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
Activity Narrative
This activity also relates to other NUMAT activities which include, Prevention /Abstinence and Being
Faithful, Prevention Other, Adult and Pediatric care and treatment, Counseling and testing, Laboratory
infrastructure, Strategic Information and policy analysis system and strengthening. The NUMAT project,
which covers the sub regions of Acholi and Lango, was awarded in August 06 with FY 2006 resources. The
project covers 9 districts in the post conflict region of Northern Uganda with an overall goal of expanding
access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in
Northern Uganda. With both sub regions now enjoying relative peace, NUMAT has continued to place
emphasis on strengthening capacity and utilization of HIV/AIDS/TB and malaria services at all the different
levels of service delivery with special focus on HC IV and III which are close to where the population is
returning. The FY2009 activities are a continuation from FY2008.
In FY2008, NUMAT focused on improving and strengthening existing PMTCT services, especially in
hospitals, HC IVs and HC IIIs. Emphasis was also placed on scaling up services to more HC IIIs and
selected HC IIs with MCH facilities in order to increase access to services by the target populations. A total
of 80 sites were supported. NUMAT input was in the form of technical assistance (TA) through support
supervision and mentoring of PMTCT service providers; establishing and strengthening of the already
existing Family support groups (FSGs); distribution of IEC/BCC materials; delivery of data and Logistics
Management Information System (LMIS) tools; provision of buffer stocks of HIV test kits to sites
experiencing shortages; supporting the supply chain management with emphasis to PMTCT supplies (HIV
test kits, ARVs). NUMAT conducted trainings in the areas of new PMTCT policy guidelines giving
prominence to the combined ARV regimens and HAART for eligible HIV+ mothers; Integrated Infant and
Young Child feeding counselling; PMTCT counselling training; Early Infant HIV Diagnosis; and
implementation of FSGs. NUMAT strengthened PMTCT-ART collaboration activities in 10 PMTCT/ART
sites with specific attention to CD4 testing (while working with a contracted partner-Cnapsis), WHO clinical
staging, HAART initiation for eligible mothers and Opportunistic infections management / prophylaxis. In
Kitgum and Pader districts, the PMTCT activities were supported through AVSI as a grantee.
NUMAT continued to support the established FSGs at the health units and these helped mothers, their
partners and infants to access and adhere to ARV regimens and infant feeding options, and were able to
receive psychosocial support for their families. The members were also linked to ‘wrap-around' services
such as home based care, family planning, food and nutrition support. NUMAT also supported Rwot Ogwok
Ayaru Foundation (ROAF), a local CBO in Lamwo County in Kitgum, to conduct community based FSGs in
PMTCT sites of Padibe HC IV, St Peter and Paul Padibe HC III, and Madi Opei HC IV. A total of 202 HIV
positive mothers and their partners to benefit from these meetings that are conducted twice a month by
ROAF in addition to over 350 mothers and partners who benefit from facility based FSGs. Over 60 mother-
baby pairs have been followed up through home visits and FSG meetings.
NUMAT teamed up with the Ministry of Health and district partners to provide regular integrated PMTCT
and HCT technical support supervision to all sites in the 9 districts. During supervision visits, revised
PMTCT and HCT policy guidelines; Integrated MCH registers; LMIS and reporting tools; as well as IEC
materials on infant feeding were distributed to the sites. In addition, health workers were oriented on the
revised PMTCT and HCT policy guidelines (including HAART and use of combination regimens for PMTCT
as well as early infant HIV diagnosis) and how to use MCH registers and LMIS and reporting tools. The
supervision teams provided HIV test kits, Nevirapine tablets and suspension to facilities that lacked them.
NUMAT also supported formation of supervision teams in the districts of Gulu and Amuru and these were
able to carry out quarterly supervision visits.
A total of 116 health workers were trained as PMTCT and infant feeding counselors. The training helped to
prepare an additional 20 sites that will be fully supported in FY2009. NUMAT also conducted EID trainings
in the districts of Amuru and Apac in addition to Lira and Gulu regional referral hospitals where 203 health
workers from 32 PMTCT sites were trained. The health facilities were also supplied with EID materials.
Thirty six health workers were also trained in FSG implementation.
Because of the NUMAT support, over 56,000 pregnant women benefited from PMTCT services in form of
counseling, testing and receiving test results.
In FY 2009, NUMAT will continue to provide technical assistance to the existing 80 PMTCT sites and 20
new sites in the 9 districts of Gulu, Amuru, Kitgum, Pader, Oyam, Lira, Apac, Dokolo and Amolatar. The
scale up of PMTCT services to more sites will enable NUMAT to reach more pregnant women with the
services. The technical assistance will take the form of support supervision and mentoring of PMTCT
service providers; orientation of health workers in new PMTCT advances/policies as per MOH guidelines;
provision of buffer stocks of HIV test kits and ARVs for PMTCT; strengthen the supply chain management
with emphasis to PMTCT supplies. Support supervision will involve partners at 3 levels: 1) MOH led
supervision- to be conducted bi-annually will involve all the partners in the region, 2) District led supervision-
to be carried out quarterly in order to follow up recommendations by MOH teams, and 3) HSD led
supervision - to be done monthly in order to deal with all the site specific issues.
NUMAT will support the districts of Kitgum, Pader, Oyam, Lira, Apac, Dokolo and Amolatar to form PMTCT
support supervision teams both at district and HSD levels. The teams will be established according to the
MOH guidelines.
NUMAT will support integrated outreach services from health units to IDP camps. This will be done while
putting into consideration of the fact that IDP population is currently returning to their homes and that there
has been formation of satellite camps which are near to their homes in view of the human resource
challenges in the region. NUMAT will support NGOS and local CBOs especially in the areas of mobilization
for the outreach activities. Again, emphasis will be placed on areas with limited access to services.
To promote behavioural change and as part of health education, NUMAT will procure and distribute more
IEC/BCC materials and equipment to all the 100 PMTCT sites. The materials will focus on male partner
Activity Narrative: involvement, early infant HIV diagnosis, ARV adherence, ANC attendance and hospital delivery. Radio talk
shows on local radio stations will be strengthened. Drama activities will also be conducted, by locally based
CBOs, like ROAF, focusing on all PMTCT interventions.
A total of 72 health workers will be trained in PMTCT counseling, another 180 (20 per district) will be
trained in family planning counseling within the context of HIV/AIDS. NUMAT will partner with Engender
Health and Family Planning Association of Uganda to support Family planning services with emphasis to
dual protection.
PMTCT orientation trainings mainly targeting the newly recruited health workers will be supported. This will
be supplemented by attachment of health workers, especially from peripheral/lower health facilities to HC IV
and hospitals to acquire the necessary "hands-on" skills. More health workers in the districts of Pader,
Kitgum, Gulu, Lira, Oyam, Dokolo and Amolatar will be trained in DBS collection and supplies will be
provided. Districts will also be supported to transport blood samples (DBS) for DNA-PCR testing to the
JCRC laboratory center of excellence in Gulu at least twice a month, so that tested children can be linked to
care and support. NUMAT will also support more training in integrated infant and young child feeding
counseling where 72 health workers will be trained.
NUMAT will support regional PMTCT bi-annual coordination meetings in each of the sub-regions for
purposes of sharing experiences, challenges upholding best practices, and addressing site/district specific
PMTCT related issues/challenges. This will bring together all PMTCT stakeholders and partners in each of
the regions. The existing Family support groups will be strengthened and 12 more will be established. In
order to strengthen the community component of PMTCT, peer mothers and fathers, community counseling
aides and other community owned resource persons will be provided with skills to provide support to HIV
positive mothers and their families. Sexual and gender based violence (SGBV) activities will be incorporated
within the PMTCT services. Safe motherhood, including post-natal services and follow up of babies with
emphasis on immunization, growth monitoring and infant feeding will be given priority in PY3.
