HEALTH SECTOR ISSUE NO. 1 MAY 2017

THE REPUBLIC OF MINISTRY OF HEALTH NEWSLETTER

Uganda Registers Decline in Infant and Maternal Mortality Rates ganda has made tremendous strides The survey indicates a significant de- deaths per 100,000 live births. There is Uin maternal health, according to the cline in maternal mortality rates, from also marked improvement in pregnant sixth Demographic and Health Survey as high as 438 deaths per 100,000 live women attending four or more antenatal 2016. births in the 2011 to the current 336 (Continues to page 12)

National Health Laboratory Services: What the growing recognition means aboratory services constitute the entry point into From setting up 100 laboratory hubs which are Lquality health care by enabling proper disease diagnosis, geographically located to cover the entire country, each of monitoring, control as well as guiding treatment. Over 70% which is supporting 25 to 30 lower health facilities with of the decisions made in patient management as well as in referral lab services through designated bike riders attached disease prevention and control are dependent on laboratory to each hub, the Ministry has extensively increased access to results. laboratory services. The laboratory sub-sector is therefore one of the priority systems that the Government of Uganda through the (Continues to page 4) Ministry of Health has undertaken to strengthen.

65,590 women Mulago Hospital FEATURED benefit from the renovation works to CONDITION: voucher project be completed by July Depression - page 4 - page 6 - page 8 2 3

Ministry of Health Top Management

THE REPUBLIC OF UGANDA MINISTRY OF HEALTH From the Editor ministry of health reetings and a warm welcome to our very first issue of the Health Mandate GSector Newsletter! We couldn’t be more excited to have made it to Ministry of Health is responsible for policy this point. review and development, supervision of health sector activities, reelating with health In this issue, we bring you updates on the infrastructural development, development partners, strategic planning, public health policies and programs, a closer insight into the setting standards and quality assurance, resource Internationally accredited and recognised National Health Laboratory mobilisation, advising Government of Uganda Services and other exciting messages and facts from the different on health-related matters, and ensuring quality, subdivisions of the health sector. health equity, and fairness in contribution towards the cost of health care. The success of the sector and the ultimate goal of improved service delivery is a reflection of the outstanding work and support of our Hon. Dr. Jane Ruth Aceng – Minister of Health Vision partners and stakeholders, not forgetting the dedicated service of health Our Vision is to have a healthy and productive professionals. population that contributes to socio-economic growth and national development. I seize this opportunity to thank all those who have submitted their contributions for this Issue, the assistance and guidance of the Publications Committee and the efforts put in by the Editorial team to Mission make this a reality. Our Mission is to provide the highest possible level of health services to all people in Uganda We are honoured to share the work of a team of committed and through delivery of promotive, preventive, thoughtful people, from the various sub-sectors and development curative, palliative and rehabilitative health partners. services at all levels”. We appreciate your support and are so happy to have you as a reader of Editor Uganda’s Health Sector Newsletter. Vivian Nakaliika Serwanjja Please feel free to provide your feedback and send pertinent information Assistant Editor on what you would love to read about in our forthcoming issues. Abirahmi Kananathan Hon. Sarah Opendi – Minister of State Hon. Dr. Joyce Moriku Kaducu – Dr. Diana Atwine – Permanent With warmest thanks, for General Duties Minister of State for Primary Health Secretary Associate Editor Care Rukia Nakamatte Mbaziira Vivian Nakaliika Serwanjja Contributing writers Editor Enock Kusasira Mulago National Referral Hospital

Bashir Hangi Uganda Sanitation Fund

Additional input Edmund Mwebembezi World Health Organisation (WHO)

Catherine Ntabadde Makumbi UNICEF Mr. Ssegawa Ronald Gyagenda – Under Prof. Anthony K. Mbonye – Ag. Direc- Dr. Henry Mwebesa – Director Health Photographer Secretary tor General Health Services Services, Planning and Development Sam Nalwala 4 5

(Continues from page 1)

To improve the laboratory capacity at each hub to enable it meet the demand, National each hub had its lab infrastructure upgraded, equipment profile improved, and manpower increased. To improve the quality of services emanating from Health the laboratory hubs, each hub lab was enrolled in the Strengthening Laborato- ry Management Towards Accreditation (SLMTA) program with the aim of hav- Laboratory ing each laboratory hub internationally accredited with time.

