Quarterly
Report, July – September.
Comprehensive HIV Prevention and awareness campaign in Amuru District. _____________________________________ Background: HIV/AIDS still remained a major challenges in northern Uganda ,after suffering the effect of war for a period of twenty-three years, Acholi sub-region lag behind more especially in health area where government intervention were usually seen limited. Thus in the month of JulySeptember, GWED-G in partnership with GlobeMed Columbia conducted various activities in all the seven parishes of Lamogi sub-county in Amuru district. The activities carried out included; community sensitizations, and under this sensitizations many topic were discussed like FP, ANC, PMTCT EMOC and HIV/AIDS preventions. Family Planning: In fact this project recognizes that there are several distinct facets to the association between HIV/AIDS and fertility. To begin with, the causality underlying the association can run in either direction – HIV/AIDS can affect fertility desires and outcomes, and fertility can affect the risk of HIV/AIDS. The two may also share common causes that induce an association between HIV/AIDS and fertility. Indeed, the major proximate determinants of HIV infection and pregnancy are virtually the same -- sexual exposure (through socially recognized unions or otherwise), contraceptive practice, reproductive tract infection, breastfeeding practices – and for this reason an empirical evidences between the two seems almost unavoidable yet very complicated for the grassroots communities to understand. During sensitization program on FP, information were rendered to women, youths, men , couples on the availability of the different family planning methods, types, the ways they work for this case emphasizes were made on both long and short term method, the availability of this reproductive services, possible likely side effect ,and the service provider for all the types. This is because FP was consider essential to HIV pregnant mothers as it reduces unwanted pregnancy that contribute to an increased in maternal and child mortality and morbidity. 362 women and child mothers including their spouse benefited from family planning services. Antenatal Care, PMTCT, Emoc: The major objective of this activity was to create awareness to the women on the advantages of attending to ANC in relations to HIV/AIDS infections as it was evident that pregnant women in post conflict societies in northern Uganda experience adverse social and physical difficulties within their home village yet their reached to urban antenatal hospital and clinic is very hard. Mothers got sensitized on benefits of goal oriented ANC, Signs and symptoms of high risk pregnancy as the major causes which contributes to maternal death despite all effort made through different stake holder. The women reported previously suffering from complications such as, hemorrhage, pre-eclampsia, infection, obstructed labor and finally complications of unsafe abortion and if not prevented and treated early at ANC, it can cause both maternal and new born death. Since this has been an ongoing activity, 97 women reported visiting their health facilities and benefited from ANC services. The project encouraged HIV pregnant mothers to attend ANC and have healthier babies free from HIV virus because these virus can passed to the un-born babies in different stages; during pregnancy, breast feeding and the worst one is at birth. All this can be prevented if PMTCT program is well practice and followed thus GLOBEMED has strengthen the prevention programs by reaching out to many people who have little knowledge on this services yet they needed it most and if supported well under this services, they are able to deliver HIV negative children
with constant follow up of field staff and VHTs before and after deliveries. A woman tells her story of success and how she became part of GlobeMed – GWED-G beneficiary.
It Works! Ms Akello Christine - 30 years old testifies! Ms Christine lives in Amii Lobo village in lamogi sub-county. Amii Lobo village is 30 kilometers away from Amuru town , and 45km from Gulu town, Christine lived in the IDP camp during the insurgency and got infected with HIV/AIDS through the husband whose live was full of risky behaviors. She realized she was positive after testing during PMTCT and all she knew was that the child will be delivered HIV Positive as it’s been an issue with every pregnant HIV infected mothers in her village. She got traumatized due to community stigmatization and started isolating herself until one day on her way to the market she saw people gathered listening to HIV/AIDS transmission education for mothers by GWEDG social workers and how women can benefit from antenatal care services and PMTCT. She paid close attention when the staff was high lighting on the key benefit of PMTCT to HIV pregnant mothers, She got so inspired and enrolled for PMTCT services at Kaladima health centre 15KM away from her village . Now I am very proud of my child who turned up negative at 4months, and at 6months. I am going back for third test at 8months. I must really appreciate the GlobeMed teams and GWED-G because m sure many women are benefiting from these preventions messages and restoring their life, besides the organization has given us income generating activities where we are involved in livelihoods activities, now we are sure of milk for our
children and at a later stage they can take porridge and lives free of AIDS.