PMTCT-ART linkages will be strengthened in all ART sites to enable health workers to offer care and
support to HIV positive women and their HIV+ family members/partners - including co-trimoxazole
prophylaxis and CD4+ services - and enable eligible individuals to access ARVs. Coordination meetings
and CME sessions between ART and PMTCT/MCH departments will be supported in order to strengthen
the linkages. This will mainly target large facilities like hospitals where departments tend to exist/operate
independently and or in isolation. This will be in addition to already supported CME monthly sessions for the
regional hospitals.
NUMAT will continue to partner with AVSI in the districts of Pader and Kitgum in the delivery of PMTCT
services. Emphasis will be placed on scaling up PMTCT services to more sites. Additionally, under the AVSI
grant, NUMAT will provide food/nutrition support to 60 HIV+ pregnant/ lactating women.
Apart from supporting established channels of follow up like immunization clinics, Post-Natal Clinics, FGSs,
NUMAT will support local CBOs to follow up mothers and their babies. Additionally, realizing that only 38%
of mothers deliver in health units, NUMAT will support the training of Traditional Birth Attendants, Village
Health Teams, Community Drug Distributors and CBOs to help the referral for accessing PMTCT
interventions and also the follow up of mother-baby pairs in the communities.
In FY 2009, NUMAT targets to have 122,295 pregnant women counselled, tested and receive results from
the 100 NUMAT supported PMTCT sites. This translates into 7,949 HIV+ mothers (6.5% of those tested)
and of these NUMAT targets to have 7,429 (80%) HIV+ pregnant women receive ARV for PMTCT
prophylaxis and a similar number of infants (100%) born to HIV + mothers to receive ARVs for prophylaxis.
This is possible since Nevirapine suspension can now be repackaged and given to pregnant women. It is
also expected that 50% (2,475) of all HIV + pregnant women will have their CD4+ counts done to assess
their eligibility for HAART in addition to WHO clinical staging. The PMTCT_ART collaborative activities will
be strengthened in mainly the 23 NUMAT supported ART sites and approximately 1,120 (20% of HIV +
pregnant women) are expected to be eligible for HAART.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15467
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15467 4696.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $850,000
International
Development
8466 4696.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $761,542
International UPHOLD/PIASC
Development Y Primary;
TASO; AIC;
Conflict
4696 4696.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $250,000
International Districts
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Refugees/Internally Displaced Persons
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $120,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $4,000
Economic Strengthening
Education
Water
Table 3.3.01:
This activity also relates to Counseling and Testing, Prevention Of Mother To Child Transmission, Adult
Care and Treatment, Strategic Information and Health Policy Analysis Systems and Strengthening. The
NUMAT project, which covers the sub regions of Acholi and Lango, was awarded in August 06 with FY
2006 resources. The project covers 9 districts in the post conflict region of Northern Uganda with an overall
goal of expanding access to and utilization of HIV, TB and malaria prevention, treatment, care and support
activities in Northern Uganda. With both sub regions now enjoying relative peace, NUMAT has continued to
place emphasis on strengthening capacity and utilization of HIV/AIDS/TB and malaria services at all the
different levels of service delivery with special focus on HC IV and III which are close to where the
population is returning. This activity is a continuation from FY 2008.
In FY 2008 NUMAT reached an estimated 198,497 people with HIV prevention messages through
promoting positive social norms and healthy sexual behaviors such as abstaining from sex till marriage and
being faithful to one faithful partner, correct and consistent condom use, as well as issues related to stigma
and discrimination, and sexual and gender based violence. Approximately 68,185 youth were reached with
abstinence only messages, 136,345 were reached with AB messages and 62,150 were reached with other
prevention messages. NUMAT strengthened the capacity of the 9 Youth Advisory Groups . A total of 87
master trainers were trained to facilitate the roll-out of HIV prevention activities among the youth both in
and out of school. These master trainers trained 728 peer educators and provided them with monthly
supportive supervision which included discussions on their experiences, lessons learnt and data collection
on the number of people reached by prevention messages. Using a variety of tested approaches, messages
on abstinence, delayed sexual debut, faithfulness and condom use were relayed to and promoted among
both in school and out of school youth by the peer educators. NUMAT trained 480 religious and cultural
leaders on issues of HIV/AIDS response and on Stigma and discrimination reduction.. These leaders
reached an estimated 37,000 people with AB messages as well as issues related to stigma and
discrimination of People living with HIV. NUMAT trained and provided follow up support to over 690
community resource persons (animators) on SGBV and its link to HIV transmission. The animators in turn
sensitized the community in camps and in the return sites on gender, sexual and reproductive health rights.
They also helped in reporting and referring SGBV cases for immediate medical and legal support. Over
35,984 people were reached by NUMAT's supported SGBV activities.
Working with local CSOs, women's groups and the uniformed forces including the UPDF, Prisons and
Police, behaviour change agents trained the previous financial year increased the demand of condoms and
reduced high risk behaviors among an estimated 1,826 adults and most at risk populations. The BCAs
sensitized their peers and community members and referred them to other HIV services like HCT, PMTCT
ART,HBC and other economic empowerment activities (including Village Saving and Loans Associations).
In FY 2009, NUMAT will support activities that build on those achieved from FY 2008. These will include the
following:
ACTIVITY UNCHANGED FROM FY 2008
• Facilitating the establishment of youth and parental committees that will strengthen community dialogues
between the youth and adults about issues affecting young people such as improving parent-child
communication on HIV and sexuality.
• Supporting families and communities to build skills that promote sexual norms and behaviors , working on
issues related to Stigma and discrimination and Gender Based Violence by promoting family life education
and addressing other gender issues;
• Engaging community leaders, uniformed services and the police including community security guards in
programs to reduce SGBV; prevent HIV and empower communities to promote societal norms that reduce
the risk of HIV transmission and promote the use and access to condoms and HIV counseling and testing
services.
• NUMAT will work with the district GBV working group and other stakeholders to map SGBV services and
actors , and also to undertake a Community KAP assessment which will help inform the IEC SGBV
strategy.
•Supporting media campaigns that reinforce and make abstinence, fidelity, partner reduction, HIV
counseling and testing, and other safer behaviors legitimate options and standards of behavior for both
youth and adults; For example, Supporting IEC/BCC activities that promote positive behaviors for the
prevention of HIV infection, TB and malaria. Of particular interest will be messages regarding alcohol
consumption and risk taking behaviors.
• Carrying out campaigns to sensitize the community about HIV prevention, stigma and discrimination as
well as sexual and gender based violence
• With the mobilization of FBOs for prevention (primarily abstinence/faithfulness) activities using the
Channels of Hope methodology, NUMAT will support activities that emphasis reduction of stigma and
discrimination among PHAs, abstinence, fidelity, partner reduction, HIV counseling and testing, and other
positive social norms for both youth and adults
• NUMAT will continue supporting youth-led community programs to help youth, their parents, and the
broader community, personalize the risk associated with early sexual activity, sex outside of marriage,
multiple partnerships, and cross-generational and transactional sex.
• NUMAT will also continue supporting the review, revision and adaptation of other curricula, interactive
materials, radio programmes and toolkits available in the country to make them suitable for the districts in
Acholi and Lango regions. HIV prevention messages will be linked to health centers and CSO that provide
HCT, reproductive health and condom services in addition to vocational training and economic
empowerment activities.