Building the national laboratory network did not end by setting up the Services 100 laboratory hubs, but also involved setting up a national coordination centre for laboratory services – Uganda National Health Laboratory Services What the growing recognition (UNHLS)- at Butabika. means for Ugandans Besides being a coordination centre for laboratory services across the country, UNHLS has several national reference by the South African National Accredi- “We can now be confident of the results laboratories notably the Early Infant tation System (SANAS) for the next four emanating from this laboratory for HIV Diagnosis (EID), the Viral Load, years. The certificate of accreditation patient diagnosis and monitoring. The the Sickle Cell, the Hepatitis and the became effective from 2nd February results this laboratory generates un- Bacteriology laboratories etc. All these 2017 and will expire on the 1st February der the scope of this accreditation are laboratories are offering public health 2021 when it will be renewed as long as considered one and the same as those The Vice President Edward Sekandi joins Health Minister Dr. Jane Ruth Aceng, US Amb Deborah Malac and other ministers services to all Ugandans through the the standards are maintained. produced from any standard laboratory to cut the cake symbolizing UNHLS’ grand opening sample transport network, which is also in Europe and America.“ Aisu notes. coordinated at this site and all the ser- The accreditation demonstrates techni- equipment coupled with the already work to complement the existing cen- (Uganda National Health Laboratory vices offered at this facility are free. cal competency and the operation of a The achievement is expected to attract existing 9 Abbott M2000 equipment and tralised system, which will remain the Services), making it a semi-autonomous quality management system in accor- even more modern technologies and 5 Roche CAP CTM equipment, CPHL’s backbone of our VL/EID programing. institution, with the ability to mobilise To set up this laboratory network, both dance with the recognized International widen the range and scope of services VL/EID laboratory now has capacity its own resources. government and health development Standard ISO 15189-2012. this laboratory can offer. to test over 2,300,000 tests a year. With The Honourable Minister of Health Dr. partners have invested significant effort this very high VL testing capacity in one Jane Ruth Aceng reiterates government These great achievements were attained and resources. These efforts have begun During the period when the certificate Mr. Aisu is franked by the Permanent centralised laboratory, supported by a commitment to maintain the quality with support from the Ministry of to yield positive results. Between 2012 is effective, work from the EID and Viral Secretary Ministry of Health, Dr. Diana national wide hub based sample trans- of laboratory systems in Uganda, and Health partners, especially the United and now the laboratory sub-sector has Load laboratory of Uganda National Atwine. “A time will come when we will port network, Uganda has cost effective- support more laboratories in the na- States government through the Centres won 7 continental awards for good Health Laboratories (UNHLS) will be have no need to send a patient or a sam- ly made VL monitoring accessible to all tional network to attain accreditation as for Disease Prevention and Control practices and innovations such as the recognized and respected internation- ple abroad for laboratory diagnosis. This its ART patients in barely 2 years. No quickly as possible. (CDC) and the United States Agency national specimen referral system. Many ally. achievement comes in timely when the country had demonstrated this kind of for International Development (US- countries have had to come here and bill to make UNHLS autonomous is be- efficiency on the African Continent. Hon. Dr. Aceng says, “We have already AID) who have joined efforts with the benchmark on our laboratory system These awards reflect Government and fore parliament. This even gives us more earmarked at least six (6) more labora- Government of Uganda to strengthen and sample referral network. partner commitment and efforts to confidence that when UNHLS become Uganda has adopted this centralised tories at Regional Referral Hospital and laboratory systems. strengthening laboratory services to autonomous, they will be able to attract model for VL/EID testing because of General Hospital levels to be accredited The latest addition to these prestigious assume their central place in health care meaningful collaborations to make their its cost effectiveness, easy data manage- before the end of this year, 2017”. “This The Government of Uganda is commit- awards is the International Accreditation delivery. operations self-sustainable.” ment, logistics management, and quality endeavour will continue until all the ted to improving the health status of the of the Early Infant HIV Diagnosis (EID) management, with optimal use of re- 100 hub laboratories attain international people of Uganda so as to make them and Viral Load Testing Laboratory at the According to the Director, Uganda The Uganda National Health Laboratory sources and overall improved and easy accreditation.” She adds. productive and take the country to a National Health Laboratory Services in National Health Laboratory Services, Services (UNHLS) has recently acquired program monitoring and coordination. middle-income status. The Ministry of Butabika. Stephen Aisu, the laboratory can now the newest technology Cobas 8800, the To sustain and even take to scale this Health has thus undertaken to strength- attract a full range of researches and 1st of its kind in East and Central Africa, We are cognisant of the advent of new high performance of CPHL, a bill has en key health systems, which will drive This facility, which tests specimens from researchers given its international ac- with capacity to run 3000 VL tests a day. point of care technologies for both EID been tabled before parliament, which a sustainable revolution in the health all districts in Uganda, was accredited creditation. With this new robust high throughput and VL, which are well come, and will will fully transform CPHL into UNHLS sector. 6 7

