Improving Child Health at the Front Line

In a small village in rural east-central Uganda, baby Josephin is happily babbling to her mother Kevina and crawling around the yard. She has recovered well from a bout of bad diarrhea that she was suffering from just one day ago. Josephin is one of the lucky ones. She was able to access effective treatment in her village that allowed her to make a quick recovery.


While Uganda has made significant progress in improving the health of its population over the past 10 years, more than 5 percent of Ugandan children will not reach their 5th birthday.[1] In fact, over 270 children under 5 die every day in Uganda.[2]

More than half of these deaths are caused by just three diseases: pneumonia, malaria, and diarrhea.[3] All of these diseases are both preventable and easily treatable—so why do they kill so many children in Uganda?

There are many factors that can contribute to these deaths, but a primary one is a limited access to health care and medicine. With only one doctor for every 24,000 people in Uganda[4] and most rural residents traveling (usually on foot) approximately seven kilometers to the nearest health facility,[5] more than 48 percent of the population has trouble accessing health care due to distance.

Given these difficulties in accessing care in a health facility, many people turn to small private drug stores that can be found in nearly every village in the country.

Florence owns one such drug store in this rural village. Prior to starting the drug shop, Florence worked as a Nursing Assistant at a medical center in the nearby town of Iganga. She says she started the drug shop three years ago “to help the community around this area because health services are very far from here.”


Florence was the first person Kevina turned to when Josephin developed diarrhea. Kevina finds it difficult to get to the nearest public health facility and is therefore reluctant to go there; by contrast, she finds Florence’s local drug shop to be “very approachable and nearby.” Kevina was very happy with the treatment and service she and her daughter received at the drug shop, and has even noticed an improvement in the service from Florence since she attended a child health training program recently.

In 2016, with support from UNICEF and The ELMA Foundation, the Clinton Health Access Initiative, Inc. (CHAI) rolled out a training program for drug shop workers like Florence, which included a six-day training and on-going mentorship in seven districts in Uganda. The program covers the latest guidelines for diagnosing and treating pneumonia, malaria, and diarrhea, as well as the key danger signs to look for, and when to refer for more help. So far, in 2016, the program has trained providers from more than 1,500 drug shops, with plans to expand the program nationally by 2018.



Florence thinks that the biggest benefit of the training is her increased knowledge of correct treatment and dosage. Sometimes, prior to the training she was under-dosing or incorrectly treating patients. She also appreciates having time with her one-on-one visits with her mentor, who is friendly and helps her improve her practices.

Since attending the training, Florence believes that her business is more successful as she now has better access to essential child health products to treat pneumonia, malaria, and diarrhea at reduced prices. This is a result of CHAI’s work with importers, manufacturers, and wholesalers to ensure the drug shops have reliable access to products at affordable prices. This ensures that Florence always has the correct products available for her community at a price patients and caregivers can afford.

Early data from the program confirms that other drug shops are benefiting as well. Availability of the key child health medicines has increased an average of 22 percentage points from 53 percent to 75 percent, and 92 percent of training attendees were able to answer all questions in a knowledge quiz correctly.[6]

This progress thus far is promising. As the program expands, more children just like Josephin will be able get the right diagnosis and treatment so that they can stay strong and healthy for years to come.


[1] UNICEF – A Promise Renewed 2015
[2] UNICEF – Uganda profile 2013
[3] UNICEF – Uganda profile 2013
[4] Healthworker shortage in Uganda – BMAU Briefing Paper – 2013
[5] DHS Uganda 2011
[6] CHAI mentor data 2016