Our partnership initially focused on TB control and management in the Eastern Cape province of South Africa. In 2006, however, we extended our commitment and are supporting AMREF in their work to strengthen healthcare systems and integrate the management of TB, HIV and malaria programmes in Uganda, where there is a high burden of all three diseases.
HIV/AIDS, malaria and TB are placing a huge strain on Uganda’s already fragile health system. Health centres are under-funded and under-staffed. Information gathering is inaccurate and unreliable. Laboratories lack fundamental equipment, qualified staff and supplies. Medicines are sometimes available but the infrastructure is not in place to ensure appropriate delivery. And the evident links between the three diseases, which exacerbate early mortality, are not being managed in an integrated way. TB, which is both preventable and curable, has seen a dangerous revival linked critically to escalating rates of HIV infection, and malaria causes more illness and death than any other single disease. There is compelling evidence that HIV infection results in greater risks of mortality from malaria because malaria infection increases the HIV viral load among adults, leading to increased mother-to-child transmission of HIV during pregnancy. So far, health services have concentrated on addressing single diseases and the inadequate access to information at the community level has hindered any collaborative activity from taking place and thus the effectiveness of treatment has been reduced.
During 2007, AMREF and AstraZeneca worked together with the Ministry of Health in Uganda to develop a model for integrating the management of HIV/AIDS, malaria and TB that will provide a framework for effective and efficient healthcare at both local and national levels.
The first programme is now underway. Those initially targeted to benefit are the poor and remote communities in the Luwero and Kiboga districts of central Uganda, particularly women of child-bearing age, people living with HIV/AIDS and children under the age of seven. These districts have been chosen because of high incidence rates, partly as a result of lack of funding in healthcare and conflict in preceding years, which has destroyed much of the local healthcare infrastructure. The programme is focused on: Training health workers In Kiboga, only 50% of staff places are filled due to lack of funding and qualified staff. AMREF will train community health workers and health staff in rural clinics to better prevent, diagnose and treat HIV, TB and malaria. Improving efficiency and work practices in laboratories In Luwero, funding is available for lab technicians, but there are no qualified staff available to fill these vacancies. AMREF will train laboratory staff to diagnose results more accurately and prevent samples from being contaminated, leading to misdiagnosis. Improving health information management systems Important health information is not being collected and analysed, which leads to poor planning, particularly in terms of drug supplies. The project will train health workers to gather and analyse information and use this information for better health planning, including ordering the correct amounts of the drugs needed. Promoting a more integrated approach to disease – AMREF will advocate at district, national, regional and international levels for more integrated approaches to HIV, TB and malaria.
In addition, in June 2008, on the occasion of a candlelight memorial to honour people who have died from AIDS, held in Wobulenzi, in the Luwero district , AstraZeneca and the African Medical and Research Foundation (AMREF) set up a mobile clinic and laboratory to test for TB, HIV/AIDS and malaria and provide counselling and referral services for those who needed them.
Computers – an essential component
As well as improving health information management systems, another key objective of the AMREF programme is to create a computer-based comprehensive care model so that no matter where a patient is in the system - whether it is at the village level or in a district hospital setting, they can receive the most appropriate care.
Today, most of the 800,000 people living in the remote and rural districts of Luwero and Kiboga do not have health records stored with a physician or healthcare centre. For those that do, health workers at the community health centres manually record the information. This not only causes delays in physically getting the information to the district level health centre for analysis but also increases the possibility of errors due to manual input. And people don’t always use the same healthcare centre – patients often go to one place to be treated for malaria, another for TB and yet another for HIV/AIDS, making it virtually impossible to track their medical history.
Access to the kind of technology that would support a centralised health management information system for improved patient care is currently very limited – which is why AstraZeneca and our computer supplier, Lenovo (www.lenovo.com) recently donated a number of ‘notebook’ and desktop computers to the programme. These computers will enable the capture and collation of vital health records that are needed to make sure a patient’s progress through the healthcare system is properly monitored. Spreading the word
While modern technological support is critical to the success of the programme, the importance of personal contact cannot be ignored. Peer-to-peer education on the prevention and treatment of malaria, TB and HIV/AIDS delivered by trained community healthcare workers remains the most effective way to keep disease under control. With our support, AMREF provides training to much-needed, locally-based healthcare workers so that they can deliver potentially life-saving information. These dedicated volunteers, who often live in the villages where they work, provide education and psycho-social support within their communities. Our commitment
Our partnership with AMREF is one part of our commitment to making a contribution to improving healthcare in the developing world. You can read about other aspects of our commitment in this section of our website, including our dedicated TB research and partnerships with the Red Cross, Axios and VSO which are also focused on helping vulnerable communities to strengthen their local healthcare capabilities. |