Rwanda to use drones to deliver blood supplies in remote areas

By Esther Nakkazi

Rwanda has been awarded $800,000 by the UPS Foundation to support the initial launch of using drones to deliver life-saving medicines like blood and vaccines.

The UPS Foundation has partnered with Zipline a California­-based robotics company and GAVI the vaccine Alliance to make this happen.

Starting later this year, the Rwandan government will begin using Zipline drones, which can make up to 150 deliveries per day of life-saving blood to 21 transfusing facilities located in the western half of the country.

This public-private partnership combines a century of global logistics expertise, cold chain and healthcare delivery from UPS with Zipline’s national drone delivery network and Gavi’s experience in developing countries focused on saving lives and protecting health in the most remote places of the world.

In a press statement issued on 09/May Eduardo Martinez, president of The UPS Foundation and chief diversity and inclusion officer at UPS said the public-private partnerships are the key to solving many of the world’s challenges, with each partner contributing its unique expertise.

While Rwanda’s national drone network is initially focused on the delivery of blood supplies, the plan is to expand the initiative to include vaccines, treatments for HIV/AIDS, malaria, tuberculosis, and many other essential and lifesaving medicines. Rwanda’s drone delivery operation is expected to save thousands of lives over the next three years and could serve as a model for other countries.

“UPS is always exploring innovative ways to enhance humanitarian logistics to help save lives, and we’re proud to partner with Gavi and Zipline as we explore ways to extend the Rwandan government’s innovations at a global scale.”

According to the WHO¹, Africa has the highest rate in the world of maternal death due to postpartum hemorrhaging, which makes access to lifesaving blood transfusions critically important for women across the continent.

“Our partnership with UPS and Zipline is an exciting step into a new territory for the delivery of medical supplies,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “It is a totally different way of delivering vaccines to remote communities and we are extremely interested to learn if UAVs can provide a safe, effective way to make vaccines available for some of the hardest-to-reach children.”

“The inability to deliver life-saving medicines to the people who need them the most causes millions of preventable deaths each year. The work of this partnership will help solve that problem once and for all,” said Zipline CEO Keller Rinaudo.

“With the expertise and vision of UPS, Gavi and Zipline, instant drone delivery will allow us to save thousands of lives in a way that was never before possible.”

ends

GAVI Alliance funds Uganda yellow fever vaccination as outbreak rages on

By Esther Nakkazi

Uganda has received 714,579 doses of yellow fever vaccine, from the GAVI Alliance, worth 643,765 US dollars (over shs 2 billion), for an emergency reactive mass vaccination campaign in two districts.

Masaka and Rukungiri districts have been hit by a yellow fever outbreak recording 30 suspected cases and 11 deaths. Uganda started experiencing a yellow fever outbreak in January 2016 prior to this it reported a yellow fever outbreak in 2010 that affected five districts in the northern part of the country.

The  International Coordination Group on vaccines comprising of UNICEF, WHO, MSF, and the IFRC okayed for GAVI to pay for the vaccines. 

Immunisation of 698,850 people, aged six months and above will be done in the two districts and a campaign is scheduled to begin in the second week of May.

“The importance of carrying out a massive vaccination campaign is to interrupt the transmission. With this exercise, the affected population will be able to achieve immunity against yellow fever,” said Ms Aida Girma, UNICEF representative in Uganda.

Currently, the Government of Uganda, through the Ministry of Health and its partners, UNICEF, WHO, MSF and CDC, is supporting social mobilization activities, facilitation of health workers, and capacity building of health teams in the affected districts. 

Social mobilization activities include engaging local leaders and village health teams to conduct interpersonal and door-to-door communication with communities in small groups. Utilization of the local media using radio messages is also on-going.

Dr Jane Ruth Acheng, the Director General of Health Services at the Ministry of Health is the overall coordination of the response being done by the National Task Force and she says the general objective of the response plan is to reduce avoidable morbidity and mortality due to the outbreak.

According to WHO, there is no specific treatment for yellow fever but the international organisation recommends that patients should be provided with supportive treatment which includes rehydration therapy for dehydration, analgesics for fever, diazepam for restlessness, and bed nets for preventing the spread of infection.

“Vaccination is the major preventive measure against the disease because it is highly effective,” added Dr Wondimagegnehu Alemu, WHO country representative in Uganda. 

The WHO situation report released on 5th May shows that countries in Africa have suffered from a yellow fever outbreak. One was detected in Angola late in December 2015 and confirmed by the Institut Pasteur Dakar (IP-D) on 20 January 2016. Subsequently, a rapid increase in the number of cases has been observed.

