1. Overall goals and objectives

The overall goal of UNHCR in Uganda is to seeking lasting and dignified solutions for refugees and IDPs by safeguarding their rights and ensuring a favourable protection climate

2. Target populations and geographic coverage

The project will be implemented in Kyaka II refugee settlement in Kyegegwa district (formally part of Kyenjojo district) located 270km west from Kampala. The settlement is surrounded by three sub-counties of Mpara, Kyegegwa and Kasule of Kyaka constituency (HSD) and covers a ground area of about 11.75 sq km.

The HSD together with other development partners like UNCHR/GTZ, private not for profits health units and private for profit health facilities play important role in the health service delivery, disease prevention, promotion and support supervision, coordination and planning and direct curative health service delivery.

The settlement is multi-ethnic, with Congolese and Rwandese being majority and other minority groups include; Rwandese, Burundians, Kenyans and Sudanese. The number refugee has more than tripled since late 2005 to the current figure of 18,230 due to the Congolese influx from Eastern DRC.

Approximately 10,000 national live in the vicinity of the settlement and benefit from the social services provided for refugees.

The health services system comprises of preventive, curative and health reproductive services. Both out- patient services and In-patient services at Health Centers are provided. The health system is implemented according the health policy by Ministry of Health. The minimum healthcare package of Uganda is adhered too and this includes immunization, malaria control, ANC, nutrition, TB control and maternal and child health. 2. Enhancing cost effectiveness and sustainability

The project will use community-owned resource during planning, implementation, and monitoring of activities to ensure that the knowledge stays within the community at the end of the project. A lot of capacity will be built for the local community (including certified trainings) to effectively implement the project activities. The multi-sectoral activities implemented will be linked to the respective national sector activities to ensure sustainability in the event of closure of the project.

Where livelihood or income generating activities apply, they will be revolving in nature to ensure sustainability with a multiplier effect.

4. Health Systems Strengthening REDACTED. The project will support the recruitment of additional 4 health workers, and refresher training of the existing health workers as well as community based workers and persons living with HIV/AIDS. The recruited staff will provide other medical functions to support the refugee health system. Supplementary drugs and medical supplies will be procured to support the current ruptures in the drugs and medical supplies, thus improve the quality of care.

5. Cross-Cutting Budget Attributions Although all the activities have multi-sectoral components, areas highlighted below have received the corresponding allocations: Human Resources for Health ($25,000): - Additional staff will be recruited and certified refresher trainings for the others Construction/Renovation & Equipping REDACTED Food and Nutrition ($15,288): - nutrition support for PMTCT mothers, OVCs and food security support. Economic Strengthening ($8,500): - Income generation opportunities for persons living with HIV and OVC foster families. Education ($14,000) - Education support for orphans and vulnerable children as a measure to keep them in school and deter them from risky transactional sex activities with its Health and HIV consequences Gender-based Violence ($16,000) - The project will support police to response to cases, improve community awareness about the referral pathways, and working with men and boys to prevent SGBV. The project will support the procurement of post-exposure prophylaxis for the victims of rape.

1. Target populations and coverage of target population or geographic area

This will target orphans, unaccompanied minors, separated children, children infected and affected by HIV/AIDS, and foster families.

2. Description of service delivery or other activity carried out

The project will support the training of caregivers in comprehensive HIV management, as well as identification and documentation of the OVCs. Most vulnerable children will be support with scholastic materials so that they can stay in school; it is anticipated that the scholastic materials will have age- appropriate HIV/AIDS messages. The foster families and older children headed households will be supported with revolving income generating activities. Health workers will benefit from the Community management of acute malnutrition training to provide nutrition support.

3. Integration with other health activities The livelihood and the nutrition training will directly contributed to food security and nutrition as a component of health services.

4. Relation to the national program The support will be in line with the national policy on OVC

5. Health Systems Strengthening and Human Resources for Health The nutrition capacity building for health workers will directly contribute to the strengthening of the health system.

1. Target populations and coverage of target population or geographic area This will target the entire population including heath workers in the health facilities

2. Description of service delivery or other activity carried out

The project will support recruitment of a laboratory technician and a counselor to support the HIV counseling and testing services. The provider initiated testing and counseling, home-based, routine, and voluntary counseling and testing will be scaled up in Kyaka II refugee settlements to ensure that the majority of the people know their status. A motorcycle will be procured to support the outreach team. To ensure consistence, HCT consumables and outreach tents will be procured to avoid stock outs; while couple counseling and testing will be fostered through motivational packages. The national HIV reference laboratory will be facilitated to do routine quality control activities for HIV testing. Demand for the services will be created through behaviour change communication - IEC materials, drama, songs, etc.

3. Integration with other health activities This will be part of an integrated health outreach.

4. Relation to the national program The HIV counseling and testing commodities will be obtained from the national supply system, but supplementary procurement will be made in cases of pipeline breaks in the national supply system. The HIV counseling and testing guidelines will be inline with the Policy and the national HIV strategic plan.

5. Health Systems Strengthening and Human Resources for Health Additional staffs recruitment, procurement of medical supplies and logistical support that directly strengthens the health care system.

1. Target populations and coverage of target population or geographic area

The activity will target young and older adolescents in & out of school; and older age groups in relationships living in Kyaka II refugee settlements and the surround host population.

2. Description of service delivery or other activity carried out

This multi-sectoral activity will be implemented by health, education, teachers, community services, religious leaders, traditional leaders, and political leaders. It will focus on using the community or school peer educator networks, use of sports to disseminate information, information, education and communication materials, use of puppetry to disseminate information on abstinence and being faithful. Power relations in marriage being one of the underlying cause of GBV and subsequently HIV, the project will SGBV prevention and response activities in the community focusing on community policing, rolling out the management referral pathway, and working with men and boys (who are mostly the perpetuators). The Police will be support with a motorcycle to follow-up reported cases of SGBV. The project will work with commercial sex workers to disseminate information to their peers, community, and their clients.

Aggressive behaviour change communication campaigns will be carried out through trigger video shows, music, dance, and drama both in school and out of schools. An HIV/AIDS stall will be installed in the local markets where services will be made accessible to busy business community. PLHIV will be trained as expert clients to disseminate the information as well as through IEC materials.

3. Integration with other health activities The health team will be accompanying the BCC team to provide factual health information but also to provide HIV counseling and testing.

4. Relation to the national program The activities are in line with the national school health policy, the PIASCY programme, the National HIV strategic plan, and National HIV priority action plan. 5. Health Systems Strengthening and Human Resources for Health The activity will strengthen the community component of the refugee health care system because of the integrated outreaches with other services like immunizations, de-worming, growth monitoring and antenatal care.

1. Target populations and coverage of target population or geographic area This will target the entire population including heath workers in the health facilities

2. Description of service delivery or other activity carried out

Other prevention will focus on training health workers on universal precautions as well as procurement of universal precaution commodities. Health workers will receive an on off site training in safe male circumcision which skill will be used in the SMC theatre that will be constructed and equipped. The demand for same male circumcision will be created in the community though behaviour change communication.

All discordant couples will be followed-up with regular support to avert the infections. Condoms will be promoted in the community through condom dispensers, dialogues with religious leaders, and putting them in bars and other social places.

3. Integration with other health activities The activities are part of the health activities

4. Relation to the national program The activities are line with the ministry of health same male circumcision policy, guidelines on injection safety, National HIV strategic plan, and the minimum health care package of the national health policy

5. Health Systems Strengthening and Human Resources for Health Medical commodities will be procured, health workers trained, health facility renovated, and community based health care system strengthened.

1. Target populations and coverage of target population or geographic area

The target will be women of reproductive age-group 5391 refugees and their sexual partners living in Kyaka II refugee settlement and the surrounding host population.

2. Description of service delivery or other activity carried out

Although there will be a lot of interaction between this service delivery area and AB and OP, activities will focus on provision quality adolescent sexual and reproductive health services for those in and out of school using a network of peer educators, provision of quality user-friendly family planning methods to women of reproductive age-group including those who are HIV-positive, provision of ART to HIV positive pregnant mothers and their babies as well as cotrimoxazole prophylaxis. Nutrition support will be provided to the pregnant mothers after adequate counseling on infant feeding options (to ensure the AFASS principle applies). For community ownership and sustainability, mother-to-mother support groups will be formed in the communities to foster social support and learning, the presence of services will be publicized using IEC materials.

The maternity ward will be extended that will also house a well equipped safe male circumcision theatre, and a reproductive health clinic. HIV Sentinel surveillance activities will also be supported in the settlement in line and alongside MoH sentinel surveillance.

3. Integration with other health activities

PMTCT services will part and parcel of the reproductive health services that will be provided at the health facilities, and the community activities will be part of the integrated health outreaches. The behaviors change communication will part of school health programme.

4. Relation to the national program The clinical guidelines, supervision, drugs and medical supplies primarily come from the national supply system although the project will procure supplementary commodities during the periods of raptures in the national system.

5. Health Systems Strengthening and Human Resources for Health Two staff will be recruited to support the project, health facility will be improved.

1. Target populations and coverage of target population or geographic area

This will target TB patients, all HIV positive clients and the general community in Kyaka II refugee settlement and the surround host population.

2. Description of service delivery or other activity carried out

This will involve provision of minimum package for HIV positive clients, procurement of supplementary drugs for opportunistic infections, a CD+ machine to monitor patients on treatment, as well as quality control for TB testing. Health workers will be trained on TB/HIV co-infection, support activities to roll out CB-DOTS in the community, and procure TB drugs during periods of shortages. Laboratory supplies will be procured to support the laboratory services in the refugee settlement.

Post-test clubs will be supported to conceptualize the new Positive Health, Dignity, and Prevention (PHDP) principle as a means of keeping health but also prevent infection transmission. Dry blood spots for early infant diagnosis will be strengthened, including procurement of pediatric formulations of the drugs

3. Integration with other health activities The laboratory services will serve other health activities in the settlement

4. Relation to the national program TB reagents and supplied by the national programme, but the project will support where there are shortages.

5. Health Systems Strengthening and Human Resources for Health Support the quality of medical services, and human resources skills and knowledge, as well as commodities for health services.