Improving quality of HIV care in a staff limited rural health center in Namutumba District Eastern Uganda.



In April 2010 Bulange Health Center III stated having an HIV clinic which was being managed by guest clinicians form Nsinze Health Center IV. Two or one clinician would come at the facility and issue colorinoxagole and ARVs to HIV positive patients ounce every month reports Sanyu Esereda an HIV expert patient. These clinicians had a lot of work to attend to in both Nsinze and Bulange

There was long waiting time,  delay in  initiating patients on ARVs improper records and failure to link the lab and the clinic CD4 results would get lost from the lab.  When I was  posted at Bulange I realized I had a mountain to climb as on clinic days I needed  to attend to clients in the HIV clinic and clients is the HIV and OPD patients as the guest clinicians stopped coming. Bides the above we were only seven staffs  with a wide range of activities to do only two would participate in the clinic in October to December no patient was initiated on ARVs.



 ·      I trained expert patients and nursing assistants to fill in HIV art cards.·      

Introduced two clinic days in a month the first and third Friday of the month


Assigned expert patients to park columoxazole in delivery bags for dispensing

Dividing patients into three categories ie,  PMTCT group, HIV-co-infected with TB group, and the general HIV patients.

PMTCT patients are seen by  the Midwife, HIV-co-infected with TB group are seen by a TB coordinator  and other patients are seen by the clinical officer. However, the PMTCT and TB coordinator consult the clinical officer  in case need arises.

I appointed an experts patient  to collect CD4 results from the lab and put them in the patients files. The experts patients were requested to work as adherence officers and also to form a support group.

On site training for staffs on how to issue ARVs was also done.



Increase in number of staffs participating in  the ART clinic.

Reduced patient’s waiting time

Increased number of clients self referring them selves into the clinic

Increased the number of clients in family planning

Decreased stigma among HIV patients.

It has made it easy for patients to be initiated on ARVs, especially the Nevirapine containing combination which requires an individual to start on Nevirapine once daily for two weeks to check on any reaction as they can easily be reviewed after two weeks as opposed to the one months duration  IN January to march 80% of patients eligible for HAART WERE INITIATED.

Star EC an NGO had to appoint two staffs (mentor mothers) to help in PMTCT care and follow up

Increase in utilization of family planning services

HIV patients have doubled from 72 in December  to 148 in April.

The DHO’s office added us three more staff this year to continue improving on our performance.

Increased number of VCT(voluntary counseling and testing) during ART clinic days. Each expert patient comes with about 5 people for VCT.



Well coordinated systems can reduce on work load and time wasting. People need to own the program for it to be successful. The expert patients feel that they are part of the Health Care system and work for it very hard.


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