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Global Health Econ Sustain Improving health of older adults in rural Uganda

equipped VHWs to address acute care problems (fever, health, nutrition, chronic disease, disability, and factors
diarrhea, and cough), monitor and provide medications indicative of poor health, such as households headed by
for hypertension, diabetes, and other chronic problems, adolescents or solitary elders, households with three or
administer prenatal and other maternal and child care, more children under the age of five, or those lacking access
provide follow-up care after hospitalization, and educate to clean water or proper sanitation facilities. In addition,
families. Written tests, role plays, and field observations the biannual census includes routine screening for chronic
led to “certification” in each health domain, and ongoing disease and malnutrition, as well as gathering preferences
continuing medical education sessions continue to regarding health education topics to be covered by the
reinforce learned skills monthly. VHWs receive modest VHWs.
stipends for each service delivered (Zheng et al., 2019), The health census data are inputted electronically,
efforts that are validated on foot twice monthly by a clinical generating an individualized family health sheet (FHS).
supervisor visiting homes with the VHW and monitoring VHWs maintain hard copies of these FHSs in their
performance. “family binders,” which serve as COPC medical records.
Before the Kisoro Elders Project, some older adults Furthermore, the computerized database generates a
were treated for chronic diseases by their VHW and problem-oriented cross-reference (POCR), organized
supervisor team in the monthly village-based clinics of the thematically rather than by family, which facilitates the
Chronic Disease in the Community program (Stephens identification of villagers within specific age demographics
et al., 2021). However, most received little to no health care, or with particular health issues, such as chronic diseases,
as walking an average of 5 – 10 km to the district hospital mental illnesses, recent hospitalizations, or living alone,
is the only affordable means of transportation for the vast allowing VHWs to initiate problem-targeted interventions
majority. The Kisoro Elders Project began in 2017 as a periodically (Alizadeh et al., 2021). A notable distinction
model of health care for rural older Ugandans, aiming to between the censuses carried out by the Kisoro program
improve their quality of life via straightforward, low-cost and previous surveys on the functional capacities of aging
interventions (Bloom et al., 2018). The project layered populations in LMICs, as referenced above, lies in the
geriatric care onto the framework of the Kisoro VHW emphasis placed by the Kisoro program on the delivery
program. The term “Elders” was chosen for its traditional of services to address identified health problems, thereby
connotation of respect and wisdom. closing the COPC loop.
1.4. Community-oriented focus 2. Methods
The inspiration for and guiding tenets of the KDH–DGH 2.1. Beginnings of the Kisoro Elders Project
Program and its Kisoro Elders Project, as with other To accurately define the needs and introduce the initiative
DGH projects globally, are the principles of community- to each community, meetings were conducted by the
oriented primary care (COPC), which seeks to tailor VHWs and project leadership with the village elders. These
clinical initiatives to community-based data about health discussions revealed that the principal problems faced by
needs. The concepts of COPC were embodied in the work the elderly were issues with vision, hearing, mobility, pain,
of Sidney and Emily Kark in South Africa and Israel in isolated living without a source of light, and depression.
the mid-1900s, Jack Geiger in the Mississippi Delta and It is noteworthy that depression is common in elders in
Boston in the 1960s, and Vic Sidel and Fitzhugh Mullan in Africa, and suicidality is not rare (Bedaso et al., 2022).
New York in the 1970s and 80s (Kark & Kark, 1999; Geiger, These issues are often related to poverty, hunger, loss
2002; Mullan, 1982). of family or role, loneliness, neglect, or various forms of
As outlined by these COPC pioneers, the practice abuse, physical, psychological, or financial. Consequently,
of COPC requires a continuous cycle wherein data in collaboration with the VHWs and with the support
inform practice and practice provides data. This iterative of the village chiefs, low-cost strategies to address these
process encompasses problem identification, program problems were conceptualized. This initiative expanded
development, program evaluation, and program the VHWs’ skill set to include geriatrics.
improvement. To fulfill this iterative cycle, the KDH–DGH
program relies on a biennial health census conducted by 2.2. Educational initiatives
VHWs and other program personnel. During this census, Initially, a series of 2-day intense training modules were
the health status of all households in the village is assessed conducted between February 2018 and February 2019.
and regularly updated. The variables assessed per family These sessions were led by a team that included the authors
include demographics, hospitalizations, maternal and child (PB, HB), the Kisoro Elders Project Director (IM), and the

Volume 2 Issue 2 (2024) 3 https://doi.org/10.36922/ghes.3000