Women benefit from Every Ugandan to receive 65,590 the voucher project a free mosquito net Government Rolls-out Second lthough the Maternal Mortality and private service providers have been ARate in Uganda has remarkably Universal Coverage Campaign reduced over the past few years, it still Public contracted to offer a defined package of safe remains high, at 336 deaths per 100,000 delivery service: live births each year. Sixteen percent  4 Antenatal visits as recommended by Ministry of n a bid to continuously bring down (16%) of women are married by age 15 Health, Ithe incidence of malaria in the country, the Ministry of Health recently and by age 18, 53% are married. This  Elimination of Mother to Child Transmission of HIV implies that marriage for females com- launched the Second Universal Cov- mences during adolescence; a phase of  Safe skilled delivery erage campaign for the distribution of life when the body of the female is still  Postnatal care mosquito nets. not yet fully grown to safely undergo the  Postnatal family planning physiological demands of pregnancy and The campaign follows a successful childbirth. universal coverage campaign in 2013 lished that the scheme successfully; pro- partner efforts towards improving mater- and 2014, which saw 21.5 million nets vided services to women from the poor- nal health and reducing maternal illness These statistics have a high bearing on distributed across the country. This con- est quintiles, increased safe deliveries in and death. the health of women and on the provi- tributed to a major reduction in malaria health facilities, led to significant reduc- sion of health services for women, es- prevalence in Uganda from 42 percent tions in the likelihood of out-of-pocket Through subsidized vouchers, the project pecially those that are not economically in 2013 to the current 19 percent, ac- payment for deliveries among women in has assisted in reducing vulnerability of empowered. cording to the Malaria Indicator Survey communities served by the program. poor pregnant women in accessing safe de- 2016. livery services. The project will also con- The majority of these women reside in Based on the success of the RHVP, the tribute towards empowerment of women, rural areas where safe delivery services The campaign which was launched in Government of Uganda and development increased demand and uptake of antenatal in general are inadequate. In addition to February 2017 in , marked partners expressed interest in expanding care and safe delivery services as well as geographical barriers, the poor women the commencement of Uganda’s univer- Rt. Hon. Prime Minister Dr. Ruhakana Rugunda gives a mosquito net to a child during launch the safe delivery services component of strengthening institutional capacity to de- also face significant financial barriers. sal coverage effort where LLINs will of the Long Lasting Insecticide Net (LLIN) campaign in Apac District. Looking on (L-R) Pro- the pilot project. The targeting of the liver reproductive health services. be distributed to all the 116 districts in gram Manager, National Malaria Control Program, Dr. Jimmy Opigo, Ag Director General poor under this Project by subsidizing Improving maternal health outcomes Uganda. This campaign has been divid- Health Services, Prof. Anthony K. Mbonye, Minister of Health, Hon. Dr. Jane Ruth Aceng and the cost of care is helping to reduce on The project vastly contributed to Ugan- is a key priority for the Government of ed into in six waves over a period of six State Minister of Health for Primary Health Care, Hon. Dr. Joyce Moriku Kaducu the financial barriers to care and promot- da’s National Development Plan 2011 Uganda. The main strategies are out- months with each wave having at least ing access to services that reduce risks – 2015 while seeking to transform the lined in the Road Map for Acceleration an average of 22 districts apart from the distributed, protecting over 20million However, this time, we have strength- associated with pregnancy and childbirth economy to even greater heights. of Maternal and Neonatal Mortality and sixth wave, which comprises of Kampa- Ugandans. ened our health promotion messages. for poor women. Morbidity (2006 – 2015) and the Re- la and Wakiso. Ejakait Alice Amoding alias Toto We have heavily deployed teams to Uganda is currently expanding use of productive Health Commodity Security Nowella, a resident of Kobin parish in sensitize communities on appropriate This is in line with the fulfillment of the existing contraceptive methods; intro- Strategic Plan (2010/11 – 2014/15). Under this campaign, one net will be Mukongoro sub-county, use of the nets. We have trained teams Government’s manifesto of bringing ducing implants; strengthening services These include; Expanding of maternal given per two registered people in a camped at her distribution point as early in villages that will continuously remind services closer to the people since poor for post-abortion care and resuscitation and newborn care services; Improving household and will include a sensitiza- as 7:00am on March 31st to receive her communities on ensuring that they women in Uganda face several challeng- of new-born babies; and expanding ma- management and staff motivation; and tion programme to educate the commu- five mosquito nets for the 9 members of sleep under mosquito net every night,” es with accessing safe delivery services. ternal and peri-natal death audits. In Strengthening supply chain management nities about the importance of sleeping her house stead had this to say, “At least she said, adding “We hope that if this addition, a separate supply chain man- for reproductive health commodities. under a net, and its effective use. this is a sigh of relief of us here. We is done, we shall increase the net use Currently URHVP is using both public agement system for reproductive health last received mosquito nets three years coverage in the country.” and private service providers licensed to commodities has been set up to serve pri- The Uganda Reproductive Health During the launch of the campaign, the ago and they had worn out, dirty with practice by the relevant medical councils. vate providers and government is in the Voucher Project (URHVP) is building on Prime Minister Rt. Hon. Ruhakana Ru- holes all over. During registration, we The Director General Health Services, These have been contracted to offer a de- process of streamlining the management a successful pilot voucher scheme that gunda called on the nation to embrace were promised to come early as there Prof. Anthony Mbonye, said that control fined package of safe delivery service; and operations of ambulance services provided safe delivery services to poor the vision of a malaria free Uganda, were several people that were to receive and elimination of malaria requires ex- four Antenatal visits as recommended by countrywide. pregnant women. This project has sup- cautioning them against inappropriate mosquito nets.” She said. panded coverage and access to effective Ministry of Health, Elimination of Moth- ported 65,590 women achieving 130% use of the mosquito nets. malaria control interventions such as in- er to Child Transmission of HIV through In 2012, Uganda also adopted the pol- of targeted safe deliveries and treated Dr. Jane Ruth Aceng, the Minister of secticide-treated nets (ITNs), which has HIV/AIDS testing and counseling, safe icy to enroll all HIV positive pregnant 31,658 cases of STIs, achieving 90% of To this end, distribution has so far Health says more efforts have been put been proven to be an effective means skilled delivery, postnatal care, and post- women in the eMTCT program and giv- target and enrolled over 120 private pro- been successfully been concluded in in place to improve net usage in this of preventing infection and reducing natal family planning. ing them lifelong treatment. All these viders. the Acholi-Lango, and Teso, Karamo- campaign. “There has been a lot of mis- malaria transmission. “In populations interventions a directed towards achiev- ja, East central, West Nile and Bugi- use of nets due to ignorance of commu- The URHVP provides an opportunity to ing and sustaining maternal wholesome nities about appropriate use of the nets. The evaluation of the program estab- su where 10 million nets have been (Continues to page 8) reflect on the impact of Government and health indices for the country. 8 9 Government Rolls-out Second Universal Coverage Campaign Meningitis crisis (Continues from page 7) Govt rolls-out immunisation campaign, registering 98% coverage with mosquito nets, ITNs have shown to reduce all-cause child mortality by about 20%, decrease clinical cases of malaria by about 50%, and t has been a disaster in our area. Other than falling friends at school get regular attacks,” severe malaria by 45%.” he said. sick to easily treated and manageable diseases, she said, adding that she was the first to Dr. Jimmy Opigo, the National Malaria Control “I receive the Meningitis vaccine from the Program said that the campaign will be finalized people in my community are affected by this meningitis outreach conducted at their local church. in August with the final distribution taking place menace. Such people are left with nothing to do apart from in and . He is optimistic wailing away and eventually die. We are happy that the The preventive immunization campaign that the campaign will be useful and achieve its government has finally come to our rescue,” said Onyango focused on Northern Uganda and parts objective of reducing Malaria incidence. of Western Uganda, because they lie The campaign is funded by the Government of Kior- LC1chairperson Nyori village, Oleba Sub County in in the Meningitis belt of Sub Saharan Uganda, the Global Fund to Fight Malaria, TB Africa, which has experienced frequent and HIV, Against Malaria Foundation, UKaid outbreaks of Meningococcal Meningi- and the USAID/President’s Malaria Initiative tis epidemics leading to mortality and to a tune of approximately 360 Billion Uganda morbidity. The campaign further helped Shillings. Other implementing partners include to strengthen surveillance and routine the World Health Organization, UNICEF, PACE, immunization service delivery in the Communication for Health Communities, UNBS, districts, and achieve 80% coverage for NDA and the Church of Uganda. vaccination in the 39 high risk districts.

