In early 2017 in the Ntungamo district of Uganda, a two-year-old boy named Aaron was treated at a private clinic and then at a hospital for pneumonia—the diagnosis for his persistent cough and fever. However, Aaron’s condition continued to deteriorate. His desperate parents took the boy to Itojo Hospital, a rural hospital whose staff had recently been trained on a package of care designed to serve the whole child.
The nurse consulted a guide on Integrated Management of Neonatal and Childhood Illnesses (IMNCI) and requested further tests. She then diagnosed the child with severe malnutrition and tuberculosis (TB), and initiated the appropriate referral and treatment procedures.
Aaron’s mother, Annet, was delighted. “My two-year old son, Aaron got much improvement on treatment. I noticed the swelling of the legs had disappeared, his appetite improved, the cough subsided and the fever reduced. I can now sleep well because before I was always worried all day and night. I am now happy because he is even gaining weight from 8.0kgs now he weighs 11kgs and can play well. I am happy with the services my child got from the hospital because my child could have died”.
Training for Aaron’s providers was supported by the Maternal and Child Survival Program (MCSP), a flagship program of the United States Agency for International Development (USAID).
Through MCSP, JSI is revitalizing and scaling up IMNCI using innovative approaches, such as employing the cost saving WHO Distance Learning model and Uganda’s Ministry of Health (MOH) Short interrupted Course to train health workers. MCSP is also applying the components of the World Health Organization’s ‘Reaching Every Child’ approach from the immunization field, to scale up an integrated package of child health interventions at every level of the health care system. The Reaching Every Child approach, which features strategies such as planning, stakeholder engagement, targeted outreach, and data monitoring and use, incorporates principles that can be adapted for other aspects of child health.
In Uganda, gaps in health worker knowledge often lead to misdiagnosis, mistaken prescription and treatment, poor management of complicated cases, and delayed referral. These factors contribute to the deaths of an estimated 1 in 16 children under the age of five each year.
In response, MCSP launched efforts to build local capacity to implement a set of proven child health interventions using the IMNCI approach. JSI provides technical assistance and capacity building to improve case finding, referral, and clinical management of malaria, diarrhea, pneumonia, malnutrition, and HIV/TB. The program works from the community to the national level to engage leaders and stakeholders, to improve health worker practices and procedures, and to ensure that young children receive preventive care, timely and accurate assessment and treatment, and timely referral.
We are demonstrating how to work through the MOH and partner organizations to build local capacity without directly doing the work ourselves. JSI’s technical assistance enables partners and district health teams to strengthen the capacity of health workers to deliver low-cost, high-impact child health interventions at every level of care. We are also showing how components of the Reaching Every Child approach for immunization can be applied to implement a package of child health interventions at scale.
For under-five patients like Aaron, these changes represent lives saved. After a month of inpatient treatment he was released in good condition. And through contact tracing, the hospital identified and treated a relative with drug-resistant TB, who also received treatment.
Many of our partners are interested in using the findings from our demonstration to improve access to, and the quality of child health services in Uganda.