PREFA'S Health Systems Strengthening Experience

PREFA has for over 12 years managed and implemented beneficiary-led programs through community and district Health Systems Strengthening approach with support from development partners including; Centers for Disease Control and Prevention (CDC), United States Agency International Development (USAID), UKAID, Civil Society fund (CSF),and Tere des Homes and Girls Advocacy Alliance (GAA).PREFA’s core programing and experience as part of health systems strengthening contributes to local and national priorities to reduce inequalities and improve access in line with the Sustainable Development Goal 3, 1 and 5. PREFA’s programming is hinged on the National Development Plan 11 (NDP11), Health Sector Strategic Plan and World Health Organization’s HSS building blocks.

Service delivery: PREFA builds the capacity of the existing health workers and facilitates them to achieve the planned deliverables; the health workers in turn mentor and supervise their colleagues towards effective service delivery. In order to strengthen service delivery PREFA has also identified and capacity built community health workers who support routinely at health facilities. The community health workers (VHTs) cause demand creation through mobilization awareness, referral and linkage for service delivery at the health facilities both public and private. PREFA uses community peer structures such as Family Support Groups (FSGs); Male Champions for Male involvement; Appointment and client tracing; E- Health; Peer to peer support; Use of informal trade; Edutainment; Engaging the private sector and community based groups/clubs and Service delivery referral and linkages.

PREFA pioneered the Family Support Groups which have been adopted by the ministry of health (MoH).Thematic areas of focus include: Capacity building for 1,573 health workers, Care & treatment for mother-baby pairs, facility-community linkages, gender integration, and family planning, Monitoring & Evaluation as well as National & District level coordination.  A total of 620,642 were reached with HCT, 3,249,834 deliveries under skilled attendance, pregnant women on ART 829,579. A total of 1,746,784 male partners were tested for HIV; 916,484 reached with modern family planning use. PREFA procured astrometric equipment to support health facilities and Over 4,000 family support groups were formed in 2017

Health management information systems (HMIS): PREFA reports through the National health Management Information System. With support from MoH and METS, PREFA strengthens the HMIS through the following strategies; capacity building through didactic trainings and mentorship of health workers, biostatisticians , health information assistants , focal persons and community health workers in data management and use (over 561 trained). Printing and distribution of relevant HMIS tools to all supported districts and health facilities including provision of modems to enable timely data entry and reporting.  PREFA captures data using HMIS tools and reports through the DHIS2. PREFA supports districts and health facilities to conduct performance reviews to guide program implementation. PREFA with her partners support districts and health facilities to use data for quality improvement. PREFA supports health facilities to conduct continuous quality improvement projects which they work on and document success and share experiences biannually session fora’s involving other key players like District health officers(DHOs) District Quality improvement focal persons, MoH (Quality Assurance Department) and other health facilities for experiential learning.

Supply chain management: PREFA supports the accreditation of both public and private health facilities to enable them access medical logistics from the national commodity warehouses. In addition, PREFA continues to capacity build health workers in logistics management including provision of buffer stocks to mitigate stock outs. PREFA also Facilitates District Logistics Coordinators and District Assistant Drug Inspectors to monitor stock levels in supported district health facilities. PREFA collectively with CSO engage on quarterly basis the leadership of National warehouses for health commodities (NMS, JMS, Medical Access and the pharma industry) to discuss health commodity management. PREFA builds the capacity of health workers and health management committees in on- lining ordering and monitoring of health commodities respectively in supported districts.

Human resources for health (HRH): In order to support the development of a sustainable health workforce with the skills to provide quality services, PREFA recruited 80 health workers to support provision of quality PMTCT services at high volume facilities. These have since been absorbed by the local governments. PREFA recruited and trained 600 community health workers (CHEWs) who are currently involved in community mobilization, referral and linkage of communities to health and related services. PREFA facilitates quarterly mentorship using the already trained district and health facility health workers at both public and private health facilities and community

Health financing: PREFA supports the district and community based organizations in planning and budgeting processes which helps to identify funding gaps and form a basis for equitable sub granting. Sub grantees are trained on grant management and subsequently supported to effectively and efficiently utilize the grants. PREFA extends transport vouchers and fuel for ambulances to enable both public and private health facilities and communities handle emergency cases and facilitate referrals and linkages. Currently PREFA has engaged the family centered approach to boost household health financing to contribute to their family members’ health including empowering them to appreciate the need for national and community health schemes (house hold contribution)

Infrastructure development: To improve the work space environment, PREFA has renovated seven maternity units and ANC waiting areas in 40 supported districts. In addition, 90 health facilities in supported districts have currently been provided with tents to facilitate the provision of adolescent and youth friendly services.

Leadership and Governance: PREFA’s support for governance and leadership in HSS is at national, district and community levels. PREFA is a member of several technical working groups that engage in policy formulation and guidelines at the following line ministries; Ministry Health, Ministry of Gender, Labor and Social Development, Ministry of Education and Sports and at Uganda AIDS Commission. PREFA has memorandum of understanding (MoUs) with districts and other civil society organizations where PREFA has built capacity of district and community leadership such as district health teams, District health Management Teams, Health Unit Management Committees, District and sub county AIDS committees to plan, implement, monitor and supervise the implementation of planned interventions as well as reporting. PREFA has established 21 Community Advisory Boards (CABs) in supported districts to advocate for increase in the utilization of SRH services and lobby for by laws that promote uptake of SRH services by communities.