The Project Search/ Population Council, in partnership with Uganda Bureau of statistics (UBOS), are

conducting the Ministry of Gender Labor and Social development (MGLSD) 2008/9 OVC situation analysis

(formative assessment) with two main objectives, 1) conduct an updated orphans and vulnerable children

(OVC) situational analysis, and 2) identify the strategies, approaches and funding necessary to deliver

comprehensive services to OVC in Uganda. The last OVC situational analysis in Uganda was conducted in

2001 and was limited in both scope and geographical coverage. The last OVC situation analysis done in

2001 primarily focused on orphans (did not include vulnerable children) and only covered eight districts.

This analysis was used extensively in the development of the Ministry of Gender, Labor and Social

Development's (MGLSD) National OVC policy and Strategic Program Plan of Interventions for Orphans and

Other Vulnerable Children (NSPPI). Since that time, the national OVC response has grown considerably

and there is a need to re-examine and better understand the situation of OVC in Uganda, including child

and family access to comprehensive OVC services throughout the country, and the actual cost of delivering

these services. As a major OVC development partner in Uganda, the United States Government (USG) is

supporting the Government of Uganda (GOU) through MGLSD to conduct a situation analysis (formative

assessment) to update the NSPPI and provide a more accurate baseline of the situation for OVC in the

country. Data will be instrumental in facilitating country-wide planning and in improving future OVC program

design and implementation. This assessment will also serve as a USG PEPFAR program area review to

inform ongoing and future USG investments for OVC. This activity is expected to end in June 2009.

After the successful completion of the OVC situation analysis, Population Council will make and

disseminate to all stakeholders a report highlighting the current and future projected OVC population, a

clear and context specific definitions of OVC, the causes of problems facing families and communities and

their coping strategies with OVC. This formative assessment will inform the country of the

comprehensiveness of services currently received by OVC, models of care, cost of providing

comprehensive OVC services and will identify successes, best practices, and areas for further

development. Lastly the report will recommend to the government, HIV/AIDS development partners, the

national OVC steering committee, NGOs, and other cooperating partners appropriate strategies for

addressing the needs of communities coping with orphaned children.

FY09 follow on activities

The OVC situation analysis report will the basis for 1) informing the review of the current OVC policy and

strategic program plan of interventions; 2) developing stronger programs to meet the needs of orphans and

vulnerable children, families, and communities; 3) developing relevant and appropriate interventions that

protect the rights of children and ensure their quality comprehensive care; 4) revising and developing a new

monitoring and evaluation framework for continued assessment of the situation of orphans and other

vulnerable children; and constructing a user friendly OVC information system; 5) advocating for and

mobilizing additional financial resources and other forms of support for action and generating social and

community mobilization responses. Strengthening the capacity of the Ministry of Gender, Labor and Social

Development (MGLSD) to provide strategic direction, coordination, and monitoring of the overall response

to Orphans and Vulnerable Children (OVC), which includes strengthening links to Districts and civil society

responses. Specific activities will include;

1. Policy and strategic plans; a) Conduct consultative meetings to review the national OVC policy and the

National strategic program plan of interventions (NSPPI), b) Initiate legislative review to explore whether the

country has reviewed and updated the legal framework relating to orphans and other children made

vulnerable by HIV/AIDS c) Develop a new 2009/10 - 2014/15 NSPPI, and disseminate the new policy and

plan d) Translate the revised policy document into 5 Uganda main languages

2. Management, Planning and Coordination mechanism; a) Revitalize the NOSC in inter-ministerial

planning, coordination, oversight and monitoring of the multisectoral response to OVC at national. b)

Establish or strengthen process for policy and program planning at national level. C) Strengthen the

capacity of senior NIU staff to strategically plan, cost and budget, review OVC program frameworks and

workplans; d) Strengthen the capacity of NIU and Planning Unit within MGLSD to plan, monitor and analyze

OVC data and disseminate performance reports and results. e) Strengthen capacity of NIU effectively

coordinate OVC response at national levels. f) Support NIU to effectively supervise TSOs g) Strengthen

working relationships and effective partnerships with civil society fund, private partners and public services

in the national OVC response

3. MONITORING & EVALUATION; a) Determine whether M & E is being conducted nationally into the

situation of orphans and other children made vulnerable by HIV/AIDS, and into programs addressing their

needs.

