Transcript 3.2 Country Presentations - Uganda

In the name of God the Most Gracious Most
Merciful
Faith-based organizations and Government
Partnerships: experience from Uganda on the
successes and challenges in implementing the
Global Plan to eliminate New HIV infections
among children.
Presentation From Uganda
Presenter: Prof. Magid Kagimu, MBChB, M.Med, MSc, PhD.
Chairman, Islamic Medical Association of Uganda (IMAU),
and Director, Postgraduate Programme, Department of
Medicine, Makerere University College of Health Sciences.
Best Teacher Award 2010/2011
1
Introduction
 Uganda is implementing option B+ and HIV Treatment for
eMTCT through the Public Private Partnerships for Health
(PPPH) approach
 Public Health Sector (Central & District Local Governments)
 Private Not For Profit health providers (PNFP-FBOs)
 Private Health Practitioners (PHP)
 “Traditional and Complimentary Medicine Practitioners (TCMP)”
 The health sector Faith Based Organization fall under four
umbrella organisations
 Uganda Catholic Medical Bureau (UCMB),
 Uganda Protestant Medical Bureau (UPMB),
 Uganda Muslim Medical Bureau (UMMB), and
 Uganda Orthodox Medical Bureau (UOMB).
 Together these bureaus represent over 75% of the 863 PNFP
health units while the remainder fall under other humanitarian
organisations and community-based health care organisations.
Introduction
 The FBOs provide health services to the
population from established static health
units/facilities and work with communities and
other counterparts to provide non-facility-based
health services and technical assistance.
 The FBO-PNFP sector presently has over 863
health units (64 Hospitals, 15 HC IVs, 264 HC IIIs
and 520 HC IIs). These facilities are largely found
in the rural areas (86%).
3
Introduction
 MoH operates 2,844 (63 Hospitals, 170 HC IVs, 916
HC IIISs and 1695 HC IIs).
 Of the 48 health training schools in the country,
20 are operated by FBO-PNFP organisations.
 GOU through MoH seconds Staffs to FBOs
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Introduction
 HIV/AIDS Funding to the private sector is largely
through the AIDS Development Partners
 GOU through the National Ware house (Joint
Medical Stores, and Medical Access Uganda
Limited), provides ARVs, HIV test kits and lab
Reagents free of charges to the private sector
 In addition GOU supports non-facility based
services through national programmes such as
Community and Environmental Health and
Communicable Diseases Control.
5
Experiences with service delivery
Models used by the FBOs incorporate Faith as an
important component of HIV/AIDS prevention, treatment
and care. An example from IMAU is the “Faith-based
approach to accelerating delivery of comprehensive
HIV/AIDS Prevention, Treatment and Care services
(FABAPTCA)”. This contributes to all four prongs of
PMTCT:
1.Prevention of HIV infections among potential and actual
mothers and fathers
2. Prevention of unwanted pregnancies among HIV positive
women
3.Prevention of HIV transmission from HIV positive mother
to the child
4. Prevention of AIDS- related illness and death among HIV
positive mothers and their children
6
Faith-based Approach to accelerating delivery of comprehensive
HIV/AIDS Prevention, Treatment and Care Services (FABAPTCA)
The Problem
HIV new infections continue to rise every year from
84,000 in 1994 to 130,000 in 2011.
HIV prevalence rose from 6.4% in 2005 to 7.3% in 2011.
HIV/AIDS is the leading cause of adult deaths.
Everyday 353 new HIV infections and 175 deaths. Every
one death, 2 new HIV infections occur
Mulago Ward 4A, where I work, death certificate
books from Jan – July 2012 showed 134/194 (69%)
deaths due to AIDS, majority 81/134 (60%) women.
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Benefits of 5-pillar faith-based approach to HIV/AIDS
prevention
Each of its five pillars has empirical scientific data
supporting it from our research study done among 15-24
year old youth in response to the challenge that the
FBAA was unscientific and not evidence based.
(1) Believing in God and His messengers (The
Messengers of God include Angels, Prophets,
Parents and Religious leaders)
Feeling guided by God in daily activities is associated
with lower HIV infections.
Parental guidance is associated with lower HIV
infections.
(2) Learning Scientific information:
Higher levels of religiosity are associated with lower HIV
infections.
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Benefits of FBAA
(3)
Using faith teachings:
Frequent prayers are associated with lower HIV
infections
(4) Forming partnerships with religious leaders:
Listening to or watching religious programs on radio and TV
is associated with low HIV risk behaviors.
(5) Using concept of self-control:
Fasting as a means of self-control is associated with lower HIV
infections


All these components contribute to the socialization process
of an individual from the religious perspective and have a big
role to play in HIV prevention and control
There is data from our research study among the 15-24 year old
youth which supports the role of religiosity in HIV prevention
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Association between religiosity and HIV among Christians
(Epidemic Stoppers)
Cases
n (%)
Controls
n (%)
Odds 95% CI
ratio
Feeling guided by God in daily
activities
High (many times a day)
Moderate
14 (13)
92 (22)
95 (87)
328 (78)
1.90
1.03- 3.50 0.035
Feeling thankful for God’s
blessings
High (many times a day)
Moderate
18 (14)
88 (22)
112 (86)
311 (78)
1.76
1.01- 3.11 0.042
Dimension
p-value
Daily spiritual experiences
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Association between religiosity and HIV
among Christians
Dimension
Cases
n (%)
Controls
n (%)
Private religious practices
Praying privately other than at
church
High (several times a day)
51 (16) 276 (84)
Moderate
54 (27) 145 (73)
Odds
ratio
95% CI
p-value
2.02
1.30- 3.11
0.001
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Association between religiosity and HIV
among Christians
Dimension
Cases
n (%)
Controls
n (%)
Odds
ratio
95% CI
pvalue
Religious commitment
Trying hard to be patient in dealings
with
oneself and others
High (strongly agree)
Moderate
26 (15)
80 (23)
153 (85)
270 (77) 1.74
1.07- 2.84 0.024
Trying hard to love God with all one’s
heart, soul and mind
High (strongly agree)
Moderate
44 (16)
62 (24)
223 (84)
200 (76) 1.57
1.01- 2.42 0.039
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Significant association between religiosity and
HIV among Muslims (Epidemic Stoppers)
Characteristic
HIV Positive HIV Negative
N(%)
N(%)
Odds
ratio
95% CI
p-value
Fasting
High (≥ 1 month per year) 21(2)
Moderate
8(5)
1,009(98)
156(95)
2.46
1.07-5.67
0.028
Sujda
Yes
No
6(1)
22(3)
487(99)
651(97)
2.74
1.10-6.83
0.024
Parental Existence
Both parents alive
One or both parents died
9(1)
19(4)
720(99)
470(94)
3.23
1.45-7.23
0.003
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Association between religiosity, HIV-risk behaviours
and HIV infections on bivariate analysis of combined
Muslim and Christian youth
High religiosity
N(%)
Moderate religiosity
N(%)
Low
religiosity
Ever had sex
No (abstaining = A)
Yes
94 (28)
240(72)
34(14)
210(86)
1 (6)
17(94)
<0.001
Ever drank alcohol
No
Yes
192(58)
140(42)
98(40)
145(60)
6 (33)
12(67)
<0.001
HIV status
Negative (controls)
Positive (cases)
282(84)
52 (16)
183(75)
61(25)
15 (83)
3 (17)
0.017
Ever used narcotics
Yes
No
9 (3)
322(97)
22 (9)
218(91)
1 (6)
17(94)
0.004
Characteristic
p-value
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Collaboration between Government and FBO
 FBOs participate in Policy formulation,
revisions and dissemination and in High level
fora such as Health Policy and Advisory
Committee, Country Coordinating
mechanism, UAC Board, etc
Govt. supports FBOs service delivery through:
1. Primary health care funds
2. Training health workers – in-service
3. Supervision of health facility
4. Antiretroviral and Anti-TB medicines
5. M & E and IEC materials.
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Factors responsible for success in FBOs
Service Delivery:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
For God and my country ( Uganda motto),On God’s
selfless health service (IMAU mot to), imitate the
healing ministry of Christ (UCMB & UPMB)
Religious leaders support
Local council leaders support
Faith teachings
Training religious leaders
Incentives for volunteers e.g. Bicycles, lunch
allowance.
Supportive supervision through monthly meetings
Interreligious collaboration
Funding for infrastructure, human resources and
logistics
Accountability to community and donors.
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Factors responsible for success in Govt/FBO
collaboration -1:
An enabling environment of Public Private Partnership
for health that allows for effective coordination of
efforts among all partners
2. Every year the FBO sector qualifies between 500 and
600 nurses/midwives (over 60 % of the total Country
annual output). These staff are deployed in both Public
and Private sectors.
3. The FBO-PNFP operates 40% of all hospitals and 20%
of all lower-level health centres, and currently employs
approximately 34% of the facility-based heath workers
in the country.
1.
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Factors responsible for success in Govt/FBO
collaboration:
The partnership has enabled the country to mobilize
additional resources to improve the health of the
population (from abroad, through user fees, and through
various local initiatives for income generation)
5. The total contribution of government of Uganda to the
FB-PNFP has been increasing over the years from Uganda
Shillings 3bn in 1998 to Uganda Shillings 18bn in 2010.
6. Cooperative Government officers
7. Accountability and trust.
4.
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Challenges
FBOs model of service delivery challenges :
1. Inadequate funds

to sustain volunteer motivation, through
training , supervision and

other incentives, and for regular supply of
commodities.
2. High expectations from religious leaders and
communities of sustained funding of
activities because of poverty.
3. Inadequate scaling up of FBO models for
greater impact
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Challenges in Govt/FBO collaboration:
4. Bureaucracy causing delays in receiving government
support
5. Heavy burden of Parallel M & E Systems
6. Human resource inadequacies & mal-distribution
between urban and rural settings and attrition of
qualified staff from PNFPs to public facilities and private
practice continues to be a problem.
7. Poor infrastructure especially inadequate laboratory
services (EID, CD4, Viral load)
8. User fees increasing with rising cost of service delivery
9. Infrequent and poor Technical Assistance by the public
sector
10. Doctrinal stand of the FBOs on certain services e.g. FP
and some so called human rights approaches
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Recommendations
1. Govt and FBOs should recognize and accept the
value of the faith-based approach to HIV
prevention and allow each partner to perform their
role in accordance with their belief system.
2. Govt and FBOs should plan, implement and
monitor the HIV/AIDS response together.
3. Govt and FBOs should scale up faith-based
approaches to HIV prevention such as:
i. Five pillar faith-based approach to HIV prevention
ii. FABAPTCA model of health service delivery
ii. Move beyond the ABC strategy to ABCDE.
D=Diini ( religiosity), E= Education
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Recommmendations
4. Govt and FBOs should mobilize funds for
activities to support religious leaders and their
assistants including:
i. Training and refresher training in HIV/AIDS
service delivery
ii. Incentives – transport, communication,
allowances
iii Funding the Religious leaders activities as well,
since they contribute to HIVAIDS service
delivery and not stop at the religious health
institutions
iv. Support supervision
v. IEC materials, media activities
vi. Income generating activities to address PID
(Poverty, Ignorance and Disease)
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Recommendations
5. Govt and FBOs should mobilize funds to support Health
care workers especially providing performance related
allowances
6. Govt and FBOs should mobilize resources to support FBOs
to champion the faith-based approach to HIV/AIDS
activities of:
a) Advocacy
b) Coordination
c) Information, education and communication
d) Training
e) Health service delivery
f)
Monitoring and evaluation e.g. setting up surveillance
sites to monitor the outcome and impact of the faithbased approach to HIV/AIDS on HIV prevention.
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HIV Prevention is better than cure
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Supporting faith with knowledge
The second Epistle General of Peter Chapter 1 verse 5:
And beside this, giving all diligence,
add to your faith virtue; and to
virtue knowledge.
25
Govt/FBO collaboration in knowledge generation
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Govt/FBO collaboration in Knowledge
generation
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