Benon Kwesiga MBChB (MUST), MPH (Mak)

Benon Kwesiga,

MBChB (MUST), MPH (Mak),
+256773184371/+256701184371
benon.kwesiga@musph.ac.ug, benonkwesiga@gmail.com

Host Mentor

Dr. Eddie Mukooyo
Asst-Commissioner Division of Health Information

Carol Kyozira
Division Health Information

Academic Mentor

Dr. Nazarus Mbona Tumwesigye, Associate Professor
Makerere University School of Public Health

ABOUT THE FELLOW

Benon Kwesiga holds a Master’s Degree in Public Health (MPH) from Makerere University and a Bachelor’s Degree in Medicine and Surgery (MBChB) of Mbarara University of Science and Technology.

After his academic studies, Benon worked as a Clinician in a Government hospital and later as a Regional Team lead/Monitoring and Evaluation Focal Person in the Uganda Ministry of Health (MoH) – Western Region Performance Monitoring Team. Upon joining PHFP-FETin January 2015, Benon was attached to MoH Division of Health Information (DHI), a one-stop centre of excellence mandated with collection, analysis, interpretation and dissemination of the Health Management Information System (HMIS) data.

DHI facilitates easy access to functional, timely and complete health-related information to enable public health action through performance based decision making at all levels of the health sector. While at DHI, Benon received comprehensive training in the District Health Information System version 2 (DHIS2), a web-based database of Uganda’s HMIS data.

Since that training, Benon has conducted data extraction, cleaning, analysis and interpretation of weekly epidemiological surveillance data of diseases prioritised for Integrated Disease Surveillance and Response (IDSR) in Uganda to help in outbreak detection among other uses. Benon led 2 outbreak investigations and was involved in another 5 during this time. He analysed eMTCT surveillance data and conducted a planned epidemiological study on Village Health Team (VHT) member’s adherence to reporting requirements in IDSR.

He wrote 3 articles in the Uganda National Institute of Public Health (UNIPH) quarterly epibulletin and wrote a newspaper article. Benon also presented his work at both National and international conferences and has several manuscripts in the pipeline for publication.

Fellow’s achievements at host site

Comprehensive training in DHIS2 and training of District level health workers on the same.
Weekly analysis of epidemiological data of diseases prioritised for Integrated Disease Surveillance and Response (IDSR) in Uganda.
Participation in concept development of the balanced scorecard approach in MoH and its pilot activities.
Participation in IDSR trainings.
Participation in the compilation of the Annual Health Sector Performance Reports (2015/16)

Program-specific achievements (key deliverables)

Descriptive analysis of Uganda’s eMTCT surveillance data in DHIS2 between 2012 and 2015.
Outbreaks investigations: Led 2 and participated in 5.
Wrote 3 articles in MoH UNIPH quarterly Epibulletin
Wrote a newspaper article in Uganda New Vision
Two presentations at national conferences and 1 at an international conference.
Manuscript undergoing review in a peer reviewed journal
Conducted a planned study: Village Health Team functionality and adherence to reporting requirements in IDSR, Kasese, Uganda

Summary of Planned study:

Title: Village Health Team functionality and adherence to reporting requirements in Integrated Disease Surveillance and Response, Kasese, Uganda

Background: Uganda and particularly Kasese District has a high number and frequency of disease outbreaks whose detection and reporting at community level is usually absent or delayed. Most outbreaks in Kasese are detected at health facility level although the earliest point of detection should be at community level, an indicator of a poorly functioning community surveillance system.

According to the Community Based Disease/ Event Surveillance system in Uganda, Community Health Workers (CHWs), commonly referred to as Village Health Team members (VHTs), are expected to play a key role in Community Based Surveillance so as to enable early detection and response to priority diseases/events at community level to the nearest health facility.

This study aimed to assess CHW functionality and adherence to Community Based Disease/ Event Surveillance (CBS) guidelines as well as factors associated with it in Kasese to identify ways of enabling CHWs to improve CBS.

Methods: This mixed methods cross-sectional study was carried out among CHWs and key health officials in Kasese District. Using multistage randomized cluster sampling a total of 203 CHWs were selected and interviewed. Proportions of CHW functionality and adherence to CBS guidelines were calculated. Association between CHWs adherence to CBS guidelines and several factors derived from existing evidence was assessed.

Results: The mean age of the CHWs was 40 years (range: 24-70) with equal sex distribution. Only 1/3 (65%) had studied beyond secondary school. Almost all (98.5%) were currently functional while 94% owned a mobile phone and 89% owned and used a CHW book. Only 84% had received initial training upon recruitment while most had received refresher training of some sort.

73.4 % had been supervised in the previous 3 months while only 59% of CHWs had been properly recruited during a village meeting. 57% felt that CHW work was too much while most (84%) walked on foot to do their work.

All VHTs offered health education to families during home visits, 77% kept records of home visits, 67% referred patients, and 63% reported unusual health events while 56% possessed adequate knowledge of Community Case Definitions (CCDs).

Using a composite variable we found that only 58% of VHTs were adequately adhering to CBS guidelines. After multivariate analysis, not having studied beyond primary school (OR=1.9, CI=1.02-3.5), not owning a CHW book (OR=3.4, CI=1.2-9.4) and not being supervised during work (OR=2.7. CI=1.4-5.2) were associated with poor adherence to CBC guidelines.

Conclusion: VHTs are not adequately adhering to MoH guidelines for CBS and several reasons for this have been identified. Proper recruitment, adequate and continuous training and sustained support supervision of CHWs would help improve CBS in Uganda and similar settings.

Lessons learnt over the course of the fellowship

Key skills/competencies acquired

Analysis and interpretation of surveillance data including use of epiinfo, STATA and QGIS mapping software. Comprehensive skills in routine analysis of weekly epidemiological surveillance data for IDSR priority diseases in Uganda.
Comprehensive practical experience in outbreak investigation.
Scientific writing and presentation skills–abstracts, power point presentations (at National and International Conferences) and manuscripts.
Training others in field epidemiology principals, Leadership and team building skills.
Participating in building partnerships between various stakeholders: Ministry of Health Makerere University School of Public Health, CDC and other Development Partners.

Next steps in career

Having acquired advanced skills in field epidemiology, his career plan is to become an accomplished epidemiologist in communicable and non-communicable diseases.