Kampala — DR Herman Kyabagu, a primary healthcare specialist in the health ministry says: "Before independence, Uganda's healthcare system was enviable and was considered the best healthcare system in sub-Saharan Africa because of strong primary healthcare.

"We had health visitors who worked with sub-county and parish chiefs to ensure home hygiene, latrine coverage, malaria control, safe water, immunisation and nutrition," he says.

The Public Health Act used to provide for functional disease prevention programmes and healthcare was free and funded by the Government.

"Health visitors moved from door-to-door and one would be charged if they had no latrine in their homes. Everyone was mandated to have a granary and would only access it after being permitted by the chief.

This ensured food security and good nutrition," Kyabagu explains.

This period witnessed good health indicators, for instance between 1940 and 1970, infant mortality had reduced from 250 deaths per 1,000 live births to 120.

But the political turmoil that characterised the 1970s up to the mid-1980s brought down the public health system. It was further buried in 1986 when the Government implemented the World Bank/IMF programmes of decentralisation.

Speaking at the Public Healthcare Global conference in Alma Ata, Kyabagu said the new system opts for selective rather than comprehensive primary healthcare services, which has led to the rise of disease loads, overwhelmed health systems, diminishing personnel and constrained budgets.

"By 2000, there were 57 programmes in the health sector. Some of them were donor-funded and not under government control.

The environment brewed uncoordinated programming and fragmentation of services and did not adequately handle the disease burden that has been growing with the population explosion," Kyabagu says.

Significance of village healthcare teams

Uganda's health system is organised in a way that there is a national referral hospital, regional referral hospitals, district general hospitals, healthcare centres IV, III and II, respectively from top to bottom.

Village healthcare teams act as a link to primary care - the first contact people have with the healthcare system to seek services for diagnosis, treatment and follow-up of specific health problems or to access routine screening like annual check-ups.

"Village healthcare teams are like the health centre I, but without structures. They provide health without physical buildings, but if the community so wishes, they can build," Mugisha says.

"Communities pick individuals whom they can work with, are available, trustworthy, and occasionally, with basic information for record keeping.

"Each member should serve 25 - 30 households, but they still work as a team," he adds.

They coordinate with healthcare IIs which have health workers to train the teams, supervise, receive referrals or help refer complex cases.

The health centre also works as a storage facility for the basic information materials on contraceptives and mosquito nets.

Mugisha says village healthcare teams are 'doing miracles because communities prefer their own people, claiming that health workers are rude.

"We are soon launching a campaign on polio, measles and child health days and we are going to rely heavily on the teams," Mugisha reveals.

"Since their inception in 2004, they have provided programmes like home-based management of simple diseases, with significant results. Some have provided family planning services and administered modern contraceptives like diprovera (injectplan).

"They also collect information on epidemics which helps us counter the diseases in their early stages. If it were not for village healthcare teams, ebola in Bundibugyo district would have escalated.

The teams have also pushed up antenatal care attendance, healthcare attended births, deliveries in health units and HIV voluntary counselling and testing," he discloses.

Mugisha says the approach has worked in areas that call for specific focus such as Busoga (jiggers), Nebbi (the plague) and the north (guinea worm).