ministry of health vht

MINISTRY OF HEALTH

VHTVillage Health Team

Strategy and Operational Guidelines

VHT

Health Education and Promotion Division

March 2010

________________________________________________________________________________________________________________________________________________________________Strategy and Operational Guidelines

Strategy and Operational Guidelines______________________________________________________________________________________________________________________________________________________________ 3

ContentsForeword ........................................................................................... 5

Acknowledgements ............................................................................. 6

1. BACKGROUND ............................................................................. 7

2. JUSTIFICATION FOR THE VHT STRATEGY .................................... 9

3. VILLAGE HEALTH TEAM (VHT) ....................................................11

1. Criteria for selection ................................................................ 11

2. Qualities of a VHT Member ....................................................... 11

3. Composition of the VHT............................................................ 12

4. Objectives of VHT .................................................................... 12

5. The roles and responsibilities of a Village Health Team ................. 12

4. GUIDING PRINCIPLES FOR VHT STRATEGY ................................13

1. Community Ownership ............................................................. 13

2. Equity and Access ................................................................... 13

3. Community Support ................................................................ 13

5. IMPLEMENTATION STRATEGY ....................................................14

1. Advocacy, social mobilisation and communication ........................ 14

2. Networking and Partnerships .................................................... 14

3. Capacity Building ................................................................... 14

4. Resource Mobilisation .............................................................. 14

6. VHT CO-ORDINATION .................................................................15

1. National Level ......................................................................... 15

Stakeholders Forum ............................................................ 15

National Coordination Committee ......................................... 15

The Secretariat .................................................................. 16

2. District level ........................................................................... 17

3. Health Sub-District .................................................................. 17

4. Sub-County ............................................................................ 17 Cont

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4 ________________________________________________________________________________________________________________________________________________________________Strategy and Operational Guidelines

5. Health Facility ......................................................................... 17

6. Community (Parish and LC1 Levels) ........................................... 18

7. MOTIVATION AND SUSTAINABILITY ..........................................19

1. Initial Incentives ..................................................................... 19

2. Continuous/consistent use of the VHTs ....................................... 19

3. VHTs health promotion initiatives .............................................. 19

4. Budgetary provision ................................................................ 20

5. Allowances ............................................................................. 20

6. Refresher Training of VHTs ....................................................... 20

7. Logistics and Supplies .............................................................. 20

8. Follow up, support Supervision and mentoring ............................ 20

9. Recognition and appreciation .................................................... 21

10. Preferential Treatment ............................................................. 21

11. Functional linkages between VHTs and health facilities ................. 21

12. Regular meetings .................................................................... 21

13. Study tours and exchange visits ................................................ 21

8. ROLES AND RESPONSIBILITIES OF DIFFERENT STAKEHOLDERS 22

1. Ministry of Health .................................................................... 22

2. Development Partners ............................................................. 22

3. Local Governments .................................................................. 22

4. Health Facilities ...................................................................... 23

5. Non Government Organization and Civil Society Organisations ...... 23

6. Local Council 1 Executive ......................................................... 23

7. Communities .......................................................................... 23

9. VHT IMPLEMENTATION GUIDELINES ..........................................24

10. STANDARDS FOR VHT IMPLEMENTATION ..............................38

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FOREWORD

Village Health Teams (VHTs) were established by the Ministry of Health to empower communities to take part in the decisions that affect their health; mobilize communities for health programs, and strengthen the delivery of health services at house-hold level.

The Primary Health Care principle recognizes that health services should be accessible, cost-effective, tailored to local needs, characterized by inter – sectoral co-operation and delivered with the participation of the people. It is envisaged that the VHT strategy will enable the realisation the Alma Ata Declaration, and the recent 2008 Ouagadougou Declaration on Primary Health Care and Health Systems in Africa to which Uganda subscribes.

According to the HSSP 2000/01 – 2005/06, the key challenge to the health care system is to extend basic health care service to the entire population especially in rural areas where access to healthcare is limited. It is in this regard that HSSP I recommended establishment of VHTs, HSSP II and HSSP III called for roll out and consolidation of the VHT strategy.

This Village Health Team (VHT) Strategy and Operational Guidelines therefore incorporates lessons learned during the nine years since the publication of the first Strategy and Plan in September 2001. It has been updated following a long consultation process with stakeholders and Partners.

This document is intended to facilitate a good understanding of the VHTs strategy. This is the official guide to individuals and organisations that plan to or are implementing community-based health activities in Uganda. The important point to note is that all health activities and interventions must be coordinated through the VHT structure. The Ministry of Health will not allow creation of parallel or competing community structures apart from the VHTs. It is our policy and guiding document which we hope all stakeholders and partners will follow and support as we strive for better health for all Ugandans.

Dr. Nathan Kenya-Mugisha

For: Director General Health Services

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ACKNOWLEDGEMENTS

The Ministry of Health would like to acknowledge with appreciation the resourceful support and facilitation received from UNICEF to review and finalise this document, together with the technical input from World Health Organization Country Office and Support to Health Sector Strategic Plan Project (SHSSPP).

Gratitude is extended to the Village Health Team Secretariat headed by Mr. Gilbert Muyambi and Mr. Samuel Ahimbisibwe which worked so hard to put this document in this current form.

The Ministry would also like to appreciate the input of various stakeholders during the preparation process who contributed information and ideas that enabled drafting of the document. In particular I want to thank my colleagues in the Ministry of Health, Officials from districts and SHSSPP, World Health Organisation and UNICEF; without their interest and willingness to share their experiences, the scope of this document would have been limited.

Particular mention is made of the following persons whose input and participation in various meetings enabled drafting to this document. Mr. Godfrey Kaggwa, Mr. Arsen Nzabakurikiza, Mr. Benjamin Sensasi, Dr. Geoffrey Bisoborwa, Mr. Collins Mwesigye, Dr. Charles Katureebe, Dr Claudia Hudspeth, Dr. Francine Kimanuka, Dr. Deo Sekimpi, Mr. Solomon Onyango and Ms. Rita Mwagale.

Dr. Paul Kagwa

Assistant Commissioner

Health Promotion and Education Division

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1. BACKGROUND

Over the years, the Government of Uganda has been striving to improve the socio-economic standards of living through strategies such as the Poverty Eradication Action Plan (PEAP) and Vision 2020. These reforms, encapsulated in the Economic Recovery Program (ERP 1987) have aptly noted the significant role of health care delivery in development. Therefore, one of the fundamental missions of government has been improvement of health care for all in terms of provision, accessibility and utilization. Several studies in Uganda indicate unacceptably high morbidity and mortality rates from preventable diseases. Other studies have indicated that only about 49% of the population lives within five kilometres from a health facility.

In Uganda, over 75% of the diseases are preventable if only people changed and adopted appropriate and well known behaviors geared towards better health (MoH, 2005). Positive behaviors focusing on personal hygiene, sanitation, nutrition, sexual practices among others would improve the well being of many people and thus avert the high morbidity and mortality due to preventable diseases such as malaria, tuberculosis, upper respiratory infections, HIV/AIDS and childhood vaccine preventable diseases.

Implementation of health promotion and basic disease prevention measures at personal, family and community levels can turn the situation round and help the country make big strides toward the Millennium Development Goals and thus achieve better health and development for the people. Unfortunately, Uganda, like many African countries suffers from serious shortage of health human resources who would oversee and guide the people to implement these basic health interventions.

Community participation and empowerment is a strategy that enables communities to take responsibility for their own health and wellbeing and to participate actively in the management of their local health services. In the Uganda context, this will take the form of the Village Health Team (VHT).

The VHT will help to engender community participation in health and link the communities to the formal health service delivery system. This will also help bridge the current health human resource gap especially in rural or peripheral areas where the majority of the people live.

Establishment and utilization of VHTs demonstrates the commitment of Uganda to the aspirations and principles of the 1978 Alma Ata declaration and the 2008 Ouagadougou Declaration on Primary Health Care and Health Systems in Africa. These historic declarations emphasize fostering full community involvement in health and health care delivery in accordance with the primary health care approach. Inspiration for the VHT is also drawn from the 1986 Ottawa Charter on Health Promotion that calls for formulation of public health Se

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policies, creation supportive environments, strengthening community action, developing personal skills and re-orienting health services all geared towards appropriate health care development and delivery.

According to the HSSP 2000/01 – 2005/06, the key challenge to the health care system is to extend basic health care service to the entire population especially in rural areas where almost thirty percent of the people live below the poverty line. It is in this regard that HSSP I recommended establishment of VHTs, HSSP II and HSSP III called for roll out and consolidation of the VHT strategy Village Heath Teams (VHTs) strategy was therefore conceived as a vehicle that could potentially help deliver much needed basic health care services direct to households and communities in Uganda.

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2. JUSTIFICATION FOR THE VHT STRATEGY

Health is recognised as one of the fundamental pillars of human and national development and this is not only consistent with Uganda’s development priorities but is also a commitment to achieving health related Millennium Development Goals (MoH, 2005). There is therefore a direct link between development and health outcomes at individual, community and national levels (MoFPED, 2001). Consequently, it is critical to foster an integrated approach to development tackling health from a development perspective. It is envisaged that engendering community participation and ownership through community-based structures such as VHTs will increase individual and community control over the determinants of health thereby contributing significantly to social-economic development of a country (WHO, 1986).

