ICWEA executive director, Lillian Mworeko, speaking during the national dissemination of the community scorecard findings meeting at Golf Course hotel, Kampala. Photo by Elvis Basudde
HEALTH | HIV/AIDS
As the effects of the COVID-19 pandemic continue to bite hard, a community scorecard assessment (CSCA) to monitor health service delivery in a variety of diseases has revealed that Uganda is making steady fast progress.
The International Community of Women Living with HIV Eastern Africa (ICWEA) together with the Global Fund conducted the community scorecard exercise for TB, malaria, HIV/AIDS, gender equality processes, and human rights aspects to improve social accountability across thirty-two districts, covering randomly selected 168 health centres from level 111 to 1V hospitals.
Quoting evidence from communities’ highlights strength gaps in health service delivery in Uganda, the scorecard indicated that in general, health service delivery performance was ranked as performing well.
“The participants largely attributed the good performance to investment in the HIV prevention, malaria prevention, focused Sexual Reproductive Health education and counseling services and focused community health programs,” the scorecard states.
Adding, “Other attributes include Social Behaviour Change Communication (SBCC) /Health promotion interventions, integration of services to ensure reach of all vulnerable populations like expectant mothers and under five years.”
The ICWEA executive director, Lillian Mworeko, said a community scorecard is an important tool; it gives us the community perspective of the government policies and guidelines that we are implementing, on top of giving the service beneficiaries a voice.
She said that before this assessment, they knew that these HIV prevention services worked well at a national level, yet it was not clear how the beneficiaries perceived the services at various health facilities-or even if it would be possible to almost all HIV indicators performing well.
“The scorecard basically gets views from both the service providers and then the beneficiaries. This new analysis demonstrates that scaling up combination HIV prevention is possible and can turn the tide of the epidemic,” Mworeko said
She was speaking during the national dissemination of the community scorecard findings meeting on Friday at Golf Course hotel, Kampala.
The scorecard, however, shows there is low performance of key health areas.
“Especially on the quality of psychosocial services, rights awareness and support, availability of legal support and social services, the existence of sexual and gender-based violence, and related maternal health indicators cervical and breast cancer routine screening services were not satisfactory,” revealed the scorecard.
Mworeko said that this low performance is attributed to various factors from un-enabling environment to enforce policies, gaps in the health workforce, and infrastructure challenges.
Speaking on behalf of, Dr Nelson Musoba-Director General UAC, Charles Otai noted that as a country, we have made great strides in the fight against the epidemic from the 1990s by reducing the prevalence from about 18% to 6% in 2017.
“We have also been able to reduce new HIV infections by about half in the past 10 years. We reduce about 94,000 infections per year but as per 2019 we had 53,000 new infections. We have also been able to reduce the modernity rates due to HIV/AIDS by almost half in the past 10 years where we used to have about 53,000 deaths per year. By last year, we had 21,000 deaths attributed to HIV and AIDS,” he said.
Otai revealed that Uganda is among the first countries globally to achieve the 2nd 90 and 3rd 90 by enrolling 90% on antiretroviral therapy (ART) and 90% viral suppression.
Uganda was one point less to achieve the 1st 90, meaning 89% of people living with HIV were tested and knew their HIV positive status.
“The scale of 89, 90, 90 is exceptionally good performance, a big milestone as a country. We are now 11% away in the first 90, 10% away in the second 90, and 10% away in the third 90,” he said.
UNAIDS recently released a report indicating that at the end of 2019, 14 countries including Uganda had achieved 83% target.
We have also been able to have a sustainable number of people living with HIV of 1.4 in 2019, and all these efforts have been achieved because of the evidence based policies by the government supported by a comprehensive multispectral response.
Having achieved the 90, 90, 90, Otai says the government is now timing the 95.95.95 targets by 2025.
But before we go there, we need to interrogate why we failed to achieve some targets, because there are about 200,000 people who are living with HIV in Uganda but they don’t know.
Globally, about 78 million people have been infected with HIV and 35 million people, close to the current population of Uganda, have died from AIDS related illnesses since the start of the HIV/AIDS epidemic.
Otai said we should not fail to identify those people who have HIV but they don’t know, and that we should double our efforts to identify them to prevent new HIV infections otherwise if we don’t identify them there is potential for us to reverse our gains in fighting HIV.
Dr Maggie Kigozi, chairman of the Uganda Country Coordinating Mechanism (CCM) Board of Global Fund, hailed ICWEA for conducting the community scorecard exercise which brought out issues that affect the health system in Uganda.
“We are pleasantly surprised to read this very great work that you have done to give us evidence based facts that even the government can use to plan. You have been demanding and I am happy to say we as Global Fund have delivered,” Kigozi said.
Adding, “Global Fund is a stakeholder organisation right from Geneva, Africa, and nationally. Our role as Global Fund is to mobilize resources, and we want to clap ourselves from moving for four hundred million dollars this year, and next year we have six hundred million dollars. On top of this, we do resource mobilisation for COVID-19.”
Recommandations
Key recommendations were highlighted for various stakeholders including the ministry of health, Uganda AIDS Commission, implementing partners, and civil society organisations.
They range from ensuring that service integration is effective and addressing social -structural barriers in the design of the programs.
Others are to ensure all interventions are reaching the most-in-need and ensuring social mobilisation across the health areas, community awareness about social protection, and anti-stigma interventions.
Creating a supportive environment for key affecting the population, space for and by young people were equally highlighted especially at the health centre.
Also recommended was the training of the health workforce on youth and key population friendly service provision and scaling up advocacy for gender, human rights, and social protection interventions.
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