Uganda at Work

We spent a night in the bustling capital of Kampala before being picked up to spend a week in Ishaka, a rural area about a six hour drive west and only about 100 kilometers from the Congo border. Thanks (again) to Jennifer Stockert and Minnesota-based HealthPartners, we would spend the week working here with Uganda Health Cooperative (UHC), HealthPartners' local NGO affiliate.

Wow. What an amazing team. Led by Dr. Owembabazi Ndyanabo Wilberforce, UHC works to get community and village members enrolled in their prepaid health plan and faces many of the same health care questions that we face in the states, for example, "Why should I keep paying my 5,000 shillings (equivalent to US $2.50) every three months if I'm not sick? Isn't that money just going to pay for someone else?"

Never mind that a single incident of malaria could kill a child or bankrupt an entire family, but it is difficult to discuss the benefits of pre-payment and preventative health care when basic needs - food, shelter, clothing - are a constant concern for many within the rural areas of Uganda. In addition, the caregivers that are available are typically used to fee-for-service, curative care, so have less incentive to go into the communities and help prevent potentially more urgent treatment and care down the road (thereby reducing their revenue stream). Sound familiar?

To gain members, UHC mobilizes Village Health Teams (VHTs) and also works to identify Income Generating Activities (IGAs) for communities to help them pay for their health membership. The easier it is for community members to earn money and join and stay in the health plan, the easier it is to keep them healthy and keep premiums low. So while it's not rocket science, it's obviously much easier said than done since we still haven't figured it out in the states.

The UCH staff have all the knowledge and enthusiasm in place and their drive to bring members into the health schemes and help prevent malaria (rampant and a major issue in Uganda) and other communicable diseases is an important and ambitious one. I learn quickly that I'm a guide, a consultant, someone with a fresh perspective to an ongoing problem. In no way am I a teacher. To use a cringe-worthy workplace cliche, I'm simply there to sharpen the tools that are already in the team's toolkit.

Over the course of two intensive days (after a couple of days of orientation and a tour of one of the local clinics), we covered a number of areas. And while we might not have used such corporate speak, we broadly talked through stakeholder management, data collection, feedback and reporting mechanisms, communications messaging architecture, conducting difficult conversations, common communications tactics, and creating emotional and intellectual connections with your message.

I was also able to spend a full day with the local UCH Board of Directors covering similar topics (mainly fleshing out a plan of attack for identifying sustainable IGAs) and offered the team and the board ongoing consultative services which I very much hope they will take me up on.

Before we left, I was already seeing project plans being changed and updated - and being made more specific and concrete - so I hope it helped. For me, the experience was rewarding and frustrating at the same time. They are doing such great work with so little - and the people they are trying to help have even less - but there is so much optimism I know they will continue to progress and achieve improved health within the country.

We have so much more in the states, it would be refreshing to see things moving in the the right direction more quickly back at home (although we know that Kaiser Permanente is leading that charge and proving what can be done with thoughtful, integrated care delivery).

Courtney, in the meantime, spent some time consulting at a hospital and children's program in the area and was touched by the openness, wisdom, and kindness of the doctors, counselors, patients and students displayed despite the immense daily challenges they face.