Using Leadership and Management Skills to Increase Client Load at RHU-Kapchorwa

Bernard Zikanga

Reproductive Health Uganda

Demeter Namuyobo

Medical Coordinator, Reproductive Health Uganda

The Reproductive Health Uganda (RHU) Kapchorwa Branch offers a wide range of integrated sexual and reproductive health (SRH) services which include health education, HIV counseling and testing, family planning, cervical cancer screening, management of STIs, condom education and distribution, comprehensive post-abortion care, and laboratory diagnostic services.

Despite offering all of these services, reproductive health indicators have remained low in the clinic’s catchment area in Eastern Uganda. Of particular note is the unmet need for contraceptive services at 41% above the national average, and the high rates of unsafe abortion.

As a result of low demand, the RHU Kapchorwa branch suffered from a low client load across all of its service delivery points. 1,320 clients received services in May 2014, when 350 clients visited the clinic, 630 by community-based reproductive health agents (CBRHAs), and 340 were visited during outreach.

The Leadership Development Program Plus (LDP+)

The U.S. Agency for International Development-funded LDP+, supported by the International Planned Parenthood Federation (IPPF) and Management Sciences for Health (MSH), helped RHU staff identify service delivery challenges and obstacles to an increased client load for SRH services. During the training, the Kapchorwa team identified their unique challenges contributing to low client load and began to solve them as a team. Their goal was to increase the number of SRH clients at the Kapchorwa branch from 1,320 in May to a monthly target of 5,600 clients.

As a team, RHU Kapchorwa applied the leadership and management practices they learned during the LDP+, such as the root-cause analysis of a challenge and setting targets and priority actions to achieve their desired result of 5,600 monthly clients. 

For example, the team analyzed their situation and realized that a lack of client outreach and poor data collection were the main causes for their low client load. Other issues they identified included: a lack of laboratory services, long waiting hours due to only one service delivery room, and a lack of CBRHAs for advocacy and community outreach regarding RHU services.

With the knowledge gained from the LDP+, the RHU Kapchorwa team set priority actions to overcome these barriers. For example, they began conducting outreach at nearby public places–markets, churches, and the town council–using locally available resources. They also identified another room for service delivery and subsequently reduced the previously long waiting hours. Finally, more CBRHAs were hired and a laboratory technician was recruited.

To track all of these improvements, and to continually assess their workplace, weekly meetings and continuous professional development opportunities are held to discuss performance and improve data capture.

Chelangat Adrine, a RHU Kapchorwa client, appreciated the service improvements. (Photo: Bernard Zikanga)

These innovative and low-cost strategies resulted in an increased client load from 1,320 clients in May to a monthly client load of 11,000 in November, far surpassing the monthly target of 5,600 clients. In addition to increasing the client load for SRH services, the application of leadership and management practices at the branch yielded additional results. For example, family planning uptake for long-term methods increased from 220 in June to 3,012 in November. Similarly, the branch team’s improved time management has also addressed late reporting at 9:00am, improving it to 8:00am. Furthermore, the sustainability of the LDP+ skills and practices continues to yield impressive results at RHU Kapchorwa.

Chelangat Adrine, a RHU Kapchorwa client, appreciated the improved services and said, “RHU Kapchorwa’s services have greatly helped me space my children and these days I find it easy to come to your clinic and be served immediately without waiting for long, as it used to be.”