HEALTH AND NUTRITION

 Immunization  Maternal health  PMTCT and paediatric HIV  Nutrition  Health systems  Health and nutrition in emergencies

◦ DHOs ◦ NGO partners  ACF(Kaabong, Moroto)  AFLI(Karamoja)  CESVI(Abim, Kaabong)  Concern(Nakapiripirit)  CUAMM(Karamoja)  IRC(Kotido, Moroto, Nakapiripirit)  MSF(Moroto, Nakapiripirit)  URCS(Karamoja)

◦ Bridging plan (Jan-Jun 2010)  Maintain / consolidate  VHTs  Sponsorship  Nutrition coordination / quality care  Data / evidence base ◦ Annual work plan 2010/11  Maternal and newborn health  IYCF  Integration and best practices

Health, nutrition and CAA

Since 2005/06 when Kaabong become a district, it became apparent that access to basic health care services was a big challenge to contributing to achieving the 4 th, 5 th and 6 th MDGs. The major gaps were identified in the maternal and child health and nutrition and HIV/AIDS

The intervention activities implemented during the year under review therefore, were aimed at improving access to basic health care services in these areas. These activities were implemented by the district in partnership with NGOs; CUAM, CESVI, ACF and MSF

 DPT3 coverage improved from 50% in 2007/08 to 63% against 80% target  ANC 1 st visit at 45% and 4 th visit reduced from 33% to 20.4% against 60% target.  Institutional deliveries have improved from 5% during 2007/08 to 6.7% this year against a national average of 34%.  Pregnant women tested for HIV have improved from 22% last year to 34%.

 HIV prevalence among pregnant mothers has reduced from 2.6% last year to 1,6%.  71% of HIV exposed children have been tested for HIV against a target of 50%.  90.9% of these children have been started on co-trimoxazole against a target of 10%.  The number of HC IIIs and above providing PMTCT services have risen from 29% last year to 60% against a target of 100% (CESVI & MSF).

 Under nutrition, the district GAM has reduced from 15% in 2007 to 9.5% to date.  Under infrastructure, CUAM has constructed three staff houses and fenced two health facilities.  Staffing for midwives has improved from 5 to 10 with support from CUAM.

 Involvement of VHTs in mobilization activities.  Ringing of bells at the out post as a mobilization strategy.  Use of a mobile public address system as a mobilization strategy during implementation (use of police vehicles).  Engagement of operational partners (NGOs).  Institutional out reaches for Albendazole and TT in schools

 Inadequate human resource.  Lack of infrastructure and equipment leading to poor access.  Poor data capture and management.  Unrealistic population estimates.  Poor quality of available health services.  Insecurity  Poor referral system

Increase access to quality health care through;  Task shifting.  Recruitment and training of health workers.  Establish and equip service centers.  Improve mobilization strategies.  Establish a strong monitoring and evaluation framework.

Health, nutrition and CAA Kotido district

 1 HSD-District with 17 health units  Total district population of 188,100  38,561 under fives.  9,405 pregnant women  38,000 WCBA.  8,088 infants

Health, nutrition and CAA

 1 HSD-District with 17 health units  Total district population of 188,100  38,561 under fives.  9,405 pregnant women  38,000 WCBA.  8,088 infants

 EPI  Mass polio activities.  Support to routine outreaches.  Sunday TTV non pregnant WCBA.  Build capacity of health units to plan for catchment pop.  Maternal health  Integrated PMTCT/ANC outreaches.  Build capacity for commodity management to ensure no stock-outs of commodities for ANC in all HC 3 and 4's  C.A.A  Support establishment of ART clinic and monthly Paediatric ART outreaches.  Procure supplies and logistics for PMTCT and pediatric care services.  PMTCT outreaches

 Nutrition  Opening of TFC in Kotido H.C.4  Provision of supplies to the TFC and OTP.  Trained 3 H/W’s from Kotido H.C.4 on mgt of acute malnutrition.  Child days plus activities  Strengthening community based systems  Rollout of the VHT system in the district  Production of monthly reports.  Strengthening facility based health systems  Promotion of the retention and usage of all LLITNs in the district  Community Education/ campaign about ITN

 DPT 3 5,278 (65.3%)  TTV 2 non pregnant 12,473 (32.8%)  TTV 2 Pregnant 5,509 (58.6%)  TTV 2 Non Pregnant 5,509 (43.6%)  ANC 4 th visit 2,193 (23.3%)  IPT 2 2,783 (29.8%)  Deliveries 1,034 (11.3%)  PMTCT 4,737 (50.4%)  VHT,330(100%) Coverage  Vit A(1 st round- 111%, 2rd round -106%)  Deworming(1 st round- 75%, 2rd round -66%)

 Use of VHT’s in mobilize of the population(mass polio & measles campaigns.  Use of religious leaders to help boost TTV non pregnant.  Setup of a coordination mechanism at the district health office to regulate the use of the village health teams by the different partners.