• NUMAT will continue working with NGOs and CSO, as well as the UPDF to increase demand for
condoms. Targeted messages for most at risk groups will be developed, as well as determining best
locations and distribution points for condoms. The project will also continue working with PHA groups to
integrate condom messages and distribution into ongoing service provision activities.
• NUMAT will also support other prevention efforts like syndromic management of STIs which will be
integrated in all other areas. This will include integrated training of health workers in management of STI
and HIV/AIDS, supporting logistics for STI drugs including procurement of STI drugs should situations of
stock outs occur. Supporting integrated support supervision of STI with HIV/AIDS activities as well as linking
Activity Narrative: STI clients to HCT within their treatment areas and through referral from lower units.
• Instead of rolling out PIASCY as initially planned in FY 2008 this ACTIVITY HAS BEEN MODIFIED IN
THE FOLLOWING WAYS:
• NUMAT will use the Adventures Unlimited, Choose Freedom and YEAH Campaign Curricula to
compliment the PIASCY program that will be rolled out by the UNITY project in the region. NUMAT will train
teachers, youth leaders, peer educators and mentors identified through the community, schools and youth
groups. These curricula will equip youth with "value-based life skills" to enable them make informed choices
and avoid risky behaviour.
Continuing Activity: 15468
15468 8775.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $800,000
8775 8775.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $550,000
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Military Populations
Estimated amount of funding that is planned for Human Capacity Development $60,000
Table 3.3.02:
• Supporting media campaigns that reinforce and make abstinence, fidelity, partner reduction, HIV
Continuing Activity: 15473
15473 4698.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $250,000
8467 4698.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $250,000
4698 4698.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $450,000
Estimated amount of funding that is planned for Human Capacity Development $56,425
Table 3.3.03:
This activity also relates to Prevention /Abstinence and Being Faithful, Prevention Other, PMTCT, Adult and
Pediatric care and treatment, Counseling and testing, Laboratory infrastructure, Strategic Information and
policy analysis system and strengthening. The NUMAT project, which covers the sub regions of Acholi and
Lango, was awarded in August 06 with FY 2006 resources. The project covers 9 districts in the post conflict
region of Northern Uganda with an overall goal of expanding access to and utilization of HIV, TB and
malaria prevention, treatment, care and support activities in Northern Uganda. With both sub regions now
enjoying relative peace, NUMAT has continued to place emphasis on strengthening capacity and utilization
of HIV/AIDS/TB and malaria services at all the different levels of service delivery with special focus on HC
IV and III which are close to where the population is returning.
In FY2008, NUMAT continued to strengthen relationships with stakeholders in the various district local
governments and the communities. Working partnerships were forged with various agencies for example
WHO, NGEN+, PSI, JCRC, CNAPSIS and others as their respective areas of expertise were exploited to
improve the access and quality of treatment, care and support for the HIV positive population of Northern
Uganda. NUMAT partnered with WHO, the AIDS control programme and Palliative Care Association of
Uganda to provide training for 170 health workers in various aspects of adult care and treatment, including
pain and symptom management for HIV patients, management of OIs, and integrated management of Adult
infectious diseases (IMAI). The trainings were augmented with on site mentor ship by technical support
teams from NUMAT and the Ministry of Health. NUMAT also supported training of trainers in
comprehensive HIV care and aspects of palliative care that would add to the professional resource of the
region. Medical students from Makerere University were also engaged to gain experience as they supported
the human resource gaps at the various sites. In a bid to support the training young doctors at Gulu
University, NUMAT intends to support the publication, printing and dissemination of the 2008/2009 Gulu
University Medical Journal that will carry an HIV related theme. Meanwhile after a year of putting structures
and processes in place to support an efficient ARV drug supply, the drugs were finally delivered to 17 sites
supported by NUMAT, 6 additional sites were identified for assessment and were subsequently accredited
by MOH. All the NUMAT supported health facilities are district hospitals, health centre IV and III that
chronically lack adequate staffing and laboratory capacities. In effort to improve confidence and utilization of
these 23 ART sites and decongest larger health facilities like the regional referral hospitals, several
complimentary areas of support for treatment, care and support were addressed. In conjunction with JCRC
and CNAPSIS Free CD4 and full blood count testing were offered to all clients accessing care at the health
facilities. This resulted in a 65 percent increase of enrolment of clients onto ART as a result of the free CD4
tests provided. Health workers felt motivated to work by this support. Limitations in community follow up
were addressed by promoting and motivating the set up and development of PHA groups and Networks.
The JSI arm of NUMAT supported the mobilization and training of 103 PHA volunteers to work as Network
support agents (NSA) in 45 health facilities. Other than their role to link fellow PHAs and family members to
community and health facility- based care and treatment services, the NSAs also supported counseling,
community based care and support. Further home based care was provided through World Vision's
community care coalition (CCC) that came into being when 750 home based care providers from the nine
districts were trained to support HIV adults in the community by monitoring their health, monitoring
adherence, offering on going counseling and identifying needs for wrap around services that guided referral
for appropriate care.
In FY 2009, NUMAT will continue to coordinate, promote and implement adult care and treatment activities.
HIV related care activities will be scaled up and consolidated in lower health units, Sub County, parish level
and small transit IDP camps with special emphasis on hard to reach and high risk communities. Paramount
in this effort is the adoption of the "Model Site Concept" that will make it possible for PHAs and all the
communities in these unique settings to receive holistic prevention, treatment, care and support services.
This will involve implementing synchronized activities from all the NUMAT program areas as well as that of
the collaborators. NUMAT will also continue to improve linkages for PHAs and their families to essential
clinical and wrap around services including food, material support, and family planning in the project
catchment area. Training and motivation of Network support agents and community health workers will
continue promoting both community and facility based adherence monitoring, tracing and follow up. It is
envisaged that by participation of PHAs themselves, more patients will be encouraged to seek and remain
in care. The expansion of community care services and referral networks will be promoted by PHAs working
in collaboration with health facilities, NGOS, CBOs and the World Vision promoted Community Care
Coalitions (CCC). NUMAT through strengthening collaborating partnerships with other USG supported
programs like PSI, IRCU, AFFORD, IHAA, NuLife will improve the availabilities of wraparound services for
PHAs. These services will include delivery of prevention & care packages for PHAs including Cotrimoxazole
prophylaxis for opportunistic infections (OIs), ITNs , peer psychosocial support, IEC/BCC for prevention
among the positives, condoms and ART. At health facility level, on site mentorship for health workers for
Adult HIV treatment and care will continue. Specific formal trainings, especially in ART and OI management
and the various aspects of palliative care will be carried out to keep up with gaps created by the high
turnover of the human resource in many of the health facilities. Both financial and non financial forms of
motivation will be provided to the health workers. Non financial motivation will include sponsorship for
workshops, seminars and exchange visits where appropriate. NUMAT will also be involved in Adult
comprehensive care training and related programs when the Gulu University Journal is produced carrying a
relevant HIV related theme. IEC/BCC materials that were produced and translated in the previous period
will be printed and disseminated. The Ministry of Health will continue to provide support supervision and
spearhead assessment and accreditation of additional ART clinics to achieve the target of 30 clinics. As the
ART clinics are rolled out and strengthened, NUMAT will carry out a baseline survey on patient retention
and adherence on the ART programs. Results of the survey will support further evaluations of the quality of
care at the sites. NUMAT will offer a total of 21,880 free CD4 tests and about 600 full hemogram tests to
PHAs through AIC and CNAPSIS. This is an increase from 4800 CD4 tests offered in the last FY. NUMAT
has supported capacity building as regards CD4 testing by conducting training for health workers in HIV
care and by on site mentoring focusing on CD4 utilization. Threshold sentinel testing of ARV drug
resistance will also commence according to work plan in a bid to ensure efficacy of ARV drugs.
