Promoting HIV/AIDS prevention and the provision of maternal and child health, ANC, PMTCT, Family Planning, Mama Kits, and livelihoods to the war affected communities of Amuru District.
Promoting Maternal health and new born.
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Introduction:
This project is a continuation and scaled up project being implemented in partnership with GlobeMed student at the University of Columbia funding the HIV/AIDS prevention strategies to improve the well being of war affected communities of Amuru district and improve on the utilization of ANC, PMTCT, Counseling services, reproductive health education and support of expectant mothers with mama kits. During this quarter the communities at Amuru District are busy opening up farm land and it’s a rainy season. The war affected communities were settled in IDP camp during the war and couldn’t cultivate much, however now with the glimpse of peace in the region; people are trying to till their land which is the only resources left. Culturally Acholi communities were very rich with cattle and were farming in cooperatives marketing groups were they get money from cash crops and that was what they used to send their children to school with including keeping the various livestock and poultry. Apparently the communities returned back home barehanded without any resources to rebuilt themselves. It was voluntary return without support from the government. The civil society organization and humanitarian agencies (UNHCR) supported the durable solutions for the IDP communities where the PSN- Person with Special Needs where the ones supported with constructions of huts and their farm land opened. Very little time is devoted to cultural activities as the internally displaced person is resettling themselves in their original homeland and most of the cultural values were lost, the war has contributed to further erosion of Acholi Culture and institutions particularly the clan and family systems. Families used to sit in a forum called ‘wang OO’ where fire was made in the middle of the compound every evening and educations on sexuality, culture and behavior change communications were conducted by mothers, father, aunties, uncles and elders to their children especially girls and boys. Apparently there are no mechanisms used at family level to address issues with children and youths leading to most children and youths growing without proper discipline and respect as it used to be and parenting has become a challenge. This has affected the couples too, Acholi men were seen has heroes and accorded high respect by their wives. These made the gender relations very poor because women cannot negotiate with their partner’s proper utilization of reproductive health including negotiating for safer sex. The war in Northern Uganda has had serious impact on both men and women as individuals, ranging from loss of life and property, separations of families, physical assault, rape, imprisonment, detention, disability, hunger and poor health. This project was designed with two objectives. 1. Undertake campaign aimed at creating awareness to 1000 vulnerable HIV/AIDS clients on prevention strategies to young mothers. 2. Mitigate the impact of HIV/AIDS to 20 clients of child bearing age and pregnant mothers with IGA alternatives. Activities conducted during the quarter: In first quarter we had some feedback sessions with the communities which directed most of the activities conducted this quarter. The feedback and community meeting conducted were evidenced based and up rooted various issues in the communities including the following; •
The meeting with men and women indicates that there are still evidences that many people still living in the communities with attitudes of infecting others, these were common amongst men though some women were also reportedly having relationship with young men and boys. In Coke Parish, a school boy of 19years was reported locked in a room by a woman of 38years old and was abused in Parabongo trading centre.
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•
Through the Village health Team - VHT and different care givers trained within the villages and communities, GWED-G recognized that the numbers of people living with HIV/AIDS was more than those registered at the health centers. About 800 people from communities of Coke and Agawryugi were living positively and not having access to treatment and others already very ill. Most of these people monitored by GWED-G health staffs and VHTs were found to be very sick that they can hardly make it to the hospital due to long distances, while others due to stigma related issues.
•
Many HIV positive mothers who still give births to HIV positive babies due to lack of information’s and educations.
Thus to increase on more knowledge awareness raising programs was conducted in 7 Villages of Agwaryugi and Coke using various designed methodologies.
HIV/AIDS Awareness From April upto June, community sensitizations was conducted in the villages of Pakira, Tekano market, Keyo, Amiyo lobo in Palema parish. The sensitization programs were centered mainly on HIV/AIDS signs and symptoms, methods of prevention and ways of contraction with its consequences to the communities, as for our campaign strategy we encouraged positive living among the communities to reduce re-infection of other members. The insight of youth perspective especially why HIV/AIDS is spreading among young people and to generate ideas on appropriate channels and opportunities for communication on HIV/AIDS at families, schools, communities and national levels were also discussed. The emerging issues with our communities are lack of adequate knowledge and understanding on HIV/AIDS transmissions, dangers and control mechanism. There is need for routine education with sensitization messages and communications that should be rolled out at community levels. Pamela Angwech, GWED-G Director, while on field visit was quoted mentioning to communities that “It’s been for long now that we have been dealing with issues surrounding HIV/AIDS pandemic, however we need to break the silence, banish stigma and discrimination, and ensure total inclusiveness within the struggle against HIV/Aids, work more with men and let it be a family concern” she said.