 Frequent campaigns interfered with routine activities.  Difficulty in data capture as indicators are not present in HMIS(PMTCT & Nutrition).  VHT's not adequately involved in routine mobilisation and monitoring especially EPI.  The VHT reporting format requires serious review.

 Train VHT’s in the different modules.  Training members of the VHT's on use of child health card as a monitoring tool for assessing EPI coverage in villages.  continue the Sunday TTV non pregnant initiative and expand to schools & institutions.  Continue with integrated outreach activities  Train 30 health workers in mgt of malnutrition at TFC and OTP level.  Organize a strategy to target the 6-14 year olds, especially those to be found in the grazing areas(leave albendazole with the VHT's overnight for 3 days to continue administering the drugs)

Health, nutrition and CAA Moroto District 20 th Nov 2009

 Population: 276,000  WCBA: 63,480  Preg. Women: 14,352  Children <5 Yrs: 56,580  Children <1 Yr: 11,868  3 HSDs with 2 Hospitals, 9 HC IIIs, 9 HC IIs and 2 Mobile Clinics

 EPI  Micro-planning for Outreaches  Routine Outreaches  Outreaches to the Hard to Reach Areas  5 rounds of Mass polio Immunisation campaigns.  One round of Mass Measles Immunisation  Child Days Plus activities in July  Maternal Health  Training of Health Workers on ANC +.  Support to the Supply Chain Management.  Support to integrated Community Outreaches.

 VHTs  Involved in the community mobilisation in support for the Mass Polio Immunisation campaigns.  CAA  Support for Early Infant Diagnosis through DBS.  Support for Integrated Outreaches.  Support Supervision and Monitoring of the PMTCT and Paediatric HIV AIDS programmes.

VariablesNumbersPercentageDPT TT2 Non Preg Women TT2 Preg Women ANC 4 th Visit IPT Deliveries in HUs PMTCT Mothers HIV Tests VHTs Trained VHTs Active

 Involvement of Stakeholders in Routine Activities and campaigns  Involvement of VHTs in Community Health service delivery  Coordination of Health, Nutrition and HIV/AIDS SGs

 The Numerous Polio Campaigns.  Not all indicators are Captured in the HMIS, incomplete and late reporting  Low VHT coverage and the drop out rate is high for the trained.  Late release of funds Vs work plans.  Excessive bureaucracy and paper work in requests and reporting.  Little or no involvement of LGs in partners proposal reviews.

 There is need to harmonise the selected indicators with the available data tools  HMIS strengthening at the District and the LLUs including appropriate HRs, Trainings, Support Supervision and Mentoring are very essential.  VHTs; An appropriate selection, Training, supply of tools, Motivation as well as support for the routine running costs should be catered for.  Timely release of funds!  The bureaucracy; can the hassle be reduced?!  It is important that the LGs are involved in reviewing the Project Proposals of the District implementing partners

ALAKARA NOOI

Health, nutrition and CAA ABIM DISTRICT 33

 1 HSD-District with 18 HUs and a district hospital  Staffing position at 60.4% & technical at 44.6%  Doctor patient ratio, 1 to 30,328 people  Midwives, 1 to 348 pregnant mothers  Health system strengthening on track; district league standing from 52 to 49 to 29 in the past three FYs 34

◦ 5 rounds of mass polio-March to October ◦ Child days-April & October ◦ Trainings-HMIS, TT, full ANC package ◦ Setting up ORT corners in all the HUs ◦ Routine EPI outreach support to all HUs ◦ Radio messages on malaria, diarrhea and pneumonia ◦ Training of pediatric core team/TOTs ◦ PMTCT outreaches + CESVI ◦ HSD/DHT/Integrated monitoring of CSD&CAA 35

INDICATORSTARGETACHIEVEMENT EPI (Infant) DPT3100%104% Measles100% TT2 Pregnant70%81% Vitamin A100%96% ANC 1 st Visits100%94% 4 th Visit50%38% IPT260%34% HU deliveries50%30% 36

