Health – Integrated Health and Development Initiative

IHDI selected by TASO and Ministry of Health to Implement Malaria prevention project in Dadamu Sub-County of Arua City

Type of report: Narrative	End of Activity Dates (dd/mm/yr): 01/…09./……2022	End of Month Month: September; Year_2022
Submission details	Date of Submission to SR (dd/mm/yr): _______10/__10_/___2022	Dates received by SR (dd/mm/yr): _____10___/____10_____/__2022_________
Name of CSO/CBO:	_____IHDI_______________________	District: _______Arua City____
Name of the Subrecipient (SR)	__TASO_____________________

Executive summary

Name of the Activities: Refer to activity in the Budget/Concept
Inception meeting with stakeholders
Orientation of Health Workers in Orivu Health Centre III on Malaria
Orientation of village health teams (VHTs) in Dadamu Sub county on Malaria
Background to the activity:

Brief Description of the Activity (Max of three paragraphs about the problem the activity is addressing, why the activity is important? How will it will address the problem? Describe the location where the activity was implemented (Subcounty, parish, Village as applicable and target population)

Dadamu sub-county in Arua city has population of 50,600 with seven (7) parishes and fifty-one (51) villages; but only one health facility (HC III) (UBOS, 2022). The inception meeting was held in Arua city health office board room to discuss the malaria project.

Dadamu has the highest malaria prevalence in Arua City. 64% of the OPD attendances in Dadamu Sub- County were due to Malaria while the incidence of malaria in the whole population of Dadamu was 29% with risk of rising even higher (DHIS2 2020/2021 report).

The inception meeting helped to bring together key stakeholders to discuss why malaria burden was highest in Dadamu and how the problem can be addressed using locally available resources in addition to the Global fund through TASO.

While orientation helped to bring together private practioners and health workers of Orivu HC III to discuss why malaria burden was highest in Dadamu and how the problem can be addressed using locally available resources in addition to the Global fund through TASO. The training also helped build the capacity of the health workers in malaria case management in pregnant women, children under 5 years and children between 5-15 years old.

The VHTs in Dadamu were oriented on malaria case management in children under 5 years and refer children between 5-15 years old for care in the hospital and educate the community on malaria prevention

Objectives of the Activities:

These are statement(s) that explain the reasoning behind an activity or the aim e.g. what you ought to achieve after implementation of this activity (end results)

The objectives for the month of October were as follows;

To conduct an inception meeting with stakeholders on malaria in Arua city
To conduct orientation of health workers on malaria in Orivu Health centre
To conduct orientation of VHTs on malaria prevention, treatment in Dadamu sub county

Methodology of Implementation (Describe how the activity was implemented, Implementers involved and steps involved from beginning to end, resources used. Basically, the approaches used to implement the activities(s).

The stakeholders’ inception meeting started by consultative meeting by IHDI team and CITY health team at the office of the principle health officer. This meeting resolved on when and where the stakeholders meeting would be held and for how long.

Specific tasks were then allocated to both key IHDI and City health staff. These included drafting and signing of the invitation letter by the principle health officer and distribution of the invitation letters to the agreed stakeholders who included: Resident city commissioner, Arua City, His Worship, the Mayor of Arua City, the City clerk, secretary social services Arua City, chairperson social services, secretary social services, Ayivu Division, Inspector of schools, Arua City, Health Assistant, Dadamu Sub-county, Community Development officer, Dadamu Sub-county, Program Assistant, TASO Arua, 5 members of City health team, 3 IHDI board members, 5 IHDI staff and In charge of Orivu HC III.

IHDI team then held a micro- planning meeting to discuss the procurement of stationery, refreshment, cleaning and arrangement of the board room, detailed agenda for the meeting with timeline and allocation of specific tasks to IHDI staff for example the admin and finance officer was tasked to do procurement of stationery and pay transport refund to the participants. M&E officer was tasked to come up with detailed program and ED was tasked to prepare the presentation.