Continuing Activity: 15480
15480 4699.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $1,000,000
8468 4699.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $871,966
4699 4699.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $871,966
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.08:
Continuing Activity: 15488
15488 4705.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $800,000
8472 4705.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $800,000
4705 4705.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $755,000
Estimated amount of funding that is planned for Human Capacity Development $25,000
Table 3.3.09:
In FY2008 only 127 children in NUMAT supported facilities were on ART, of these only 9 were below 2
years of age. Health workers considered pediatric treatment, care and support complicated and preferred to
refer the children to bigger hospitals for specialist management. HIV led many children to be orphaned while
others were additionally ill. This caused the children to loose out on appropriate screening, prevention and
treatment of malaria, parasitic infestations, malnutrition and other childhood diseases. NUMAT embarked on
rigorous capacity building for the health workers at the supported health facilities. The trainings covered
ART, palliative care and various aspects of pediatric psychosocial support. 36 health workers were trained
in comprehensive pediatric care and treatment. 96 health workers also trained in pain and symptom
management for HIV patients and management of OI's whose benefits were cross cutting addressing
treatment and care in both adults and children. Up to 660 children were also offered free CD4 and full blood
count testing as part of the process of scaling up access and quality of ART in the supported sites. Early
infant diagnosis was also supported in 10 sites. All these efforts led up to 40 percent of tested infants and
children found eligible. While NUMAT planned and procured Adult ARV formulations for some of the older
children. Meanwhile the need for pediatric formulations for the younger children led to negotiations with
Baylor Children's College Uganda who could additionally impart best practices and clinical skills in
paediatric care to the health workers in the supported sites.
During the same period 750 home based care providers from the nine districts were trained to support HIV
positive children in the community by monitoring their health status, monitoring ART adherence, offering
them on going counseling and identifying economical, social, educational and psychological effects of
HIV /AIDS on the children so that they could be referred for appropriate care. The project also mobilized
and trained 103 PHA volunteers to work as Network support agents (NSA) in 45 health facilities. In addition
to their cardinal role of linking fellow PHAs and family members to community and health facility- based care
and treatment services, NSAs also supported children with counseling, community based care and support.
In FY 2009, NUMAT will scale up paediatric care and treatment activities through coordination with MOH,
district local governments, other agencies and communities. More HIV affected children including those
actually HIV positive will benefit from an increase in the number of Health facilities able to provide holistic
paediatric care. This will be made possible as MOH supports NUMAT led site assessments and
subsequently accredits suitable ART sites. By the end of the period NUMAT will have supported up to 30
accredited sites.
Some of these sites will be "model sites" - hard to reach and high risk communities targeted by NUMAT with
an aim of increasing access and quality of holistic treatment and care for children and their families. The
model site concept is a synchronised effort by all the different NUMAT program areas providing holistic
clinical and community based support for children in, transit IDP camps, fishing villages, military camps and
other environments that increase their vulnerabilities to HIV, malaria and Tuberculosis.
NUMAT has signed an MOU with Baylor Children's College Uganda (BCCU) forging a partnership with an
objective of promoting skills of health workers in paediatric care through pedagogic and on site mentorship
in all aspects of Pediatric HIV treatment, care and psychosocial support with particular consideration for
disclosure and promoting life skills in children, adolescents and their caregivers affected by HIV. BCCU will
also supply pediatric formulations for children less than 5 years of age. Comprehensive paediatric care will
also encompass growth monitoring, and management of childhood diseases. Other routine support for child
health for instance, nutritional assessments of anthropometric status, immunisation, provision of promulti-
micronutrient supplements, therapeutic or supplementary feeding support for clinically malnourished
patients, infant feeding support will be promoted. NUMAT will support PHA networks and other groups that
provide psychosocial and wrap around support for children, adolescents, caregivers and families.
Additionally, NUMAT will make use of home visitors coordinated by Community care coalitions (CCCs) that
will provide Community based ARV adherence monitoring and follow up for the children.
CD4 and full blood count testing at all the NUMAT supported sites will continue albeit at a larger scale than
in PY2. A total of 21,880 CD4 tests and about 600 full hemogram tests will be offered to both children and
adults requiring the test through AIC and CNAPSIS. This is an increase from 4800 CD4 tests offered in the
last FY. NUMAT has supported capacity building as regards CD4 testing by conducting training for health
workers in HIV care, by on site mentoring focusing on CD4 utilization.
Linkages with other program areas including the PMTCT program will be strengthened. Early Infant
Diagnosis will be scaled up by training health workers in dry blood spot collection and communities will be
sensitised to link children with essential HIV clinical services. Communities will also be encouraged to link
HIV affected children to wrap around services including food, material, and educational support. Referral
networks involving PHA groups, health facilities, NGOS, CBOs and Community Care Coalitions (CCC) will
allow the expansion of access to these services. The health visitors shall continue to monitor the health
status of children in their homes; monitor ARV adherence, identify economic social, educational and
psychosocial effects of HIV and AIDS on children and refer them for the wrap around services.
Collaboration with other USG supported programmes like PSI, IRCU, AFFORD, IHAA, NuLife to exploit
initiatives will additionally expand and improve care and support for children. Benefits would include
promotion of prevention & care packages including Cotrimoxazole prophylaxis for opportunistic infections
(OIs), ITNs , and additional psychosocial support.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.10:
Activity Narrative:
Continuing Activity: 15487
15487 15487.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $1,100,000
Table 3.3.11:
This is part of NUMAT activities which include Prevention/Abstinence and Being Faithful, Prevention Other,
PMTCT, Adult and Pediatric care and treatment, Counseling and testing, Laboratory infrastructure, Strategic
Information and policy analysis system and strengthening. The NUMAT project, which covers the sub
regions of Acholi and Lango, was awarded in August 06 with FY 2006 resources. The project covers 9
districts in the post conflict region of Northern Uganda with an overall goal of expanding access to and
utilization of HIV, TB and malaria prevention, treatment, care and support activities in Northern Uganda.
With both sub regions now enjoying relative peace, NUMAT has continued to place emphasis on
strengthening capacity and utilization of HIV/AIDS/TB and malaria services at all the different levels of
service delivery with special focus on HC IV and III which are close to where the population is returning. The
FY2009 activities are a continuation from FY2008.
In FY 2008 NUMAT continued supporting the nine districts in strengthening CB-DOTs activities and TB/HIV
collaborative activities. 565 Health workers as well as 59 Network support agents were trained in TB/HIV
collaborative activities. 30 Health workers from Gulu and 40 from Lira were trained on CB DOTS activities.
All the districts were supported to conduct quarterly support supervision for health workers and community
volunteers involved in CB-DOTs and TB/HIV collaborative activities. NUMAT supported the dissemination of
TB/HIV policy guidelines and TB/HIV communication strategy to the districts' TB/HIV stake holders. This
has helped the implementation of TB/HIV collaborative activities in the districts.
