Community Linkage Facilitators at the Forefront of Ending TB in Northern Uganda

Seventy-year-old Grace weighed a mere 80 pounds when Santa Odongo, a community linkage facilitator, found her bed-ridden and alone at home in Namasale. Grace, who lives with HIV, had missed medical appointments and had not been taking her antiretroviral medication. She didn’t know it at the time, but Grace also had tuberculosis (TB)

Fishing is a primary economic activity in Namasale, a village on the shores of Lake Kyoga in Northern Uganda. The sex trade flourishes there too, in the shadow of the landing sites and trading centers, making the people who live and work in and pass through Namasale highly vulnerable to both HIV and TB.

Community linkage facilitators are a critical part of the health system in northern Uganda. Well-known and respected in their community, they are essential health facility team members and significantly improve early detection and treatment of HIV and TB. As part of its comprehensive service delivery strategy, the JSI-managed, USAID-funded Regional Health Integration to Enhance Services-North, Lango (RHITES-N, Lango) activity recruits and trains community linkage facilitators like Santa to identify, educate, and counsel people living with HIV and/or TB; deliver medicines to communities; follow up with clients who have dropped out of treatment; and update registers in real-time.

Santa met Grace during her routine round of household visits in the community and remembers the day well. “I think [Grace] was about to die. She was one of our lost clients and was showing symptoms of TB. Immediately, we brought her to the facility and I helped look after her and find her relatives.”

After the test at the clinic, the lab indicated that Grace had TB, her sputum sample was sent by motorcycle to the RHITES-N, Lango-supported district hospital lab for confirmatory testing.

Once the results were confirmed, Grace received TB medication. We also helped her eat more nutritious foods and gave her emotional support. Now she eats well and has gained her weight back—that’s why we call her ‘Good Feeding.’ She looks like she was never sick,” Santa said happily.

RHITES-N, Lango also trains health workers to analyze sputum samples from health center labs and to record, update, and report data, which is key to improving retention and bringing people back to care.

The five-year RHITES-N, Lango activity supports an estimated 2.1 million people in Uganda’s Lango sub-region. Now in its fourth year, it has provided TB services to almost 15,000 people.

Story and photos by Karin Bridger for JSI