Skilling Youth: A Promising Model to Expand Uganda’s Health and Social Service Workforce
Meet Edmond, Elvis, Eva, George, Aliyu and Helen; they are smart and ambitious young people dedicating their prodigious talents to improve the lives of highly vulnerable children and youth in Uganda’s East Central Region. They are Interns and Locums with the Bantwana Initiative.
For the past six years, Bantwana’s STAR-EC and TSO projects have helped Uganda’s district governments and communities expand access to urgent health, child protection, and social services for highly vulnerable children and families. Bantwana recruits, trains, and supervises Interns and Locums who are critical to the success of these programs. They provide valuable human resource capacity to overstretched clinic and district staff, ensuring that vulnerable children and their families have access to critical services. Bantwana’s Intern/Locum program also addresses Uganda’s significant youth unemployment by developing participants’ skills and starting them on a career path that enables them to give back to their communities.
Bantwana’s youth employment program works at two critical points of service delivery intersection. Interns help Community Development Officers (CDOs) respond to families referred for child protection and other services, organize follow-up visits at family homes, and facilitate monthly meetings with health and other community providers to improve service coordination. Locums are assigned to health facilities to help clinic staff improve the systems that track patients and the services they receive. Interns and Locums communicate closely with each other to ensure coordination from clinic to community. For example, if an Intern refers a patient to a health center, they document the referral and notify the Locum so that the patient will have a point of contact at the clinic. Conversely, if a patient misses an appointment or doesn’t show up to receive medication, the Locum notifies the Intern, who will often help to track down the patient in their community.
“Between the government-supported health and community development services, and the network of civil society organizations working in the region, many free or low-cost services are available for people who need them,” explains Helen, a Locum working in Luuka District. “But people either don’t know about these services, or aren’t receiving them for one reason or another.”
Bantwana facilitates monthly meetings with all the Interns and Locums to share experiences, challenges, best practices, and to brainstorm solutions together. These may include ideas for improving coordination, documentation, or addressing the mistrust and negative perception some communities hold of service providers based on previous poor service quality or negative experiences. In less than a year, the Interns and Locums have already designed and implemented strategies to overcome some of these challenges.
Edmond, a Locum, noticed that duplicate entries of the same patients in health center service registries were severely complicating the follow-up process. He transferred all of the patient data from the handwritten registries into an Excel spreadsheet in alphabetical order to quickly identify duplicate entries and streamline the data associated with each patient.
Elvis, another Locum, took on the issue of undocumented referrals. Health workers were in the habit of verbally referring patients to treatment and services without recording the referrals, which made it impossible to know what treatment and services patients had received and when. Elvis worked closely with health workers to improve consistent documentation of referrals. “When I came, the Health Center was only recording 30% or referrals, and now we are up to 60%,” he says.
Aliyu, an Intern, noticed a break-down in cooperation between police and health workers when it came to addressing domestic or sexual violence. Police need health workers to corroborate information about injuries sustained by victims in order to prosecute crimes, but health workers were often not willing to share that information. Aliyu brought local police departments and health workers together to improve communication and trust and has since seen improvement in the cooperation between the two service providers.
Intern Eva was frustrated by the unreceptive attitudes she encountered among community members when trying to link them to services. “So many people have come through these villages promising services,” she explains. “But when nothing changes, people lose trust; they don’t believe that you can help them if you don’t have material things—money, medicine, food. You have to show them you are sincere, that you really care about them, and follow up with them again and again to build back their trust and motivation to seek out these services.”
Bantwana’s Interns and Locums feel motivated by the impact they’ve had in the short amount of time they have been working. Their successes and the positive changes they have helped make in peoples’ lives encourage them to keep pressing, even when things seem bleak.
“I just love working with the community,” Eva explains. “It has helped me appreciate my community and appreciate myself. You go to these households and see the way people struggle and think: ‘What can I do to help these people through?'”
“I love working at the health facility, because I can see the changes I am helping to make,” says Helen. “There is more accountability now. The health workers—everybody—knows that if a patient tests positive for HIV and is not enrolled in care, I’m going to follow up, I’m going to find out what happened to that person, and I’m going to make sure that person gets into care.”
The Interns and Locums agree that the most important impact they have made is on the children, who now have a better chance at leading healthy, productive lives through the services they and their families have received.
“It is so important to help children,” says Elvis. “Every child has goals and ideas and, if given a good chance, they have the potential to do great things.”