Ms Christine Akello.
Ms Pamela Angwech the executive director for GWED-G was quoted saying in her field monitoring visits two significant issues: 1. She said Training for health workers on clinical skills, as well as on client-provider interaction, is critical to ensure high quality, professional ANC and delivery services. In addition, more, qualified health workers need to be recruited and essential drugs, supplies, equipment and infrastructure made available to improve the extremely difficult working conditions for staff and enable providers to offer quality care. I am very disappointed that we are fighting HIV which has no cure, but losing many lives due to poor service provisions and a lack of human resource! This is unacceptable for any country where people pay tax! 2. Secondly she said ANC services are a significant opportunity to provide women with education and counseling on pregnancy, labor, and delivery. The danger signs of pregnancy and labor and the importance of skilled delivery assistance should be emphasized as timely recognition and treatment of complications is critical for preventing both fistula and maternal crises overall. Crucially, women should be strongly encouraged to deliver in a health facility so they can receive emergency care promptly if needed. With the minimum resource available. I ask the VHTs to do their best and safe lives of our already poor and vulnerable mothers.
For effective PMTCT practices, the project discouraged women from attending to TBAs (Traditional birth attendants), and giving birth in their hands because they are not effective in preventing maternal deaths. They are not midwives or medical professional and do not have the skills necessary to deal with life threatening problems. In addition some TBAs mistakenly believe that certain practices help women during delivery, although these, in fact, cause harm examples pushing on the abdomen to hasten delivery yet all this practice are not recommended from ministry of health as a safe delivery approach. TBAs can only be trained on how to recognized obstetric complications and how best referral can be made effective for these women with complication promptly. Emergency Obstetrical Care (Emoc).communities in Lamogi sub-county were sensitized to understand that government are to ensure all health facilities in place be able to provide emergency obstetric care services[ EMOC] and that all these health facilities are supported by a functioning referral system. This can only be achieved by the number of [EMOC] cases reported and referred. More so through this awareness raising men were made to understand their role in supporting their pregnant women by taking them to the hospital, helping in garden work and participating in sharing domestic work at home. This is because 85% of complications during pregnancy are associated to domestic workloads at home making them vulnerable and thus lowering their immunity and exposing them to risk of getting infection, abortion and miscarriages. These therefore makes EMOC package services very essential to all pregnant mother once followed properly and implemented well with the knowledge of a trained medical personnel without any delay while administering of antibiotics, oxytocic, anticonvulsant for preeclampsia, and eclampsia, removal of placenta, removal of retained product, and assisted vaginal delivery are most effective means to reduce death attributed to child bearing. But there are a lot of challenges associated to lack of adequate Emoc provisions to our communities; eg.
A case study of negligence: In Uganda September the – monitor news papers publications published a story of Namboozo who died in labor due to negligence from medical health workers and limited facilities to help mothers deliver, the health workers asked her to pay 300,000/= which she shouldn’t raise immediately as she wait for her poor husband who went looking for money which he never got, on his arrival, he found out that Namboozo had bleed to death due to ruptured uterus and prolong labour with a 5.2kg baby weight. Namboozo is a case of 430 maternal mortality cases in every 100,000 births registered in Uganda. Most of these occurred as lack of ethical responsibilities in this case, medical doctor was responsible to perform emergency operation to save lives of both the mother and her unborn baby if they were to follow the guidance package on Emoc from ministry of health.
Awareness campaign on HIV/AIDS Preventions strategies. Critical prevention strategies for effective HIV awareness were conducted in Agwaryugi, Coke, Giragira, Pagoro, Oboo, Lacor, and Palema. Quiet essential this quarter was the element of behavioral attitude change, practice of safer sex through condoms use and ABC approaches as sustainable directive ways of avoiding getting infections. Most of the researches have shown that despite knowledge of HIV infections amongst people in communities, others deliberately still carried bad attitude of infecting other members who are not HIV positive. And this has put many people both women and men, youth adolescents and children who are considered most at risk continued suffering. GWED-G program addressed critical gaps through creating men groups who are mainly youth role model to work within their existing structure to sensitize families and their own communities on HIV AIDS preventions, condoms use through distribution to fellow youth within their age bracket linking them to health center to promote campaign on VCT and also work towards attitude change there- by encouraging them to fully participate in youth clubs offering counseling services, and above all conduct out reaches and home visit ,fastening referral pathway for those who may be very weak like the bed ridden clients that may need referral to hospital and health center. Apparently there are about 5groups. Voluntary Counseling and testing and Condom distributions. The project conducted massive mobilizations and sensitizations on the benefits of VCT to youths and the general communities in the parishes of Agwaryugi, Giragira, Pagoro, Oboo, Lacor, and Palema respectively. 501 youths turned up for VCT and 603 communities tested within this quarter.
