Projects – URC

Lesotho Health Systems Strengthening and Counter Gender Based Violence Support

urc — Thu, 28 Mar 2024 21:01:20 +0000

Participants in a workshop organized by the Reducing the Burden of HIV/AIDS and Health Systems Strengthening project in Lesotho. Photo credit: URC

The Challenge

Improve primary healthcare services and standards of care, improve healthcare, and work with the Ministry of Health to modernize health data systems. Overall, improve health outcomes, especially maternal and child health. Support the sustainability of PEPFAR’s hard-fought achievement in reaching HIV/AIDS epidemic control.

Overview and Objectives

Part of the Millennium Challenge Corporation (MCC) Lesotho Health and Horticulture Compact, this project is an important step in URC’s continued commitment to improving health outcomes for the Basotho people. URC’s team of experts – familiar with evidence-based interventions in health system strengthening – will conduct short-term intensive investigations that support Compact implementation.

This work builds on URC’s efforts in Lesotho since 2018 under the Reducing the Burden of HIV/AIDS and Health Systems Strengthening project. Under that project, URC completed extensive research and assessments to guide the development of the Compact’s health systems strengthening project. URC helped MCC develop the logic model, the monitoring and evaluation framework, and six requests for proposals for the Lesotho-based contractors who will implement the activities alongside the MOH.

Evaluation of the Impact of The Global Fund Contribution on Benin’s National Tuberculosis Program

urc — Mon, 27 Feb 2023 17:43:30 +0000

Caption. Photo credit: name

Overview and Objectives

This evaluation assessed the National Tuberculosis Program in Benin, in particular, the Global Fund’s contribution. URC collected and analyzed clinical, financial, and other data to determine whether Global Fund investments effectively reached expected beneficiaries and whether activities were successfully implemented. The final report describes the degree to which Millennium Development Goal 6, “Combating Tuberculosis,” had been reached in the country.

Evaluation objectives were:

Qualitative data collection, including semi-structured interviews with health care workers at the central and provincial levels
Quantitative data collection, including patient record audits and lab assessments
Data analysis and report writing

Uganda Health Activity

urc — Mon, 05 Dec 2022 06:00:00 +0000

Photo credit: Martin Mwesigwa

The Challenge

Although Uganda’s health indicators have improved, implementation of family health high impact interventions at all levels of the health system are suboptimal and social norms and trust in the health system vary within subregions. The country’s new National Community Health Strategy provides an opportunity to strengthen Uganda’s community health services, staffed primarily by unpaid and overburdened volunteers. Barriers to quality of care include quality improvement approaches that are top-down and poorly utilized for family health services. Gender and social norms inhibit access to quality services, especially for vulnerable groups.

Overview and Objectives

The USAID Uganda Health Activity (UHA) will accelerate inclusive access to respectful, people-centered care for Ugandan families, propel the country across the finish line for sustainable HIV epidemic control, and ensure that family health and HIV interventions and outcomes are anchored in strong local health systems that use data to drive results and efficiently manage human, institutional, and financial resources.

URC and its partners will support Uganda to bridge the divide between national policymaking and local action by:

Transforming existing human resources for health (HRH) at the community, facility, district, and regional levels into proponents, managers, and providers of respectful, people-centered care
Bolstering the political stewardship, local ownership, private sector engagement (PSE), multi-sectoral collaboration, and community participation to achieve equity, sustainability, and accountability
Introducing governance and health systems strengthening (HSS) interventions across 72 health districts in seven diverse sub-regions to ensure that local health service delivery (HSD) networks, through Uganda’s hub and spoke model, improve their performance and management systems to equitably deliver cost-effective, high quality health services in their catchment areas
Saturating 30 of these districts with a robust program of direct HSD support that improves access to, demand for, and use of quality family health services at the community and facility levels

President’s Malaria Initiative Eliminate Malaria (PMI-EM) Activity

urc — Fri, 01 Oct 2021 05:00:00 +0000

A community health worker in Myanmar discusses malaria prevention with a member of the community. Photo credit: URC

The Challenge

Myanmar has significantly reduced the indigenous transmission of Plasmodium falciparum (Pf) malaria. Since URC began working on malaria in Myanmar, the country has experienced a 90% reduction in malaria cases and is now on a path towards ending malaria.

Challenges remain in strengthening the health system management and response to malaria. For example, interventions such as malaria surveillance, case finding and tracking, and the prevention and treatment of the disease all must remain robust or improve to continue on the path toward malaria elimination.