The dusty winds and cold nights, which characterize the period between December and June in the meningitis belt, increase the risk of meningitis. Transmission of Meningitis is further facilitated by overcrowded housing and large population displacements.

“This type of vaccination will help countries to move away from reactive response to emergencies to preventive immunization that eliminates epidemic outbreak threats.” Dr Tarande Constant Meningits vaccination in Uganda Manzila, Acting World Health Organisa- tion Representative in Uganda. n an effort to protect the population uary 2017, registered a roaring 98% Ifrom the risk of Meningitis, the coverage on average, across all the 39 Meningococcal Meningitis is a bacterial Ministry of Health rolled out a routine high-risk districts. form of Meningitis that covers the thin preventive immunisation campaign to brain membrane and spinal cord and can cover districts in the Meningitis belt. The selected high risk districts includ- cause brain damage and death in 50% ed; Abim, Adjumani, Agago, Alebtong, of cases if not treated. Anyone is prone The campaign that targeted all chil- Amolator, Amudat, Amuria, Amuru, to meningitis, however; infants and dren and young adults aged 1-29, was Apac, Arua, buliisa, Dokolo, , Ho- children are at more risk of contracting launched in Omoro district by the Min- imaKaabong, Kaberamaido, Katakwi, the disease. istry Minister of Health Hon. Dr. Jane Kiryandongo, Kitgum, Koboko, Kole, Ruth Aceng with an objective of reduc- Kotido, Lamwo, Lira, Maracha, Masin- The risk factors for meningococcal ing morbidity, mortality and disability di, Moroto, Moyo, Nakapiripirit, Napak, meningitis are people who have had due to Meningitis. Nebbi, Nwoya, Omoro, Otuke, Oyam, close or prolonged contact with a person Pader, Soroti, Yumbe and Zombo. infected with meningitis The campaign, supported with funds from the World Health Organization and Kation Achan, a thirty six year old year Immunisation is one of the key strat- UNICEF, is one of the Government of mother of three children from Nyai vil- egies that the Government of Uganda Uganda strategies intended to reduce lage in Adumi sub-county is implementing in its roadmap to the the suffering of people in the Meningitis was excited on having heard about the attainment of the Sustainable Develop- belt. program. “We were informed over radio ment Goal 3, which underlines the need that our district was to benefit from the for good health and well – being. The immunisation exercise, that took program. Our children have been at place between the 19th and 23rd Jan- risk of meningitis because most of their 10 11 Health Infrastructure Mulago Hospital renovation works to be The scope of Renovation of Lower Mulago is as follows: Kawolo Hospital refurbishment completed  Expansion of the ICU from 8 to 27 beds kicks off  Expansion of the Operating Theatres New gate at lower Mulago by July from 7 to 18 OTs)  Expansion of the Accident &Emer- Busolwe design works underway gency (Casualty) department hospital) of Mulago National Referral  Creating a road strictly for ambulato- On March 30, 2017, Ministry of Health ensure they meet the expected quality and Hospital. ry services to the A&E ward signed works and supervision agree- within the set deadlines” Dr. Atwine notes.  Installation of 10 New Lifts ments for the refurbishment and equip- The loans were also used to finance the  Provision of medical gases to all the ping of Kawolo and Busolwe hospitals. The construction site at Kawolo Hospi- training of health workers in specialised 1000 beds tal was handed over to Excel construc- areas where there were skills gaps i.e.  Replacement of all the electrical These agreements triggered immedi- tion on April 28, 2017, and is expected organ transplant, specialised Uro-gynae- wiring & installations ate commencement of civil works for to take a maximum of 18 months, while cology, perinatology, assisted repro-  Overhaul of the sewerage system Kawolo hospital and designing works definitive designs for Busolwe are ex- ductive technologies, laparoscopy and  Video feed from all Operating the- for Busolwe hospital. pected to be finalised by end July 2017. hysteroscopy, specialised gynaecology, atres to Lecture rooms echo-cardiography, nuclear medicine, The Permanent Secretary, Ministry The Director Health Services, Planning  CCTV camera surveillance in and critical care, neonatal care, geriatrics of Health, Dr. Diana Atwine says that and Development, Dr. Henry Mwebesa around the hospital and stroke management. On completion while some structures are going to be says, the project mainly focuses on the  Installation of fire protection systems of these projects in July 2017, the hospi- renovated, others in deplorable state are complete refurbishment and improve- going to be completely demolished and ment of all infrastructure at Kawolo and tal will offer super-specialised services Status on construction Maternal & replaced with new ones. Busolwe general hospitals given their Artistic impression through a sustainable business model. Neonatal Unit  age and state of dilapidation. Mulago hospital has acquired additional Capacity of 320 beds. “The two facilities were prioritised given  equipment for MRI, CT scan, mammog- 130 beds for Ante, delivery and post their location and the big population that “This project seeks to contribute to- raphy, 4D ultrasound, DNA Haema- natal services. they serve. We are going to closely mon- wards universal health coverage with In October 2015, His Excellency Presi- are utilized for renovation, remodel-  tology analysers, chemistry analysers, 45 gynaecological oncology itor and supervise works at all stages to essential health and related services dent Yoweri Museveni honored his call ling and equipping of lower Mulago,  InVitro Fertilization (IVF) equipment, 60 urogynaecology especially VVF. to the people of Uganda by commis- construction and equipping of Kiruddu  25 Associated reproductive health sioning the renovation works of Mulago and Kawempe city referral hospitals laparoscopy, hysteroscopy, critical care equipment such as ventilators, de- technologies. National Referral Hospital. His gesture and construction of super Specialised  fibrillators, patient monitors and organ 60 beds for private (self-contained showed his commitment to improving Maternal and Neonatal Unit (Women’s rooms). service delivery in the country as noted transplant equipment. in the National Development Plan (NDP The construction of the specialized II) and the Health Sector Strategic De- women’s hospital and renovation of velopment Plan (HSSP). lower Mulago are expected to end in July and September 2017 