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In a world where access to healthcare is a fundamental right, millions of people living in remote and underserved communities still struggle to receive the essential medical attention they need. Health Access Connect (HAC), a dynamic organization committed to improving healthcare access in remote areas, has initiated several transformative projects aimed at bridging this critical gap. In this blog post, we will delve into four of HAC’s innovative initiatives: Medicycles, Treat & Teach, Technical Assistance, and Digital Square. Let’s journey into these impactful projects that are making healthcare accessible to those who need it most.

A VHT and a Medical Workers starting their Journey to a community clinical outreach

Medicycles: Closing the distance to Healthcare

HAC’s Medicycles project is a beacon of hope for remote communities located more than 5 kilometers from the nearest health facility. These communities often face challenges in accessing government doctors, nurses, and medicines regularly. To address this issue, HAC collaborates with local Community Associations (LCAs) to organize monthly or bimonthly one-day outreach clinics. Every member of the LCA contributes 2000 Ugx (0.53 $) that will be used to help transport and facilitate the government workers to come to their communities to test and treat various medical issues ranging from Malaria, STDs, STIs, HIV, immunization, Antennal Care and many more.

This model has not only improved access to primary healthcare but has also been recognized as a recommended service delivery model in national HIV guidelines. You can explore more about the Medicycles model in HAC’s detailed Global Health Action article. https://bit.ly/hac-model.

Treat & Teach: Empowering Communities with Family Planning

Treat & Teach is another remarkable initiative by HAC aimed at improving access to family planning services in remote and underserved communities. The project identifies the gaps in family planning access, including the lack of on-the-job experience of healthcare workers, commodity stock outs, limited awareness of contraceptive methods, and the challenge of reaching distant healthcare facilities. 

To address these issues, HAC establishes outreach clinics, conducts on-the-job health worker training, manages the supply chain efficiently, generates demand through Community Health Workers (CHWs), and offers family planning services. Since its inception in 2019, Treat & Teach has not only met but exceeded Couple Years of Protection (CYP) targets, thanks to its innovative and holistic approach.

Technical Assistance: Transforming ART Services

HAC’s Technical Assistance project focuses on enhancing the convenience, outcomes, and overall health system performance for individuals receiving antiretroviral treatment (ART). Collaborating with the Africa Resource Centre (ARC), HAC has taken on the task of adapting the successful Medicycles outreach clinic model into national policy. They provide training to implementing partners on setting up outreach clinics and promoting the adoption of Community Led Drug Distribution Points (CLDDP) nationwide.

Additionally, HAC works closely with the Ministry of Health (MOH) to establish dashboards, distribute essential materials, and coordinate with partners to ensure seamless ART services delivery.

Digital Square: Improving Visibility on Supply Chain Performance in Uganda

In a groundbreaking partnership with Signalytic, HAC is committed to enhancing supply chain performance in the last mile in Uganda. This project involves equipping rural districts with appropriate hardware-software packages tailored to their limited infrastructure. HAC is ensuring better coordination and visibility in the healthcare supply chain through training of Health workers and responsible persons at the health facilities on how to track drug stocks with the S+ machines and the phones .

Moreover, on-the-job coaching, IT support, and advocacy efforts aimed at decision-makers are further strengthening the healthcare supply chain in Uganda, ultimately benefiting those in need of essential medical supplies and medications.

Through the Medicycles, Treat & Teach, and Technical Assistance projects, we are making a significant impact on primary healthcare, family planning, and ART services. Our Digital Square project to enhance supply chain performance in Uganda is yet another testament to our dedication to creating a healthier world for all. As we look to the future, we can only hope that more organizations and individuals will join hands with HAC to bridge the healthcare gap and ensure that everyone, regardless of their location, has access to quality healthcare services.

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At the center of Kitoffaali village, where access to good health is a challenge resides Nakacwa Cissy, a dedicated and empowered member of the Village Health Team (VHT). Her journey began in 2021 when she embarked on a transformative training experience with Health Access Connect (HAC) at Maria Flo Hotel in Masaka. Today, Nakacwa Cissy shares her remarkable story of growth, impact, and the confidence she gained through this journey.

Family Planning Field Officer, Shakira Kalembe interviewing Miss Cissy

Empowering Change, One Woman at a Time

As a VHT, Nakacwa Cissy’s role extends far beyond the boundaries of her village. She proudly reveals that her efforts have led to preventing of countless unwanted pregnancies among the women she serves. Armed with knowledge and skills gained from the training, she administers injectables and educates women on long-term family planning methods. These interventions not only empower women but also contribute to the overall well-being of the community.

