Assessing Malaria Treatment and Control in Selected … · Stop Malaria Project Uganda Assessing Malaria Treatment and Control in selected Health Facilities vi 3.3.3 Malaria Treatment

Assessing Malaria Treatment and Control in Selected Health Facilities

October 2010

Stop Malaria Project Uganda

Assessing Malaria Treatment and Control in selected Health Facilities ii

Stop Malaria Project is a five-year

program (2008-2013) of

development assistance funded by

the Presidential Malaria Initiative

and United States Agency for

International Development (USAID)

The Project is managed by Johns

Hopkins University Bloomberg

School of public health Center for

Communication programs

(JHU/CCP), Malaria Consortium, the

Infectious Disease Institute,

Communication for development

foundation and the Uganda Health

Marketing Group.

Plot 2 Sturrock Road,

Kololo Opposite Lohana Academy

P.O.box 8045 Kampala, Uganda

Tel: +256 (0) 312 300450

Tel: +256 (0) 312 300421

Fax: +256 (0) 312 300425


Assessing Malaria Treatment and Control in selected Health Facilities iii

Acknowledgements

Stop Malaria Project with support from Focus Development Associates performed the activities that led to the compilation of

this report. The report is based on information collected by Stop Malaria Project, analyzed and reported by Focus

Development Associates a management and Development Consultancy Firm.

The consultancy team comprised of Patrick Nsamba Oshabe, Prosper Behumbize and Dr. Kayita Godfrey. Special Thanks

goes to Dr. William Katamba, Dr. Sam Guidoi, and Flora Gombe from SMP who aided the smooth completion of all exercises

that led to the completion of this report. In addition we appreciate the efforts of supervisors, District Health Officers and

health facility staff of visited centers that fully supported the assessment activities and cooperated with the supervisors


Assessing Malaria Treatment and Control in selected Health Facilities iv


Assessing Malaria Treatment and Control in selected Health Facilities v

Table of Contents

1.0 BACKGROUND TO MALARIA IN UGANDA ............................................................................................................................................ 1

1.2 THE STOP MALARIA PROJECT ....................................................................................................................................................................... 2

1.3 SUPPORT SUPERVISION ................................................................................................................................................................................. 2

2.0 METHODOLOGY AND CHARACTERISTICS OF THE SUPERVISED FACILITIES...................................................................................... 3

3.0 SUPERVISION FINDINGS............................................................................................................................................................................ 5

3.1 MALARIA DURING PREGNANCY ......................................................................................................................................................... 5

3.1.1 Provision of ANC Services ................................................................................................................................................................... 5

3.1.2 IPTp during ANC Visits. ...................................................................................................................................................................... 6

3.1.3 IPTp under DOTs ................................................................................................................................................................................ 7

3.1.4 Routine provision of Folic Acid and De-worming of Pregnant Women................................................................................................. 8

3.1.5 Availability of Supply of Clean and Safe water to administer IPT under DOT...................................................................................... 9

3.1.6 Availability of ANC Cards ................................................................................................................................................................. 10

3.1.8 Utilization of ANC IEC Materials ...................................................................................................................................................... 12

3.1.8 Utilization of ANC IEC Materials ...................................................................................................................................................... 12

3.1.9 Dispensation of LLIN through ANC ................................................................................................................................................... 13

3.1.10 Provision of Health Education Talks during ANC ............................................................................................................................ 14

3.2 HEALTH MANAGEMENT INFORMATION SYSTEM ............................................................................................................................. 15

3.2.1 Existence of up to date HMIS registers .............................................................................................................................................. 15

3.2.2 Completing HMIS Reports Appropriately........................................................................................................................................... 16

3.2.3 Availability of trained HMIS officers ................................................................................................................................................. 17

3.2.4 Availability of data management computer ........................................................................................................................................ 18

3.2.5 Availability of Health Unit Management Committees......................................................................................................................... 19

3.3 CASE MANAGEMENT .......................................................................................................................................................................... 20

3.3.1 Availability of trained Staff to Manage Malaria ................................................................................................................................. 20

3.3.2 Utilization of treatment guidelines in treatment of malaria ................................................................................................................ 21


Assessing Malaria Treatment and Control in selected Health Facilities vi

3.3.3 Malaria Treatment based on Laboratory Diagnosis ........................................................................................................................... 22

3.3.4 Referral of Emergency Cases............................................................................................................................................................. 23

3.3.5 Facility Clinical Audit ....................................................................................................................................................................... 24

3.3.6 Monthly Malaria Case Management .................................................................................................................................................. 25

3.4 LABARATORY MANAGEMENT............................................................................................................................................................ 26

3.4.1 Availability of Functional Laboratory at the Facility ......................................................................................................................... 26

3.4.2 Availability of Skilled Human Resources............................................................................................................................................ 27

3.4.3 Techniques used in Diagnosis of Malaria........................................................................................................................................... 28

3.4.4 Maintenance of Laboratory Equipment .............................................................................................................................................. 29

3.4.5 Preparation of Stains used in Laboratory........................................................................................................................................... 29

3.4.6 Management of Laboratory Data....................................................................................................................................................... 30

3.4.7 Availability of Staff Trained in Logistics Management ....................................................................................................................... 31

3.5 DRUG VERIFICATION ........................................................................................................................................................................... 32

3.6 IEC VERIFICATION ................................................................................................................................................................................ 33

3.6.1Availability of Malaria Specific Health Education Talks ..................................................................................................................... 33

3.6.2 Community Awareness activities about Malaria................................................................................................................................. 34

3.7 SUPPORT SUPERVISION........................................................................................................................................................................ 35

4.0 RECOMMENDED ACTION POINTS......................................................................................................................................................... 36

5.0 APPENDICES ............................................................................................................................................................................................. 37


Assessing Malaria Treatment and Control in selected Health Facilities 1

1.0 BACKGROUND TO MALARIA IN UGANDA

In Uganda, malaria is the most commonly reported disease by both public and private health facilities. Clinically-

diagnosed malaria is the leading cause of morbidity and mortality, accounting for 25 to 40 percent of outpatient visits

at health facilities, 15 to 20 percent of all hospital admissions, and 9 to 14 percent of all hospital deaths. The overall

malaria specific mortality is estimated to be between 70000 and 100000 child deaths annually a death toll that exceeds

that of HIV/AIDs. Nearly half of in-patient deaths among children under the age of five are attributed to clinical malaria.

According to Ministry of Health, Malaria impacts negatively on the household, community incomes and the national

economy, thus keeping

the affected communities trapped in perpetual poverty. Available statistics show that families spend 25% of their

income on malaria. Poor school performance and absenteeism due to malaria reduce chances of escaping from

poverty. Poor people tend to live in environments conducive to mosquito breeding and malaria transmission. Thus

malaria enhances poverty, which in turn causes poor disease management, locking people in a malaria-poverty trap.

Despite the overwhelming burden imposed by malaria in Uganda, there is increasing optimism that the tide can be

turned through the establishment of several initiatives. The United States government launched the President’s Malaria

Initiative (PMI), with the goal of reducing malaria-related deaths in selected countries, including Uganda, by 50% within

five years. Through PMI and other large funding sources, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria,

Uganda have an unprecedented opportunity to reduce malaria associated morbidity and mortality on a national

scale.

Several Policies, strategies and Innovative approaches to malaria control targeting high-risk populations have been

initiated by Ministry of Health and development partners, among which have included; the Malaria Control program,

malaria control policy, malaria strategic plan and a fully fledged malaria consortium to coordinate all these efforts.



1.2 The Stop Malaria Project

The Stop Malaria Project is a five-year program (2008-2013) of development assistance funded by the Presidential

Malaria Initiative and United States Agency for International Development (USAID).

The project is designed to contribute to USAID Uganda’s Strategic Objective of improving human capacity through

improved human health. Specifically the project contributes to program by assisting the government of Uganda to

reach the PMI and Roll Back Malaria (RBM) goal of reducing malaria related mortality by 50%. To help achieve this goal,

SMP uses an integrated set of approaches that reach recipients at multiple levels, including behavioral change

interventions at the individual, household, and community levels, service delivery strengthening at the health facility

level, and institutional capacity building at the district and national levels.

1.3 Support Supervision

As a way of monitoring and evaluating project activities SMP collects data on a number of interventions including rapid

district assessments, support supervision and facility assessment. In months of August and September, 2009 SMP carried

out a support supervision exercise in 14 districts

The purpose of the support supervision was to assess the capacity and gaps of selected health facilities in controlling

and treatment of malaria related cases. The assessment investigated issues related to availability of services, quality of

services, and utilization of services.

Key services investigated included; ANC/IPTp services, Health Unit Management systems, Case Management,

Laboratory, Drug Verification, IEC verification and support supervision. The assessment was carried out in Government,

NGO/PNFP, and Private Health facilities especially those at the level of Hospitals, HCIVs, and HCIIIs.



2.0 METHODOLOGY AND CHARACTERISTICS OF THE SUPERVISED FACILITIES A check list was used as a supervisory tool for the activity. It was adopted from the ministry of health and was reviewed

and revised in the supervisory orientation meetings. In each district Supervisors comprised of two team members from

SMP, a district malaria focal person, the HMIS focal person and Laboratory technician who could be joined with other

members who where previously trained as facilitators in IPTp.

A total of 482 facilities from 18 districts1 where supervised in the

fourth quarter; Majority (55) of them where from Mukono District

followed by Luwero (53), Wakiso (45), Mpigi (44), Hoima (41) Soroti

(34) and Masindi (33). Others included 27 facilities from Rakai, 24

facilities from Kibaale, 20 facilities from Kiboga and Nakasongola.

Katakwi (10), Buliisa (10), Bukedea (11), Nakaseke and Amuria 13

facilities where among the districts with fewest number of facilities

supervised.

Out of the 482 facilities supervised in the quarter majority (376)

were Government aided, 90 were aided by NGOs or faith based

organisations or churches and 16 were privately owned.