GWED-G Director speaking to women and
Community members attending to sensitization campaign.
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Family Planning: The main objective of sensitizing communities on family planning was to create awareness on the existing family planning methods and leverage demand for family planning services by the communities within the project constituencies. Sensitization was centered around family planning methods, the different types, both long and short term methods, Example of short term includes; condoms, oral pill plans contraceptives, lactating mothers(breast feeding), injected plan and the bead method. The long term methods given were Norplant, inter-uterine device (IUD), copper T, total abdominal hysterectomy (TAH) while explaining to beneficiaries the benefit of using each method, possible side effects and its management, and procedures to follow while using each method. “One woman testifies after the sensitization that they have attended family planning services together with the husband, she quoted, the methods m using now was chosen by my husband after being counseled and educated by GWED-G social workers.”
Franny GWED-G Social Worker indicates to women the various methods of family planning.
Educations on antenatal care: Communities in Agawaryugi were sensitized on antenatal care; services rendered during (ANC), benefits of (ANC) and the roles played by men in supporting their women for antenatal care. We also sensitized the communities on the prevention of mother to child transmission (PMTCT) with their benefits for mothers and the unborn baby. The primary aim of PMTCT programs is to decrease the number of HIV infected babies born to HIV positive mothers. Primary prevention of HIV infections particularly amongst women of child bearing age has always been very essential in HIV prevention. This was also to increase the levels of attendance for voluntary counseling and testing for pregnant mothers in order to save their lives. This service also improves the quality and prolongs life of infected mothers. “ In Palema Parish a woman testified, this program enlightened me and opened my eyes, I used the knowledge and visited for PMTCT and ANC, Later on I made sure I delivered this baby at the hospital, I shall take her for first testing after 3months to confirm her status’’.
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Cross – sections of children born under the PMTCT Programs. “ One lady who has joined the women groups and working as a role model testified to the groups that , people used to laugh at us more when you conceived, but m happy as I talked now I have a girl now who is 9 years old but was tested negative. All this achievement was successful because of regular attendance to Ante-natal care services, following all advices given to us during ANC and also procedure learnt on PMTCT while attending health education talk like, giving birth in the health facilities with qualified mid-wives and within availability of drugs to administer when labor start”
Working with men as partners to promote ANC and PMTCT Programs for their partners, Globally, male involvement has been recognized as a priority focus area to be strengthened in PMTCT. This can be accomplished by encouraging couples counselling and mutual disclosure. This will benefit adherence, improve uptake and continuation of family planning methods and provide family-centred care and treatment. Male partners who are diagnosed as being HIV-positive should be given or referred to appropriate treatment and care. Men in the 6 parishes benefited from HIV/AIDS prevention campaign to promote maternal and child health through the provision of comprehensive family planning methods, ANC, PMTCT, mama kits and livelihood opportunities, It was discovered that men plays a lot of role in promoting maternal health and child health, although most of the women suffer because of their husband negative attitudes on HIV preventions, however it’s realized that unless men are brought on board as partners to promote HIV preventions and health of their families, it will still be very difficult to roll out programs at family and household level. Men were educated on their roles to support their spouse during pregnancies and dangers of high risk pregnancies, signs and symptoms. Together couples were educated on too short, too tall, too soon and too many symptoms and others included bleeding which is a sign of danger. Men were encouraged to accompany their partners to hospital for counseling, testing and help women with household core. This will fully incorporate men as partners in reproductive health for women and preventive mechanism on HIV. Key issues covered during orientations and trainings with men and their partners • • • •
Clarifying general values, beliefs, and attitudes about sexuality, pregnancy and gender dynamics. Understanding how HIV are transmitted during pregnancy and what the key preventions messages are. Understanding women’s HIV risk during pregnancy Understanding the advantages and disadvantages of voluntary HIV counseling and testing (VCT)
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• • • • •
Understanding the importance of preventions of mother to child transmission (PMTCT) of HIV Demonstrating the use of both male and female condom Understanding the impotence of promoting condoms and to counseling women in the postpartum period. Understanding dual protection and how to counsel women on dual protections. Understanding the risk and benefit of various infant feeding options.