“I am proud to be a VHT because I have saved many women from getting unwanted pregnancies,”

Nakacwa Cissy reflects with a sense of accomplishment.

Her words echo the impact that a single empowered individual can have on an entire community.

A midwife educating mothers about family planning

Nakacwa Cissy acknowledges that the training provided by HAC has been instrumental in establishing trust with her clients. Through her engagement, she has not only gained the respect of the women she serves but has also expanded her network of friends, including both men and women. This network acts as a powerful conduct for raising awareness about the importance of family planning.

“Building relationships is key. I actively engage with them to spread awareness,”

Miss Cissy shares. It’s a testament to the ripple effect that informed and empowered individuals can create.

Nakacwa Cissy candidly discusses the challenges faced by VHTs. She highlights the scarcity of long-term family planning methods as a minor hurdle, which was resolved after some time. It’s a reminder that progress is often accompanied by obstacles, but the determination to overcome them is what drives lasting change. 

Nakacwa Cissy concludes her testimonial with gratitude. She thanks the Health Access Connect team for their exceptional services, which have empowered her to make a difference in her community. She also humbly acknowledges the value of continuous learning and invites constructive feedback to aid her growth as an individual and a VHT.

In the tale of Nakacwa Cissy, we witness the power of knowledge, training, and empowerment. Through her experiences, we are reminded that the impact of a single individual can reverberate through an entire community. As she continues her journey, one thing remains clear: Nakacwa Cissy’s story is an inspiring example of the potential within us all to create positive change.

The commendable efforts of Village Health Teams (VHTs) in assisting Health Access Connect to link remote communities to healthcare services are truly noteworthy. Their sense of pride in this work makes collaborating with them even more seamless.

Miss Cissy is not alone in her dedication; we have observed several VHTs who take immense pride in serving their communities. One such example is Salongo Ssemukasa Evalisto. Residing in Bulimire village, Kakkamba parish, Kisekka sub-county, Salongo is a VHT stationed at Kiwangala Health Centre IV in Lwengo district, which falls under Bukoto South.

“I am glad because these days I am quite a different person since I treat and convey health messages to people which not only benefit the recipients but also turns me into a more reputable person than ever before.”

Mr. Ssemukasa brags

HAC Family Planning Office Miss Shakira with Mr. Ssemukasa Evalisto having a chat before setting out for outreach clinic

The efforts led by Health Access Connect (HAC) With Support from Bergstrom Foundation in Low-Density High Frequency (LDHF) on-job trainings of healthcare workers and Village Health Teams in family planning across Kalangala, Masaka, and Lwengo districts stand as a remarkable stride towards improved healthcare services and empowered communities.

By focusing on the grassroots level and ensuring consistent, comprehensive training, HAC is not only imparting knowledge but also nurturing lasting change. As these districts continue to benefit from HAC’s initiatives, the ripple effects will undoubtedly be felt in healthier families, educated communities, and ultimately, a more robust healthcare system for all. Through these ongoing endeavors, HAC sets a commendable example for organizations aiming to bring about meaningful transformations in underserved regions.

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As one of the furthest islands on Lake Victoria in Kalangala district, Nakawa Bugaba remote community is located close to 30km from its nearest health facility. The community located at the top of the hill can only be accessed either by a boat taxi that only passes by 3 times a day or motorcycle taxis, which aren’t common in the community

The Island came to be populated after farmers and fishermen migrated to it because of its fertile soils and plenty of fish. In spite of the island community’s strategic location, its residents have faced a great struggle in accessing services crucial to their day-to-day living.

The community’s 47-year-old female councilor, Nassanga Saphina, testified on their behalf.

“I came to this community in 2007 when the situation was really bad! The first challenge we had was in accessing health services. The second was in accessing water which we haven’t solved up to now. People get water from a pond which they share with animals like dogs, goats, cows, and snakes.”

Approaching Nakawa Bugaba Island by Boat

Due to these challenges, Nakawa remote community has suffered a higher burden of infectious diseases and deaths attached to their poor access to healthcare services and safe water. Two of the community members suffered helplessly at the hand of this problem, watching their family members fall sick yet unable to access any kind of medical attention. Today, they testify

““My wife fell very sick when she was pregnant. It was late in the night and we couldn’t access transport means to travel to the nearest health facility. It was one of the hardest situations I ever faced in this area regarding transport and health services. She had to endure helplessly the long distance to the lake, and then we had to wait for a boat that was going to the health center. Luckily after hours of waiting, we got on the boat and made it to the health facility. But it wasn’t easy, we really struggled. We were on the verge of life and death”

—  Fulujensio Lununye, a 40-year-old businessman in the community remembered. 