Meanwhile during orientation of health workers, methodologies used included Lectures, question and answer sessions, practical demonstrations.

The health workers’ training started with a consultative meeting by IHDI team and CITY health team at the office of the principle health officer and later with the in charge of Orivu HCIII. This meeting resolved on when and where the training would be held and for how long.

Specific tasks were then allocated to IHDI, City health staff and Health facility team. These included

IHDI team holding a micro- planning meeting to discuss the procurement of stationery, refreshments for the participants and develop a training agenda with training content in consultation with city health team.

The in charge Orivu health unit was tasked with the responsibility of mobilizing the health workers to be available to participate in the training. Detailed tasks to IHDI staff for example the admin & finance officer was tasked to do procurement of stationery and pay transport refund to the participants. M&E officer was tasked to come up with detailed program and training material and ED was tasked to prepare the presentation.

Finally for the VHT orientation, methodologies used included lectures, question and answer sessions, practical demonstrations on Smart homes, RDT use and reporting tools.

The VHT training started with a consultative meeting by IHDI team and CITY health team at the office of the principle health officer and later with the in charge of Orivu HCIII and also with TASO health assistant who supported IHDI with iCCM training materials and reporting tools. This meeting resolved on the number of trainings to be conducted, when and where the trainings would be held and for how long.

Specific tasks were then allocated to IHDI, and health facility team since the city health team were fully engaged in another training together with ministry of health and TASO. The tasks included

The in charge Orivu health unit was tasked with the responsibility of mobilizing the VHTs to be available to participate in the training at the former Dadamu Sub-county headquarters.

Detailed tasks to IHDI staff for example the admin & finance officer was tasked to do procurement of stationery, refreshments and pay transport refund to the participants. M&E officer was tasked to come up with detailed program and training material for malaria under the age of 5 years and ED was tasked to prepare the presentation on the project and on IHDI.

Achievements/Results obtained ((where possible include photos that depict an activity going (see format provide), Include Quantitative summaries in a format of your choice as per indicators listed in the excel template)

Objective one: To update the stakeholders on the malaria project in Dadamu and strategies that will be used in project implementation

IHDI Executive Director, Dr Dricile Ratib Updated the participants on the historical perspective of IHDI which was that “IHDI became registered as a CBO (Reg. No 503/1549) with Arua DL in 2014 with its headquarters in Arua. It was incorporated as a company limited by guarantee (Certificate No. 80020001729599) in 2018.
Within same year 2018, the organization was upgraded from CBO to NGO status with registration number 5055 and got registered with new name of the Integrated Health and Development Initiative (IHDI).
IHDI has its headquarters in Arua City 3KM along Arua-Pakwach road next to CEFORD. The office is in the first floor with space for meetings, finance, administration, programs, M&E and the Executive Director.
64% of the OPD attendances in Dadamu Sub- County were due to Malaria while the incidence of malaria in the whole population of Dadamu was 29% which is the highest in Arua City with risk of rising even higher (DHIS2 2020/2021 report).
IHDI in partnership with TASO-Uganda is implementing prevention of malaria amongst pregnant mothers, under five children, children 5-15 years with funding from Global fund which is for 4 months.
IHDI will work with and through the existing government and community structures such as Health workers at Orivu health Centre III, Parish Development Committees, VHTs, primary school children and their teachers to implement prevention, and treatment services to pregnant mothers, children under the age of 5 and children 5-15 years.

PHOTO
	The story I want to tell in the photo Consultative meeting in the Office of the Principle Health officer-Arua City to plan for the inception meeting with stakeholders on Malaria prevention in Dadamu Sub-county. On the right is Dr. Apangu Pontious, the Principle Health officer, Center is Dr. Dricile Ratib, ED –IHDI and Left is Mr. Alioni Sunday, the M and E officer, IHDI.
Photo Caption:

PHOTO
	The story I want to tell in the photo Acting IHDI Board Director, Mrs Grace Drabu (Standing Left) giving her remarks during the inception meeting. She commented the IHDI staff and Board members for the commitment they showed towards the community health and development since 2013. She Pledged support for the project and urged an innovative approach in dealing with VHTs
Photo Caption: “Many partners have been working through VHTs. What is new or innovative this time” says Grace, Retired Mid-wife and former District official; Acting Board Chair IHDI.

