Uganda: Healthcare Implementing Partner for UNHCR at Kiryandongo Refugee Settlement

Background

RMF's Implementing Partner Program for UNHCR at Kiryandongo Real Medicine Foundation signed a tripartite agreement as an official "Implementing Partner" of UNHCR on 1st of July 2014 with the Office of the High Commissioner for Refugees (UNHCR) and OPM to provide health services through the established health centers in Kiryandongo Refugee Settlement namely Panyadoli Hill Health Centre II, Panyadoli Health Centre III, at Reception Centre.  Acting as an official Implementing Partner of UNHCR at Kiryandongo, we are now able to expand our already existing support of health programs and address two goals of emergency operations and care and maintenance of the originally targeted 24,722 (20,269 new caseload and 4,453 old caseload) refugees and asylum seekers in Kiryandongo Refugee Settlement through the delivery of quality healthcare services. 

 
However, by the end of December 2014, the project had grown to benefit 35,664 refugees (according to UNHCR December 2015 Statistics), this indicates 30% beneficiary increase. It is also recorded that over 10,000 nationals living within and in the vicinity of the settlement continue to benefit from the project.
 
The continued precarious situation in South Sudan has necessitated continued influx of new arrivals, between November and December over 700 new arrivals were screened by RMF health workers, thus stretching on the available resources.
 
By the end of the year, RMF delivered health services to the communities through established health centres: Panyadoli Hill Health Centre II, Panyadoli Health Centre III and Reception Centre clinic and through conducting outreaches through static units (i.e.  Reception center clinic) and enhanced by outreach for communities with limited access to the existing health units or located over 5 km from the health facility as per the Ministry of Health access standard.   

Health Programs

Kiryandongo Refugee Settlement has a total of three health centers which includes; Panyadoli Health Center III, Panyadoli Hills Health Center II and Reception Center (Health Center II). The Refugee Settlement also receives services from other partners that bridge the gaps in health service delivery. For instance community services, environment and livelihood programmes are implemented by InterAid-Uganda; Danish Refugee Council (DRC) for WASH and livelihood; International Rescue Committee (IRC) providing reproductive health services; TPO for mental health; Samaritan Purse-food distribution in collaboration with WFP; ACF and Concern Worldwide for nutrition; Windle Trust for education; AIRD for logistics. UNHCR and OPM conduct oversight function including ensuring that activities are planned, coordinated and reviewed on a weekly, monthly and quarterly basis through coordination meetings chaired by OPM at settlement level.

During the programme implementation RMF has observed three key factors in regards to the programme risk management and including the following;

• The district leadership: We realized that working closely with the local governments and other community leaders is  important if we were to achieve our objectives effectively and efficiently. Hence, RMF made the District Health fully aware of the project objectives to justify our relevance in terms of health care delivery in the District through an inception meeting with the District Health Officer. This yielded high level cooperation that contributed to the realization of programme goals and objectives 
• Community: We realized that the persons of concern and community at large must be willing to accept and cooperate with RMF if we were to deliver quality services to the community.  During the project inception, we held an introductory meeting with refugee leaders as they represent the wider community, the objective was to highlight programme intended goals and objectives in order to enlist their cooperation throughout programme implementation.
• Cooperation with other partners: Full cooperation and coordination with other implementing and operating partners delivering services was important for us if we were to realize our goals in the proposed programme. During implementation a lot was shared in terms of work plans, referrals, and any other relevant information that enhanced coordinated approach to service delivery. 

Staff Recruited

1 Program Officer
1 Finance and Admininstration Officer
3 Clinical Officers
1 Medical Doctor
1 Lab Technician
2 Lab Assistants
4 Enrolled Nurses
3 Midwives
2 Data clerks
1 HIV Counselor
6 Interpreters
5 Cleaners

Actual Impact

There has been general improvement in quality of life at the settlment and the increase in number of staff in all health facilities has tremendously added value to health services, the establishment of the health clinic at reception center has reduced overcrowding at Panyadoli health center, and hence the hospital utilization rate has increased and changed health seeking behaviour among the refugees. Generally the health indicators largely increased or remained constant:

• 41,702 patient consultations during the year
• 11 Staff trainings on HIS
• 29 Staff trainings on UNHCR CoC
• 50 Trained VHTs on disease surveillance, disease outbreak control team
• 45 Trainings of health workers on SOPs
• 0.09% Crude mortality rates
• 0.0% Under five mortality
• 86.6 % Measles coverage
• 100% Access to primary health care
• 1:40 Clinician/patient ratio per day
• 1.2 Health facility utilization rate
• 50% <5 IPD deaths within 24 hours
• 22% Bed occupancy rate
• 61.8% Hospitalization rate
• 26% Vaccine Coverage rate
• 88.2% postnatal Vitamin A Distribution
• 764 of PoCs referred to secondary and tertiary health care
• 48 Routine immunization programmes established and maintained
• Procured medical equipment

Reproductive Health and HIV/AIDS Programs

HIV/AIDS Voluntary Counselling and Testing (VCT) were provided in Panyadoli Health Center III, the ART clinics have been conducted every Wednesday, condoms have been distributed and opportunistic infections properly managed. Communities have been sensitized on prevention, care and guard against discrimination and stigma and engaging in risky lifestyles that lead to the spread of HIV/AIDs, these services are conducted both at the static units and outreaches. The recruitment of the HIV/AIDs counsellor has helped build confidence among the clients in need of HCT services at the health facility and outreach sessions. Availability of skilled mid wives has increased ANC services at both health facilities, overall mothers are now seeing hope in deliveries.

