VHT training Number of VHTs with basic training 2000 Number of VHTs without basic training 200 Number of active VHTs 2100 Number of VHTs that has dropped 100 Duration of basic training 5 Organization that funded the training SHHPPII, Global Health Refresher training Has there been any refresher training in the district Organization that supported the refresher training Global Health Content of the refresher training Nutrition, HIV, Sanitation, Safe motherhood Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings - Have any feedback reports been provided to sub-counties in the No last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They do mobilization of the community, sensitize the community, and treat minor illnesses like diarrhoea What partners support VHT activities in the district? SPRING, AMREF, Muhabura Challenges faced in implementing the VHT programme Lack of funds is the greatest challenge 222

227 District: KITGUM Status of VHT Implementation Number of sub-counties 10 Number of parishes 33 Number of villages 600 Number of sub-counties with trained VHTs 9 Number of parishes with trained VHTs - Number of villages with trained VHTs 557 % of sub-counties covered by VHTs 90 % of parishes covered by VHTs % of villages covered by VHTs 93 TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 12 How many are still active 12 Organization that conducted TOTs MOH 223

228 VHT training Number of VHTs with basic training 498 Number of VHTs without basic training 1036 Number of active VHTs 1476 Number of VHTs that has dropped 58 Duration of basic training 5 Organization that funded the training IRC, AMREF Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNPA, AMREF Content of the refresher training Maternal and new born care, adolescence sexual reproductive health Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Community mobilization, Health Education, Administering of NTDs drugs, Home Visits, Referral of children and adults What partners support VHT activities in the district? UNICEF, AMREF, World vision Support to VHTs by partners Training, Drug supply, Supervision, Mentorship, Review meetings Challenges faced in implementing the VHT programme Lack of funds, Lack of transport, Illiteracy levels are high 224

229 District: KOBOKO Status of VHT Implementation Number of sub-counties 7 Number of parishes 47 Number of villages 394 Number of sub-counties with trained VHTs 7 Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - 225

230 VHT training Number of VHTs with basic training - Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Community mobilization, Administering of NTDs drugs, Health Education, Home Visits, Immunization What partners support VHT activities in the district? UNHCR Challenges faced in implementing the VHT programme The district does not have a budget line for VHTs activates The district do not have incentives like bicycle maintenance, protective gear, reporting tools 226

231 District: KOLE Status of VHT Implementation Number of sub-counties 5 Number of parishes 28 Number of villages 474 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 28 Number of villages with trained VHTs 474 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 5 How many are still in the district 5 How many are still active - Organization that conducted TOTs World vision VHT training Number of VHTs with basic training 1018 Number of VHTs without basic training 96 Number of active VHTs 1114 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training UNICEF 227

232 Refresher training Has there been any refresher training in the district Organization that supported the refresher training World vision Content of the refresher training Home visits, Referrals, Immunisation, Conducting meetings Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Referrals, Community Sensitization, Reporting to the facility What partners support VHT activities in the district? NUHITES, Crane health services, World Vision, UNICEF Challenges faced in implementing the VHT programme Some are not so knowledgeable by virtue of education so they cannot be trained in certain things Facilitation by the district is lacking, they are mostly facilitated by partners Things in the DHE office are not streamlined, so programmes are directed to the wrong people Political influence VHTs only go for programme that are well paying 228

233 District: KOTIDO Status of VHT Implementation Number of sub-counties 6 Number of parishes 25 Number of villages 165 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 25 Number of villages with trained VHTs 165 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 18 How many are still in the district 18 How many are still active 18 Organization that conducted TOTs MOH, WHO 229

234 VHT training Number of VHTs with basic training 365 Number of VHTs without basic training Number of active VHTs 320 Number of VHTs that has dropped 45 Duration of basic training 5 Organization that funded the training WHO, UNICEF, PATHFINDER Refresher training Has there been any refresher training in the district Organization that supported the refresher training International Red Cross Content of the refresher training ICCM Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Referrals, child care, screening for malnutrition What partners support VHT activities in the district? CAFH, World Vision, UNICEF, IRC Support to VHTs by partners Strengthening the national capacity to provide quality VHT strategy implementation Funding for core activities, Drugs and other supplies and logistics Training VHTs Challenges faced in implementing the VHT programme Poor motivation Some time they get substandard products Limited supplies of drugs 230

235 District: KUMI Status of VHT Implementation Number of sub-counties 7 Number of parishes 83 Number of villages 171 Number of sub-counties with trained VHTs 7 Number of parishes with trained VHTs 83 Number of villages with trained VHTs 171 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 14 How many are still in the district 13 How many are still active 10 Organization that conducted TOTs Strides 231

236 VHT training Number of VHTs with basic training 721 Number of VHTs without basic training 150 Number of active VHTs 771 Number of VHTs that has dropped 100 Duration of basic training 6 Organization that funded the training STRIDES, USAID Refresher training Has there been any refresher training in the district Organization that supported the refresher training PILGRIM, BAYLOR, THETA Content of the refresher training HIV/AIDs, Family planning Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Health education, Home Visits, Immunization, administering of NTDs drugs, Community Mobilization, Referrals What partners support VHT activities in the district? Baylor Uganda, PILGRIM Support to VHTs by partners Capacity building e.g. training Funding e.g. transport allowance, meals, training etc. Logistical supplies, Provision of monthly bicycle repair allowances Challenges faced in implementing the VHT programme Lack of enough manpower at the facilities hence poor supervision of VHTs Lack of finances to facilitate VHT activities Heavy work load y the VHTs as all programmes target using them 232

237 District: KWEEN Status of VHT Implementation Number of sub-counties 12 Number of parishes 67 Number of villages 484 Number of sub-counties with trained VHTs 12 Number of parishes with trained VHTs 67 Number of villages with trained VHTs 484 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 10 How many are still active 10 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 560 Number of VHTs without basic training 408 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 2 Organization that funded the training MOH 233

238 Refresher training Has there been any refresher training in the district Organization that supported the refresher training PACE Content of the refresher training Malaria, HIV,AIDS,TB Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Referrals, Administering of NTDs drugs, Health Education, Community Mobilization, Home Visits What partners support VHT activities in the district? PACE, Star E Challenges faced in implementing the VHT programme Lack of training Lack of motivation Absence of co-ordination meetings 234

239 District: Kyakwanzi Status of VHT Implementation Number of sub-counties 11 Number of parishes 84 Number of villages 396 Number of sub-counties with trained VHTs 11 Number of parishes with trained VHTs 84 Number of villages with trained VHTs 380 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 96 TOT Training Has TOT training been carried out How many TOTs were trained 5 How many are still in the district 5 How many are still active 5 Organization that conducted TOTs Ministry of Health, AMREF VHT training Number of VHTs with basic training 673 Number of VHTs without basic training - Number of active VHTs 973 Number of VHTs that has dropped 552 Duration of basic training 6 Organization that funded the training AMREF 235

240 Refresher training Has there been any refresher training in the district Organization that supported the refresher training AMREF Content of the refresher training Malaria, TB Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Mobilization of communities during outreaches and immunization They offer first aid treatment to under-fives as were trained What partners support VHT activities in the district? Malaria Consortium, World Vision Challenges faced in implementing the VHT programme No logistics No drugs High drop out Poor transport means 236

241 District: Kyegegwa Status of VHT Implementation Number of sub-counties 8 Number of parishes 42 Number of villages 456 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs 42 Number of villages with trained VHTs 456 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 8 How many are still in the district 7 How many are still active 7 Organization that conducted TOTs UNICEF VHT training Number of VHTs with basic training 1430 Number of VHTs without basic training 0 Number of active VHTs 1210 Number of VHTs that has dropped 220 Duration of basic training 5 Organization that funded the training UNICEF 237