4. RESOURCES; monitor the availability and utilization of government and donor resources to meet the

needs of orphans and other children made vulnerable by HIV/AIDS and other causes.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15843

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15843 15843.08 U.S. Agency for To Be Determined 7273 7273.08 Project

International SEARCH: OVC

Development Formative

Assessment

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $400,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 14 - HVCT Prevention: Counseling and Testing

Total Planned Funding for Program Budget Code: $18,588,347

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

HIV/AIDS Counseling and Testing (CT) is an entry point for HIV positive clients to HIV prevention, care, treatment and support

services and also provides uninfected people with an opportunity to receive reinforcement and advice on how to remain negative.

A key goal of the national CT policy is to provide universal CT, so that all Ugandans above 15 know their status and receive

appropriate support to prevent transmission of HIV for those testing positive and avoid infection for those testing negative. In

FY09, the Emergency Plan in Uganda will continue to support a mix of CT approaches to respond to the national priorities.

In FY08, 2 million Ugandans, accounting for nine percent of the adult population, received CT services. Of these, 80% (1.6 million)

received them from USG supported services. Less men access CT services due to low perception of risk and low health seeking

behavior. The USG program currently supports at least one CT service organization in all but four districts, but accounts for a

geographical coverage of less than 10 percent. According to the 2005 Uganda HIV/AIDS Sero-Behavioral Survey (UHSBS), 70

percent of HIV-positive Ugandans do not know their sero-status due to stigma, poverty, insecurity, limited access and lack of

information.

USG supports multiple CT models to increase access: 1) Voluntary Counseling and Testing (VCT); 2) Routine Counseling and

Testing (RCT); and 3) Home-Based Counseling and Testing. VCT accounts for more than 50% of people currently reached. In

FY09, increased community outreach and work-based programs will bring VCT services closer to communities with a specific

emphasis on targeting high-risk groups like fishing communities, truck drivers and, internally displaced people. In FY09, RCT will

be expanded to cover more regional and district hospitals and lower level health facilities so that more patients attending a health

facility can be tested for HIV. CT can be provided through 100 percent community door-to-door access or through a family-based

approach. In family-based CT, index HIV positive clients serve as entry points to members of entire households, including

spouses and children. Family based CT is beneficial in supporting disclosure of HIV status, obtaining support for discordant

couples and promoting adherence. In FY09, care and treatment organizations will continue to support family-based CT, quality

post-test counseling and referral to post-test clubs (PTCs) to enhance care and on-going support for those testing positive. Door-

to-Door CT will also be supported in high HIV prevalence communities in central and northern Uganda. During FY07, USG

conducted a cost effectiveness study of each of these approaches; and preliminary findings indicate that 100% door-to-door CT is

cheapest per individual tested and at identifying first time testers; RCT is most effective at identifying HIV-positive individuals,

couples while stand-alone VCT is most effective at identifying eligible couples and, family based VCT through the index client is

most effective at identifying HIV infected children. In addition, the USG is completing an assessment to evaluate the behavior

change impact from implementing a district wide door-to-door program.

The Ugandan CT policy sets standards for training, provision of CT services, testing algorithms, quality assurance, and monitoring

and evaluation. Post-test counseling with emphasis on HIV status disclosure and partner testing, referral linkages to care,

treatment, and follow up, are emphasized for all those testing HIV positive. For clients testing HIV negative, risk

avoidance/reduction counseling and linkages to PTCs are made. In addition, community based support programs will be

supported to adopt the prevention package for those who test negative. The prevention package includes, linking risk assessment

with risk reduction counseling including condom use; messaging around repeat HIV tests; emphasis on mutual sexual faithfulness;

couple communication and decision-making; STI management; Family planning and Medical Male Circumcision counseling.

Working with CT17, the prevention package will need to be consolidated, approved and popularized among different stakeholders.

Standards are provided for special groups including children, couples and people with disabilities. Testing protocols are in place

for new CT approaches. Rapid HIV testing using serial algorithms is recommended; using Determine for screening, Statpak for

confirmation and Unigold as the tie-breaker. Blood collection by finger stick is the preferred method but is not widely used in

Uganda due to a lack of supplies and support supervision. In FY09, USG will support MOH in providing support supervision and

refresher training to CT service providers. In addition, USG will support training for counselors in TB/HIV integration and ensure

adequate supplies and effective referral and linkages between CT and TB treatment sites.