Of the 482 facilities supervised 274 were HCIIIs, 133 were HCIIs 43

HCIVs and 22 Hospitals. In some instances supervisors failed to

categorize health facilities especially those that are privately

owned. 2 were from Kaberamaido, 3 from Luwero, 2 from Mukono

and 2 from Rakai District

The supervisory activities where undertaken in the months of July,

August and completed in September 2010. And data analysis and report production commissioned and completed in

October 2010.

1

At the time of collecting this data some districts had been partitioned by government of Uganda, e.g Mukono now comprises of Buvuma and Buikwe, Mpigi

comprises of Gomba and Butambala, Masindi comprises of Kiryandongo etc. For the sake of this report Buvuma and Buikwe where taken as Mukono, Gomba

and Butambala as Mpigi, and Kiryandongo as Masindi.

Number of Supervised Facilities by Ownership

District Name Govt NGO-PNFP Private Total

AMURIA 9 4 13

BUKEDEA 8 3 11

BULIISA 8 1 1 10

HOIMA 33 6 2 41

KABERAMAIDO 10 2 2 14

KATAKWI 8 2 10

KIBAALE 18 6 24

KIBOGA 18 1 1 20

KUMI 13 2 15

LUWERO 32 15 6 53

MASINDI 28 5 33

MPIGI 34 9 1 44

MUKONO 40 14 1 55

NAKASEKE 11 2 13

NAKASONGOLA 18 2 20

RAKAI 24 3 27

SOROTI 26 6 2 34

WAKISO 38 7 45

Total 376 90 16 482



At the time of the supervision of the 133 HCIIs supervised; 91 indicated that they had 3-6 members of staff, 29 facilities

indicated that they had less than 2 members of staff. It was only 8 and 3 facilities that indicated that they had a staff

team of 7-10 members and 11-20 members respectively.

Out of the 274 HCIIIs

supervised 115 facilities

indicated that they had a

staff team composing of 7-

10 members, 97 facilities

indicated that they had 3-

6 staff members and only 5

facilities indicated that

they had less than two

members of staff. Most (20)

HCIVs had more than 20

members of staff, while 18 facilities indicate that they had 11-20 members of staff.

It should be noted however that although a significant number of facilities indicated that they had higher numbers of

staff members, the data-set points out to the fact that a significant number of health workers were off duty during

support supervision. Although most (91) HCIIs had 3-6 staff members and only 29 facilities had less than 2 staff members,

90 facilities indicated that they had less than 2 members of staff on duty, only 40 facilities had 3-6 members present. The

same scenario can be seen with HCIIIs. Although there only 5 HCIIIs that reported to have less than 2 staff members, 55

HCIIIs had less than 2 staff members at the time of the assignment.

When it came to specific health worker staffing2 at facility level; o of the 133 HCIIs only 3 indicated that they can access services of a Doctor, only 18 facilities indicated that they had one or more clinical

officer(s), 71 had one or more Nurses, 63 had one or more laboratory personnel, and only 7 had one or more HMIS officer(s)

o Of the 274 HCIII supervised, only 7 facilities indicated that they had one or more Doctors, 155 had one more clinical officers, 196 had

one or more nurses, 188 facilities had one or more laboratory personnel, and 110 indicated that they had one or more HMIS officer(s).

o Of the 43 HCIVs supervised in this quarter, only 15 had one or more doctors, 29 had one or more clinical officers, 38 facilities indicated

that they one or more nurses, 39 facilities had laboratory personnel and 28 facilities had one or more HMIS officer(s).

o Of the 22 Hospitals supervised, 10 hospitals indicated that they lacked services of a Doctor, 3 did not give their opinion on whether they

had clinical officers, 2 hospitals expressed the desire for Nurses, 3 hospitals did not have a laboratory personnel and 2 had no HMIS

officers at the time of this assignment.

2 For details on staffing go to appendix????

Number of Health Workers at the Facility

Level No Response Less than 2 3-6 staff 7-10staff 11-20Staff 21+ Total

HC II 2 29 91 8 3 133 HC III 5 5 97 115 47 5 274 HC IV 1 1 3 18 20 43

Hospital 3 19 22 Number of health workers Present at the facility during

HC II 1 90 40 2 0 0 133 HC III 10 55 172 33 4 0 274

HC IV 5 0 14 19 5 0 43

Hospital 3 3 16 22



3.0 SUPERVISION FINDINGS The section provides information on key supervisory areas which included, management of malaria among expecting

mothers, health information management system for malaria, management of malaria case, laboratory management,

IEC information, support supervision and drug management.

3.1 MALARIA DURING PREGNANCY

Malaria during pregnancy is associated with poor maternal, obstetrical and infant outcomes. Malaria affects pregnant

women living in both low and high transmission areas. In pregnant women living in high transmission areas, malaria

magnifies the risk of anemia, contributing indirectly or directly to significant morbidity and mortality.

In the malaria control strategic plan 2005/6-2009/10, pregnant women were to be targeted for the distribution with

ITN/LLIN particularly through ANC services. This was expected not only to increase the protection of this vulnerable

group but also help to improve the uptake of ANC services in general.

To increase the proportion of pregnant women receiving two doses of IPTp, SMP distributed malaria in pregnancy wall

charts and gestational wheels to health centers as job-aids. Health workers were trained in IPTp and received regular

supportive supervision. SMP also provided cups and safe drinking water to ensure that directly observed treatment of

IPTp dosing was possible at both public and private ANC clinics.

3.1.1 Provision of ANC Services

SMP intended to find out whether the supervised facilities provided antenatal care on a daily basis to help protect

pregnant women from dangers associated with malaria. From the data-set 135 (28%) facilities indicated that they do

not provide ANC on a daily basis. 3%(15) of the facilities indicated that they do not provide ANC services at all and 8

(2%) facilities did not give their opinion about this ANC query. Katakwi district has the highest percentage (80%) of her

facilities not providing ANC on a daily basis, followed by Kiboga with 45% of her facilities indicating the same. Wakiso

(38%), Soroti (38%), Nakaseke (38%), Amuria (38%), Mukono (33%) and Kibaale (33%) are other districts with a significant

percentage of their respective facilities indicating that they do not provide ANC on a daily basis. Kumi District (93%),

Luwero (87%), Buliisa (80%) and Mpigi (80%) had the highest coverage of facilities indicating that they provided ANC on

a daily basis.

Although most facilities indicated that they provided ANC on a daily basis, it was discovered that although services can

be accessed on all days of the week, there are specific days in almost all health facilities designated for

ANC clinic and most mothers are used to this system. However there health facilities where services cannot



be accessed unless on the designated days of the week3 and facilities where ANC cannot be accessed at all because

they do not have midwives to attend to mothers.

3.1.2 IPTp during ANC Visits.

The current MOH Intermittent Preventive

Treatment (IPT) policy states that; all pregnant

women - even if they do not have fever or other

signs of malaria- should take 3 tablets of

Sulfadoxine-Pyramethamine (SP) once between

4 and 6 months of pregnancy and 3 SP tablets

between 7 and 9 months. Pregnant women

infected with HIV should take 3 doses of SP 1

month apart or stay on cotrimoxazol (e.g.

Septrin).

From table 3 above Amuria (38%) and Soroti (26%) Districts had the highest proportion of health facilities that do not

provide IPT during ANC visits. Katakwi and Kibaale had all their facilities reporting that they provide IPT during ANC.

Generally most districts had majority of their facilities reporting that they provided IPT. If the trend continues its

anticipated that the serious health risk for pregnant women posed by malaria in Uganda will reduce.

3 Most facilities have ANC clinics run twice a week on specific days agreed upon by the health facility and expecting mothers.

Proportion of facilities providing Intermittent Preventive Treatment

District Name

Facilities

without opinion

Facilities

providing IPTp

Facilities that do

not provide IPTp

Facilities that do

not provide ANC

AMURIA 62% 38%

BUKEDEA 73% 18% 9%

BULIISA 10% 90%

HOIMA 5% 85% 2% 7%

KABERAMAIDO 64% 21% 14%

KATAKWI 100%

KIBAALE 100%

KIBOGA 10% 80% 10%

KUMI 93% 7%

LUWERO 2% 98%

MASINDI 85% 12% 3%

MPIGI 2% 89% 9%

MUKONO 4% 87% 4% 5%

NAKASEKE 23% 69% 8%

NAKASONGOLA 90% 5% 5%

RAKAI 4% 89% 4% 4%

SOROTI 71% 26% 3%

WAKISO 91% 4% 4%

Total 3% 86% 7% 4%



3.1.3 IPTp under DOTs

Using Directly Observed Treatment (DOT), among pregnant women attending public as well as private sector health services is part of a comprehensive reproductive health package recommended during focused ANC services by MOH.

From table 4; it can be noted that majority (74%) of health

facilities indicated that they provided IPTp under DOT.

However some Districts like Bukedea (27%), Kaberamaido

(29%), Soroti (24%) and Wakiso (24%) had significant

proportions of facilities that indicated that they do not

provide IPT under directly observed treatment as

recommended by MOH. Katakwi (30%), Nakaseke (15%) and

Kumi (13%) hardly gave their opinion about the question at

hand.

Most health facilities including those that indicated to provide IPT under DOT, faced challenges related to lack of

consistent supply of clean water and disposable drinking cups. Nakasongola district had 55% of her facilities indicating

that they lacked adequate cups, 49% of facilities in Wakiso reported the same and 39% of facilities in Masindi4.

Those that insist on using non disposable cups face another challenge of hygiene and sanitation since it was

uncommon to prove rewashing of already used cups. Health workers also indicated that they sometimes get resistance

from mothers who prefer taking medicine home to take it after they’ve had a meal.

4

Go to appendix for detailed table about adequacy of cups for drinking water.

