The Health Initiatives for the Private Sector (HIPS) Project aims to increase access to and use of HIV/AIDS, tuberculosis (TB), reproductive health/family planning (RH/FP) and malaria services through mid- and large-size employers and private clinics. The HIPS Project has four main tasks:1) Expand and strengthen access to and utilization of health and HIV/AIDS services in the private sector; 2) expand the number of Global Development Alliance (GDA) partnerships; 3) Capacity Building support initiatives to strengthen private sector worker/employer associations; 4) Develop innovative and proven approaches to support orphans and other vulnerable children (OVC).Working with over 100 companies and 100 private MOH-accredited clinics in 57 districts, HIPS has demonstrated that the private sector can play a vital role in increasing access to and utilization of health services in Uganda.During the last 12 months of the project, the HIPS team will focus on three key elements to maximize impact:1) Quality of Services: HIPS facilitates regular and comprehensive support supervision to our partners to ensure that staffs are adequately trained and clinics have appropriate supplies, equipment and referral networks for proper diagnosis and treatment; 2) Integration of Services: HIPS aims to have 90% of our partner clinics providing HIV, TB, malaria, and RH/FP services by the end of the project; 3) Sustainability of Services and Exit Strategy: HIPS has built capacity within the Federation of Uganda Employers (FUE), Uganda Manufacturers Association (UMA), MOH and DHTs and our company partners and private clinics to carry forward health workplace and community programs.

Among the challenges facing health service delivery is the increasing number of patients with HIV/AIDS and the increasing burden that the pandemic is placing on hospitals and healthcare systems, making it difficult for the systems to function effectively. The home-based community response of caring for HIV individuals is also stretched. The HIPS Project is implementing the HIV clinical and community care and support program model which in 2011 has so far enabled the project to reach 26,884 HIV positive clients through partnerships with 100 private partner company facilities and clinics, located in 36 districts. The program strategy is to ensure access to quality comprehensive and integrated HIV/AIDS care package through the available community resources. The companies provide larger contribution in form of infrastructure, human resource and drugs to all clients, majority of which are community members.In 2011, HIPS in collaboration with Mild-May Uganda and districts, has supported training of 107 health workers and home based care givers (HBCG) that have been equipped with kits to support the HIV patients under their care and linked to health facilities within their communities for easy referral and follow up. Services offered at the private partner facilities include cotrimoxazole prophylaxis, treatment of opportunistic infections including TB, pain relief, home based care, laboratory investigations such as complete blood count (CBC), CD4 cell count and diagnostics for opportunistic infections. HIPS also supports private partner companies to sensitize and mobilize communities (this also addresses issues of HIV stigma/disclosure), organize PHAs into social support groups to address their household psycho-socio and economic need through such activities as, formation of income generation groups in farming activities which also contribute towards food security and nutrition.In 2012, HIPS will focus its intervention on offering improved and sustainable quality of care that is integrated within the community, District and National health services delivery package with the objective of reaching 35,000 HIV positive adults and children within the catchment area of 100 private partner company facilities and clinics. The project will continue to support training and mentoring of health workers and community care givers in order for them to continue providing their clients with quality services. The companies and PHAs will be assisted to get linked into existing referral facilities, NGOs and community based organizations to ensure integration and sustainability of the community based HIV/AIDS care programs and where necessary clinical care programs.Key activities for FY 2012:1.Onsite mentoring and training of private health providers in HIV care and support.2.Support selected facilities and community care givers with kits and basic supplies for care and support.3.Support integrated follow up of patients in community for HIV/TB care, RH and Malaria among the selected HIPS partner companies.4.Support selected facilities and community care givers with kits and basic supplies for palliative care5.Establish collaboration mechanisms with local CBOs and NGOs providing palliative care services to facilitate linkages and referral.

HIPS Project engages the Ugandan private sector to find cost effective and sustainable approaches to support OVC. HIPS has designed corporate engagement models to encourage companies to fund OVC care and support services. In 2011 through 12 matching grants, HIPS and corporate partners reached 3,035 OVC, spanning 25 districts. All OVC received at minimum 4 services, including psychosocial support, education, healthcare services and household strengthening economic activities. HIPS also built the capacity of 315 caregivers in child protection, psychosocial support, OVC care and support and socio-economic security.Using a 1:1 matching grant, HIPS has strengthened the capacity of OVC implementing partners in the delivery of care, building capacity of families in socio-economic activities and supported education interventions for OVC. Child protection interventions focused on building the capacity of local community and religious leaders to identify and refer cases of child abuse, in partnership with the Police, the Probation and Community development district offices. Health care interventions focused on establishment of functional referral for OVC in need of health care services, identification and referral of HIV positive children. HIPS partners have provided psychosocial support at three levels; the caregivers (trained to support children), the teachers (trained in behavioral change communication with formation and mentoring of peer support groups) and children (trained in cognitive and life planning skills) levels. HIPS socio-economic security strengthening activities focused on capacity building in entrepreneurships skills, apprenticeship skills training for OVC and engagement in group income generating activities as well as Village Saving and Loan schemes for OVC households, realizing savings worth Ug.shs.15,226,800 and loans to group members of Ug.shs. 53,925,250.

IN 2012, HIPS will continue to build capacity and provide technical support to the 12 OVC implementing partners in the delivery of OVC care and support, and also scale up access to health care services, education, psychosocial support, child protection, socio-economic security, food and nutritional support at school & household level, monitoring and support supervision visits, and foster partnerships with other service providers. HIPS Quality improvement approaches will focus on safety of services provided, accessibility, effectiveness and efficiency, community participation and sustainability. Child protection interventions with local community and religious leaders as well as socio-economic security interventions for households using entrepreneurship skills development and scaling up of the Village Scheme Loan Association (VSLA) approach to ensure sustainability of services will also be supported.

Planned activities for FY 2012:

1.Strengthen income of OVC households using the VSLA approach by conducting monitoring, mentoring and support visits for VSLA groups2.Build the capacity of community, local and religious leaders in child protection.3.Support partners to identify OVC that are HIV positive and refer them for palliative care services and specialized care.4.Build the capacity of partners in the delivery of care, psychosocial support and child protection.5.Support development of functional collaboration, networking and referral mechanisms with stakeholders in the districts.

The HIPS Project works with Private partner companies and health facilities through established partnerships to design and implement comprehensive workplace health programs to enhance to quality HIV/AIDS, TB, Malaria and Reproductive Health/Family Planning services. To foster sustainability, the Project has built the technical and programmatic capacity of private sector employer organizations, the Federation of Uganda Employers (FUE) and the Uganda Manufacturers Association (UMA) to assume leadership and steer the prevention with community heath activities forward.In 2011, the HIPS project closely worked with the Mild-May Centre, the AIDS Information Centre, MOH, Central Public Health Laboratory, JHU/CCP, Rakai Health Services Project and other national institutions to conduct training of multidisciplinary teams of health workers who are active in HIV/AIDS, TB, FP and RH Programs and community care givers at partner sites. The HIPS project in partnership with, local district officials and MOH provided on job-training, mentorship and regular support supervision to all its 100 private partner sites using a comprehensive support supervision tool based on the national supervision guidelines. The HIPS project also supported consensus building and dialogue between the Public and Private sectors, PPPH policy orientation for 20 pilot districts, facilitated inception of the PPPH Policy roll-out in 2 regions (Western & South Western), and kick-started Public-Private joint planning exercises in 5 out of the 20 pilot districts.In 2012, HIPS in collaboration with Mild-may will design and extensively market a costed training package that is tailored for private practitioners. HIPS will work closely with the MOH, line ministries, Development partners and the Private health sector to further support roll out of the PPPH policy implementation in 8 districts. Due to lack of formal access to high quality affordable specialized HIV laboratory services, HIPS in collaboration with the MOH and SIMS Medical Centre is to support strengthening of laboratory systems, the design and establishment of an accredited national reference laboratory for ART services in the private sector. HIPS in collaboration with all its key partners (including FUE & UMA) is focused on full integration of quality services and strengthening of established partnerships to sustain functionality and implementation of workplace health programmes at all respective private partner company sites.

Key activities in FY 2012.1. Training and refresher training for 1,500 peer educators and strengthen community health programmes2. Training of 36 health workers in safe male circumcision.3. Provide training to 100 private partner clinicians in HIV/AIDS Palliative care and delivery of ART services4. Build capacity of private health professionals in provision of comprehensive quality health care services (in RH/FP, PMTCT, Pediatric Care, safe motherhood, TB/HIV management, IPT/Malaria control).5. Provide training to 50 private health workers in HIV testing and counseling.6. Set up a Public-Private Partnership ART reference laboratory.7. On-job training of private facilities on the recently revised HMIS tools8. Support Public Private Partnerships in Health through provision of technical support and further roll out implementation of the PPPH Policy country-wide and support functional institutionalization of PPPH structures (at National & district levels).

In 2010, the Ministry of Health approved and started to advocate for safe medical circumcision as a key intervention for HIV prevention package (Health Sector Strategic Plan 2010-2015). In order to scale up this HIV prevention, the HIPS Project started to support implementation of Safe Male Circumcision among 10 partner private sector companies and clinics as part of the HIV prevention package offered to employees, dependents and the community. Through leveraging of resources at partner companies and clinics, HIPS has employed the BCC model to advocate for services uptake using men only seminars and outreaches to mobilize men at partner companies as a mechanism to create demand for the services while the companies take on to offer the service free of charge to both the employees and community.In 2011, the HIPS Project has facilitated training of 36 health care workers through the Rakai Health Sciences Program and Walter Reed Project on provision of safe male circumcision. HIPS has adapted and developed IEC materials on Safe Male Circumcision (SMC), procured and distributed equipment to 24 partner private sector facilities. Participating partner companies and clinics have extended in kind contribution, which includes: provision and renovation of infrastructure to match the recommended standards, staff, drugs such as analgesics, supplies and materials for post operative care, community mobilization and follow up.In 2011 the Project introduced surgical outreaches as a way to scale up the service for those private sector companies and clinics that expressed the need. Some of the companies that have so far participated in the surgical camps include KCCL, MacLeod Russells Tea Estate, Kinyara Sugar Works and Family Health Medical Center. A total of 1755 males have been circumcised by the 3rd quarter, as part of the minimum package of MC for HIV prevention among the 24 private facilities. HIPS targeted to circumcise 2000 males in 2011.During 2012, HIPS will continue to promote health outreaches with key focus on surgical camps amongst participating companies in order to minimize missed opportunities and increase vital health service uptake. HIPS is also targeting to circumcise 25,000 males upon informed consent and HIV testing. The project will also support training of more health workers on MMC at the Rakai Project and Walter Reed Trainings. HIPS will in addition extend support through training, equipment/medical supplies and support supervision of partner facilities so as to ensure quality and integration of services.Key Activities in 2012:

1. Support MMC camps and integrated men only seminars at 15 private partner sites2. Equip 5 additional partner clinics sites with supplies including, MMC kits, HIV Test Kits3. Conduct training of 36 health workers in safe male circumcision

The HIPS project works with private partner companies that support schools to implement a school HIV prevention program commonly known as the Good Life At School (GLAS). This initiative is geared towards expanding the life skills program to benefit young people in schools to prevent transmission of HIV, particularly in the 12-19 yr age group. The key approach school based peer education using the cascade approach and entertainment approach thats coupled with provision of life skills and health information for adoption of abstinence and other related healthy practices like early treatment of Sexually Transmitted Infections and HIV Counseling and testing.

In 2011, 87 teachers have been trained as trainers for student peer educators. 1,333 student peer educators were trained from 29 schools located in 4 districts with a targeted population of 30,812 young people. Out of these 28,439 students were reached with information and skills for adoption of abstinence and 20 schools have incorporated the activities into their main school program and agenda for extra curriculum activities. Efforts have been made to actively involve district leadership and other implementing partners within the districts. In Kasese district, which hosts 15 of the supported schools, meetings were conducted with implementers resulting in some of them extensively supporting the program. HIPS private partners extend contributions in areas such as; training of student peer educators, IEC materials distribution, Drama activities, HIV associated stigma reduction and counselor visits. Sexual prevention activities have also been incorporated in HIPS support supervision activities targeting partner companies implementing school health HIV programmes. The Ministry of education has recommended the replication of this model program for use by other district implementers.

In FY 2012, HIPS is targeting to reach 15,000 students with preventive interventions primarily focused on abstinence and/or being faithful. Further support is focused on strengthening collaboration and advocacy with district implementers for possible integration of supported school HIV prevention interventions into their plans. HIPS will extend support supervision to partner companies and integration of health communication messages into existing school health programs and activities. Key risk reduction behaviors to be promoted in schools include: adoption of abstinence, promoting the benefits from delaying sexual debut, early treatment of STIS, information sharing focusing on HIV counseling and testing, life skills within peer pressure environment and dealing with myths about sex and sexuality. A rapid assessment exercise will be conducted to establish the extent to which the supported HIV prevention program has addressed key health knowledge and skills among students.

Key Activities for FY2012:1.Support schools to conduct peer education sessions to reach 15,000 students and the implementation of small group based student peer education sessions.2.Adapt, reproduce and disseminate communication materials on HIV prevention and related health practices.3.Support and conduct district advocacy meetings for the integration of school based HIV prevention program.4.Support integrated support supervision visits with district implementers5.Support partner schools to integrate HIV prevention messages in existing activities.6.Support rapid assessment exercise for the school HIV prevention pro

The HIPS Project works with Private partner companies and health facilities through established partnerships to design and implement comprehensive workplace health programs to enhance to quality HIV/AIDS, TB, Malaria and Reproductive Health/Family Planning services. To foster sustainability, the Project has built the technical and programmatic capacity of private sector employer organizations, the Federation of Uganda Employers (FUE) and the Uganda Manufacturers Association (UMA) to assume leadership and steer these partnerships forward.In 2011, the HIPS project, in collaboration with FUE and UMA, has provided support to 143 private partner company facilities and clinics in HIV Voluntary Counseling and Testing services located in 43 districts. HIPS has trained over 48 counselors in VCT, provided 49,170 people with VCT services through outreaches and on site clinics. The Project in partnership with JHU/Couples Counseling Project supported training of 23 counselors in couple counseling and testing, selected from private partners conducting HCT services. In addition, the HIPS project partnered with Nile Breweries on a cost share partnership basis to pilot home based VCT services for employees and communities particularly farmers in Katakwi District-Usuk Parish. Up to 4,400 people were counseled and tested for HIV in their homes of which 175 were found HIV positive, started on Septrin prophylaxis and referred to Katakwi Health Center IV for further diagnostic screening and management.In 2012, HIPS in collaboration with the Ministry of Health (MOH), AIDS Information Center and Mulago Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) will direct efforts towards integration and sustainability of quality services at the static health facilities, special health fair events that promote VCT and regular community outreaches to ensure delivery of a comprehensive health package to employees, dependants and surrounding communities. Special focus in 2012 is to embark on mobilizing more couples for counseling and testing. During support supervision visits, health workers will be supported on effective data entry, analysis and reporting. HIPS will also focus on expanding the HCT services; strengthen IEC/BCC community health activities and integration of services (TB, Malaria, Reproductive Health, nutritional support, Safe Male Circumcision).

Key activities for 2012:1. Cost share with private companies the bills of printing and distributing VCT forms, client cards, job aids, clinical guidelines, clinic registers and client forms to respective partner health facility sites.2. Strengthen existing and establish new functional linkages of its private sector partners with organizations/resource agencies such as AIC, MJAP, JMS, UHMG, the STAR Projects, MSIU to streamline distribution, and access of quality health products and supplies including free HIV test kits.3. Train 50 private health workers from partner sites in HCT.4. Provide VCT services to 1,250 truckers, 2,000 bar workers and 3,250 smallholder farmers as well as to their partners.

5. Train 50 counselors in couple counseling and testing to strengthen HCT services, Men-only seminar activities, follow up of HIV positive couples and discordant couples, and enhance referral mechanisms between private partner facilities and the communities.

The HIPS project supports private sector companies to implement communication activities for promoting HIV prevention practices among employees and surrounding communities. In this strategy, HIPS main goal is reducing HIV risk among sexually active men and women addressing high risk transmission among vulnerable population groups (fishermen, bar maids and long distant truck drivers). Focused activities include; Consistent condom use, Medical Male Circumcision (MMC), reduction of multiple concurrent sexual relationships and unfaithfulness in sexual relationships, and early treatment of sexually transmitted infections. HIPS works with over 100 private partner companies located in 57 districts with a total employee population of up to 50,000. 70% of the targeted populations are from community members. The peer education strategy (small group based of not more than 25 peers) is the major approach utilized in reaching out to the target audience with prevention communication messages. The peer educator conducts interactive discussions using a developed guide for a period of 12 months. This approach strengthens relations, builds confidence and reinforces message sharing for prevention action among peers.

In 2011, HIPS targeted 1,500 and has so far trained up to 1,320 peer educators, of which 850 were oriented on the small group approach. Other key prevention communication approaches deployed include; men only seminars, pre-recorded radio discussions, sexual network games and post test drama shows. 45,000 people were reached through health education information and skills through small group discussions.

In FY 2012 HIPS support will be focused on strengthening mechanisms and approaches for ensuring sustainability, quality and integration of HIV prevention communication activities. HIPS support involves enhancing technical capacities of the Uganda Manufacturers Association _UMA and Federation of Uganda Employers _ FUE to design and implement HIV prevention communication programs with partner companies. HIPS will support the integration of health communication messages into partner routine programs and activities with a key focus on vulnerable groups (Long distant truck drivers, hospitality workers and fishermen) with implementation of small group based peer education activities ( include informal discussions, radio discussions, sexual network games, conduct community health fairs and men only seminars).

Key Activities for FY2012:

1.Re-orient and train 1,500 peer educators on small group based approach for peer education.2.Support small group based peer education activities to reach 45,000 people with HIV prevention information and skills.3.Conduct partner meetings to advocate for integration of HIV prevention activities into occupation health and safety budgets.4.Support companies to integrate BCC messages and disseminate quality assurance guidelines5.Adapt, reproduce and disseminate communication materials on HIV prevention and other promoted health practices6.Facilitate through FUE/UMA community health fairs and men only seminars7.Support 8 partners to reach out to vulnerable groups (Fishermen, hospitality workers and Long distant truck drivers).

HIPS works in partnership with small, medium and large size business companies and clinics in Ugandas private sector to increase access to free anti retroviral treatment (ART). HIPS in collaboration with the Ministry of Health AIDS Control Program have to date accredited 100 private partner facilities as ART Centres in the country. These facilities are distributed in 31 districts of the country.In 2011, HIPS in partnership with the Ministry of Health and its private partner facilities has been able to provide free AIDS treatment to 4837 clients with the majority (70%) from catchment communities while the rest are company employees and dependants. However, the ARV shortage previously experienced in the country made it difficult for some of the private sector companies and clinics to access ARVs from the National Medical Store hence by the end of June 2011, only about 50% of the accredited facilities were able to provide ART. As a result, there have been drop outs and transfers of ART clients from some of the private partner sites to other ART sites including public facilities until recently when the ARV situation in the country improved.HIPS in partnership with Mild-May Uganda, has supported training of 191 health care workers in the use of ARVs in resource limited areas and other HIV/AIDS related courses in order to improve their skills. HIPS in partnership with the MOH, facilitated partner private sector laboratory and clinic staff to undertake ART logistics management training .Through cost sharing, the Project has equipped private partner facilities with basic medical and laboratory equipment and supplies required for client monitoring during treatment. Equipment provided includes: machines for chemistry analysis, microscopes, weighing scales, heamoglobinometers and reagents for diagnosis of opportunistic infections such as tuberculosis. The Project, in collaboration with the MOH, has ensured reporting, adherence and carried out regular support supervision of accredited private facilities.In 2012, the main focus of the HIPS project will be to ensure improved access to ARVs from the Ministry of Health by the accredited facilities for sustainability. In addition, HIPS is to support training of 100 private health workers in the delivery of ART services. The Project will also target to enroll 500 HIV clients on ARVs, support improvement of quality of services through provision of medical equipment and supplies, mentoring of staffs and joint support supervision. The Project will ensure integration of ART with PMTCT, TB diagnosis and treatment for the private partner facilities.

Key Activities for FY 2012:1.Support on job training for 60 health workers in PMTCT and Pediatric Care2.Conduct on job training to 90 health workers on TB/HIV Management.3.Conduct training and follow up of 100 health workers to strengthen ART service delivery and cohort analysis4.Conduct support supervision and follow up of all accredited clinics in partnership with the Districts.