Objective two: To build the capacity of the health workers on malaria prevention, diagnosis and case management.

IHDI had a successful training of 15 health workers of Orivu HCIII and 1 private practitioner in Orivu HCIII catchment area making a total of 16 health workers trained against 15 planned for. This was more than 100% of the target as shown in the table below.

Cadre trained	Male	Female
Clinical Officer	1	0
Enrolled Nurse	2	2
Enrolled Midwife	0	4
Laboratory personnel	3	0
Others	2	2
*Total*	8	8

The topics covered included Malaria in pregnancy, the rapid diagnostic test and Mass action against malaria prevention (MAAM) and case management which included how to make malaria smart homes, smart health facilities and smart schools.

PHOTO
	The story I want to tell in the photo Pregnant mothers and children are at highest risk of malaria morbidity and mortality in Arua and Dadamu Sub-county in particular. IHDI team though it necessary to orient the health workers in Dadam HCIII on malaria in pregnancy. The points of the presentation by the IHDI M and E Officer included: 1.1: Introduction and background to Malaria in Pregnancy 1.2: Malaria in pregnancy 1.3: Malaria in pregnancy policy and strategy 1.4: Prevention of malaria in pregnancy 1.5: Treatment of malaria in pregnancy 1.6: Care, prevention & Treatment of MIP in special groups
Photo Caption: “We need to have sustainable malaria prevention in Dadamu this will be achieved if we have SMART health Facility, Smart Schools and Smart Homes.” Said The M and E officer IHDI, Mr Alioni Sunday. When asked a smart home was he said it was the prevention of mosquito vectors that transmit malaria from entering hour homes by growing mosquito repellants like lemon grass around our compounds and closing windows and vents with mosquito wires.

PHOTO
	The story I want to tell in the photo The ministry of health malaria strategic plan states that one has to test blood positive for malaria before administering the ant-malaria medications. This is mandatory for all health workers and VHTs. IHDI team thought it necessary to orient the health facility staff on malaria diagnostics and then the Health facility staff will orient the VHTs on the same. The session was both theory and practical as seen in the photo aside
Photo Caption: The laboratory technician of Dadamu HCIII, demonstrating Malaria Rapid diagnostic test during the malaria prevention orientation in Dadam health center III. “It is important to read the manufacturers leaflet to ensure correct diagnostic tests” he added.

Objective two: To build the capacity of the VHTs on malaria prevention, diagnosis and case management.

IHDI had a successful training of VHTs of Dadamu Sub-county. There were 42 VHTs who turned up in the 1^st training and 40 turned up for the second training making a total of 82 VHTs trained out of the 102 planned. This was 80.4% of the target as shown in the figure below

PHOTO

	The story I want to tell in the photo Malaria has persisted in Arua city at high prevalence rates, hence need to be innovative in the prevention strategies. The M and E officer, IHDI –right and the IHDI laboratory technician left, demonstrating to the VHTs some of the herbs that repel mosquitoes and each VHT is encouraged to grow them at their homes. It was noted that sme of the herbs that repel mosquitoes grow widely in the gardens of VHTs, but are not aware that they can be used in the fight against malaria.
Photo Caption: “We need to have sustainable malaria prevention in Dadamu this will be achieved if we have SMART health Facility, Smart Schools and Smart Homes.” Said The M and E officer IHDI, Mr Alioni Sunday. When asked a smart home was he said it was the prevention of mosquito vectors that transmit malaria from entering hour homes by growing mosquito repellants like lemon grass around our compounds and closing windows and vents with mosquito wires.