242 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Referrals, Community Mobilization, distribution of NTDs drugs, Community Sensitization What partners support VHT activities in the district? UNICEF, Baylor Uganda, Church of Uganda Support to VHTs by partners Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme There is no budget for VHTs Transport challenges Lack of constant supervision 238

243 District: Kyenjojo Status of VHT Implementation Number of sub-counties 16 Number of parishes 99 Number of villages 662 Number of sub-counties with trained VHTs 16 Number of parishes with trained VHTs 99 Number of villages with trained VHTs 630 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 95 TOT Training Has TOT training been carried out How many TOTs were trained 40 How many are still in the district 40 How many are still active 40 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 2623 Number of VHTs without basic training 2623 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training UNICEF 239

244 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Content of the refresher training Duration of refresher training (days) 3 Baylor, Strides, Malaria Consortium Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Referrals, Community Mobilization, distribution of NTDs drugs, Home Visits What partners support VHT activities in the district? Strides, Baylor, UNICEF, Malaria Consortium, Church of Uganda, PACE, Global Fund, Marie Stopes, KING Uganda, Samaritan PURSE. Challenges faced in implementing the VHT programme Lack of facilitation of both VHTs and district officials Lack of refresher courses Lack of working materials like stationary Lack of proper reporting system of VHTs Limited supply of medicine to VHTs 240

245 District: LAMWO Status of VHT Implementation Number of sub-counties 11 Number of parishes 53 Number of villages 358 Number of sub-counties with trained VHTs 11 Number of parishes with trained VHTs 53 Number of villages with trained VHTs 358 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 21 How many are still in the district 12 How many are still active 12 Organization that conducted TOTs MOH 241

246 VHT training Number of VHTs with basic training 1068 Number of VHTs without basic training 130 Number of active VHTs 568 Number of VHTs that has dropped 500 Duration of basic training 5 Organization that funded the training International Red Cross, AVSI Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Community mobilization, Home Visits, Health Education, Referrals, Administering of NTDs drugs What partners support VHT activities in the district? Plan Uganda Challenges faced in implementing the VHT programme Lack of tools for the VHTs No resources at the district to motivate VHTs No orientation courses for VHTs High attrition rate No partner giving direct support to the VHT activities at the district. No motivation for the VHTs at all levels 242

247 District: LIRA Status of VHT Implementation Number of sub-counties 13 Number of parishes 89 Number of villages 751 Number of sub-counties with trained VHTs 13 Number of parishes with trained VHTs 89 Number of villages with trained VHTs 751 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained - How many are still in the district 6 How many are still active 5 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training - Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training - Organization that funded the training MOH 243

248 Refresher training Has there been any refresher training in the district Organization that supported the refresher training NUMAT, Crane Health, Theta Content of the refresher training Home based management of fever, Community PMTCT, Basics of malaria, TB and HIV. Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings - Have any feedback reports been provided to sub-counties in the No last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Referrals, Home Visits, Administering of NTDs drugs, Community Mobilization, Community Sensitization What partners support VHT activities in the district? Plan Uganda Support to VHTs by partners Capacity building, Support supervision, Provision of monthly bicycle repair allowance, Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme Limited funding so it is a challenge carrying out training and motivating VHTs District leaders are not in support of VHT activities. Lack of coordination meetings 244

249 District: LUUKA Status of VHT Implementation Number of sub-counties 8 Number of parishes 43 Number of villages 255 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs 43 Number of villages with trained VHTs 255 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 24 How many are still in the district 24 How many are still active 24 Organization that conducted TOTs Star EC 245

250 VHT training Number of VHTs with basic training 1275 Number of VHTs without basic training - Number of active VHTs 1275 Number of VHTs that has dropped 1275 Duration of basic training 5 Organization that funded the training STAR EC Refresher training Has there been any refresher training in the district Organization that supported the refresher training STAR EC, KADO Content of the refresher training Malaria, TB, HIV Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs VHTs mobilize for immunization and community outreaches Report strange disease cases to the health centre They follow up patients discharged from the facility They refer patients to the health centre including pregnant mothers They conduct health education and surveillance about hygiene and sanitation in the villages They do home visiting and use the data from the visits to fill and compile reports What partners support VHT activities in the district? STAR EC, PACE Challenges faced in implementing the VHT programme District lacks funds to support the VHT programme; VHTs don't have the necessary tools like registers VHTs now lack transport means to carry on home visits 246

251 District: LUWERO Status of VHT Implementation Number of sub-counties 13 Number of parishes 90 Number of villages 596 Number of sub-counties with trained VHTs 13 Number of parishes with trained VHTs 90 Number of villages with trained VHTs 596 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 26 How many are still in the district 20 How many are still active 20 Organization that conducted TOTs AMREF VHT training Number of VHTs with basic training 2980 Number of VHTs without basic training 0 Number of active VHTs 2000 Number of VHTs that has dropped 980 Duration of basic training 5 Organization that funded the training AMREF 247

252 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They carry out health education especially hygiene and sanitation and also taking community records They help in carrying out outreaches and immunization of children under five years. They help in training water committees at their local areas of operation What partners support VHT activities in the district? PLAN International, AMREF, PACE, Global Fund, UNACO, Health Vine, Chain Agent, CORDI, Caritas, Mbuya Outreach, Abagara Uganda. Support to VHTs by partners Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme Report forms not available Refresher courses not emphasized to empower VHTs with skills and ideas No transport facilitation 248

253 District: LWENGO Status of VHT Implementation Number of sub-counties 8 Number of parishes 45 Number of villages 445 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs 45 Number of villages with trained VHTs 445 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 63 How many are still in the district 63 How many are still active 63 Organization that conducted TOTs Malaria consortium 249

254 VHT training Number of VHTs with basic training 1802 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped 901 Duration of basic training 6 Organization that funded the training Malaria consortium, MOH Refresher training Has there been any refresher training in the district Organization that supported the refresher training Malaria consortium Content of the refresher training Referrals, danger signs, mtrac Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHT Distribution of NTDs drugs, Referrals, Home Visits, Community mobilization What partners support VHT activities in the district? Malaria Consortium Challenges faced in implementing the VHT programme Distribution of fake supplies, No supervision by the ministry, Inadequate supply of drugs and other logistics, No budget allocation for the VHT programme, Lack of transport by both the focal person and the VHTs, Misallocation of VHT bicycles 250

255 District: LYANTONDE Status of VHT Implementation Number of sub-counties 7 Number of parishes 28 Number of villages 218 Number of sub-counties with trained VHTs - Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs - % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 16 How many are still in the district 16 How many are still active - Organization that conducted TOTs MOH VHT training Number of VHTs with basic training - Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 7 Organization that funded the training UNICEF 251

256 Refresher training Has there been any refresher training in the district Organization that supported the refresher training PACE, Mild may, MOH Content of the refresher training VHT package Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs They mobilize mothers during immunization and sometimes the VHTs help in data entry during immunization, they carry out health education, Home visits to post-natal mothers, They do referrals for very sick children, Community sensitization, and Drug distribution What partners support VHT activities in the district? Mild may, PACE, UNICEF Challenges faced in implementing the VHT programme Inadequate funds 252