It reported that as of 4 May 2016, Angola has reported 2,149 suspected cases of yellow fever with 277 deaths. Among those cases, 661 have been laboratory confirmed. Despite vaccination campaigns in Luanda, there is still circulation of the virus in most districts of Luanda and in five additional provinces.

Three countries have reported confirmed yellow fever cases exported from Angola: Democratic Republic of The Congo (DRC) (37 cases), Kenya (two cases) and People’s Republic of China (11 cases). Namibia has also reported a suspect yellow fever case exported from Angola. This highlights the risk of international spread through non-immunised travellers.

On 22 March 2016, the Ministry of Health of DRC notified human cases of yellow fever in connection with Angola. The Government officially declared the yellow fever outbreak on 23 April. As of 4 May, DRC has reported 5 probable cases and 39 laboratory confirmed cases: 37 imported from Angola, reported in Kongo central province and Kinshasa and two autochthonous cases in Ndjili, Kinshasa and Matadi, Kongo central province. The possibility of locally acquired infections is under investigation for at least 10 non-classified cases in both Kinshasa and Kongo central provinces.

The virus in Angola and DRC is largely concentrated in main cities and is likely to have been introduced to the cities following increased yellow fever viral circulation among monkeys in the forest.

What is yellow fever?

Yellow fever is a viral infection that is transmitted to humans through a bite from a mosquito carrying the yellow fever virus. It causes fever, yellowing of the eyes, and bleeding from any part of the body. The "yellow" in the name refers to the jaundice (Nkaka) that affects some patients.

What are the signs and symptoms of yellow fever?

After three to six days of infection with the yellow fever virus, the following signs and symptoms usually appear:

• Rapid onset fever
• Abdominal pain
• Diarrhoea
• Vomiting
• General body weakness
• Yellowing of the eyes
• Loss of appetite
• Bleeding from any part of the body

Some patients may develop yellow eyes, abdominal pain, bleeding from the mouth, nose, eyes and stomach. Most patients fight the infection and the signs and symptoms disappear after three to four days. However, those unable to fight the infection worsen (toxic phase) and many of these eventually die within 10 to 14 days.

How is yellow fever spread?

The yellow fever virus is spread by mosquitoes, which transmit the virus to humans through a bite, leading to the spread of the disease in communities. The infected mosquitoes that spread the disease usually bite people during the day. They breed in open containers around homes, as well as pools of stagnant water and bushes.

Who is at risk of getting yellow fever?

Anyone who is bitten by an infected mosquito can get the disease. However, it is important to note that some members of the community may be more at risk of catching the disease than others, for example: 

• Anyone who is not immunized against yellow fever;
• People who work or live in forests

How is yellow fever treated?

There is no specific treatment for yellow fever. Health workers can only offer supportive care to treat dehydration and fever. Bacterial infections linked to the diseases can be treated with antibiotics. It is important to seek early treatment when symptoms show.

How can yellow fever be prevented?

• Vaccination
• Mosquito control
• Personal protection: wear long sleeve shirts or blouses, trousers, long dresses and long skirts 

Countries have scaled up viral load testing but health workers have failed to interpret the results

http://www.observer.ug/lifestyle/42-entertainment/43763-patients-health-workers-struggle-with-viral-load-results ( I first published this in this publication, below is the unedited version)

Health workers still do not know how to use and to communicate high viral load results and neither do patients understand the terms

By Esther Nakkazi

Viral load testing may be the gold standard for monitoring HIV treatment outcomes but countries that have scaled it up have an emerging problem; some health workers cannot interpret the laboratory results to appropriately manage patients on anti HIV drugs.

Laboratory reports with viral load results now have to be issued with a sad face or a smiling face to help health workers and patients interpret the outcomes.

Kenneth Mwehonge, the health policy programs officer at the Coalition for Health Promotion and Social Development (HEPS Uganda) says there is low level of knowledge of viral load among people with HIV and health workers.

“Interpretation of results is still a challenge. Health workers still do not know how to use them to communicate the high viral load and neither do patients understand the terms,” he says.

The confusion is especially evident because both parties are used to CD4 count, which has been well communicated over the years. 

Experts have termed CD4 as ‘soldiers’ that protect them or improve their immunity but there is no equivalent for viral load yet in the local dialect.

CD4 cells are a type of white blood cells that play a major role in protecting the body from infection. They send signals to activate the body’s immune response when they detect intruders like bacteria. The higher the CD4 count the better for a patient.