Proportion of facilities providing IPT under DOT

District Name

Without

Opinion

IPT under

DOT

IPT not

under DOT

No ANC

services

AMURIA 8% 77% 8% 8%

BUKEDEA 9% 55% 27% 9%

BULIISA 10% 80% 10%

HOIMA 2% 78% 10% 10%


KATAKWI 30% 70%

KIBAALE 79% 21%

KIBOGA 5% 75% 5% 15%

KUMI 13% 80% 7%

LUWERO 4% 79% 17%

MASINDI 76% 12% 12%

MPIGI 7% 68% 11% 14%

MUKONO 2% 78% 13% 7%

NAKASEKE 15% 77% 8%

NAKASONGOLA 5% 80% 5% 10%

RAKAI 4% 70% 19% 7%

SOROTI 6% 65% 24% 6%

WAKISO 69% 24% 7%

Total 5% 74% 15% 7%



3.1.4 Routine provision of Folic Acid and De-worming of Pregnant Women

Proportion of facilities that provide Folic acid for pregnant

women

Proportion of facilities that routinely de-worm pregnant

women

District Name

Without

opinion

Folic acid

provided

No folic

acid

No

services

Without

opinion De-worming

provided

No de-worming

services

Not

Applicable

AMURIA 8% 85% 8% 23% 69% 8%

BUKEDEA 9% 73% 9% 9% 18% 73% 9%

BULIISA 10% 90% 10% 90%

HOIMA 2% 81% 12% 5% 7% 78% 10% 5%

KABERAMAIDO 86% 14% 86% 14%

KATAKWI 90% 10% 90% 10%

KIBAALE 4% 92% 4% 4% 96%

KIBOGA 5% 85% 10% 5% 85% 10%

KUMI 100% 100%

LUWERO 4% 91% 6% 9% 89% 2%

MASINDI 88% 9% 3% 91% 6% 3%

MPIGI 2% 80% 11% 7% 2% 82% 9% 7%

MUKONO 91% 4% 6% 4% 89% 2% 6%

NAKASEKE 8% 92% 8% 85% 8%

NAKASONGOLA 85% 10% 5% 5% 90% 5%

RAKAI 4% 78% 15% 4% 4% 89% 4% 4%

SOROTI 3% 74% 21% 3% 3% 88% 6% 3%

WAKISO 93% 4% 2% 4% 82% 11% 2%

Total 3% 86% 8% 4% 5% 86% 5% 4%

Most facilities in all districts were found to be providing de-worming services to pregnant women. However routine Stock

outs of Folic Acid were recorded in almost all health facilities including those that indicated that they provide it

routinely. They indicated that an inconsistency in the supply of albendazole causes failure to routinely de-worm

pregnant women in some facilities. However most health workers indicated that they sensitize pregnant women about

the advantages of de-worming to pregnant mothers.



3.1.5 Availability of Supply of Clean and Safe water to administer IPT under DOT

During support supervision SMP desired to find out whether facilities have reliable supply of water safe for drinking 5 in

the ANC clinic. Most facilities in all districts indicated that they had safe water (treated or boiled) for drinking and use in

the ANC clinic.

It was only Buliisa district that

had no facilities indicating

that they had no safe water.

Nakaseke (31%),

Kaberamaido (29%) and

Bukedea (27%) had the

highest proportion of facilities

indicating that they do have

clean water. Nakaseke district

should be a point of concern because in table 4 above it had 77% of

her facilities indicating that they provide IPT under DOT. This may imply

that they could be using untreated water to administer the drugs.

Most facilities were found to use Aqua safe and water guard tablets to

treat water used in the ANC clinic. In times of stockut of drugs a few

health facilities where found with mechanisms of boiling water. Some

facilities sometimes improvise and use other water containers like

buckets, water jugs among others.

Supervision team intended to establish the source of clean water for the facilities. Apart from Kumi, Wakiso and Mukono

that had a significant number of facilities using tap water, majority depended on ordinary/shallow wells and boreholes

for water. Nakaseke, Bukedea and Kibaale districts had the biggest proportion of facilities depending on wells for water.

Some facilities had water tanks installed or other containers used to harvest rain water.

5

Water safe for drinking is either treated or boiled as opposed to many facilities that equated safe water to clean water e.g. rain water and borehole water

even when its not treated or boiled.

Proportion of facilities with safe water by district

District Name No Opinion

Safe Water

available

No safe

water

AMURIA 8% 77% 15%

BUKEDEA 9% 64% 27%

BULIISA 10% 90%

HOIMA 7% 73% 20%


KATAKWI 90% 10%

KIBAALE 83% 17%

KIBOGA 15% 75% 10%

KUMI 73% 27%

LUWERO 2% 87% 11%

MASINDI 76% 24%

MPIGI 5% 77% 18%

MUKONO 9% 76% 15%

NAKASEKE 69% 31%

NAKASONGOLA 90% 10%

RAKAI 78% 22%

SOROTI 85% 15%

WAKISO 4% 82% 13%

Total 4% 79% 17%



3.1.6 Availability of ANC Cards

The table below provides information on a cross

tabulation of all facilities that indicated that they

provided ANC services on a daily basis and those that

indicated that ANC is not6 daily against whether they

provided ANC cards during ANC visits.

In Amuria district 86% of facilities providing Anc on a

daily basis indicated that they provided ANC cards

while 14% of them do not provide ANC cards. Only

40% of facilities without daily ANC provided cards with

60% of them indicating that they do not provide cards.

Wakiso district had 52% of her facilities that provide

ANC on a daily basis providing cards while 48%

indicating that they do not provide cards. 47% of

Wakiso’s facilities that do not run daily ANC clinics

provides cards while 53% of them don’t provide cards.

All facilities in Masindi that don’t run daily ANC clinics

indicated that they provided cards, while almost all

facilities in Kibaale though they indicated that they run

daily ANC clinics, 50% of them did not provide cards

while 50% did not respond the query.

From the dataset in the above table, one can

conclude that facilities that provide daily ANC services

where found to provide Cards more than their

counterparts that do not run a daily clinic.

6

Some facilities may not be providing services daily but provides it say twice a week.

Proportion of facilities providing ANC services and ANC Cards during visits

District Name

ANC

Daily?

No

Response

Anc Cards

Provided

No Cards

Provides

No ANC

at all

Yes 86% 14% AMURIA

No 40% 60%

Yes 100% BUKEDEA

No 33% 67%

Yes 50% 50% HOIMA

No 100%

Yes 50% 50% KABERAMAIDO

No 33% 67%

Yes 100% KATAKWI

No 38% 63%

KIBAALE Yes 50% 50%

Yes 89% 11% KIBOGA

No 44% 44% 11%

KUMI Yes 93% 7%

Yes 2% 83% 15% LUWERO

No 71% 29%

MASINDI No 100%

MPIGI Yes 83% 17%

Yes 94% 6% MUKONO

No 78% 17% 6%

Yes 86% 14% NAKASEKE

No 60% 40%

Yes 71% 29% NAKASONGOLA

No 33% 33% 33%

Yes 44% 56% RAKAI

No 44% 44% 11%

Yes 45% 55% SOROTI

No 33% 67%

Yes 52% 48% WAKISO

No 47% 53%



3.1.7 Record Management of IPTp activities

Amuria district recorded the highest proportion (80%) of facilities that do not record IPTp properly and all of them were

facilities that indicated that their ANC clinic is not open daily. Bukedea district followed the same situation with majority

(67%) of facilities found with poorly recorded IPTp being those that never provides it on a daily basis. This was the same

story in many districts with exception Buliisa, Kiboga Nakaseke and Nakasongola.

From the records most facilities had recorded IPTp properly with exception of few cases where the column for IPT3 was

found missing. Supervisors also observed lack of consistency in recording since registers are not managed by one

person. For example in some facilities IPTp was not recorded immediately and health workers indicated that they fill in

the gaps later on when they get time. Most facilities also experience regular stock out of ANC cards, and they indicated

that under such circumstances they request mothers to buy exercise books.

Proportion of facilities that recorded IPT correctly in the ANC register per district

District Name ANC daily?

Without Opinion

IPTp recorded well

IPTp poorly recorded

NO ANC services

Yes 100% AMURIA

No 20% 80%

Yes 100% BUKEDEA

No 33% 67%

Yes 87% 13% BULIISA

No 100%

Yes 96 % 4% HOIMA

No 78% 22%

Yes 11% 78% 12% KABERAMAIDO

No 67% 33%

Yes 100% KATAKWI

No 75% 25%

Yes 87% 13% KIBAALE

No 13% 62% 25%

Yes 12% 56% 33% KIBOGA

No 89% 12%

KUMI Yes 7% 93%

Proportion of facilities that recorded IPT correctly in the ANC register per district

District Name ANC daily?

Without Opinion

IPTp recorded well

IPTp poorly recorded

NO ANC services

Yes 6% 77% 13.00% 4 % LUWERO

No 57% 43%

Yes 95% 4.80% MASINDI

No 78% 27%

Yes 89% 11 % MPIGI

No 33% 33% 34%

Yes 5.90% 82% 12% MUKONO

No 5% 72% 16% 6%

Yes 100% NAKASEKE

No 20.00% 80.00%

Yes 88.20% 11.80% NAKASONGOLA

No 66.70% 33.30%

Yes 83.30% 16.70% RAKAI

No 66.70% 22.20% 11.10%

Yes 80.00% 20.00% SOROTI No 7.70% 61.50% 30.80%

Yes 7.40% 85.20% 7.40% WAKISO No 88.20% 5.90% 5.90%



3.1.8 Utilization of ANC IEC Materials

Generally most facilities had pregnancy posters

displayed in the waiting area for patients to see. It was

rather unfortunate that most of the facilities had no

posters displayed in local language; most of them were

found to be in English. Given the fact that most of these

facilities are rural based, local language based IEC

materials would create more impact since people can

carry the message they carry with them instead of just

looking at pictures. They stand a chance of

misinterpreting which may be fatal to their lives.

From the table it can be observed that Kaberamaido

(57%), Kibaale (54%), Mukono (51%), Nakasongola (45%),

Wakiso (44%) and Soroti (35%) districts had the highest

proportion of facilities which did not have IEC materials

displayed.

