Healthy Child Uganda has developed many different programs to reduce maternal, newborn and child deaths. Many HCU activities provide training for university faculty and staff, health care workers, and community volunteers. Other activities encourage community development and innovation. Here are some examples of what we do:
Training Courses and Model Programs
CHW Training and Model Program
CHW Training and Model Program (2004 – 2009)
Between 2004 and 2009, Healthy Child Uganda developed and implemented a model CHW program in 175 villages in southwestern Uganda. Two volunteers were selected from each village (by the village community itself) and were then trained as CHWs to promote child health. During a 5-day course, these volunteers learned to treat and prevent common illnesses, and recognize when to refer sick children to hospitals. They met monthly with local health centre staff for retraining and reporting. CHW responsibilities include:
- Visiting homes with pregnant women, newborn babies, and young children
- Conducting health education presentations
- Organizing health and development initiatives within their own villages
- Encouraging parents to take children for immunization and weighing
- Assessing children when they are sick and determining if they need to go immediately to a health centre or if they can be treated safely at home
- Advocating for children in their village, especially those with special needs
The HCU CHW Model (locally known as the “CORPs Model”) has been extremely successful. Retention of volunteer CHWs after 5 years exceeds 80%. Fewer children are sick and malnourished and child deaths have reduced dramatically (by more than 50% according to CHW monthly reports). An encouraging spin off has been tremendous enthusiasm and empowerment among these volunteer CHWs and many new innovations and community projects.
Village Health Teams
Village Health Teams (2009 – Present)
Today, the CHW programming is expanding and evolving throughout Uganda. Uganda now recognizes CHWs as a formal part of the national health care system with hopes that soon all Ugandan villages will have teams of CHW’s (Village Health Teams, or “VHTs”).
The HCU CHW model was easy to modify to the national VHT program and HCU was well-positioned to make the transition; HCU has been helping to train and support new CHWs (VHT members) in its project areas. At this time, there are over 5,500 active HCU-trained CHWs/VHT members in rural Uganda.
Integrated Community Case Management
Integrated Community Case Management (2010 – 2013)
ICCM means that CHWs are trained to give simple medicines to children sick with malaria, pneumonia and diarrhea. HCU has partnered with the Ugandan Ministry of Health and partner NGOs to develop this national activity. VHT members were trained to give these medicines with hopes that children in rural Uganda will have better access to life-saving treatments.
HCU researchers also be tested how best to train health workers for the distribution of such medicines and to look at the potential for mobile phone use by CHWs.
Community Development Training
Community Development Training (2007 – Present)
Because of the education they have received and their role in the community, CHWs can clearly see the many barriers to better child health. Poverty, poor water and sanitation, limited infrastructure, transportation problems and gender issues all contribute to poor health. In response, HCU has initiated special CHW workshops on topics such as development and gender, leadership, how to generate income and build community infrastructure.
We have also arranged for specialized training on these topics:
- Energy efficient store building
- Biosand water filtration (in conjunction with CAWST)
- Small business management (in conjunction with change Agent)
- Growing orange sweet potatoes (in conjunction with Harvest Plus)
Health Centre Staff Training
Health Centre Staff Training (2004 – Present)
At the request of the district and health centre staff themselves, HCU has provided training courses for nurses, midwives, clinical officers and lab technicians from local health centres. Courses have included: HBB (Helping Babies Breathe/Newborn resuscitation), IMCI (Integrated Management of Childhood Illness), EmOC (Emergency Obstetric Care), ENC (Essential Newborn Care), (in conjunction with Save the Children and MUST paediatrics), Nutrition, and special care for children with disabilities (in conjunction with OURS).
“I attended a one-day Newborn C-IMCI workshop recently and they told me that when a baby is born, we should put the baby on the mother’s stomach (Kangaroo Care) while waiting for the placenta to deliver. I have been doing that ever since and I have noticed that babies are much healthier… Before, we had cases of hypothermia occurring. This is such a great thing to know how to do!“
Nutrition Training (2010 – Present)
As a pilot project, VHT members from several villages in Kitungura Parish were chosen to attend a 5-day Nutrition Leadership Training to learn about advanced nutrition. A 2-day Nutrition training was also conducted in Bushenyi and Rubirizi between 2012-2014, as part of the Healthy Child Uganda Muskoka Project, funded by the Department of Foreign Affairs, Trade and Development Canada. These VHTs will now share their knowledge in growing, selecting, and preparing locally available foods with their communities.