“Patients ask after their immunity in terms of ‘soldiers’ (CD4) increasing and reducing,” said Carol Nakintu, a nurse at Kyosima clinic in a suburb of the capital, Kampala, that offers HIV care to patients in Kampala.

Over the years, patients have been told to know that the higher the CD4 count the healthier and loosely they have many ‘soldiers’ keeping them safe. It is the opposite for viral load because the lower the viral load the healthier.

Health workers say unlike CD4 count where HIV positive patients will know how many ‘soldiers’ are keeping guard, if they communicate viral load saying it is undetectable they will think that they are cured and do not need to take their drugs says Mwehonge.

In July 2013, the WHO passed HIV treatment guidelines  to monitor HIV patients response to anti retroviral drugs and diagnosis of treatment failure.

The guidelines recommend routine viral load testing six months after initiating treatment and once a year thereafter.

In Uganda, viral load testing was taken up by most of the HIV treatment facilities only a year back and health workers say they did not think the demand would be high because everybody was using CD4 and they were comfortable with interpreting the results.

The viral load test measures the amount of HIV virus in the blood, showing if a patient is responding to treatment. If the virus is above 1000 copies/ml its high and detectable if it lower than 1000 copies/ml then its low or undetectable and there is virologic suppression. 

Sad and Smiling face for Viral load results;

High viral load results show two things; either the patient is not taking their drugs diligently thus not adhering or there is drug resistance. They can at this point transmit HIV to a sexual partner. The laboratory results issued to such a patients report have a sad face.

While a low viral load means the virus is not affecting the health of the patient, they are less infectious and will not spread it to their sexual partner. The laboratory results have a sad face.

At the Uganda Ministry of Health Central Public Health Laboratories where about 600,000 samples of viral load are analysed annually, Charles Kiyaga, the national program coordinator says besides the gloomy and smiling faces on the patients’ reports they also provide footnotes and mentorship to health workers to be able to interpret the results.

When the lab report has a gloomy face, they also encourage the patient to get adherence support before they declare treatment failure and switching to second line HIV medicines that are more expensive.

In 2015, Central Public Health Laboratories of the 10,113 patients eligible for a second viral load test, only 66 percent of patients with a detectable viral load received their results for the second test.

This is informing us that the data is not utilised for patient management or some health facilities have no capacity to follow up patients, said Kiyaga. The viral load test costs about $20 and CPHL makes it available to all HIV patients in Uganda.

The Médecins Sans Frontières (MSF) laboratory in Arua, in North Western Uganda, by January 2016, the lab was serving 16,000 patients and of these 17-21 percent had a detectable viral load.

Ephraim Ajule, viral load activity manager, at the MSF lab says they advise the patients with a detectable viral load to undergo adherence counselling.

“When it comes to adherence it is the counsellors who know what to say and what to do,” says Ajule. But many health facilities including theirs have few or no counsellors to do adherence counselling. It is done by nurses.

Testing is repeated annually for patients with undetectable viral load and every six months if the patient is on second line drugs and for children. The science is that after the first year of initiating treatment patients viral load is usually undetectable. 

But children are checked often because they do not swallow their drugs diligently and appropriate dosage should be by weight which is usually not measured.  “Children can refuse to take drugs and they do not understand why they should take these drugs, as well when they become teenagers they go into denial,” said nurse Nakintu.

If adherence counselling is done properly and the viral load is measured and its still high then there is drug failure and the patient has to be switched. But nurses are afraid to switch patients to second or third line HIV drugs which do not exit.

In Uganda, access to third line drugs is very limited and most of these are still not in public health facilities observed Mwehonge.

“I am scared to put patients on second or third line drugs. I am not going to change the life of this person. I want to keep them on first line because I do not know what else to give them,” said Nakintu.

“We sometimes have to create individualised regimens for patients who fail on first line drugs which is a problem. Some of these drugs are not in the country and have to be ordered from another country. From the time it is confirmed to be resistant to the time they are initiated it takes 10 months,” said Ajule.

This problem is not unique to Uganda. In rural South Africa more than half of the patients with persistent viremia are not switched to second line, and for those who are switched it happens with a delay of one year from an elevated viral load (Venables at al. 20th IAS Conference)

In the Swaziland viral monitoring program of the patients with detectable viral load, after 6 months only 5% were switched to second line, 51% were still on first line, 37% were lost to follow up, 9% had died (Jobanputra JAIDS 2014)

To solve the problem of viral load issues, experts suggest that more adherence counsellors should be trained, better monitoring and follow up should be done as well more advocacy is required.

