Health and social well-being

Matsan Health Africa in collaboration with the Uganda Prison services and Ministry of Health of Uganda adopted a stop Tuberculosis strategy among prisoners, prison staffs and communities

Matsan aims at screening inmates  for Tuberculosis at the entry of the prison facility, this will make early diagnosis for those who come in with TB disease, this strategy has been implemented in the management of infectious diseases like Ebola where people from high risk places are screened for the disease before they are allowed to enter a low risk area.

This strategy also has been used in management of COVID-19 to limit its spread to low risk areas where people from high risk areas are quarantined and  tested, those found positive are treated until cured before they are allowed to enter the community.

Screening of inmates for Tuberculosis infection at entry and exit will mitigate the spread of the disease among others.

Globally, there were 10million TB infections in 2018 of which more than 95% of patients with TB live in low-and middle-income countries, where poverty and extreme hunger are endemic and devastating public health issue. The TB burden is estimated to be 24% in SSA of global TB cases. In Africa, 607,332 people have died due to TB disease compared to 79,545 deaths due to COVID-19 since 1 March 2020 to 10 April, 2021, making Tuberculosis a more serious global challenge than COVID-19.

Uganda remains one of the 30-high burden TB/HIV countries in the world with an estimated prevalence of  253 TB cases/100,000 people and TB Incidence rate is 200/ 100,000 population. The threat of Multi-Drug Resistant TB is 3.5/100,000 and the country reports only 26 % MDR-TB cases. For example, in 2019, 15,600 people died due to TB in Uganda.   

The Uganda Prisons Service has average population of 35,000 inmates across 233 prisons with prevalence of 654 TB cases/100,000 population compared to national prevalence of 253 TB cases/100,000 population. Efforts to control TB in Uganda Prison Services are complicated by high HIV prevalence (11%), high HIV/TB co-morbidity, prison congestion, poor nutrition and inadequate infrastructure and a weak prison health system

The concept of screening inmates for Tuberculosis infection at the entry to the prison facility and communities emerged from recent solutions that are being used in management of infectious diseases like Ebola and COVID-19 to limit their spread, where people from high risk areas or places are screened for the disease before they are allowed to enter a low risk area. This has led to increased Tuberculosis case detection rate by 90% in the region.

Our solution actively identifies inmates with Tuberculosis in the Prison &  communities using Rapid TB-LAM and GeneXpert Techniques and those found with TB are started on TB treatment and linked to other services like nutrition supplements in case of malnutrition and HIV testing as its the protocol for every TB patient to be screened for HIV. This has created demand among prison communities, since many people from Uganda prison services have been identified and linked to health care facilities for prompt diagnosis and treatment.

Our strong preference has been given to prisoners, prison staffs and communities that directly benefit and are located within the congregate communities particularly prisons.  This is because there are many TB cases in prisons as compared to the general population in Uganda by 401 TB cases/100,000 population). 

Efforts to control TB in Uganda Prison Services are complicated by the high HIV prevalence (11%), high HIV/TB co-morbidity, prison congestion, poor nutrition, inadequate infrastructure, limited TB awareness and a weak prison health system.

During our community outreach activities, we have been interfacing with prison community in the detention facilities and what has been noticed over the time is the congestion in the prison wards and the limited medical services for the ever rising numbers of TB cases reported annually in the Health Management Information System country reports, the organization was inspired to ensure that prisoners have increased access to essential and affordable health care in prisons which is currently the hot spot area for Tuberculosis in Uganda and this is one of the key MIT Solve's objectives for improvement in the quality of life.

Our problem, solution and our target population are aligned with the goals of the grant.  Our solution covers the early tuberculosis detection and treatment of the Tuberculosis patients as well as HIV testing in the prison communities and we are committed to ensure the well being of prisoners as they serve their sentences in the detention places. The target population are the prisoners and prison staffs who do not have access to better health care services due to weak prison health system. So implementation of screening of Tuberculosis at entry and exit will definitely mitigate or eliminate spread of Tuberculosis.

The reason for selecting the above stage of development is the strategy has been piloted in two districts so far that is Nakasongola and Masindi among the prisoners and the neighboring communities. This has helped the organization to increase Tuberculosis detection rate to 90% as well as reduced the transmission of new HIV infections by 40% in these two districts. So far about 500,000 people have been reached through our community linkage facilitators but we expect to implement this strategy through out the country and Africa at large. The organization believes that Tuberculosis infection is not part of sentence’’ so all the communities have the right to be free from any illness including the prisoners during the time of sentence/detention.

Our solution is innovative in a such way that it employs prioritization Matrix to identify which problems are the most important to work on solving first. The Matrix helps us  rank problems or issues generated through brainstorming, using weighted criteria that are important to our project as an organization to achieve consensus about the proposed solution. Its public involvement has helped to obtain more information to the decision making and technical knowledge about the context upon which decisions made by the communities and stakeholders have been successfully implemented.

The organization adopted a community engagement initiative to achieve its goals towards improving access to affordable service delivery to its people because the services offered are based on the informed choices of the community. More so, the sense of the community ownership of the project that exist in these communities has helped us to  implement our projects at a lower cost but more importantly, the willingness of the community to actively participate in the implementation of our projects has been the power house for Matsan Health Africa to make the difference between a good and poor decisions.

Also Involving women in the implementation of the community projects has been another key strategy for our organization. Hence our solution has been transformative throughout the implementation processes and helped us to rise tuberculosis yields by 90% and lowered the transmission of new HIV infections by 40%

The solution is serving about 100,000 people and is expected to serve 500,000 people in one year. We are targeting 1million people basing on the available resource envelope but if our resource envelope is enhanced, then we can serve 10million people and more in five years to come. This will be achieved through integration of TB screening services into routine care activities at various entry points in health facilities beyond Outpatient department such as Maternal and Child Health, Diabetic clinics, Nutrition units. This is because our study demonstrated that active screening for TB within antenatal care yielded 37% among women during pregnancy;11% screened in HIV clinics; 1.3% of screened adults with Diabetes had TB, 7–fold greater than the general population and 15% of TB cases had Diabetes. Also showed pooled prevalence of 14% active TB among the malnourished persons.

To reach the targets set out in the End TB Strategy among the prison communities,

We shall use the following performance indicators

• Annual decline in TB incidences among the prisoners at rate of 10%
• Decline of Proportion of people with all forms of TB who die from the disease (the case-fatality ratio) to <5% by 2025 among the prison communities.
• Increase in the proportion of people curing and completing TB treatment (complete and cure rate including MDR and XDR)
• Increase in case suspicion index among the prisoners (TB case detection rate including MDR and XDR)
• # of TB patients with result for isoniazid and rifampicin DST
• # of Confirmed MDR-TB cases detected among TB patients tested for isoniazid and rifampicin DST
• # of Confirmed MDR-TB cases tested for susceptibility to fluoroquinolone and second-line injectable
• # of MDR-TB cases (suspected or confirmed) enrolled on MDR-TB treatment
• # of Confirmed MDR-TB cases enrolled on MDR-TB treatment regimen
• # of Confirmed XDR-TB cases enrolled on XDR-TB treatment regimen
• # of MDR-TB cases on MDR-TB treatment regimen with negative culture by six months
• # MDR-TB cases on MDR-TB treatment regimen who died by six months

The organization has 10 full time workers and 5 Volunteers,

Two full time Medical Officers

Four full time Nursing Officers

Two full time Public Health Specialists

One full time Social Scientist

One full time Medical Laboratory Scientists

Matsan Health Africa is comprised of a diverse experts in clinical care, public health, data management and  social workers with enough experiences to execute our solution beyond reasonable doubt with a wonderful a track record of high performance and excellent leadership in the health care industry. As such, the organization have been  able to increase tuberculosis detection rate by 90% towards its stop and eliminate Tuberculosis strategy in congregate settings like prisons. Also through its community participatory action initiative there is a significant access to care, reduced HIV/TB stigma as well as reduced transmissions of new HIV infections in the communities by 40%. Our organization leadership works with Ugandan ministry of Health to guide strategy.

In conclusion, the expertise our team has, will enable us to attract the different resources needed to succeed and make an impact

We care about each individual and we are responsive, supportive, kind and patient at all times through our training, research and outreach activities.
We are fair, truthful, honest in all interactions and seek to adhere to the highest ethical conduct and scientific standards
We are hardworking and have a passion for continuous quality improvement and strive for useful results from our efforts. We are loyal to each other, respect each other and communicate openly. Matsan empowers women through community sensitization and trainings aimed at mitigating the vise of cultural and religious practices which dehumanize the woman and leave them at the disadvantage to compete favorably in the society. The organization advocates for gender balance in employment opportunities and on record we have five (5) women in leadership positions as directors.

Matsan Health Africa have made a positive impact on the quality of peoples' lives in line with its mission of aiding health and social well-being of communities as well as promoting human dignity through focused equity and innovation which is clearly aligned with solve's core objectives such as ensuring access to essential and affordable healthcare, ending epidemics (HIV/AIDS, Malaria and Tuberculosis) as well as communicable and non-communicable diseases for sustainable development through a referral system.

Despite having the big vision of uplifting human conditions to reduce disease burden, more especially in the rural poor and inmates in prison, we still have the challenge of the resource envelope and deficit of operational logistics to reach our desired target and therefore applying to solve will enhance our capacity to serve the marginalized,under served population and improve the quality of life in our communities. 

Matsan Health Africa in order to advance its expertise and measure progress in achieving its goals, we need a comprehensive support to enhance impact and effectiveness of action through combined and more efficient use of resources, innovation and a strong commitment to achieve sustained success.We also need the above support and partners to develop a sustainable long-term strategy that will effectively enable us  work and have a lasting effect on the lives of people.

To achieve a sound financial management,we need guidance on issues such as the proper operation of bank accounts, the treatment of income, making payments, project files, monitoring and auditing, the management of petty cash, eligibility issues, requirements for matching funds, internal financial procedures, taxation matters, the treatment of assets, the role of the organization secretarial function, and audit requirements. Training in relation to good practice in financial management is required on a regular basis.

Along with strategic planning, monitoring and evaluation are key components for a successful partnership

In conclusion,different situations require tailored solutions and workable agreements.

Solve Members, MIT faculty, Centers for Diseases Control, Plan International University of Research, RTI International,Robert Wood Johnson Foundation,Vodafone Americas Foundation, Grant funding and other foundations that offer support in impact assessment validation.

Any partnership, big or small, can help with the creativeness because  working with people who have previously taken part in engagement activities can help to guide you through unfamiliar processes and also assist with your own professional development.

Matsan health Africa as a non profit organization needs partnership to increase our funding in order to achieve our big vision of ensuring community health and socially empowered Africa 

Matsan health Africa need partnership in order to advance its expertise in a host of relevant things such as understanding the needs of our target audience, timings and logistics, and to reach a wider audience such as charitable organizations that will help to aid a well being and health of the under-served populations, marginalized and rural poor communities as well as ease access to affordable services. 

Working in partnership can deepen and strengthen  relationships as well as introduce us to new people with new ideas. This may lead to other projects in the future.

Robert Wood Johnson Foundation Prize is open to solutions that directly address the health and well-being of people in the US but in Uganda also Matsan Health Africa has a mission to aid health and well being of the people through innovation and focused equity but we are crippled by the limited resources to offer our communities with reasonable services that foster their well-being and health. We quality for this prize because the government of Uganda provides financial support to the health sector, amidst other competing priorities. Generally the Government of Uganda’s share of the health expenditure over the years has stagnated at around 15%. This means that the country is still highly dependent on external support, which accounts for about 45% of the health expenditure and raises concerns about sustainability. Out of pocket payments stand at 37% and is far above the recommended maximum of 20% for catastrophic expenditure meaning the financial risk protection is poor and there are concerns for equity. Therefore, Matsan health Africa as not for profit organization seeks for this prize to support the scale up of proven innovative and cost-effective solutions for the prevention, care and treatment of TB, malaria, HIV, Malnutrition, viral hepatitis and extreme poverty as well as strengthening capacity for supporting operational research and monitoring the disease trends in the vulnerable, marginalized, under served population and improve the quality of life in our communities.

Uganda is one of the largest refugee-hosting nations in the world, with over 1,400,000 refugees. Currently, it has 11 refugee settlement camps, almost 50% of refugees in Uganda are located in the Bidi Bidi camp which also happen to be the world’s largest settlement camp. This calls for more support from Humanitarian organizations like Matsan Health Africa to continue delivering quality and sustainable assistance to Refugees and this justifies how we qualify for this prize.  

Refugee TB patients face a big challenge to access treatment as soon as they need it because of the legal processes they go thru before they are settled in countries, they seek refuge and they are from communities who experience poverty and face an embedded disadvantage as being poor is associated with a higher risk of TB infection, active disease, delayed diagnosis, poor adherence, and fatality

TB care providers have to respond to barriers to treatment by bringing care out into the community, enhancing patient mobility, providing supportive services, and reaching out to potential patients. Interventions to improve migrant access and adherence to quality services necessarily extend outside of the health system and require significant resources to expand equitable access to treatment.

 Our solution of providing rapid TB assessment services to refugees as they are still in the refugee holding centers save the lives of those currently suffering form the TB disease and also prevent the spread to new cases , because the holding centers are at most times congested and  with limited Medical services.