“Yes, life was really tough for us surely,”

Gloria Tushemerirwe,  a 44-year-old mother also rushed to agree with Mr. Fulujensio’s experience, as she remembered her own,

“I reached a point and I started using my own understanding to treat myself and the family. I realized they were many in this community that were doing the same. I would make one trip to the health facility and get painkillers. Whenever we were not well in the house, I would just give them medicines like coartem, metro, and other capsules. My husband fell very sick and because we couldn’t access the health facility, we just used the medicines we had in the house.”

Ms. Tushemerirwe recalls that this was their way of living until they witnessed a tragic situation when self-medication made them lose a loved one.

She says,

 “My friend was bitten by a snake while in the bush at around 11 am, we all gathered around to advise her medically on what to do, but all was in vain. Her condition instead worsened. Later, at around 5 pm, we decided to transport her to the health facility. We carried her using polythene bags tied on sticks down the hill to get on the boat. But sadly, it was too late,  she died on the way.”

This challenge in accessing health that has been suffered by everyone in Nakawa community, at least once, continued until they allowed Health Access Connect to intervene in their situation. Ms. Nassanga, the community female councilor reached her climax with this problem after witnessing a father in the community lose his 5-year-old son after struggling to find transport means to the health center. 

“I rushed to the District Health Offices the following day and pleaded with them to bring health workers to our community, I told them all about the struggles that we were facing with accessing health services. After some good convincing, they told me about Health Access Connect and the change they are making in the remote communities of Kalangala District. They gave me Ms. Costaritah’s (Program Manager) phone number, and since then our story changed” 

Arriving with health workers and health services at the community for an outreach clinic, gave us a chance to see the joy that was painted on the community member’s faces. Pregnant mothers were already waiting to receive antenatal care services, mothers were waiting to present their infants for immunizations. Men, women, and children in need of different health services were all attended to.

Health workers arriving at Nakawa Bugaba Community for an HAC outreach clinic

As a community that mainly depends on rice farming, fishing, and small-scale businesses, their output has been dramatically improved due to their improved access to healthcare. With consistent access to healthcare services at HAC monthly outreach clinics, the people rely on a system that closely monitors their health and provides them with their needed healthcare services thus keeping them energized to also focus on the other aspects of their lives e.g. economic growth.

Mr. Fulunjesio proudly grazes his goats in the field

“I have over 50 goats, I also purchase rice from farmers and sell it on the mainland. This has helped me to pay school fees for my children, and support my family’s basic needs.”

 Mr. Fulujensio proudly talks about his source of living. 

Ms. Nassanga Saphina gratefully concluded that

“ Health Access Connect has greatly helped us. We have many children who need to be for example immunized and pregnant women with no money to meet transport costs to the health facility, the people living with HIV/AIDs in our community have also been sorted out with constant refills of Antiretroviral treatment being brought to their community. We are so grateful and ask God to bless HAC with more funds.”

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“My husband told me he never wanted to see me using family planning, he hated it. The people in my neighborhood also discouraged me from ever using it. They told me it doesn’t work, and that I could still conceive even when practicing it. All these words frightened me and I never used family planning,”

Ms. Mariam Asiimwe, a 30-year-old mother of 5 remembered how the community shaped her attitude towards family planning in the past.

With a number of myths, misconceptions, superstitions, and stigmatization attached to it, Ms. Mariam had no option but to turn a deaf ear to all the advice she got from those that supported family planning. Nonetheless, even though she wanted to practice family planning, there was no way she could access it in her community.  

The mother of 5 hails from a small hard-to-reach marginalized community called Mikunyu village. It’s at least 13km away from its nearest health facility, Kabulega Health Center III. One has to incur a transport cost of 10,000 Uganda shillings(US$2) to reach the health center, yet Ms. Mariam lives on less than $1 a day. Squeezed between these constraints, she had given up on ever having access to family planning services. At least not until she got to know about Health Access Connect’s activities in the neighboring community, Kitunga.

Ms. Mariam Asiimwe speaking to HAC’s Family Planning Field Officer, Shakira Kalembe

“One day, while in the garden, I heard an announcement from the public speaker that every month, an organization called Health Access Connect brings family planning outreach clinics to Kitunga. I was so reluctant about visiting the outreach clinic. Then, I also heard a group of ladies talk about how family planning has helped them have control over their reproductive health and they love it. I was convinced to visit the outreach clinic.”

— Ms. Mariam retorted.

