Promoting unity of purpose in district health service delivery in Uganda through partnerships, trust building and evidence-based decision-making.
BACKGROUND
The Uganda Program for Human and Holistic Development (UPHOLD), a USAID-funded project which supports health services in 34 Ugandan districts, was conceived at a time when promising interventions could not be expanded due to fragmented systems. This paper focuses on how the program addressed fragmentation to improve service delivery in the health sector.


METHODS
UPHOLD achieved results by utilizing grants and technical support to strengthen capacity in a decentralized setting to foster institutional behavior change, promote strengthened partnerships among stakeholders in health, and produce increased transparency and accountability. In addition, the Lot Quality Assurance Sampling (LQAS) survey methodology was institutionalized to promote a culture of evidence-based decision-making at the district level.


RESULTS
Evidence-based decision-making and partnership-oriented implementation led to programmatic results and institutional behavior change in districts through synergetic relationships between local governments and Civil Society Organizations. The use of Insecticide Treated Nets increased from 11.2% in 2004 to 17.2% in 2005, clients utilizing HIV/AIDS counselling and testing services increased from 6,205 in 2004 to 85 947 in 2005 and using Lot Quality Assurance Sampling methodology has begun to positively influence district and national staff mind sets leading to more evidence-based planning and decision-making.


CONCLUSIONS
The pillars of 'evidence-based decision-making' and 'partnerships', together with approaches which strengthen existing synergies, produced more results, faster. Programs designed to work with fragmented settings should consider using the same pillars and blocks to ultimately make a difference in the lives of program beneficiaries.
Orobaton
Nosa
N
The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland. nosaorobaton@yahoo.com
Nsabagasani
Xavier
X
Ekochu
Elizabeth
E
Oki
Judith
J
Kironde
Samson
S
Lippeveld
Theo
T
D003153:Community Health Services / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003695:Delivery of Health Care / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D015658:HIV Infections / Q000517:prevention & control; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D008288:Malaria / Q000517:prevention & control; D017146:Models, Organizational; D009032:Mosquito Control / Q000458:organization & administration; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D011785:Quality Assurance, Health Care; D012494:Sampling Studies; D035502:Trust; D014454:Uganda