PHOTO
	The story I want to tell in the photo The ministry of health malaria strategic plan states that one has to test blood positive for malaria before administering the ant-malaria medications. This is mandatory for all health workers and VHTs. IHDI team thought it necessary to orient the VHTs on malaria practical diagnostic technics. The session was both theory, with illustrations on flipchart and practical as seen in the photo aside
Photo Caption: The laboratory technician of Orivu HCIII (center), demonstrating Malaria Rapid diagnostic test during the malaria prevention orientation in Dadam Sub-County. “It is important to read the manufacturers leaflet to ensure correct diagnostic tests” he added. “Prick the ring finger at the cross point of two lines drawn from the either side of the finger nails as shown in the diagram to avoid nerve injury which will be very painful for the patient” he stressed. Looking on the right is Alidria Michael, the In-charge of Orivu Health Center III.

PHOTO
	The story I want to tell in the photo The 2021 DHIS 2 data showed that Dadamu was number one in Malaria burden and it was not clear why this was so. The purpose of the orientation of the VHTs on the iCCM reporting tools was to ensure that the data was accurate. After the training on the quarterly summary book, the Incharge of Orivu requested one of the VHTs to take the participants through the monthly reporting tool which was the easiest.
One of the VHTs (standing) taking participants through the monthly reporting form to ensure that they have understood the message from the in-charge Orivu health center III to whom they report.

Challenges encountered during implementation
Competing activities that took away some of the invited key stakeholders for example the mayor of the city.
Limited funds could not allow IHDI have a whole day’s meeting to exhaust fully the issues at hand
High expectations from some of the stakeholders such as VHTs and community
More participants attended than planned hence overspending on transport refund during Health worker training
Logistics challenges to transport refreshments and other training materials from the city to the training venue.
Transport refund for VHTs was missed out in the budget. This had to be covered from savings in inception meeting and line for masks, since IHDI had some masks to give VHTs.
Bank reconciliation failed after days of trying

Lessons Learnt (Statements about the good practices or what worked well/didn’t work well in the process of implementing the activity)
IHDI team learnt from the stakeholders that one of the major challenges in the control of malaria is the misuse of mosquito nets by the community members for example misuse of mosquito nets for catching white ants and misconceptions about mosquito nets.
Stakeholder engagement meetings are very important for ownership and accountability
Some of the stakeholder were relatively new hence didn’t know about IHDI hence IHDI as a CBO was officially introduced to the whole city during the inception meeting
Inadequate knowledge about malaria prevention and case management among some of the health workers and VHTs hence need for regular refresher training and mentorship.
Health workers are willing to work with IHDI to implement malaria project in Dadamu sub county
The concept of malaria SMART homes was new to the health workers and VHTs during the training.
Some VHTs had forgotten how to fill the iCCM reporting forms, hence they were taken slowly by the facilitator

Recommendations for performance improvement

Next meeting to consider fuel and car hire for logistics
Regular refresher training on malaria prevention and case management
Refresher training on MAAM strategy to the health workers and VHTs of Orivu HCIII as its new concept for them
Joint planning and implementation of malaria activities with the staff of Orivu health centre
Regular refresher training on malaria prevention and case management
Follow up home visits to VHTs to see application of the concept of smart homes
On-job training and mentorship for IHDI staff on Bank reconciliation by TASO finance staff

Strategies for the next activities

Continue with early and joint planning meeting with the stakeholders during project implementation
Continue with joint implementation of the project activities with the key partners such the City health office, health facility staff among others.
Early procurement planning and implementation
Use common mosquito repellant herbs during orientation of VHTs
On-job mentorship for IHDI staff on bank reconciliation

REVIEWS/ APPROVALS

CSO/CBO Level

1.Prepared by: Alioni Sunday	Title: M & E Officer	Date: 08/10/2022	Signature
2. Approved by: Dr Dricile Ratib	Title: E.D	Date: 10/10/2022	Signature
Sub-recipient level 1.Reviewed by: Title: Date: Signature 2. Approved by: Title: Date: Signature Comments and decision by the SR.