Health Systems Strengthening

Health Systems Strengthening (HSS) across a facility-community continuum

HSS and District Led Programming (DLP):  BU uses community and health systems strengthening to improve comprehensive HIV services across a facility-community continuum to reach the UNAIDS 95-95-95 targets (Figure 1 & Table 1).

Health service delivery: BU provides comprehensive HIV/AIDS services to all populations with a special focus on subpopulations with poorly performing indices, such as children, AGYW, KP, PP and men. Its community-facility bi-directional linkage framework model links HIV+ clients to health services.

BU has strengthened FSWs’ capacity for peer mobilization, case identification, and referral and linkage to health services, leading to improved adherence and stigma reduction. BU has recruited, trained, mentored 32 CSOs staff in Fort portal and Hoima regions and used referral maps to link each HF (252) to a CSO; This has led to >44,000 successful referrals every quarter.

Our Miles in HSST

• Determined Resilient Empowered AIDS-free Mentored (DREAMS) Lite intervention: BU has implemented DREAMS Lite interventions targeting AGYW in all sub counties of Kyegegwa District to control HIV infections, GBV, teenage pregnancies and improve PMTCT outcomes.
• Non-communicable diseases integration experience: BU integrates noncommunicable diseases (NCD) screening and management into HIV/TB service delivery (Text Box 2).
• Expertise in telemedicine (call centre and KP hot line): BU created the first national pediatric and adolescent call center. The call center supports HWs to provide high quality HIV/TB care, SRHR and VMMC services. BU runs a 24-hour KP 24-hour toll-free hotline to provide timely support for access to KP services.

• Flexibility, adaptability, responsiveness to rapidly changing global, national & PEPFAR guidance: BU has successfully responded to rapidly changing guidelines using qualified staff and 50 trained district mentors in the Fort portal and Hoima regions.
• BU scaled evidence-based differentiated service delivery models (DSDM) for client-tailored services and recency testing at regional, district, HF, and community levels.

Essential Commodities and new technologies

• Strengthening district and HF supply chain systems: BU partners with national health supply chain mechanisms to ensure optimal stocks of ART/other health commodities.
• Strengthening laboratory quality management: BU has trained 16 SPARS technical assistance

teams to monitor laboratory service quality and performance.. All 7 (100%) lab hubs in the Fort portal region have attained SANAS accreditation; 3) A College of American Pathologists certified laboratory at our COE that continues to maintain accreditation.

Health Management Information Systems (HMIS):  Our M&E team trains and mentors DHTs/CSOs to use national and PEPFAR tools for planning.  We have strong experience in project monitoring, Continuous Quality Improvement (CQI) and data quality assessments and conduct monthly/ quarterly district review meetings to promote data us

• Continuous Quality Improvement (CQI): BU supports institutionalization and sustainability of CQI practices through DLP and HSS

Health Financing:

BU has managed >400 sub-grantees at district, municipality, HF, CBO, and PLHIV-network levels in 4 regions.

Leadership and Governance: BU with Pepal (2015-2018), implemented ‘Caring Together’ project in all 8 Soroti and 9 Fortportal districts. BU trained frontline HWs on basic leadership tenets to improve HF functionality.

• Support for District and community structures: We have supported reactivation of accountability and monitoring structures at district and community levels.
• District Led Programming (DLP): BU pioneered the DLP framework to reinforce district and municipality public health response for epidemic control; signs Partnership Framework Agreements with districts; supports districts to update their HIV epidemic profiles; works with the RRHs community department to provide joint, targeted, culturally sensitive TA, by embedding technical staff into District Health Teams (“twinning approach”); and has set up a community of practice network for cross-learning across districts and regions via e-health platforms.
• Support to Fort portal and Hoima Regional Referral Hospital (FRRH & HRRH): As the regional IP, BU has supported FRRH to successfully transition from BU support to government to government (G2G) funding. BU developed and disseminated the transition plans for FRRH; provides good oversight, coordination, and support supervision to districts; planning and budgeting for HIV services is data-driven and collaborative; and the RRH provides quality HIV service delivery (HTS, PMTCT, ART, and TB treatment).

Health and Community Workforce: BU HW capacity building includes virtual training, blended virtual and in-person training (for practicum), onsite and remote mentorship, and support supervision