Research Methods Course
Research Methods Course (2006 – Present)
Out of the partnership between MUST and our two Canadian university partners (Dalhousie and Calgary), an idea was generated for a 2-week Research Methods Course. This is now being offered annually to MUST faculty and post-graduate students. Using a multidisciplinary, small group, problem-based approach, experienced Canadian tutors are partnered with Ugandan colleagues to lead seminars focused on answering real life, practical health-related questions; they explore issues of how to develop research projects and proposals, methodology, publication and personal career development.
MUST Student Placement and Twinning Opportunities
MUST Student Placement and Twinning Opportunities
Healthy Child Uganda and MUST support opportunities for students to work in rural communities and gain experience. Each year, 40 students from MUST’s faculties of medicine, nursing, and lab science work for 4 weeks at selected health centres. Students receive valuable education during this time while they are linked with rural communities and providing much-needed services at these health centres.
HCU has also offered elective “student placements.” Since 2008, teams of students from MUST’s faculties of development studies, education, science and medicine spent one month together with selected communities, exploring and addressing specific health and development issues.
Through a “twinning program,” students from development studies are offered a unique opportunity to be matched with a rural village. Paired students visit their village at least once a month for a full year. They work with the community to set goals that address major health and development issues, and then implement initiatives for change.
Research and Evaluation
Research Grants and Operational Research
Research Grants & Operational Research
A significant benefit of the university support associated with HCU has been the interest and capacity to support research, monitoring and evaluation of models and programs. We conduct operational research, impact evaluations, and undertake micro-research projects. Basically, we want to know what is working, what isn’t and why. We are fortunate that donors and research-granting bodies have recognized the importance of such evaluation and are supporting this important work.
Here are examples of our previous research projects:
- What are local barriers and enhancements to child health? (CIHR-funded)
- What motivates volunteer CHWs? (AUCC-funded)
- How can volunteer CHWs be retained? (CIDA-funded)
- How can we evaluate the CHW model? (using qualitative and quantitative assessments and operational data) (CIDA-funded).
Major research projects have included studies of Integrated Community Case Management (iCCM), use of mobile phones by CHWs, program cost-analysis and long-term CHW retention (all IDRC-AHSI-CIDA funded).
MicroResearch recognizes that locally relevant questions need to be asked and answered, especially those posed by community or health system stakeholders. Like “micro finance,” “micro research” involves a series of small grants that are offered to local multidisciplinary teams comprised of community members, health providers and academics. These teams develop and ask ongoing research questions that are immediately relevant to local and applied health issues in their community.
A more formal micro research training, mentoring and funding program has been developed for MUST and other East Africa institutions. There are currently several micro research studies underway by MUST researchers that receive small grants from HCU.
 “MicroResearch” has been described in the Canadian Medical Association Journal (MacDonald 2008).
Special Child Program
Special Child Program
In every community there are children who are particularly vulnerable – orphaned, neglected, disabled, severely malnourished, or continuously sick. Healthy Child Uganda trains CHWs to refer and/or accompany these children to local health centre staff. Following assessment, the HCU team and the CHW make regular home visits to check on the child’s progress. Support for the child and its family may involve help with social issues, with advocacy, or with medical treatment and supplies, rehabilitation and nutritional supplementation.
HCU and CHWs have many motivating success stories about special children. To date, HCU has helped more than 200 “Special Children” who have been registered with the program. Here are some of our success stories:
- Many children with severe malnutrition have been successfully rehabilitated
- Several children with clubfoot, hydrocephalus, spina bifida, and Down Syndrome have undergone rehabilitation and surgical treatment
- Dozens of orphans missing one or both parents have been supported
- Several abused or abandoned children have been relocated or supported within their families while under continuing care
- Children suffering from severe cerebral palsy have been provided with local rehabilitation
- A number of children are currently being treated for epilepsy
In 2007-08, a Canadian non-profit called Buy-A-Net provided a generous donation of 12,000 bednets to prevent malaria. These were distributed by CHWs to local homes with children under 5 years old or with pregnant women. Since then, the rate of bednet use has improved from less than 4% to over 40% and many fewer children are suffering from malaria.
Our HCU communities have developed the following demonstration sites:
- Local communal gardens have been planted by several communities.
- “EcoSan” Latrines (toilets): A new EcoSan model latrine has just been completed in Rugazi parish.
 “EcoSan” is an abbreviation for Ecological Sanitation. An EcoSan toilet is one that is designed according to the principles of Ecological Sanitation, and is a safe, hygienic and environmentally-sustainable model. For examples, see:
Model Homes Competitions
Model Homes Competitions
The “Model Homes Competition” concept is an original CHW idea. Homes in local villages were challenged to show how they could be “healthy child homes.” Criteria were developed by CHWs; an ideal home has children who have been immunized and have health cards (to keep records), it has a source for safe drinking water, it has a healthy garden, it boasts a clean latrine, etc. Winners are determined by local judges and locally collected; prizes are awarded for the best home within a village and also the best one among several villages.