Cross sections of couple who reported for VCT and children and youths at Awer Parish.
Further more on VCT, community were told to take routine counseling and testing [RTC] as the only appropriate way to fight HIV/AIDS especially the youth to practiced ABC approach and this is because many people who get infected on daily bases do not practice this intervention as key concepts to fight against HIV/AIDS. looking at women as the most at risk, VCT and RTC would help them know their status since they would go for it voluntarily and on routine basis and by doing this, they will act as role model in their community educating other women on how to go about mother to child transmission [MTC] and also encouraging those who are pregnant to test and enrolled for HIV care, support treatment and adopt behavior for HIV prevention and control. Table showing attendance for the different activities conducted within the quarter. LISTS OF PARISHES
AGWAYUGI & COKE
GIRA-GIRA & PAGORO
OBOO
LACOR
PALEMA
By Age
M
F
M
F
F
M
M
F
M
F
below 5 yrs (children under 5)who benefited from dry blood sport (DBS) 5-17 years school children who attended VCT and got tested
7
10
0
0
3
0
0
0
0
0
22
18
7
15
22
3
0
0
0
0
18-35yrs youth who turned up for VCT program above 35-60yrs (middle aged mother who turned up for ANC couple who accompanied their wives for ANC/FP
43
152
24
96
124
62
0
0
0
0
0
105
0
74
116
0
0
40
0
93
33
0
43
0
8
0
5
0
8
0
mothers enrolled for PMTCT program and got nevirapine tabs on labour on set Totals
0
20
0
18
0
6
0
11
0
14
105
305
74
203
273
71
5
51
8
107
by categories
M
F
M
F
M
F
M
F
M
F
no of babies tested and enrolled for niverapine syrup no of babies tested negative
9
11
8
13
6
9
5
10
3
21
2
4
0
0
0
0
0
0
0
4
total nos of communities tested
45
108
41
57
48
96
35
71
34
68
total nos of deliveries
0
20
0
17
0
14
0
18
0
22
condom distributions
238
75
146
46
86
22
65
6
89
10
other family planning services ;both long and short method others (specify)orphans
0
105
0
66
0
56
0
47
0
88
indirect beneficiaries’ community who benefited from the program of awareness sensitization/campaign
128
342
78
98
76
231
82
221
99
146
Total
422
665
273
297
216
428
187
373
225
359
Phase II: IGA distribution to beneficiaries The Table Below Show the List of Beneficiaries N0. 01 02 03 04 05 06 07 08 09 10
NAMES ATIM AGNES LAKER FLORANCE ANENA LILLY AKUN LUCY ABALO JENNIFER ROSE ATTO ADONG MOLLY LAKOP CONCY ALANYO VICKY AMONY STELLA
PARISH GIRAGIRA GIRAGIRA GIRAGIRA GIRAGIRA GIRAGIRA GIRAGIRA GIRAGIRA PALEMA PALEMA PALEMA
VILLAGE OLWAL OLWAL OLWAL OLWAL OLWAL OLWAL OLWAL AMILOBO AMILOBO AMILOBO
CROPS GRAND-NUTS GRAND-NUTS GRAND-NUTS GRAND-NUTS GRAND-NUTS GRAND-NUTS GRAND-NUTS GRAND-NUTS GRAND-NUTS GRAND-NUTS
As part of our activities for this main quarter, GWED-G distributed out ten bags (10) of grandnuts seeds to the HIV positive mothers .The objectives of this was to empower the affected mothers by ensuring their full participation in economic activities that generate income for sustainable households of women living with HIV/AIDS. This project is also geared towards supporting women during lactating period for babies and fight malnutrition. Effective balance diet is also required for a healthily families especially those living with HIV/AIDS. The IGA distributions were mainly targeting the most vulnerable women under the project in the seven different parishes of Agwaryugi, Giragira, Pagoro, Oboo, Lacor, Coke and Palema
Cross section of mothers in their groundnuts garden. Harvesting Beans. In the first phase of the project, other women were given 25kg of beans and currently completed harvesting of their beans. The families harvested from 400kgs – 500kgs of beans per household.
Cross sections of families harvesting their beans.
Follow up of beneficiaries IGAs /out reaches Monitoring and follow up visit were carried up by project field staff and VHTs in all the individual house hold and gardens, The VHTs role were to promote health program and help the community living with HIV/AIDS lead a positive life through home visiting and referral as this will create awareness and as a step toward HIVAIDS fight. the aims of the visit was also to monitor the progress of the seedlings, provide technical support and identify the achievement and gaps that require immediate action for project success as it was done before the assessment of thirty HIV pregnant mother using poverty house hold indicators to be supported with IGAs project to increase on their income. during our field monitoring visits, we noted that our beneficiaries’ fairly had good harvest with the highest client got up to five bags of beans while for the rest ranges’ from one to three bags despite heavier rain destroyed many crops this year leaving out many homes vulnerable without food stuff to be eaten. More so on outreaches, our follow up indicate that children born within the project period were mainly testing negative with testimony from their mother. Distribution of bicycles for VHTs. Empowering VHTs without providing transport would not make them perform their duty well as required out of them especially when it comes to follow up and conducting out reaches for bed ridden client and counseling services to the individual families/house hold in different homes. The bicycle would also ease movement for the VHTs when it comes to data collection from health centre which are far from the communities this will enable them collect effective data and make proper follow up for referral.
Frany handing over new bicycles to VHTs.
Summary of achievements in the quarter •
Over 1000 communities reached with HIV/AIDS preventions messages.
•
30 mothers finally supported with livelihoods seeds that shall increase on their economic activities and household income.
•
20 mothers harvested beans each household received from 400kg – 500kg in the first phase of harvest.
•
362 women, including their spouse benefited from Family planning services
•
87 school children got tested and 501 youths, including 603 adults got tested.
•
10 babies tested free of HIV/AIDS.
•
783 condoms distributed.
•
3 bicycles procured and delivered to VHTs.
Challenges. •
Transport cost keeps getting expensive and GWED-G administration has spent tremendous amount on transport hire and fuel. This is because the cost of fuel increased and dollar rates keep getting high, secondly the return sites are far.
•
persistence shortages of some FP services more so when it comes to long term method e.g inter –uterine device and implant in other health center. GWED-G is conducting follow-up with health facilities to boost in health centers services since they are busy mobilizing communities.
•
Health facilities are too far from most community which limits their access to services hence need for mobile clinic.
•
Most communities still live under denial and infecting other despite their knowledge of HIV/AIDS.
•
The project target few beneficiaries for support yet many who are vulnerable and suffer the same problem are left out. GWED-G was called for an expansion meetings.
Lesson Learnt/opportunities. • Positive turn up by communities for sensitization program on FP, ANC.PMTCT EMOC and VCT program. • Increased turned up for ANC mothers on first visit with regularly attendance. • Improved care for HIV positive women hence increased partners testing, adherence and child care. • GWED-G and GlobeMed needs to discuss further on scaling up this particular • •
Recommendation: Integrating PMTCT program as part of ANC services will lead to improved quality reproductive health service that will help mothers deliver healthy baby not infected with HIV/AIDS. At the health facility levels in Amuru district and much more northern Uganda, the structures, equipment, supplies and medicines are generally insufficient. While some medicines and equipment are available, certain ones required to provide critical evidence –based interventions were not. A consistent problem in conflict and post conflict settings is the lack of qualified staff to provide services at the existing health facilities. This poses significant problems related to emergency obstetric care for HIV/AIDS mothers. Many women are unable to access health facility services due to communication and transportations problem. GWED-G /GlobeMed shall train some few health workers and VHTs who shall ensure effective referrals at community levels.
Pending Activities: •
Continuous referrals of clients for services and testing (routine)
•
Continuous monitoring of Livelihoods groundnuts plantations for women (routine until December) and advising on marketing.
•
Data collections to form part of the Annual reports. (routine until December)
•
Finalizing the financial reports (this is will be done by end of October)
•
Finalizing the GWED-G websites document. (to be completed by October)