A Leader’s Vision for Malaria Reduction in Uganda Through Community Ownership of Health

The new U.S. President’s Malaria Initiative (PMI) Uganda Malaria Reduction Activity, funded by USAID, aims to improve the survival and well-being of Uganda’s most vulnerable pregnant women and children (0–15) in selected regions.

Through this U.S. Government flagship malaria activity in Uganda, JSI and partners will work with the Government of Uganda to strengthen technical, managerial, financial, and leadership capacity at all levels of the health care delivery system.

Benjamin Binagwa is the activity’s chief of party, and he talks here about his vision over the next five years and his motivation to lead this effort against malaria.

Q: What is the malaria context in Uganda?

Malaria is endemic in all parts of Uganda. The regions where we will be working have the highest prevalence in the country. The average national malaria prevalence is 9%, but the West Nile Region is at 22%; 12% in Lango; 34% in Karamoja; and 21% in Busoga region. These regions are significantly more endemic for malaria for a number of reasons, including the terrain in the highlands and the socio-cultural context.

Mosquitoes know no borders, and the efforts that are being put in Uganda may not necessarily be the same efforts being put in other countries. Therefore, it will be important that the regional bloc designs interventions that are able to deal with the malaria challenge across the region. Malaria presents a significant negative impact on economic development, so we are looking at this impact across East Africa, especially at the household level, and how we can work together across borders to ensure that we protect our communities.

Q: What are the Activity’s main objectives, and how do they contribute to Uganda’s public health?

The Activity has three main objectives:

1. Strengthening the capacity of malaria prevention and ownership of health at community and household levels.
We appreciate that a lot of effort has gone into strengthening capacity at the health facility level in terms of case management, however, in terms of community and household level engagement and ownership of malaria prevention efforts, there is still a gap.

2. Supporting private, for-profit health facilities to improve malaria case management, reporting, and referrals.
In Uganda, most community members visit the nearest drug shop or clinic when they have a headache or a fever. However, some of that data for malaria treatment is not captured at the district level. Also, in terms of case management, these private, for-profit health facilities sometimes only respond to what the patient is asking for, which can lead to under-dosing.

3. Improve technical managerial, financial and leadership capacity, as well as accountability, at the different levels of the healthcare delivery system.
There has been a lot of capacity building at health facility and district levels, but we still see inadequate utilization of data for planning. We believe very strongly that data is an important tool for planning. At the end of the day, good data management allows you to track, report and see the impact of activities and interventions.

In terms of how these objectives contribute to Uganda’s public health, if we can make inroads into empowering communities and households to own their own health care, this will contribute to communities that are ready to respond not just to malaria, but to any other ailment. We want to raise awareness about disease prevention and health care among communities, especially in terms of health care-seeking behavior and understanding what individuals can do to protect themselves.

Also, if we engage the private for-profit health facilities and are able to build their capacity, support them to report data and be able to refer clients in time to avoid severe malaria, this will contribute significantly to the overall health of individuals and communities, and therefore people’s productivity. At the end of the day, malaria is one of the main causes of hospitalization and outpatient visits in the country. Private for-profit health facilities play a significant role in terms of malaria and overall health care delivery in Uganda, so this is a sector that cannot be neglected.

Q: As leader of the U.S. Government’s flagship malaria program in Uganda, what are you excited about?

I’m coming from the Research Triangle Institute, where I led the neglected tropical disease (NTD) program for the last five years and seven months. I joined the NTD group for a number of reasons: my mother had podoconiosis, an NTD, which is similar to elephantiasis, a complication of lymphatic filariasis, an NTD caused by the same mosquito that transmits malaria. I lived with my mother with that disease, which causes swollen legs and painful infections. I joined the NTD program to make sure that I make a contribution to the elimination of diseases similar to podoconiosis. When I left that program recently to join JSI and this Activity, Uganda had reached the threshold for stopping mass drug administration for lymphatic filariasis. I’m very excited about that.

