The National Expansion Program (NEP) was designed to
increase access and utilization of pediatric HIV/AIDS services in Uganda. BIPAI
Uganda, with support from PEPFAR supports upcountry Ministry of Health
facilities to integrate pediatric HIV/AIDS care and treatment services into
existing health systems. Emphasis is put on rural, underserved facilities in
areas with a high prevalence of HIV infection.
Sites are first assessed for basic competences to identify
gaps in service delivery. Priorities are set and action plans drawn with health
facility and district staff. These plans serve as the baseline against which
future performance is measured. Basing on the findings, health workers are then
trained through didactic sessions, mentorship and supervision to build their knowledge,
skills and capacity.
Available data indicates a remarkable improvement in the
number of children and adults enrolled and active in care since the inception
of the program. In fact, access to standard HIV care increased three-fold after
initiation of the program.
Taking pediatric HIV/AIDS care beyond Kampala
Amidst the successes of the NEP, challenges still exist.
Patients lost to follow-up are perhaps still one of the biggest and most
difficult challenges. Many clients once diagnosed do not return to the health
centre or will return only when too sick to stay away. This often greatly
compromises the success of antiretroviral therapy.
Weak planning and service delivery systems in some
facilities compromises service quality. In many instances, health workers are
unmotivated and disinterested resulting in poor service delivery. Inadequate
planning has at times resulted in drug stock outs in pharmacies. Inadequate
resources, especially human resources, results in work overload and
task-shifting when NEP plans are implemented.
Perhaps the greatest limitation has been poor laboratory coverage across the country,
especially for early infant diagnosis of HIV. Most upcountry facilities must deliver
samples to testing labs hundreds of kilometers away, resulting in caregivers
waiting months for test results. This contributes to low infant enrollment.