respectively. The With funding from Africa Develop- process of operationalizing the newly ment Bank (USD 88M) and Islamic refurbished and constructed hospital is Development Bank (USD 32M), the underway and aimed to improve service renovation is expected to decongest delivery by streamlining referrals, pro- Mulago National Referral Hospital and viding super-specialized health care and improve health services in Kampala Staff units enhancing training and research. City and Uganda at whole. These loans 12 13 Kawolo, Infant, maternal Uganda Sanitation Fund Busolwe mortality rates decline USF championing sanitation in Uganda by works through refurbishment and improvement establishing a learning hub of the two facilities.” Dr. Mwebesa says. ince its commencement of opera- tainability of results. Behavior change The renovation of the two facilities has Stions in Uganda six years ago, the communication is a major component been funded under the Spain – Uganda Uganda Sanitation Fund (USF) pro- 3.4 million in promoting and reinforcing positive debt swap to a tune of US$ 20 million. gramme has helped get the people in its behavior to ensure sustainability of areas of operation out of faeces infested The programme has so far achievements and avoid slippage. Scope of works communities to Open Defecation Free registered over 3.4 million (ODF) environments. living in Open Defecation With these tremendous achievements in The civil works shall include; USF areas of operation, the programme The USF programme has demonstrated Free environments has established itself as a learning hub Kawolo Hospital impressive efforts to support millions of with innovative approaches that lead to of their own sanitation with facilitation • Detailed designs, tender documents people to radically change their sanita- quicker achievement of open defeca- tion situation and end open defecation from the Ministry through District Local tion free communities in a short time. and cost estimates for construction/ Governments. renovation. by delivering sanitation at scale and The innovative approaches to commu- • Existing Out Patient Department fostering an enabling environment for The Uganda Sanitation Fund provides nity mobilisation and triggering plus renovated. the sanitation sub-sector to thrive. funding and technical support to dis- technological innovations in terms of • New Trauma centre /Radiology de- tricts to implement sanitation activities facilities can be replicated by other none The USF programme has proved to be USF supported districts and hence take partment constructed. a catalyst to advance towards national with focus on changing behaviors of (Continues from page 1) sanitation to scale. • New Obstetric and General Theatres Infant mortlity sanitation coverage and eliminating communities which is essential for sus- constructed. open defecation in their communities. care visits from 48% in 2011 to 60% • Expansion of delivery suites deaths per 1000 live Targeting a total population of over 4.5 in 2016 while the number of births in • New mortuary, complete with 9 body births in 2016 million people to live in open defecation fridge constructed. health facilities increased from 57% in 43 free environments, the programme has 2011 to 73% in 2016. • All wards renovated local and International development so far registered over 3.4 million living • New staff houses for 4 staff con- commitments such as the National in ODF environments, 5311 villages de- Infant Mortality, according to the structed. Development Plan and Sustainable clared ODF villages, over 5000 house- survey, has also declined from 54 • Water supply and sewerage system Development Goals. holds adopting the use of handwashing deaths per 1000 live births in 2011 to improved facilities and latrine coverage standing 43 deaths per 1000 live births in 2016. • Signed maintenance contracts for The release of these findings will at 95%. The programme achievements The report also indicated that child medical equipment and hospital guide in planning and monitoring over the last six years are summarized mortality has seen a steady drop from furniture for 5 years. of services offered across the health in the table. 38 deaths per 1000 live births in 2011 sector to accelerate efforts in curbing to 22 deaths per 1000 live births in maternal mortality rates despite the This achievement is largely attributed to Busolwe Hospital 2016. current reduction. the programme’s approach of Commu- • nity Led Total Sanitation (CLTS) which Detailed designs, tender documents Whereas the country is on good track Among other indices, Uganda has empowers communities to be in charge and cost estimates for construction/ to total elimination of preventable ma- progressed in immunization, nutrition renovation. ternal mortality, Government tirelessly • levels and use of insecticide treated All medical buildings refurbished continues to commit to improvement • mosquito nets, which shows good USF achievements over the last six years New Trauma centre /Radiology de- and sustainability of good health ser- progress as a sector and as a nation. partment constructed. vices in order to achieve better health • Indicator (s) Cumulative total 6 Year % Achieved Against New Obstetric and General Theatres indices. constructed. Efficient use of resources across the Achieved Targets 6 Year Target • health sector is paramount in achiev- Villages triggered 7,560 7,577 100 Expansion of delivery suites As part of this effort, Government of • ing better indices in the future. How- New mortuary, complete with 9 body Uganda is focusing on procuring good Villages declared ODF 5,311 7,577 70 ever, achievement of these outcomes fridge constructed. medical equipment, increasing human People living in ODF villages 3,414,000 4,550,000 75 • requires a multi-sectoral approach, Water supply and sewerage system resource for health and continuous that brings on board all players. New latrines constructed 293,104 319,223 92 improved sensitization of the population on best • Additional population served 1,491,205 1,596,113 93 Power supply and distribution im- practices. proved The survey was undertaken by the New HWF installed 508,471 715,030 71 • Construction of placenta and medical Uganda Bureau of Statistics, with This survey will help in monitoring Households adopting HWWS 581,541 715,030 81 support from the development partners waste pits national health programs and mea- • especially USAID, UNICEF, UNFPA, Latrine Coverage 95 100 95 Construction of attendants’ kitchen sure progress towards meeting both and laundry and ICF Macro. 14 15 pictorial Multisensory impairments Children below 3 years to receive free specialist service