In 1967, I contracted cerebral malaria. That ambulance ride to the hospital was the first time my mother and I traveled in a car. The hospital was about 150 kilometers away from home. It was a very trying period for my mother. Fortunately, I survived. And that’s why I’m here. Malaria has been painful in our area, in my home, in villages, and in Uganda generally. Having survived it plays an important role in my drive to help implement activities aimed at preventing, controlling or even eliminating this disease. So there’s definitely a personal reason for me to join the malaria fight.

Aside from that, I’m bringing experience and skills, especially for reaching out to communities and households, which is an important component of this Activity. I have a lot of expertise in implementing activities that require active participation of communities in the design and evaluation of interventions.

Finally, I’m also excited to come back to JSI. I worked with JSI from 2003-2006 when we had the flagship HIV program in Uganda. JSI recognized the work that I did on that project, and it was an important milestone in my career.

This is an exciting period for me in my career: leading a malaria prevention program, onboarding the team, and working together with the Ministry of Health (MOH) and with my JSI colleagues in Washington and Boston. I’m excited to try out new innovations in malaria prevention at the community level. I’m excited to lead a project that supports the government with malaria control in high prevalence regions. The team and project partners are strong and I’m excited to work with them, and it gives me a feeling of satisfaction right from the beginning.

Q: What will be your top priorities over the next few months?

We need to make sure the recruitment process to set up the team is up and running. Our senior leadership team is almost fully in place. I’m trying to find the right mix of people from different backgrounds so that we begin to think differently.

The other priority for me is launching the project, which we’re doing on World Malaria Day with MOH. We certainly need to get the message out there that there is a program that’s going to support the Government of Uganda in the malaria space.

A top priority for me is to make sure that we begin to engage those districts that have an upsurge in malaria, such as the Busoga region. We’re already working with the MOH to support districts that are struggling with malaria, and we’re planning to work with those districts to make sure that logistics and supplies are in place, and to train health workers and village health teams to test for malaria and use available health tools.

Another priority for us as a program is to reach out to the districts and to the regions that we will be working with to discuss the type of support that they’re going to be receiving from us. It’s especially key that we explain that everything the Activity does is a joint effort with them and with the communities. They are all involved in program implementation as active participants, and not just as beneficiaries and onlookers. We want to instill to communities that this is a program for them, for their own benefit, for their own health, and therefore their active participation is very important.

Q: Who is part of the Activity consortium, apart from JSI?

JSI provides high-quality technical and managerial assistance. We aim to improve the delivery of health services to vulnerable and underserved populations at risk for malaria and many other ailments. In Uganda, JSI has worked in different areas of the health system, including strengthening maternal and child health, immunization, TB, and HIV. The leadership that JSI is providing is really based on our vast experience in the region.

We are delighted to be working on this activity with a consortium of partners including the Program for Accessible Health, Communication, and Education (PACE); Makerere University’s Child Health and Development Center; Another Option; Busara Center for Behavioral Economics; and Medical Care Development International (MCDI). It’s a very strong team, and everything we do will be guided by Uganda’s National Malaria Strategic Plan.

Q: Lastly, what is your vision for the project?

I would like to see the hospitalization indicators in our regions reduced, so that at the end of the project’s five years, we will see a significant reduction in malaria hospitalizations and outpatient visits.

I also envision the empowerment of communities to realize they can manage health issues by taking simple preventive measures against malaria. I also want to ensure we engage and make sure that the for-profit sector is a key partner in the fight against malaria, and that they are able to report data that is incorporated in health management information systems.

I want to appreciate and recognize the contribution of the Ministry of Health and the National Malaria Control Program. Likewise, I want to thank USAID and the PMI for their guidance and support. We have the challenge to make sure we work towards meeting not only their expectations but the expectations of those communities that we are supporting. I look forward to a time when we will all celebrate success as we implement this program.