Regional Health Integration to Enhance Services-North, Acholi (RHITES-N, Acholi) Activity

The Challenge

The Acholi region of northern Uganda faces a variety of challenges affecting population health, including: one of the highest burdens of HIV and malaria in the country; lower-than-optimal viral load suppression for people living with HIV (especially children); the second-highest rate of institutional maternal mortality in the country; low levels of antenatal care visits among pregnant women; and recent civil conflict and ongoing security challenges.

Overview and Objectives

USAID/Uganda uses an integrated health system strengthening approach for primary health care, in line with Uganda’s Health Sector Strategic and Investment Plan. RHITES-N, Acholi is one of five USAID/Uganda activities focused on comprehensive regional health and HIV/AIDS programs. RHITES-N, Acholi worked to:

• Increase access to and utilization of quality health services;
• Strengthen district health systems for delivery of quality services; and
• Increase adoption of healthy behaviors.

The activity (2017-2023) was active in eight districts in northern Uganda – Amuru, Nwoya, Gulu, Pader, Lamwo, Kitgum, Omoro, and Agago – with an estimated total population of 1.8 million. Since inception in 2017, the activity supported more than 330 health facilities.

Achievements

RHITES-N, Acholi has successfully impacted health practices and outcomes across several priority areas, including HIV/AIDS, tuberculosis, malaria, family planning, maternal and newborn health, nutrition, and COVID-19. Achievements include:

HIV/AIDS: The activity increased antiretroviral therapy coverage to people living with HIV and successfully increased the associated viral load suppression rates. We scaled up interventions targeting high-risk populations with HIV testing services, including HIV self-testing in Gulu and Kitgum. In 2021, the activity reached 96% of the target of adolescent girls and young women with a full package of services appropriate to their age and HIV risk. The DREAMS program in Omoro, Gulu, and Agago Districts enrolled 106,914 at-risk adolescent girls and young women. Since its inception, RHITES-N, Acholi has provided voluntary medical male circumcision to nearly 80,000 adolescent boys and men. In fiscal year 2022 (FY22), the HIV activities were successfully handed over to the USAID Local Partner Health Services Activity – Ankole and Acholi.

Malaria: The proportion of malaria cases confirmed by either rapid diagnostic tests or microscopy increased from 77% to 95% during the activity’s first four years. For the same period, the proportion of confirmed cases that were appropriately treated increased from 56% to 97%. In FY22, malaria activities were transitioned to the USAID PMI Malaria Reduction Activity.

Family planning, maternal, and newborn health: RHITES-N, Acholi supported several interventions to provide quality, integrated, rights-based family planning (FP) services. In FY22, 226,560 FP users accessed services, 53% of which were new users. The number of pregnant women attending ANC1 increased by 24%, from 76,064 in 2017 to 94,190 in 2022. The activity procured essential equipment for the Kitgum General Hospital neonatal intensive care unit. And, in Pader and Kitgum districts, construction was completed on two new maternity units in three health facilities.

Nutrition: The activity provided training and mentorship to health workers on nutritional assessment, counseling, and support and integrated these services into different entry points. The percentage of clients accessing these services increased from 11% to 71%.

COVID-19: The activity supported a blood donation drive to avert a shortage during COVID-19, contributing to a four-fold increase of blood supply, meeting 70% of the region’s demand.