Harriet Musiitwa walks into Entebbe General Hospital, carrying her 2year old son, Aaron on the back. Aaron is visually impaired. “My dream is to have my only son gain his full sight” she says. But without support, this can only remain a dream. Aaron is just but one of the many children who are born with visual and State Minister of Health for General Duties, Hon. Sarah Opendi and Ministry of Health delegation led by Minister of Health, Hon. Dr. hearing impairments, but are unable to Owek. Charles Peter Mayiga cut a cake to symbolize the partnership Jane Ruth Aceng during a meeting with First Lady of Uganda and meet the cost of screening and possible between Ministry of Health and Buganda Kingdom in the fight against Elimination of Mother to Child Transmission of HIV (eMTCT) treatment. Sickle Cell Disease champion, Hon. Janet Museveni However, this struggle will soon be a thing of the past, as Ministry of Health in collaboration with Sense Interna- tional has established the first visual and hearing screening programme for children with multisensory impairments this project to assist the government In Uganda, there are limited screening between 0-3 years. of Uganda with developing a plan to and Early Interventions (EI) services sustain the screening and Early Inter- for children with sensory and multi-sen- The Early Interventions program is vention programme beyond the life of sory impairments. New-born babies a free service for all children aged the project and roll it out on a wider are not screened for visual and hearing 0-3 years and is available at Entebbe scale in an affordable way. This way, we impairments, nor are they provided with Hospital, Wakiso, Ndejje and Kasangati shall be contributing to the global aim essential and appropriate support in the Health Centre IVs, from Monday to of reducing the prevalence of childhood crucial early years of development. Friday. blindness from 0.75:1000 to 0.4:1000 by the year 2020 among other targets.” This project will therefore ensure that Through this program, children born Josephine Akiru, Country Representa- children born with complex sensory Permanent Secretary, Dr. Diana Atwine addresses the media during the accreditation of the Central Public Health Laboratory in Butabika. with complex visual and hearing impair- tive, Sense International Uganda. impairments, like Aaron, have improved ments will have improved developmen- developmental outcomes, through tal outcomes, by accessing a specialist Under this program, the Ministry of accessing a specialist early intervention early intervention health service. Health recruited Occupational Thera- and rehabilitation health service. pists who are based at each of the health “This program is expected to make a facilities to oversee the daily program “The programme will also provide tremendous contribution towards reduc- activities, which include; screening of data on the prevalence of Congeni- ing child mortality and will provide data children, providing early intervention tal Rubella Syndrome and associated for Government of Uganda to introduce therapy and management of database impairments required by Government Rubella vaccine in the routine vaccina- and reports as well as training of health and other stakeholders to introduce the tion schedule.” Prof. Anthony Mbonye, workers who carry out hearing and Rubella Vaccination at the public health Ag. Director General Health Services. visual screening. Early Intervention facilities, which is not currently being units equipped with hearing and visual provided and yet required to prevent Rubella virus often causes visual and screening and therapy equipment have congenital impairments in children.” Dr. Minister of Health, Hon. Dr. Jane Ruth Aceng tours the USAID Uganda National Ambulance Services at work during the Internation- hearing impairments including congen- been established at each of these health Stanley Bubikire, Program Manager, funded TB Multi Drug Resistant laboratory in Lira Regional Referral al Association of Athletics Federation World Cross Country champi- Hospital onships at Kololo Airstrip, Kampala. ital defects of the heart if exposure of facilities. Disability Prevention and Rehabilita- the virus to the pregnant mother occurs tion. within three months of pregnancy. “From the time I gave birth to my son, I have been wanting to take my child The Ministry of Health, working with With funding support from DFID, this for proper screening and if possible, to Sense international, urges all stakehold- project is currently being piloted in have his eyes operated on to enable him ers to support the successful implemen- Wakiso district and after 3 years (2016- see properly, but I didn’t have enough tation and eventual replication of this 2019) the Government of Uganda will money. Now that Government has come program in all major health facilities roll it out to other health facilities across in to help us, we are so grateful and am across the country, as we move to ease the country depending on the outcomes. hopeful that my Aaron will see well.” access of services for the multisensory Harriet Musiitwa adds. impaired persons. “We aim to use the learnings from 16 17 FEATURED CONDITION Childhood depression What parents and teachers need to know