In Uganda as in other African countries, there is an acute shortage of health workers especially in rural and peripheral areas due to attrition, HIV/AIDS, migration or search for greener pastures (Lehmann and Sanders, 2007). This realisation makes initiation and widespread implementation of VHTs even more critical in order to reduce the workload on the few health workers or as a stop-gap measure in places where there is none.

Besides, in Uganda, more than 75% of the diseases are preventable (MoH, 2000) which can only be achieved through increased awareness, behavioural change and adoption of positive health practices. According to the National Health Policy, Health Sector Plans I, II and III the most effective way to achieve this is through interpersonal and group communication that VHTs can effectively perform in the villages where they live and are well known.

In addition, Uganda’s poor health indicators such as, low latrine coverage, falling immunization coverage, inadequate and inappropriate ITN use, malnutrition or the high total fertility rate can be partly tackled through constant dialogue with the community members using VHTs. Moreover, in Uganda geographical access to health care facilities is limited to only 49% of households due to long distance or other natural features such as marshes, rivers, hills, forests or mountains (MoH, 2000). VHTs will help bridge the gap that exists between the un-served households and the formal health system. In that sense, VHTs will be the first contact with the health system or indeed as health centre I and this is consistent with the “task-shifting” approach.

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In the past, MoH programmes undertook community activities in a vertical manner leading to fragmentation, duplication, wastage of resources and dissemination of conflicting messages. The table below shows some examples of the community based interventions that have been implemented vertically by MoH programmes vertically.

Programme Resource persons trained for community work

UCBHCA District and sub-county trainersParish Development committeesCommunity Health Workers

IMCICommunity Owned Resource PersonsCommunity Based Growth Promoters

MCPDistrict and sub-county trainersParish MobilisersDrug distributors

UNEPI Parish Mobilisers

RHCommunity Based Distributors for OCPTBAs

ACPCounselling AidesHome care providersCondom Distributors

EH&SWater Source CommitteesSanitation Aides (civil servants)

The VHT strategy is therefore meant to harmonise this arrangement so that MoH and partners approach the communities in an organised fashion that will increase efficiency and effectiveness of our programmes thus making them relevant to the communities.

The VHTs will also facilitate data collection at community level which will greatly assist in health planning and response in addition to undertaking disease surveillance and reporting especially in epidemic prone areas. There are also community resources that the VHTs can identify and harmonise to supplement the meagre district resources available for community activities.

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3. VILLAGE HEALTH TEAM (VHT)

The Village Health Team is a community based (village) structure whose members are selected by the people themselves to promote health and wellbeing of the people in their areas of residence/jurisdiction. It is the lowest health delivery structure and serves as a Health Centre I.

Criteria for selection1.

At the end of the village sensitisation meetings, the Village/Local Council I with the help of the trainer maps all households in the village and from every 25-30 households they select one member of the VHT, through a popular vote. VHTs must be selected by the community itself and not imposed by political structures. The number should on average be five members per team. Selection should be gender sensitive. Political leaders such as the LC I chairperson, vice chairperson and secretary are not be eligible for membership for purposes of ensuring checks and balances.

Potential VHT members may already be Community Health Workers, Traditional Birth Attendants, Drug distributors or similar if acceptable to the community. If a VHT member drops out, a new member will be identified from the community during the quarterly review meetings. The new member will acquire knowledge and skills from on-job training.

Qualities of a VHT Member2.

After successful sensitization of the community leaders, community members and other key stake holders on the importance of VHTs, the following criteria shall be used for selection:

Should be exemplary, honest, trustworthy and respected Y

Should be willing to serve as a volunteer Y

Must be a resident of the village Y

Should be available to perform specified VHT tasks Y

Should be interested in health and development matters Y

Should be a good mobilizer and communicator Y

Ideally should be able to read and write at least the local language Y

Should be dependable and approachable Y

Should be a good listener Y

Should be 18 years and above Y Sect

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Composition of the VHT 3.

The size of the team depends on the number of households in a given village. On average it should be one team member per 25-30 households. The more sparsely populated area is, the less the number of households per member. However in areas where people live in close proximity, the number of households per VHT member can be more than 30. The team selected per village must be gender balanced with at least a third of the members women. Each Village should have an average of five VHT members.

Objectives of VHT4.

The overall objective of the VHT strategy is to promote health at individual, family and community levels. Specific Objectives are:

To promote community participation and involvement in health1.

To promote positive health behaviour and practices 2.

To promote health care seeking behaviour3.

To strengthen timely health service delivery at community and 4. household levels

To promote community based health information system5.

To foster coordinated delivery of integrated services at community 6. level

The major roles and responsibilities of a Village Health Team5.

These shall include the following:

Home visiting Y

Mobilization of communities for utilization of health services Y

Health Promotion and Education Y

Community based case management of common ill health conditions Y

Follow up of the mothers during pregnancy and afterbirth and the Ynewborns for provision of advice, recognition of danger signs and referral

Follow up of people who have been discharged from health facility and Ythose on long term treatment

Distribution of health commodities Y

Community information management Y

Disease surveillance YSect

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4. GUIDING PRINCIPLES FOR VHT STRATEGY

The guiding principles for the VHT strategy will be the following:

Community Ownership1. The community is responsible for selection, supervision and support of the VHT. The VHTs are fully accountable to the communities in which they operate and their services/ responsibilities are community driven.

Equity and Access2. VHT services are meant to o benefit all members of the community especially those in rural peripheral areas or marginalised communities.

Community Support3. While performing their roles and responsibilities, the VHTs shall be supported by their own communities, local health facilities and local political structures.

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5. IMPLEMENTATION STRATEGIES

The following Strategies are recommended to facilitate implementation of VHT strategy:

Advocacy, social mobilisation and communication 1. This aims at creating awareness, building consensus, and gaining political commitment and support (e.g. resource allocation). Standardized communication strategies and materials for advocacy, and social mobilisation and communication coordinated by the Ministry of Health will be used for different target groups.

Networking and Partnerships 2. This will be between households, communities, VHTs, the health system, the political structure, community based organisations, development partners, community structures such as churches, schools and extension workers.

Capacity Building3. Training sessions will be conducted guided by the Ministry of Health for district facilitators and DHT members. The Ministry of Health and district health teams will ensure provision of Health Promotion materials, HMIS data collection tools and availability of basic VHT Kits. They will also build supervisory capacity at all levels in addition to improving the logistical distribution system to reach the VHTs.

Resource Mobilisation4. Functioning of VHTs requires continuous, harmonised pooled financial support, planning, and monitoring and well coordinated resource allocation. At all levels, there should a clear allocation of funds for integrated community level interventions through the VHT.

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6. VHT CO-ORDINATION

The Ministry of Health is the central player, leader and driving force of the Village Health Team Strategy. The Ministry shall coordinate advocacy and fund raising activities and also ensure that effective interventions are selected at district and local levels according to local needs but in conformity with national policy. All actors shall work within a common framework with standardised key messages, harmonised training and communication materials, and using the VHT as conduit for service delivery. Below is how the VHT will be coordinated at different levels.

National level1. Stakeholders ForumThere shall be a Stakeholders Forum whose membership includes; key Technical and Health Development Partners, Key Implementing Partners and Key funding Partners. The forum shall be responsible for coordination, VHT consensus building and experience sharing. The Stakeholders Forum shall be convened at least once a year. The health policy advisory committee shall steer this forum.

National Coordination CommitteeThe National Coordination Committee will work through the Basic Package Working Group. It will comprise of membership from the basic package Technical Working Group and shall meet quarterly.

Some of the membership shall include among others:

Ministry of Health programmes i.e. a.

Malaria Control Programme ♦

Reproductive Health Division ♦

Child Health Division ♦

Uganda National Expanded Programme on Immunization (UNEPI) ♦

Environmental Health Division ♦

Health Management Information System ♦

Nutrition Section ♦

National Tuberculosis and Leprosy Programme ♦

Health Planning Department ♦

AIDS Control Programme ♦

Neglected Tropical Diseases ♦

Support to Health Sector Strategic Plan 11 (SHSSPP2) ♦ Sect

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Other Government Ministries and Institutionsb.

Development Partnersc.

UNICEF ♦

World Health Organisation ♦

UNFPA ♦

USAID ♦

World Bank ♦

DANIDA ♦

SIDA ♦

ADB ♦

NGOs/CSOs (International and National) ♦

The functions of the National Coordination Committee shall be:

Leadership and stewardship ♦

Policy guidance ♦

Oversee progress ♦

Technical guidance ♦

Mobilise funding for VHT implementation ♦

The SecretariatThere shall be a Secretariat headed by the Assistant Commissioner for Health Promotion and Education. Health Promotion and Education shall be responsible for overseeing and coordinating the implementation of VHT at all levels. The Health Promotion and Education Division shall be the VHT National Coordination Office. The Roles of the secretariat shall include:

Harmonising of community based interventions of different programme Yand streamlining them into the National VHT plan

Guide activities of development partners to ensure effective coverage Yand logical synchronization of community based interventions

Documenting all the VHTs operations and activities Y

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District Level2. At district level, the District Health Officer (DHO) shall be responsible for overall planning, implementation and monitoring of VHT activities. He can delegate a member of the district health team to be responsible for the VHT activities. Through the Chief Administrative Officer, all other departments will be required to utilise and support the VHT structure to implement their health related community activities.