TB/HIV collaboration zonal activities were supported including quarterly support supervision by the Zonal
TB supervisor together with NUMAT technical team. All the 9 districts were supervised and during this
supervision, 86 Health units were visited and 216 health workers were supported (trained on Job) mainly on
treatment of patients and recording and reporting especially of TB/HIV data. 23 patients on CB-DOTS were
visited by the Zonal supervisor and the NUMAT technical team. Radio programmes have been supported to
sensitise communities on TB/HIV related issues. As a result of NUMAT TB and TB/HIV supported activities,
a total 6388 TB patients in 2008 were started on TB treatment of these, 3176 were new sputum positive
cases, giving a case detection rate of 70.3% and 3759 were put on CB-DOTS strategy.
On TB/HIV, out of the total 6388 started on TB treatment, 3589 (56.2%) were tested for HIV and given
results, 2015 patients were found to be co-infected and of these 50.1% were put on co-trimoxazole
prophylaxis.
Most of the targets were achieved apart from the Proportion of TB patients tested for HIV and given results
where the target was 70% and we achieved 56.2%. This needs more effort especially on recording and
reporting of all TB patients tested for HIV.
In FY2009, NUMAT will build on achievements of FY2008 and will continue supporting the following
activities;
The 9 districts in Acholi and lango will continue to be supported to carry out TB/HIV trainings, planning
meetings, support supervision and delivery of drugs and logistics to the patients. NUMAT will make TB/HIV
training of the health workers in the lower level health units a priority since the trainings of the two referral
hospitals are over. NUMAT will first train the District health workers who in turn will train the lower level units
in their respective districts. This will increase the number of TB patients tested for HIV from the present
56.2% to over 70% next year. This will in turn increase TB patients on HIV care.
NUMAT will Continue supporting community education efforts that provide simple messages about TB
symptoms and the importance of early detection and complete cure.
Drugs and other logistics are essential in TB control activities, therefore, NUMAT will Continue providing
logistical support to assure drugs and other supplies are secure and reach health units in time.
NUMAT will continue providing support to the zonal TB supervisor and District TB supervisors in form of
allowances and fuel so that they are able to provide supervision and on job training of Sub County Health
Workers (SCHWs).
The districts in collaboration with NTLP will be supported to develop appropriate IEC/BCC messages and
tools to improve awareness of TB/HIV services and the need for HIV and TB testing. This is in the process
and NUMAT is working with Health Communication Partnership to ensure that messages applicable to the
two regions of Acholi and Lango are produced.
NUMAT will extend TB and TB/HIV services to those at risk eg those in prisons, police and the army by
supporting the districts to carry out tests, trainings and support supervision in these uniformed forces.
All the districts will be supported to improve on infection control measures so as to reduce TB/HIV co-
infection. This will be done by supporting the districts to develop Infection Control plans in their health
facilities and infection control topics will be included in TB/HIV trainings for the lower level units' health
workers. NUMAT will improve the TB unit in Aduku Health centre IV by putting up a shed with benches and
create more space for clients so as to reduce congestion thus improving infection control there.
NUMAT will continue to support the strengthening of HIV/TB collaborative activities. This will be through
activities that will see more TB patients screened for HIV, and more HIV patients screened for TB. The
NUMAT technical staff in TB, PHA, ART and PMTCT/HCT will continue working together integrating
screening of TB in HIV patients/clients and integrating co-trimoxazole prophylaxis and ART into care for
TB/HIV co infected. NUMAT will train health workers in TB /HIV collaborative activities and also encourage
and support joint planning for TB/HIV at the district and facility levels.
Districts will be supported to carry out integrated out reaches and NUMAT will provide logistics to the district
technical people (DTLS and DLFP) to visit the non diagnostic health units so as to screen and test patients
for TB and HIV. The patients found positive will be referred for the appropriate care. In order to get credible
and early information, NUMAT will facilitate all the districts' TB Supervisors (DTLS) by giving them transport
support to collect TB data on a quarterly basis to reduce delays in reporting.
The project will continue working with NTLP, NGO hospitals, Private practitioners, Tuberculosis Control
Assistance Program (TBCAP), CDC, WHO, AVSI, CBOs, and GLRA on TB and TB/HIV activities.
Continuing Activity: 15481
15481 4700.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $600,000
8469 4700.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $600,000
4700 4700.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $559,824
Table 3.3.12:
This is part of NUMAT activities which include Prevention /Abstinence and Being Faithful, Prevention Other,
Adult and Pediatric care and treatment, PMTCT, Laboratory infrastructure, Strategic Information and policy
analysis system and strengthening. The NUMAT project, which covers the sub regions of Acholi and Lango,
was awarded in August 06 with FY 2006 resources. The project covers 9 districts in the post conflict region
of Northern Uganda with an overall goal of expanding access to and utilization of HIV, TB and malaria
prevention, treatment, care and support activities in Northern Uganda. With both sub regions now enjoying
relative peace, NUMAT has continued to place emphasis on strengthening capacity and utilization of
HIV/AIDS/TB and malaria services at all the different levels of service delivery with special focus on HC IV
and III which are close to where the population is returning. The FY2009 activities are a continuation from
FY2008.
In FY 2008, NUMAT supported HCT activities together with AIDS Information Centre (AIC), the NUMAT sub
-partner; National Guidance and Empowerment Network of People Living with HIV/AIDS (NGEN+); Straight
Talk Foundation / Gulu Youth Centre; among others. These partners helped to roll out HCT services
through voluntary CT, provider initiated CT and outreach approaches by targeting the most at risk
populations, namely internally displaced persons in camps, youth, prison inmates, uniformed personnel,
students in higher institutions and fishing communities. A total of 91 health facilities including hospitals,
health centre IVs, health centre IIIs and selected health centre IIs were supported to provide HCT. The
support offered included: technical supervision; capacity building; provision of logistics tools, registers,
cards and HIV test kits to facilities without these commodities.
Ten Post Test Clubs (PTCs) were established in 5 districts of Amuru, Amolatar, Apac, Dokolo and Oyam
and the clubs were supported with equipment and costumes for drama and music activities. Over 3,000 HIV
positive and negative individuals have benefited from PTC activities including psycho-social support
meetings; educational talks; and music, dance and drama activities. A total of 404 health workers from
Gulu and Lira regional referral hospitals were trained in provider initiated counseling and testing while 161
support and administrative staff from the same hospitals received orientation. Blood samples were sent to a
reference laboratory at Uganda Virus Research Institute for quality control/assurance of HIV tests
conducted in all sites. As a result of the mentioned support, over 100,000 people benefited from HCT
services from the project supported static and outreach sites in FY 2008. The average sero-positivity rate
was 12.6%.
Activities for FY 2009 will build on FY 2008 achievements and will involve working closely with the central
and local governments, CSOs and the private sector, to develop HCT services tailored not only to
individual, family and community needs but also to the needs of the most at risk populations. NUMAT will
consolidate and strengthen existing facilities, where HCT services are provided and support the
establishment of new HCT service delivery points. This will be done in order to increase geographical and
population coverage. The project will also support the roll out of the national approach of provider-initiated
HCT to all hospitals and selected HC IVs. NUMAT partner, AIC will continue to take lead in HCT activities
and work to transfer best practices to government systems, including the VCT model of HCT service
delivery. NUMAT will continue to support directly other CSOs that have demonstrated capacity to provide
out reach HCT services to difficult to reach areas. Using the Ministry of Health approved curriculum within a
rationalized human resources development strategy, health workers will be trained as HIV/AIDS counsellors
and laboratory and other critical staff will be trained on HIV testing in selected facilities. Counselors will also
be trained to deal with pediatric and couples counseling. NUMAT will also work with the existing structures
and local human resources in camps; integrating HCT activities into existing activities and strengthening
existing groups like CBOs. NUMAT will continue to support outreach services in HCT to peripheral
communities and IDPs and to identified most-at-risk-populations including fishing communities. Other
populations vulnerable to HIV infection, such as pregnant women and their partners, TB-infected individuals
and persons with STIs will be given particular attention. The outreaches will be initially to HC III facilities that
do not have the capability to offer these services. Logistical support will be provided by NUMAT to enable
implementation of these activities. NUMAT will focus on integrating prevention, care and support services
into ongoing outreaches and fill gaps in the 9 districts. In addition, referrals will be emphasized to ensure
linkages between community and facility-based HCT, care and support services so that the tested
individuals can access a wide range of wrap around services. HIV testing at static and outreach sites will
generate a lot of wastes. NUMAT plans to procure waste management supplies including bins, bin liners
and fuel as well as protective wear in order to handle these wastes and control infections. Support will also
be extended towards transportation of wastes for incineration to Lira and Gulu regional referral hospitals.
In order to increase demand for testing, targeted HCT promotion and community mobilization as well as
distribution of IEC materials in all communities will continue to be given attention. Targeted populations will
include groups at most risk like discordant couples and those engaged in transactional sex. Where
appropriate materials do not exist for certain populations or language groups, either existing materials will
be translated and /or adapted or new materials will be developed using a participatory process. To ensure
the smooth flow of supplies for uninterrupted service delivery, the project will invest in logistics training of
the concerned health workers with support from SCMS and MOH. The project will also support the District
Health Offices and CSO providers of HCT accessing to supplies and test kits from National Medical Stores.
The project will continue to support procurement of US and Ugandan government approved buffer test kits
and work with the existing distribution systems to ensure their constant availability at all supported sites.
NUMAT will establish PTCs at selected health facilities providing HCT as well as camps that do not
currently have such groups. Each PTC will be supported to form a drama group for sensitizing and
mobilizing people to access HCT, availed psychosocial support counselors to offer ongoing counseling to
members, provided with regular educational talks and indoor games and also provided with training in peer
education and other activities. Working with PTCs and through strengthening referral mechanisms, those
who test positive from the HCT sites will be supported and linked to a wide range of palliative care, ART and
other wrap around services. Quality control/assurance will be strengthened in order to promote provision of
quality services.
Continuing Activity: 15486
15486 4702.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $570,000
8470 4702.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $500,000
4702 4702.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $400,000
Table 3.3.14:
Introduction and overview of the organization and project:
This activity relates to Prevention /Abstinence and Being Faithful, Prevention Other, PMTCT, Palliative care:
Basic health care, Counseling and testing, ART, Strategic Information and policy analysis system and
strengthening. The NUMAT project, which covers the sub regions of Acholi and Lango, was awarded in
August 06 with FY 2006 resources. The project covers nine districts in the post conflict region of Northern
Uganda with an overall goal of expanding access to and utilization of HIV, TB and malaria prevention,
treatment, care and support activities in Northern Uganda. With both sub regions now enjoying relative
peace, NUMAT has continued to place emphasis on strengthening capacity and utilization of HIV/AIDS/TB
and malaria services at all the different levels of service delivery with special focus on HC IV and III which
are close to where the population is returning.
Progress to date and outline of activities and achievements:
In FY 2008 NUMAT embarked on the process of refurbishing selected laboratories at HC III in the nine
districts to meet the standards set by the Ministry of Health. Following an in-service training curriculum 59
practicing laboratory personnel were trained on tests for diagnosis and management of HIV/AIDS/TB and
malaria; 17 clinicians attended a Training of Trainers' (ToTs) course on rational utilization of laboratory
services - capacity building for the district personnel in preparation for the roll out of the re-orientation of
clinicians on rational laboratory utilization in the districts; Seven students from the project districts have
been sponsored in various laboratory training schools for a two year Laboratory Assistants' course; these
students are bonded to districts and after completion of training will have to serve in the districts; select
equipment such as Microscopes, Manual centrifuges, Refrigerators, Colorimeters, Water filters, Microlitre
pipettes, Counting chambers, Tally counters have been provided to 29 health facilities based on the gaps
identified; these 29 laboratories have capacity (personnel and equipment) to provide both HIV testing and
HIV disease monitoring tests. A total of 64 health unit laboratories were supervised by District Laboratory
Focal Persons (DLFPs), National trainers/supervisors and Central Public Health Laboratories (CPHL) staff
and an improvement in the quality of laboratory services was registered. Nine DLFPs from the project area
were attached to Uganda Virus Research Institute - HIV Reference Laboratory for five days for mentoring
and enhancement of their competencies in quality control for HIV/AIDS diagnosis and monitoring clients on
ART; Reference text books (District Laboratory Practice in Tropical countries, Part 1 and 2 by Monica
Cheesebrough, Microscopy of Tropical Diseases - Colour plates learning bench aid series) were provided
to 64 health facilities with functional laboratories to provide back up to enhance quality day to day service
provision as most laboratories are run by one staff. An estimated 80,000 HIV tests; 8,100 tests for TB;
14,000 Syphilis tests and 1,500 HIV monitoring test were performed during the reporting period.
Activities for FY2009:
In FY 2009, for the laboratory infrastructure program area, NUMAT project will continue building on the
achievements gained through the joined efforts of partners and agencies such as CDC, UNICEF, UNOCHA,
WHO supporting the laboratory sector. This will be through strengthening the laboratory capacity at the
lower level of the health systems, particularly HC III. ALL ACTIVITIES ARE UNCHANGED FROM FY 2008
1. Renovating infrastructure to meet the minimum standards set by Ministry of Health- NUMAT working
closely with district authorities will identify priority health laboratory facilities for refurbishment, conduct an
assessment of the state of the laboratories and counseling rooms then remodel the laboratories to meet the
standards set by the Ministry of Health. In FY 2009 NUMAT will complete the refurbishment works started in
20 laboratories in FY2008.
2. Training of personnel - NUMAT through the districts, will conduct refresher training of 50 laboratory staff
that have not yet received the refresher training. The laboratory personnel will undergo a two week in-
service training in HIV rapid testing, sputum smears microscopy, total and differential white blood cell
counting, hemoglobin estimation, blood smear examination for malaria and other haemoparasites, diagnosis
of other opportunistic infections common in HIV/AIDS, Laboratory management and Laboratory disease
surveillance. The training will be based on an in-service training curriculum revised in FY2008. NUMAT will
support the re-orientation training of 180 clinicians in best practices in utilization of laboratory services, this
activity will be conducted by the Trainers that under went a Training of Trainers course that was conducted
in FY2008. This activity will be conducted at district level.
3. Procure/Provide select supplementary equipment and supplies that will enable units to undertake
appropriate laboratory tests for the diagnosis and treatment of HIV, TB and malaria. Based on the gaps
identified during performance monitoring visits to the health facilities, NUMAT will quantify, procure and
deliver the equipment to the health facilities. The select equipment will include but not be limited to
Microscopes, Autoclaves, Counting chambers, Cool boxes and other supplies.
4. Strengthen the capacity of higher level laboratories to conduct specialized tests such as CD4 count, Liver
Functional Tests (LFTs) and Renal Functional Tests (RFTs). NUMAT by networking with other partners will
support training of personnel in the performance of CD4 counts, LFTs and RFTs while ensuring availability
of laboratory supplies that support the tests at the facilities.
5. Strengthen specimen referral from the lower facilities to higher levels through supporting the health
facilities to obtain specimen packaging and transportation materials from Central Public Health Laboratories
(CPHL) and from the National Medical stores (NMS).