Kumi (87%), Katakwi (80%), Amuria (77%), Nakaseke (77%)

Districts had the highest proportion of districts that had facilities with IEC materials with information focusing on mothers

displayed. It was rather unfortunate that most of these facilities had English based posters or IEC materials.

Other districts which significantly need to be supplied with adequate IEC materials are: Masindi, Buliisa, Luwero, Bukedea, Mpigi, Rakai, Katakwi and Kiboga.

Supervisors also observed outdated posters in some facilities hence those supplying ought to replace them with update

posters as recommended by ministry of health. These posters ought to be well hoisted and stacked on facility walls or

notice boards.

Proportion of facilities with IEC materials displayed in the ANC clinic

District Name

No

Response

IEC materials

displayed

No IEC

materials

No

Services

AMURIA 8% 77% 15%

BUKEDEA 64% 27% 9%

BULIISA 10% 60% 30%

HOIMA 10% 59% 29% 2%


KATAKWI 80% 20%

KIBAALE 8% 38% 54%

KIBOGA 5% 65% 20% 10%

KUMI 7% 87% 7%

LUWERO 6% 64% 30%

MASINDI 6% 52% 39% 3%

MPIGI 7% 64% 25% 5%

MUKONO 6% 38% 51% 6%

NAKASEKE 8% 77% 15%


RAKAI 11% 67% 22%

SOROTI 6% 56% 35% 3%

WAKISO 2% 49% 44% 4%

Total 6% 57% 34% 3%



3.1.9 Dispensation of LLIN through ANC

The malaria control strategic plan 2005/6-2009/10 targeted pregnant women for the distribution of ITN/LLIN particularly

through ANC services. This was expected not only to increase the protection of this vulnerable group but also help

improve the uptake of ANC services in general.

The support supervision carried in the 4th quarter as

represented in the table below shows that only 6% of all the

facilities supervised distributed nets through ANC and 4% were

not sure or never gave their opinion.

It was only Buliisa (20%) Kumi (20%), Wakiso (11%) with

significant number of facilities indicating that they provide

LLNs through ANC.

Most facilities indicated that the government has not

previously supplied facilities with free nets to distribute to

pregnant mothers on a routine basis apart from those that

were distributed sometime back as one off activity. Most

facilities indicated that their patients have previously

benefited from in mass distribution of nets at community level

through local governments and local community leaders and

during child days plus at the health facility. Other distributions

are done occasionally by NGOs and other Programs

mentioned among them were Malaria Consortium, Pace and

Hunger project.

This partly explain why almost all facilities experienced stock out of LLNs. Health workers though indicated that they

continue to sensitize mothers about the importance sleeping under an insecticide treated mosquito net. However they

faced a challenge of prescribing the best quality nets especially when they send mothers to shops and the fact that

most mothers are poor. Nets that are permanently treated are very expensive and the ones in shops that are affordable

are either not treated or poorly treated and are of low quality.

Proportion of Facilities distributing LLNs through ANC

District Name

Without

opinion

LLNs

distributed

No LLNs

distributed

No

services

AMURIA 8% 92%

BUKEDEA 9% 9% 73% 9%

BULIISA 20% 60% 20%

HOIMA 5% 10% 78% 7%


KATAKWI 100%

KIBAALE 4% 4% 92%

KIBOGA 10% 85% 5%

KUMI 20% 80%

LUWERO 2% 98%

MASINDI 6% 6% 85% 3%

MPIGI 2% 82% 16%

MUKONO 6% 9% 78% 7%

NAKASEKE 8% 8% 85%

NAKASONGOLA 95% 5%

RAKAI 7% 4% 82% 7%

SOROTI 3% 9% 85% 3%

WAKISO 4% 11% 82% 2%

Total 4% 6% 84% 5%



3.1.10 Provision of Health Education Talks during ANC

Majority of health facilities supervised in the 4th quarter were found to be providing educational talks about malaria

during ANC visits.

Most districts had higher proportions of facilities

indicating that they provided educational

talks. Districts with significant proportions of

facilities indicating that they do not provide

educational talks during ANC included;

Nakasongola (35%), Luwero (32%) Nakaseke

(31%), Masindi (30%), Kibaale (29%), Amuria

(23%) and Wakiso (22%).

It should be noted however that, it was only a

small number of facilities that could prove that

they actually undertake educational talks. The

few facilities that could prove had plans

displayed on notice boards/facility walls to

notify participants that there will education

talks. Other evidence was found in work plans

and timetables of health workers.

For the majority of health facilities, although

they quickly informed supervisors that they provided general health education talks including malaria, most of them

could neither produce a work plan nor a report as evidence to show that these are the topics and these were the

participants.

A significant number of these facilities indicated that health education is given but not formalized and it’s given on

individual basis as mothers come one at ago. As a way of responding to these some health facilities indicated that they

resorted to organizing educational talks on immunization days when many mothers are expected to attend. Routine

formal education talks at the facility were irregular and most facilities pointed towards lack of teaching aides, malaria

IEC materials and limited staff.

Proportion of facilities that provided educational talks about malaria during ANC

District Name

Without

opinion

Educational

talks provided

No Educational

talks provided

No ANC

Services

AMURIA 77% 23%

BUKEDEA 82% 9% 9%

BULIISA 10% 90%

HOIMA 5% 73% 17% 5%

KABERAMAIDO 78.60% 7% 14%

KATAKWI 10% 80% 10%

KIBAALE 4% 67% 29%

KIBOGA 10% 70% 10.00% 10.00%

KUMI 7% 93%

LUWERO 4% 64% 32%

MASINDI 6% 61% 30% 3%

MPIGI 7% 73% 11% 9%

MUKONO 6% 71% 18% 6%

NAKASEKE 8% 62% 31%

NAKASONGOLA 5% 55% 35% 5%

RAKAI 4% 82% 11% 4%

SOROTI 6% 79% 12% 3%

WAKISO 7% 67% 22% 4%

Total 5% 71% 19% 4%



3.2 HEALTH MANAGEMENT INFORMATION SYSTEM7 The Health Management Information System (HMIS) collects data from all health facilities in the public and not-for profit private

sector with respect to curative as well as preventive services. The malaria control strategic plan 2005/6-2009/10 aimed at

improving the collection, quality and utilization of routine data to monitor the implementation of malaria related

interventions hence SMP supervised the existence of HMIS at facility level.

In the support supervision assignment, the team reviewed the existence of data registers at the facilities supervised,

whether reports were made, quality of data collected, existence of personnel, a database and utilization of data.

3.2.1 Existence of up to date HMIS registers.

From the table below majority of districts that were supervised for

HMIS indicated that they had well recorded and updated registers.

Apart from Kibaale where a significant proportion (29%) of facilities

never responded to the question, most facilities had evidence that

they where having updated registers. There were insignificant

proportions of facilities that were found missing OPD, ANC and

inpatients registers.

It should however be pointed out that many facilities indicated that

they experience regular stock outs of pre-printed registers. Counter

books or black books were found to be improvised in facilities as

away of adhering to the requirement.

A significant proportion of facilities were found to have registers but

with anomalies of proper recording. Some registers were found

missing some information like patients weight, client numbers,

headings, reasons for referral and in some instances health workers

were found to be using non conventional abbreviations in recording

data rendered such information unusable to the third party. It was also noted that some facilities improvising registers

were not distinguishing between severe and uncomplicated malaria.

7 It should be noted that data presented in this section is missing the districts of Nakasongola, Nakaseke and Rakai. In addition to that 9 facilities in Mpigi, 24 facilities in Mukono and 5 facilities in Wakiso are also missing. This was attributed to an error in printing the tools used in gathering information. So the user of this

report should put this error into consideration when making decisions regarding these 6 districts on this particular section.

Proportion of facilities with updated HMIS registers

District Name

No

Comment

Registers exist &

up –to-date

No

registers

AMURIA 100%

BUKEDEA 100%

BULIISA 89% 11.1%

HOIMA 5% 95%

KABERAMAIDO 7% 93%

KATAKWI 100%

KIBAALE 29% 71%

KIBOGA 10% 90%

KUMI 93% 7%

LUWERO 17% 81% 2%

MASINDI 18% 82%

MPIGI 3% 91% 6%

MUKONO 3% 97%

SOROTI 12% 79% 9%

WAKISO 3% 98%

Total 9% 89% 2%



3.2.2 Completing HMIS Reports Appropriately

Majority (73%) of

facilities in all

districts that

reported that they

kept up-to-date

registers were found

to be compiling

monthly HMIS

summary reports.

It was mainly

Bukedea with a

highest proportion

of facilities that

were less effective

in completing

monthly reports

appropriately.

From the table above OPD forms were filled more compared to the inpatients forms and quarterly summary. With

exception of Masindi and Kibaale districts which were found at least consistently filling summary reports appropriately

for OPD all districts need to vitalize summary reports especially Bukedea district, Kumi, Kaberamaido, Katakwi and

Amuria

It should be noted that a significant proportion of facilities that had updated registers were hesitant to comment about

summary reports. This implies that they also do not fill them hence it points to weaknesses in the general utilization of

information gathered in the registers. In addition there was no evidence of report submission to the district or even a

feedback from the district about the shared data. There was no evidence to show that the reports are utilized in

decision making regarding health unit management and health service delivery.

Of the 383 facilities that SMP supervised their HMIS in the quarter; 42% had recorded their data wrongly, 27% missed the

comparison, it was only 31% of the facilities with properly recorded data and only 13% with exact data8.

8 Wrongly recorded HMIS data had the difference on the HMIS report and the register being greater than +-5, while properly recorded data had the difference

equals or with in +/-5. Exact data was data where there was no difference between HMIS report and the registers.

