Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3340
Country/Region: Uganda
Year: 2009
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health Center for Communication Programs
Organizational Type: University
Funding Agency: USAID
Total Funding: $5,813,900

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $800,000

INTRODUCTION

Since its inception in November 2005, the AFFORD Health Marketing Initiative has primarily worked to

increase accessibility to condoms through several channels, with special emphasis on high risk locations.

The project has used innovative communication approaches and channels to reach specific populations

with HIV and STI prevention messages and products. Condoms and direct counseling have been promoted

aggressively to most at risk groups (MARPS) across the country. The general public has also been exposed

to a wide range of communication messages promoting fidelity, reduction in sexual partners and correct and

consistent use of condoms for sexually active adults. The project has also addressed gender norms related

to increasing the risk of HIV infection.

PROGRESS TO DATE

Increased condom outlets and product distribution

In a bid to make condoms even more readily accessible at high risk locations, AFFORD stocked condoms in

as many bars as possible in all the regions of the country and carried out direct condom promotion at these

locations. This together with getting more corner shops (dukas) to stock condoms resulted in an increase of

condom outlets from 29,000 in 2007 to 32,000 in 2008. This benefited both the project and suppliers of

other brands of condoms. Socially marketed condoms in Uganda increased from 22 million in 2005 to 30

million in 2006, 34 million in 2007 and we are expecting about 38 million in 2008. Protector, the AFFORD

promoted condom brand and the oldest on the market, appeared to be a tired brand. In 2008, AFFORD

repackaged Protector in an attempt to make the brand more attractive to consumers.

Targeting Most At Risk Populations (MARPS)

AFFORD has continuously identified locations of high risk behaviors targeting most at risk populations with

HIV and STI prevention. Using community outreach and interpersonal communication, the project has

directly reached fishermen in several fishing communities, commercial sex workers in four major locations in

the country, the military, police and other private security agencies. Working through six partners, a total of

29,671 MARPS were reached in 2008. The MARPS program included HIV counseling and testing, STI

diagnosis and treatment, family planning services, condom promotion and productive skills training as

alternative means of income generation for sex workers who would like to transition to safer lifestyles.

Through subcontractors, AFFORD trained 607 peer educators in FY 2008 among commercial sex workers,

police, UPDF and fishermen. They were trained to address gender and social norms and practices that

increase men's risk of HIV infection using the "Be a Man" training manual and tools. These interpersonal

approaches reached 28,378 people in 21 districts.

In an effort to facilitate sustainable programming for MARPS, AFFORD supported the establishment of the

MARPS network, a national network that brings together all organizations working with MARPS. The

MARPS network‘s main function is to facilitate information sharing and dissemination of best practices,

provide strategic direction in MARPS programming and advocate for resource allocation to MARPS

interventions. To date the MARPS network has a membership of 20 organizations, a three year strategic

plan and a functional secretariat

The Good Life! Campaign

Formative research revealed that Ugandans equate "wellness" with material wealth rather than physical

health. This insight led to the development of the Good Life platform, designed to promote the simple things

Ugandans can do everyday to keep healthy and save money, thereby improving overall quality of life.

The Good Life campaign launched with The Good Life! Show, a highly popular TV, radio and experiential

game show that uses edutainment to increase knowledge, facilitate couple communication, promote healthy

behaviors, and increase demand for products and services. Areas of HIV focus include risk perception,

condom use, HIV testing, disclosure, PMTCT, adherence, and positive living. In FY 2008, 24 episodes were

broadcast on 3 TV stations, 20 radio stations in 5 languages and appeared in 120 locations countywide

through the experiential road shows.

The experiential road shows were further refined to enhance interpersonal communication and resulted in

the development of the "four tent" model. Using this approach, fewer people gather under a tent to learn

about HIV prevention and engage in meaningful exchange with the moderators. The four tent approach

went to 120 communities in 2008 reaching 300,000 people.

In partnership with the HIPS project, AFFORD implemented a number of workplace programs targeting

major companies and sugar and tea plantation workers. A total of 32,000 people in 16 workplaces were

reached through this intervention with HIV prevention messages and products including condoms.

Interpersonal communication at the village level - Popular Opinion Leaders

AFFORD created the Popular Opinion Leader model in 2006 to complement its efforts at reaching

Ugandans at the grassroots. Popular Opinion Leaders are volunteers recruited at the village level and

trained to offer education on basic health issues including HIV/AIDS. To date over 700 POLs are operating

in 18 districts. In FY 2008, 736 new POLs were trained in 23 districts. POLs use interpersonal approaches

to raise awareness on condom use, HIV testing, discordance, and benefits of early treatments of STIs.

Addressing Alcohol and Sexual Violence

In FY 2008, AFFORD and its partner PULSE reached over 100,000 people in high risk locations in Uganda.

AFFORD trained over 190 bar and lodge owners in condom use at the work place, STI and HIV referral,

and sexual violence to staff and patrons. Working in collaboration with UPHOLD, AFFORD also oriented

231 bar and lodge owners in 12 districts on HIV in the workplace. The objective was to enhance bar and

lodge owners' knowledge on the relationship between alcohol consumption, sexual violence and HIV

transmission in order for them to promote and enforce key HIV/AIDS prevention practices and basic work

place polices in their establishments.

FY 2009 ACTIVITIES

In FY 2009 AFFORD will consolidate its gains by maintaining all its existing activities as mentioned above.

The project will strengthen the quality of programming with the aim of reaching more under-served areas

Activity Narrative: and people with HIV prevention messages. AFFORD will use local languages and approaches that the

intended population can appreciate and effectively participate in promoting the reduction of sexual partners

and consistent and correct condom use. AFFORD expects to reach approximately 390,000 people directly

through HIV prevention messages.

C

ondom Distribution

AFFORD will work on increasing its distribution by increasing the number of outlets stocking condoms. The

following strategies will be adopted:

Increasing number of wholesale outlets with our products. The number of outlets is expected to increase to

50,000.

Recruit Fast Moving Consumer Goods (FMCG) distributor: AFFORD will recruit 3 FMCG distributors as

means of reaching existing high risk locations (bars, lodges, hotels, etc). FMCG distributors (especially beer

distributors) target the same locations as those for condom distribution. AFFORD piggybacks on distribution

mechanisms of FMCG products like laundry soaps, toothpaste (Unilever products) and beers to increase

availability and accessibility of condoms in high risk locations and outlets. Distributing condoms through HIV

prevention stakeholders/organizations: Through the HIPS project, AFFORD will sell condoms to companies

that employ large numbers of staff. This will be extended further to reach other NGO's working in the areas

of HIV prevention, for example, MAVAP, AIC, IRC, and MSF, among others.

Condom promotion

AFFORD will concentrate on improving acceptability of condoms at MARPS locations and general retail

outlets using the medium of karaoke in bars. The bars will also serve as channels for condom sales.

In order to encourage condom stocking by traders, AFFORD will carry out trade promotion, providing

attractive incentives for traders that buy and restock condoms in good purchase quantities.

AFFORD will liaise with beer companies to hold joint promotions. This will cut costs of promotions and at

the same time highlight responsible drinking, coupled with correct and consistent condom use.

AFFORD will also roll out a merchandising campaign to ensure condom visibility, emphasizing the

affordability of the condoms. This campaign will ensure that point of sale materials are properly displayed

and that condom stocks are available at these outlets.

The field teams (PMOs) will work together with night club management countrywide to organize condom

promotions. Night clubs have proven to be locations for high risk behavior.

Targeting Most At Risk Populations

In FY 2009 AFFORD will continue MARPS interventions in its current districts, and work with the MARPS

network and organizations to scale up interventions for fishermen, truckers and CSWs in 8 new districts.

AFFORD will also expand the number of MARPS organizations it is working with from 8 to 10.

Peer Educators (PE) program: Through sub grants to MARPS organizations, AFFORD will conduct

refresher training for the 607 previously trained PEs and train 500 new PEs for all four categories of MARPS

(CSW, military, police and fishermen). AFFORD will support PEs to reach 100,000 people through

interpersonal communication and community mobilization with HIV/AIDS messages and link them to

needed products and services for reproductive health. AFFORD will reproduce and distribute support

materials, job aids and tools needed by PEs to do their work. Support materials will focus on HIV prevention

approaches and gender norms that increase the risk of HIV transmission, and address alcohol consumption

and sexual violence. AFFORD will continue to target men with gender positive messages from the male

perspective.

Access to friendly service outlets: AFFORD will continue to support MARPS to access friendly services for

HCT, STI and family planning. Special and convenient places like previously supported drop-in centers for

CSW will be supported and equipped to make them fully functional. AFFORD will support establishment of 2

additional drop in centers for CSW. Similarly 2 additional safe sailing boats manned by PEs to deliver

services and products to fishermen and fishing communities in remote fish landing sites will be procured

and equipped. Static condom outlets in military and police barracks and parking yards for long distance

truck drivers will be procured for 10 new locations each.

Internally displaced persons (IDPs): Of the 31 priority districts supported by AFFORD, 4 have been under

conflict, still have high populations of IDPs and have high HIV prevalence. In 2009 AFFORD, will extend

HIV prevention interventions through our innovative communication campaign and use the product

distribution mechanisms to step up condom promotion and addressing gender norms that increase the risk

of HIV transmission. In addition, through sub grants, AFFORD will identify and support organizations

providing tailored HIV prevention programs using community mobilization and interpersonal communication.

Good Life Campaign

In FY 2009 AFFORD will continue to use the Good Life campaign to address critical issues that drive the

epidemic in Uganda. Mass media will reinforce community interventions, positive behaviors, risk perception

and gender issues influencing people's behaviors. The Good Life Essence campaign will be launched,

which will include better linkages to the AFFORD health messages and products through mass media, a

loyalty scheme and rewards to consumers who recall, purchase and use the AFFORD products and

messages. It will culminate into the Good Life awards rewarding households, communities, distributors and

POLs who emulate the Good Life. The Good Life Show will also be shown in more community video halls

and generate discussions thereafter while also scaling up the 4 tent model, which will cover the whole

country.

Interpersonal communication at the village level - Popular Opinion Leaders

In FY 2009 AFFORD will continue to work with CDFU to consolidate gains registered in the 23 districts.

Refresher training for POLs to enhance their skills in interpersonal communication and community

mobilization will be held. AFFORD will continue to strengthen this interventions aimed at preventing sexual

Activity Narrative: transmission of HIV to reach 100,000 people. Through this intervention AFFORD and CDFU will intensify

activities in the 23 districts with more in depth activities for condom promotion, prevention among discordant

couples and raise awareness on gender issues that increase the risk of HIV transmission. AFFORD will

also intensify interventions for gender using the Be a Man campaign and the African Transformation Model,

a skill building model to analyze gender stereotypes. Special attention will be given to strengthening

interventions for fidelity and partner reduction by working with religious leaders and other community self

help groups. Through this intervention AFFORD will reach 500 couples and 20,000 men with gender and

HIV /AIDS prevention messages.

Addressing Alcohol and Sexual Violence

In FY 2009 bar and lodge owners, small local brewers, brothel owners and pimps who link sex workers to

their clients and engage in alcohol and substance abuse will be sensitized through interpersonal activities.

AFFORD will collaborate with organization like Serenity Center and Indigenous Knowledge Resource

Center to mainstream alcohol and sexual violence training in all our prevention programs. AFFORD will train

50 peer educators and reach 60,000 people with alcohol and sexual violence messages.

AFFORD will also promote responsible drinking using consumer promotions, community activities and mass

media. Mass media and community activities will target men using male dominated activities like soccer and

drama. At these activities gender based violence and alcohol will be discussed and men's responsibility

promoted. Direct condom promotion and sales events will take place.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

Refugees/Internally Displaced Persons

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $250,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $2,713,900

INTRODUCTION

Since its inception in November 2005, the AFFORD Health Marketing Initiative has primarily worked to

increase accessibility to condoms through several channels, with special emphasis on high risk locations.

The project has used innovative communication approaches and channels to reach specific populations

with HIV and STI prevention messages and products. Condoms and direct counseling have been promoted

aggressively to most at risk groups (MARPS) across the country. The general public has also been exposed

to a wide range of communication messages promoting fidelity, reduction in sexual partners and correct and

consistent use of condoms for sexually active adults. The project has also addressed gender norms related

to increasing the risk of HIV infection.

PROGRESS TO DATE

Increased condom outlets and product distribution

In a bid to make condoms even more readily accessible at high risk locations, AFFORD stocked condoms in

as many bars as possible in all the regions of the country and carried out direct condom promotion at these

locations. This together with getting more corner shops (dukas) to stock condoms resulted in an increase of

condom outlets from 29,000 in 2007 to 32,000 in 2008. This benefited both the project and suppliers of

other brands of condoms. Socially marketed condoms in Uganda increased from 22 million in 2005 to 30

million in 2006, 34 million in 2007 and we are expecting about 38 million in 2008. Protector, the AFFORD

promoted condom brand and the oldest on the market, appeared to be a tired brand. In 2008, AFFORD

repackaged Protector in an attempt to make the brand more attractive to consumers.

Targeting Most At Risk Populations (MARPS)

AFFORD has continuously identified locations of high risk behaviors targeting most at risk populations with

HIV and STI prevention. Using community outreach and interpersonal communication, the project has

directly reached fishermen in several fishing communities, commercial sex workers in four major locations in

the country, the military, police and other private security agencies. Working through six partners, a total of

29,671 MARPS were reached in 2008. The MARPS program included HIV counseling and testing, STI

diagnosis and treatment, family planning services, condom promotion and productive skills training as

alternative means of income generation for sex workers who would like to transition to safer lifestyles.

Through subcontractors, AFFORD trained 607 peer educators in FY 2008 among commercial sex workers,

police, UPDF and fishermen. They were trained to address gender and social norms and practices that

increase men's risk of HIV infection using the "Be a Man" training manual and tools. These interpersonal

approaches reached 28,378 people in 21 districts.

In an effort to facilitate sustainable programming for MARPS, AFFORD supported the establishment of the

MARPS network, a national network that brings together all organizations working with MARPS. The

MARPS network‘s main function is to facilitate information sharing and dissemination of best practices,

provide strategic direction in MARPS programming and advocate for resource allocation to MARPS

interventions. To date the MARPS network has a membership of 20 organizations, a three year strategic

plan and a functional secretariat

The Good Life! Campaign

Formative research revealed that Ugandans equate "wellness" with material wealth rather than physical

health. This insight led to the development of the Good Life platform, designed to promote the simple things

Ugandans can do everyday to keep healthy and save money, thereby improving overall quality of life.

The Good Life campaign launched with The Good Life! Show, a highly popular TV, radio and experiential

game show that uses edutainment to increase knowledge, facilitate couple communication, promote healthy

behaviors, and increase demand for products and services. Areas of HIV focus include risk perception,

condom use, HIV testing, disclosure, PMTCT, adherence, and positive living. In FY 2008, 24 episodes were

broadcast on 3 TV stations, 20 radio stations in 5 languages and appeared in 120 locations countywide

through the experiential road shows.

The experiential road shows were further refined to enhance interpersonal communication and resulted in

the development of the "four tent" model. Using this approach, fewer people gather under a tent to learn

about HIV prevention and engage in meaningful exchange with the moderators. The four tent approach

went to 120 communities in 2008 reaching 300,000 people.

In partnership with the HIPS project, AFFORD implemented a number of workplace programs targeting

major companies and sugar and tea plantation workers. A total of 32,000 people in 16 workplaces were

reached through this intervention with HIV prevention messages and products including condoms.

Interpersonal communication at the village level - Popular Opinion Leaders

AFFORD created the Popular Opinion Leader model in 2006 to complement its efforts at reaching

Ugandans at the grassroots. Popular Opinion Leaders are volunteers recruited at the village level and

trained to offer education on basic health issues including HIV/AIDS. To date over 700 POLs are operating

in 18 districts. In FY 2008, 736 new POLs were trained in 23 districts. POLs use interpersonal approaches

to raise awareness on condom use, HIV testing, discordance, and benefits of early treatments of STIs.

Addressing Alcohol and Sexual Violence

In FY 2008, AFFORD and its partner PULSE reached over 100,000 people in high risk locations in Uganda.

AFFORD trained over 190 bar and lodge owners in condom use at the work place, STI and HIV referral,

and sexual violence to staff and patrons. Working in collaboration with UPHOLD, AFFORD also oriented

231 bar and lodge owners in 12 districts on HIV in the workplace. The objective was to enhance bar and

lodge owners' knowledge on the relationship between alcohol consumption, sexual violence and HIV

transmission in order for them to promote and enforce key HIV/AIDS prevention practices and basic work

place polices in their establishments.

FY 2009 ACTIVITIES

In FY 2009 AFFORD will consolidate its gains by maintaining all its existing activities as mentioned above.

The project will strengthen the quality of programming with the aim of reaching more under-served areas

Activity Narrative: and people with HIV prevention messages. AFFORD will use local languages and approaches that the

intended population can appreciate and effectively participate in promoting the reduction of sexual partners

and consistent and correct condom use. AFFORD expects to reach approximately 390,000 people directly

through HIV prevention messages.

C

ondom Distribution

AFFORD will work on increasing its distribution by increasing the number of outlets stocking condoms. The

following strategies will be adopted:

Increasing number of wholesale outlets with our products. The number of outlets is expected to increase to

50,000.

Recruit Fast Moving Consumer Goods (FMCG) distributor: AFFORD will recruit 3 FMCG distributors as

means of reaching existing high risk locations (bars, lodges, hotels, etc). FMCG distributors (especially beer

distributors) target the same locations as those for condom distribution. AFFORD piggybacks on distribution

mechanisms of FMCG products like laundry soaps, toothpaste (Unilever products) and beers to increase

availability and accessibility of condoms in high risk locations and outlets. Distributing condoms through HIV

prevention stakeholders/organizations: Through the HIPS project, AFFORD will sell condoms to companies

that employ large numbers of staff. This will be extended further to reach other NGO's working in the areas

of HIV prevention, for example, MAVAP, AIC, IRC, and MSF, among others.

Condom promotion

AFFORD will concentrate on improving acceptability of condoms at MARPS locations and general retail

outlets using the medium of karaoke in bars. The bars will also serve as channels for condom sales.

In order to encourage condom stocking by traders, AFFORD will carry out trade promotion, providing

attractive incentives for traders that buy and restock condoms in good purchase quantities.

AFFORD will liaise with beer companies to hold joint promotions. This will cut costs of promotions and at

the same time highlight responsible drinking, coupled with correct and consistent condom use.

AFFORD will also roll out a merchandising campaign to ensure condom visibility, emphasizing the

affordability of the condoms. This campaign will ensure that point of sale materials are properly displayed

and that condom stocks are available at these outlets.

The field teams (PMOs) will work together with night club management countrywide to organize condom

promotions. Night clubs have proven to be locations for high risk behavior.

Targeting Most At Risk Populations

In FY 2009 AFFORD will continue MARPS interventions in its current districts, and work with the MARPS

network and organizations to scale up interventions for fishermen, truckers and CSWs in 8 new districts.

AFFORD will also expand the number of MARPS organizations it is working with from 8 to 10.

Peer Educators (PE) program: Through sub grants to MARPS organizations, AFFORD will conduct

refresher training for the 607 previously trained PEs and train 500 new PEs for all four categories of MARPS

(CSW, military, police and fishermen). AFFORD will support PEs to reach 100,000 people through

interpersonal communication and community mobilization with HIV/AIDS messages and link them to

needed products and services for reproductive health. AFFORD will reproduce and distribute support

materials, job aids and tools needed by PEs to do their work. Support materials will focus on HIV prevention

approaches and gender norms that increase the risk of HIV transmission, and address alcohol consumption

and sexual violence. AFFORD will continue to target men with gender positive messages from the male

perspective.

Access to friendly service outlets: AFFORD will continue to support MARPS to access friendly services for

HCT, STI and family planning. Special and convenient places like previously supported drop-in centers for

CSW will be supported and equipped to make them fully functional. AFFORD will support establishment of 2

additional drop in centers for CSW. Similarly 2 additional safe sailing boats manned by PEs to deliver

services and products to fishermen and fishing communities in remote fish landing sites will be procured

and equipped. Static condom outlets in military and police barracks and parking yards for long distance

truck drivers will be procured for 10 new locations each.

Internally displaced persons (IDPs): Of the 31 priority districts supported by AFFORD, 4 have been under

conflict, still have high populations of IDPs and have high HIV prevalence. In 2009 AFFORD, will extend

HIV prevention interventions through our innovative communication campaign and use the product

distribution mechanisms to step up condom promotion and addressing gender norms that increase the risk

of HIV transmission. In addition, through sub grants, AFFORD will identify and support organizations

providing tailored HIV prevention programs using community mobilization and interpersonal communication.

Good Life Campaign

In FY 2009 AFFORD will continue to use the Good Life campaign to address critical issues that drive the

epidemic in Uganda. Mass media will reinforce community interventions, positive behaviors, risk perception

and gender issues influencing people's behaviors. The Good Life Essence campaign will be launched,

which will include better linkages to the AFFORD health messages and products through mass media, a

loyalty scheme and rewards to consumers who recall, purchase and use the AFFORD products and

messages. It will culminate into the Good Life awards rewarding households, communities, distributors and

POLs who emulate the Good Life. The Good Life Show will also be shown in more community video halls

and generate discussions thereafter while also scaling up the 4 tent model, which will cover the whole

country.

Interpersonal communication at the village level - Popular Opinion Leaders

In FY 2009 AFFORD will continue to work with CDFU to consolidate gains registered in the 23 districts.

Refresher training for POLs to enhance their skills in interpersonal communication and community

mobilization will be held. AFFORD will continue to strengthen this interventions aimed at preventing sexual

Activity Narrative: transmission of HIV to reach 100,000 people. Through this intervention AFFORD and CDFU will intensify

activities in the 23 districts with more in depth activities for condom promotion, prevention among discordant

couples and raise awareness on gender issues that increase the risk of HIV transmission. AFFORD will

also intensify interventions for gender using the Be a Man campaign and the African Transformation Model,

a skill building model to analyze gender stereotypes. Special attention will be given to strengthening

interventions for fidelity and partner reduction by working with religious leaders and other community self

help groups. Through this intervention AFFORD will reach 500 couples and 20,000 men with gender and

HIV /AIDS prevention messages.

Addressing Alcohol and Sexual Violence

In FY 2009 bar and lodge owners, small local brewers, brothel owners and pimps who link sex workers to

their clients and engage in alcohol and substance abuse will be sensitized through interpersonal activities.

AFFORD will collaborate with organization like Serenity Center and Indigenous Knowledge Resource

Center to mainstream alcohol and sexual violence training in all our prevention programs. AFFORD will train

50 peer educators and reach 60,000 people with alcohol and sexual violence messages.

AFFORD will also promote responsible drinking using consumer promotions, community activities and mass

media. Mass media and community activities will target men using male dominated activities like soccer and

drama. At these activities gender based violence and alcohol will be discussed and men's responsibility

promoted. Direct condom promotion and sales events will take place.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14218

Continued Associated Activity Information

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

System ID System ID

14218 4385.08 U.S. Agency for Johns Hopkins 6743 3340.08 Health Comm $1,100,000

International University Center Partnership;

Development for Communication AFFORD

Programs

9229 4385.07 U.S. Agency for Johns Hopkins 4841 3340.07 Health Comm $1,100,000

International University Center Partnership;

Development for Communication AFFORD

Programs

4385 4385.06 U.S. Agency for Johns Hopkins 3334 1032.06 Health $1,000,000

International University Center Communication

Development for Communication Partnership

Programs

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

Refugees/Internally Displaced Persons

Workplace Programs

Human Capacity Development

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

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Care: Adult Care and Support (HBHC): $1,840,000

INTRODUCTION

The AFFORD Health Marketing Initiative (AFFORD) is a cooperative agreement awarded to the Johns

Hopkins Bloomberg School of Public Health Centre for Communication Programs in October 2005.

AFFORD has the following objectives:

1) Increase accessibility and affordability of HIV/AIDS, reproductive health, child survival and malaria

products and services for Ugandans using innovative private sector approaches; 2) Enhance knowledge,

and correct use of HIV/FP/CS/Malaria products and services to encourage and sustain healthy behaviours

and lifestyles; 3) Strengthen/establish indigenous organization(s) for sustainable and self sufficient delivery

of key health marketing functions, including product distribution and promotion. AFFORD is a consortium of

6 organizations, three international and three local. All 6 consortium members have contributed to the

creation of an indigenous organization, the Uganda Health Marketing Group (UHMG), and are building the

required skills and capacity to continue in the footsteps of AFFORD when the project comes to an end.

UHMG is now incorporated as a not for profit company and is working alongside other consortium partners.

UHMG continues to build its technical, managerial and financial capacity to effectively deliver the objectives

of AFFORD now and in the future.

AFFORD has worked through the private sector to provide quality health maintenance products to PLHAs

as well as provide counseling and referral services for clients. In 2008 HCT became a main part of the

AFFORD care and support program through its carefully selected 100 private clinics. The project's

numerous communication channels are used to promote these services. Through this intervention the

private sector is increasingly contributing more to HIV prevention and health maintenance.

PROGRESS TO DATE

In FY 2008 AFFORD realized that in order to effectively provide care for PLHAs who seek palliative basic

care services from the private commercial sector, it is important to establish their serostatus. Because most

people avoid the public health facilities for various reasons including stigma, AFFORD supported the

establishment of HCT services in 100 private clinics to ease access to HCT services without fear of

stigmatization. Selection of eligible clinics was done in collaboration with the Ministry of Health (MOH) and

Central Public Health Laboratories (CPHL) using an assessment tool jointly developed with AFFORD.

Service providers from these clinics were trained by MOH trainers using national curricula for HIV

counseling and laboratory practice. The Making Medical Injections Safe (MMIS) project trained providers in

these clinics in health care waste management. These Good Life Clinics were provided with test kits and

other consumables. Good Life Clinics have since provided excellent and convenient facilities for people to

know their serostatus. Through the Good Life Clinics 11,113 people have tested and received their HIV test

results. Data collection tools and laboratory practice standard guidelines used by the clinics are provided by

MOH. Good Life Clinics are now linked through a network of geographically spread out clinics providing an

assemblage of services for family planning, HIV, child health and malaria prevention among other medical

services provided.

Adult treatment and care

In FY 2008, AFFORD's palliative basic care included strengthening the capacity of health workers in private

commercial clinics and drug shops with knowledge and skills to deliver basic palliative care services.

Identification of palliative care outlets was done in collaboration with District Officials with using a database

of registered drug shops and clinics generated by the National Drug Authority. In total 1557 health workers,

each representing an outlet, were trained using a module developed by AFFORD. Among these 410 were

clinics and 1147 drug shops. To ease access to a range of palliative care products AFFORD linked these

clinics to AFFORD's product distribution network. Job aids and support materials for providers and client

information is availed to all participating outlets. To date palliative care clinics have reached 100,962 people

with services and products while many more PLHAs have accessed and been referred for needed services

through participating drug shops.

Health Maintenance Products and OI Drugs

AFFORD has developed products that are being promoted to PLHAs for health maintenance. These

products include Aquasafe water purification tablets, Restors Low Osmolarity ORS, Cotramox (one month

pack cotrimoxazole), Acyclovir tablets and cream for adults and children in the treatment of HSV2 and a

triple action topical cream of dermatological infections. All these products are in distribution with the

exception of the Acyclovir and triple action cream which will be introduced on the market in November 2008.

In addition, the project works with six commercial net distributors to make LLINs affordable to PLHAs.

Though AFFORD carries its own brand of products, it promotes several brands of health maintenance

products and OI drugs through its wide network of pharmacies and drug shops. About 1147 pharmacists

and drug shop operators have been trained to provide palliative care counseling and provision of health

products. The retailers have been linked to major pharmaceutical distributors and wholesalers to get

continuous supply of these products. 510 private clinics have also been trained and are carrying a wide

range of health maintenance products and OI drugs.

Good Life Campaign

Formative research revealed that Ugandans equate "wellness" with material wealth rather than physical

health. This insight led to the development of the Good Life platform, designed to promote the simple things

Ugandans can do everyday to keep healthy and save money, thereby improving overall quality of life.

The Good Life campaign launched with The Good Life! Show, a highly popular TV, radio and experiential

game show that uses edutainment to increase knowledge, facilitate couple communication, promote healthy

behaviors, and increase demand for products and services. Areas of HIV focus included health

maintenance for PLHA, risk perception, condom use, HIV testing, disclosure, and PMTCT. In FY 2008, 24

episodes were broadcast on 3 TV stations, 20 radio stations in 5 languages and appeared in 120 locations

countywide through the experiential road shows. The experiential road shows were further refined to

enhance interpersonal communication and resulted in the development of the "four tent" model. Using this

approach, fewer people gather under a tent to receive messages and are able to ask pertinent questions

which they otherwise would not have been able to ask. The four tent approach went to 120 communities in

2008 reaching 300,000 people.

In partnership with the HIPS project, AFFORD implemented a number of workplace programs targeting

major companies and sugar and tea plantation workers. A total of 32,000 people in 16 workplaces were

reached through this intervention.

Recruitment, training and management of 100 model clinics

Activity Narrative: Selection of eligible clinics was done in collaboration with MOH and CPHL using an assessment tool jointly

developed with AFFORD. Clinics were assessed on various areas including management policies, logistics

management, personnel, range of services offered and work load in each service area, infection control,

availability of MOH guidelines and policies on treatment and service provision as well as willingness to

partner with AFFORD. Service providers from the selected clinics were trained by MOH trainers using

national curricula for HIV counseling and HIV Rapid Testing by CPHL trainers. Clinics were then provided

with testing kits and consumables, as well as data collection tools and supported to integrate HCT services

in their ongoing medical services. The providers were also trained in other critical areas supported by

AFFORD including malaria prevention and treatment, family planning, and child health.

Post training support is provided to ensure that clinics have basic management systems like basic data

collection tools to enable them to collect and submit data to the district health office, documentation of their

experiences, supply chain and stores management to help minimize stock out and knowledge of national

policies and guidelines for implementation of various medical services. Periodic support supervision is

provided by the technical teams composed of AFFORD and MOH staff. Support supervision teams provide

on-site mentoring and assess quality issues related to HCT service delivery.

FY 2009 ACTIVITIES - Reaching 108,000 people with care and treatment

In FY 2009 AFFORD will consolidate its successes over the past three years and expand its activities

geographically to reach more people who need services. We will increase the number of PLHAs reached

with care and treatment from 100,000 in 2008 to 108,000 through our various channels. The clinics offering

HCT will be increased by another 100 making a total of 200 clinics. Refresher trainings will be organized for

the wide range of service providers supporting the provision of health maintenance products and making

crucial referrals to appropriate health faculties. Various communication approaches will continue to raise

awareness of the usefulness of health maintenance as well as promote facilities where services can be

sought.

The following are the details of programmes planned for FY 2009:

Adult treatment and care

In FY 2009, AFFORD will scale up its intervention reaching PLHAs with treatments and care services

through clinics, PLHA networks, midwives, other partner organizations. Through 610 clinics offering

palliative care services we expect to reach 78,000 PLHAs. With an increase in the good life clinics providing

HIV counseling and testing services from 100 in 2008 to 200 in 2009 we expect 36,000 people to test and

receive their results and others referred for other needed services including ART. AFFORD will procure test

kits according to the recommended algorithm as follows: 40,000 determine test AFFORD will also work with

the Uganda Private Midwives Association (UPMA) to train its membership and link them to distribution

networks for palliative care products. Together with health workers from private clinics, midwives will be

trained in health care waste management and provided with safety boxes and color coded waste bins to

ensure safe disposal of waste. A total of 400 people will be trained to support delivery of HCT services

through private clinics and midwifery's. Through the UPMA 5000 people will be reached. . AFFORD

provides continued management and technical support supervision to the newly recruited 100 clinics along

side the previous 100 clinics.

Training: In FY 2009 AFFORD will conduct training and onsite mentoring to 2767 health workers in palliative

care services outlets. Private health providers will also be oriented on new products introduced on the

market including Cotramox, Acyclovir and a triple action topical cream of dermatological infections among

others. We will work together with the Association of Private Medical Practitioners to design refresher

training modules based on frequently asked questions from health workers in private practice. The health

workers will also be provided with the Palliative Care Handbook for continued reference as well as other job

aids and client materials.

AFFORD will conduct in-depth scale up of palliative care to the drug shop operators through its district

based trainers and field staff. More in depth detailing for the products already on the market and those

newly introduced for palliative care will be conducted, including ensuring steady supply for other products

such as Protector condom, condom ‘O', Aquasafe water purification tablet, Zinkid, Restors, and LLINs.

AFFORD will work with PLHA organizations to increase members' access to health maintenance products

and services. In collaboration with National Forum for PLHAs in Uganda, AFFORD will reach PLHA groups

like Positive Men's Union (POMU), National Community of Women Living with HIV/AIDS (NACWOLA), and

Young Positives. District networks of PLHAs will be supported to train their members in palliative care, and

availed with options on available outlets for service provision. A total of 500 PLHAs will be oriented and

these will in turn reach 15,000 PLHAs with palliative care information and products.

Through the Good Life communication platform, AFFORD will target PLHAs, their caretakers and families

with palliative care and health maintenance messages and direct them to outlets and providers that stock

quality products for health maintenance.

In FY 2009 AFFORD will also strengthen collaboration with other palliative care stakeholders to extend

products and services to a wider community beyond our targeted districts. AFFORD will collaborate with

organizations like The AIDS Support Organization (TASO), Joint Clinical Research Center (JCRC),

International AIDS Alliance and NUMAT to extend quality services to PLHAs. Through this intervention

AFFORD will reach 10,000 people with palliative care services and products.

Purchase and Distribution of OI Drugs

AFFORD will continue to use traditional social marketing to distribute a range of high quality palliative care

products targeted at PLHAs through private commercial channels (drug shops, pharmacies, clinics and

midwiferies). The range of products will include Cotrimoxazole (Cotramox) and Acyclovir (Clovirex), LLINs,

condoms, and multivitamin (Nutriboost). It should be noted that the palliative care program will leverage the

existence of products supported with child survival funds. These include Aquasafe (water purification

product), Zinkid (Zn) and Restors (ORS) and others like LLINs, condoms, and multivitamin (Nutriboost).

AFFORD plans to avail it through selected specialized clinics hospitals and other distribution networks for

AFFORD products.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14222

Continued Associated Activity Information

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

System ID System ID

14222 4409.08 U.S. Agency for Johns Hopkins 6743 3340.08 Health Comm $2,300,000

International University Center Partnership;

Development for Communication AFFORD

Programs

8440 4409.07 U.S. Agency for Johns Hopkins 4841 3340.07 Health Comm $2,000,000

International University Center Partnership;

Development for Communication AFFORD

Programs

4409 4409.06 U.S. Agency for Johns Hopkins 3340 3340.06 AFFORD $2,000,000

International University Center

Development for Communication

Programs

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

Refugees/Internally Displaced Persons

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $610,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $20,000

Table 3.3.08:

Funding for Care: Pediatric Care and Support (PDCS): $460,000

INTRODUCTION

The AFFORD Health Marketing Initiative (AFFORD) is a cooperative agreement awarded to the Johns

Hopkins Bloomberg School of Public Health Centre for Communication Programs in October 2005.

AFFORD has the following objectives:

1) Increase accessibility and affordability of HIV/AIDS, reproductive health, child survival and malaria

products and services for Ugandans using innovative private sector approaches; 2) Enhance knowledge,

and correct use of HIV/FP/CS/Malaria products and services to encourage and sustain healthy behaviours

and lifestyles; 3) Strengthen/establish indigenous organization(s) for sustainable and self sufficient delivery

of key health marketing functions, including product distribution and promotion. AFFORD is a consortium of

6 organizations, three international and three local. All 6 consortium members have contributed to the

creation of an indigenous organization, the Uganda Health Marketing Group (UHMG), and are building the

required skills and capacity to continue in the footsteps of AFFORD when the project comes to an end.

UHMG is now incorporated as a not for profit company and is working alongside other consortium partners.

UHMG continues to build its technical, managerial and financial capacity to effectively deliver the objectives

of AFFORD now and in the future.

AFFORD has worked through the private sector to provide quality palliative care products and services to

PLHAs including provision of counseling and referral services for clients. In 2007/8 AFFORD developed a

network of100 private clinics referred to as the Good Life clinics that offer comprehensive service in

palliative care for individuals and families. In addition, AFFORD's wide network of other clinics, midwiferies,

pharmacies and drug shops across Uganda supports the intervention with information and carefully

coordinated referrals. The numerous communication channels developed are utilized in the promotion of

these services. Through this intervention the private sector is increasingly contributing its share to care for

PLHAs.

PROGRESS TO DATE

In FY 2008, AFFORD through its 510 private clinics providing palliative care the project reached 100,962

adult PLHAs with services and products. Over the years AFFORD has observed that demand for palliative

care services for children from PLHA families has been progressively increasing. Indeed family members,

care givers and children of PLHAs have received palliative care services from AFFORD supported clinics

and used palliative care products provided by these 510 clinics. Treatment of opportunistic infections has

also without doubt brought new hope and opportunities to individuals, families, and care givers of PLHAs.

As PLHAs regain their health and strength, they are in a position to change the predominant attitude of the

existing services in the private sector.

Health Maintenance Products and OI Drugs

AFFORD has developed products that are being promoted to PLHAs for palliative care. Specific products

like Cotrimoxazole, Aquasafe water purification tablets, Restors low osmolarity ORS, Zinkid (Zinc treatment

for diarrhea in children under five) and long lasting Insecticide treated Mosquito nets (LLINs) are particularly

promoted for pediatric care of children living with HIV. All these products in distribution are available on the

market and in our supported clinics at subsidized prices.

Good Life Campaign

Formative research revealed that Ugandans equate "wellness" with material wealth rather than physical

health. This insight led to the development of the Good Life platform, designed to promote the simple things

Ugandans can do everyday to keep healthy and save money, thereby improving overall quality of life.

The Good Life campaign launched with The Good Life! Show, a highly popular TV, radio and experiential

game show that uses edutainment to increase knowledge, facilitate couple communication, promote healthy

behaviors, and increase demand for products and services. Areas of HIV focus included palliative care for

PLHAs (both adults and children), risk perception, condom use, HIV testing, disclosure, and PMTCT. In FY

2008, 24 episodes were broadcast on 3 TV stations, 20 radio stations in 5 languages and appeared in 120

locations countywide through the experiential road shows. The experiential road shows were further refined

to enhance interpersonal communication and resulted in the development of the "four tent" model. Using

this approach, fewer people gather under a tent to receive messages and are able to ask pertinent

questions which they otherwise would not have been able to ask.

FY 2009 ACTIVITIES - Reaching 12,000 children with care and treatment

Pediatric care and support

AFFORD's approach in the past years has targeted families and individuals with palliative care and support

for PLHAs. In FY2009 the project will expand its care and support activities to capture more children living

with HIV who require palliative care services and products. PLHAs accessing services from these clinics will

be used as index persons to link service providers to their families. AFFORD will invest in building

capacities of participating private clinics and enhance skills of providers so that they can better deliver

quality palliative care services for HIV positive children and young people below 17 years of age. As an

entry point into pediatric palliative care, participating clinics will be trained in dry blood spot (DBS-PCR)

testing for children.

Specifically AFFORD will be increasing the number of clinics in its Good Life network from 100 to 200 in 20

districts. The staff of the clinics will be trained in offering pediatric care for children living with HIV.

In FY2009,AFFORD through its partners and the Good Life Clinics will:

a) Strengthen skills of health workers in infant diagnosis of HIV

Being aware that early infant diagnosis can serve as the bridge between prevention care and treatment,

AFFORD will train health workers in private clinics to incorporate collection of dried blood spot (DBS) and

which will then be sent to regional hospitals and JCRC TREAT centers for HIV testing. Along side DBS will

be conventional HIV testing services for young people between 14-17 years of age will be continued.

b) Increase access to cotrimoxazole prophylaxis , safe water, diarrhea management and malaria

prevention interventions for children:

Prevention of opportunistic infections will be a critical component of pediatric care. Children with HIV

infection are susceptible to co -infection like tuberculosis, serious and recurrent pneumonia, meningitis,

malaria and diarrhea. Out interventions will focus on promoting cotrimoxazole prophylaxis, prevention of

diarrhea using water purification tablets (Aquasafe) and vessel and reducing severity and frequency of

Activity Narrative: diarrhea episodes using Restors and Zinkid, support distribution of LLINs to children and PLHA household

to reduce risk of malaria. In addition we will support and link care givers to immunizations programs in their

localities so that HIV positive children receive their routine immunization. Health workers will be trained to

provide routine follow to infected children.

c) Nutritional care:

Poor nutrition among HIV infected children weakens the immune system and exposes children to more

severe opportunistic infections. They are further at risk because of mal-absorption of nutrients, increased

metabolism due to infections and poor feeding habits. AFFORD will through the Good life clinics conduct

nutrition training for health workers who in turn through counseling and interpersonal communication will

pass on this important information to care givers of affected children. Care givers of these children will also

be linked to other implementing partners with nutrition and home based care programs. We will develop

nutrition job aids and other reference materials for both health workers and families of infected children.

An estimated number of 400 health workers will be trained to offer this specialized care. To support

providers to effectively take on this expanded role, AFFORD will provide job aids and support materials for

providers and client information on pediatric AIDS care.

Through the various channels mentioned above the project expects to reach about 4,000 children under two

years, 5000 between 2 and 14years and 3,000 between 14 and 17 years.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14222

Continued Associated Activity Information

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

System ID System ID

14222 4409.08 U.S. Agency for Johns Hopkins 6743 3340.08 Health Comm $2,300,000

International University Center Partnership;

Development for Communication AFFORD

Programs

8440 4409.07 U.S. Agency for Johns Hopkins 4841 3340.07 Health Comm $2,000,000

International University Center Partnership;

Development for Communication AFFORD

Programs

4409 4409.06 U.S. Agency for Johns Hopkins 3340 3340.06 AFFORD $2,000,000

International University Center

Development for Communication

Programs

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

Refugees/Internally Displaced Persons

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $80,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $20,000

Table 3.3.10:

Subpartners Total: $3,380,000
Palladium Group (formerly Futures Group): $380,000
Pulse Uganda: $280,000
Communication for Development Foundation - Uganda: $200,000
Uganda Health Marketing Group: $2,520,000
Cross Cutting Budget Categories and Known Amounts Total: $1,395,000
Human Resources for Health $250,000
Human Resources for Health $400,000
Food and Nutrition: Policy, Tools, and Service Delivery $15,000
Human Resources for Health $610,000
Water $20,000
Human Resources for Health $80,000
Water $20,000