VHT activities shall be fully integrated into the District Health Development and Operational Plans and it will be the guiding document for community-level health interventions in the district.

All stakeholders and implementers are coordinated by the DHO and all community level health interventions coordinated through VHT.

Health Sub-DistrictThe in-charge of the Health Sub-District with the assistance of the Assistant Health Education office shall be responsible for overall planning and coordination VHT activities at the Health Sub-District level. VHT activities shall be integrated into the Health Sub-District work plan which is developed from Health centre level. The in-charge shall be responsible for sensitisation of sub-county leaders and will ensure that activities of partners working at sub-county level are included in the sub-county and health facility work plans which are eventually amalgamated into a Health Sub-district work plan. The in-charge and the Assistant Health Education Office will be the custodians of supplies and commodities that are used by the VHT

Sub-CountyThe In-charge of HCIII with assistance of other sub county VHT Trainers will be responsible for planning, implementation and monitoring of VHT activities in the sub county. The In-charge may delegate some of the responsibilities to an active and competent Health worker in-charge of the sub-county. The in-charge in collaboration with the sub-county chief shall ensure that the health activities of NGO’s are implemented through the VHTs.

Health FacilityHealth facilities of all levels shall be responsible for coordination, implementation, monitoring and evaluation of VHT activities within their areas of responsibility. Health Centres shall provide technical guidance to the VHTs, replenish Se

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commodities and health supplies, hold regular meetings with VHT members, encourage them to participate in health unit activities and give them support supervision.

Community (Parish and LC 1Levels)This is the implementation level of VHT activities. The Community leaders (LC1 and Parish chief) will be responsible for coordination, overseeing and administrative (non-technical) supervision of VHT activities in their areas. The VHTs will be accountable to the community leaders. For proper function VHT members will select a team leader, a secretary and treasurer from amongst themselves and coordinator at parish level.

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7. MOTIVATION AND SUSTAINABILITY

VHT Members are expected to perform their roles and responsibilities on Voluntary basis, and yet they are expected to achieve the set objectives for the VHT strategy. The Ministry of Health therefore proposes some incentive mechanisms that may be used to reward and motivate the VHT members and thereby sustain the programme.

Initial Incentives1. The following shall be provided to the VHT as incentives to accept the assignment and begin work:

Good quality training Y

Award of certificates Y

Commissioning ceremony Y

Badges, T-shirts, bags Y

Job aides Y

IEC materials Y

Registers Y

Continuous/consistent use of the VHTs2. These will be required to sustain the services of the VHT and minimize attrition hence they should be provided on a continuous basis.

VHT is a government policy and it stipulates that all health activities at community level by the government, NGOs and or Partners targeting communities shall be coordinated through VHTs. This includes health promotion activities, campaigns and other health events and functions. This will keep VHT members engaged, will feel useful and benefit from the benefits of the programs’ activities including allowances. VHTs can also be assigned tasks like distribution of IEC materials. This in turn makes the community value and continue demanding and utilising their services.

Health Promotion Activities3. VHTs will be supported to initiate and organise health promotion initiatives like drama with health messages. This will serve as entertainment or recreation as well as education for community from which VHT members earn recognition. Se

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Budgetary provision4. As a priority area in health service delivery, VHT activities should be planned and budgeted for at all levels from national to the village level. Local councils should put in place innovative financing mechanisms to support VHT. Areas for budgeting include but not limited to the following:

Support supervision Y

Facilitation for regular meetings between VHT, health workers and Ytrainers

Allowances for VHTs. The Ministry of Health and District Local YGovernment shall advise on the rates from time to time to guide actors for purposes of harmonisation. A minimum monthly stipend of $5 (UGX 10000) which can be paid quarterly during the Quarterly Review and planning meetings)

Monitoring Y

Task Specific Allowances5. Government, NGO’s and Partners will facilitate VHTs in the performance of specific extraordinary tasks. Such allowances will cover items like transport and lunch.

Refresher Training of VHTs6. The VHTs shall undergo continuous refresher and update training organized by Government, NGO’s and Partners using standardized VHT materials, additional modules for specific services and other specific areas like: Malaria, Reproductive Health, Child Health and others. This will improve their knowledge and skills and also motivate them to keep serving as VHT members.

Logistics and Supplies7. There should be a constant supply of medicines and supplies and other logistical support to enable VHTs provide services to their clients including their own families all the time. Once there is shortage of these supplies the VHTs may be demeaned by the community which may lead to frustration.

Follow up, support Supervision and mentoring8. VHTs will receive regular follow up and supervision from their trainers and health workers. During supervision VHTs will be supported to improve their skills. Where necessary, VHTs will be offered apprenticeship training at the health facility to get hands on training.Se

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Recognition and appreciation by health workers, leaders and 9. community

Leaders at all levels shall be oriented to recognize and show appreciation of the services of VHTs in public. This works as a marketing strategy for the services of the VHTs and also makes them feel important and that their services are valued and hence keep serving.

Preferential treatment10. Aside from the medical criteria for priority treatments, VHT shall be given preferential treatment at health facilities and other services in the community

Functional linkages between VHTs and health facilities11. VHTs will be closely linked to the health facilities. They will receive apprentiship training at health facilities. Health facilities will be oriented to honor referrals from VHTs and refer discharged patients where necessary for follow up in the community.

Regular meetings between trainers, health workers and VHTs 12. (Including community leaders)

There will be quarterly meetings between VHTs, Health facility staff including the trainers/supervisors and LC I chairpersons, Parish Chiefs and LC II Chairperson. During the meetings, VHTs will be able will share experiences, present their reports and obtain feedback. The meetings will also be used as opportunity to provide refresher trainings to VHTs. At the end of the meeting, all those attending will get a transport refund of UGX 5000. In addition, VHTs will be given their monthly stipend for the previous quarter.

Study tours and exchange visits13. Government and Partners shall from time to time organize study tours and exchange visits for VHTs. This will enable VHTs to learn through observation of best practices within and outside their own districts. Travel and its associated fun and allowances will serve as a motivation for the VHTs.

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8. ROLES AND RESPONSIBILITIES OF DIFFERENT STAKEHOLDERS

Ministry of Health1. To provide policy framework for the establishment, functioning, monitoring and evaluation of the VHTs. The Ministry will specifically:

Define minimum package of services and standards to be provided Yby VHT

Provide guidelines on recruitment, retention, facilitation and motivation Yof VHTs

Policies to link VHTs with health and health related interventions Y

To ensure availability of medicines and supplies as provided for in the Ypackage

MOH to take lead in resource mobilization for VHTs Y

To provide overall coordination and supervision in VHT implementation Y

To link up with relevant ministries to harmonise policy frameworks in Ysupport of VHTs.

Local Governments2. To integrate VHT strategy into their development and operational Yplans

To allocate and avail resources for implementation of activities Y

To formulate, pass and enforce by-laws in support of VHT functions Y

To promote intersectoral collaboration in the local government Y

To ensure harmonised and integrated implementation of health Yactivities at community level using VHTs.

To ensure that all those delivering community based health care Yinterventions do so through VHTs and avoid creating other parallel structures

Development Partners3. To contribute to policy development, monitoring and evaluation Y

To provide technical, financial and logistical support for the Yoperationalization of the VHT strategy

To support documentation and sharing of best practices Y

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Non Government Organization and Civil Society Organisations4. Participate in joint planning with Government Health planning authority Yat all levels

Facilitate functioning of VHTs in accordance with the National Strategy YGuidelines

Integrate their community based health programmes into the district YVHT plan

Promote and raise the profile of the VHT strategy Y

Sensitize communities on the roles of VHTs Y

Health Facilities5. To take overall technical responsibility for all VHT activities within Ytheir areas of responsibility

Conduct training and supervision of VHTs Y

Support management of medicines and supplies for VHTs Y

To regularly organize planning, review meetings and refresher Yprogrammes with VHTs in their catchment areas

To receive, analyze, utilize VHT data and provide feedback Y

Local Council 1 Executive 6. To advocate for VHTs Y

Sensitize communities on the roles of VHTs Y

Provide time for VHTs to talk about health issues at community Ymeetings and other public gatherings

Enforce implementation of advice based on recommendations given Yby VHTs on health issues

Initiate and implement motivation schemes for VHTs Y

Participate and also mobilise communities to participate in VHT Yinitiated activities

Communities7. Volunteer for VHT work Y

Select VHT according to the national guidelines Y

Seek and utilize and the services of the VHT Y

Recognize and appreciate the services of VHT Y

Help VHTs to collect medicines and supplies from heath centres Y

Report health incidences in the community to VHTs Y

Respond to the call for community activities initiated by VHTs Y Sect

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9. VHT IMPLEMENTATION GUIDELINES

The VHT Operation Guidelines provide a benchmark for VHT implementation at different levels and identifies roles and responsibilities for each party at the following levels:-

National Level Y

District Level Y

Health Sub-District Level Y

Sub-county Level Y

Parish Level Y

Community Level Y

The Guidelines specify in detail what activities that needs to be done at each level and how each activity will be done. It also identifies the responsible person or officer for a particular activity, source of funding and the indicators to show that that a particular activity has been accomplished.