INDICATORSTARGETACHIEVEMENT TFC death<10%19% % of exposed children tested for HIV50%100% % of exposed children on CTX prophylaxis10%93.4% Functionality of H/C3 and HOSP100% % of pregnancies tested for HIV80%90.1% % of HIV+ women given ARVs for PMTCT50%69% % Villages with functional VHTs100%30% % of VHTs reporting monthly100%32% % VHTs trained; mal, diarrhea & pneumonia100%0% 37

 Involvement of VHTs, Red Cross Volunteers, LCs, Parish chiefs & teachers  Through & through involvement of stakeholders & development partners  Strong supervision from HSD& DHT  Mentoring/training on data management, human resource for health  Use of ICT for reminders on key issues  Coordination meetings for CAA and CSD 38

 Data management incapacities  Human resource inadequacy  Medical supply management problems cf gas/vaccines, medicines.  Inadequate transport for referrals, outreaches & follow up  Numerous new settlements e.g. Kobulin & Camkok  Insecurity cf mass polio  VHT functionality ????? Ownership and facilitation  Population (54, ,400) cf 90,713 39

 Strengthen community involvement and participation in health service delivery cf VHTs, TBAs, LCs, Parish chiefs and Development partners  Strengthening supervision by DHT/HSD and HCIIIs  Continuous training/mentoring on data and health logistics management  Harmonizing coordination of core teams for CAA and CSD 40

 Use of ICT for communication/data base set  Human resources; recruitment and training of new personnel e.g. midwives cf 32  New acceptable population figures Can UBOS support be tapped?  Facilitate monthly mobile clinics 41

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 BDR  VHTs  Data collection and management  Social mobilization for child survival  School health (deworming, TT)  Disaster risk reduction and emergency preparedness / response  Human resources

Health & nutrition CAA by District Health Officer Nakapiripirit

Overview:  3 HSDs  2 HC IV, 1 HOSP, 6 HC III, 7 HC II  Staffing at least stands at about75%  Most health facilities are with in 5km from catchment populations  Doctor patient ratio is 1:46,000  8 ANC/PMTCT/Paediatric sites  Partners:UNICEF, WFP, SAVE THE CHILDREN, CUAMM, IRC,CONCERN

 NUTRITION  Target At least 50% of children with severe acute malnutrition are identified and treated  2 TFCs and 10 OTCs operational in the district  U 5 Screened 58,502 and 740 treated

 ITN coverage >90%  100% coverage of VHTs; 240 VHTs functional  DPT3 coverage 60%  Measles coverage 85%  TT2 coverage 34%

CategoryResults Estimated no. of pregnant women (5% of total population) 11,538 No. and % of pregnant women counseled and tested for HIV (Target: 80% of all new ANC attendees) 3272(28%) No. and % of HIV positive pregnant women identified. 48(11%) No. and % of pregnant women who received ARV prophylaxis (Target: 50% of HIV positive women identified) 42(9.8%) No. and % of HIV positive pregnant women accessing cotrimoxazole prophylaxis (Target: 70% of identified HIV positive pregnant women) 48(11%) No. partners tested for HIV811(7%)

No. and % of children born to HIV positive mothers who are tested for HIV using PCR. (Target: 50% of children born to HIV positive mothers) 48(15%) No. and % of children born to HIV positive mothers who access ARVs for PMTCT. (Target: 40% of newborns to HIV positive women identified) 28

 Many mothers have learnt the nutritional program & can now mobilize others to bring their children to the program  Innovative approaches to reach highly pastoral/mobile communities  Use of pre-packed Nevirapine increases the ARV prophylactic uptake among children.

 A few mothers still misuse plump nut  Inconsistence funding  Poor health seeking behavior of the people  Occasional stock out of gas  Hard to reach nature of the district and some communities leaving in the mountain  Inadquate space in most of the Hus  Long distance to be moved by mothers

 Lack of transport in most of the health centres  Inadequate human resource in most health units

 Strengthen integrated outreaches to hard to reach areas  Intensify routine EPI outreaches  Avoid gas stock outs  Support child days planning and activities  Need for continuous sensitization at parish level in ITN use  Need for monthly mobilization of communities for ANC

 Build capacity of VHTs to promote early ANC visits  Support health centre 2 to hard to reach to provide ANC services  Need for refresher training for health unit in charges and record assistants  Support sponsorship of students  Build maternity block and laboratory in Karita HC III

 Support monthly meeting btn HU in charges and VHTs  Refresher training for VHTs on mgt of fever, diarrhoea and pneumonia  Need for quarterly review meetings wit VHTs  Strengthen Paediatric care and treatment strengthen the community follow up and referral of HIV positive pregnant women and their children for comprehensive ART services

THANK YOU VERY MUCH