Uganda: Using Mildmay’s expertise to strengthen health systems

The staff and clients at the Bishop Caesar Asili Memorial Health Centre in Luwero knew Mildmay Uganda’s work well; since 2008, Mildmay had delivered essential HIV services and care at the centre. Over the subsequent five years, with a new tranche of funding from the United States Centers for Disease Control and Prevention (CDC), Mildmay’s role changed. Drawing on its HIV expertise, Mildmay acted in an advisory capacity to strengthen existing systems and structures so the health centre could deliver services more independently.

Mildmay began rolling out the same approach at 130 health facilities across 20 districts in central Uganda, with regional field teams paying regular visits to assist. “We were giving these clinics the skills and the confidence, so tomorrow if we were not there they could still do it themselves,” said Norah Namono, Public Relations Officer for Mildmay Uganda.

Support focused on HIV provision: group and individual counselling, testing, Prevention of Mother‑to‑Child Transmission (PMTCT), care and treatment, while general health services benefitted through integrated practice. At Luwero, for example, the 66 beds served patients with malaria, pneumonia, flu and HIV without separation, reflecting integration rather than treating HIV in isolation.

Before Mildmay started at Luwero, around 3,700 HIV‑positive patients were registered, but none received lifesaving antiretroviral therapy (ART). Many were dying because treatment was unavailable. A Mildmay team visited every fortnight to distribute ART and train staff to build capacity. “Then they started to wean us off.

Now we were on our own and they came only to support and advise us,” said Sister Ernestine Akulu, the health centre administrator. “It became a supervisory role, training and technical support. We still needed it. Mildmay was playing a very, very big role and was needed on the ground at Luwero and other places.”

The Bishop Caesar Asili Health Centre subsequently cared for more than 400 HIV‑positive patients and continued to receive ART supplies from Mildmay. PMTCT remained a priority and a challenge. During a visit, the team met Noah, a two‑day‑old baby born to a mother who had not accessed antenatal care at Luwero and had tested HIV‑positive shortly before delivery; the risk of transmission was higher than if she had engaged earlier. “It was important that all facilities had a focus on PMTCT,” said Sister Ernestine. “As soon as pregnant women came here, they were tested. The problem was that many mums‑to‑be still did not reach clinics or hospitals—this caused frustration and often sadness. If they did come in pregnancy, there was every chance most HIV‑positive mothers would give birth to HIV‑negative children.”