Ultimately, everyone agrees that patient empowerment about viral load is key and campaigns to educate all stakeholders should start. Some centres of excellence like Infectious Disease Institute (IDI) in Kampala have already done it.

Patients have to ask physicians about their viral load which may be difficult at the beginning but it will be done. It needs to come down to the clients themselves, said Isaac Ssewanyana, the director at the Ministry of Health, Central Public Health Laboratories (CPHL)

Ssewanyana suggests that a guide on how to make a decision by health workers should be developed.
“The approach of empowering patients and educating them is what will change the scenario. Patients should have the anger to demand for their viral load results just as they ask after their CD4 count,” said Charles Brown an HIV prevention advocate with IDI.

ends

Project saves lives; reduces malaria prevalence to single digits

A student walks away after receiving a bed net from Malaria Consortium

By Esther Nakkazi

Last year, I travelled with a team from Malaria Consortium Uganda to Tororo district. The week long exercise was to distribute long-lasting insecticide-treated bednets to school going children.

Through the  Malaria Control Culture Project  funded by Comic Relief and the 2013 government national mass distribution campaign, Malaria prevalence has gone down in Tororo from 53% in 2009 to 33% in 2014 and 18% in 2015 and only 8% this year.

Our first stop was at Atapara Primary School, Paya sub-county, a government-aided school with most of the children from poor households and under the government Universal Primary Education (UPE).

When we entered the primary one class, I was shocked at the numbers of pupils, some sited on the floor and others sharing desks. I wondered how the children, most of them without shoes, nor school uniform would even use the bednets. This class had 249 pupils. 

At break time, the whole school assembled under a huge tree, we were introduced, visitors from Malaria Consortium who had come to bring bednets. You could see the excitement among pupils. Parents started trekking into the school and joined us under the huge tree in the school compound.

Before the Malaria Consortium big van with bednets arrived, we had an awareness session. The deputy headmaster, Stephen Oketcho told us that about 15 percent out of a student population of 1,209 suffer from malaria per week. That increases school absenteeism and of course affects students performance.

Students walk home with bed nets after school

The stats are also representative of Tororo district, which has one of the highest malaria cases in the world. People who live in Tororo have annual mosquito bites of 560 times or 1.5 bites per night according to a study by Malaria Consortium.

Tororo, located in eastern Uganda near the border with Kenya has a weather pattern that favours mosquito breeding. It rains often, leaving soggy soils. So does the flat terrain, with rocky grounds that collect stagnant water. With this the most viable option could be sleeping in mosquito nets but it takes  time for a behaviour to catch up.

The awareness exercise kicked off. 'How many of you slept under a mosquito net yesterday'? Claire Nyachwo, a health educator shouted in the local Japadhola language. Some hands shot up, roughly half of the school pupils and many parents mostly the women.

Prior to this project, in 2013, the Uganda government had carried out a national universal coverage campaign distributing free bed nets to all its citizens.

Dr. Godfrey Magumba, the head of Malaria Consortium Uganda said they built on that mass campaign to distribute bednets to pregnant women attending antenatal care, to school going children in primary schools and to business people in the private sector.

Through the Malaria Control Culture project in Tororo headed by Dr. Julian Atim they aimed to increase the proportion of household members who slept under insecticide treated bednets and schools are a sure way to build that critical mass from the community.

Dr. Anthony Nuwa, the Malaria Consortium Uganda country technical coordinator explained that schools are key to maintain a coverage of 80 percent of people sleeping under insecticide treated nets.
Within two years of working in Tororo , bednet coverage has remained high at 91 percent against the national level of 90 percent in 2014 and 70 percent in 2015.

In most cases, after national mass distribution bednet coverage falls by 20 percent in the first year and up to 60 percent in 2 years without replacement but Tororo district has maintained its high coverage because of the project intervention, explained Dr. Nuwa.

Back at Atapara primary school, Nyachwo went on to explain to the eager listeners, why sleeping under an insecticide-treated bed net was important. She asked teachers how they know that a child has malaria?

“Once a kid is shivering, has a high temperature, has flu or vomits, we suspect malaria. We escort them back home and advise that they go to a hospital and test for malaria,” said teacher Abbo. The school has no school nurse.

“How long does it take for the chemicals to expire from bednets when washed? How often should bednets be washed? some parents asked.

Dr. Magumba says bednets can be washed with bar soap not a detergent and they should be dried under a shade so that the chemical in the bednet is maintained.

