Working with communities to tackle malaria in Uganda HENRY TITO OKWALINGA PROJECT OFFICER, MALARIA, AMREF UGANDA

2 OVERVIEW 1.About AMREF 2.Malaria in Uganda 3.AMREF & GSK’s Uganda Malaria Partnership Programme (UMPP) 4.Lessons Learned

3 ABOUT AMREF AMREF improves the health of poor people in Africa through: 1.Building capacity of local institutions to manage and deliver affordable, accessible health care 2.Empowering communities to engage in health delivery 3.Piloting and replicating innovative approaches to health development. eg: through harnessing new technologies, such as eLearning and telemedicine 4.Health systems research to influence policy and practice AMREF targets the most vulnerable: mothers and children, nomadic populations, IDPs and people living in remote rural areas and urban slums.

4 THE MALARIA SITUATION IN UGANDA Malaria is number one killer of children in Uganda 95% of Uganda subject to intense perennial malaria Key risk groups are children under five, people Living with HIV/AIDS and pregnant women Malaria accounts for: 51% of out patient department attendances 47% of under five mortality 30% of deaths during pregnancy

5 THE UGANDA MALARIA PARTNERSHIP PROGRAMME (UMPP) Project developed in response to GlaxoSmithKline's African Malaria Partnership focus on community behaviour change and AMREF’s focus on community-based health care Implemented in 3 districts in Uganda over 3 years, targeting children under five and pregnant women Operated as a consortium with four NGOs and in collaboration with district health services Funding and technical assistance provided by the GlaxoSmithKline Africa Malaria Partnership Technical support and guidance provided by Ministry of Health (MOH)

6 UMPP GOAL To reduce malaria related morbidity and mortality among children under five years of age and pregnant women STRATEGY Promote use of ITNs by both pregnant women and children under five Promote home based management of fever (HBMF) among under fives Promote Intermittent Presumptive Treatment (IPT) of malaria in pregnancy

7 IMPLEMENTATION Partnership with Government Formation of District and Sub-County Coordination Committees Partners Review Meetings with Ministry of Health Building Local Capacity Training of Community Medicine Distributors (CMDs) and health workers Support of CMDs at household level Communications materials, film shows/drama to promote HBMF, IPT and ITNs Accelerating Replication Documentation and dissemination workshops to accelerate replication of project activities Supported sub-county and district leaders to develop annual malaria plans and budgets to ensure sustainability of UMPP activities

8 RESULTS ITNs High demand for ITNs An increase in households with one ITN from 25% to 76%. Morbidity and Mortality Reduction in cases of complicated malaria among under fives from 25% to 3.2% Reduction of malaria-related deaths among the U5s from 6.4% to 0.1% Reduction of malaria episodes among U5s in a year from 6 to < 3 An increase in children receiving treatment for fever within 24hrs from 34% to 84%

9 RESULTS contd Retention of CMDs A drop out rate of CMD volunteers of 6.8% (vs 37% in non-UMPP districts) Scale-Up Using UMPP models, AMREF has secured over $7 million for scale-up in central and northern Uganda CMD model adopted by Government of Uganda and scaled-up in 72 districts

10 LESSONS LEARNED 1.Highlighted the importance of community based behaviour change communication to reduce morbidity and mortality due to malaria 2.Maintaining high levels of CMDs performance and retention requires provision of effective training, support and incentives 3.Decentralisation channels resources directly to beneficiaries, actively involving them in the activities and ensuring that donor money reaches the grass roots 4.Working in close partnership with Government contributes to national-lead initiatives, accelerates scale-up and builds local capacity

11 Thank-you To GlaxoSmithKline’s Africa Malaria Partnership To Ministry of Health in Uganda To Malaria Consortium for technical support To our partners – Africare, Uganda Red Cross and Communication & Development for Uganda