6. Strengthen laboratory quality assurance systems through supportive supervision by the DLFPs, National
trainers/supervisors and staff from CPHL. NUMAT will facilitate the supervisors to conduct regular technical
support supervision visits for the laboratory staff at their work places. The laboratory personnel will receive
on-site training and mentoring during the visits. Standard Operating Procedures (SOPs) will be printed,
laminated and distributed to laboratories to further enhance provision of quality laboratory services.
7. In line with the MoH's Human Resource Development strategy of increasing availability of qualified
laboratory personnel at the health facilities particularly in severely Humana resource constrained districts
like in the North, NUMAT will continue to work closely with the districts to identify and sponsor an additional
18 currently unqualified staff (Microscopists) that have the minimum requirements for Laboratory Assistant's
courses as well as continue to support the 7 that are already in school. The sponsored students on
qualifying will be expected to serve the district for a period of time as agreed upon in the bond agreement
signed between them and the district before the commencement of the course.
8. NUMAT will document and disseminate innovative approaches to integrating HIV, TB and malaria
Activity Narrative: diagnosis.
Continuing Activity: 15490
15490 4706.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $300,000
8473 4706.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $300,000
4706 4706.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $300,000
Estimated amount of funding that is planned for Human Capacity Development $31,760
Table 3.3.16:
This activity is a continuation from FY2008. This activity also relates to Prevention /Abstinence and Being
Faithful, Prevention/ Other, PMTCT, Palliative care: Basic health care, Counseling and testing, ART,
Improve Laboratory Capacity/ Laboratory Infrastructure and Other/ Policy analysis and system
August 06 with FY 2006 resources. The project covers 9 districts in the post conflict region of Northern
are close to where the population is returning
In FY 2008 NUMAT focused on capacity building and 65 individuals (HMIS focal persons and record clerks)
were trained in strategic information. Other key achievements in FY 2008 included support to the
strengthening of the Health Management Information System (HMIS) through training, support supervision
in data management and executing data quality assessments in selected health units. Data collection
activities were supported through provision of data collection tools which included registers and monthly
reports to health units, equipping selected districts with computers and external hard drives for data
storage/management, as well as logistical facilitation of HMIS focal persons to collect data periodically.
NUMAT also supported the districts in the dissemination of key study findings at various forums including
conferences, workshops and others. Some of the findings disseminated included the Lot Quality Assurance
Survey (LQAS) reports. A total of 14 district technical persons were supported to attend the Uganda
National AIDS Conference. NUMAT has also supported districts to conduct quarterly review meetings on
data related issues.
In FY 2009 NUMAT will build on its previous activities to continue to strengthen the capacity of its supported
districts to collect and utilize timely and quality data for planning purposes and informed decision making.
NUMAT hopes to do this by promoting a continuous cycle of data demand, collection, analysis and
utilization to improve on management of health conditions through support to a number (7) of initiatives as
follows;
(1) Health Management Information System (HMIS): NUMAT will train district HMIS Focal Persons (FP) to
manage data collection from the lower level health units and facilitate detailed analysis (on performance
indicators & coverage rates), and utilization of data. Record assistants at health sub-districts will be
sensitized, equipped with skills and facilitated to extract data from service registers and enter it into
summary forms. The HMIS Focal Persons and the record assistants will be supported in data analysis,
utilization and storage at the district and lower levels. Districts will be supported annually to monitor
progress on critical health indicators specifically: HIV/AIDS, TB and malaria indicators, and to routinely
utilize data for their planning purposes and supporting service delivery. NUMAT will continue to work with
the Community Services Departments (CSD) in the districts to strengthen the collection of community
services data. NUMAT is also committed to accuracy of information for purposes of accountability and,
more importantly, for use of quality data to improve programme activities. With that regard, data quality
assessment and validation exercises will be conducted to identify data challenges and improve on the
quality of data. NUMAT will also support the scale up of the web enabled HMIS in few piloting districts. (2)
Dissemination: NUMAT will support the production of focused documents aimed at informing decision
makers as well as disseminate information through a wide range of products and avenues such as
comprehensive reports, manuals, brochures, journal articles, technical briefs, and workshops. District staff
will be supported to participate in relevant national/international conferences (3) Lot Quality Assurance
Sampling (LQAS): NUMAT will conduct individual district-based LQAS surveys which will be used by the
districts to identify priority areas and assist in developing strategies for addressing the identified gaps and
monitor progress towards improving the quality of the health systems. The surveys will also provide
accurate measures of coverage or health system quality at a more aggregate level, (4) Health Facility
Assessment (HFA): NUMAT will supplement the LQAS information with a Health Facility Assessment to
generate data on the status, availability and quality of health services, (5) District health assembly: District
health assemblies will be supported to improve planning of district health systems and evaluation of their
performances prior to the national health assembly, (6) Performance Monitoring Plans: NUMAT supports
the demand for effective monitoring and evaluation and hence will build the capacity of the districts and
local organizations to design M&E plans as tools to monitor and evaluate their outputs and outcomes of
their activities, (7) GIS Mapping: At NUMAT, we know that improved analysis and use of data lead to better
health program decision making and, ultimately, to improved health outcomes. NUMAT will thus use GIS as
a tool to turn data about the location of health facilities, populations, and other variables into maps that can
visually display the availability and distribution of health services in the region. This will go a long way in
guiding districts and other stakeholders in the allocation and targeting of resources.
Continuing Activity: 15495
15495 4712.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $200,000
8475 4712.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $200,000
4712 4712.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $200,000
Table 3.3.17:
Basic health care, Counseling and testing, ART, Strategic Information and Lab infrastructure
improvement.The NUMAT project, which covers the sub regions of Acholi and Lango, was awarded in
In FY2008 NUMAT undertook capacity assessment of HIV/AIDS coordination structures in the 9 districts in
the region with a view of identifying the status of functionality and consequently areas of support. Uganda
AIDS Commission and other members of the Decentralized Response and Self -Coordinating Entity
provided technical support and were also invited to participate.. the findings revealed that generally
coordination of HIV/AIDS was weak due largely to the insurgency in Acholi-region but also due to the failure
of some districts to constitute coordination structures; lack of funding; limited coordination capacity; non-
ratification of HIV/AIDS coordination guidelines; Lack of HIV/AIDS strategic plans and poor civil society
coordination . As a result of this, the assessment exercise was preceded by trainers of trainer's (TOT)
workshop on HIV/AIDS coordination in all the 9 districts for the purpose building internal capacities of
districts to coordinate HIV/AIDS. Participants for this workshop included; District planners (9), HIV/AIDS
focal persons (9), District Education officers (9), PHA representatives (2), CSO representatives (2), and
AMICAAL coordinators (5). Follow-up activities that were planned and done by the trainees included; the
development of specific HIV/AIDS coordination work-plans for the 9 districts and some urban centers.
NUMAT specifically funded the ; Re-activation of coordination structures at the district and sub-county
level; meetings and field monitoring activities of coordination structures(District HIV/AIDS Committees
(DAC); District HIV/AIDS Task forces(DAT) and Sub-County HIV/AIDS Committees(SAC) /Sub-County
HIV/AIDS Task force (SAT). Other forms of financial and technical support provided by the program to
address HIV/AIDS gaps identified during the assessment included the development of 5year HIV/AIDS
strategic plans for Gulu, Amuru and Kitgum districts that will be integrated in the District Develop Plans of
the respective districts as well as the strengthening of Civil Society Organizations involved in HIV/AIDS
work in the region. Notably the program was able to support PHA networks of Gulu, Kitgum and Lira to
undergo organizational self assessment and develop their 5 year strategic plans. The PHA forums that were
supported are now currently using the plans to re-organize their internal systems and structures and are
now more focused in implementing activities for the benefit of their members. NUMAT has also provided
equipment and supplies to PHA networks as partial support to actualizing their strategic plans. Other
capacity building initiatives by the Program to the PHA networks included the facilitation of the networks to
participate in national events such as woman's day, national HIV/AIDS conference and PEPFAR
implementer's workshop.