Proportion of facilities with completed HMIS summary reports in the last three months

HMIS 105-OPD form HMIS 106-Quarterly Summary HMIS 108 In-patients summary

District Month 1 Month 2 Month 3 Month 1 Month 2 Month 3 Month 1 Month 2 Month 3

AMURIA 15% 8% 8% 8% 8% 8%

BUKEDEA

BULIISA 56% 56% 56% 11% 11% 11% 33% 33% 33%

HOIMA 56% 56% 56% 15% 12% 12% 12% 12% 13%

KABERAMAIDO 29% 29% 29% 14% 14% 14% 21% 21% 21%

KATAKWI 20% 20% 10% 10% 10% 10%

KIBAALE 83% 83% 79% 25% 21% 21% 42% 42% 42%

KIBOGA 35% 35% 35% 10% 5% 5% 20% 20% 25%

KUMI 13% 13% 13% 13% 13% 13% 13% 13% 13%

LUWERO 28% 26% 25% 8% 8% 8% 9% 9% 9%

MASINDI 91% 91% 88% 31% 31% 31% 41% 41% 41%

MPIGI 40% 37% 37% 3% 3% 3% 3% 3% 3%

MUKONO 23% 19% 19% 10% 10% 10% 16% 13% 13%

SOROTI 24% 24% 24% 9% 9% 9% 9% 9% 9%

WAKISO 30% 30% 30% 30% 30% 30% 30% 30% 26%



3.2.3 Availability of trained HMIS officers

From the table above, Hoima district (81%) had the highest proportion of facilities with HMIS officers at facility; however

30% of them indicated that they were not trained. Kumi had 73% of her facilities having HMIS officers and majority (91%)

of them had received training.

Bukedea district only had 46% of her facilities indicating that they have an HMIS officer and unfortunately only 60% of

them had received training, the 40% indicated that they had not received training.

Although Buliisa (22%), Kaberamaido (29%), and Kiboga (32%) had fewer facilities indicating that they had a HMIS

officer, all the few that existed were found trained.

It should be noted that Masindi (52%), Mukono (31%) Kibaale (33%) and Wakiso (33%) were among the districts that high

proportions of their facilities lacking HMIS officers but at the same times they had higher proportions of untrained HMIS

officers.

Proportion of facilities with HMIS Officers Proportion of facilities whose HMIS officer is trained

District Name

No

comment

HMIS is

available

No HMIS

officer

HMIS

officer? No Comment

HMIS officer was

trained

HMIS officer not

trained

AMURIA 17% 67% 17% Yes 13% 63% 25%

BUKEDEA 46% 55% Yes 60% 40%

BULIISA 22% 78% Yes 100%

HOIMA 81% 20% Yes 70% 30%

KABERAMAIDO 7% 29% 64% Yes 100%

KATAKWI 60% 40% Yes 100%

KIBAALE 67% 33% Yes 69% 31%

KIBOGA 32% 68% Yes 100%

KUMI 73% 27% Yes 9% 91%

LUWERO 8% 45% 47% Yes 13% 79% 8%

MASINDI 6% 42% 52% Yes 7% 64% 29%

MPIGI 3% 38% 59% Yes 83% 17%

MUKONO 69% 31% Yes 9% 55% 36%

SOROTI 56% 44% Yes 11% 90%

WAKISO 68% 33% Yes 11% 56% 32%

Total 3% 55% 42% Total 6% 73% 19%



3.2.4 Availability of data management computer

Modern day data management requires electronic gadgets that are used in storing huge some of data. A computer is

one of them. From the table below Very few facilities indicated that they have a computer at the facility dedicated to

management of health information.

Its only Kiboga district (50%) where half of her health facilities accessed a computer for data management. Other

districts Like Kumi (27%), Luwero (25%), Mukono (26%), Soroti (27%), and Wakiso (23%) had only a quarter or less of their

facilities having a data management computer.

It’s important to note that some facilities that indicated to have a computer in many instances their computers where

found either un-utilized or non functional. This was either because they lacked servicing or because they are not

connected to electricity or solar power supply. In some facilities there was no person trained to use them since some of

them are donations.

Proportion of facilities that had a computer for Data management

District No Comment Computer Available No Computer

AMURIA 8% 92%

BUKEDEA 9% 91%

BULIISA 22% 78%

HOIMA 20% 81%

KABERAMAIDO 14% 86%

KATAKWI 20% 80%

KIBAALE 25% 75%

KIBOGA 50% 50%

KUMI 27% 73%

LUWERO 8% 25% 68%

MASINDI 6% 12% 82%

MPIGI 6% 20% 74%

MUKONO 3% 26% 71%

SOROTI 3% 27% 71%

WAKISO 23% 78%

Total 3% 23% 75%



3.2.5 Availability of Health Unit Management Committees

From the table above it can be seen that most (82%) facilities where found to have HMUC in all districts. All facilities in

Buliisa, Katakwi and Kumi indicated that they had these committees. Luwero district (28%) had the highest proportion of

facilities without HUMC, followed by Wakiso (23%) and Bukedea (18%).

Bukedea (43%), Amuria (42%), Katakwi (40%) and Kibaale (35%) were among the districts with high proportions of

facilities that indicated that they have a HUMC but don’t meet regularly. Facilities indicated that they face challenges

with holding meeting because of limited funds and lack of commitment from members hence they end up taking long

without holding them. Some facilities hold meetings once a year and others twice a year instead of the recommended

quarterly basis.

Although many facilities indicated that they hold quarterly meetings, in some facilities supervisors failed to find evidence

in form of minutes or reports of the held meetings. There also a general lack of HUMC guidelines for use at the facility.

Majority of facilities (53%) indicated that they do not conduct Self Assessments worst among them being

Kibaale and Bukedea where only 8% and 18% respectively reported that they hardly do self assessments.

Proportion of facilities that had a health unit management committee Proportion of facilities with a functional HUMC

District Name No Comment HUMC exist No HUMC HUMC? No comment HUMC meet HUMC don’t Meet

AMURIA 8% 92% Yes 58% 42%

BUKEDEA 18% 64% 18% Yes 57% 43%

BULIISA 100% Yes 11% 67% 22%

HOIMA 85% 15% Yes 9% 69% 23%

KABERAMAIDO 14% 79% 7% Yes 18% 64% 18%

KATAKWI 100% Yes 10% 50% 40%

KIBAALE 4% 83% 13% Yes 15% 50% 35%

KIBOGA 90% 10% Yes 11% 67% 17%

KUMI 100% Yes 87% 13%

LUWERO 13% 59% 28% Yes 19% 77% 3%

MASINDI 94% 6% Yes 7% 84% 10%

MPIGI 9% 86% 6% Yes 10% 87% 3%

MUKONO 3% 90% 7% Yes 7% 79% 14%

SOROTI 85% 15% Yes 10% 90%

WAKISO 8% 70% 23% Yes 7% 75% 18%

Total 5% 82% 13% Total 10% 72% 17%



3.3 CASE MANAGEMENT According to the Malaria operation plan, Key objectives of the Malaria Control strategic plan for 2005-2010 included;

Ensuring universal access to ACTs including patients accessing treatment through the private sector, enhancing the

prompt treatment of children under five within 24 hours of fever onset through the provision of home-based

management of malaria fever using ACT, Reducing the case fatality of severe malaria by establishing a system to

provide highly effective pre-referral treatment and improve the management capacity for severe malaria at health

facilities and hospitals. It also aimed at increasing the proportion of malaria cases confirmed by high quality clinical and parasitological diagnosis guided by feasibility and cost effectiveness.

3.3.1 Availability of trained Staff to Manage Malaria

Proportion of facilities with a given number of trained staff in

uncomplicated malaria

Proportion of facilities with a given number of trained

staff in severe malaria

District Trained Staff?

No Comment One

two-three four-six

Seven -10 Ten+

No Comment One

two-three four-six

Seven-ten Ten+

AMURIA Yes 40% 40% 20% 20% 20% 40% 10% 10%

BUKEDEA Yes 20% 50% 20% 10% 20% 40% 20% 10% 10%

BULIISA Yes 67% 11% 22% 33% 22% 22% 11% 11%

HOIMA Yes 26% 11% 37% 26% 11% 14% 37% 34% 3%

KABERAMAIDO Yes 9% 9% 36% 9% 9% 9% 9% 55% 9% 27%

KATAKWI Yes 50% 38% 13% 38% 38% 13% 13%

KIBAALE Yes 55% 20% 15% 5% 5% 15% 15% 25% 25% 5% 15%

KIBOGA Yes 47% 6% 24% 12% 12% 38% 6% 44% 6% 6%

KUMI Yes 20% 7% 7% 47% 13% 7% 20% 13% 20% 33% 7% 7%

LUWERO Yes 32% 35% 19% 11% 3% 24% 43% 19% 11% 3%

MASINDI Yes 48% 13% 19% 10% 6% 3% 10% 26% 29% 29% 6%

MPIGI Yes 11% 40% 20% 20% 9% 14% 26% 23% 29% 9%

MUKONO Yes 74% 16% 7% 2% 27% 30% 9% 32% 2%

NAKASEKE Yes 11% 22% 33% 22% 11% 11% 11% 22% 22% 22% 11%

NAKASONGOLA Yes 14% 14% 36% 29% 7% 14% 36% 29% 14% 7%

RAKAI Yes 60% 5% 20% 10% 5% 24% 14% 19% 33% 10%

SOROTI Yes 17% 25% 42% 17% 4% 8% 8% 25% 38% 17% 4%

WAKISO Yes 36% 9% 21% 27% 3% 3% 42% 9% 18% 18% 12%

79% (381) of the facilities supervised indicated that they had at least a staff trained in management of malaria cases. It

was 12% of facilities that indicated that they had no trained staff. The table above represents data on the number of

staff in uncomplicated malaria and severe malaria. Most facilities had between 1and 6 staff members

trained.



3.3.2 Utilization of treatment guidelines in treatment of malaria

In June 2005, after a study

on the malaria treatment

policy took a decision to

change the policy on

malaria treatment from

Chloroquine +

Sulfadoxine/Pyrimethamine

combination to Artemisinin-

based Combination

Therapies (ACTs).

Artemether/Lumefantrine is

henceforth the first line

treatment for

uncomplicated malaria

and Artesunate +

Amodiaquine the

alternative. Parenteral

quinine is the

recommended treatment

for severe and

complicated malaria and

Sulfadoxine/Pyrimethamine

is the recommended medicine for Intermittent Preventive Treatment (IPT) during pregnancy the policy reads. Guidelines

in line with the new policy were developed and were expected to be distributed to most of the health facilities.