A message for Parents and teachers Risk factors for childhood depression epression is a common mental dis- Category Special risk factor Dorder that presents with persistent low mood (sadness) or loss of interest Academic Dissatisfaction with grades, School absenteeism in pleasurable activities. In children, Social support Low social support from friends and family depression is rather difficult to identify. Social and Interpersonal conflict with parents, poor coping skills, low Parents and teachers often fail to rec- coping skills self-rated social competence ognize its symptoms especially in very stress Major life event , daily challenges young children. Dispositional Self-consciousness, low self-esteem, emotional reliance( However, as a teacher or caregiver, you factors over dependence on others), internalizing problem behav- very year, World Health day is can identify depression through the ior, past suicide attempts, past depression, past anxiety Ecommemorated on 07 April to focus following; on issues of global concern as a means WORLD In children of 5-10 years, depression • of promoting health. This year, the day Psychomotor retardation (slowed concentrate and make decisions. can be noticed by watching for; thinking and moving) and hypersom- was held under the theme “Depression; 7. Feelings of worthlessness or inappro- nia (excessive sleeping) are more Let us Talk” to raise awareness about 1. Clingy behaviour (the child does not priate guilt. Depression. want to let go of their parent) common in adolescents. HEALTH DAY 8. Fatigue or loss of energy. 2. Refusal to attend school/ finding In order for someone to be diagnosed as Depression is a common mental dis- reason to miss school. having a mental illness, 9. Recurrent thoughts of death with order that presents with persistent low 5 or more of these 9 symptoms below a specific plan for committing the 3. Exaggerated fears/ blown up worries. o mood or loss of interest in pleasurable must exist and must have existed for suicide. activities. This is commonly associated 2017 4. Frequent body complaints such as close to 2 weeks It is important, to note that among with unexplained sadness for at least stomachache, body ache, and head- At least one of the symptoms is either adolescents, depression occurs at almost two weeks, lack or disturbed sleep, loss o aches. depressed mood or loss of interest in twice the rate for girls as it does for of interest in social contact, self-blame Minister of State for Primary Health pleasure. boys. and low self-esteem and this often leads In Adolescents, depression can be no- Dr. Lukwata: Care, Hon. Dr. Joyce Moriku Kaducu o Symptoms cause significant distress to suicidal thoughts or self-harm. notes that Ministry of Health has trained ticed by watching for; in an individual’s daily functioning. People need to know that Causes of childhood depression primary health care workers to recog- 1. Sulkiness (bad temper, bad humour, o Symptoms are not better accounted This disorder is the second leading “ nize and treat depression. moodiness or oddness) for by significant losses like bereave- Among children early experiences cause of disability in the world and depression is ment. o 2. Withdrawing from family activities are a significant contributor to a common among 15-29 year olds. A and “We have sensitized Village Health depression. survey done in 2014 showed that 3 out preventable or school activities can be treated as this Teams (VHTs) in several regions about 10 people had serious depression in depression including identification, 3. Appetite problems (under or over Symptoms o Research has shown that Paren- Uganda and high levels of the condition will reduce the stigma referral and follow up after discharge eating) thus weight disturbance tal depression exposes the child to are most prevalent in Northern Uganda. associated with the 1. Feelings of Sadness, hopelessness depression as they transmit their neg- from health facility” Hon. Dr. Kaducu 4. Loss of energy being miserable and feeling dejected. condition and lead to more adds. ative and low mood to their children Depression is common among women people seeking help.” 5. Feelings of worthlessness. 2. Motivational deficits including Lack through interactions. following childbirth often leading to She urges communities to take keen or loss of interest in normal daily Alternatively they are simply not poor physical development of their interest in their members who manifest activity. o Identification of childhood able to respond to their children’s babies. The condition may also follow symptoms of depression to support them depression 3. Significant weight loss or gain when another mental illness such as anxiety, emotional needs thus leaving the to get care. not dieting causing a change in body children feeling helpless physical illness such as HIV infection, The process of identification for depres- weight of 5% in a single month. heart disease, cancer, drug abuse and sion in childhood is almost the same as to highlight that the condition can be Government is strengthening efforts in (under or over eating) Parents, teachers, childhood depres- harmful use of alcohol. those specified for adult major depres- treated. providing both treatment and psycho- sion is a reality and a big threat to the sion. However the symptoms may vary 4. Psychomotor agitation or slowed social interventions. First line treatment well-being of our children. Look out Dr. Hafsa Lukwata, a Senior Medical with age. progress nearly every day. “People need to know that depression medicines and highly skilled profes- for any of the above signs in the child Officer in the Mental Health Section of is preventable and can be treated as this 5. Insomnia or hypersomnia nearly sional and psychosocial interventions • under your care. Together, we can stop the Ministry of Health, stresses the need will reduce the stigma associated with Complaining about body pains, irrita- every day (under or over sleeping). for depression are available at all levels bility and social withdrawal are more depression before it stops us. to create awareness about depression the condition and lead to more people of care, that is, Health Centre III to common in children than adolescents. 6. Diminished ability to think and and use World Health Day as a platform seeking help” says Dr. Lukwata. Regional Referral Hospitals. 18 19 onE-On-onE WITH referral level we administer electro-convulsive therapy (ECT) on top of the other interventions. A GOOD HEALTH Q: What are the risk factors associated with depression in DR. BASANGWA Uganda? WORKER A: Genetic predisposition is the biggest of these. Other factors is one of the commonest reasons for mental health consulta- include Unemployment, living alone (poor psychosocial support), tion in Uganda. To get a clear picture of this condition from Old age, drug and substance abuse, gender (females are more pre- Depression disposed), associated physical illness, for example in cancer, HIV the Ugandan perspective, we engaged Dr. David Basangwa, A senior Consultant Psychia- and TB patients. In fact, we always encourage healthcare givers to trist and Executive Director – Butabika Hospital. screen these patients for depression and render them appropriate attention. Q: What is the current status of depression in Uganda? Q: What is the most at risk population for depression in Ugan- da? A: Depression globally, is taking on an increasing toll. It is estimated that by the year 2020, it will be the second most A: Females are more vulnerable to depression, and this is attributed commonly diagnosed condition, after heart disease. to a number of factors; In Uganda, we are seeing more and more cases of depression The natural female cycles predispose females to depression. In seeking treatment at Butabika and other health facilities. We some instances, women get depressed as a result of contraceptive do not have updated data about depression because we have use. In the general sense, females take up a lot of responsibilities in not done a study recently to establish the magnitude. However, families and the community. In some communities, all the family previous studies have indicated that about 25% of consulta- burden is rested on the woman, which increases their exposure to tions at primary health care facilities are related to depression depressive illness. There’s also a special type of depression which and a large portion of these are found to be suffering from follows pregnancy and childbirth. All these factors put females depressive illness. From this, we can put the total number of more at risk of getting depressed. Ugandans who suffer from depression every year at 10 - 15%. ccording to World Health Organization Q: What interventions has Government of Uganda put in place Q: Does Butabika hospital receive any cases of depression, (WHO), a health worker is a person who is to tackle depressive illness? A If so, how many cases are received per year? engaged in actions whose primary intent is to enhance health. Health workers protect and im- A: Government is aware of the increasing challenge of depression A: Annually, Butabika Hospital handles about 8000 – 9000 prove health of their communities. There are a amongst the population and has worked round to increase access inpatients. Of these, about 800-1000 are coming because of few qualities that a health worker should possess to care. Depression falls under mental health, and mental health depressive illness. This number only covers those that are and these are: has been integrated into general healthcare. The services are now admitted; yet the majority of our patients are attended to at offered as part of the minimum healthcare package accessed from • Interpersonal/Communication skills: Good outpatient level. In the outpatient mental clinic, we receive the lowest levels of healthcare in the country. communication skills enhance the doctor-pa- about 30,000 patients in a year, and about 4000 of these are Government has also invested in training of health workers in tient relationship. Speaking and listening skills depressive cases. mental Health to ensure adequate care. General health workers at are essential when dealing with patients. It is all levels are now able to recognise patients with depressive illness, important for a health worker to understand Q: What are the common causes of depression in Uganda? offer treatment and if need arises, refer the patients in time. It is now and explain needs and treatment of the pa- a requirement that all health workers in pre-service training must tient A: The majority of depression cases we receive at Butabika have input of mental health before they are passed out. Many of are related with environmental factors. These largely relate • respect: A good health worker should be these health workers come to Butabika Hospital for the training, and with living conditions, domestic violence, inability to take care mindful of the confidentiality of the patient and this facilitates timely care for the patients. of one’s family, loss of a job, and business related challenges. culture and traditions Designated mental health units have been set up at all Regional Environmental situations are the commonest cause of depres- Referral Hospitals, manned by mental health professionals. Butabi- • Emotional stability: Due to the stressful na- sion, closely followed by genetic causes where one inherits the they try to deal with using alcohol or drugs, while others drink ka Hospital has also been refurbished, and is now better placed to ture of their jobs such as witnessing pain condition from a biological parent who has suffered depressive themselves into depression. handle even the most complicated cases of depressive illness and and death, it is important that a health worker symptoms. We also see a number that have encountered or Q: What are the available treatments for depression in Ugan- mental health in general. maintains composure when dealing with pa- survived traumatic situations like rape, accidents, and natural tients and preventing stress on oneself calamities. All these predispose people to depressive illness. da? Q: Advice to the public? • Empathy: A good health worker should be There are also cases of young people who suffer heartbreaks A: Depression is treated according to severity. In mild cases, the empathetic towards his or her patients. He or A: Depression is a common problem that keeps increasing every in love, and many of these end p injuring themselves. Age is patient will only require psychosocial support and some counsel- she should provide comfort and solace to pa- day. However, we have the capacity to prevent it. As is the case with another predisposing factor. As we grow older, we get more ling, from family and friends. When it gets severe, it calls for the tients other conditions, prevention of depression goes along with proper predisposed to getting depression, so the elderly are very intervention of the health worker, and besides the professional self-care. It should not be looked at as an isolated condition; it is • Quick response: It is important to respond vulnerable. This is normally accompanied by other factors counselling and guidance, they will require some medication. part of general health. Take precaution, help and support each other, quickly to emergencies in order to save lives especially the diseases that come with old age. When their Sometimes they take pills to help with their state. These medicines and avoid behaviour that exposes you to depression like violence children leave the home or in some cases the spouse passes on, are available in all public health facilities, at all levels, at no cost. • Punctuality: A good health worker should be and substance abuse. Early consultation is very paramount, if you they go into isolation. When depression gets really severe, one requires to be admitted punctual. This prevents the patient from get- find yourself in a difficult situation - either physical or psychologi- Alcohol and substance abuse is another common cause. This is in the hospital, and managed by competent health workers. If the ting frustrated cal, and for the healthcare givers, please consider early referral. The a two-way factor, some start with depressive symptoms, which medicines given at the lower levels do not help, at the national earlier this is done, the better the outcome. 20

…in the next issue

End of a project: Achievements of the Uganda Health Systems Strengthening Project

The National Health Insurance Scheme; What should Ugandans expect

Know your rights as a health worker, patient.

The upcoming polio campaign

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