Cross sections of men attending to sensitization programs and others are consulting GWED-G Staff on understanding the family planning handbook manual.
Referrals in the different health Facilities: Referrals’ were conducted by GWED-G local grassroots health structures that were established to support the efficient delivery of the project; others were already existing structures that were strengthened for continued support of PLWHA. The network including the Village Health Team (VHT), Peer Village Health Educators (PVHE), out of the two networks, GWED-G established another structures called Community Mobilizes (CM) and Community Facilitators (CF). These teams are very helpful in taking services near to clients and conducting referrals of clients and mothers for emergency cases that required hospital or health centre attention. They were also involved in conducting outreaches door to door and home visits. With these strong collaborations, there has been an increase in the numbers of pregnant mothers self reporting for testing at all the nearby facilities within Kaladima Health Centre II, Olwal Health Centre II, Parabongo Health Centre II, and Awer Health Centre II respectively. GWED-G also established a link for referrals of youths to access services with specific health staff within the health centres so that they can have access to services like counseling, Voluntary counseling and testing, and further
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referrals. provision of septrine prophylaxis for treating minor infections and encouraging youth to have positive altitudes and work to promote their health, they were also encouraged to form youths clubs and use it as a forum for educating themselves on their reproductive health and sexuality. Numbers of people referred: • • • • •
165 mothers were referred for ANC in H/C of kaladima H/C II, Awer H/CII, Olwal H/CII and parabongo H/ CII. Over 400 mothers both women, youth and adolescent were referred for family planning services in the H/C of kaladima, olwal, awer and parabongo H/C. Over 500 members both women and men ,youth and adolescent referred for HIV/AIDS counseling and testing in kaladima HC olwal HC ,Awer HC, and parabongo HC. Over 80 homes visited and were render counseling services in palema, coke and Agwayugi . 6 couples, referred for HIV testing in kaladima H/C II.
Conducting home visits and outreaches to promote Voluntary Counseling and Testing, Outreaches were conducted by the GWED-G staffs, Village Health Team (VHT), Peer Village Health Educators (PVHE), Community Mobilizers (CM) and Community Facilitators (CF). Activities conducted included Voluntary Counseling and Testing- VCT at village levels to take services back home. Community Facilitators and Mobilisers worked hand in hand to reach out to beneficiaries in hard reach areas.
Nancy, the GWED-G VHT worker conducts her educations and outreaches to women and young girls even when they are doing their private work in the garden. She explains the risk of HIV and encourages voluntary testing and counseling.
GWED-G health workers, VHTs, PVH carried out home visits in various villages in the parishes of Agwayugi, coke, oboo, palema, lacor, pagora and Giragira. The main objective of the out reaches and home visits were to reach out every community and strengthen the reproductive health services deliveries. During community out reaches, many topics were discussed to the different communities they include family planning, HIV/AIDS, ANC, PMTCT with emphasis on who are the services providers, how to access them ,the possible likely side effects and the management of those side effects. Incase of any drug reaction. For family planning the idea was to take reproductive health services nearer to the population who need them most.
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Through this out reaches /home visits youth were encouraged to promote or practice safer sex through condom use, go for HIV/AIDS testing, counseling services and join peer health educators club to help sensitize most at risks specifically the uniformed forces like young people, commercial sex workers and those that are hard to reach like those who live in the remote areas and lack transport and knowledge to live healthy. During home visits, psychosocial support was rendered inform of counseling to the needy clients in parishes of oboo, Palema, coke and Agwayugi. The topic discussed were mainly family planning, HIV/AIDS and ANC. The project address the myths of FP among the community through enlighten them on the different types both long and short methods. the advantages to the mother ,family and to the government .during out reaches ,GWED-G health staff with VHTs sensitized communities on ANC with effort on danger of not attending ANC and the risk of giving birth at home in the hand of unqualified staff.
Distribution of livelihood support to support the IGA component for the women living with HIV/AIDS GWED-G identified 30 pregnant mothers who are living with HIV/aids to benefit from Income generating activities that can contributes to improve on their lives, the children they are expecting and the their families. If they have increased income, they can work on rebuilding their lives because they could afford full medical support with the income raised. Apart from generating income, the nutritional food supplements generated from vegetables food products will increase improve wellbeing. HIV compromises the nutritional status of infected persons. Malnutrition exacerbates the effects of HIV, further weakening the immune system. Improving nutrition by maintaining a healthy diet can help to strengthen the immune system, prevent weight loss and delay HIV disease progression. This makes it possible for the HIV-infected mothers to remain productive, and improve or prolong their quality of life. Amongst the women beneficiaries, 20 women selected farming and were supported with seeds for beans. They were given 25kg of seeds and these are only seeds for beans. The gardens will be managed by the women with support from their family members, marketing is being conducted by GWED-G. The objective of this support is to reduce on the transmission of mother to child of HIV through provision of alternative feeding mechanism for the new born.
The following are beneficiaries for the IGAs project in Lamogi Sub County S/N 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17
Name Abalo Hellen Alanyo Lucy Auma Lillian Acan Betty Ajok Grace Anena Josker Oyella Cenci Atto Jenifer Arach Christine Acheng Filder Aol Nighty Lakot magreat Akello Christine Aciro Lillian Labol Joyce Adong Beatrice Amono Susan
Parish Palema Palema Palema Palema Palema Palema Palema Palema Palema Palema palema palema Palema Palema Palema Agwayugi Agwayugi
Village Tochi Amilobo-Lalem Amilobo-Aber Amilobo-Keyo TC Pakiri Tochi-Chuma Amilobo-Lalem Amilobo-Aber Pakiri Pakiri pakira Amilobo-Lalem Amilobo-Lalem Amilobo-Keyo Amilobo-Keyo Odur Odur
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18 19 20
Acan Alice Akech Nighty Anek Jackline
Agwayugi Agwayugi Agwayugi
Odur Odur Odur
Beneficiaries receiving their seeds from the Social Worker- Franny
Distribution of mother kits to HIV vulnerable pregnant mothers. 30 HIV positive mothers were support with mama kits donated from Globe Med Chapter student from Columbia University. These goods were mailed and sent to the women through GWED-G. The kits were received by the district director health services in the presence of the District secretaries for health, chief administrative officer and other hospital representative especially nurses. Before the dispatch of these kits, GWED-G conducted educations to mothers on how to use Mama Kits, the importance in contributing to maternal and child health. The fetal stethoscope was to help the medical doctors who offer services in pediatric wards and maternity to detect any danger in baby’s condition befor any complication arise .the stethoscope will also help all the medical staff to identify and make possible referral incase they can not handle those conditions in health centers due to shortages of medical facilities . The DHO representative of Amuru and Nwoya were very happy and appreciative the support given by the students whom they described as being self driven to promote global health for the poor war affected communities in northern Uganda.
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The medical supretedant of Anaka Hospital Dr. Loum Bishop received the stethoscope handed over by GWED-G staffs Franny Acoko and Tykun Ojimo. “ I still remember, they just came last year to see our hospital, they were moving around and just like any other students we had always received, I thought they would only ask us questions and will definitely go back and we shall not hear from them anymore! Surprisingly, see what the outcome! They contributes to save live of the women in our region, according to GWED-G, they said these students are not working at all but raising every little dollar for the communities of Northern Uganda, we strongly send our regards and we believes these are already responsible citizens of America.’’, he said! They promised to work hard in partnership with GWED-G and also mentioned that they will continue to collaborate and work in partnership with GWED-G and GlobeMed. They mentioned that maternal motility claimed over 514,000 women’s lives each year yet all this lives could be saved if affordable, good-quality obstetric care were available 24 hours at hospital facility. These would allow quick detections of complications
The Medical Doctor and Nurse Verifies the Kits if they are complete.
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Here the Doctor hands over a complete Kit to a mother admitted at Anaka Hospital labour ward awaiting delivery, lastly the nurse and Doctor speak to women who are about to use the kits on its proper management, they mentioned what shall be used by health personnel and what will be used by mothers.
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Beneficiaries direct and indirect Beneficiary tables for the indirect and direct beneficiaries. 0-4
5-17
18-24
> 50
25-50
Type of Direct Beneficiary to date
TOTAL f
m
1. HIV positive Mothers and women of child bearing age.
f
m
02
f
m
23
f
m
f
m 100
75 13
16
5
4
9
03
2. Village Heath Teams - VHTs 3. Peer Village Heath Educators - PVHE 4. Community Facilitators - CF
2
8
6
16
5. Community Mobilisers -CM
1
4
11
16
6. Men networks
6
12
6
2
7. Family Support Groups 8. IGA beneficiaries direct beneficiaries. TOTAL
3
2
00
00
f
12
3
30
41
106
18-24
64
f
m
f
m
Community sensitization in different parishes on HIV/AIDS preventions. Referrals for Ante-natal services.
66
34
100
70
200
130
Referrals for family planning services
50
Referral for HIV counseling and testing Home visit/out reaches
120
f
m 600
155
187
45
50
250
400
20
150
53
190
78
611
1
3
43
13
83
143
3
2
1
6
Couples referrals for HIV testing 4 7
30
26
17
Men’s groups active in the project
259
22
10
16
00
> 50
m
IGA beneficiaries and their family members.
00
25-50
f
Beneficiaries of mama kits
48
24
25
30
5-17 m
12
3
06
0-4
Numbers of people reached with services and indirect beneficiaries.
4
24
10
23
10
8
120
60
35 102
1
2
239 172
Family Planning
3
120
277
292
PMTCT services and ANC services
5
140
247
392
12
Distribution of Condom
16
Reproductive health educations to youths. Totals.
16
7
124
278
99
207
222
553
235
818
582
135
36
806 1478
465
1
2
3934
Indicators by interventions:
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Activities
Indicators.
HIV/AIDS prevention awareness campaign and sensitizations
•
80% of the communities attended the prevention campaign.
•
479 persons attended to the various preventions strategies.
•
Increased knowledge and understanding on the risks of HIV/AIDS within the project catchments.
•
70% of communities understanding most of the means for HIV transmission
Addressing negative traditional practices that promote HIV transmissions.
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Education on antenatal care and PMTCT Services, •
Enhancing community engagement and mobilizations including male involvements.
•
172 men enrolled into the programs.
•
Encouraging discloser of HIV amongst couples.
•
23 couples disclosed their HIV status to their couples.
•
Strengthening of MCH services including, malaria prevention (IPT and ITNs), and strategies to reach those missed in ANC and safe delivery practices.
•
45% of mothers within the project catchment referred for MCH services at hospital and health centre levels.
•
105 women and men referred for ARV treatments and 172 men attended the PMTCT services.
•
611 patients referred for counseling and testing.
•
60% of clients received their ARV treatment while 45% referred for PMTCT services.
•
Integration of routine counseling and testing (100% counseling with opt out model) in MCH services.
• Provision of ARVs for PMTCT 03
Screening and treatment of opportunistic infections among mothers and their families
•
70% of HIV clients attended education on the management of opportunistic infections.
04
HIV Counseling and testing
•
611 clients attended to different counseling
13
05
Promoting male and female condom use
•
135 condom distributed (condom was out of stock at some point at the hospital).
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Family Planning
•
292 women enrolled for planning.
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Outreaches and home visits
•
143 homes visited through outreach programs.
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Other indicators. •
At least 75% of all pregnant women attending antenatal care are provided with information on PMTCT.
•
At least 75% of pregnant women living with HIV receive antiretroviral prophylaxis or antiretroviral therapy to reduce the risk of mother –to child transmission.
•
At least 80% pregnant women attending antenatal care are tested for HIV.
•
80% of women received seed grant for IGA this quarter.
•
20 women will invest in vegetables production as part of nutritional food supplement.
HIV affected women supported with livelihood component (IGA)
Feedback from communities, •
Communities have been receptive enough on the project. The project is covering Parishes of Coke, Oboo, Lacor, Palema, GiraGira, Pagoro,and Agwaryugi. Parish chiefs and leaders are requesting for an expansion but GWED-G mentioned that it’s impossible immediately we need to work with the already expanded Parishes and Villages.