When she got back home that day, Mariam told her husband all about what the ladies said and then convinced him to visit the family planning outreach clinic with her. At the outreach clinic, Ms. Mariam and her husband presented all that they heard about family planning, and the health worker counseled them about all information concerning family planning and left the decision in their hands.

“The health workers educated us about many aspects concerning family planning before letting us have a final decision on the method that we would want to practice. They made sure that our decision was kept confidential between us and the health worker,”

In 2019, Health Access Connect, funded by Bergstrom Foundation, began activities in remote communities within Masaka and Kalangala districts. Since then, the organization has trained over 80 community health workers on how to offer family planning counseling, offer short-term methods of family planning, and refer clients for long-term and permanent methods of family planning. HAC has also conducted many family planning health education sessions in the community, with the intention to break the misconceptions and myths that were previously attached to practicing family planning. This has over time changed people’s perspectives, and they have continuously embraced the family planning outreach clinics in their community. So far, over 17000 patients have been reached with family planning.

Mothers listen to a family planning health education session before receiving family planning services at the outreach. 

Today, Ms. Mariam and her husband’s attitude towards family planning means success to us.

“Since I started using family planning, I have never been disappointed. I even see that the rate of unwanted pregnancies in our community has reduced.” 

She says

Ms. Mariam only has to walk one kilometer to access the family planning services that she is in need of. she was also happy to tell us how her husband is actually the one who always reminds her to visit the family planning outreach clinic when it is happening. 

“I am so grateful for the services given out by Health Access Connect. These services are really so meaningful to us because many times a person may fail to access health services due to the distance, transport costs, and the time it may take to be attended to at the health center, because of the long line. Even the education we have got today is wonderful! We have added much knowledge. Indeed, there are many benefits we have got from the clinics.”

This is what Ms. Mariam had to say when asked what she would tell the donors that have chosen to fund the work HAC is doing in her community. 

Just like Ms. Mariam’s story, we hope to see a change in the reproductive health of so many other mothers, men, and women of reproductive health. We want to fulfill their unmet need for family planning services.

Health Access Connect is already linking healthcare services to over 70 remote communities located in the districts of Kalangala, Masaka, Lwengo, Rakai, Lyantonde, Sembabule, Gomba, Mukono, Buikwe, Bugiri and Iganga . Within a span of 7 years, so far over 50,000 patient services have been provided within these communities. Although, there are still thousands of difficult-to-reach marginalized communities within Uganda and around the world that Health Access Connect hopes to link with Family Planning services, as well as other primary healthcare services. We need your help to fulfill this hope!

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Ms. Nankumba Lillian is a 28-year- old mother to 5 children and she lives in Kyampengere community located in Uganda. Before Health Access Connect (HAC) started work in her community, she spent years wondering if there would ever be a simpler alternative to access the free safe motherhood services offered at the government health facility, but all was in vain! The only other alternative she resorted to was getting herbs from the community’s traditional birth attendants (TBAs), which was such a risk to her life.

Kyampengere community is one of the furthest remote communities in Lwengo district located in Uganda. Its nearest health facility, Kakoma Health Center III is at least 30km away. Since the men and women mainly depend on subsistence farming as a source of income, they live on average less than $1 a day. The community requires both motorcycle taxis and vehicles to reach far distances, charging them transport costs of up to 40,000 Uganda shillings (US$11) for a to and fro journey. 

Due to these high costs, Ms. Nankumba and her fellow pregnant mothers within the community had to suffer and endure the challenge for years, especially during her 4 pregnancies.

“We had to use 40,000 Uganda shillings (US$11) for the journey to Kakoma health facility. When we failed to raise that money, I and my fellow pregnant mothers at that time could resort to getting herbs from the traditional birth attendants here but we could suffer a lot,”

— Ms. Nankumba remembered

The 28-year-old’s eventual end with Traditional birth attendants was when she lost her close friend and their baby during childbirth at the hands of a traditional birth attendant. Ms. Nankuma sadly narrated.

“The birth attendant could assure us that we are going to deliver and that she will help us during delivery. However, when the time for my friend to deliver came, the TBA was unable to help her. My friend lost a lot of blood. We realized late and decided to rush her to Kakoma health facility but it was too late, she and the baby didn’t make it there, they died!”

The mother of 5 said.

Haunted with this fear of losing her own life and her babies as well, Ms. Nankumba had given up on ever receiving the safe motherhood and infant services that she deeply desired to utilize. This was not until she heard an announcement from the Community radio locally known as  ‘bizindaalo’, that there were some visitors from Health Access Connect that were to conduct a community meeting. She was curious to know what the meeting was all about, so she attended it

“They told us that they would like to help us have health services brought here to our community. Those health services include antenatal care, immunizations, malaria treatment, and so many others. They also told us that in case we were going to receive medical treatment, we could each contribute 2000 Uganda shillings (US$55 cents), so that we can cover the transport costs of the health workers that have come to attend to us,”

Some of the community members gather around for a community meeting conducted by HAC. The Field Officer speaks to the people about the work HAC does in remote communities

With a smile on her face, the mother continued,

““So much relief came to me because I thought about the 40,000 Uganda shillings (US$11) that we were initially spending on accessing these services, and the 2000 Uganda shillings (55 cents) that we were now to contribute in supporting the transportation of the health workers coming to an outreach clinic in our community. My heart jumped for joy!”

The 28 years older mother, alongside the rest of the community, embraced HAC’s model to link them to healthcare services.  Since then, they have never looked back, accessing healthcare became so much easier.

In July 2020, Health Access Connect established a monthly outreach clinic in Kyampengere remote community. Here, close to 100 community members came to seek life-saving health services. HAC made sure to empower and give responsibility to the community health workers of Kyampengere community to coordinate the HAC outreach clinics. 

On a monthly basis, medical supplies and health care workers are brought directly to the community, eliminating the need to walk 30km or more for basic health services. 

Ms. Nankumba, who had not yet closed the chapter of having more children, reflects on HAC’s impact on her community with gratitude,

“I just delivered my 5th child and they gave me all the required treatment I needed. They also gave me a mosquito net to protect me from the malaria parasite, and they still care for me and my child who is now three weeks old. These days, I take little time to get the health services that I need from the outreach clinic, then I go back home to my business”. In every outreach clinic, HAC staff plan and work to ensure everyone who comes to the clinic’s needs are taken care of.”.

Pregnant chats with the health worker before she receives medical attention.

Through consistently addressing the medical needs of the people of Kyempewo remote community, HAC’s beneficiaries have time and energy to pursue their passions and businesses and rest assured of a healthier life.

“Knowing the struggle that Ms. Nankumba and her friends went through during pregnancy, we acknowledged the vulnerability of pregnant and breastfeeding mothers in these remote communities. So we ensure that they are well catered for to have continuous access to safe motherhood and infant health services.” Costaritah Nalukwago, HAC’s Program Manager mentioned

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Written by Mercy Ahukana, Communications & Development Officer, Health Access Connect.

We drove into the compound of Buwunga Health Center III at about 10 am, all thrilled about how the day was going to turn out. The weather was also in full agreement with us! As we prepared to start the walk to Tekera remote community, I had an opportunity to engage with one of the staff members on what they think about remote residents that have to walk a 7.2km journey to access health services.

“Walking a 7.2km journey is no joke even though it looks near when traveling in a car. For someone to actually walk this journey when they are not well, takes so much strength and effort, and I respect men and women in remote communities for that. Today I also want to taste what it means to walk a 7.2km journey to a health facility. Otherwise, I am glad to be part of a team that changes this story for remote communities”

— Patricia Tumuheki, HAC’s Finance & Administration officer commented.

At exactly 10:30 am, we set off from Buwunga Health Center III, as a team, to walk the journey to Tekera remote community. The road to the community is extremely dusty and busy with loaded trucks speeding to and fro on the road. This made the journey a lot more tiring since we had to keep crossing the road from side to side just to avoid the dust hovering all over us.

HAC staff pose for a photo at Buwunga Health Center III before they start the 7.2km journey to Tekera remote community

An hour later, It seemed like the journey had not yet even started, we had a long distance ahead of us to Tekera community. We took a turn to a less busy road and started drawing closer to Tekera remote community. Since the population is widely spread all over, our team members, Mark Kayongo and Patricia Tumuheki held out the megaphones and started mobilizing the surrounding communities to visit the outreach clinic that was taking place in Tekera community. As we kept on walking, we grabbed the attention of some of the mothers, shopkeepers, and farmers. They paid close attention as Patricia and Mark provided more information about the outreach clinic.

“Health workers from Buwunga Health Center III have arrived in Tekera community and the outreach clinic has already began. If you are in need of medical attention come and they give you treatment. They are providing antiretroviral services, antenatal care, postnatal care, immunization, family planning, malaria treatment and so many other primary healthcare services. Please visit the clinic.”

— Patricia and Mark kept on announcing in intervals are they walked the journey.

Some of the community members that listened approached and told us about their health conditions wondering if they were able to receive treatment at the outreach clinic. The answer was yes! I recall one of the community members, in particular, asking us,

“ My baby is suffering from a skin infection that has been giving her alot of discomfort for some time now. I am worried about her. If I bring her to the outreach clinic, will she receive treatment?”

Exactly two hours later, feeling depleted in strength, we finally arrived at Tekera remote community. About 50 community members were already gathered under a tent at the outreach clinic. When they saw us, their faces were lit up with smiles giving us a warm welcome to their peaceful community. The community mobilizer that had earlier mobilized the members to attend the outreach clinic, sat under the tent registering all patients that had come to seek medical attention.

“When a patient comes to the outreach clinic, they first register there name with me, then I give them a card with a number. The health workers follow these card numbers in attending to patients in an orderly manner. This is to ensure that everyone can get treatment according to the time they came, apart from emergency cases.”

— The community mobilizer explained.

There were three health workers at the outreach. One health worker was carrying out blood tests for the patients, another health worker diagnosing patients, while the other was prescribing medication to the patients. Some of our team members who are trained in public health decided to support the health workers in diagnosing and prescribing medication to the community members.  

The rest of the team, including me, engaged the other community members on how their experience has been with these outreach clinics. We also conducted a health education session for the community members. The people listened attentively and even asked questions where they needed clarifications.

“Musawo (Doctor), one of the sicknesses we really struggle with here (Tekera community) is flue and cough. It spreads around so fast and it is very deadly among the elderly and the young, yet we don’t have a near health facility. These outreach clinics have really helped us. The health workers come and work on us and it really helps us to get better. I hope they continue bringing these outreach clinics to us”

— Muwanga Tadeo, Father, Tekera remote community

Patients being attended to by the health workers, supported by the HAC Staff at the outreach clinic in Tekera remote community.

By 5 pm, all the patients that visited the outreach clinic were all attended to. It was a true meaning of what closing the distance means to us at Health Access Connect. Like we did for Tekera remote community, we also want to close the distance for the thousands of remote communities in Uganda and around the world. They deserve to easily access healthcare services. Although, we are limited in doing this without your help. This month, as we host our walkathon fundraiser to raise funds that can help us expand our work to additional remote communities, we request your support.  

In Uganda, as it is in most developing countries around the world: fertility, maternal mortality, and teenage pregnancy rates remain among the highest globally. Approximately 30.1% of Women in Uganda’s rural areas have reported high levels of the unmet need to use contraception[1], teenage pregnancies stand at 25% [2] and the modern contraceptive prevalence rate is lower than 20% [3]. HAC has identified that the drivers of this unmet need are the limited access to health facilities, due to long-distance and unaffordable transport costs, few skilled family planning health workers, and limited medicine and supplies at the health facility. 

This challenge leaves women, especially adolescents and young adults at risk of unplanned births, unsafe abortions, maternal injury, and death. As Health Access Connect (HAC), we don’t want any of these things to happen. In fact, we want to empower Ugandans living in remote areas to understand and control their fertility. To ensure this happens, our team is focused on doing three essential things: 1) ensuring there is a sustainable last-mile family planning delivery system in remote communities, 2) ensuring that government healthcare workers, as well as community health workers, are efficiently trained and experienced on how to administer family planning, and finally, 3) ensuring that there is a continuous supply chain of family planning commodities in remote villages. 

We believe as long as these essentials are achieved, they will be a constant solution to the unmet need for family planning in remote communities, as well as a path to avoiding risks like unplanned pregnancies, unsafe abortions, maternal injury, and death. Currently, HAC is doing this work in the districts of Masaka and Kalangala, and we hope to expand that work in the future. 

At HAC, we have a tried and tested strategic approach to solving the problem of limited access to and utilization of family planning in remote communities. With the support of Erik E. & Edith H. Bergstrom Foundation, we help to bring about lasting and impactful changes in remote communities by providing on-job training to both government health workers and community health workers on how to administer family planning, with a consistent supply chain.

Our efforts in the districts we are currently operating in have been rewarding for the past two years. Nonetheless, the vision is to expand our work to reach Ugandans in remote areas. This is because millions of men and women all over Uganda’s remote areas still continue to face challenges with their reproductive health, simply because they can’t access family planning services.

Our Approach

Our team works at giving vulnerable men and women in remote areas the opportunity to understand and control their fertility. This involves partnering with government health facilities and Village Health Teams (VHTs) to deliver family planning services to those that need it, as well as create awareness of the importance of family planning.

Our community-based model has helped establish sustainable solutions that lay the foundation for men and women in remote areas to have control over their reproductive health, as they please.

Here are our focus areas: 

1. Grassroot sustainable outreach clinics

In all HAC’s endeavors to deliver family planning services, sustainability is key. With this, HAC empowers the communities to take lead in working hand in hand with health facilities that can enlighten them about family planning and deliver to them all methods of family planning. To ensure that patients/clients are being given quality care, HAC provides examination beds and curtains for privacy during the outreach clinics.

2. Low-density high-frequency training of health workers

HAC has a set standard of operating procedures for health workers that administer family planning to clients in remote communities. Therefore, in order to ensure that health workers meet these standards, HAC conducts training workshops that involve both theory and practical applications. With these workshops, health workers are able to efficiently serve patients in need.

3. Demand generation and service provision by Village Health Teams (VHTs)

VHTs are local volunteers in these remote communities who are equipped and trained to provide emergency front-line care and the most essential life-saving interventions. HAC trains them in offering family planning counseling and administering short-term family methods like pills, condoms, and injectables. HAC keeps in touch with them to make sure they practicing what they learn from the training. 

4. Supplementing Commodities

In order to prevent out-of-stock scenarios, HAC continuously procures and distributes family planning commodities as buffer stocks. 

5. Improving Commodity Monitoring

Since one of HAC’s key essentials is to ensure continuity in the supply chain of family planning commodities, HAC trains health facility stock managers to use a logistics management information system (eLMIS) to report on FP commodities. Furthermore, using a six-month moving average model, HAC sets up a system to monitor data and forecast family planning commodity demand

Impact

Here are some of the family planning service numbers that we have achieved:

• 8,399 patient services provided
• 9397 Couple-Years Protection dispersed
• 476 established family planning outreach clinics.

With a sustainable family planning delivery system, Ugandans in remote areas can have control over their reproductive health, giving them the opportunity to plan for their lives and families how they please

“If tomorrow Health Access Connect was not in the picture anymore, would remote communities continue to have health services brought nearer to them at outreach clinics? ,” Costaritah Nalukwago, Program Manager of HAC, asked partners of HAC during a stakeholders’ meeting in Masaka district.

In a bid to address the problem of limited access to and utilization of health services in Uganda, various successful last-mile health delivery solutions have been developed. However, these solutions have over time been constrained by time-bound, vertical project grants that support only a limited set of health interventions and create aid dependency. This basically implies that once the funding ends, the aided communities get back to struggling their way to accessing free health services.

Isaac Sserwada, the senior medical clinic officer of Mugoye Health Center III, one of HAC’s project stakeholders, has over the years witnessed how the dependency mindset in Uganda and other parts of Africa has limited its growth and development. According to him, he is 100% in support of a strategy that brings an essence of sustainability to Africa.

In Health Access Connect’s endeavors to address the problem remote communities face in accessing health services, sustainability has always been a core value from day one. HAC’s Co-founder and Program Director, Carolyn Ariokot, summarizes how the sustainability and independence aspect of HAC’s solution works:

The community members own the intervention. HAC educates the community and links them directly to the health workers. The community members make small contributions (10% of what would cost each one of them to reach the nearest health centre) and use that to facilitate health workers’ travel logistics. HAC works towards empowering the community members to mobilize each other and interact with the health workers.

One may raise a valid question that, why should vulnerable communities have to pay $55 cents (2000 Uganda shillings) for health services at outreach clinics, yet these services are supposed to be for free? Health Access Connect looks at it this way: the $55 cents are only meant to facilitate the health workers that are traveling the journey to come to patients in remote communities. The contribution of $55 cents by each patient/client to access health services at the outreach clinics is a lot more affordable and cheaper compared to what would have been spent by an individual traveling the long journey to access treatment. Their transport costs could go up to 5 US dollars (20,000 Uganda shillings)

In Kalangala District the Ugandan Ministry of Health has established 15 health facilities spread over its 84 islands.  Nonetheless, the district faces great health challenges. For example, there is a higher HIV prevalence rate (18%, compared to 6.5% nationally) and a rate of teenage pregnancies (48.3%, compared to the national rate of 24.8%).

Antiretroviral therapy, family planning, antenatal care, immunizations, and other primary healthcare services are being poorly utilized in Kalangala simply due to the long geographical distance and unaffordable transportation costs that discourage vulnerable patients from traveling to the nearest health facility.

We had a chance to interact with Vincent Toweesa, one of the community beneficiaries of HAC’s work in Kalangala District. His memory of how challenging the situation was for him, and his fellow village members saddened our hearts, “ The transport costs were too high, yet we had very little money. We could use a motorcycle to get to the docking site, then get on the ferry (if at all you were able to find it). Once the ferry docked, we had to board a taxi to the health center. This really discouraged us from attaining professional medical treatment,” he remembered

This challenge that Vincent and his village mates faced, is still faced by millions of vulnerable patients in Uganda and all over the world, forcing them to suffer at the hand of preventable illnesses and deaths. The communities do not need Health Access Connect to solve this problem, they themselves are able to take responsibility to solve it. They just need to be empowered and that is what we are here to do!

Through our last-mile differentiated service delivery project titled ‘Medicycles’, which involves setting up a sustainable, community-led way for government health workers and their medicines to reach remote villages, we have empowered over 50 remote communities that have received over 40,000 patient services over the years, at monthly outreach clinics. We are seeing an improvement in their utilization of healthcare. HAC has instilled into these communities the ability to independently lead in bringing public health workers and health services to their communities. They do not need us to access these health services, they are able to take responsibility for their access to healthcare.

Even Towesa Vincent can witness:

Accessing health services is a lot better. We have benefited a lot from the Medicycles’ project model that has given us a solution on how we can bring health workers and services closer to us. A person can only use ten minutes of their time in accessing health services and then go back to their own businesses.

Isaac Sserwada is excited about how HAC’s work is breaking the dependency cycle in remote communities. “What makes me happy is that Health Access Connect makes the community own the outreach clinics. Even if, one day HAC gets out of the picture, we rest assured that the community will take it upon itself to sustain the outreach clinics.”

“This collaboration with the Ugandan Ministry of Health and the Africa Resource Center (ARC) could impact the lives of over one million people in remote communities over the next three to five years! This is what we have been dreaming of since we started in 2014.” Kevin Gibbons, Executive Director and Co-founder of Health Access Connect (HAC) commented.

People must have access to healthcare. The stakes are high. A study taken in 2018 showed that an estimated 1.4 million people are living with HIV, and an estimated 23,000 Ugandans died of AIDS-related illnesses. Furthermore, as of 2018, around 27% of adults living with HIV and 33% of children living with HIV were still not on treatment. Persistent disparities remain around who is accessing treatment.

In 2014, Kevin Gibbons and Carolyne Ariokot, co-founders of HAC, witnessed these disparities in the fishing villages on the shores of Lake Victoria. People living in remote areas had and still have difficulty accessing life-sustaining health services, such as HIV prevention, antiretroviral treatment, maternal health, vaccinations, and other services mainly due to the long distances and transport costs required to reach the nearest health facility.

 “We identified a simple problem: people living with HIV in these remote villages were dying because of their failure to access antiretroviral treatment. I had the opportunity to interview people in those villages, and I remember them pointing out the homes of their neighbours who passed away because of the failure to access these health services,” said Kevin Gibbons. 

 Peter (not real name), a fisherman from Lwabalega, a fishing village on Lake Victoria, also confirmed how difficult the access to antiretroviral treatment was. He said, “It was bad. Here at Lwabalega, we had difficulty getting healthcare and medications because of lack of money for transport. When I got infected, I thought that I was going to die! People were hiding their HIV status to avoid stigma.” 

It is for this reason that the initial need for Health Access Connect came about. HAC came up with a service delivery model called “Medicycles”  that simply involves organizing remote communities to set up a way to bring government healthcare workers to deliver health services to their communities. Over the years, Medicycles has helped to expand sustainable access to life-sustaining health services in remote areas.

This year,  Health Access Connect has been given an opportunity to expand the Medicycles community-led outreach clinic model by incorporating it into the national health guidelines and teaching other organizations how to organize communities to make outreach clinics possible. The program is targeting patients all over Uganda living in communities that are greater than 5km from the nearest health facility. HAC, in partnership with the Ugandan Ministry of Health and Africa Resource Centre, has already begun, and this collaboration could lead to over one million people in remote areas all over Uganda accessing health services near their homes in the next 3-5 years. 

“Through our Medicycles program, we have so far offered HIV testing and counseling to 4,878 patients of whom 107 tested HIV positive and 117 were linked to regular antiretroviral treatment. We are currently teaching different organizations how to implement the Medicycles outreach clinics,” says Bridget Nanyonjo, HAC Monitoring and Evaluation Officer.

Today, like the other patients living with HIV in remote communities, hope and gratitude are filled in Peter’s words of expression towards what HAC has done in his community. He says,  “Now, those who were hiding their HIV status are experiencing reduced stigma, and take their drugs. When they see others getting tested, talking with health workers and taking ART drugs, they also feel less fear and do the same. The doctor told me that when you take your tablets you can even live 50 more years if you follow the instructions of the health workers. That gives people the future.”

Another Medicycles beneficiary says, “We thank Health Access Connect for helping us a lot. We pray for HAC to stay long in service to this village. Thank you very much.”