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Village Health Teams critical in reduction of diseases among under-fives in North Eastern Uganda

By Catherine N. Makumbi

Paul Locham, 58, is seated on a stool attending to a mother who has brought her 3 year old to treat cough. He pulls out a timer to check the respiratory system of the child before prescribing medication for her.

Pneumonia, malaria, diarrhoea are the major causes of illness of children below the age of five. The three illnesses contribute to about 40% of under five deaths in Uganda.

Locham is a Village Health Team (VHT) member providing community clinical treatment in Karamoja, North Eastern Uganda. He is among hundreds of VHTs providing treatment for mild illnesses like pneumonia, malaria, diarrhoea through the UNICEF supported Integrated Community Case Management (ICCM).

Before the introduction of ICCM in Uganda in 2010, a total 33 million cases of pneumonia, malaria, diarrhoea went untreated every in Uganda with a potential loss of 100,000 lives for those cases that ended up becoming complicated.

“I have been doing this work for five years. I am in charge of 100 households comprising of 700 people. I treat children below five years mainly for mild illnesses. We do referral if the situation is severe,” Locham who is also an elder in his village explains.

Among the roles he plays, Locham explained that he mobilises pregnant mothers to attend Ante natal care, mobilise parents to take children for immunisation, use mosquito nets especially for the under five children.

ICCM is part of the VHT strategy for promoting health and preventing death. Through this strategy, VHTs are trained and supported to deliver or promote the use of preventive interventions particularly immunisation, hand washing, optimal complementary feeding, insecticide treated nets and intermitted preventive treatment of malaria during pregnancy.

In Kotido, the VHT Coordinator Eugen Oulanyah said ICCM has been a good programme the past two years as it has reduced outpatient numbers at the health centres.  “We now only handle severe malaria, pneumonia and diarrhoea cases or those complicated at the health centres. ICCM has reduced case fatality rates in communities,” he explains. Oulanyah says case fatality in Kotido communities was 2% and now it is 0.1%.  Thanks to the work of the VHTs. In Kotido, there are 330 VHTs.

Through training, VHTs have had their capacities boosted for effective service delivery.  Peter Loidi, 8, says having VHTs in his community makes him safe because they treat children.  According to Loidi, he has seen a VHT in his community treat many children. Abim District Health Officer Owiny De Paul says, “With the new strategy of ICCM, deaths have reduced. We have also seen the referral system improve.” He added that in 2014, there were 7 deaths in Abim district, a reduction from 54 in 2013 for under five.

Dr. Sharif Nalibe, Kaabong district health officer says the VHTs are doing a great job adding that 30% of the population leave far away from health centres and as such, the VHTs’ roles are very crucial. He commended UNICEF for the support towards VHT.  Kaabong has 760 VHTs trained and equipped to provide ICCM services.

UNICEF Health Specialist Dr. Jackson Ojera says there is plan to integrate drug stocks distribution with that of National Medical Stores, a government agency to ease stock outs. He added that monthly meetings with VHTs is a requirement to review their work and also undertake supervision visits at household levels.

On average, the VHTs in Kaabong district treat 89% of mild cases of pneumonia, malaria and diarrhoea with 24 hours. This is beyond the target of 80%.  The severe cases are always referred to a health facility.

In Abim district where ICCM has just been introduced, malaria admission reduced to 28,400 in 2014 from 34267 in 2013; diarrhoea reduced to 5,302 in 2014 from 5691 in 2013; Pneumonia reduced to 1031 in 2014 from 1033 in 2013. Abim has 618 VHTs who all underwent training.   The number of cases reduced from 60% in 2011 to 55.3% in 2014 (malaria), 10.6% in 201ll to 10.3% in 2014 (diarrhoea), 2.54% to 2.01% (pneumonia).

Through ICCM, the government and partners are bringing services closer to the people in the community, hence reducing inequities to health services. It is currently in 38 districts.
 

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