257 District: MANAFWA Status of VHT Implementation Number of sub-counties 30 Number of parishes 164 Number of villages 1475 Number of sub-counties with trained VHTs 0 Number of parishes with trained VHTs 0 Number of villages with trained VHTs 0 % of sub-counties covered by VHTs 0 % of parishes covered by VHTs 0 % of villages covered by VHTs 0 TOT Training Has TOT training been carried out How many TOTs were trained 21 How many are still in the district 21 How many are still active 21 Organization that conducted TOTs UNICEF VHT training Number of VHTs with basic training 81 Number of VHTs without basic training 2950 Number of active VHTs 81 Number of VHTs that has dropped Duration of basic training 5 Organization that funded the training UNICEF 253

258 Refresher training Has there been any refresher training in the district Organization that supported the refresher training TASO, PACE, Mbale cup, Salvation army Content of the refresher training Referrals, Maternal health, family planning, malaria, nutrition Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Health education, Referrals, Reporting to the facility, Community Mobilization, Community Sensitization, Immunization What partners support VHT activities in the district? TASO, PACE, Mbale cup, Salvation Army Support given to VHTs by partners Capacity building for example training Logistical supplies Funding e.g. transport allowance, meals, training etc. Challenges faced in implementing the VHT programme Motivation challenges Lack of identification for VHTs No basic training done for all current VHTs No review meetings Lack of proper reporting tools 254

259 District: MARACHA Status of VHT Implementation Number of sub-counties 8 Number of parishes 42 Number of villages 411 Number of sub-counties with trained VHTs - Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs - % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 1184 Number of VHTs without basic training - Number of active VHTs 822 Number of VHTs that has dropped 191 Duration of basic training 5 Organization that funded the training ADF, MOH 255

260 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Community mobilization, Community Sensitization, Referrals, Routine outpatient or outreach referrals What partners support VHT activities in the district? Baylor Uganda, SNV, RICE Support to VHTs by partners Funding e.g. transport allowance, meals, training etc. Logistical supplies Challenges faced in implementing the VHT programme The DHT does not have capacity because TOT has not been trained DHT is very few to handle 411 villages Inadequate training tools Wrong version of IEC materials and reporting forms 256

261 District: MASAKA Status of VHT Implementation Number of sub-counties 9 Number of parishes 39 Number of villages 356 Number of sub-counties with trained VHTs 9 Number of parishes with trained VHTs 39 Number of villages with trained VHTs 356 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 16 How many are still in the district - How many are still active - Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1400 Number of VHTs without basic training 0 Number of active VHTs 1372 Number of VHTs that has dropped 28 Duration of basic training 5 Organization that funded the training UNICEF 257

262 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Global fund, UNICEF Content of the refresher training - Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Drug distribution, they carry out patient follow-up, They write reports, Home visits, community sensitization about immunization, treatment of children below 5 What partners support VHT activities in the district? Uganda Cares, Mild May, PREFA, Red Cross Support to VHTs by partners Activity based allowance, Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats, uniforms and torches Challenges faced in implementing the VHT programme Lack of reporting tools, Lack of enough motivation Poor quality logistics given to VHTs like bicycles Inadequate funds 258

263 District: MASINDI Status of VHT Implementation Number of sub-counties 9 Number of parishes 32 Number of villages 336 Number of sub-counties with trained VHTs 9 Number of parishes with trained VHTs 32 Number of villages with trained VHTs 336 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 664 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - 259

264 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Administering NTDs drugs, Community Mobilization, Health Education, Home Visits, Referrals, Immunization What partners support VHT activities in the district? SCHIPHA, TASO Challenges faced in implementing the VHT programme Limited resources Motivation of VHTs Lack of proper coordination of data flow from VHTs through the health system Lack of transport to visit VHTs Low staffing level at the health centre 260

265 District: MAYUGE Status of VHT Implementation Number of sub-counties 13 Number of parishes 73 Number of villages 512 Number of sub-counties with trained VHTs 2 Number of parishes with trained VHTs 34 Number of villages with trained VHTs 205 % of sub-counties covered by VHTs 15 % of parishes covered by VHTs 47 % of villages covered by VHTs 40 TOT Training Has TOT training been carried out How many TOTs were trained 25 How many are still in the district 25 How many are still active 25 Organization that conducted TOTs Strides, Star EC VHT training Number of VHTs with basic training 1015 Number of VHTs without basic training 1485 Number of active VHTs 2399 Number of VHTs that has dropped 101 Duration of basic training 5 Organization that funded the training Strides, star EC, TASO 261

266 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Star EC Content of the refresher training Referral links and networking Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs They register the patients, fill forms or charts for the pregnant mothers They refer and follow up patients They do surveillance in the community They do home visits to ensure good hygiene and sanitation in the community They also report in case of any strange disease in the community These VHTs sensitize the community on any upcoming health activity or event What partners support VHT activities in the district? Strides, Star EC, MUSPH, Family Life Education Programme Challenges faced in implementing the VHT programme District lacks funds to run the VHT program A big number of VHTs have not received the basic training High dropout rates of VHTs especially the trained VHTs There is no sustainability plan in place for the VHT program Lack of enough reporting tools especially at parish level DHT lacks the necessary resources (transport) to do regular supervision of the program 262

267 District: MBALE Status of VHT Implementation Number of sub-counties 23 Number of parishes 107 Number of villages 1300 Number of sub-counties with trained VHTs 23 Number of parishes with trained VHTs 107 Number of villages with trained VHTs 1300 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 30 How many are still in the district 30 How many are still active 30 Organization that conducted TOTs Malaria consortium VHT training Number of VHTs with basic training 3214 Number of VHTs without basic training 0 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training Malaria consortium 263

268 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Malaria consortium, TASO, PACE Content of the refresher training Malaria prevention, HIV and AIDS prevention, family training Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings - Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Health education, reporting to the facility, Home Visits, Referrals, Community Mobilization, Immunization What partners support VHT activities in the district? SPOT LIGHT ON AFRICA, world vision, PACE, Malaria Consortium Support to VHTs by partners Funding e.g. transport allowances, VHT incentives like gumboots, umbrellas, rain coats and torches, advocating for VHT supervision Challenges faced in implementing the VHT programme No direct funding from the centre for their activities High dropout rates because of low motivation/morale Lack of trained VHTs in ICCM 264

269 District: Mbarara Status of VHT Implementation Number of sub-counties 17 Number of parishes 79 Number of villages 759 Number of sub-counties with trained VHTs 17 Number of parishes with trained VHTs 79 Number of villages with trained VHTs 759 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 51 How many are still in the district 51 How many are still active 51 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 2582 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training MOH, ICOBI 265

270 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities - No Functions of VHTs They teach the community on how to maintain hygiene, help health workers during child days, and help to distribute condoms in the community What partners support VHT activities in the district? Health child Uganda, TASO Support to VHTs by partners Capacity building e.g. training, Funding e.g. transport allowance, meals, training Advocating for VHT motivation e.g. plates, cups Challenges faced in implementing the VHT programme No tool for reporting Not oriented and supervised It s among the unfunded programs therefore not motivated 266

271 District: MITOOMA Status of VHT Implementation Number of sub-counties 12 Number of parishes 62 Number of villages 554 Number of sub-counties with trained VHTs 11 Number of parishes with trained VHTs 57 Number of villages with trained VHTs 460 % of sub-counties covered by VHTs 92 % of parishes covered by VHTs 92 % of villages covered by VHTs 83 TOT Training Has TOT training been carried out How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1104 Number of VHTs without basic training 94 Number of active VHTs 1198 Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training MOH, SHHSPPII 267

272 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Global fund Content of the refresher training Malaria, diarrhoea, respiratory infections Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They do home visiting, referrals and health education in churches and here at the health centre They do community mobilization What partners support VHT activities in the district? Global fund, STAR SW Challenges faced in implementing the VHT programme Supervision is the greatest because of lack of transport No regular meetings to assess performance Most VHTs have forgotten what they were taught in the training Motivation issues 268

273 District: MITYANA Status of VHT Implementation Number of sub-counties 12 Number of parishes 89 Number of villages 640 Number of sub-counties with trained VHTs 12 Number of parishes with trained VHTs Number of villages with trained VHTs 628 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs % of villages covered by VHTs 98 TOT Training Has TOT training been carried out How many TOTs were trained 20 How many are still in the district 19 How many are still active 19 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training - Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training MOH, Strides 269

274 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Strides Content of the refresher training HIV/AIDS PREVENTION, FAMILY PLANNING, NUTRITION Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs They teach the community more about health education for example sanitation They always provide nutrition trainings especially in infants They report disease outbreak to the health centres What partners support VHT activities in the district? FHI 360, SCHIPA, MARIE STOPES, STRIDES, Reproductive Health Uganda Support to VHTs by partners Capacity building, drugs and logistics Challenges faced in implementing the VHT programme Low coverage of VHTs thus low impact Implementing partners directly deal with the VHTs omitting the district structure Implementing partners use the same partners over and over ignoring the others who are left redundant Imbalanced distribution of equipment Political interference 270

275 District: MOROTO Status of VHT Implementation Number of sub-counties 6 Number of parishes 28 Number of villages 159 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 28 Number of villages with trained VHTs 159 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 18 How many are still in the district 15 How many are still active 15 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 318 Number of VHTs without basic training 47 Number of active VHTs 365 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training UNICEF 271

276 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Content of the refresher training UNICEF, International Red Cross, malaria consortium TREATMENT, Drugs management, record keeping, identification of danger signs, treatment of fever, cough, diarrhoa, etc. Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities yes Functions of VHTs Distribution of drugs like for NTDs, immunization, sanitation issues, screening of children and mapping of pregnant mothers What partners support VHT activities in the district? UNICEF, UNFPA, IRC, CAUMM Support to VHTs by partners We facilitate them and provide allowances Strengthening the national capacity to provide quality VHT strategy implementation Providing technical advice, Funding for core activities, Drugs and other supplies and logistics, Advocacy, Training VHTs, Facilitate the monthly supervision, provision of certificates Challenges faced in implementing the VHT programme High illiteracy, Poor pay of the VHTs, Mobile communities Bad Terrain e.g. Tapac & Katik Ekile sub-county 272

277 District: MOYO Status of VHT Implementation Number of sub-counties 9 Number of parishes 42 Number of villages 225 Number of sub-counties with trained VHTs 9 Number of parishes with trained VHTs 42 Number of villages with trained VHTs 225 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 6 How many are still active 6 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1500 Number of VHTs without basic training 142 Number of active VHTs 1054 Number of VHTs that has dropped 588 Duration of basic training 10 Organization that funded the training ADP/World Bank 273

278 Refresher training Has there been any refresher training in the district Organization that supported the refresher training PRDP, UHMG Content of the refresher training Malaria, HIV/AIDS,TB, Sanitation, Immunization Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities - Functions of VHTs Community mobilization, Referrals, Distribution of NTDs drugs, Health Education, Reporting to the facility What partners support VHT activities in the district? Baylor Uganda Support to VHTs by partners Activity based allowance, VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches. Funding e.g. transport allowance, meals, training. Provision of monthly bicycle repair allowance Challenges faced in implementing the VHT programme No direct funding to support VHT programs at the district Low capacity of VHTs in some programs Translation of IEC material by VHTs to be useful at community level and information management 274

279 District: MPIGI Status of VHT Implementation Number of sub-counties 8 Number of parishes 56 Number of villages 341 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs 56 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 21 How many are still in the district 21 How many are still active 21 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1354 Number of VHTs without basic training - Number of active VHTs 1084 Number of VHTs that has dropped 270 Duration of basic training 5 Organization that funded the training WHO 275

280 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Malaria consortium Content of the refresher training - Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They help to measure and check for weight and height more especially in non-communicable diseases They follow up patients They counsel youth and give them condoms for prevention of unwanted pregnancies VHTs help to mobilize the community They carry out nutrition assessment in the community and act as links between the health centres and communities VHTs also give a hand in treatment during outreaches such as immunization They treat minor illnesses in the community such as simple diarrhoea, dehydration, simple malaria They do health education e.g. hygiene, sensitizing people to have latrines, and also to take children What partners support VHT activities in the district? MALARIA CONSORTIUM, STOP MALARIA, WORLD VISION, STRIDES Support to VHTs by partners Capacity building e.g. training Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme Lack of sustainability for VHTs where projects phase out and they are left redundant Data collection is still a big problem Meetings are not regularly held Lack of government support especially finance 276

281 District: MUBENDE Status of VHT Implementation Number of sub-counties 18 Number of parishes 174 Number of villages 1244 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs 44 % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 5 How many are still in the district 5 How many are still active 4 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training - Number of VHTs without basic training - Number of active VHTs 891 Number of VHTs that has dropped 133 Duration of basic training 14 Organization that funded the training MOH, PATHFINDER, REPRODUCTIVE HEALTH 277

282 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Sensitize the community on HIV testing and counselling They organize youthful programmes and teach the youth on how to be safe in their youthful stages and distribute condoms They make follow ups in communities and carry out health education Reducing on congestion and long waiting hours by counting and packing drugs, What partners support VHT activities in the district? WORLD VISION, PACE Funding e.g. transport allowance, meals, training Capacity building e.g. training Challenges faced in implementing the VHT programme VHTs have very high expectations, VHTs were given poor quality supplies as bicycles, No tools and equipment to use such as gumboots, No interest for male involvement, Poor attitude of some health workers towards VHTs, Some VHTs have not received basic training, and Selection of some VHTs did not follow the guidelines 278

283 District: MUKONO Status of VHT Implementation Number of sub-counties 15 Number of parishes 80 Number of villages 609 Number of sub-counties with trained VHTs 12 Number of parishes with trained VHTs - Number of villages with trained VHTs - % of sub-counties covered by VHTs 80 % of parishes covered by VHTs - % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 10 How many are still active 10 Organization that conducted TOTs Stop malaria VHT training Number of VHTs with basic training 1861 Number of VHTs without basic training 686 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training Ministry of Health, Stop malaria, World vision, Omni-med 279

284 Refresher training Has there been any refresher training in the district Organization that supported the refresher training PACE Content of the refresher training roles of VHTs, village record books, diseases like malaria, TB,HIV, screening of cervical cancer, family planning Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs They refer and follow up patients who are attended to by the health facility.and also cleaning up They also help in the health education especially during immunization and antenatal classes De-worming of children during family days and child health days What partners support VHT activities in the district? Omni-med Support to VHTs by partners Capacity building e.g. training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme Lack of support to VHTs from ministry of health Shortage of tools like village record books, referral forms 280

285 District: NAKAPIRIPIRIT Status of VHT Implementation Number of sub-counties 8 Number of parishes 36 Number of villages 176 Number of sub-counties with trained VHTs 8 Number of parishes with trained VHTs 36 Number of villages with trained VHTs 171 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 97 TOT Training Has TOT training been carried out How many TOTs were trained 14 How many are still in the district 10 How many are still active 10 Organization that conducted TOTs UNICEF, IRC VHT training Number of VHTs with basic training 343 Number of VHTs without basic training 0 Number of active VHTs 343 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training UNICEF, IRC, CAUUM, WAP 281

286 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF, IRC Content of the refresher training TREATMENT Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Immunization, treatment of fever, screening for malnutrition, follow up What partners support VHT activities in the district? UNICEF, IRC Support to VHTs by partners We facilitate them and provide allowances, Providing technical advice, Funding for core activities, Drugs and other supplies and logistics, Advocacy, Training VHTs Challenges faced in implementing the VHT programme High illiteracy Lack of funds to support VHT at district High demand by VHTs 282

287 District: NAKASEKE Status of VHT Implementation Number of sub-counties 15 Number of parishes 56 Number of villages 328 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 30 Number of villages with trained VHTs 176 % of sub-counties covered by VHTs 67 % of parishes covered by VHTs 54 % of villages covered by VHTs 54 TOT Training Has TOT training been carried out How many TOTs were trained 16 How many are still in the district 10 How many are still active 10 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 656 Number of VHTs without basic training 0 Number of active VHTs 328 Number of VHTs that has dropped 328 Duration of basic training 3 Organization that funded the training MOH 283

288 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Busoga trust Content of the refresher training Malaria, HIV, TB Duration of refresher training (days) 1 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs They are involved in carrying out data collection during surveys being conducted by the facility. They also help to promote health through health education and sanitation. What partners support VHT activities in the district? Busoga trust, Mild may Support to VHTs by partners Capacity building, Involving VHTs in several activities Challenges faced in implementing the VHT programme Lack of funds for coordination meeting No equipment like boots, registers, VHT kits No motivation for VHT Lack of drugs 284

289 District: NAKASONGOLA Status of VHT Implementation Number of sub-counties 11 Number of parishes 59 Number of villages 330 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 52 Number of villages with trained VHTs 285 % of sub-counties covered by VHTs 91 % of parishes covered by VHTs 88 % of villages covered by VHTs 86 TOT Training Has TOT training been carried out How many TOTs were trained 18 How many are still in the district 11 How many are still active 11 Organization that conducted TOTs MOH, Save the children VHT training Number of VHTs with basic training 1405 Number of VHTs without basic training - Number of active VHTs 733 Number of VHTs that has dropped 472 Duration of basic training 5 Organization that funded the training UNICEF 285

290 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs They help in distributing medicines within communities They also help in promoting family planning methods to communities What partners support VHT activities in the district? AMREF, Save the Children. PREFA Support to VHTs by partners Advocacy, Funding e.g. transport allowance, meals, training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme No budget is allocated for VHTs High dropout of VHTs, Lack of drugs and other supplies 286

291 District: NAMAYINGO Status of VHT Implementation Number of sub-counties 9 Number of parishes 43 Number of villages - Number of sub-counties with trained VHTs 9 Number of parishes with trained VHTs 26 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 60 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 12 How many are still active 12 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 630 Number of VHTs without basic training 620 Number of active VHTs 1250 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training STAR EC 287

292 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Star EC, PACE, Environment ministry Content of the refresher training TB, Safe male circumcision, HIV, Documentation, Malaria, Surveillance, Sanitation improvement, Mother to Mother care Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities YES Functions of VHTs They do home visits They refer patients to this health centre They do teach the village members about personal and environmental hygiene They also make monthly village health reports Mobilise people for outreaches Help in filling child health cards during growth monitoring and promotion Offer health education to clients at the health facility What partners support VHT activities in the district? STAR EC, Mother to Mother, PACE, GOAL Challenges faced in implementing the VHT programme Lack of capacity in terms of funds to monitor the VHT programme Some of the trained VHTs were not equipped after training There are no funds/budget to motivate VHTs financially 288

293 District: NAMUTUMBA Status of VHT Implementation Number of sub-counties 7 Number of parishes 37 Number of villages 349 Number of sub-counties with trained VHTs 7 Number of parishes with trained VHTs 37 Number of villages with trained VHTs 318 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 91 TOT Training Has TOT training been carried out YES How many TOTs were trained 19 How many are still in the district 19 How many are still active 19 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1590 Number of VHTs without basic training 225 Number of active VHTs 1745 Number of VHTs that has dropped 70 Duration of basic training 5 Organization that funded the training STAR EC, MOH, SPRING 289

294 Refresher training Has there been any refresher training in the district YES Organization that supported the refresher training STAR EC,MARISTOPES, SPRING, Kagum Development Association Content of the refresher training HIV and AIDS, TB, Family Planning, Referrals for pregnant and lactating mothers, Malaria Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Identify the sick community members and refer them to the health centre They conduct home visits doing hygiene and sanitation surveillance They help in the fight against malaria by distributing LLINs and malaria medicines Sensitize the communities about the health programs and activities They follow up patients who have been referred or discharged from the health centre They do surveillance and report strange disease cases in the communities Sensitize community members about health promotion for example hygiene and sanitation Distribute NTD drugs in the community They give the first treatment to the patients before they are referred to the health centre What partners support VHT activities in the district? STAR EC, MARISTOPES, SPRING, Kagum Development Association Support to VHTs by partners Capacity building, of VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Mentorship, Drugs, other supplies and logistics Challenges faced in implementing the VHT programme VHTs are inadequately motivated financially No transport means for VHT supervisors VHT dropout and means replacing them and training others There are no reporting tools for VHTs Some VHTs have never been trained District does not plan for VHTs in the district budget Some health workers have a very poor attitude towards VHTs 290

295 District: Napak Status of VHT Implementation Number of sub-counties 7 Number of parishes 33 Number of villages 317 Number of sub-counties with trained VHTs 7 Number of parishes with trained VHTs 30 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 91 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 14 How many are still in the district 14 How many are still active 14 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 40 Number of VHTs without basic training 20 Number of active VHTs 620 Number of VHTs that has dropped 0 Duration of basic training 6 Organization that funded the training UNICEF 291

296 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF Content of the refresher training ICCM, REFERRALS, Nutrition, Report writing Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Referrals What partners support VHT activities in the district? UNICEF, IRC, CUUAM Support to VHTs by partners We facilitate them and provide allowances, Providing technical advice, Funding for core activities, Drugs and other supplies and logistics, Training VHTs Challenges faced in implementing the VHT programme Capacity building, Inadequate funds, Illiteracy 292

297 District: NEBBI Status of VHT Implementation Number of sub-counties 15 Number of parishes 81 Number of villages 879 Number of sub-counties with trained VHTs 15 Number of parishes with trained VHTs 81 Number of villages with trained VHTs 879 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 7 How many are still active 7 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 879 Number of VHTs without basic training 0 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training Global fund 293

298 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Community mobilisation, Referrals, Administering of NTDs drugs, Community Sensitization, What partners support VHT activities in the district? Baylor Uganda Challenges faced in implementing the VHT programme Funding is not enough Lack of reporting forum for VHTs Lack of referrals form from MOH Lack of motivation Protective gears like torches, gum boots bicycles are not always in good condition They also face a challenge of bad weather especially during rainy season 294

299 District: NGORA Status of VHT Implementation Number of sub-counties 5 Number of parishes 67 Number of villages 137 Number of sub-counties with trained VHTs 1 Number of parishes with trained VHTs 2 Number of villages with trained VHTs 8 % of sub-counties covered by VHTs 20 % of parishes covered by VHTs 3 % of villages covered by VHTs 6 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 40 Number of VHTs without basic training 625 Number of active VHTs 665 Number of VHTs that has dropped 0 Duration of basic training 3 Organization that funded the training MOH 295

300 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Pilgrims, BAYLOR, THETA PACE Content of the refresher training Communicating palliative care, pillars of PMTCT, diarrhoea, malaria, HIV,TB, Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Health education, Community Mobilization, Administering of NTDs drugs, Home Visits, Referrals, Reporting to the facility What partners support VHT activities in the district? Baylor Uganda, pilgrims, THETA, Challenges faced in implementing the VHT programme Not all VHTs have been trained Motivation for VHTs is only done by partners Spouses discourage their partners from doing VHT work Community members undermine the VHTs Some health centres neglect the VHTs when they fall sick Supplies like bicycles given to the VHTs they break down easily, complicating transport. 296

301 District: NTOROKO Status of VHT Implementation Number of sub-counties 10 Number of parishes 49 Number of villages 206 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 40 Number of villages with trained VHTs 168 % of sub-counties covered by VHTs 50 % of parishes covered by VHTs 82 % of villages covered by VHTs 82 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 1236 Number of VHTs without basic training 76 Number of active VHTs 326 Number of VHTs that has dropped 986 Duration of basic training 5 Organization that funded the training World vision 297

302 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF Content of the refresher training Nutrition Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Community mobilization, Reporting to the facility, Home Visits What partners support VHT activities in the district? Baylor, UNICEF, Save the children Support to VHTs by partners Activity based allowance, Logistical supplies, Challenges faced in implementing the VHT programme No funds Voluntarism de-motivates VHTs VHTs are unable to use the reporting tools Increased dropout rate Basic training didn t cover the whole district Implementing partners select a few VHTs to work with and the rest are left out No transport means for both VHTs and DHTs to supervise 298

303 District: NTUNGAMO Status of VHT Implementation Number of sub-counties 21 Number of parishes 96 Number of villages 913 Number of sub-counties with trained VHTs 21 Number of parishes with trained VHTs 96 Number of villages with trained VHTs 913 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 26 How many are still in the district 25 How many are still active 25 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 3695 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 6 Organization that funded the training UNICEF 299

304 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF Content of the refresher training Abridged version since some had trained in 2009 SHH Duration of refresher training (days) 6 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs They distribute the health supplies to the communities They do health visits to community households They also do community awareness, refer clients and do follow up They check on nutrition of children They also report any outbreak of illnesses/diseases to the HCII in case of any. They hold monthly meetings with the community for awareness What partners support VHT activities in the district? Health Child Uganda, STAR SW, UNICEF Support to VHTs by partners Logistical supplies, Capacity building, Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme Funding because as a district we don t have a budget for VHTs Lack of enough supplies to facilitate the program e.g. referral forms Reluctance of VHTs to do their work effectively 300

305 District: NWOYA Status of VHT Implementation Number of sub-counties 5 Number of parishes 24 Number of villages 54 Number of sub-counties with trained VHTs 5 Number of parishes with trained VHTs 24 Number of villages with trained VHTs 54 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 3 How many are still in the district 2 How many are still active 2 Organization that conducted TOTs WHO/ MOH VHT training Number of VHTs with basic training 637 Number of VHTs without basic training 237 Number of active VHTs 637 Number of VHTs that has dropped 237 Duration of basic training 10 Organization that funded the training WHO/UNICEF 301

306 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Content of the refresher training PACE MALARIA, HIV/AIDS,TB ICCM Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Distribution of NTDs drugs, Routine outpatient or outreach referrals, Community Mobilization, Community Sensitization, Health Education What partners support VHT activities in the district? AVSI, PACE Support to VHTs by partners Capacity building e.g. training Drugs, other supplies and logistics, Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme No transport for supervisors No funding for VHT activities Lack of proper coordination between partners and the district No drugs kits No drugs for VHT activities 302

307 District: OTUKE Status of VHT Implementation Number of sub-counties 6 Number of parishes 31 Number of villages 248 Number of sub-counties with trained VHTs 6 Number of parishes with trained VHTs 31 Number of villages with trained VHTs 248 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 6 How many are still active 6 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 560 Number of VHTs without basic training 230 Number of active VHTs 510 Number of VHTs that has dropped 280 Duration of basic training 5 Organization that funded the training MOH 303

308 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF Content of the refresher training Community mobilization management of fever at community level, referral of clients, control of diarrhoea Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings No Have any feedback reports been provided to sub-counties in the No last one year Do you do a regular supportive supervision of the VHT activities - Functions of VHTs Community Sensitization, distribution of NTDs drugs, Home Visits, Immunisation, Referrals What partners support VHT activities in the district? Crane health services, UNICEF Challenges faced in implementing the VHT programme Transfers of VHT supervisors affect their morale Nepotism and segregation where people without skills are put in office to deal with VHTs Attrition, others have died, migrated due to lack of motivation Lack of resources to motivate the VHTs 304

309 District: OYAM Status of VHT Implementation Number of sub-counties 12 Number of parishes 64 Number of villages 1096 Number of sub-counties with trained VHTs 7 Number of parishes with trained VHTs 42 Number of villages with trained VHTs 898 % of sub-counties covered by VHTs 58 % of parishes covered by VHTs 66 % of villages covered by VHTs 82 TOT Training Has TOT training been carried out How many TOTs were trained 24 How many are still in the district 6 How many are still active 6 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 3592 Number of VHTs without basic training 1384 Number of active VHTs 1976 Number of VHTs that has dropped 3000 Duration of basic training 5 Organization that funded the training HSSP With funding from African development Bank 305

310 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Nu-Hites, World Vision, PRDP CDFU, FHI, Pathfinder Content of the refresher training HIV, TB, Nutrition PMTCT Reproductive Health Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Community mobilization, Health Education, Community Sensitization, Immunization What partners support VHT activities in the district? Communication from Development Foundation Uganda, Uganda Health marketing Family Health International, NUHITES Support to VHTs by partners Capacity building, Provision of monthly bicycle repair allowance, Activity based allowance, Funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme Dropout rate and those who have not got core training Difficulty in capturing data of those who have left and those staying Different rates of VHT motivation by partners The motivation of VHTs in terms of monetary incentive is very limited because they are very many Others come only when there is something It's very hard to find a community member who meets all the criteria for VHT e.g. in the whole village 306

311 District: PADER Status of VHT Implementation Number of sub-counties 12 Number of parishes 52 Number of villages 640 Number of sub-counties with trained VHTs 7 Number of parishes with trained VHTs 31 Number of villages with trained VHTs 351 % of sub-counties covered by VHTs 58 % of parishes covered by VHTs 60 % of villages covered by VHTs 55 TOT Training Has TOT training been carried out How many TOTs were trained 15 How many are still in the district 11 How many are still active 11 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 987 Number of VHTs without basic training 313 Number of active VHTs 1244 Number of VHTs that has dropped 56 Duration of basic training 10 Organization that funded the training SCI, AMREF, AVSI 307

312 Refresher training Has there been any refresher training in the district Organization that supported the refresher training SCI, AMREF, AVSI Content of the refresher training Basic VHT cores, ICCM Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Distribution of NTDs drugs, Home Visits, Community Mobilization, Community Sensitization, Immunization What partners support VHT activities in the district? Save the children, AVSI, AMREF Challenges faced in implementing the VHT programme Inadequate transport Inadequate funding for the VHT activities Inadequate human resources High rate of VHT dropout Lack of refresher training of VHT trainers Inadequate tools for VHT activities 308

313 District: PALIISA Status of VHT Implementation Number of sub-counties 21 Number of parishes 85 Number of villages 856 Number of sub-counties with trained VHTs 0 Number of parishes with trained VHTs 0 Number of villages with trained VHTs 0 % of sub-counties covered by VHTs 0 % of parishes covered by VHTs 0 % of villages covered by VHTs 0 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 0 Number of VHTs without basic training 1712 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training - Organization that funded the training - 309

314 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Content of the refresher training MOH, MANIFEST, STAR E Palliative Care, TB, HIV/AIDS, maternal and Antenatal Health NTD drug distribution Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs They distribute NTD drugs in the community Refer mothers with danger signs and Low birth weight babies Sensitize community members about health promotion for example hygiene and sanitation They sensitize families (husbands and wives) about birth preparedness Encourage pregnant women to go for antenatal services Mobilize people for immunization What partners support VHT activities in the district? MANIFEST Support to VHTs by partners Capacity building, VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme The district lacks funds for implementation of the VHT programme There are challenges in selection of VHTs (some communities select incompetent, uneducated people) Dropout rates are so high The entire programme is dependent on partner support The VHTs are still fewer compared to the population 310

315 District: RAKAI Status of VHT Implementation Number of sub-counties 22 Number of parishes 105 Number of villages 750 Number of sub-counties with trained VHTs 22 Number of parishes with trained VHTs 15 Number of villages with trained VHTs - % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 14 % of villages covered by VHTs - TOT Training Has TOT training been carried out How many TOTs were trained 20 How many are still in the district 5 How many are still active 1 Organization that conducted TOTs MOH, World vision VHT training Number of VHTs with basic training 3000 Number of VHTs without basic training 1500 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training MOH, UNICEF 311

316 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF Content of the refresher training roles of VHTs danger signs referrals data recording Duration of refresher training (days) 5 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Community mobilization, community sensitization, referrals, home visits, drug distribution, immunization What partners support VHT activities in the district? World vision, UNICEF Challenges faced in implementing the VHT programme Lack of funding Lack of motivation Inadequate trainings Lack of supplies Lack of transport 312

317 District: Rubirizi Status of VHT Implementation Number of sub-counties 11 Number of parishes 53 Number of villages 293 Number of sub-counties with trained VHTs 11 Number of parishes with trained VHTs 53 Number of villages with trained VHTs 293 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 23 How many are still in the district 23 How many are still active 23 Organization that conducted TOTs Health child Uganda VHT training Number of VHTs with basic training 1020 Number of VHTs without basic training 0 Number of active VHTs 918 Number of VHTs that has dropped 102 Duration of basic training 5 Organization that funded the training Child health Uganda 313

318 Refresher training Has there been any refresher training in the district Organization that supported the refresher training Strides, malaria consortium Content of the refresher training - Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Health education, reporting to the facility, Community Sensitization What partners support VHT activities in the district? Child Health Uganda, Church Of Uganda Support to VHTs by partners Strengthening district VHTs capacity Providing technical advice Provision of transport nine motorcycles have been provided so far. Training to VHTs Challenges faced in implementing the VHT programme Financial constraints from the district Transport challenges Lack of medical and working equipment 314

319 District: RUKUNGIRI Status of VHT Implementation Number of sub-counties 12 Number of parishes 80 Number of villages 835 Number of sub-counties with trained VHTs 2 Number of parishes with trained VHTs 13 Number of villages with trained VHTs 142 % of sub-counties covered by VHTs 17 % of parishes covered by VHTs 16 % of villages covered by VHTs 17 TOT Training Has TOT training been carried out How many TOTs were trained 30 How many are still in the district 30 How many are still active - Organization that conducted TOTs SHHSSPII VHT training Number of VHTs with basic training 426 Number of VHTs without basic training 693 Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training MOH 315

320 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Refer serious cases to health centres They do home visiting They encourage mothers to go for antenatal visits and also encourage them to give birth from the health centre They do health education in their communities and also at the outreach. Also assist in supplying of nets. What partners support VHT activities in the district? AMREF, PACE, STAR SW, RUGADA Challenges faced in implementing the VHT programme Partners coordinating VHTs aren t easy Partners go to the community and pick their own supporters instead of VHTs thus clashing I feel dormant since am not facilitated thus making me not to do work 316

321 District: SEMBABULE Status of VHT Implementation Number of sub-counties 8 Number of parishes 42 Number of villages 420 Number of sub-counties with trained VHTs 3 Number of parishes with trained VHTs 15 Number of villages with trained VHTs 204 % of sub-counties covered by VHTs 38 % of parishes covered by VHTs 36 % of villages covered by VHTs 49 TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 10 How many are still active 10 Organization that conducted TOTs Strides VHT training Number of VHTs with basic training 600 Number of VHTs without basic training 900 Number of active VHTs 1300 Number of VHTs that has dropped 200 Duration of basic training 5 Organization that funded the training MOH, Health education vision 317

322 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No No Functions of VHTs Health Education, Referrals What partners support VHT activities in the district? None Challenges faced in implementing the VHT programme Lack of funds to facilitate programme Lack of refresher courses Inadequate training 318

323 District: SERERE Status of VHT Implementation Number of sub-counties 10 Number of parishes 49 Number of villages 250 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 49 Number of villages with trained VHTs 250 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 4 How many are still in the district 2 How many are still active 2 Organization that conducted TOTs SHSSPP VHT training Number of VHTs with basic training 350 Number of VHTs without basic training 1130 Number of active VHTs 1330 Number of VHTs that has dropped 150 Duration of basic training 6 Organization that funded the training SHSSPP 319

324 Refresher training Has there been any refresher training in the district Organization that supported the refresher training AMREF, Health need Uganda Partners for children worldwide Content of the refresher training HIV Prevention, Follow ups Hygiene and sanitation Reproductive health, Fistula Referrals Duration of refresher training (days) 4 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Administering NTDs drugs, Community Sensitization, Health Education, Referrals, Counselling, Immunisation, Community Mobilization What partners support VHT activities in the district? How Uganda, Baylor, Soruda, Hope after rape Support to VHTs by partners Capacity building, logistical supplies, funding e.g. transport allowance, meals, training Challenges faced in implementing the VHT programme Sustaining them Motivating them is a challenge Their commitment and quality of service is poor Most VHTs are not trained and can't give qualitative data 320

325 District: SHEEMA Status of VHT Implementation Number of sub-counties 12 Number of parishes 55 Number of villages 580 Number of sub-counties with trained VHTs 3 Number of parishes with trained VHTs 13 Number of villages with trained VHTs 156 % of sub-counties covered by VHTs 25 % of parishes covered by VHTs 24 % of villages covered by VHTs 27 TOT Training Has TOT training been carried out How many TOTs were trained 26 How many are still in the district 26 How many are still active 26 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 525 Number of VHTs without basic training 635 Number of active VHTs 1160 Number of VHTs that has dropped 0 Duration of basic training 5 Organization that funded the training MOH 321

326 Refresher training Has there been any refresher training in the district Organization that supported the refresher training TASO, C.O.U Content of the refresher training Malaria, HIV, TB Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs They also help do health education on sanitation hygiene in the communities They do monitoring of sanitation in community They do some verbal referrals to health centres They also participate in community work VHTs help to check for mosquito net usage in the community and others distribute condoms for family They also do counselling and advice people to go for health check up What partners support VHT activities in the district? UNICEF, STAR SW, MARIE STOPES Support to VHTs by partners Capacity building Funding e.g. transport allowance, meals, training etc. VHT incentives e.g. gumboots, umbrellas, rain coats and torches Challenges faced in implementing the VHT programme Training of small VHTs leaving out many an trained Trained VHTs aren t equipped with reporting tools e.g. forms, registers, bicycles Lack of funds for supervision and supplies like drugs 322

327 District: SIRONKO Status of VHT Implementation Number of sub-counties 21 Number of parishes 132 Number of villages 1284 Number of sub-counties with trained VHTs 1 Number of parishes with trained VHTs 3 Number of villages with trained VHTs 38 % of sub-counties covered by VHTs 5 % of parishes covered by VHTs 2 % of villages covered by VHTs 3 TOT Training Has TOT training been carried out No How many TOTs were trained - How many are still in the district - How many are still active - Organization that conducted TOTs - VHT training Number of VHTs with basic training 76 Number of VHTs without basic training 2494 Number of active VHTs 2568 Number of VHTs that has dropped 2 Duration of basic training 5 Organization that funded the training BUYOBO DEVELOPMENT ASSOCIATION 323

328 Refresher training Has there been any refresher training in the district Organization that supported the refresher training PACE Content of the refresher training Malaria, TB, HIV/AIDS, Reproductive health Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Community mobilization, Routine outpatient or outreach referrals, Home Visits, Health Education What partners support VHT activities in the district? PACE, Buyobo Development Association Support that partners give to VHTs Capacity building e.g. training VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Provision of tokens for VHT motivation e.g. plates, cups. Provision of refreshments such as soda, tea Logistical supplies Challenges faced in implementing the VHT programme Lack of funds to train Guidelines on selection not followed/supported Lack of funds for follow ups The tools in the Register are too complicated for them They lack morale as volunteers 324

329 District: SOROTI Status of VHT Implementation Number of sub-counties 10 Number of parishes 50 Number of villages 382 Number of sub-counties with trained VHTs 3 Number of parishes with trained VHTs 17 Number of villages with trained VHTs 154 % of sub-counties covered by VHTs 30 % of parishes covered by VHTs 34 % of villages covered by VHTs 40 TOT Training Has TOT training been carried out How many TOTs were trained 10 How many are still in the district 10 How many are still active 10 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 458 Number of VHTs without basic training 940 Number of active VHTs 984 Number of VHTs that has dropped 414 Duration of basic training 5 Organization that funded the training World vision 325

330 Refresher training Has there been any refresher training in the district Organization that supported the refresher training World vision AMREF BAYLOR PILGRIM Content of the refresher training Malaria, TB, HIV/AIDS Duration of refresher training (days) 3 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Health education, Home Visits, Immunisation, Community Sensitization, Referrals What partners support VHT activities in the district? World vision, Baylor, AMREF, AIC Support to VHTs by partners VHT incentives e.g. bicycles, gumboots, umbrellas, rain coats and torches Funding e.g. transport allowance, meals, training Activity based allowance, Drugs, other supplies and logistics Challenges faced in implementing the VHT programme VHT remuneration is very poor The low level of education among some VHTs Inadequate funding leading to poor facilitation of VHT activities 326

331 District: TORORO Status of VHT Implementation Number of sub-counties 21 Number of parishes 88 Number of villages 854 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 40 Number of villages with trained VHTs 468 % of sub-counties covered by VHTs 48 % of parishes covered by VHTs 45 % of villages covered by VHTs 55 TOT Training Has TOT training been carried out How many TOTs were trained 15 How many are still in the district 7 How many are still active 7 Organization that conducted TOTs Plan Uganda VHT training Number of VHTs with basic training 2440 Number of VHTs without basic training 1935 Number of active VHTs 3775 Number of VHTs that has dropped 600 Duration of basic training 5 Organization that funded the training Plan Uganda, World vision Uganda 327

332 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No Functions of VHTs Referrals, Home Visits, Community mobilization What partners support VHT activities in the district? Plan Uganda, World vision Challenges faced in implementing the VHT programme Lack of village register Lack of reporting tools Lack of counselling cards 328

333 District: WAKISO Status of VHT Implementation Number of sub-counties 23 Number of parishes 148 Number of villages 720 Number of sub-counties with trained VHTs 23 Number of parishes with trained VHTs 148 Number of villages with trained VHTs 720 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 7 How many are still in the district 7 How many are still active 7 Organization that conducted TOTs Malaria consortium VHT training Number of VHTs with basic training 2880 Number of VHTs without basic training 0 Number of active VHTs 2794 Number of VHTs that has dropped 86 Duration of basic training 5 Organization that funded the training UNICEF 329

334 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UNICEF Content of the refresher training Capturing records, disease surveillance, m-track reporting, Antenatal care Duration of refresher training (days) 2 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No No Functions of VHTs Drug distribution to community members Home visits checking on the mothers and remind them to make their children to complete their doses Refer mothers to the health facility for antenatal treatment and also make referrals to children Mobilize the community on immunization days and as well help in filling the child immunization Help health workers to collect data and information as far as health is concerned Encourage their communities to carry out proper sanitation in their homes for example digging pit latrines What partners support VHT activities in the district? UNICEF, AMREF, Malaria consortium, Mild may, Challenges faced in implementing the VHT programme Stockout of medicine they supply No motivation from districts Not all VHTs got bicycles 330

335 District: YUMBE Status of VHT Implementation Number of sub-counties 13 Number of parishes 101 Number of villages 636 Number of sub-counties with trained VHTs 13 Number of parishes with trained VHTs 101 Number of villages with trained VHTs 636 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 12 How many are still in the district 7 How many are still active 5 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 2093 Number of VHTs without basic training 0 Number of active VHTs 1272 Number of VHTs that has dropped 821 Duration of basic training 7 Organization that funded the training UNFPA 331

336 Refresher training Has there been any refresher training in the district Organization that supported the refresher training UHMG, UNFPA Content of the refresher training Reproductive health, family planning Duration of refresher training (days) 7 Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities Functions of VHTs Health Education, Reporting to the facility, Counselling, Immunization, Community mobilization What partners support VHT activities in the district? UNFPA Challenges faced in implementing the VHT programme Lack of comprehensive VHTs training using MOH guidelines In adequate motivation (Basic financial incentive) Attrition among VHTs Irregular reporting about VHTs 332

337 District: ZOMBO Status of VHT Implementation Number of sub-counties 10 Number of parishes 54 Number of villages 691 Number of sub-counties with trained VHTs 10 Number of parishes with trained VHTs 54 Number of villages with trained VHTs 691 % of sub-counties covered by VHTs 100 % of parishes covered by VHTs 100 % of villages covered by VHTs 100 TOT Training Has TOT training been carried out How many TOTs were trained 50 How many are still in the district 45 How many are still active 12 Organization that conducted TOTs MOH VHT training Number of VHTs with basic training 1669 Number of VHTs without basic training - Number of active VHTs - Number of VHTs that has dropped - Duration of basic training 5 Organization that funded the training UNICEF 333

338 Refresher training Has there been any refresher training in the district No Organization that supported the refresher training - Content of the refresher training - Duration of refresher training (days) - Coordination, supervision and feedback Is the district conducting VHT coordination meetings Have any feedback reports been provided to sub-counties in the last one year Do you do a regular supportive supervision of the VHT activities No - No Functions of VHTs Distribution of NTDs drugs, Community Sensitization, Health Education, Mobilization of community What partners support VHT activities in the district? Baylor Uganda Challenges faced in implementing the VHT programme Some of the supplies given to the VHTs like the bicycles and torches are sub standard VHTs lack protective gears like gumboots and umbrellas Many VHTs dropped out because they did not understand the concept of the VHTs that is voluntary Some villages are too big for the current number of 2 VHTs per village 334

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