When the awareness exercise was over other pupils were told to return to their classes except pupils from three classes, primary one, three and five who were to receive bed nets.

So last week the   Malaria Control Culture Project won the Africa Excellence Awards ‘Change Communication’ category. Daudi Ochieng, Malaria Consortium Uganda Communications Manager said that this campaign approach can inspire other public health campaigns to engage the private sector and stimulate the individual responsibility for health seeking behaviour to create sustainable gain in behaviour change.

The award honours outstanding achievements and the most successful campaigns and projects in the field of public relations and communications in Africa.

The project focused on two communication objectives; to create a culture of sleeping under an insecticide-treated bednet every night and to promote other malaria control behaviour, such as seeking treatment within 24 hours of fever onset and testing before treatment.

On World Malaria day, celebrated 25 April World over, during a press conference at their offices Dr. Atim said more people in Tororo are aware of the importance of bednets and are willing to buy and replace an old one, which improves sustainability of the project.

Dr. Nuwa said the major ingredient of this project was change communication that was done effectively.

It is now the onus of the government to adopt this innovation so that school going children are given bednets and effective communication is done. But also that they do not just get free things but learn to buy and replace old ones before the government gives free ones.

For in this project after the bednets, which last for 2-3 years became old, people bought and replaced them after knowing their importance.

“We hope this reinforces the fact that when you do little efforts and it makes a difference it can save people’s lives,” concluded Magumba.  

ends. 

10 'Interesting' questions About the Dapivirine Vaginal Ring:

By Esther Nakkazi

On 22 February this year, news of two trials of HIV prevention for women was released at the 2016 CROIC Conference. A big thank you to the researchers and the 2,629 women at 15 sites in Malawi, South Africa, Uganda and Zimbabwe who enrolled in the ASPIRE study led by the Microbicide Trials Network

Another big thanks to the 1,959 women at 7 sites in South Africa and Uganda who participated in the Ring Study, led by the International Partnership for Microbicides and of course the scientists. They added another tool for HIV prevention that can be used by women.

In both studies, the ASPIRE and The Ring Study some women used the ring with dapivirine, a first long-acting ARV-based product while others used a placebo. These were Phase III trials designed to evaluate whether the dapivirine ring is safe and effective when used for one month at a time. Both studies found evidence of modest protection.

Women over 21 years of age appeared also to use the ring most consistently. The ring was not effective in women ages 18 to 21 years, who also had the lowest adherence.

Since they released news about these studies, I have attended many forums discussing the vaginal ring results, worth mentioning is our own science cafe organised by the Health Journalists Network in Uganda. It was the 11th we ever held and generated the biggest media coverage and buzz.

For the forums I have attended pertaining to this new innovation here are some of damn absurd questions that I have heard being posed to scientists:

1. Can’t the vaginal ring get stuck in the fallopian tubes?
2. Will the ring be a ‘one size fits all’? (The concern was that some penises are bigger than others and will not pass through the ring?)
3. Will the dosage in the ring be effective for people who have multiple sex acts? Won’t the dapivirine reduce and not last for the one month it is intended for?
4. If you wash the vagina frequently won’t it affect the medicine (dapivirine) in the ring? 
5. Does douching affect the ring? 
6. How long does the ring start working after inserting it?
7. Won’t the vaginal ring get stuck on the penis during sex?
8. Doesn't the dapivirine vaginal ring make women infertile?
9. Can the ring be used by lesbians?
10. For the ring not to work among below 21 year olds is it only because of adherence or for another reason like the age of the vagina?

ends-

Just How Much Difference Can An SMS Make?

By Esther Nakkazi

Research shows that an SMS can change lives. But how much difference can it make? TTC Mobile, a Dutch social enterprise that offers the technology to implement mobile interventions in Africa, Latin America and Asia, contracted the impact researchers from Avance to find the answer to this question.

Researchers found that in two projects found that text messages sent out resulted in behavioural change and better informed end users, nearly all of them directly applied their newly gained knowledge. According to the partners of TTC Mobile, mobile interventions appeared particularly more efficient than alternative methods, with regard to cost and scale.

The impact study resulted in eye-opening outcomes that make a great case for the social impact of mobile interventions. Participants from the two projects run by TTC Mobile were surveyed and/or interviewed and several partners of TTC Mobile were interviewed as well.

The ACLO project was an SMS service of Connect4Change consortium that sent up-to-date market information to small-scale farmers in Bolivia between November 2013 and December 2015. 