Procuring and distributing test kits is largely done by National Medical Stores (NMS). Most public health facilities receive their test

kits through the NMS supply chain management system. Global fund, UNICEF and other donors pool their donations to NMS. In

prior years, irregular supplies, inconsistent forecasting and limited capacity to distribute CT commodities to public health facilities

led to stock-outs. In FY09, the Supply Chain Management project will continue to strengthen supply chain management of CT

commodities by providing technical assistance to NMS and Joint Medical Stores. This will cover forecasting procurement, and

distribution CT commodities--first to the districts, and then to health facilities. As TB/HIV integration is strengthened and RCT

expanded, additional test kits will be procured to address the resulting increase in demand for CT.

Currently, TASO, AIC and MOH conduct most of the training of counselors and CT service providers. All certified CT providers

have a MOH CT register, and all laboratories have a laboratory request form. While centers are required to report monthly, the

shortage of staff at MOH and acute shortages of health workers at all levels of the healthcare delivery system have resulted in

delays in data entry and analysis. In FY09 USG will continue to support task shifting through the training and use of alternative

human resources, including volunteers and People Living with HIV/AIDS (PHAs), to bridge the gap. The MOH will develop

guidelines and protocols that define the working relationship between the public health facility health workers and the PHA

networks. In addition, the USG will work closely with the MOH to ensure that appropriate guidelines that help monitor CT quality

within the private sector are in place.

USG utilizes an integrated approach to promote CT services. Community mobilization is integrated into all prevention, care, and

treatment programs. In Uganda, political leaders such as parliamentarians and district leaders are effective community mobilizers.

USG will support programs that promote "Know Your Status" targeting married and cohabiting couples and programs that build

the capacity of health workers and district and national political leadership to promote HIV/AIDS, TB, and malaria awareness and

the importance of being tested for HIV.

Under the Health Sector Strategic Plan II, all Health Center IVs and Health Center IIIs should have CT services by 2006 and 2010

respectively. These targets for HC IVs have not been achieved. USG will support the MOH scale-up the number of sites providing

CT as well as the individuals and couples reached with CT services. Emphasis will be placed on the enhancing male participation

in CT services. Priority will be placed in expanding RCT to Regional, and District hospitals as well as Health centre IVs. In FY09,

quality assurance, support supervision, and equity considerations in CT provision will be stepped up. Post-test counseling for

those testing HIV negative will be strengthened and linkages will be made to existing prevention programs. Through the PHA

networks program and strengthening of PTCs, referral linkages to care and treatment and community support will be

strengthened. In FY09, USG will continue to support the training of PHAs and volunteers as counselors to bridge the human

resources gap and reduce the counseling load on the "traditional" health workers. The MOH will develop guidelines and protocols

that define the working relationship between the public health facility health workers and the PHA networks. CT for OVCs and the

use of pediatric clients as an entry point to households will be strengthened. All these activities will be implemented in

collaboration with national CT technical working group, CT17, and the MOH CT policy committee.

Table 3.3.14:

Project Search is a new activity aimed at supporting the Uganda AIDS Commission (UAC) to operationalize

an M&E system. Once the M&E system is in place, UAC will be able to collate, analyze and disseminate

multisectoral information that is needed to inform the HIV/AIDS response at strategic, management and

operational levels. The support for UAC demonstrates USG commitment to the "three ones" principle in

Uganda.

In FY 2008, UAC received USG technical assistance through the ACE Project (Chemonics) which

contributed to a number of achievements including the completion of a new five year national HIV/AIDS

strategic plan, a national Performance Monitoring and Management Plan (PMMP) and its operational guide.

In FY 2009 USG will continue to support UAC to ensure that a multisectoral M&E System and its

accompanying information flow system are fully operational. Given that USG is only one of the several

development partners assisting the UAC, the FY 2009 support will be based on an agreed set of activities

that are catalytic to realizing a functional M&E and Information system. The UAC is currently in the process

of mapping out the technical support needs for the roll out of the PMMP. Areas of USG support may include

database development and management, capacity building of UAC M&E staff and operationalizing the

PMMP. Once the areas of support are mapped out, USG will be able to identify which needs could be best

met with PEFPAR support. These resources will be used to support the areas of need identified through a

consultative process with UAC, donors and other stakeholders.

It is expected that the majority of activities that may be selected for support will include training of the

relevant staff to use the tools anticipated under the PMMP. At least one person from each of the 80 districts

and 20 at the national level will be trained. The assistance will also involve other organizations (e.g.

Ministries of Gender, Health, Local Government, Education, Agriculture etc) that are either users or

suppliers of UAC data/information.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.17: