PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
INTRODUCTION
Since its inception in November 2005, the AFFORD Health Marketing Initiative has primarily worked to
increase accessibility to condoms through several channels, with special emphasis on high risk locations.
The project has used innovative communication approaches and channels to reach specific populations
with HIV and STI prevention messages and products. Condoms and direct counseling have been promoted
aggressively to most at risk groups (MARPS) across the country. The general public has also been exposed
to a wide range of communication messages promoting fidelity, reduction in sexual partners and correct and
consistent use of condoms for sexually active adults. The project has also addressed gender norms related
to increasing the risk of HIV infection.
PROGRESS TO DATE
Increased condom outlets and product distribution
In a bid to make condoms even more readily accessible at high risk locations, AFFORD stocked condoms in
as many bars as possible in all the regions of the country and carried out direct condom promotion at these
locations. This together with getting more corner shops (dukas) to stock condoms resulted in an increase of
condom outlets from 29,000 in 2007 to 32,000 in 2008. This benefited both the project and suppliers of
other brands of condoms. Socially marketed condoms in Uganda increased from 22 million in 2005 to 30
million in 2006, 34 million in 2007 and we are expecting about 38 million in 2008. Protector, the AFFORD
promoted condom brand and the oldest on the market, appeared to be a tired brand. In 2008, AFFORD
repackaged Protector in an attempt to make the brand more attractive to consumers.
Targeting Most At Risk Populations (MARPS)
AFFORD has continuously identified locations of high risk behaviors targeting most at risk populations with
HIV and STI prevention. Using community outreach and interpersonal communication, the project has
directly reached fishermen in several fishing communities, commercial sex workers in four major locations in
the country, the military, police and other private security agencies. Working through six partners, a total of
29,671 MARPS were reached in 2008. The MARPS program included HIV counseling and testing, STI
diagnosis and treatment, family planning services, condom promotion and productive skills training as
alternative means of income generation for sex workers who would like to transition to safer lifestyles.
Through subcontractors, AFFORD trained 607 peer educators in FY 2008 among commercial sex workers,
police, UPDF and fishermen. They were trained to address gender and social norms and practices that
increase men's risk of HIV infection using the "Be a Man" training manual and tools. These interpersonal
approaches reached 28,378 people in 21 districts.
In an effort to facilitate sustainable programming for MARPS, AFFORD supported the establishment of the
MARPS network, a national network that brings together all organizations working with MARPS. The
MARPS network‘s main function is to facilitate information sharing and dissemination of best practices,
provide strategic direction in MARPS programming and advocate for resource allocation to MARPS
interventions. To date the MARPS network has a membership of 20 organizations, a three year strategic
plan and a functional secretariat
The Good Life! Campaign
Formative research revealed that Ugandans equate "wellness" with material wealth rather than physical
health. This insight led to the development of the Good Life platform, designed to promote the simple things
Ugandans can do everyday to keep healthy and save money, thereby improving overall quality of life.
The Good Life campaign launched with The Good Life! Show, a highly popular TV, radio and experiential
game show that uses edutainment to increase knowledge, facilitate couple communication, promote healthy
behaviors, and increase demand for products and services. Areas of HIV focus include risk perception,
condom use, HIV testing, disclosure, PMTCT, adherence, and positive living. In FY 2008, 24 episodes were
broadcast on 3 TV stations, 20 radio stations in 5 languages and appeared in 120 locations countywide
through the experiential road shows.
The experiential road shows were further refined to enhance interpersonal communication and resulted in
the development of the "four tent" model. Using this approach, fewer people gather under a tent to learn
about HIV prevention and engage in meaningful exchange with the moderators. The four tent approach
went to 120 communities in 2008 reaching 300,000 people.
In partnership with the HIPS project, AFFORD implemented a number of workplace programs targeting
major companies and sugar and tea plantation workers. A total of 32,000 people in 16 workplaces were
reached through this intervention with HIV prevention messages and products including condoms.
Interpersonal communication at the village level - Popular Opinion Leaders
AFFORD created the Popular Opinion Leader model in 2006 to complement its efforts at reaching
Ugandans at the grassroots. Popular Opinion Leaders are volunteers recruited at the village level and
trained to offer education on basic health issues including HIV/AIDS. To date over 700 POLs are operating
in 18 districts. In FY 2008, 736 new POLs were trained in 23 districts. POLs use interpersonal approaches
to raise awareness on condom use, HIV testing, discordance, and benefits of early treatments of STIs.
Addressing Alcohol and Sexual Violence
In FY 2008, AFFORD and its partner PULSE reached over 100,000 people in high risk locations in Uganda.
AFFORD trained over 190 bar and lodge owners in condom use at the work place, STI and HIV referral,
and sexual violence to staff and patrons. Working in collaboration with UPHOLD, AFFORD also oriented
231 bar and lodge owners in 12 districts on HIV in the workplace. The objective was to enhance bar and
lodge owners' knowledge on the relationship between alcohol consumption, sexual violence and HIV
transmission in order for them to promote and enforce key HIV/AIDS prevention practices and basic work
place polices in their establishments.
FY 2009 ACTIVITIES
In FY 2009 AFFORD will consolidate its gains by maintaining all its existing activities as mentioned above.
The project will strengthen the quality of programming with the aim of reaching more under-served areas
Activity Narrative: and people with HIV prevention messages. AFFORD will use local languages and approaches that the
intended population can appreciate and effectively participate in promoting the reduction of sexual partners
and consistent and correct condom use. AFFORD expects to reach approximately 390,000 people directly
through HIV prevention messages.
C
ondom Distribution
AFFORD will work on increasing its distribution by increasing the number of outlets stocking condoms. The
following strategies will be adopted:
Increasing number of wholesale outlets with our products. The number of outlets is expected to increase to
50,000.
Recruit Fast Moving Consumer Goods (FMCG) distributor: AFFORD will recruit 3 FMCG distributors as
means of reaching existing high risk locations (bars, lodges, hotels, etc). FMCG distributors (especially beer
distributors) target the same locations as those for condom distribution. AFFORD piggybacks on distribution
mechanisms of FMCG products like laundry soaps, toothpaste (Unilever products) and beers to increase
availability and accessibility of condoms in high risk locations and outlets. Distributing condoms through HIV
prevention stakeholders/organizations: Through the HIPS project, AFFORD will sell condoms to companies
that employ large numbers of staff. This will be extended further to reach other NGO's working in the areas
of HIV prevention, for example, MAVAP, AIC, IRC, and MSF, among others.
Condom promotion
AFFORD will concentrate on improving acceptability of condoms at MARPS locations and general retail
outlets using the medium of karaoke in bars. The bars will also serve as channels for condom sales.
In order to encourage condom stocking by traders, AFFORD will carry out trade promotion, providing
attractive incentives for traders that buy and restock condoms in good purchase quantities.
AFFORD will liaise with beer companies to hold joint promotions. This will cut costs of promotions and at
the same time highlight responsible drinking, coupled with correct and consistent condom use.
AFFORD will also roll out a merchandising campaign to ensure condom visibility, emphasizing the
affordability of the condoms. This campaign will ensure that point of sale materials are properly displayed
and that condom stocks are available at these outlets.
The field teams (PMOs) will work together with night club management countrywide to organize condom
promotions. Night clubs have proven to be locations for high risk behavior.
Targeting Most At Risk Populations
In FY 2009 AFFORD will continue MARPS interventions in its current districts, and work with the MARPS
network and organizations to scale up interventions for fishermen, truckers and CSWs in 8 new districts.
AFFORD will also expand the number of MARPS organizations it is working with from 8 to 10.
Peer Educators (PE) program: Through sub grants to MARPS organizations, AFFORD will conduct
refresher training for the 607 previously trained PEs and train 500 new PEs for all four categories of MARPS
(CSW, military, police and fishermen). AFFORD will support PEs to reach 100,000 people through
interpersonal communication and community mobilization with HIV/AIDS messages and link them to
needed products and services for reproductive health. AFFORD will reproduce and distribute support
materials, job aids and tools needed by PEs to do their work. Support materials will focus on HIV prevention
approaches and gender norms that increase the risk of HIV transmission, and address alcohol consumption
and sexual violence. AFFORD will continue to target men with gender positive messages from the male
perspective.
Access to friendly service outlets: AFFORD will continue to support MARPS to access friendly services for
HCT, STI and family planning. Special and convenient places like previously supported drop-in centers for
CSW will be supported and equipped to make them fully functional. AFFORD will support establishment of 2
additional drop in centers for CSW. Similarly 2 additional safe sailing boats manned by PEs to deliver
services and products to fishermen and fishing communities in remote fish landing sites will be procured
and equipped. Static condom outlets in military and police barracks and parking yards for long distance
truck drivers will be procured for 10 new locations each.
Internally displaced persons (IDPs): Of the 31 priority districts supported by AFFORD, 4 have been under
conflict, still have high populations of IDPs and have high HIV prevalence. In 2009 AFFORD, will extend
HIV prevention interventions through our innovative communication campaign and use the product
distribution mechanisms to step up condom promotion and addressing gender norms that increase the risk
of HIV transmission. In addition, through sub grants, AFFORD will identify and support organizations
providing tailored HIV prevention programs using community mobilization and interpersonal communication.
Good Life Campaign
In FY 2009 AFFORD will continue to use the Good Life campaign to address critical issues that drive the
epidemic in Uganda. Mass media will reinforce community interventions, positive behaviors, risk perception
and gender issues influencing people's behaviors. The Good Life Essence campaign will be launched,
which will include better linkages to the AFFORD health messages and products through mass media, a
loyalty scheme and rewards to consumers who recall, purchase and use the AFFORD products and
messages. It will culminate into the Good Life awards rewarding households, communities, distributors and
POLs who emulate the Good Life. The Good Life Show will also be shown in more community video halls
and generate discussions thereafter while also scaling up the 4 tent model, which will cover the whole
country.
In FY 2009 AFFORD will continue to work with CDFU to consolidate gains registered in the 23 districts.
Refresher training for POLs to enhance their skills in interpersonal communication and community
mobilization will be held. AFFORD will continue to strengthen this interventions aimed at preventing sexual
Activity Narrative: transmission of HIV to reach 100,000 people. Through this intervention AFFORD and CDFU will intensify
activities in the 23 districts with more in depth activities for condom promotion, prevention among discordant
couples and raise awareness on gender issues that increase the risk of HIV transmission. AFFORD will
also intensify interventions for gender using the Be a Man campaign and the African Transformation Model,
a skill building model to analyze gender stereotypes. Special attention will be given to strengthening
interventions for fidelity and partner reduction by working with religious leaders and other community self
help groups. Through this intervention AFFORD will reach 500 couples and 20,000 men with gender and
HIV /AIDS prevention messages.
In FY 2009 bar and lodge owners, small local brewers, brothel owners and pimps who link sex workers to
their clients and engage in alcohol and substance abuse will be sensitized through interpersonal activities.
AFFORD will collaborate with organization like Serenity Center and Indigenous Knowledge Resource
Center to mainstream alcohol and sexual violence training in all our prevention programs. AFFORD will train
50 peer educators and reach 60,000 people with alcohol and sexual violence messages.
AFFORD will also promote responsible drinking using consumer promotions, community activities and mass
media. Mass media and community activities will target men using male dominated activities like soccer and
drama. At these activities gender based violence and alcohol will be discussed and men's responsibility
promoted. Direct condom promotion and sales events will take place.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
Refugees/Internally Displaced Persons
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $250,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
New/Continuing Activity: Continuing Activity
Continuing Activity: 14218
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14218 4385.08 U.S. Agency for Johns Hopkins 6743 3340.08 Health Comm $1,100,000
International University Center Partnership;
Development for Communication AFFORD
Programs
9229 4385.07 U.S. Agency for Johns Hopkins 4841 3340.07 Health Comm $1,100,000
4385 4385.06 U.S. Agency for Johns Hopkins 3334 1032.06 Health $1,000,000
International University Center Communication
Development for Communication Partnership
Estimated amount of funding that is planned for Human Capacity Development $400,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,000
and Service Delivery
Table 3.3.03:
The AFFORD Health Marketing Initiative (AFFORD) is a cooperative agreement awarded to the Johns
Hopkins Bloomberg School of Public Health Centre for Communication Programs in October 2005.
AFFORD has the following objectives:
1) Increase accessibility and affordability of HIV/AIDS, reproductive health, child survival and malaria
products and services for Ugandans using innovative private sector approaches; 2) Enhance knowledge,
and correct use of HIV/FP/CS/Malaria products and services to encourage and sustain healthy behaviours
and lifestyles; 3) Strengthen/establish indigenous organization(s) for sustainable and self sufficient delivery
of key health marketing functions, including product distribution and promotion. AFFORD is a consortium of
6 organizations, three international and three local. All 6 consortium members have contributed to the
creation of an indigenous organization, the Uganda Health Marketing Group (UHMG), and are building the
required skills and capacity to continue in the footsteps of AFFORD when the project comes to an end.
UHMG is now incorporated as a not for profit company and is working alongside other consortium partners.
UHMG continues to build its technical, managerial and financial capacity to effectively deliver the objectives
of AFFORD now and in the future.
AFFORD has worked through the private sector to provide quality health maintenance products to PLHAs
as well as provide counseling and referral services for clients. In 2008 HCT became a main part of the
AFFORD care and support program through its carefully selected 100 private clinics. The project's
numerous communication channels are used to promote these services. Through this intervention the
private sector is increasingly contributing more to HIV prevention and health maintenance.
In FY 2008 AFFORD realized that in order to effectively provide care for PLHAs who seek palliative basic
care services from the private commercial sector, it is important to establish their serostatus. Because most
people avoid the public health facilities for various reasons including stigma, AFFORD supported the
establishment of HCT services in 100 private clinics to ease access to HCT services without fear of
stigmatization. Selection of eligible clinics was done in collaboration with the Ministry of Health (MOH) and
Central Public Health Laboratories (CPHL) using an assessment tool jointly developed with AFFORD.
Service providers from these clinics were trained by MOH trainers using national curricula for HIV
counseling and laboratory practice. The Making Medical Injections Safe (MMIS) project trained providers in
these clinics in health care waste management. These Good Life Clinics were provided with test kits and
other consumables. Good Life Clinics have since provided excellent and convenient facilities for people to
know their serostatus. Through the Good Life Clinics 11,113 people have tested and received their HIV test
results. Data collection tools and laboratory practice standard guidelines used by the clinics are provided by
MOH. Good Life Clinics are now linked through a network of geographically spread out clinics providing an
assemblage of services for family planning, HIV, child health and malaria prevention among other medical
services provided.
Adult treatment and care
In FY 2008, AFFORD's palliative basic care included strengthening the capacity of health workers in private
commercial clinics and drug shops with knowledge and skills to deliver basic palliative care services.
Identification of palliative care outlets was done in collaboration with District Officials with using a database
of registered drug shops and clinics generated by the National Drug Authority. In total 1557 health workers,
each representing an outlet, were trained using a module developed by AFFORD. Among these 410 were
clinics and 1147 drug shops. To ease access to a range of palliative care products AFFORD linked these
clinics to AFFORD's product distribution network. Job aids and support materials for providers and client
information is availed to all participating outlets. To date palliative care clinics have reached 100,962 people
with services and products while many more PLHAs have accessed and been referred for needed services
through participating drug shops.
Health Maintenance Products and OI Drugs
AFFORD has developed products that are being promoted to PLHAs for health maintenance. These
products include Aquasafe water purification tablets, Restors Low Osmolarity ORS, Cotramox (one month
pack cotrimoxazole), Acyclovir tablets and cream for adults and children in the treatment of HSV2 and a
triple action topical cream of dermatological infections. All these products are in distribution with the
exception of the Acyclovir and triple action cream which will be introduced on the market in November 2008.
In addition, the project works with six commercial net distributors to make LLINs affordable to PLHAs.
Though AFFORD carries its own brand of products, it promotes several brands of health maintenance
products and OI drugs through its wide network of pharmacies and drug shops. About 1147 pharmacists
and drug shop operators have been trained to provide palliative care counseling and provision of health
products. The retailers have been linked to major pharmaceutical distributors and wholesalers to get
continuous supply of these products. 510 private clinics have also been trained and are carrying a wide
range of health maintenance products and OI drugs.
behaviors, and increase demand for products and services. Areas of HIV focus included health
maintenance for PLHA, risk perception, condom use, HIV testing, disclosure, and PMTCT. In FY 2008, 24
episodes were broadcast on 3 TV stations, 20 radio stations in 5 languages and appeared in 120 locations
countywide through the experiential road shows. The experiential road shows were further refined to
enhance interpersonal communication and resulted in the development of the "four tent" model. Using this
approach, fewer people gather under a tent to receive messages and are able to ask pertinent questions
which they otherwise would not have been able to ask. The four tent approach went to 120 communities in
2008 reaching 300,000 people.
reached through this intervention.
Recruitment, training and management of 100 model clinics
Activity Narrative: Selection of eligible clinics was done in collaboration with MOH and CPHL using an assessment tool jointly
developed with AFFORD. Clinics were assessed on various areas including management policies, logistics
management, personnel, range of services offered and work load in each service area, infection control,
availability of MOH guidelines and policies on treatment and service provision as well as willingness to
partner with AFFORD. Service providers from the selected clinics were trained by MOH trainers using
national curricula for HIV counseling and HIV Rapid Testing by CPHL trainers. Clinics were then provided
with testing kits and consumables, as well as data collection tools and supported to integrate HCT services
in their ongoing medical services. The providers were also trained in other critical areas supported by
AFFORD including malaria prevention and treatment, family planning, and child health.
Post training support is provided to ensure that clinics have basic management systems like basic data
collection tools to enable them to collect and submit data to the district health office, documentation of their
experiences, supply chain and stores management to help minimize stock out and knowledge of national
policies and guidelines for implementation of various medical services. Periodic support supervision is
provided by the technical teams composed of AFFORD and MOH staff. Support supervision teams provide
on-site mentoring and assess quality issues related to HCT service delivery.
FY 2009 ACTIVITIES - Reaching 108,000 people with care and treatment
In FY 2009 AFFORD will consolidate its successes over the past three years and expand its activities
geographically to reach more people who need services. We will increase the number of PLHAs reached
with care and treatment from 100,000 in 2008 to 108,000 through our various channels. The clinics offering
HCT will be increased by another 100 making a total of 200 clinics. Refresher trainings will be organized for
the wide range of service providers supporting the provision of health maintenance products and making
crucial referrals to appropriate health faculties. Various communication approaches will continue to raise
awareness of the usefulness of health maintenance as well as promote facilities where services can be
sought.
The following are the details of programmes planned for FY 2009:
In FY 2009, AFFORD will scale up its intervention reaching PLHAs with treatments and care services
through clinics, PLHA networks, midwives, other partner organizations. Through 610 clinics offering
palliative care services we expect to reach 78,000 PLHAs. With an increase in the good life clinics providing
HIV counseling and testing services from 100 in 2008 to 200 in 2009 we expect 36,000 people to test and
receive their results and others referred for other needed services including ART. AFFORD will procure test
kits according to the recommended algorithm as follows: 40,000 determine test AFFORD will also work with
the Uganda Private Midwives Association (UPMA) to train its membership and link them to distribution
networks for palliative care products. Together with health workers from private clinics, midwives will be
trained in health care waste management and provided with safety boxes and color coded waste bins to
ensure safe disposal of waste. A total of 400 people will be trained to support delivery of HCT services
through private clinics and midwifery's. Through the UPMA 5000 people will be reached. . AFFORD
provides continued management and technical support supervision to the newly recruited 100 clinics along
side the previous 100 clinics.