As part of strengthening the health systems in the region, the program facilitated districts to form and train
Health Unit Management Committees in the districts of Pader, Kitgum, Apac, Dokolo, Oyam, Amuru,
Amolatar and Lira. Other forms of included District health Team meetings, support supervision and planning
by DHT for Malaria, HIV/AIDS and TB activities.
Human resource for health continues to be a critical factor in health service delivery in the region. The
program carried out a rapid assessment on the status of human resources for health in all the 9 districts
with a view of identifying the staffing gaps and critically needed cadres of health workers. The assessment
revealed overall low staffing levels in the region: with following specific staffing gaps: Gulu (75%); Kitgum
(60%); Pader (37%); Amuru (66%); Amolatar (20%); Oyam (20%); Lira, Apac, Dokolo (10% each). The
most critically needed cadres of health workers are medical officers, Enrolled Nurses, Enrolled Mid-wives,
Enrolled Psychiatric Nurses, Senior Medical officers, Orthopedics, Public health nurses, Laboratory
personnel, dentists and information assistants. Other factors that habit human resources for health in the
region that were identified in during the assessment and also in another assessment carried out by Ministry
of Health and Capacity Project (2008) included the lack of accommodation for health workers; difficulties in
accessing the government payroll; lack of basic equipment and supplies ; inadequate skills of health
workers; Incomplete composition and facilitation of District Service Commission(DSC); Failure of districts to
induct newly recruited staffs and poor records management among others.
In addressing the human resource gaps, NUMAT supported the recruitment process (advertisement, short-
listing and interviewing) of health workers in Gulu (215 positions) and Oyam (20 positions); trained Lira
District Health Management Team (22 persons) on performance improvement through support supervision
with a focus on PMTCT in partnership with Capacity project; Identified sites for Distance Education
Programme in Lango sub-region for skills enhancement of in-service health workers; trained a number of
health workers in various skills related to HIV/AIDS across the region and stated the process of reviewing
distance education training materials with the review of medical laboratory practice manual; As a stop-gap
measure to address the acute shortage of health workers in the region, the program partnered with
Makerere University under the Community Based Education Services (COBES) program in which 40
medical students with a professional mix of pharmacy, nursing, general medicine, and radiology were
deployed in 7 health units in the region. The students were able to temporarily fill the human resource gaps
in these units through involvement in a range of health activities (immunization of infants &pregnant women
mothers, strengthening of HMIS gap through recording of accurate data, HCT activities, dispensing of ART
drugs and clerking patients etc.
ALL ACTIVITIES ARE UNCHANGED FROM FY 2008
1. Support HIV/AIDS coordination structures in districts (DACs, DATs, SACs and SATs). The program will
continue to support the re-activation of HIV/AIDS coordination structures especially in Acholi region were
Activity Narrative: populations are gradually returning to their original homes. Special focus will be put to on the sub county
coordination structures in those sub counties where populations are returning. NUMAT will continue to work
with PHA networks and other AIDS civil society organisations to strengthen coordination among CSOs and
participaton in the HIV/AIDS response at the district and lower levels. Coordination structures will continue
to be provided with logistical support to meet and monitor HIV/AIDS related activities .
2. Support towards Health Sub-district coordination: NUMAT will continue to facilitate districts to establish,,
train and support health unit management committees so as to improve community involvement and
participation in the management of health facilities .
3. Develop District HIV/AIDS strategic plans for Amolatar, Lira and Apac : Mainstreaming of HIV/AIDS in
district development plans is a key requirement for local governments and HIV/AIDS strategic plans are
strong tools for mobilising different stakeholders in achieving District HIV/AIDS objectives. NUMAT will
therefore support the 3 districts of Amoltar, Lira nad Apac to strengthen HIV/AIDS coordination, develop
HIV/AIDS strategic plans and integrate HIV/AIDS in district development plans.
4. Support technical and policy review meetings/workshops on specific areas in HIV/AIDS: NUMAT will
continue to up-date key stakeholders in the region on key government policies related to its core business
of malaria, HIV/AIDS and TB. These forums will also be used to share and learn about models being
piloted /used by NUMAT and other key stakeholders in the region and nationally.
5.Organisational and institutional support of partnering civil society organisations and PHA forums; To
strengthen the Civil society voice in the management and coordination of the HIV/AIDS response and to
increase the implementation capacity of CSOs to implement HIV/AIDS activities, NUMAT will provide
institutional support to selected partner CSOs including PHA networks. The support will go towards
strengthening of the CSOs' systems , structures and human capacity
6.Support districts to recruit and deploy health workers. NUMAT will provide financial, logistical and
technical support to districts to advertise vacant positions, interview, recruit, orient and deploy health
workers to address the identified human resource gaps in the districts
7.Support districts to carry out induction training of newly recruited staff. Staff induction is critical in the
retention of staff since it's through this process that they get empowered with information regarding
Government of Uganda civil service standing orders and what is expected of them as health workers.
NUMAT will therefore continue to work with the Ministry of health, Public service and the districts to ensure
this is done for all the 9 districts.
8.Conduct pre-service and in-service training of health workers; NUMAT will continue to support training of
health workers in relevant skills
9.Strengthen continuing professional development (CPD) of health workers through distance education
programmes (DEP): In close partnership with Ministry of Health Human Resource Division and Capacity
project, NUMAT will operationalize the Distance Education Programme Centres by training tutors, centre
coordinators and providing the required resources (reading materials, course curriculums, computers etc.)
10.Continue to partner with human resources for health stakeholders and health training institutions and
communities; NUMAT will partner with health training institutions in the region and at the national level in
order to address human resource gaps. The Community Based Education Services approach of Makerere
medical school will be supported and replicated elsewhere with other health institutions since it has proved
effective in supporting health units cope with workload while at the same time addressing the training needs
of students.
NEW ACTIVITIES FOR FY 2009
1.Support districts to undertake performance improvement support supervision of health workers; the
performance improvement approach that was piloted for PMTCT will be replicated in other areas in
HIV/AIDS, Malaria, and TB. The approach has proved to be simple to adopt and effective in addressing
quality of service issues.
2.Support districts to establish and maintain human resources for health information systems; NUMAT will
work with Ministry of health, Capacity project and districts to set up human resource data base that will be
used to maintain staff records on training, deployment etc.
3.Work with districts in the region to undertake training needs assessment of health workers and develop
district training plans; In order to support districts to rationalise training and to avoid duplication, NUMAT will
support districts to undertake training needs assessment of health workers and to use this in developing
training plans.
4.Work with others in identifying appropriate strategies for attracting, retaining and motivating health
workers; NUMAT will work with others in the region and nationally to advocate for appropriate mechanisms
of attracting and retaining health workers in the region.
Continuing Activity: 15494
15494 4711.08 U.S. Agency for John Snow, Inc. 7156 7156.08 NUMAT $400,000
8474 4711.07 U.S. Agency for John Snow, Inc. 4839 696.07 UPHOLD; $350,000
4711 4711.06 U.S. Agency for John Snow, Inc. 3167 3167.06 NUMAT/Conflict $200,000
Estimated amount of funding that is planned for Human Capacity Development $110,000
Table 3.3.18:
