Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 12485
Country/Region: Uganda
Year: 2010
Main Partner: Not Available
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $0

Uganda is one of the countries that have embraced the GIPA principle which seeks to maximize the rights and responsibilities of PLHA through creating an environment that allows self expression and participation in key HIV/AIDS decision making processes as well as service delivery. Currently, thousands of PLHA groups and organizations exist in Uganda, working in a variety of forms and contexts, to improve access to HIV/AIDS services, advocate for rights of PLHA and reducing further transmission of HIV. Overtime, PHA groups have grown in prominence Uganda and given that they are home grown and community based, they have evolved as essential bridges between service providers and communities.

In further consolidation of this principle, USAID/Uganda has supported a three year program to mobilize and strengthen community based PLHA groups to coordinate and increase their role in HIV/AIDS advocacy and service delivery at community, sub-district and district level. The activity, implemented by the International HIV/AIDS Alliance, has improved the visibility of PLHA groups and demonstrated the immense capability that these groups have in providing services directly to their members, facilitating referrals and linkages between communities and facilities as well as influencing community action on HIV/AIDS. Using a network approach, the program mobilized and trained community based PHA groups to serve as community HIV/AIDS resource persons and key points of referral for HIV/AIDS information and education.

Being predominantly led by expert PLHA, these groups also offered intermediate care to their members and used personal experiences to eliminate stigma that in many ways inhibited HIV/AIDS service seeking behavior. Consequently, the greatest contribution of this program was acknowledged in creation of demand for services delivered at district and sub-district health facilities as well as other private and non-governmental organizations. In FY 2009 the program contributed to the remarkable increase in adults, children and their families accessing care and treatment services in health facilities through mobilization of communities, raising HIV/AIDS awareness and facilitating referrals and linkages to various services in the districts of operation. The PHA groups have also played a critical role in supporting the ART program through provision of ART education, ART adherence counseling and following up clients in their homes to ensure that drugs are appropriately taken. In addition, through the project, the Alliance has linked the PHA groups with the CDC funded PACE Program which has provided basic care commodities including safe water vessels, water treatment solutions, insecticide treated nets and condoms, which enhance individual quality of life by minimizing the onset of opportunistic infections. Working in partnership with NuLIFE , the program is also training NSA in integration of nutrition in care and support programs for PHA.

Funding for Care: Adult Care and Support (HBHC): $0

As of March 2009, the program had trained 1,302 Network Support Agents (NSA) who are positioned at health facilities (HCIII and HCIV) to facilitate entry of PLHA into care services. A total of 745 individual PHA groups were supported in 40 districts of Uganda. Through increased mobilization, education and referrals by NSAs and PHA groups, the health facilities reported increased uptake of care and support services. The Alliance program ended in July 2009 but left behind one of the most creative models for scaling up access to HIV/AIDS services in resource constrained contexts. Therefore, USAID is designing a follow-on program (TBD) that will consolidate and take to scale the Alliance model for AIDS care and support.

The new program, anticipated to be awarded by March 2010, will build upon the achievements of the Alliance activity to continue creating demand for HIV/AIDS services at community level, while at the same time consolidating community based service delivery. The project will also continue supporting post test clubs because they facilitate transition of individuals from counseling and testing to care, treatment and prevention services. The capacity of groups will be strengthened to facilitate and manage referral systems and linkages between home/community based care and health facility-based care.

Gender norms and practices are a barrier to people accessing care and support services. The program will conduct BCC campaigns and gender awareness sessions aimed at challenging the traditional roles of men as they can provide support as caregivers and improving men's health seeking behavior. A family centered approach to care and support will be employed to ensure that the project targets both men and women in the target households while promoting family planning among families affected by HIV.

The role of NSAs will particularly be strengthened and their capacity further built to assume more roles in facility-based services in order to increase time available for physicians and clinicians to offer intensive care to PLHA. They will be trained to assume more of the non-clinical tasks at the health facilities such as records management, pre-test counseling, triaging of clients and dispensing of prophylactic cotrimoxazole.

In order to enhance quality and sustainability of the program, activities will be scaled down to focus on fewer districts, especially given that most of those covered by the ending program have been absorbed into other USAID-funded care and treatment programs. The new program will continue to pay particular attention to building capacity of the PHA groups to strengthen their coordination and to empower them to engage and influence HIV/AIDS policy and programming at district and national level. The program is anticipated to work creatively with the various PHA groups to initiate innovative approaches that increase opportunities for further growth and sustainability of these initiatives at community level. Efforts will also be made to strengthen the national level PHA chapters to enable them to provide leadership and inspiration to lower level groups as they all strive to address HIV/AIDS issues and challenges at their various levels.

The major focus of this activity will be to create demand for HIV/AIDS care and treatment services that will largely be delivered by PEPFAR-supported facilities. The activity will not provide any direct services, other than home-based care, which will also be an auxiliary service to those delivered at static facilities. The NSAs and PHA group members will continue to provide leadership and guidance aimed at demystifying HIV/AIDS and ultimately make care and support services a normal health care activity. Therefore, notwithstanding the incredible role the PHA groups play in increasing access to care and support services, no targets will be set. Program achievements will be reported in narrative form, including best practices and or case stories.

Funding for Care: Orphans and Vulnerable Children (HKID): $0

The OVC will be a significant component of the new program. The new program, will facilitate PHA groups and networks in communities to actively engage in social protection of OVC using a variety of approaches and interventions. Most importantly, the PHA networks are predominantly led by expert PLHA who are open about their HIV-positive status and are therefore in a pivotal position to influence service delivery for OVC and minimize the risk of HIV transmission to children. As organized groups, PHA networks also provide the best contexts for addressing child protection, education, health and pyschosocial support for OVC. They are also able to provide mutual counseling on HIV prevention, support each other to disclose status to spouses and to adopt appropriate behaviours such as treatment adherence for those on ART, all of which minimize risk of HIV transmission.

In FY 2010 this activity will support at least 500 clusters of PHA groups and networks to deliver comprehensive and quality OVC services through family and community interventions. Capacities of PHA groups will be strengthened in the areas of needs identification, OVC programming and monitoring and evaluation, reporting and resource mobilization in order to deliver adequate and appropriate protection, care and support services. In addition, members of PHA groups and other OVC care givers will be trained in caring for OVC. Financial support will continue to be provided to groups to provide direct inputs as well as ensure economic viability of vulnerable households so that they are able to meet the varied needs of the OVC including education, health care, food and nutrition among others. Gender issues in relation to economic enterprises will be addressed to provide women with support systems for their productive and reproductive roles since they shoulder the major burden of care for OVC. The project therefore will conduct gender awareness sessions for groups and support groups to link up with organizations that implement family life programs and or train on labor saving technologies.

Through the community engagement strategy, the project will promote community ownership of the OVC challenge and develop linkages between PHA groups, church groups, school authorities, NGOs (including grantees of the civil society fund ) and CBOs providing care and support to OVC. Developing linkages will provide opportunities for the children and their families to have access to a range of services that they need

Funding for Testing: HIV Testing and Counseling (HVCT): $0

The TBD Program, anticipated to be awarded by March 2010, will continue to facilitate delivery of HCT services since it is an entry point into prevention, care, treatment and other services. In consideration of the acute manpower constraints facing most health facilities in Uganda, the role of NSAs will particularly be strengthened and their capacity further built to assume more roles both at community and facility levels. They will be further trained and facilitated to carry out pre-test and post-test counseling, rapid HIV testing, running of post-test clubs and management of referrals and linkages to care, treatment and prevention services. The new program will continue to pay particular attention to building capacity of the PHA groups to strengthen their coordination and to empower them to engage and influence HIV/AIDS policy and programming at district and national level. The program is anticipated to work creatively with the various PHA groups to initiate innovative approaches that increase opportunities for further growth and sustainability of these initiatives at community level.

The PHA groups and networks will play a key role in community mobilization for HCT through conducting dramas, public dialogues and HCT campaigns. Particular attention will be paid to increasing uptake of counseling and testing among men, as well as promotion of couple counseling and testing, disclosure of sero-status to spouses and support for discordant couples. PHA groups will also be facilitated to link up with several HCT providers namely AIC, PREFA, JCRC and TASO to provide community outreaches for HCT services within their respective communities as one cost-effective way of providing services to those confronting challenges with accessing facility-based services. The groups and the NSAs will ensure that all those that test positive for HIV are linked to care and treatment services. They will also continue providing community-level intermediate care and support to those that test positive in order to successfully carry them through the coping journey.

In order to enhance quality and sustainability of the program, activities will be scaled town to focus on fewer districts, especially given that most of those covered by the ended program have been absorbed into other USAID funded care and treatment programs. Efforts will also be made to strengthen the national level PHA chapters to enable them to provide leadership and inspiration to lower level groups as they all strive to address HIV/AIDS issues and challenges at their various levels.

The major focus of this activity will be to create demand for HIV/AIDS counseling and testing that will largely be delivered by PEPFAR supported facilities. The activity will not provide any direct services, other than pre-test and post-test counseling, which will be auxiliary services to those delivered at static facilities. The NSAs and PHA group members will continue to provide leadership and guidance aimed at demystifying HIV/AIDS and ultimately make counseling and testing a normal health care activity. Therefore, notwithstanding the incredible role the PHA groups play in increasing access HCT, no targets will be set. Program achievements will be reported in narrative form, including best practices and or case stories.

Funding for Care: TB/HIV (HVTB): $0

The new program, will build upon the achievements of the Alliance activity to continue creating demand for HIV/AIDS services at community level, while at the same time consolidating community based service delivery. The new program will continue to support integration of TB/HIV activities at health service delivery points. Their key role will be to identify individuals with high risk of TB infection and refer them to the health facilities for diagnosis and treatment. They will also continue to enlighten the communities on TB as a treatable infection, emphasize its strong association with HIV, encourage early diagnosis and treatment, reduce stigma and defaulter rates as well as promote preventive and care aspects of tuberculosis. Through routine home visits, PHA groups members and NSAs will spearhead adherence monitoring for those on treatment and provide on-going counseling to enhance treatment adherence. Defaulter cases and symptoms of treatment failure will be reported to the health units through the established network referral mechanisms. NSAs and identified group members will be trained as focal persons on CB-DOTS using national TB/HIV collaborative guidelines and provided with relevant materials and logistical support to improve drug adherence and defaulter tracing. All identified TB/HIV patients will be enrolled in the HIV/AIDS care and support program for the PHA groups.

At facility level, the NSAs will work with health workers to ensure that they strengthen infection control measures particularly by limiting the time that known TB patients spend at the facility and to ensure that HIV/AIDS services are delivered in spacious and well ventilated premises. NSAs will also liaise with health workers to ensure that all individuals diagnosed with TB have access to HIV counseling and testing. The role of NSAs will particularly be strengthened and their capacity further built to assume more roles in facility based services in order to increase time available for physicians and clinicians to offer intensive care to PLHA. They will be trained to assume more of the non-clinical tasks at the health facilities that relate to TB management such as records management, conducting of health education talks, screening of patients using standard job cards, collection of samples and facilitating access to diagnostic facilities for those requiring laboratory examinations.

The new program will continue to pay particular attention to building capacity of the PHA groups to strengthen their coordination and to empower them to engage and influence HIV/AIDS policy and programming at district and national level. The program is anticipated to work creatively with the various PHA groups to initiate innovative approaches that increase opportunities for further growth and sustainability of these initiatives at community level. Efforts will also be made to strengthen the national level PHA chapters to enable them to provide leadership and inspiration to lower level groups as they all strive to address HIV/AIDS issues and challenges at their various levels.

The major focus of this activity will be to create demand for HIV/AIDS care and treatment and to ensure that TB is given priority attention in HIV/AIDS settings. The actual treatment services will be delivered by PEPFAR-supported facilities. The activity will not provide any direct services, other than community-level care and adherence monitoring, which are auxiliary services to those delivered at static facilities. Therefore, notwithstanding the incredible role the PHA groups play in increasing access to TB care and support services, no targets will be set. Program achievements will be reported in narrative form, including best practices and or case stories.