From the table above most facilities in all the districts were found to be using the clinical and treatment guidelines. It

should be pointed out that Bukedea (46%), Kaberamaido (36%), Mpigi (32%), Amuria (31%), Katakwi (30%) and Kibaale

(29%) districts had significant proportions of facilities indicating that they hardly follow the guidelines. This was partly

attributed to limited supply of first line drugs hence they often get out of stock leaving HW with no alternative.

50% of the facilities in Nakaseke and Kibaale districts, followed by 36% and 35% of Luwero and Soroti respectively were

among the districts with high proportions of facilities having no clinical and treatment guidelines in the OPD

and IPW. Some facilities were found with 2003 guidelines which are outdated.

Proportion of facilities with health workers treating

according National Malaria treatment guidelines

Proportion of facilities with Malaria

guidelines in the OPD and IPW

District Name

No

Comment

Guidelines

followed

Guidelines

Not followed

No

Comment

Guidelines

in OPD &IPW

No guidelines in

OPD & IPW

AMURIA 69% 31% 77% 23%

BUKEDEA 55% 46% 73% 27%

BULIISA 90% 10% 90% 10%

HOIMA 5% 81% 15% 2% 78% 20%


KATAKWI 70% 30% 80% 20%

KIBAALE 71% 29% 4% 46% 50%

KIBOGA 80% 20% 15% 60% 25%

KUMI 100% 93% 7%

LUWERO 17% 62% 21% 4% 60% 36%

MASINDI 9% 73% 18% 67% 33%

MPIGI 9% 59% 32% 2% 48% 50%

MUKONO 84% 16% 4% 67% 29%

NAKASEKE 8% 69% 23% 46% 54%

NAKASONGOLA 10% 65% 25% 55% 45%

RAKAI 11% 70% 19% 4% 70% 26%

SOROTI 91% 9% 6% 59% 35%

WAKISO 4% 89% 7% 4% 80% 16%

Total 5% 75% 20% 3% 66% 31%



3.3.3 Malaria Treatment based on Laboratory Diagnosis

The Malaria treatment policy advocates for no more

presumptive treatment of malaria by Cleary stating that;

The diagnosis of malaria will largely be dependent on

history and physical examination. Blood slide

microscopy was to remain the “gold” standard for

malaria laboratory diagnosis. Rapid diagnostic tests

(RDTs) were to be used in special situations such as

malaria epidemics and mass population

displacements9.

Apart from Kumi and Bukedea district the rest of the

districts had considerable proportions of their facilities

indicating that they do not use laboratory diagnosis in

management of malaria cases which is adjacent to the

malaria treatment policy 2005.

Amuria (69%), Nakaseke (54%) Hoima (51%) Buliisa (50%),

Kibaale (50%), Luwere (49%) were among the districts

with majority of their health facilities indicating that

malaria treatment is not laboratory based.

Some of the above facilities indicated that they were lacking functional laboratories to help in the diagnosis of Malaria.

Other facilities indicated that they rely on clinical treatment which mainly uses signs and symptoms. And in some

facilities were laboratories were existent faced challenges of stock out of reagents and inability/reluctance of patients

to meet the laboratory costs hence a hardship in replenishment of laboratory supplies.

Almost all facilities supervised indicated that their facilities are open all the time and that health workers are on duty 24

hours a day and 7 days a week. Supervisors later on discovered that it was hard for health workers supervised to inform

the team that some days the facility is closed and staff off duty. A more triangulated approach about consistent

functionality of the facility and availability of health workers may be thought about in the next quarter supervision.

9

National Policy on Malaria Treatment 2005

Proportion of facilities that treated malaria based on lab diagnosis

District Name No

Response Lab Diagnosis

based Not Lab diagnosis

based

AMURIA 31% 69%

BUKEDEA 91% 9%

BULIISA 50% 50%

HOIMA 49% 51%

KABERAMAIDO 71% 29%

KATAKWI 70% 30%

KIBAALE 50% 50%

KIBOGA 55% 45%

KUMI 87% 13%

LUWERO 6% 45% 49%

MASINDI 3% 49% 49%

MPIGI 41% 59%

MUKONO 62% 38%

NAKASEKE 46% 54%

NAKASONGOLA 50% 50%

RAKAI 63% 37%

SOROTI 59% 41%

WAKISO 58% 42%

Total 1% 55% 44%



3.3.4 Referral of Emergency Cases

It is a general rule in the health service provision for HWs to

provide some type of assistance for transporting a sick person to

a referral facility, such as communicating to the next level,

providing ambulance, arranging community transport and

or/funds for public means.

From the table below Buliisa (70%), followed by Bukedea,

Mukono (62%), Soroti (56%) Katakwi (50%) and Kibaale(50%)

districts exhibited the higher proportions of their facilities

indicating that they did not have a systematic and consistent

referral mechanism for emergency cases. Other districts with

significant number of their facilities indicating that they did not

have a referral system included; Masindi (49%), Mpigi (48%),

Nakaseke (46%), Nakasongola (45%), Luweero (36%) Kiboga

(35%), Hoima (32%) and Amuria (31%).

Facilities that indicated that they have a referral system were

found to be located within smaller distances to the HSD or the

district hospital where they easily can an ambulance. Some

facilities especially HCIVs had ambulances only that most of

them would demand for fuel from patients in case of an

emergency. Some like in Masindi had broken down and required

repair

In most facilities supervised, it was incumbent on the patient or care takers to find transport in case of emergency

situations. Among the private means mentioned during the activity included Taxis and Bodabodas.

Many facilities did not have referral forms neither referral maps, caretakers just need to take heed of an instruction to

take the patient to a given higher level facility without any kind of support.

Proportion of Facilities with a referral system for

emergency cases

District Name

No

Response

Referral system

Available

No Referral

System

AMURIA 69% 31%

BUKEDEA 36% 64%

BULIISA 30% 70%

HOIMA 5% 63% 32%

KABERAMAIDO 71% 29%

KATAKWI 50% 50%

KIBAALE 4% 46% 50%

KIBOGA 10% 55% 35%

KUMI 87% 13%

LUWERO 2% 62% 36%

MASINDI 3% 49% 49%

MPIGI 11% 41% 48%

MUKONO 38% 62%

NAKASEKE 54% 46%


RAKAI 4% 74% 22%

SOROTI 3% 41% 56%

WAKISO 7% 69% 24%

Total 4% 54% 41%



3.3.5 Facility Clinical Audit

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic

review of care against explicit criteria and the implementation of change. The clinical audit process seeks to identify

areas for health service improvement, develop & carry out action plans to rectify or improve service provision and then

to re-audit to ensure that these changes have an effect.

From the table above Kumi (87%), Katakwi (80%), Kaberamaido (79%), Bukedea (64%), Amuria (62%) and Soroti (50%)

districts had the highest proportion of their facilities indicating that they had a trained staff in clinical audit. However

apart from Kumi (85%) and Kaberamaido (73%) majority of health facilities in these districts had never done a clinical

audit. On the other hand, districts like Buliisa (75%), Kiboga (75%) and Mukono (62%) which had lower proportions of their

facilities having trained staff in clinical audit were among the districts which had more facilities indicating to have done

clinical audit. There was no evidence to show that audit was done since most facilities had no action plans.

Proportion of facilities with a trained staff in

clinical audit

Proportion of facilities with a trained staff that ever

conducted a clinical audit

District Name

No

Response

Staff

trained

No staff

trained Trained?

No

Response

Clinical

audit Done

No Clinical

audit done

AMURIA 62% 39% Yes 25% 75%

BUKEDEA 9% 64% 27% Yes 100%

BULIISA 40% 60% Yes 75% 25%

HOIMA 7% 27% 66% Yes 64% 36%

KABERAMAIDO 79% 21% Yes 9% 73% 18%

KATAKWI 80% 20% Yes 13% 88%

KIBAALE 4% 29% 67% Yes 57% 43%

KIBOGA 5% 20% 75% Yes 75% 25%

KUMI 87% 13% Yes 85% 15%

LUWERO 6% 21% 74% Yes 55% 46%

MASINDI 39% 61% Yes 15% 85%

MPIGI 5% 25% 71% Yes 9% 36% 46%

MUKONO 24% 76% Yes 62% 39%

NAKASEKE 39% 62% Yes 40% 60%

NAKASONGOLA 35% 65% Yes 14% 29% 57%

RAKAI 4% 44% 52% Yes 8% 33% 50%

SOROTI 50% 50% Yes 6% 35% 59%

WAKISO 4.40% 26.70% 68.90% Yes 8% 42% 50%

Total 2.90% 36.10% 60.60% 4% 47% 48%



3.3.6 Monthly Malaria Case Management

From the table above, it can be seen that with exception of Wakiso (64%) and Rakai (52%) districts most districts had

majority of their facilities indicating that they do no carry out monthly malaria case management. Most facilities

indicated that although they carry out monthly CMEs, they had not been particular or specific on malaria. Other

facilities indicated that they are not consistently doing CMEs on a monthly basis but rather on a quarterly basis.

It’s important to note that it was had for supervisors to verify previous activities in CME because most facilities hardly had

any report and or action plans to help in decision making or reporting to the district.

Proportion of facilities that conduct monthly Malaria Case

Management

District Name

No

Response

Does Case

Management

No Case

Management

AMURIA 15% 85%

BUKEDEA 18% 82%

BULIISA 40% 60%

HOIMA 10% 20% 71%


KATAKWI 40% 60%

KIBAALE 8% 29% 63%

KIBOGA 20% 15% 65%

KUMI 7% 47% 47%

LUWERO 11% 42% 47%

MASINDI 6% 24% 70%

MPIGI 11% 39% 52%

MUKONO 56% 26% 18%

NAKASEKE 23% 77%


RAKAI 15% 52% 33%

SOROTI 12% 29% 59%

WAKISO 7% 64% 29%

Total 18% 33% 50%



3.4 LABARATORY MANAGEMENT Improving laboratory services and promoting accurate diagnosis of malaria at

community level saves lives and prevent wastage of valuable resources. Increasing

levels of resistance to cheap, first-line antimalarials means that many health workers

now promote new, more expensive treatment in the form of Artemisinin-based

Combination Therapies (ACTs).

The importance of accurate diagnosis of all the major diseases cannot be

underestimated, and efficient laboratory testing is vital to identifying and treating life-

threatening illnesses. Laboratory services in many rural areas are often run down and

yet they are critical for public health, disease control and surveillance as well as

guiding patient diagnosis and care.

Poor quality laboratory services have the greatest negative impact on poor and

vulnerable people because these people carry the largest burden of ill health. The

effective diagnosis of malaria and other life-threatening illnesses at both community

and laboratory level helps in reducing this burden. There is indirect evidence to

suggest that the mismanagement of malaria and other fevers contributes to a vicious cycle of deepening poverty and

increasing ill health in Uganda.

3.4.1 Availability of Functional Laboratory at the Facility

According to the national health system, all HCIIIs, HIVs and hospitals are expected to be running a functional

laboratory or designate a place for carrying out laboratory tests. From the data set all hospitals supervised in all districts

had functional laboratories. Majority of HCIVs with exception of 2 facilities in Wakiso had Labaratories. Kibaale (8/24)

had the highest number of HCIIIs, followed by Mpigi (6/44) and Wakiso (6/45). Other districts had 1 or 2 HCIII only

indicating that they miss a functional laboratory.

Most facilities that were found with a functional laboratory had testing protocol available at the lab. Its important to

point out that, Mukono (45%), Mpigi (30%), Luwero (29%), Hoima 27%), Kaberamaido (25%) and Nakasongola (25%) were

among the districts with significant proportions of their facilities found without testing protocols.

Through out all districts there were a few pockets of health centers with laboratories that had faulty

equipment and missing/off duty personnel hence not being fully utilized.



3.4.2 Availability of Skilled Human Resources

All facilities that indicated that had functional laboratories were found to have skilled personnel, with capacity to make

all diagnoses required. It was Kiboga district, Bukedea, Hoima, Luwero, Mpigi, Nakasongola and Soroti with 1 or 2

facilities indicating that they did not have a skilled personel. It should be noted however that some of the facilities that

did not have laboratory facilities indicated that they have personnel with skills in the subject. These facilities were from

Amuria, Bukedea, Kaberamaido, Buliisa, Mukono and Wakiso districts.

The biggest proportion of facilities in all districts indicated that they had not had their technicians to train specifically in

Microscopy/RDT either as assistants or as technicians. However there were considerable proportions of facilities that

indicated that they had 1-3 staff members who had accessed the required training as assistants and technicians.

However this was mostly true with HCIII and above in the health system.

Proportion of facilities with skilled staff in laboratory Management

District Functional

Lab? No Response

Skilled staff available

Staff not Available District

Functional Lab?

No Response

Skilled staff available

Staff not Available

Yes 100% KUMI Yes 100% AMURIA

No 100% Yes 4% 89% 7%

Yes 89% 11% LUWERO

No 100% BUKEDEA

No 100% MASINDI Yes 100%

Yes 14% 86% Yes 4% 87% 9% BULIISA

No 50% 50% MPIGI

No 14% 86%

Yes 4% 89% 8% Yes 13% 84% 3% HOIMA

No 14% 14% 72% MUKONO

No 29% 29% 43%

Yes 100% Yes 100% KABERAMAIDO

No 33% 33% 33% NAKASEKE

No 100%

Yes 100% Yes 8% 83% 8% KATAKWI

No 100% NAKASONGOLA

No 90%

Yes 100% Yes 100% KIBAALE

No 100% RAKAI

No 100%

Yes 8% 75% 17% Yes 12% 84% 4% SOROTI

No 100%

Yes 100% KIBOGA

No 33% 66% WAKISO

No 9% 36% 54%



3.4.3 Techniques used in Diagnosis of Malaria

Diagnosis of malaria involves identification of malaria parasites or its

antigens/products in the blood of the patient. The diagnosis of malaria is

confirmed by blood tests and can be divided into microscopic and non-

microscopic tests.

Microscopy: For nearly a hundred years, the direct microscopic visualization

of the parasite on the thick and/or thin blood smears has been the

accepted method for the diagnosis of malaria in most settings, from the

clinical laboratory to the field surveys. The careful examination of a well-

prepared and well-stained blood film currently remains the "gold standard"

for malaria diagnosis.

Microscopy was found to be the most widely used technique in diagnosing

malaria in all districts. Most facilities supervised were found to be using a binocular type of microscope, with monocular types reported in a few

facilities in Masindi, Bukedea and Kibaale.

Rapid Diagnostic Tests: These tests are based on the capture of the parasite antigens from the peripheral blood using either monoclonal or polyclonal antibodies against the parasite antigen targets. Currently, immunochromatographic tests can target the histidine-rich protein 2 of P.

falciparum, a pan-malarial Plasmodium aldolase, and the parasite specific lactate dehydrogenase. These RDTs do not require a laboratory, electricity, or any special equipment. A good number of facilities in Luwero, Kumi, Katakwi and Amuria indicated that they sometimes use RDTs. Some facilities recommended the method for being helpful in rural areas and during emergency cases however they indicated dissatisfaction with the inability of the method to quantify the number of malaria parasites, and that sometimes the strips fail to react or they react after a long period. Quantitative Buffy Coat (QBC) tests: The QBC Test, involves staining of the centrifuged and compressed red cell layer with acridine orange and its examination under UV light source. It is fast, easy and claimed to be more sensitive than the traditional thick smear examination. The method was reported to be used by a few facilities in Buliisa, Katakwi, Luwero and Kibaale but still not as the main method for malaria diagnosis.

Techniques used to diagnose malaria

District Microscopy RDT QBC

AMURIA 83% 25%

BUKEDEA 73% 18%

BULIISA 60% 20% 10%

HOIMA 49% 5%

KABERAMAIDO 71% 7%

KATAKWI 40% 20% 10%

KIBAALE 54% 13% 4%

KIBOGA 55% 5%

KUMI 80% 27%

LUWERO 49% 11% 4%

MASINDI 61% 3%

MPIGI 46% 7%

MUKONO 67% 11% 2%

NAKASEKE 62% 15%

NAKASONGOLA 50% 10%

RAKAI 74% 4%

SOROTI 74% 3%

WAKISO 62% 20% 2%

Total 60% 10% 2%



3.4.4 Maintenance of Laboratory Equipment

Microscopes; Depending on their use, microscopes should receive routine service once, twice, or even four times a

year. Microscopes need; complete cleaning of all optical surfaces, lubrication of all moving mechanisms, adjustments

and realignments and thorough cleaning of all external surfaces. Repairs and replacement of Power Cords, Outlets and

Voltage many times are required. Since most users are not trained in handling and maintenance of these delicate

machines breakdowns are expected since.

Apart from Luwero, Bukedea and Buliisa, every district had four or more facilities reporting to have a faulty microscope.

Although some were found to have broken down, there is a problem with maintenance of these machines. Facilities in

Amuria had taken more than a year when the microscope ran down, in Hoima about 4 microscopes had spent over 2

years, Kibaale had 1 facility with a microscope which has been for 6 years and other 2 for 3 years and the same story

goes in almost all districts.

There seemed to be no plan for maintenance plans apart from when JMS, Malaria Consortium or Baylor and other

NGOS/programs offer support. Otherwise most facilities pointed to regional hospital equipment mechanics that were

found to be very irregular and less prompt.

3.4.5 Preparation of Stains used in Laboratory

Most facilities in all districts indicated that stains come when they are commercially prepared from Joint medical stores

or National Medical Stores supplied by the districts. However many facilities with exception of those from Luwero district

indicated that stains is prepared by Laboratory staff at the facility.

Most facilities were found using the positive and negative standard control to quality assure stains especially in Amuria,

Hoima, Kumi and in Kiboga they indicated that they use the unknown slides to quality assure the stains. Other facilities

indicated that they keep a sample and take it to next level facility say at the district for quality assurance.

It is important to point out that, guidelines on quality assurance of stains and slides needs to be made known and

displayed to ensure quality for the benefit of patients. Otherwise, whereas some districts send their malaria focal person

to monitor the quality of slides in facilities, other facilities rely on keeping the positive slides to use them as a control

measure for others. A common guideline known to all facilities and laboratory assistants need to be promulgated if not

formulated.



3.4.6 Management of Laboratory Data

Data management practices aims at strengthening practices of documentation, analysis, utilization and sharing of

laboratory data generated at facility level: this may involve; Storage and retrieval of patient files, Compilation, analysis

and utilization of medical data in Malaria treatment, periodic summary reports to districts and Synthesis of interventions

that have led to improvement and those that have not.

From the table above its evident that most facilities indicated that they correctly record the medical records in the

laboratory registers however there was little evidence for analysis and summary reports for utilization at the facility. This

was is mainly attributed to limited access to electronic data management practices, which may easily analyse an

present reports as opposed to the currently used manual methods of data capture.

Proportion of facilities with a functional laboratory that enters lab data correctly

District Name Functional

Lab? No Response

Data is recorded correctly

Data is not recorded correctly

AMURIA Yes 90% 10%

BUKEDEA Yes 33% 56% 11%

BULIISA Yes 86% 14%

HOIMA Yes 15% 65% 20%

KABERAMAIDO Yes 100%

KATAKWI Yes 25% 75%

KIBAALE Yes 93% 7%

KIBOGA Yes 8% 75% 17%

KUMI Yes 100%

LUWERO Yes 18% 68% 15%

MASINDI Yes 5% 77% 19%

MPIGI Yes 9% 91%

MUKONO Yes 11% 79% 11%

NAKASEKE Yes 75% 25%

NAKASONGOLA Yes 33% 67%

RAKAI Yes 10% 91%

SOROTI Yes 8% 88% 4%

WAKISO Yes 3% 90% 6%



3.4.7 Availability of Staff Trained in Logistics Management

The table shows information of health facilities

that indicated that their staff had received

training in logistics management. From the data

set a cross tabulation of facilities and their

responses on whether they had a functional

laboratory against their opinion on having a

trained staff was done.

