Improving service access in the Mountains of the Moon.

On a pilot basis INTRAH (Program for International Training in Health University of North Carolina at Chapel Hill) and the Ministry of Health of Uganda trained 136 nurse aides from 9 districts in the western region of Uganda to provide information about the benefits of family planning during group sessions and counselling and to re-supply clients with pills and dispense condoms and foams. A follow-up study was conducted 6 months later to determine the impact on family planning acceptance. In Uganda the contraceptive prevalence rate is only about 3%. The number of nurse aides is estimated to be 8000 and they are hired locally to staff district hospitals health centers and dispensaries to carry out various tasks: setting bones stitching cuts assisting during operations providing prenatal care and delivering babies. A series of 10-day sessions were conducted in groups of 15 concerning risk factors for maternal mortality and morbidity contraceptive methods breast-feeding and contraception sexually transmitted diseases (STDs) HIV/AIDs and modes of transmission. 114 nurse aides were interviewed at follow-up by trained evaluators who used questionnaires interviews inventory lists and focus group discussions. 75% of nurse aides worked in rural areas mostly in health centers and were under 30 years of age and had completed some level of secondary education. The number of new clients increased 84% in all 9 districts which can be attributed to nurse aides. In particular new acceptors of oral contraceptives condoms and Depo-Provera rose strikingly in 34 health facilities staffed by nurse aides. In the most remote areas nurse aides were distributing an initial supply of pills and were administering Depo-Provera using their skills as immunizers. Trainers used local languages and translated nurse aide training and service guides into local languages which will be essential in increasing decentralization of service in Uganda.