Coordination and Networking

At all levels Government will be the lead and coordinating agency for VHT implementation, but all other stakeholders willing to work towards the common goal will be free to participate in a coordinated way. With Ministry of Health and District Health Offices in the lead, all stakeholders need to be brought on board, but in a coordinated way.

At national level all stakeholders supporting the VHT Strategy must do so through Ministry of Health.

At District level all stakeholders must support the VHT Strategy through the District Health Office, similarly at HSD and SC levels.

Lastly, all community level health interventions will be coordinated through the VHT.

Advocacy

Taking into account the issues in the Background to VHT strategy, advocacy will remain a key intervention for the acceptance, adequate resourcing and successful implementation of the VHT Strategy.

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Capacity Building

Capacity building shall include the clarifying of the rationale/justification of the VHT Strategy. The information and training for district level sensitisation, Training of Trainers and Initial Training of VHT shall have standard materials approved by Ministry of Health.

The VHT members should have continuous capacity building after the initial training. This should involve refresher training, hands-on work at the nearest Health Unit and regular supervision by the VHT Trainers/Supervisors.

Supervision

VHT Supervision is one of the main determinants for the SUSTAINABILITY of the VHT Strategy. The most critical supervision is that of VHT members by their VHT Trainers/ Supervisors. Adequate thought and resources need to be allocated to this.

Reporting and Feed back

Reports need to be timely so as to be useful for planning and decision making. Reports should be discussed by all key stakeholders so that they form the basis for continuous improvement of health. The Quarterly VHT Meetings should discuss reports from the previous three months.

Monitoring and Evaluation

There must be a mechanism to find out whether VHT activities are implemented according to the set guidelines, monitor the activities of the VHT and eventually evaluate the VHT impact on health.

Planning and Budgeting

The main mobiliser of financing for the VHT Strategy is Government on behalf of the people of Uganda. Partners should continue to support where necessary. Districts are also encouraged to include VHT activities in their work plans and budget for them especially supervision of VHTs.

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______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

MA

TR

IX F

OR

VH

T O

PER

ATIO

NA

L G

UID

ELIN

ES

NA

TIO

NA

L L

EV

EL

Are

a o

f fo

cus

Wh

at

wil

l b

e d

on

eH

ow

it

wil

l b

e d

on

eP

ers

on

R

esp

on

sib

leS

ou

rce o

f Fu

nd

ing

Ind

icato

rs

Coord

inat

ion

and

Net

work

ing

Est

ablis

h a

nd o

per

atio

nal

ize

nat

ional

coord

inat

ing

com

mitte

e an

d s

ecre

tariat

Dev

elop s

trat

egy,

guid

elin

es

• an

d s

tandar

ds

Hold

quar

terly

mee

tings

• D

isse

min

ate

guid

elin

es•

Dev

elop a

sca

le-u

p p

lan f

or

• VH

T im

ple

men

tation.

MO

H

• sp

ecifi

cally

D

HS (

C&

C),

Sec

reta

riat

(ACH

S-H

P&E

Offi

ce)

Min

istr

y of

• H

ealth

Part

ner

s•

Min

ute

s of

• m

eetings

Nat

ional

•

Coord

inat

ion

Com

mitte

e in

pla

ceSec

reta

riat

in

• pla

ce

Advo

cacy

Rai

se p

rofile

of VH

T d

evel

opin

g

conse

nsu

s ab

out

the

nee

d f

or

VH

T a

nd M

obili

zing s

upport

in

cludin

g fi

nan

cial

support

Lobbyi

ng f

or

reso

urc

es•

Orien

tation o

f par

tner

s,

• polit

ical

lea

der

s, lin

e m

inis

trie

s an

d d

istr

ict

auth

orities

, re

ligio

us

org

anis

atio

ns,

Tra

ditio

nal

le

ader

s an

d o

ther

nat

ional

st

akeh

old

ers.

H

ave

in p

lace

sta

ndar

dis

ed

• ad

voca

cy t

ools

The

Sec

reta

riat

Min

istr

y of

• H

ealth

Part

ner

s•

Num

ber

of tim

es

• st

akeh

old

ers’

fo

rum

has

met

Part

icip

atio

n o

f •

stak

ehold

ers

in

VH

T a

ctiv

itie

s

Cap

acity

build

ing

Dev

elop t

rain

ing p

lan,

• D

evel

op t

rain

ing m

ater

ials

• Tec

hnic

al s

upport

to d

istr

icts

•

for

VH

T c

apac

ity

build

ing

Conduct

dis

tric

t le

vel

• orien

tation for

lea

der

sConduct

dis

tric

t tr

ainin

g o

f •

trai

ner

sM

onitor

trai

nin

g a

t lo

wer

•

leve

lsD

evel

op a

nd a

vail

•

imple

men

tation g

uid

elin

es

to b

e a

dher

ed t

o b

y th

e M

OH

, Pa

rtner

s, dis

tric

ts a

nd

NG

Os

Tra

inin

g

• Sen

sitisa

tions

• Fi

eld t

rips

• Sem

inar

s •

work

shops

•

The

• Sec

reta

riat

Nat

ional

•

Tra

iner

s

Min

istr

y of

• H

ealth

Part

ner

s•

Nat

ional

•

Coord

inat

ion

Com

mitte

eA V

HT tr

ainin

g

• pla

n in p

lace

, VH

T t

rain

ing

• m

ater

ials

in p

lace

Tec

hnic

al S

upport

•

Tea

m t

o a

ssis

t dis

tric

ts w

ith V

HT

capac

ity

build

ing

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

__

27

Super

visi

on

Conduct

support

super

visi

on

• to

the

dis

tric

t hea

lth t

eam

Incl

ude

VH

T s

uper

visi

on in

• th

e quar

terly

Are

a Tea

m v

isits

Rev

iew

dis

tric

t VH

T r

eport

s•

Conduct

tec

hnic

al s

upport

•

super

visi

on

Sec

reta

riat

• Tra

iner

s •

Nat

ional

Co-

• ord

inat

ing

Com

mitte

e

Min

istr

y of

• H

ealth

Part

ner

s•

Rep

ort

s of

• quar

terly

area

te

am v

isits

Support

•

super

visi

on

report

s to

dis

tric

ts

Rep

ort

ing a

nd

feed

bac

k

Dev

elop a

dis

tric

t re

port

ing

• fo

rmat

Des

ign a

com

pute

r pro

gra

m

• to

cap

ture

all

dat

aPr

oduce

quar

terly

and

• an

nual

re

port

s

Rec

eive

rep

ort

s fr

om

dis

tric

ts

• ab

out,

tra

inin

g,

activi

ties

, fu

ndin

g a

gen

cies

an

d o

ther

sCom

pile

info

rmat

ion into

a

• dat

a bas

eRec

eive

quer

ies

and inquirie

s •

about

VH

T a

nd r

espond

acco

rdin

gly

Mak

e fe

ed-b

ack

report

s to

all

• dis

tric

ts a

bout

VH

T a

ctiv

itie

s co

untr

ywid

ePr

ovi

de

a co

mpre

hen

sive

•

report

for

the

Annual

Nat

ional

H

ealth A

ssem

bly

The

• Sec

reta

riat

M

oH

Res

ourc

e •

Cen

tre

Min

istr

y of

• H

ealth

Part

ner

s•

Rep

ort

s•

NH

A r

eport

• D

atab

ase

•

Monitoring

and

eval

uat

ion

Monitoring

Chec

klis

t fo

r D

evel

op a

nd

• av

ail im

ple

men

tation

guid

elin

es t

o b

e a

dher

ed

to b

y th

e M

OH

, Pa

rtner

s,

dis

tric

ts a

nd N

GO

sRev

iew

ing d

istr

ict

report

s•

Conduct

ing s

upport

•

super

visi

on

Eva

luat

ion

Conduct

a m

id-t

erm

rev

iew

•

ever

y tw

o y

ears

Conduct

a c

om

pre

hen

sive

•

eval

uat

ion e

very

five

yea

rsConduct

fiel

d r

esea

rch

•

The

• se

cret

aria

tD

evel

opm

ent

• Pa

rtner

sM

OH

•

Progra

mm

esRes

ourc

e •

Cen

tre

Univ

ersi

ties

/ •

rese

arch

in

stitutions

Min

istr

y of

• H

ealth

Part

ner

s•

Hav

e a

funct

ional

•

M&

E P

rogra

mm

e in

pla

ce(D

evel

op

• in

dic

ators

fro

m

activi

ties

)Eva

luat

ion r

eport

•

Section 9

28

___

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

Plan

nin

g a

nd

budget

ing

Ensu

re t

her

e is

a V

HT

• Budget

lin

e su

pport

ed b

y M

OFP

ED

at

nat

ional

and

dis

tric

t le

vels

Dev

elop b

udget

s an

d

• pro

posa

ls

Proje

ct fi

nan

cial

req

uirem

ents

•

for

VH

TM

obili

se f

undin

g t

o s

upport

•

VH

TAdvo

cate

for

funds

•

Plan

nin

g

• Sec

reta

riat

Min

istr

y of

• H

ealth

Part

ner

s•

Sta

kehold

ers

foru

m

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

__

29

DIS

TR

ICT

LEV

EL

Are

a o

f fo

cus

Wh

at

wil

l b

e d

on

eH

ow

it

wil

l b

e d

on

eP

ers

on

R

esp

on

sib

leS

ou

rce o

f Fu

nd

ing

Ind

icato

rs

Coord

inat

ion/

Linka

ges

Build

Multis

ecto

ral

• par

tner

ship

s an

d lin

kages

in

support

of th

e VH

T S

trat

egy

in t

he

Dis

tric

tBuild

Multis

ecto

ral

• par

tner

ship

s an

d lin

kages

in

support

of th

e VH

T S

trat

egy

in t

he

Dis

tric

t

Orien

tation lea

der

s an

d

• par

tner

s in

key

sta

kehold

ers

im

ple

men

ting a

ctiv

itie

s at

co

mm

unity

leve

l M

ainta

in D

HT c

ohes

ion

• on iss

ues

of

VH

T S

trat

egy

imple

men

tation

Defi

ne

and m

ainta

in

• lin

kages

with o

ther

Dis

tric

t D

epar

tmen

ts,

DPs

, N

GO

s,

CBO

s an

d a

ny

oth

er d

efined

st

akeh

old

ers

Defi

ne

and m

ainta

in lin

kages

•

with H

SD

s an

d S

Cs

on V

HT

issu

esO

rien

tation

lead

ers

and

• par

tner

s in

key

sta

kehold

ers

im

ple

men

ting a

ctiv

itie

s at

co

mm

unity

leve

l M

ainta

in D

HT c

ohes

ion

• on iss

ues

of

VH

T S

trat

egy

imple

men

tation

Defi

ne

and m

ainta

in

• lin

kages

with o

ther

Dis

tric

t D

epar

tmen

ts,

DPs

, N

GO

s,

CBO

s an

d a

ny

oth

er d

efined

st

akeh

old

ers

Defi

ne

and m

ainta

in lin

kages

•

with H

SD

s an

d S

Cs

on V

HT

issu

es

DH

O a

ssis

ted

• by

the

DH

E o

r oth

er n

amed

per

son in t

he

Dis

tric

t •

serv

ing

as V

HT

Coord

inat

or

CAO

to

• ch

air

the

D

istr

ict

VH

T

Coord

inat

ion

mee

ting

Min

istr

y of

• H

ealth

Min

istr

y •

of Lo

cal

Gove

rnm

ent,

Oth

er

• Pa

rtner

s

Inte

r-se

ctora

lD

istr

ict

VH

T

Coord

inat

ion

Com

mitte

eM

inute

s an

dre

port

s of m

eetings

Section 9

30

___

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

Advo

cacy

Rai

se p

rofile

of VH

T•

Dev

elopin

g c

onse

nsu

s •

about

the

nee

d for

VH

T a

nd

Mobili

zing s

upport

in

cludin

g

finan

cial

for

VH

T

Enlis

t co

llabora

tion a

nd

• su

pport

of par

tner

s Id

entify

the

stak

ehold

ers

•

Org

anis

e D

istr

ict

VH

T

• Advo

cacy

foru

ms

Use

and d

isse

min

ate

VH

T

• ad

voca

cy t

ools

Sen

sitisi

ng a

nd lobbyi

ng

• dis

tric

t polit

ical

lea

der

s,

dis

tric

t dep

artm

ents

and

const

ituen

cy a

nd s

ub-c

ounty

le

ader

s, r

elig

ious

lead

ers,

tr

aditio

nal

lea

der

s an

d o

ther

dis

tric

t st

akeh

old

ers.

Tra

nsl

ate

sta

ndar

dis

ed

• ad

voca

cy t

ools

into

loca

l la

nguag

e(s)

Map

the

VH

T p

artn

ers

and

• th

eir

VH

T a

ctiv

itie

s in

the

dis

tric

tCoord

inat

e th

e dis

sem

inat

ion

• of

VH

T m

ater

ials

Lo

bby

stak

ehold

ers/

par

tner

s •

to b

uy

in a

ll ke

y ar

eas

of

colla

bora

tions

Dev

elop a

thre

e to

five

yea

r

• D

istr

ict

VH

T m

aste

r pla

nEnsu

re t

hat

all

VH

Ts

mat

eria

ls

• ar

e co

llect

ed f

rom

Min

istr

y of

Hea

lth a

nd a

re d

istr

ibute

d t

o

all H

ealth S

ub-D

istr

icts

and

Sub-C

ounties

.D

istr

ict

Tec

hnic

al P

lannin

g

• co

mm

itte

eThro

ugh b

udget

confe

rence

•

mee

ting

Dis

tric

t H

ealth

• O

ffice

r

Min

istr

y of

• H

ealth /

M

inis

try

• of Lo

cal

Gove

rnm

ent

Oth

er

• Pa

rtner

s

VH

T in

corp

ora

ted

in d

istr

ict

pla

n a

nd

budget

pla

n

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

__

31

Cap

acity

build

ing

Conduct

HSD

/SC lev

el V

HT

• se

nsi

tisa

tion

Car

ry o

ut

Dis

tric

t Tra

inin

g o

f •

VH

T T

rain

ers

with b

ack

up

of M

OH

Super

vise

, bac

k up a

nd

• M

onitor

trai

nin

g o

f VH

Ts

at

low

er lev

els

(HSD

/SC)

Tec

hnic

al s

upport

to H

SD

s/•

SCs

for

continuous

VH

T

capac

ity

build

ing

Tra

in H

SD

/SC T

rain

ers

for

• su

per

visi

on o

f VH

T a

ctiv

itie

s

A

Dis

tric

t VH

T t

rain

ing p

lan,

• Colle

ct f

rom

MO

H V

HT

• tr

ainin

g m

ater

ials

and if

nec

essa

ry t

ransl

ate

them

into

th

e lo

cal la

nguag

e(s)

Provi

de

tech

nic

al s

upport

to

• H

SD

s an

d S

ub-C

ounties

for

VH

T c

apac

ity

build

ing

Dev

elop D

istr

ict

VH

T

• su

per

visi

on P

lan

Dev

elop D

istr

ict

VH

T M

& E

•

Plan

DH

T•

MoH

• D

istr

ict

Loca

l •

Gove

rnm

ent

Oth

er

• Pa

rtner

s

Inte

r-se

ctora

lD

istr

ict

VH

T

Coord

inat

ion

Com

mitte

eTra

inin

g p

lan

Tra

inin

g r

eport

s

Super

visi

on

Monitor

super

visi

on c

arried

•

out

by

HSD

s an

d S

Cs

Colla

te s

uper

visi

on r

eport

s•

Incl

ude

VH

T s

uper

visi

on in

• al

l D

HT fi

eld/s

uper

visi

on

visi

tsD

HT m

ember

s to

att

end

• a

spec

ified

num

ber

of

Quar

terly

Sub-C

ounty

VH

T

Mee

tings

in d

iffe

rent

HSD

s/SCs

ever

y quar

ter

Use

sta

ndar

d c

hec

k lis

t an

d

• or

super

visi

on form

sThe

secr

etar

iat

mem

ber

s to

•

atte

nd a

spec

ified

num

ber

of Q

uar

terly

Sub-C

ounty

VH

T M

eetings

in d

iffe

rent

dis

tric

ts e

very

quar

ter

Use

sta

ndar

d c

hec

k lis

t •

and o

r su

per

visi

on form

s•

Provi

de

a ch

eck

list

and o

r •

super

visi

on form

s to

HSD

an

d S

C V

HT T

rain

ers

Conduct

support

super

visi

on t

o

the

HSD

s an

d s

ub c

ounty

lev

els

DH

E o

r •

oth

er n

amed

D

istr

ict

VH

T

Coord

inat

or

Min

istr

y of

• H

ealth /

M

OLG

/Oth

er

Part

ner

s

Inte

r-se

ctora

lD

istr

ict

VH

T

Coord

inat

ion

Com

mitte

e

Section 9

32

___

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

Rep

ort

ing a

nd

feed

bac

k

Adopt

nat

ional

form

at a

nd

• co

nte

nt

of VH

T R

eport

s fr

om

H

SD

s an

d S

Cs

Ensu

re r

eport

ing c

om

pat

ible

•

with H

MIS

Rec

eive

VH

T r

eport

s fr

om

•

HSD

s an

d S

Cs

about

all VH

T t

rain

ing a

nd

• fiel

d,

activi

ties

Com

pile

info

rmat

ion into

a

• D

istr

ict

VH

T d

ata

bas

ePr

ovi

de

a co

mpre

hen

sive

•

report

for

MO

H R

esourc

e Cen

tre

and l V

HT S

ecre

tariat

Com

pile

an A

nnual

VH

T

• Rep

ort

for

the

Dis

tric

t Tec

hnic

al a

nd P

lannin

g

Com

mitte

e Pr

ovi

de

fee

d-b

ack

of

all

• ag

gre

gat

ed r

eport

s to

all

HSD

s an

d S

Cs

about

VH

T

activi

ties

and C

om

munity

Bas

ed H

ealth I

ndic

ators

Dev

elop a

dis

tric

t re

port

ing

• fo

rmat

com

pat

ible

with H

MIS

Est

ablis

h a

Dis

tric

t D

ata

bas

e •

for

VH

T a

ctiv

itie

s Pr

oduce

quar

terly

report

s

• docu

men

ting z

ero r

eport

ing

Produce

annual

rep

ort

•

DH

O•

Min

istr

y of

• H

ealth

Dis

tric

t•

LG/O

ther

• Pa

rtner

s•

Inte

r-se

ctora

lD

istr

ict

VH

TCoord

inat

ion

Com

mitte

eD

istr

ict

VH

T

dat

abas

e in

pla

ce

Monitoring

and

eval

uat

ion

Adopt

and u

se t

he

nat

ional

•

monitoring a

nd e

valu

atio

n

chec

klis

t.

Monitor

to e

nsu

re t

hat

•

guid

elin

es a

re a

dher

ed t

o b

y th

e dis

tric

ts a

nd N

GO

s during

imple

men

tation

Conduct

a m

id-t

erm

rev

iew

•

com

pre

hen

sive

ev

aluat

ion

of

all D

istr

ict

VH

T a

ctiv

itie

sRev

iew

ing H

SD

/SC V

HT

• re

port

sConduct

oper

atio

nal

fiel

d

• re

sear

ch

DH

O•

Min

istr

y of

• H

ealth

Dis

tric

t•

LG/O

ther

• Pa

rtner

s•

Chec

klis

t ad

opte

dM

id-t

erm

rev

iew

Rep

ort

s av

aila

ble

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

__

33

Plan

nin

g a

nd

budget

ing

Budget

and m

obili

se f

unds

• Rat

ional

allo

cation o

f fu

nds

• fo

r VH

T a

ctiv

itie

s in

the

Dis

tric

t

Dev

elop p

lans

and b

udget

s

• bas

ed o

n d

efined

VH

T

activi

ties

in t

he

dis

tric

tAdvo

cacy

and lobbyi

ng f

or

• VH

T f

undin

gEnsu

re t

her

e is

a V

HT B

udget

•

line

at D

istr

ict,

HSD

and S

C

leve

lsM

obili

se f

unds

for

VH

T f

rom

•

MO

H,

oth

er G

OU

Min

istr

ies

and A

gen

cies

, D

evel

opm

ent

Part

ner

s, p

riva

te s

ecto

r,

NG

Os

and o

ther

leg

itim

ate

sourc

es

DH

O’s

Offi

ce•

Min

istr

y of

• H

ealth

MO

LG/O

ther

•

Part

ner

s

Plan

s Budget

allo

cation

Section 9

34

___

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

HEA

LTH

SU

B D

ISTR

ICT

Are

a o

f fo

cus

Wh

at

will b

e d

on

eH

ow

it

will b

e d

on

eP

ers

on

R

esp

on

sib

leS

ou

rce o

f Fu

nd

ing

Ind

icato

rs

Coord

inat

ion

Inco

rpora

te a

ll VH

T

• ac

tivi

ties

in t

he

HSD

pla

n

Dev

elop H

SD

VH

T

• Im

ple

men

tation P

lan

Coord

inat

e a

ll H

SD

•

and S

C e

ffort

s to

war

ds

imple

men

ting th

e VH

T

Str

ateg

y in

the

HSD

Iden

tify

ing a

ll VH

T

• st

akeh

old

ers

in t

he

HSD

Org

anis

ing q

uar

terly

VH

T

• Coord

inat

ion m

eetings

in t

he

HSD

HSD

in

-•

char

ge

Min

istr

y of

• H

ealth/D

LG/

DPs

/NG

Os/

CBO

sO

ther

•

par

tner

s

Min

ute

s Q

uar

terly

Rep

ort

s

Super

visi

on

Dev

elop V

HT T

rain

ing

• su

per

visi

on P

lan

Orien

t Sub-C

ounty

VH

T

• tr

ainer

s on s

uper

visi

on

skill

s fo

r VH

Ts

Conduct

support

•

super

visi

on t

o t

he

Sub-

Counties

, Pa

rish

es a

nd

Vill

age

in t

he

HSD

Car

ry o

ut

support

•

super

visi

on t

o low

er h

ealth

units

Monitor

VH

T im

ple

men

tation

• ac

tivi

ties

M

onitor

super

visi

on c

arried

•

out

by

Sub-C

ounty

VH

T

Tra

iner

sConduct

Sub-C

ounty

lev

el

• se

nsi

tisa

tion t

oget

her

with

Sub-C

ounty

VH

T T

rain

ers

Part

icip

ate

in

dis

tric

t •

trai

nin

g o

f Sub-C

ounty

VH

T

trai

ner

sSuper

vise

and M

onitor

• tr

ainin

g a

t Sub-C

ounty

and

Parish

lev

els

Tec

hnic

al s

upport

to S

ub-

• County

VH

T t

rain

ers

for

VH

T

capac

ity

build

ing

Ass

ista

nt

• H

ealth

Educa

tor

or

nam

ed

HSD

VH

T

Coord

inat

or

Min

istr

y of

• H

ealth/D

LG/

DPs

/NG

Os/

CBO

sO

ther

•

par

tner

s

Super

visi

on

report

s

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

__

35

Rep

ort

ing

and f

eedbac

k

Updat

e th

e ar

ea M

P on V

HT

• im

ple

men

tation

Ensu

re V

HT r

eport

ing f

rom

•

all VH

T m

ember

s an

d S

C

VH

T T

rain

ers

in t

he

HSD

is

co

mpat

ible

with M

OH

HM

IS

form

at

Colla

te S

C V

HT s

uper

visi

on

• re

port

s in

to H

SD

super

visi

on

report

Adopt

an H

SD

VH

T

• re

port

ing f

orm

at c

om

pat

ible

w

ith

MO

H H

MIS

Rec

eive

month

ly/q

uar

terly

• VH

T r

eport

s fr

om

SC V

HT

Tra

iner

s ab

out

all VH

T

activi

ties

in t

he

HSD

Com

pile

info

rmat

ion into

•

a m

onth

ly/q

uar

terly

and

annual

H

SD

VH

T r

eport

,

accu

mula

ted t

o a

com

pute

r bas

ed

HSD

VH

T d

ata

bas

eM

ake

feed

-bac

k re

port

s to

•

all SCs

about

aggre

gat

ed

VH

T a

ctiv

itie

s in

the

HSD

Provi

de

a co

mpre

hen

sive

•

HSD

VH

T r

eport

to D

HO

HSD

In-

• ch

arge

Min

istr

y of

• H

ealth/D

LG/

DPs

/NG

Os/

CBO

sO

ther

•

par

tner

s

Rep

ort

s

Monitoring

and

eval

uat

ion

Dev

elop a

nd im

ple

men

t •

HSD

VH

T M

onitoring a

nd

Eva

luat

ion P

lan M

ake

sure

im

ple

men

tation g

uid

elin

es

are

adher

ed t

o b

y th

e su

b-

counties

Conduct

ing M

onitoring

• vi

sits

Part

icip

ate

in m

idte

rm

• re

view

s an

d 5

yea

r ev

aluat

ion

Rev

iew

SC V

HT r

eport

s•

Conduct

oper

atio

nal

fiel

d

• re

sear

ch

Acq

uire

and u

se V

HT

• im

ple

men

tation g

uid

elin

es

and s

tandar

ds

dev

eloped

by

MO

H

HSD

In-

• ch

arge

Min

istr

y of

• H

ealth/D

LG/

DPs

/NG

Os/

CBO

sO

ther

•

par

tner

s

Monitoring r

eport

sRes

earc

h r

eport

s

Plan

nin

g

and

budget

ing

Inco

rpora

te V

HT a

ctiv

itie

s •

in H

SD

pla

nConduct

pla

nnin

g m

eetings

• H

SD

In-

• ch

arge

Min

istr

y of

• H

ealth/D

LG/

DPs

/NG

Os/

CBO

sO

ther

•

par

tner

s

VH

T a

ctiv

itie

s in

cluded

in H

SD

pla

ns

Section 9

36

___

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

SU

B C

OU

NTY

Are

a o

f fo

cus

Wh

at

will b

e d

on

eH

ow

it

will b

e d

on

eP

ers

on

R

esp

on

sib

leS

ou

rce o

f Fu

nd

ing

Ind

icato

rs

Coord

inat

ion

Coord

inat

e al

l VH

T

• ac

tivi

ties

in t

he

sub

county

and m

ake

sure

th

at a

ll co

mm

unity

leve

l hea

lth inte

rven

tions

are

imple

men

ted t

hro

ugh t

he

VH

Ts

Linki

ng V

HTs

to t

he

hea

lth

• fa

cilit

ies

Pass

enab

ling b

y-la

ws

• O

rgan

ise

a hea

lth f

oru

m f

or

• al

l st

akeh

old

ers

in t

he

sub

county

HC I

II I

n-

• ch

arge

is t

he

coord

inat

or

Sub c

ounty

•

chie

f ch

airs

th

e m

eeting

MO

H•

Dis

tric

t•

Sub c

ounty

• Pa

rtner

s•

By-

law

s in

pla

ceM

inute

s fr

om

th

e Sta

kehold

ers

foru

m

Advo

cacy

Sen

sitisa

tion o

f su

b-

• co

unty

lea

der

s on V

HT

imple

men

tation

Hold

sen

sitisa

tion m

eetings

• Sub c

ounty

counci

l m

eetings

•

HC I

II I

n-

• ch

arge

is t

he

coord

inat

or

MO

H•

Dis

tric

t•

Sub c

ounty

• Pa

rtner

s•

Mee

ting r

eport

s

Cap

acity

build

ing

Plan

for

VH

T t

rain

ing

• Conduct

VH

T t

rain

ing

• Pr

ovi

de

logis

tics

•

Orien

tation o

f hea

lth

• w

ork

ers

on V

HT s

trat

egy

Org

anis

e se

lect

ion m

eetings

• O

rder

, st

ore

and d

istr

ibute

•

com

moditie

s an

d s

upplie

sM

eetings

/work

shops

•

HC I

II I

n-

• ch

arge

, CD

O,

HA

MO

H•

Dis

tric

t•

Sub c

ounty

• Pa

rtner

s•

Rep

ort

s of

VH

T

sele

ctio

n m

eetings

Inve

nto

ry o

f lo

gis

tics

Dat

abas

e of

VH

Ts

in t

he

Sub c

ounty

Tra

inin

g r

eport

s

Super

visi

on

Follo

w u

p V

HT m

ember

s in

•

thei

r co

mm

unitie

s.Conduct

month

ly V

HT

• m

eetings

Conduct

quar

terly

VH

T

• m

eetings

Conduct

Support

super

visi

on

• Sch

edule

mee

tings

• Sub C

ounty

•

VH

T t

rain

ers

MO

H•

Dis

tric

t•

Sub-c

ounty

• Pa

rtner

s•

Rep

ort

s of

VH

T

sele

ctio

n m

eetings

Rec

eivi

ng m

onth

ly

report

s

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

__

37

Rep

ort

ing

and f

eedbac

k

Subm

it V

HT a

ctiv

ity

report

s •

to H

SD

Hav

e a

VH

T p

erfo

rman

ce

• m

onitoring

Rec

eive

rep

ort

s fr

om

VH

TS

• M

ake

conso

lidat

ed V

HT

• re

port

to t

he

HSD

G

ive

VH

Ts

com

men

ts o

n

• th

e re

port

s th

ey s

ubm

itte

d

Mee

tings

with V

HT m

ember

s•

Sub C

ounty

•

VH

T t

rain

ers

MO

H•

Dis

tric

t•

Sub-c

ounty

• Pa

rtner

s•

Rep

ort

s of

VH

T

sele

ctio

n m

eetings

Monitoring

and

eval

uat

ion

Monitoring V

HT m

ember

•

activi

ties

Fo

llow

ing u

p V

HT m

ember

s •

in t

hei

r co

mm

unitie

s

Hea

lth

• Ass

ista

nt

Com

munity

• D

evel

opm

ent

offi

cer

MO

H•

Dis

tric

t•

Sub-c

ounty

• Pa

rtner

s•

Rep

ort

s

Plan

nin

g

and

budget

ing

Prep

are

a pla

n a

nd b

udget

•

for

VH

T a

ctiv

itie

s an

d

Inco

rpora

te it

in s

ub-

county

hea

lth p

lans

Sub-c

ounty

tec

hnic

al

• pla

nnin

g m

eetings

In-

Char

ge

• H

ealth

• Ass

ista

nt

CD

O•

MO

H•

Dis

tric

t•

Sub-c

ounty

• Pa

rtner

s•

Ava

ilabili

ty o

f

work

pla

n

VH

T a

ctiv

itie

s in

corp

ora

ted into

su

b c

ounty

hea

lth

pla

n

Section 9

38

___

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

HEA

LTH

CEN

TR

E I

I LEV

EL

Are

a o

f fo

cus

Wh

at

will b

e d

on

eH

ow

will it

be d

on

eP

ers

on

R

esp

on

sib

leS

ou

rce o

f Fu

nd

ing

Ind

icato

rs

Coord

inat

ion

and r

eport

ing

Org

anis

e Q

uar

terly

• m

eetings

with V

HTs

Rec

eivi

ng n

ew info

rmat

ion

• Shar

ing e

xper

ience

s •

Rev

iew

of re

port

s•

Rev

iew

and u

pdat

e of

key

• m

essa

ges

Re

pla

nnin

g

•

Quar

terly

mee

tings

•

In c

har

ge

• H

C11

VH

T f

oca

l •

per

son

Hea

lth

• Ass

ista

nts

Min

istr

y of

• H

ealth

DLG

• SCLG

, •

Com

munitie

s an

dPa

rtner

s•

Quar

terly

mee

ting

report

s an

d

regis

ters

ava

ilable

Logis

tics

and

Supplie

s

Rec

eivi

ng an

d a

ccounting

• fo

r m

edic

ines

, su

pplie

s an

d

com

moditie

s

Use

Sto

ck c

ards

to

acco

unt

• an

d r

equis

itio

n f

or

more

su

pplie

s

In c

har

ge

• H

C11

Parish

chie

f•

N/A

• Lo

gis

tica

l re

port

s

Super

visi

on

and

men

toring o

f VH

Ts

Follo

w u

p a

nd s

upport

VH

T

• m

ember

s in

the

fiel

d o

n a

m

onth

ly b

asis

Com

munity

visi

ts•

Hom

e vi

sits

•

Hea

lth

• Ass

ista

nt

VH

T t

rain

ers

•

DLG

• SCLG

•

Act

ivity

report

s

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

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______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

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39

VIL

LA

GE L

EV

EL

Are

a o

f fo

cus

Wh

at

wil

l b

e d

on

eH

ow

wil

l it

be d

on

eP

ers

on

R

esp

on

sib

leS

ou

rce o

f Fu

nd

ing

Ind

icato

rs

Coord

inat

ion

and r

eport

ing

Est

ablis

h a

VH

T lea

der

ship

•

to c

oord

inat

e VH

T m

ember

sM

onth

ly v

illag

e hea

lth t

eam

•

mee

tings

chai

red b

y th

e LC

IVill

age

leve

l D

ata

colle

ctio

n,

• use

and r

eport

ing o

f

findin

gs

Subm

it s

um

mar

y re

port

s to

•

hea

lth fac

ility

In e

ach v

illag

e, t

he

VH

T

• m

ember

s se

lect

am

ongst

th

emse

lves

a T

eam

lea

der

,

Sec

reta

ry a

nd T

reas

ure

r U

se o

f VH

T h

ouse

hold

reg

iste

r •

and s

um

mar

y fo

rms

Org

anis

ing V

HT m

eetings

with

• LC

I ch

airp

erso

n

VH

T

• Le

ader

ship

an

d

LCI

• ch

airp

erso

n

VH

T t

eam

le

ader

ship

ava

ilable

Rep

ort

s av

aila

ble

Mee

tings

take

pla

ce

Cap

acity

build

ing

Build

the

hea

lth a

nd

• dev

elopm

ent

capac

ity

of

com

munity

mem

ber

sCom

munity

empow

erm

ent

• D

istr

ibution o

f hea

lth

• co

mm

oditie

s an

d m

edic

ines

Educa

te p

eople

about

life

• sk

ills

and c

om

munity

hea

lth

pra

ctic

es

Reg

ula

r co

nta

ct w

ith

• house

hold

mem

ber

s Com

munity

dia

logues

at

• fo

rmal

or

info

rmal

mee

tings

Inte

rper

sonal

com

munic

atio

n•

Hom

e vi

sits

• Com

munity

funct

ions

e.g.

• w

eddin

gs,

burial

s, f

ootb

all

mat

ches

etc

Org

anis

e dra

ma

sess

ions

• D

uring o

utr

each

es e

.g.

child

•

day

s plu

sAppre

ntice

ship

(han

ds

on

• tr

ainin

g)

VH

T m

ember

s•

Rep

ort

s of hom

e vi

sits

Num

ber

of

funct

ions

addre

ssed

Num

ber

of

com

moditie

s re

ceiv

ed a

nd

dis

trib

ute

d

Num

ber

of

com

munity

dia

logues

hel

d

Act

ivit

ies

to

be I

mp

lem

en

ted

by V

HT M

em

bers

Ind

icato

rs

Be

a ro

le m

odel

All

VH

Ts

must

kee

p a

model

•

hom

eAva

ilabili

ty o

f sa

fe d

rinki

ng

• w

ater

A C

lean

usa

ble

lat

rine

with

• han

d w

ashin

g f

acili

ty w

ith

soap

Sep

arat

e ac

com

modat

ion f

or

• an

imal

sAva

ilabili

ty a

nd u

se o

f Lo

ng

• La

stin

g I

nse

ctic

ide

Net

(s)

VH

Ts

• N

um

ber

of VH

Ts

with m

odel

hom

es

Section 9

40

___

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

_Stra

tegy

and O

pera

tiona

l Guid

eline

s

Imple

men

t Soci

al m

obili

sation a

ctiv

itie

s

Dis

trib

ute

IEC m

ater

ials

• In

ter

Pers

onal

Com

munic

atio

n•

Dra

ma

• O

rgan

ise

sport

s ac

tivi

ties

•

Use

med

ia e

.g.

radio

s•

VH

Ts

•

Num

ber

and t

ypes

of

IEC m

ater

ials

dis

sem

inat

edN

um

ber

of

reci

pie

nt

hom

es o

f IE

C

mat

eria

ls

Hom

e vi

siting

Chec

k fo

r th

e pre

sence

and

• ad

vise

on t

he

use

of sa

nitat

ion

faci

litie

s Chec

k fo

r th

e e

xist

ence

of a

•

pre

gnan

t or

new

moth

er a

nd

advi

se o

n t

he

import

ance

of

ante

nat

al /

Post

nat

alChec

k on t

he

avai

labili

ty a

nd

• ca

re o

f new

born

s an

d o

ther

vu

lner

able

child

ren

Chec

k fo

r av

aila

bili

ty o

f peo

ple

•

with d

isab

ilities

Chec

k fo

r av

aila

bili

ty o

f ch

ronic

•

illnes

ses

Chec

k fo

r th

e pre

sence

and

• utilis

atio

n o

f I

TN

sChec

k on a

nd a

dvi

se o

n a

ny

• oth

er r

elev

ant

hea

lth iss

ues

.

VH

Ts

•

Num

ber

of

hom

es

visi

ted

Num

ber

of

hom

e vi

sits

mad

e

Sav

ing liv

es

Iden

tify

dan

ger

sig

ns

espec

ially

•

among w

om

en,

child

ren a

nd

PWD

sre

fer

case

s to

hea

lth fac

ility

• M

obili

se for

imm

unis

atio

n•

Advi

se p

regnan

t w

om

en t

o

• go for

AN

C a

nd P

ost

nat

al for

moth

ers

and t

hei

r new

born

sG

ive

sim

ple

tre

atm

ent

for

• m

alar

ia,

dia

rrhoea

, pneu

monia

an

d o

ther

s

VH

T

•

No o

f ca

ses

refe

rred

No o

f ca

ses

trea

ted

No o

f im

munis

atio

n

sess

ions

support

ed

Num

ber

of

wom

en

counse

lled f

or

AN

C

and P

NC

Num

ber

of

new

born

s vi

site

d a

t hom

e

Section 9

Stra

tegy

and O

pera

tiona

l Guid

eline

s_____

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

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41

Support

Support

peo

ple

on long

• te

rm t

reat

men

t an

d t

hose

in

nee

d o

f sp

ecia

l at

tention

e.g.

vict

ims

of

Gen

der

Bas

ed

Vio

lence

, H

IV,

CB-D

OTs

Advi

se o

n f

ood s

ecurity

and

• nutr

itio

n in h

om

esAdvi

se o

n e

duca

tion o

f •

child

ren e

spec

ially

the

Girl

Child

up t

o 1

8 y

ears

No o

f peo

ple

w

ith s

pec

ial

nee

ds

/ on long

term

tre

atm

ent

support

ed

No o

f hom

es

advi

sed o

n f

ood

secu

rity

and

nutr

itio

n

No o

f fa

mili

es

counse

lled o

n t

he

import

ance

of

educa

tion e

sp.

of

the

girl ch

ild

Linki

ng c

om

munity

to form

al h

ealth s

ecto

r

Ref

erra

l of

pat

ients

• Pa

rtic

ipat

e in

mee

tings

at

• th

e hea

lth c

entr

eFo

llow

ing u

p d

isch

arged

•

pat

ients

fro

m h

ealth f

acili

tyD

ata

colle

ctio

n a

nd r

eport

ing

•

No o

f re

ferr

als

No o

f m

eetings

par

tici

pat

ed in

No o

f dis

char

ged

pat

ients

follo

wed

up

Rep

ort

Dat

a co

llect

ion,

reco

rd k

eepin

g,

report

ing

and f

eedbac

k

Dra

w a

com

munity

map

• Fi

ll in

and u

pdat

e th

e VH

T

• house

hold

reg

iste

rRep

ort

notifiab

le d

isea

ses

• an

d o

ther

unusu

al h

ealth

occ

urr

ence

sColle

ct c

om

pile

, use

dat

a •

and g

ive

feed

bac

k to

co

mm

unity

Rep

ort

dat

a to

rel

evan

t •

auth

orities

Com

munity

map

Com

ple

ted V

HT

house

hold

reg

iste

r

Notifiab

le d

isea

ses

report

ed

Rep

ort

s an

d f

eed

bac

k to

auth

orities

Section 9


10. STANDARDS FOR VHT IMPLEMENTATION

Standards for VHT ( Showing a good example)

All VHTs must keep a model home

A clean usable latrine with hand washing facility with soap

Availability of safe drinking water

Separate accommodation for animals

Availability and use of Long Lasting Insecticide Net(s) (LLINs)

Standards for VHT Kit

All VHT members will be equipped with a standard Kit and certificate

ALL Partners will supply the same minimum kit

Composition of the VHT Kit: Badge, Bag , Register , VHT Participant Manual, Health Promotion Flip charts, Standardised IEC materials and Job Aids

Availability of essential drugs

Community Case Management

Medicines used at community level in accordance with national guidelines

The defined Essential drugs are available in the VHT drug Kit and Drugs are not expired and all strengths present

All any stock out will be documented and counted

Standards for ICCM Kit

The ICCM kit will include: Pre-packed medicines for malaria, pneumonia and diarrhea: Amoxicillin for non severe pneumonia, ACTs for uncomplicated malaria, Low Osmolarity ORS for diarrhea, Zinc for diarrhea, rectal Artesunate for pre-referral patients, diagnostic commodities e.g. respiratory timers, MUAC tape, user items e.g. Job Aid cards.

Standards for VHT Training

All VHTs will have 5 day standard training in health promotion, which conforms to • agreed norms and standards content, duration and ratios of VHTs to facilitators

Additional modular training will be given to every VHT member. •

Quality assurance will be applied for norms and standards of additional training•

Certificate•

Training will be conducted using standardised materials•

Quarterly meetings should include refresher trainings• VHTs will select amongst themselves two people but the selection of these members • should be guided by geographical location to ease access.

Thirty people should be trained as VHT members in a single training for a course • of five days.

Sect

ion

10


Minimal skills required by VHTs for Core Functions

Knows roles and responsibilities

Able to fill out VHT register

Knows Key Messages (Key Family practices)

Ability to communicate effectively

Observational skills

Mobilisation skills

Knows diseases to report

Knows how to read MUAC tape

Availability of essential Equipment and work Aides

Every VHT has a Job Aid for identifying children, newborns and women with danger • signs available and immediately accessible in VHT kit.Every VHT will have a standardised colour coded MUAC tape/strap with standardised • MoH/WHO cut offs for Malnutrition and severe malnutritionEvery VHT carrying out CCM has a means of counting respiratory rate which is • immediately available (respiratory timer, watch with second hand, mobile phone with timer function)

VHT Core Activities

(refer to the VHT handbook on VHT responsibilities Pg.6)

Ability to conduct Home visits•

Ability to organise and conduct village meetings•

Ability to carry out individual counselling•

Ability to mobilise people for health service•

Ability to communicate •

REPORTING

Reporting By VHTs

Ability to report Diseases under surveillance and other unusual health events to • the health unit

Ability to give monthly reports to the health unit •

Supervision

All VHTs will be supervised by HCII at monthly meeting when registers and reports will be checked and on job training and supervision will be carried out

All VHTs will attend quarterly supervision meeting

VHTs will receive supportive supervision in the community at least once per year

Community Case Management For VHTs

Only VHTs who have completed basic health promotion training followed by Case Management training will treat members of the community.A pregnant woman, newborn or child with a danger sign has any referral treatment given and referral letter written and immediately referred.

Sect

ion

10


NOTESN

otes

Ministry of Health Policy and Guideline on how to engage and utilize Village Health Teams in

Community-based health services delivery in Uganda

VHT

ministry of health vht

Documents