Training: In FY 2009 AFFORD will conduct training and onsite mentoring to 2767 health workers in palliative
care services outlets. Private health providers will also be oriented on new products introduced on the
market including Cotramox, Acyclovir and a triple action topical cream of dermatological infections among
others. We will work together with the Association of Private Medical Practitioners to design refresher
training modules based on frequently asked questions from health workers in private practice. The health
workers will also be provided with the Palliative Care Handbook for continued reference as well as other job
aids and client materials.
AFFORD will conduct in-depth scale up of palliative care to the drug shop operators through its district
based trainers and field staff. More in depth detailing for the products already on the market and those
newly introduced for palliative care will be conducted, including ensuring steady supply for other products
such as Protector condom, condom ‘O', Aquasafe water purification tablet, Zinkid, Restors, and LLINs.
AFFORD will work with PLHA organizations to increase members' access to health maintenance products
and services. In collaboration with National Forum for PLHAs in Uganda, AFFORD will reach PLHA groups
like Positive Men's Union (POMU), National Community of Women Living with HIV/AIDS (NACWOLA), and
Young Positives. District networks of PLHAs will be supported to train their members in palliative care, and
availed with options on available outlets for service provision. A total of 500 PLHAs will be oriented and
these will in turn reach 15,000 PLHAs with palliative care information and products.
Through the Good Life communication platform, AFFORD will target PLHAs, their caretakers and families
with palliative care and health maintenance messages and direct them to outlets and providers that stock
quality products for health maintenance.
In FY 2009 AFFORD will also strengthen collaboration with other palliative care stakeholders to extend
products and services to a wider community beyond our targeted districts. AFFORD will collaborate with
organizations like The AIDS Support Organization (TASO), Joint Clinical Research Center (JCRC),
International AIDS Alliance and NUMAT to extend quality services to PLHAs. Through this intervention
AFFORD will reach 10,000 people with palliative care services and products.
Purchase and Distribution of OI Drugs
AFFORD will continue to use traditional social marketing to distribute a range of high quality palliative care
products targeted at PLHAs through private commercial channels (drug shops, pharmacies, clinics and
midwiferies). The range of products will include Cotrimoxazole (Cotramox) and Acyclovir (Clovirex), LLINs,
condoms, and multivitamin (Nutriboost). It should be noted that the palliative care program will leverage the
existence of products supported with child survival funds. These include Aquasafe (water purification
product), Zinkid (Zn) and Restors (ORS) and others like LLINs, condoms, and multivitamin (Nutriboost).
AFFORD plans to avail it through selected specialized clinics hospitals and other distribution networks for
AFFORD products.
Continuing Activity: 14222
14222 4409.08 U.S. Agency for Johns Hopkins 6743 3340.08 Health Comm $2,300,000
8440 4409.07 U.S. Agency for Johns Hopkins 4841 3340.07 Health Comm $2,000,000
4409 4409.06 U.S. Agency for Johns Hopkins 3340 3340.06 AFFORD $2,000,000
International University Center
Development for Communication
Estimated amount of funding that is planned for Human Capacity Development $610,000
Estimated amount of funding that is planned for Water $20,000
Table 3.3.08:
AFFORD has worked through the private sector to provide quality palliative care products and services to
PLHAs including provision of counseling and referral services for clients. In 2007/8 AFFORD developed a
network of100 private clinics referred to as the Good Life clinics that offer comprehensive service in
palliative care for individuals and families. In addition, AFFORD's wide network of other clinics, midwiferies,
pharmacies and drug shops across Uganda supports the intervention with information and carefully
coordinated referrals. The numerous communication channels developed are utilized in the promotion of
these services. Through this intervention the private sector is increasingly contributing its share to care for
PLHAs.
In FY 2008, AFFORD through its 510 private clinics providing palliative care the project reached 100,962
adult PLHAs with services and products. Over the years AFFORD has observed that demand for palliative
care services for children from PLHA families has been progressively increasing. Indeed family members,
care givers and children of PLHAs have received palliative care services from AFFORD supported clinics
and used palliative care products provided by these 510 clinics. Treatment of opportunistic infections has
also without doubt brought new hope and opportunities to individuals, families, and care givers of PLHAs.
As PLHAs regain their health and strength, they are in a position to change the predominant attitude of the
existing services in the private sector.
