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Confronting the Challenge of Child Mortality in Uganda: Scale-Up and Consolidation of Gains from the CODES Project”

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Confronting the Challenge of Child Mortality in Uganda: Scale-Up and Consolidation of Gains from the CODES Project” Advocates Coalition for Development and Environment 67TH STATE OF THE NATION PLATFORM “Confronting the Challenge of Child Mortality in Uganda: Scale-up and Consolidation of Gains from the CODES project” ACODE Policy Dialogue Report Series, No. 32 Adelaine Aryaija Karemani, Barbara Ntambirweki & Moses Mukundane Advocates Coalition for Development and Environment 67TH STATE OF THE NATION PLATFORM “Confronting the Challenge of Child Mortality in Uganda: Scale-up and Consolidation of Gains from the CODES project” ACODE Policy Dialogue Report Series, No. 32 Adelaine Aryaija Karemani, Barbara Ntambirweki & Moses Mukundane 67TH STATE OF THE NATION PLATFORM ABSTRACT and lessons learnt from five years of CODES implementation.The dialogue Over the years, Uganda has made brought together a cross-section of key stakeholders in child survival in Uganda significant strides in reducing child including; Women MPs, District Health mortality. Child mortality in Uganda Officers, Chief Administrative officers of declined from 156 per 1000 live births in the 13 CODES implementation districts, 1990s, to 137 per 1000 live in 2005, 90 National Medical Stores, Health Monitoring per 1000 live births in 2011 to the current Unit, UNICEF,ACODE, CFI, MoH and 69 per 1000 live births1. This was partly Makerere University. The objectives of the due to result of increased knowledge and 67th STON were as follows: service in the health sector. The five-year Community and District Empowerment 1. To share with participants the for Scale-up (CODES) project, developed achievements and lessons learnt from 5 jointly by Uganda’s Ministry of Health, years of CODES implementation; UNICEF and Karolinska Institutet in 2. To provide a national-level platform for partnership with Advocates Coalition for participants to discuss the achievements Development and Environment (ACODE), and lessons learnt from 5 years of Child Fund International (CFI), Liverpool CODES implementation; School of Tropical Medicine (LSTM) and Makerere University School of Public 3. To provide a national-level platform Health (MUSPH) put in place a myriad for participants to discuss policy of interventions to reduce child deaths implications for CODES exit and associated with diarrhea, pneumonia and sustainability strategy. malaria. It is against this background that Advocates Coalition for Development B. Background and Environment (ACODE) together with CODES partners held the 67th State of the Child mortality remains a global health Nation Platform (STON) for a discussion concern and this explains its particular locus on “Confronting the Challenge of Child in the global health/child survival agenda. Mortality in Uganda: Scale-up and The recent Millennium Development Goals Consolidation of Gains from the CODES (MDGs) and the present Sustainable Development Goals (SDGs) put emphasis project.” A number of recommendations on reducing child mortality2. Consistent emerged key among which was the call with the global child health agenda, the to adopt the community dialogue model Government of Uganda (GOU) through to increase demand for health services the Ministry of Health (MOH), and in particularly for children and the need to partnership with Development Partners strengthen the capacity of Health Unit and Civil Society Organizations (CSOs) Management Committees (HUMCs) has undertaken several child survival through training and financial facilitation. interventions under the national framework of National Minimum Health Care Package A. Introduction (UNMHCP), Health Sector Strategic Plans (HSSP) I, II and III (2000/1-2004/5; 2005/06- This report focuses on the achievements 2 UNDP: Http://www.undp.org/content/undp/en/home/ sdgoverview/mdg_goals.html. Accessed on October 10, 1 (MFPED, 2015; MOH, 2015a; UBOS and ICF, 2011). 2016 2 Confronting the Challenge of Child Mortality in Uganda 67TH STATE OF THE NATION PLATFORM 2009/10; 2010/11-2014/15), Health and interventions that lead to an array Sector Strategic Investment Plan (HSSIP) of improvements in health outcomes, (2010/11-2014/15), and the Health Sector especially concerning the control of Development Plans (HSDP) I and II (2010/11 diarrhea, pneumonia, and malaria. – 2014/15; 2015/16 - 2019/20), inter alia (MOH, 2015a3; 2015b4). The totality of the The CODES project had 3 pillars; interventions resulted into considerable strides in reducing child mortality in the 1. Ensuring that the best interventions were country, especially the type of mortality used to reduce child death and illness in resulting from the top killer childhood each of the participating districts. diseases of diarrhea, pneumonia, and malaria, as well as diseases resulting from 2. Helping District Health Managers lack of or inadequate administering of timely to use simple tools to improve their vaccines. Consequently, contemporary performance on health service delivery. reports indicate a trend of drastic decline in child mortality rate in Uganda over the last 3. Empowering communities to demand two and a half decades, an era that overlaps and receive better quality and gain more with the United Nations MDGs epoch. access to all health services. The Uganda MDG report 2015 indicates that Uganda “missed narrowly” to meet The three pillars epitomized both MDG 4 target of reducing child mortality to C. the “Supply-Side” and “Demand-Side” the rate of 56 per 1000 live births by 2015 components of the CODES project. The (MFPED, 2015)5. “Supply Side Component” interventions were intended to improve district level The CODES project put in place a myriad health systems and health facility based- of interventions to reduce child deaths continuous quality improvement (CQI) in associated with diarrhea, pneumonia and health service delivery while the “Demand- malaria. The interventions involved activities Side Component” was intended to mobilize that were supported by the Government and galvanize citizens to demand for of Uganda, CSOs, and other non-state effective and quality health service delivery. actors all of which focused on reducing ACODE has shouldered the mandate of child mortality. Designed as a learning implementing the third pillar/Demand-Side project, CODES set out to demonstrate component of the CODES project. how strengthening of district health systems management and community empowerment could be scaled-up to D. Presentations: attain intended objectives. CODES was anticipated to help the government to Dr. Flavia Mpanga Kaggwa, boost its capacity to implement policies UNICEF, Principal Investigator, 3 Ministry of Health (2015a). Annual Health Sector CODES project: Performance Report for Financial Year 2014/15.MOH. Kampala, Uganda. 4 Ministry of Health (2015b). Health Sector Development Dr. Mpanga presented a brief overview Plan (2015/16- 2019/20) .MOH. Kampala, Uganda. of the 5-year CODES project, the policy 5 Ministry of Finance, Planning and Economic Development (2015). Millennium Development Goals Report for prospects and exit/sustainability strategy. Uganda 2015. Results, Reflections and the Way Forward. Dr. Mpanga extended appreciation to the MFPED with Support from United Nations Development Programme (UNDP). Kampala, Uganda. CODES project implementers (ACODE + Confronting the Challenge of Child Mortality in Uganda 3 67TH STATE OF THE NATION PLATFORM CFI) for their contribution towards reducing as to supervise and to track performance child mortality in Uganda, which further led of health units. Health officials were further to achieving the MDG 4. Uganda’s child empowered to put in place improvement mortality rate was noted to stand at 55/1000 plans and continuously implement in a live births which was acknowledged to SMART way for the next cycle. This has be a huge achievement. However, this resulted in strengthening all six pillars of observation was put in context and noted the health system; leading to increased to be inadequate because so many children coverage of key health interventions. Dr. continued to die needlessly. Mpanga emphasized that all this was done with very little resources—district health Dr. Mpanga shared the CODES project teams used existing resources and where hypothesis which consisted of several resources were not available or sufficient, inputs with an overall aim of reducing districts mobilized resources from other child mortality in the 13 implementation donors because the districts were now districts. The CODES hypothesis adapted able—while using data, to tell partners an approach that harnesses data that the where their need was and therefore districts already had from the HMIS/DHIS2. influenced where resources could be They also obtained data from dialoguing allocated. With this, the hypothesis was with communities to understand their that; all these inputs together would reduce experiences and reasons for not seeking child morbidity and mortality and help the health care services. With this data, districts nation get to Vision 2040 and eventually health teams were approached to perform also look into the sustainable development evidence based planning that targeted goals. Districts that participated in the CODES project included; Wave 0 (Proof of concept) namely: Buikwe, Bukomansimbi, Masaka, Mukono, Wakiso; Wave 1 (Intervention districts) of Apac, Arua, Bugiri, Buhweju, Buvuma, Luuka, Masindi and Maracha and Control districts of Alebtong, Kole, Kiryandongo, Kamuli, Iganga, Kasese, Mitoma and Sheema. The project started with a proof of concept phase in 5 districts. There were 8 intervention and 8 control districts. The project design deliberately intervened
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