Expanding HIV and TB Services in Eastern Uganda with Community Outreach and Performance-based Financing
Esther Nyende, 45, is a member of her village health team and a community leader in Uganda’s eastern Pallisa District.
When she visited the local health center as part of her duties, Nyende noticed a woman who was always seeking care, but whose condition never seemed to improve. The woman’s name was Beatrice Takali.
Nyende visited Takali at her home and, after getting to know her, encouraged Takali to be tested for HIV. Eventually, Takali agreed. “She found me in a bad state,” said Takali, 48. “I thought I was going to die. I feared to go for the HIV test. She tried to convince me several times before I agreed.”
Accompanied by Nyende, Takali went for testing to the AIDS Information Center, 52 km away in the town of Mbale. Takali tested positive for HIV, and was started on antiretroviral therapy (ART). “Now I am healthy and can do activities to support my family,” Takali said.
Photo credit: MSH staff.
Performance-based financing helps community-based organizations support village health teams
In her role as a member of the village health team, Nyende worked with the Health Promotion and Social Development (HEPS) Program, a Pallisa-based civil society organization that received a performance-based financing grant from Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E). HEPS was one of 13 civil society organizations that STAR-E partnered with to work with village health teams to sensitize and mobilize community members to create demand for HIV and tuberculosis (TB) services provided by project-supported health facilities. STAR-E provided payments based on the organizations’ achievements of agreed-upon deliverables, validated quarterly.
Brian Wafiire, HEPS program assistant, cited a number of benefits from the performance-based financing grant. “With support from STAR-E, HEPS has now developed a good relationship between the community and the health centers and they are making use of the village health teams, especially for referrals and follow-up,” he said.
HEPS referred more than 10,380 people for HIV counseling and testing and more than 1,880 people for TB screening. The program established and supported 4 facility-based family support groups, reached 70,000 community members with HIV prevention messages, distributed more than 308,000 condoms, and trained 110 village health team members on HIV prevention sensitization and mobilization.
Wafiire added that village health teams are now effectively supporting health centers to follow up with clients to ensure their adherence to treatment for HIV and TB.
Nyende alone has referred 20 clients who are now receiving ART.
Takali currently receives ART from Kamuge Health Centre III near her home. She has also sensitized others and encouraged them to get tested for HIV. “I have a brother who had been falling sick. I told him about my situation and encouraged him to go for an HIV test. He accepted, and is now on treatment,” she said.
Kasifa Mugala, 34 (pictured above) also benefited from Nyende's community outreach in eastern Uganda. Mugala started feeling ill while she was pregnant, and started antiretroviral therapy after referral for prevention of mother-to-child transmission of HIV. “I am very happy. I gave birth to a healthy baby who is now turning one year old,” Mugala said. “I did not know that I would ever be fine. I am grateful to our village health team.”
Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E) is a US Agency for International Development (USAID) Project, funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and led by Management Sciences for Health (MSH) with a consortium of international and Ugandan partners.