The idea has spread. Now annual contests are held in hundreds of villages and thousands of homes have been judged for their “healthiness.”
Health Centre Upgrades
Health Centre Upgrades
Thanks to generous support from the Department of Foreign Affairs, International Trade and Development Canada, as well as private donors, HCU has been able to implement upgrades at local health centres. Here is some of the progress we have made:
- Equipment provision for maternal and child health services for over 50 health facilities
- 72 health centres have been painted with colourful illustrations and messages about health education
- Upgrades have been made to the Rugazi Health Centre Hostel used by visiting students and faculty
- More than a dozen health centres have had water harvesting tanks installed (they had no running water before)
- At least 1 health centre has been fitted with solar power to help ensure vaccines are safely refrigerated and to enable nighttime emergency care
- Support for a local young adult to attend a laboratory technician college so that he could provide much-needed services to his community
National Child Health Days
National Child Health Days
Twice a year CHWs support “National Child Health Days” which are a country-wide initiative. On these days parents are encouraged to bring their children to outreach clinics staffed by local health care providers where children are vaccinated, weighed and given vitamins. CHWs assist and give health education during these events.
Other special outreach clinics are organized by HCU with the participation of Canadian and Ugandan paediatricians, rehabilitation specialists, social workers and other health service providers. The team assesses and treats children with special needs, and vaccination clinics are offered during outbreaks or in areas with low vaccination coverage.
Healthy Child Uganda Muskoka Project
Healthy Child Uganda: Scaling Up Comprehensive Maternal, Newborn and Child Health Programming to Create a Model District in Bushenyi, Uganda Project (2012 – 2014)
The Healthy Child Uganda (HCU): Scaling Up Comprehensive MNCH Programming to Create a Model District In Bushenyi, Uganda project is funded by the Canadian International Development Agency (CIDA), through the Muskoka Initiative.
The project builds up on an community-based HCU model that was originally developed by Mbarara University faculty and local leaders in response to unacceptable child mortality and morbidity in local communities. This project involves partnership between Mbarara University of Science and Technology (MUST), Bushenyi Health District, the Canadian Paediatric Society (CPS), and the University of Calgary (UC). Strong partnerships between Ugandan, Canadian, International organizations and institutions, as well as with community, has contributed to the successful implementation and evaluation of the HCU model since 2003.
With the support from the Muskoka initiative, HCU is expanding the Maternal, Newborn and Child Health (MNCH) program from the sub country level to the entire Bushenyi Health District and later into neighbouring Rubirizi District.
“To significantly improve the health and survival of pregnant women, newborns, and young children living in the Bushenyi and Rubirizi Districts in southwest Uganda through the delivery of a comprehensive MNCH package.”
District Health Strengthening
- Support district decision makers in developing a gender sensitive, long term, strategic plan
- Strengthening health information, inter-facility and referral systems
Improving Health Centre MNCH Service Delivery
- Capacity building of staff and facilities to enable safe deliveries, acute treatment for sick and malnourished children and primary health services
Enhance MNCH Programming at the Community Level
- Extensive training of MNCH-focused volunteer community health workers (Village Health Teams- VHTs)
- Evaluation and documentation will ensure that female and male policy makers throughout Sub-Saharan can learn from and replicate the Bushenyi District experience as a sustainable model for integrated, comprehensive MNCH delivery with subsequent testing of scale up in nearby Rubirizi District.
Collaborative work towards the improvement of health outcomes for mothers, newborns and children in Bushenyi and Rubirizi Districts provides HCU with an exciting opportunity to scale up to the district level broad and effective package of MNCH interventions. This includes the implementation of training programs and tools developed during the past decade, bringing together communities to support the health of mothers and children.
Activities seek extensive consultation with district, MUST and Ministry of Health representatives to refine model content and implementation strategies.
Management & Implementation
A team from the Bushenyi District, comprised of existing managers, health centre staff and VHTs manage the day-to-day project activities related to health service delivery.
An HCU Field Team, comprised of Ugandan field coordinators plus field staff, volunteers, and faculty are housed at the Mbarara University of Technology (MUST). The team oversees non-health service delivery activities and will lead project-specific planning, monitoring, and preparation of reports. The team reports to the Project Steering Committee, who are responsible for modifying, finalizing, and approving project plans/budgets, and conducting ongoing risk assessments.
Four joint Ugandan-Canadian technical teams, one for each of the major project activity components, oversee the training development and ongoing modification of training tools, provide input and guidance for quality assurance, documentation, and overall progress towards project outcomes.