Bukedea (22%) Rakai (29%)and Buliisa(29%), had

the lowest proportion of facilities with trained

staff in logistics management. Masindi and

Nakasongola followed with only 32% and 33% of

facilities with trained staff in Logistics

Management.

District

Functional

Lab?

No

Response

Trained staff

available

No staff

trained

Not

Applicable

Yes 60% 40% AMURIA

No 100%

Yes 22% 22% 56% BUKEDEA

No 100%

BULIISA Yes 14% 29% 57%

Yes 15% 39% 47% HOIMA

No 14% 14% 71%

Yes 13% 38% 50% KABERAMAIDO

No 33% 67%

Yes 75% 25% KATAKWI

No 100%

Yes 57% 43% KIBAALE

No 13% 50% 38%

Yes 25% 58% 17% KIBOGA

No 67% 33%

KUMI Yes 17% 50% 33%

Yes 32% 50% 18% LUWERO

No 33% 67%

MASINDI Yes 14% 32% 55%

Yes 22% 44% 34% MPIGI

No 14% 57% 29%

Yes 34% 47% 18% MUKONO

No 57% 43%

Yes 25% 50% 25% NAKASEKE

No 50% 50%

Yes 17% 33% 50% NAKASONGOLA

No 33% 67%

Yes 29% 29% 43% RAKAI

No 100%

Yes 12% 48% 40% SOROTI

No 33% 67%

Yes 24% 41% 31% 3% WAKISO

No 9% 9% 82%



3.5 DRUG VERIFICATION Proper inventory management of malaria drugs is essential in the malaria control program. All health facilities are

required to have stock cards to assist staff in monitoring the supply of selected essential malaria treatment supplies. In

this assessment quantities on Stock cards were compared with actual physical count at facility stores.

Availability updated stock cards; with exception of Bukedea, most

facilities in all districts indicated that they had updated stock cards.

Nakaseke district also had only 46% of the facilities in the district

reporting to have updated stock cards, a significant number 31%

would hardly respond to the query.

Stock out cases of Malaria drugs; most HCII and HCIII indicated that

they rarely consistently get supply of essential drugs. Sometimes they

may get supplies after a month and when they receive supplies

they are always inadequate. “…We experienced Stock Out before, we received drugs in august

and ran up to middle of September and at the moment they are out

of stock Again” Lamented the in charge of Ngariam HCIII in Katakwi

District.

Whereas some facilities where complaining about stock out of

coartem, SP and IV quinine some facilities had them in stock for the

last three months.

Proportion of facilities with updated stock cards

District No Response

Stock cards available

No updated stock cards

AMURIA 23% 62% 15%

BUKEDEA 9% 18% 73%

BULIISA 100%

HOIMA 17% 83%


KATAKWI 20% 80%

KIBAALE 8% 75% 17%

KIBOGA 91% 9%

KUMI 7% 93%

LUWERO 32% 53% 15%

MASINDI 27% 70% 3%

MPIGI 31% 67% 2%

MUKONO 9% 89% 2%

NAKASEKE 39% 46% 15%


RAKAI 23% 77%

SOROTI 18% 71% 12%

WAKISO 2% 87% 11%

Total 18% 74% 8%



3.6 IEC VERIFICATION Effective communication is the basis of behavior change for all stakeholders, their families, community leaders, program

managers and service providers. Mobilizing the communities, local, regional and national as well as political and

religious leaders to play an active role in malaria control and ensuring proper understanding of the core interventions by

the population and promoting positive change of behaviors is the major purpose of advocacy, IEC & social mobilization

malaria control strategy.

3.6.1Availability of Malaria Specific Health Education Talks

Although significant proportions of facilities especially in

Nakaseke (39%), Luwero (37%), Bukedea (36%), Kibaale (33%),

Masindi (33%), Nakasongola (32%) and Amuria (31%) indicated

that they do not provide educational talks to their clients,

majority of facilities in all districts indicated that educational talks

about malaria are provided.

It should however be noted that in almost all the facilities that

provided educational talks, there were no clear planning for

educational activities. Health workers indicated that they find

challenges with mobilizing people hence they conduct them

once in-a-while. In Soroti district most facilities only offered

malaria educational talks in OPD and ANC and during

community meetings. In Nakaseke district there are no formal

educational talks but patients are advised on key strategies to

fight malaria and it’s a one on one basis.

Availability of teaching aides: with exception of Kumi district where 87% of facilities indicated that they had job aides to help in implementation of health education, significant proportions of facilities in most districts did not have malaria teaching aides

probably this is part of the reasons to keep malaria education informal.

Availability of a health educator/Assistant attached to the facility: Facilities in Buliisa indicated that the health assistant is available and visits the facilities however in other districts most facilities indicated that health assistants are attached to their facilities but they are very irregular and has made limited contributions in malaria ED.

Proportion of facilities that gave malaria education talks to patients

District No Comment Talks available No Talks

AMURIA 69% 31%

BUKEDEA 9% 55% 36%

BULIISA 100%

HOIMA 7% 63% 29%

KABERAMAIDO 100%

KATAKWI 10% 70% 20%

KIBAALE 67% 33%

KIBOGA 10% 70% 20%

KUMI 100%

LUWERO 13% 49% 37%

MASINDI 67% 33%

MPIGI 86% 14%

MUKONO 82% 18%

NAKASEKE 62% 39%

NAKASONGOLA 68% 32%

RAKAI 4% 85% 12%

SOROTI 3% 82% 15%

WAKISO 4% 89% 6%

Total 4% 75% 22%



3.6.2 Community Awareness activities about Malaria

Health facilities are expected to conduct community awareness

activities with the aim of informing families on malaria prevention and

protection through supporting community initiatives such as

Information Education & Communication and Behaviour Change

Communication.

With exception of Bukedea and Katakwi districts Community

awareness activities in use of LLNS, sanitation, IPTp, Malaria treatment

and treatment seeking behavior was largely proportionately low in all

districts. Hoima district and Nakasongola had no single facility

reporting to carry community awareness activities.

Many facilities especially in Wakiso, Rakai, Nakaseke, Kibaale and

Soroti indicated that the work of community sensitization requires

resources because it requires mobilisation of the communities hence

making it a little had for health facilities to organize regular sensitization meetings. Such facilities indicated that

community awareness activities are now limited to activities of the health assistant with VHTs and during community

outreaches.

There were only few facilities in all districts that were found using health facility data in planning community awareness

activities. This was attributed to the less importance of health facility data in making decisions in regard to client service

in all districts. Data collected at health facilities is corrected because it’s mandatory and is prepared for the district and

MOH.

It was only Katakwi and Kumi districts with majority of their facilities indicating that they use IEC materials during

community sensitization. In all other districts it was only a few facilities where malaria related materials for the community

are available especially with the health assistant.

Higher proportions of health facilities that indicated that they carry out health education and had no reports are in the

data set. It was only Kumi (54%) with majority facilities indicating that they shared health education reports with the

district and at the facility other districts had negligible proportions of facilities conducting health education and sharing

reports with the DHE/DHI.



3.7 SUPPORT SUPERVISION Supportive supervision is a proven approach that helps transfer knowledge to practice and that ensures that learning

continues beyond the traditional training setting. Through routine visits, supervisors can provide follow-up training to

improve performance and solve other systemic problems that contribute to poor malaria management. The ultimate

goal is a sustainable system that works with supervisors to give health workers the consistent guidance and mentoring

they need to implement and maintain a safe and effective malaria program.

Proportion of facilities that received supervision from upper levels Proportion of facilities that carried out support supervision to lower

level HFs

District No Response Received Supervision No Supervision No Response Carried out Supervision Did not carry out supervision

Not Applicable

AMURIA 15% 23% 62% 8% 15% 77%

BUKEDEA 82% 18% 9% 18% 36% 36%

BULIISA 10% 90% 10% 10% 20% 60%

HOIMA 5% 83% 12% 7% 15% 37% 42%

KABERAMAIDO 9% 82% 9% 9% 9% 55% 27%

KATAKWI 100% 10% 30% 40% 20%

KIBAALE 70% 30% 17% 35% 48%

KIBOGA 5% 60% 35% 5% 25% 45% 25%

KUMI 7% 93% 7% 40% 53%

LUWERO 2% 89% 9% 2% 19% 26% 53%

MASINDI 6% 85% 9% 3% 12% 36% 49%

MPIGI 16% 73% 11% 9% 14% 30% 48%

MUKONO 2% 93% 6% 7% 36% 33% 24%

NAKASEKE 8% 85% 8% 17% 50% 33%

NAKASONGOLA 95% 5% 20% 35% 45%

RAKAI 7% 89% 4% 7% 41% 30% 22%

SOROTI 9% 79% 12% 12% 27% 38% 24%

WAKISO 2% 80% 18% 2% 44% 36% 18%

Total 5% 82% 13% 6% 24% 36% 34%

From the table above it can be seen that with exception of Amuria District, a big proportion of facilities in the rest of the

districts indicated that they had received support supervision in the previous quarter. In Buliisa facilities mentioned

support supervision to have been carried out by IDI, Baylor College and MOH. However most support supervision done

was not malaria specific except when it is done by Stop Malaria Project.

Wakiso district (44%) and Rakai district (41%) and Mukono (36%) had the highest proportion of facilities that

indicated that they had carried out supervision to lower level health facilities.



4.0 RECOMMENDED ACTION POINTS o Proposed areas for Improvement

o Proposed Action to be taken



5.0 APPENDICES

Assessing Malaria Treatment and Control in Selected … · Stop Malaria Project Uganda Assessing Malaria Treatment and Control in selected Health Facilities vi 3.3.3 Malaria Treatment

Documents