Uganda: Using Mildmay’s expertise to strengthen health systems

The staff and clients at the Bishop Caesar Asili Memorial  Health Centre in Luwero know the work of Mildmay Uganda very well – since 2008, Mildmay has been delivering important HIV services and care at the centre.

Over the next five years, with the latest tranche of funding from American donor Centers for Disease Control (CDC), Mildmay’s role will be different. Using its HIV expertise Mildmay will now act in an advisory capacity to strengthen existing systems and structures which will help the health centre deliver services and care more independently.

Mildmay is starting to roll out the same approach at 130 health facilities in 20 districts across central Uganda, with regional field teams paying regular visits to each centre to assist. “We are giving these clinics the skills and the confidence, so tomorrow if we were not there they could still do it themselves,” said Norah Namono, public relations officer for Mildmay Uganda.

The main focus of Mildmay’s support is on each facility’s HIV provision – group and individual counselling, testing, PMTCT (prevention of mother to child transmission), care and treatment – but general health services also benefit from the programme through a knock-on effect. This is especially true as health centres in Uganda begin to integrate HIV services rather than treating the disease in isolation. At Luwero, for example, there are 66 beds at the clinic for patients with malaria, pneumonia, flu and HIV which are not separated.

Before Mildmay began working at Luwero there were around 3700 HIV-positive patients registered, none of which were getting lifesaving antiretroviral treatment (ARVs). Many of these patients were dying because the centre could not provide the treatment they needed.

A Mildmay team would visit every fortnight to distribute ARVs and to give training to build capacity.

“Then they started to ween us off. Now we are on our own and they come only to support and advise us,” said health centre administrator Sister Ernestine Akulu.

“Now it is a supervisory role – they give us training and technical support. We still need it. Mildmay is playing a very, very big role and Mildmay is needed on the ground very much at Luwero and other places.”

The Bishop Caesar Asili Health Centre currently has more than 400 HIV-positive patients. The centre still receives ARVs from Mildmay.

One focus at the centre is on the prevention of mother to child transmission (PMTCT) of HIV.

It remains a challenge. When a Mildmay team visited recently, they found Noah - a two-day-old child – who had been born to a mother who had not come to the Luwero centre for pre-natal care. She had tested HIV-positive just before giving birth, and the chances of her having passed HIV on to her young son are much higher than if she had accessed HIV services earlier. Noah’s mother now has an anxious wait to see if her newborn son has HIV too.

“It’s important that all health facilities have a focus on PMTCT,” said Sr Ernestine. “As soon as pregnant women come here they are tested.

“The problem is that the majority of mums-to-be still don’t make it to a clinic or hospital – this is a cause of frustration and often sadness. If they do come to us in pregnancy there is every chance than most HIV-positive mothers will give birth to HIV-negative children.”