AFFORD has developed products that are being promoted to PLHAs for palliative care. Specific products
like Cotrimoxazole, Aquasafe water purification tablets, Restors low osmolarity ORS, Zinkid (Zinc treatment
for diarrhea in children under five) and long lasting Insecticide treated Mosquito nets (LLINs) are particularly
promoted for pediatric care of children living with HIV. All these products in distribution are available on the
market and in our supported clinics at subsidized prices.
behaviors, and increase demand for products and services. Areas of HIV focus included palliative care for
PLHAs (both adults and children), risk perception, condom use, HIV testing, disclosure, and PMTCT. In FY
2008, 24 episodes were broadcast on 3 TV stations, 20 radio stations in 5 languages and appeared in 120
locations countywide through the experiential road shows. The experiential road shows were further refined
to enhance interpersonal communication and resulted in the development of the "four tent" model. Using
this approach, fewer people gather under a tent to receive messages and are able to ask pertinent
questions which they otherwise would not have been able to ask.
FY 2009 ACTIVITIES - Reaching 12,000 children with care and treatment
Pediatric care and support
AFFORD's approach in the past years has targeted families and individuals with palliative care and support
for PLHAs. In FY2009 the project will expand its care and support activities to capture more children living
with HIV who require palliative care services and products. PLHAs accessing services from these clinics will
be used as index persons to link service providers to their families. AFFORD will invest in building
capacities of participating private clinics and enhance skills of providers so that they can better deliver
quality palliative care services for HIV positive children and young people below 17 years of age. As an
entry point into pediatric palliative care, participating clinics will be trained in dry blood spot (DBS-PCR)
testing for children.
Specifically AFFORD will be increasing the number of clinics in its Good Life network from 100 to 200 in 20
districts. The staff of the clinics will be trained in offering pediatric care for children living with HIV.
In FY2009,AFFORD through its partners and the Good Life Clinics will:
a) Strengthen skills of health workers in infant diagnosis of HIV
Being aware that early infant diagnosis can serve as the bridge between prevention care and treatment,
AFFORD will train health workers in private clinics to incorporate collection of dried blood spot (DBS) and
which will then be sent to regional hospitals and JCRC TREAT centers for HIV testing. Along side DBS will
be conventional HIV testing services for young people between 14-17 years of age will be continued.
b) Increase access to cotrimoxazole prophylaxis , safe water, diarrhea management and malaria
prevention interventions for children:
Prevention of opportunistic infections will be a critical component of pediatric care. Children with HIV
infection are susceptible to co -infection like tuberculosis, serious and recurrent pneumonia, meningitis,
malaria and diarrhea. Out interventions will focus on promoting cotrimoxazole prophylaxis, prevention of
diarrhea using water purification tablets (Aquasafe) and vessel and reducing severity and frequency of
Activity Narrative: diarrhea episodes using Restors and Zinkid, support distribution of LLINs to children and PLHA household
to reduce risk of malaria. In addition we will support and link care givers to immunizations programs in their
localities so that HIV positive children receive their routine immunization. Health workers will be trained to
provide routine follow to infected children.
c) Nutritional care:
Poor nutrition among HIV infected children weakens the immune system and exposes children to more
severe opportunistic infections. They are further at risk because of mal-absorption of nutrients, increased
metabolism due to infections and poor feeding habits. AFFORD will through the Good life clinics conduct
nutrition training for health workers who in turn through counseling and interpersonal communication will
pass on this important information to care givers of affected children. Care givers of these children will also
be linked to other implementing partners with nutrition and home based care programs. We will develop
nutrition job aids and other reference materials for both health workers and families of infected children.
An estimated number of 400 health workers will be trained to offer this specialized care. To support
providers to effectively take on this expanded role, AFFORD will provide job aids and support materials for
providers and client information on pediatric AIDS care.
Through the various channels mentioned above the project expects to reach about 4,000 children under two
years, 5000 between 2 and 14years and 3,000 between 14 and 17 years.
Estimated amount of funding that is planned for Human Capacity Development $80,000
Table 3.3.10:
