SPOTLIGHT ON MILLENNIUM VILLAGES PROJECT IN UGANDA
The Millennium Villages cluster in Uganda is the first model village in Uganda located in the sub counties of Nyakitunda and Kabuyanda in Isingiro District and located about 40km from Mbarara town. The cluster covers a population of 50,000 people in 10,000 households.
In just 2 years, Ruhiira is on the verge of transformation. The government of Ugandahas plans to scale up the Millennium Villages project to all districts in Uganda. Each district will have a Millennium Village in the poorest region of each. UNDP is establishing two villages in the North east, Kaberamaido and Kumi villages. This strategy is being incorporated into district plans and eventually to national plans, thereby taking the Millennium Villages project to unprecedented scale. Some of the incredible success to date includes:
Health service delivery in Ruhiira MVP
Impact of malaria bed nets:
Malaria incidence is down by 79%. Thanks to mass distribution of insecticide-treated bed nets and malaria testing and treatment. Baseline information collected in August 2006 revealed that 86% of Ruhiira villagers will always be ill of fever over a 2 weeks period, of which 80% recognized malaria as the cause of fever. The ownership of bed nets was only 3% at the time and none of the households owned more than two bed nets.
o A total of 44,000 bed nets were distributed in the Ruhiira Cluster. A recent rapid assessment in the cluster showed that 86% of the sleeping sites are covered by bed nets. The other remaining 14% which were not covered are attributed to the new households that have come up. A total of 1,000 new households have come up with an average of 5 sleeping sites per household. 5,000 more bed nets are to be distributed to household and surrounding villages.
o The reported average expenditure per month on malaria related treatment has significantly dropped from 26,780 Uganda shillings (USD 16) before bed net distribution to 2,667 [USD 1.6] after bed nets distribution.(90% Reduction)
o Most households now have more time to engage in productive activities that are likely to increase household income as a result of the dramatic reduction in malaria cases.
o Malaria related school absenteeism has remarkably reduced and is likely to be translated into improved student performance.
The health supermarket: deepening access to health services through community health days.
In Ruhiira a combination of a hilly topography, poor public transport system, and social cultural norms still pose a serious challenge to full access to health facilities. In particular, the hard to reach areas still witness a high disease burden. The Ruhiira MVP developed a strategy of periodically reaching out to high numbers of villagers with a range of health interventions on particular days in particular community chosen points.
o So far, a total of 55,507 people have been reached during the 2 rounds of health days conducted. This is more than patients attending all 6 health units in a 6 months period.
o Through the health days, 3408 HIV infected people have been identified and counseled, 689 mothers received antenatal care and 37,695 received various treatments.
o 68.5% (6164 of 9000) of children under 5 years of age in the project area were reached during health days and their growth monitored. Of these, 1482 were immunized, 935 malnourished children were put on constant surveillance by CHWs, 2199 dewormed, and 2599 given vitamin A supplements.
Community health
Increasing access to antenatal care, delivery services and general OPD: role of improved facilities and presence of staff
Maternal and child mortality rates are dramatically improving. The number of pregnant women now coming to health units to deliver has quadrupled. Mothers are now flocking health units.
At baseline, 32.2% of total pregnant women received ANC at a Health facility in the Project area. Currently, 80% of pregnant mothers access ANC from Health facilities at least once during their pregnancy.
Before the project, only 8% of deliveries were supervised by a skilled health worker. Currently, 70% of deliveries in the project area are done at the health unit. Overall, the District statistics of deliveries has increased by 3% as a result of increased supervised deliveries at health units in the project area. This is as a result of;
Recruitment of suitably qualified midwives and their posting to all Health facilities from September 2007 that has tremendously boosted deliveries at health units
Regular supplies of medicine and consumables
Supply of appropriate equipment like Delivery kits, delivery beds, suction machines among others
Improved privacy at health units
Regular training of mid-wives
Community sensitization about the benefits of delivering at health units
Establishment of emergency response system
Renovation of Health units and the operationalisation of the Kabuyanda operating theatre that offer comprehensive emergency obstetric care
Incentive (Laundry Soap and baby wrapper) for mothers who deliver at health units
There has been a significant increase in utilization of health care facilities across all health facilities a monthly average of 324 in 2006 to 1073in the first half of 2008. This is attributed to a number of factors: (i) recruitment of duly qualified health workers, (ii) training of the health workers to offer quality health care services. (iii) regular supply of adequate amount of medicine, equipment and medical sundries, (iv) regular support supervision jointly conducted by district health team and MVP staff, (v) community sensitization about the importance of early health seeking behavior.
Agriculture yields have tripled and villagers have set up a cereal bank to store grain and help curb the risk of food insecurity. Farmers are now terracing which is proving to be highly effective in combating soil erosion.
The villagers are diversifying high -value crops, planting trees for timber and fruit trees such as avocado, mango and citrus trees. They are also planting maize, beans and for extra income, sweet potatoes to help in malnutrition among children and pregnant mothers.
The school meals programme is helping alleviate hunger and malnutrition in school going children frompoor rural communities; as well as encouraging enrollment and reducing absenteeism. Enrollment increase by 47% in just 2 years, performance in PLE has improved with the number of better grades improving and poorer grades reducing.
Other impact interventions include:
Building and refurbishing classroom blocks, providing improved cook stoves and water harvesting tanks and construction of pit latrines and kitchens. Scholarship support to the girl child has led to increase in enrollment. Training teachers on lesson preparation, teaching methods and student assessment in order to improve the quality of teaching and learning. Standardised examinations are being done to expose the learners and to support in both formative and summative evaluation.
Several women are under taking additional income-generating activities such beads making from dry banana leaves. 200 women have been trained in making top quality beads to be exported.
The village bank established by the project and villagers has now loaned out 120 million shillings, with an interest rate of only 18% per annum to support the local communities establish enterprises. 100 villagers have been trained on entrepreneurship skills and how to make good business plans.
60km of roads opened has increased traffic counts and access to markets. Access to clean water has increased by over 50%.
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