The Ugandan government has come up with an innovative program to distribute malaria drugs to patients living far from medical facilities. In some areas of Kiboga District, the program got a boost from the support of a medical aid agency. But following the agency's departure, the program is struggling to continue. Cathy Majtenyi visited Kiboga District and filed this report for VOA.

Hafsah Nabankema prepares a dose of malaria medicine in her house in Kyatto village.

She is soon visited by a woman and her sick baby. Nabankema gives the baby the first of three doses and carefully records the procedures along with other health details. Nabankema is known in Kyatto village as a malaria drug distributor.

Malaria is a huge problem in Kiboga District and other areas of Uganda.  It accounts for about 40 percent of people seeking outpatient medical treatment at Kiboga District Hospital, and it is the number one killer of children five years of age and under.

Kiboga District has only one hospital, four doctors, and 102 trained nurses to serve a population of more than 279,000.

To address these and other challenges, in 2002 the Ugandan government implemented its "Home-Based Management of Fever" policy.

In selected districts including Kiboga, that involved selecting and training volunteers such as Nabankema to distribute malaria drugs at the village level.

Emmanuel Obatre supervises 38 drug distributors in Kapeke sub-county. He explains that villagers trust and respect the local drug distributors who he says are vital in the fight against malaria. "For us, we say that if one person dies in our village, everything collapses -- you cannot work, you cannot do something.

Obatre worked closely with the medical aid agency AMREF. The agency worked with the government in areas of Kiboga and two other districts from 2003 to 2006. The agency provided the drug distributors with additional training and supervision and supplies such as plastic containers and bicycles.

But drug distributors and those in the more formal health care system say that the government is not continuing to provide the training and supplies that AMREF did, or to even continue the government's original training. They say that makes it more difficult for the volunteer drug distributors to do their work.

Henry Tito Okwalinga is a malaria project officer with AMREF Uganda. He calls on the government to continue supporting the drug distributors.  "I urge them to take up the structures which are there and which AMREF has created, and strengthen them for the good of the work of health promotion, especially the Home-Based Management of Fever."

Dr. Allan Muruta is the director of Kiboga District Health Services. He explains that he has tried to get funding from higher levels of government to maintain the program without success. "My experience has been very futile because over the last three years, we've been getting the same amount of money in spite of the fact that the population has been increasing and that the demands are becoming more on the health sector. But apparently the government priorities are not so much in health."

Meanwhile, Hafsah Nabankema and her colleague continue to fight malaria in Kyatto village, doing what they can to ease the suffering of those afflicted with the scourge.