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APHA Scientific Session and Event Listing

Godfrey Magumba, MD, Uganda Program for Human and Holistic Development, P.O.Box 40070, Kampala, Uganda, +256 41 222 856, gmagumba@upholduganda.org, Afrodavid Bankunda, BS, Uganda Program for Human and Holistic Development, Training Consultant, The Futures Group, P.O Box 663, Kampala, Uganda, and Sara Tifft, MBA, The Futures Group, One Thomas Circle, NW, Suite 200, Washington, DC 20005.

Uganda's under-five mortality is 151; leading causes are malaria (25%), pneumonia (10%), diarrhea (13%), measles (6%) and malnutrition (65%). Formal and informal private health providers are the source of care in 87% of fever, diarrhea, and ARI cases. Private providers have few opportunities to update child health clinical management skills. They cannot leave their clinical practices to attend residential training programs. The Uganda Ministry of Health developed a three-day, non-residential child health training package for private providers. The package uses informational, observational, and practicum work to improve skills in diagnostics, curative care, and promotion of immunization, Vitamin A supplementation, deworming, infant feeding, and growth monitoring. Since January 2005 over 300 private providers have been trained. Trainees were midwives, nurses/nurse-assistants, and clinical officers. The following skill areas were new to the trainees: general danger signs; counting breaths in a child with cough; Vitamin A as treatment for pneumonia; assessing stiff neck in a child with fever; current first line treatment for fever/malaria; and identification of signs of HIV/AIDS. Six weeks later each provider received a supervisory visit. These included records reviews, verbal case histories, interviews with mothers/caretakers of sick children, and observation of the provider handling a patient. The majority of trained providers were rated Excellent and Satisfactory during followup. They improved promotion of immunization and Vitamin A supplementation, nutritional counseling and routine deworming. Patient records improved and showed an increase in the number of patients using the providers' services. There was also evidence of increased patient satisfaction. Because of the importance of reaching this segment of the service provider system, this model for improving the skills of formal and informal private providers is being further evaluated and scaled out to increase impact. Issues of ongoing supervision are also being addressed through partnerships with Uganda's district health systems.

Learning Objectives:

• 1. Participants will understand that the majority of mothers/care-seekers in Uganda use formal and informal private providers to treat sick children.
• 2. Participants will gain perspective on the role of private sector health providers in providing care for sick children in a developing country setting
• 3. Participants will understand the constraints facing private providers with respect to improving clinical skills
• 4. Participants will be able to describe how a standard residential training program for public sector health providers can be adapted to the needs of formal and informal private providers
• 5. Participants will examine the private and public sector service provider networks when looking at provision of child health services and skill improvement.
• 6. Participants will understand the key issues to scaling up skill improvement training in child health for private providers in a developing country setting

Keywords: Access and Services, Children's Health

Presenting author's disclosure statement:

Any relevant financial relationships? No