Healthy Pregnancy, Healthy Baby is a currently running SMS service of the mHealth Tanzania partnership that sends health information to pregnant women, mothers of newborns and male supporters since December 2012.

116 farmers of the ACLO project in Bolivia and 374 subscribers of Healthy Pregnancy, Healthy Baby in Tanzania were surveyed and/or interviewed. The results clearly show the great value of mobile interventions:

Mobile interventions led to behavioural change; In terms of behavioral change, nearly all of the participants indicated that the text messages they received had a direct effect on their behavior. 92% of the farmers adjusted the prices of their products based on information they received, whereas 94% of the Tanzanian women and their male supporters changed the way they took care of themselves during pregnancy. 

For example, they visited the clinic more often or increased their intake of iron folate tablets. “The doctor had forgotten to prescribe iron pills but after receiving the text I was able to remind the doctor,” said a respondent.

Mobile interventions improved conditions of end users; 80% of the farmers said that their income had improved due to the SMS service. In Tanzania, 93.2% of the participants said they gained knowledge from the text messages and 94% of the participants felt like the text messages increased the confidence in their own and in their baby’s health.

“My wife was shy to ask questions concerning the baby's health and so the messages received were very impactful,” said a respondent. 

Mobile interventions have great reach and are cost effective; In interviews, clients indicated that the mobile interventions of TTC Mobile reached more people than the traditional methods they had used previously and that they were better at reaching participants in rural, hard-to-reach areas. Also, clients indicated that the mobile interventions of TTC Mobile were more cost effective than methods that clients applied previously.

"Mobile interventions gave a total different dimension to our project: more reach and faster, more agile and real-time data.” Full study here: Read the entire research report of Avance here

New Partnership to strengthen health systems in Uganda, Kenya and Zambia

By Esther Nakkazi

Maternal mortality and Sexual and Reproductive Health Rights (SRHR) have been on the international agenda for many years, but the goal to reduce maternal mortality ratio by 75% percent remains elusive.

A five year project 30 million Euro project implemented at global and regional level as well as country level in Uganda, Kenya and Zambia hinging on this fact that now aims to reverse this trend.

The project focusses on strengthening the health system in order to realise a breakthrough, said Dr. Tim Reed from Health Action International.

According to the World Health Organisation (WHO) six interlinked and mutually reinforcing building blocks together make up the health system: human resources for health, health commodities, governance, financing, information and service delivery.

However, this project will focus on two building blocks; human resource for health, which entails increasing the availability and accessibility of skilled health workers. Human resource is essential in retaining equity and social justice.

As well as enhancing the availability of affordable medicines and family planning commodities to ensure that communities; women, girls and vulnerable groups have access to contraception and safe pregnancy, delivery and neonatal care.

“A multi prolonged approach is required to strengthen the perspective of availability and affordability of medicines,” said Dr. Emmanuel Higenyi from Joint Medical Stores.

The project will work through a partnership which comprises of Amref Health Africa, the African Center for Global Health and Social Transformation (ACHEST), Health Action International (HAI), Wemos Foundation funded by the Danish Ministry for Foreign Trade and Development Cooperation as well as Health promotion and social development (HEPS-Uganda).

The different partners will have diverse roles: Amref will handle HRH and reproductive health commodities advocacy interventions at community or district level. ACHEST will handle SRHR and Health system governance advocacy aimed at national, regional and global levels. HEPS-Uganda will do advocacy around reproductive health commodities at national level.

The partnership will work to achieve outcomes by following two interconnected strategies that go beyond influencing policies and aim for sustainable social changes as well as changes in the entire SRH sector.

The overall goal of the project is to enable communities to realise their right to the highest attainable sexual and reproductive health impact said Patricia Vermeulen from Amref Health Africa, Netherlands.

She said the project aims to contribute to achieving Sexual and reproductive health rights by training and creating space for a civil society to engage effectively with governments, the private sector and other stakeholders accountable for health systems, deliver equitable, accessible and high quality SRHR services.

Dr Jane Ruth Aceng, director general, Health Services at Uganda Ministry of Health said it will be good for civil society to be trained so that they do not take government to court without real evidence.

She cited the case of when civil society took government took government to court in 2011 because of a maternal death.

“We are excited it is building the capacity of civil society so that when they are lobbying they know how the government systems work.”

Dr. Francis Omaswa the director ACHEST said Uganda has well designed health plans however, implementation still remains an issue. He said communities should be empowered to demand for services from the health sector.

He ended with his signature phrase ‘health is made at home and repaired in health facilities.’

ends.