•
They requested for mobile clinic services since the health centre facilities are very far and most of them have gone back to their original homeland.
•
The needs for family planning is becoming high, the communities request for trainings of health workers at health facility and GWED-G should work hand in hand with family planning institutions to supply the various family planning needs like Implant, condoms, oral contraceptives like pill plan and creating supportive environment for family planning so that the community can access through working with other agents to dispel misconception on family planning services
•
Stigma surrounding HIV remains a problem and limits the success of PMTCT interventions if education is not well administered. Stigma is a barrier to couples going for VCT since HIV is still largely viewed as a death sentence by many people. HIV is often associated with immoral behaviours which makes many people fear to be tested since they worry they will be seen as bad people and blamed if their result is positive.
•
Male involvement has been inadequate in HIV/ PMTCT/ANC/Family planning communication initiatives by most partners. Men have often been left out yet they are seen as critical decision makers. If men are not
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informed of the benefits of PMTCT and clearly understand the risks to their children, they will not become a supportive force for PMTCT uptake and compliance. This includes all HIV prevention strategies. •
Stigma and cultural practices around not breastfeeding make it difficult for many mothers in PMTCT programs to avoid stigmatization. Stigma exists in situations where women may choose not to breastfeed when most people view the practice as culturally acceptable. Women who therefore do not breastfeed, are sometimes shunned or told they are not good mothers when in fact, the choice not to breastfeed may well be protecting their child. Such stigma makes it difficult for some mothers to adhere to infant feeding practices that can protect their child from HIV.
•
Body weaknesses in the first week for women who are accessing the preventive support programs ( PMTCT, Family Planning, Reproductive health kits, ANC services) were reported.
•
Some cultural practices impede the success and health of HIV prevention strategies. Some cultural practices are counterproductive to the health of men and women in relation to risk of contracting HIV. For example, widow inheritance, sexual cleansing and a tendency towards multiple partners may put men and women at greater risk for HIV infection.
•
In adequate IEC materials.
Recommendations/Action Points • • • • • • •
GWED-G needs to discuss with GlobeMed and other partners if possible how to involve the capacity Building component on the project/ this includes trainings especially for the VHT and other existing structures. Expansion of this program may be difficult unless more funds is raised since we need to work within the same project areas so that we can realize meaningful impact. The project is still continuing with follow up and home visits. This will support management of complications or side effect of drugs administered to clients. GWED-G will work to strengthen the referral ways of VHTs in the community by providing them with emergency kits. Men incorporated and enrolled into the programs already, maybe GWED-G will question its capacity to manage more men. IEC materials will be distributed in the final quarters; however the request for T-Shirts by VHT is still a question that GWED-G administration is looking at in terms of budget. GWED-G will work to strengthened relationship with health centers staffs and hospital for meaning service provision to all their clients on referrals and that requires counseling and testing.
Challenges •
Health centers and hospital lacks facilities for example in the health centers where we carried out our activities, there has been shortage of HIV testing kits for a month and we had to run round and mobilized for it to be delivered by the district health services.
• Transport, the programs has been intensive. GWED-G incurred more cost in the hiring of transport, this has collided with the increased and the very high inflation rates now in the country that has affected every budget lines. • Medical personal remained bottleneck problems with the District. Always the numbers of personal within the health unit is really inadequate.
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• There are emerging needs to establish certain structures to help facilitates the programs. This has also incurred other cost. • It has been rainy season and the road to Amuru has been very bad, the staff have been stuck several times on the way and also beaten by rain. This calls for support with rain Coats and other rain gears.
Activities planned to be implemented the next quarter July – September. •
Support the 10 Pending women with their desired IGA
•
Follow –up with the women who received the seeds and continue to distribute vegetables seeds.
•
Distribute locally available IEC materials.
•
Procure 3 bicycles to support home visits and outreach programs for the VHT.
•
Follow up the utilization of mama kits at hospital and at home for the beneficiaries.
•
Continue to work with men and secure their full participation in promoting maternal health and PMTCT.
•
Conduct 2 awareness campaigns at parish levels.
•
Conduct one massive HIV testing within the communities to promote blood safety.
•
Continue with routine referrals of all cases for redress.
•
Attend quarterly meeting with the groups and give feedback to GWED-G management.
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