KAMPALA, Uganda — Nakasongola district has significantly improved its immunization uptake, moving from category four, the poorest-performing tier, to category three. This notable progress is largely attributed to the intervention of Amref Health Africa in Uganda.
Dr. Byamukama Agaba, the district health officer for Nakasongola, confirmed the improvement, describing it as a “tremendous” change. He explained that this advancement follows the introduction of the Saving Lives and Livelihoods (SLL) project, a collaborative effort between the Africa Centers for Disease Control and Prevention (Africa CDC) and the Mastercard Foundation. Amref Health Africa is a key implementer of the SLL project, focusing on vaccine delivery and workforce development.
“Before Amref’s intervention, Nakasongola was in category four,” Dr. Byamukama stated. “We have worked closely for almost three months. When you look at the data, we have already shifted from category four to category three, meaning that there is a positive change which we are observing.”
Dr. Byamukama provided specific details on the increase in vaccination rates. Yellow fever vaccinations rose from 19% to 40%, while Measles Rubella (MR2) increased from 43% to 60%. Measles Rubella (MR1) remained at 99%, Diphtheria dose one and three both stood at 80%, Pneumococcal Conjugate Vaccines (PCV1) at 74% and PCV3 at 81%, and Rotavirus one at 75% and three at 73%. He emphasized that these figures clearly indicate the effectiveness of the interventions.
Nakasongola district’s initial poor immunization performance, leading to its category four classification, prompted Amref’s strategic approach to identify and address critical gaps. Key interventions included extensive capacity building through training programs for village health teams (VHTs), healthcare workers, and leadership. VHTs were educated on their roles in improving immunization, healthcare workers received training on new vaccines and data management, and leaders were instructed on coordination, mobilization, and popularizing services.
Improvements in data management were also a priority, with efforts focused on enhancing data quality, utilizing appropriate collection tools, and ensuring accurate data entry into the current database system. Amref facilitated stakeholder engagement through meetings to review performance and expected outcomes. Community dialogues provided valuable insights into public perceptions of health workers and uncovered issues such as a perceived lack of value for immunization, health workers not adhering to schedules, and insufficient explanation of vaccine benefits.
The project also aligned with the government’s initiative for integrated service delivery. This integration allowed mothers bringing their children for vaccination to concurrently access other services like diabetes screening or treatment for common ailments. Amref’s support led to improved vaccine distribution, with monthly deliveries from the district to health facilities, eliminating the need for health workers to travel and incur costs. Furthermore, enhanced supervision and monitoring were introduced, with monthly supervision, a significant increase from the previous quarterly schedule, supported by additional monitoring resources. Amref also funded and supported community outreach programs, increasing their number across eight selected facilities, encompassing government, private not-for-profit, and for-profit institutions.
Seruyange Robert, the district Data Quality Assessment Officer affirmed that Amref’s intervention substantially improved immunization performance. He also noted Amref’s assistance in clearing data backlogs by building capacity for data collection and streamlining data flow from facilities to the entry point.
The Saving Lives and Livelihoods project, which commenced with COVID-19 activities in Phase One, has transitioned into Phase Two with three core objectives. The first is to increase vaccination service delivery by strengthening Expanded Programme on Immunization (EPI) services, expanding vaccination beyond children under five to all age groups, including the elderly. The second objective is to develop policies and tools for life-course immunization, supporting the Ministry of Health in creating and disseminating policies and tools for implementation at national, district, and health facility levels. The third objective focuses on building health worker capacity through training on life-course immunization, facilitating experience sharing among healthcare workers, and educating community health workers and local leaders.
The project also aims to reinforce existing district-level EPI structures, particularly those related to life-course immunization. It is being implemented across eight districts: Kasanda, Mubende, Kyankwanzi, Nakasongola, Luwero, Nakaseke, Mityana, and Kiboga.
