Empowering Health Workers to Improve Service Delivery in Uganda

This post was originally published on USAID’s IMPACT blog.

Agnes Masagwayi has a fierce determination to give her community the best possible care. But as a clinical health officer in Mbale District, Uganda, she knows how difficult it can be.

Agnes Masagwayi Until recently, Agnes’s working conditions were very challenging. Her health facility often lacked running water. Essential drugs ran out. Space for maternity care was so limited that women often had to deliver their babies on the floor. And there weren’t nearly enough health workers to meet the community’s demand for care. (In Uganda there are only about 14 doctors, nurses, and midwives for every 10,000 people, yet the World Health Organization recommends a minimum threshold of about 23 per 10,000 people.)

However, working conditions started to improve when Agnes and her district health officer joined 18 other districts in the Human Resources for Health (HRH) Leadership and Management Program, a six-month course aimed at improving health services in Uganda. This training was just one part of Uganda’s efforts to improve health services by focusing on health workers.

Two USAID-supported projects led by IntraHealth International—the Uganda Capacity Program and CapacityPlus—lent a hand. In addition to improving health workforce leadership and management, the projects are working with country stakeholders to strengthen health workforce information and use the resulting data to advocate for more health workforce funding.

Agnes providing integrated HIV and family planning counseling to clientThese efforts are paying off. Not only did the Government of Uganda allocate funds to hire more than 8,000 new health workers across the country, thanks to successful advocacy, but existing health workers like Agnes are making key improvements in their facilities. Newly empowered by the leadership training, Agnes realized that “really it is ourselves who need to plan, prioritize, know what problems we have and the available opportunities for addressing them.” Here are a few of the changes Agnes and her colleagues made at their facility:

  • Running water is always available. “We acted as a team and lobbied with the district and partners,” Agnes says, proudly pointing to some big tanks outside the clinic.
  • A new maternity ward provides space for women to deliver. Agnes and her team prioritized the construction of a building to accommodate mothers.
  • Drug management helps prevent stockouts. A new system provides key data for Agnes and her colleagues. “You can forecast for your drugs using the available data,” she says.
  • New housing is available for health workers. Nearby housing constructed by the district will help attract new health workers to the area.
  • Service delivery improved. “Client care has improved in this facility so much,” Agnes beams.

Happy clients at Agnes’s facilityThe district as a whole has made progress. Out-patient services have doubled, and over half of all mothers in the district (56 percent) are now delivering in the health facilities, up from 39 percent. The district even rose in the national rankings for health service delivery, from 22 to 6 (out of 111 districts in the country in 2012). And perhaps one of the greatest successes is that more health workers have joined Agnes. “The district has recruited 205 health workers,” she says.

Meet Agnes in our new video, “That’s Improvement!”: Uganda Focuses on Health Workers. Check out our special website section to learn more and access tools that Uganda has successfully used. And join the conversation—follow CapacityPlus on Twitter and like us on Facebook.

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Photo 1 (Agnes Masagwayi) by Sarah Dwyer. Photo 2 (Agnes providing integrated HIV and family planning counseling to client) and photo 3 (Happy clients at Agnes’s facility) by Carol Bales.