Overview and Objectives

The President’s Malaria Initiative Eliminate Malaria (PMI-EM) Activity contributes to comprehensive malaria interventions in Myanmar to achieve the goal of eliminating the indigenous transmission of Pf malaria by 2025 and put Myanmar on a path to eliminate all human malaria by 2030. PMI-EM builds on URC’s 10 years of continuous implementation of PMI malaria control projects in Myanmar.

The Activity works to improve Myanmar’s comprehensive health system management of malaria interventions, including the use of data to plan, design, and implement interventions. As the number of malaria cases continues to decline, it is increasingly important for the Activity to support enhanced surveillance, monitoring, and evaluation, and the improved utilization of information systems to ensure accurate case reporting.

PMI-EM also works to strengthen the vector control, prevention, social and behavior change, and case management of malaria and support adherence to national guidelines to reduce the threat of multidrug-resistant malaria.

Cambodia Malaria Elimination Project 2 (CMEP2)

urc — Wed, 01 Sep 2021 05:00:00 +0000

A village malaria worker conducts a health education session in Battambang Province. Photo credit: Heang Chantha

The Challenge

Cambodia has not experienced a confirmed malaria death since 2018 and the malaria cases have decreased by 97% between 2000 and 2022.

But challenges remain in preventing malaria re-introduction in elimination areas and scaling up elimination efforts nationally and within specific high-risk populations, such as forest workers and mobile and migrant populations.

Overview and Objectives

The Cambodia Malaria Elimination Project 2 (CMEP2) builds on URC’s nearly two decades of working with Cambodia’s National Center for Parasitology, Entomology, and Malaria Control to eliminate malaria and control the development and spread of drug-resistant malaria in the Greater Mekong Subregion.

The goal of CMEP2 is to eliminate malaria and prevent its re-introduction in target provinces, contributing to nationwide elimination and achievement of the Cambodia Malaria Elimination Action Framework 2: A Malaria-Free Cambodia and leading efforts towards self-reliance and sustained, self-financed malaria programming.

CMEP2 works to:

Detect, effectively and safely treat, and follow up on all malaria cases and provide personal protection to high-risk populations;
Strengthen national malaria surveillance and monitoring and evaluation systems appropriate for malaria elimination and control activities as well as prevention of re-introduction; and
Build Cambodian health staff capacity to manage, intensify, and sustain malaria control and elimination efforts, especially at the provincial and operational district levels.

The activity works in six provinces: Pailin, Batambang, Pursat, Kep, Kampot, and Koh Kong – which are supported by PMI malaria elimination activities.

Achievements

In 2000, Cambodia experienced 129,167 malaria cases and 897 deaths. However, 2022 was the fifth year in a row without a malaria death in the country and cases declined to 4,053 – a 97% reduction from 2000.

CMEP2 continues to contribute to the reduction of malaria cases and move toward eliminating Plasmodium falciparum (Pf) malaria by 2023, and all species of malaria, including Plasmodium vivax (Pv), by 2025 and prevention of re-introduction and reestablishment (POR).

CMEP2 also is focusing on transition of ownership and responsibility for service delivery from the project to government counterparts. Operational districts increasingly plan, implement, and monitor activities, with the project providing technical assistance and capacity building.

Highlights of the malaria situation in Cambodia and CMEP2 project achievements during its first two years include:

The malaria incidence rate decreased to 0.26/1,000 people in 2021 from 0.56/1,000 in 2020, according to the national malaria information system. No malaria deaths have been reported in Cambodia since 2018. This is despite an estimated 58% of the total population (9.3 million people) living in malaria-endemic areas in 55 operational districts within 21 provinces.
For Pf malaria, incidence decreased to 0.02/1,000 in 2021, down from 0.05/1,000 in 2020. Pv incidence decreased by half to 0.24/1,000 people, compared to 0.51/1,000 in 2020.
Every confirmed malaria case in the country was treated according to national treatment guidelines and 95% of the cases were handled by the 1-3-7 approach: case notification on day one, 100% case investigation/classification and response by day three, and foci investigation by day seven, then continued by foci management for any identified active foci.
An unusual increase in Pf  cases in Pursat in 2022 triggered an immediate response by the project in close consultation with Cambodia’s national malaria program and other stakeholders. Among other project interventions in Pursat, CMEP2 introduced intermittent preventive treatment for forest goers (IPTf), implemented with an encouraging success rate on both coverage and adherence. Since last December 2022 till now, no single Pf malaria case occurred in Pursat.
Through strengthening microscopy diagnosis, CMEP2 supported areas can detect the non-Pf/Pv malaria species, which cannot be detected by the current rapid diagnostic test (RDT). Those species include Plasmodium malaria (Pm) and Plasmodium knowlesi (Pk).
The project conducted a social behavior change rapid assessment in the six targeted provinces in early 2023. The rapid assessment explores existing malaria SBC tools, messages, media, and approaches used by the CMEP2 and assesses the potential for innovative SBC tools, messages, media, and approaches to complement the above-mentioned inventory.

Seroprevalence and Behavioral Epidemiology Risk Survey (SABERS)

urc — Mon, 09 Aug 2021 05:00:00 +0000

TBD

Health Services Quality Accelerator Activity in Jordan

urc — Wed, 04 Aug 2021 05:00:00 +0000

A pregnant woman at a routine visit to maternal and child health section at Amman Comprehensive Health Center. Photo credit: USAID/Jordan

The Challenge

USAID and the Government of Jordan have long collaborated to advance and strengthen the country’s health system and quality and accessibility of health services. Jordan has successfully improved population health in priority areas, including reducing maternal and infant mortality. However, there continues to be a large unmet need for family planning awareness, availability, and uptake, and progress is still needed to reduce infant and child mortality rates.

Overview and Objectives

Led by URC, the USAID Health Services Quality Accelerator supports the Jordanian Ministry of Health (MOH) to accelerate and sustain improvements in reproductive, maternal, newborn, and child health (RMNCH) outcomes through the public and private health sectors.

The Activity aims to improve the quality of equitable RMNCH services through:

Strengthening delivery of integrated health care services;
Strengthening MOH capacity to lead for quality care; and
Improving patient-centered RMNCH core competencies.

The project strengthens MOH leadership and governance capacity to lead for improving quality of care through:

Enhancing MOH capacity in data management and utilization;
Improving accountability of health care provider’ performance; and
Enhancing the health care policy environment.

To support the Activity’s objectives, URC facilitates engagement between public and private stakeholders and strengthens their capacity in people-centered quality improvement.

Natalie Batshon, Director of Finance and Administration for the USAID Health Services Quality Accelerator Activity in Jordan, stresses the importance of training staff and managers on resilience so that they can better support their teams and each other.

Achievements

The USAID Health Services Quality Accelerator has achieved much since its kick-off in 2021, including these recent achievements:

Established Quality Assurance and Patient Safety (QAPS) teams at 140+ health facilities to drive incremental improvements in the quality of RMNCH services. The Activity is hard at work training these QAPS teams, with more than half already trained.
Adapted the WHO Safe Childbirth Checklist to Jordan’s context, with piloting initiated at two hospitals. Many more clinical tools are being updated in collaboration with the MOH.
Scaled up implementation, monitoring, and training on the National Guidelines to Support Vaginal Births and Reduce Unnecessary Primary Cesarean Section Deliveries, Training labor and delivery.
Supported the institutionalization of the Jordan Maternal Mortality Surveillance and Response (JMMSR) System.

Quality Services for Health (Q4H)

urc — Fri, 23 Jul 2021 05:00:00 +0000

The Ghapoha Hospital team (L-R): Selina Dussey, Acting Head QMU/MOH; Dr. George Yankey, Asst. Medical Director Ghapoha Hospital; other members of hospital quality management team. Photo credit: George Woode

The Challenge

The Government of Ghana has made great strides in strengthening its health system in recent years. Its commitment to achieving universal health coverage is anchored by the National Health Insurance Scheme and Community-Based Health Planning and Services, which is a global model for decentralized health care – strengthening and expanding the delivery of community-level primary and preventative care.

Despite these successes, systemic and behavior challenges persist to improving population health, such as limited harmonization, coordination, and linkages across the health system and its service delivery levels. As a result, health outcomes are trending in the wrong direction, including increasing mortality rates and disparities in access to quality services.

Overview and Objectives

Improving the quality of care requires coordinated, system-wide action with buy-in from key actors. Through the Q4H Activity in Ghana, URC and its partners and collaborators are integrating experience in quality improvement (QI), social and behavior change, and gender equity and social inclusion (GESI) to support Ghana’s public and private health system actors to sustainably improve health services quality across Ghana.

Q4H Activity’s objectives include:

Strengthening national, regional, and district leadership and governance of quality management (QM) structures and processes;
Instituting processes to empower and capacitate local leaders to identify and address systemic, local QM challenges, including improving the use of data at public and private service delivery points; and
Strengthening the Community Health Management Committees’ (CHMCs’) capacity to coordinate and promote a culture of quality. CHMCs supervise volunteer health workers and coordinate with health service providers and communities.

We are supporting shared learning and cross-fertilization using behavior-led QI/QM approaches from national to community levels in part by working with the Ghana Ministry of Health’s (MOH) Policy, Planning, Monitoring, and Evaluation Division, the National Quality Strategy Steering Committee, Ghana Health Service (GHS), and other relevant Agencies. We also are supporting the Health Facilities Regulatory Agency to develop tools to monitor and accredit all facility types, both public and private, as a major step to monitor and enforce adherence to quality service delivery.

These efforts include other non-governmental health providers, including the Christian Health Association of Ghana and private self-financing facilities, to support public-private investments and align QM initiatives across the health system.

Achievements

Supported the Ministry of Health (MOH) to develop a new National Healthcare Quality Strategy (NHGS 2024-2030) to guide quality management governance, processes and activities in the country.
Worked with the MOH to strengthen national leadership and governance of quality management, resulting in 96% of MOH agencies (27/28) having functional quality management teams, up from a baseline of 68% in 2021.
Strengthened the National Quality Technical Committee (NQTC) of the MOH to coordinate quality management activities of the MOH agencies through supportive supervision and quarterly NQTC meetings.
Trained 411 Community Health Management Committees (CHMCs) across 25 districts on the Ghana Community Scorecard, development of community health action plans, the Ghana Patient’s Charter, and CHMC roles and responsibilities in Community-based Health Planning and Services implementation.

The Q4H Activity achieved the following between FY22 (Oct 2021-Sep 2022) and FY24 (Oct 2023-Jun 2024):

41% increase in uploading of community scorecard scores onto DHIMS 2 in 25 districts across 7 regions (from 38% to 66%)
18% increase in percentage of functional Community-based Health Planning and Services Zones with Community Health Action Plan in 25 districts across 7 regions (from 81% to 98%)
44.1% decrease in stillbirth rate in ten high burden district hospitals in six regions (from 15/1000 to 8.4/1000 births)
64% reduction in institutional neonatal mortality rate in eleven district hospitals across five regions (from 5.4/1000 to 1.9/1000 live births)
24% increase in intermittent preventive treatment of malaria during pregnancy (IPTp) 3 coverage in 11 health facilities across 9 districts in six regions (from 64.7% to 85.1%)
44% reduction in the prevalence of anemia among pregnant women at 36 weeks in seven health facilities across five districts in four regions (from 59% to 33%)
49% reduction in institutional maternal mortality ratio in nine district hospitals across five regions (from 199/100,000 to 61/100,000 live births)

Syria Access to Health Care Activity

urc — Fri, 26 Feb 2021 06:00:00 +0000

TBD

Faith-based Action for Scaling Up Testing and Treatment for the Epidemic Response (FASTER)

urc — Tue, 01 Dec 2020 06:00:00 +0000

HIV care follow-up in East Central Uganda. Photo credit: URC

The Challenge

Every three minutes, an infant is infected with HIV somewhere in the world. That’s nearly 500 new infections each day. But only half of babies born to HIV-infected mothers receive early infant diagnosis services. UNAIDS estimates that over half of all children living with HIV still need to be identified and enrolled in treatment. Also at great risk are children and adolescents, who are the only age group for which HIV-related deaths have increased over the last decade.

Overview and Objectives

The Faith-based Action for Scaling up Testing and Treatment for the Epidemic Response (FASTER) Project addressed key gaps in the child and adolescent HIV treatment cascade, including HIV-exposed infants/early infant diagnosis. FASTER catalyzed more rapid progress towards the 95-95-95 targets in four FASTER priority countries – Uganda, Tanzania, Nigeria, Zambia, and Zimbabwe. FASTER is a component of the Faith-based Organization Capacity Strengthening for Universal HIV Services Project. Catholic Relief Services was the lead implementer.

In Uganda, URC’s role as a sub-recipient of the award was to manage booster quality improvement coaches that work with 15 health facilities in East Central and Mid-North regions of Uganda. We worked to ensure children and adolescents living with HIV reach undetectable viral loads in line with the UNAIDS 95-95-95 targets and elimination of mother-to-child transmission in Uganda.

FASTER also worked in partnership with the Ministry of Health, Ministry of Gender, Labor, and Social Development, faith-based organizations, civil society organizations, networks of persons living with HIV, adolescents living with HIV, and other key stakeholders to rapidly and strategically expand identification, HIV testing, linkage to care and treatment, adherence and retention for HIV-exposed infants, children, and adolescents living with HIV.