Preventive community based health services were enriched with outreaches through static units (i.e. Reception center clinic) and enhanced by outreach for communities with limited access to the existing health units or located over 5 km from the health facility.

RMF took an integrated outreach approach with services covering immunization, HCT, ANC, Deworming, condom distribution, health education including vital information on other cross cutting issues like gender based violence.  These outreaches were conducted on regular visits to the established sites by an integrated team of qualified staff with a clear work plan.

The folllowing list highlights some of the health achievements during the time period between July and December, 2014:

• 544 new antenatal visits were recorded during the year 
• 0 maternal deaths were recorded at Panyadoli Health center III 
• During the year  a total of 169 live Births were registered at both Panyadoli health center III and Panyadoli hills health center II 
• The crude birth rate was registered at 0.5 % in 2014 
• 100% Deliveries were conducted by skilled midwifes at the health facilities during the year. 
• There was only 1 still birth recorded during the year at Panyadoli health center III 
• All the Obstetric Complications -100%  reported at the health facilities were successfully managed 
• 0% Births performed by Caesarean section 
• During the year 63% of clients received post-test counseling and result. 
• The PMTCT Coverage was registered at 89% during the year. 
• 0 Rape Victims 
• 95% measles vaccination coverage 
• 60% antenatal coverage was recorded by project end. 
• 54% ante-natal tetanus coverage 
• 71% Coverage of IPT for Malaria in Pregnancy 
• A total of 720 persons of concern receiving  ART by end of December 2014
• HIV/AIDs prevalence reduced from 8.5% to 2.0 % at Kiryandongo Refugee Settlement by the end of 2014.
• 169 live Births
• 100% of the communities accessed to condoms within the target communities
•  A total of 5 mothers were screened for Cervical Cancer during the reporting period, RMF piloted screening on Cervical Cancer towards the end of last quarter of the programme as a result of both UNHCR training conducted on partners and also the declaration by the Ministry of health on cancer as an epidemic, in Uganda, this activity also creates focus for 2015 programme.
• Real Medicine Foundation participated in conducting HCT, services during activities to mark World AIDS Day 256 clients were counseled tested and results delivered.

Medicine purchased

During the reporting period efforts were made to ensure that drugs were locally procured for patients with illness whose drugs were not available in the stores. Services such as ultra sound scan, therapy and x-ray were not readily available in the settlment or Kiryandongo Hospital/Gulu Hopsital which are the nearest referral points, however, patients were supported financially to access such services wiith private medical practitioners.

Laboratory services provided according to country specific SOPs.

Laboratory reagents procured and supplied to the health center.

1 laboratory technician and 2 laboratory assistants recruited to support services at both Panyadoli Health center III and Panyadoli Hills health center II.

Community Outreach and Capacity Building

Various capacity building activities were undertaken as planned, these trainings were mostly planned under direct implementation,  RMF made considerable efforts to fast track implementation of this trainings as per plan and were successfully conducted with involvement of UNHCR. 
 
Training of the community health promoters (VHTs) on disease surveillance and prevention came in at a time when there are outbreaks of epidemics in the world like Ebola in West Africa. As a result four specimens of suspected cases of Polio, Measles, Ebola and Hepatitis B were delivered for laboratory confirmation at the Uganda Virus Research institute Entebbe. While all other tests turned out negative the Hepatitis B case is still under investigations.

Mosquito nets campaign and survey was conducted to establish the availability and usage of the mosquito nets and also encourage mosquito net usage as best way to prevent malaria episodes commonly recorded at Panyadoli Health center III.

• A total of 9 outposts were mapped out; Initial roll out of this programme involved RMF teams conducting a mapping exercise to establish whether the traditional outreach sites are adequate or we bring on board other sites, this exercise took into account the aspect of distance and the population statistics as the major parameters. As a result 9 posts were clearly identified as viable venues to successfully conduct integrated outreaches.
• A total of 32 outreaches were conducted three times every week  at the  established sites by an integrated team of qualified staff with a clear work plan with the services covering immunization, HCT, ANC, Deworming, condom distribution, Health education including vital information on other cross cutting issues like gender based violence. Both immunization coverage and the number of patients seeking health care services have tremendously increased  
• Recruitment and facilitation of community structures;  A total of 50 community health promoters a replica of government VHT strategy were recruited from the community to support in mobilization and  sensitizations of communities, disease surveillance, community referrals which are all the core of RMF programmes. This has increased health service utilization at both static clinics and community based outreaches.
• A total of 2 awareness campaigns were carried out with 780 children reached with information on how to identify and report diseases of epidemic nature.