MILDMAY Transforming HIV Care MILDMAY UGANDA Annual Report
April 2009 - March 2010
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
FOREWORD
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Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
Mildmay Uganda Board Members
Rev. Dr Prof. Samuel Luboga
Pastor Andrew Mwenge
Mrs Florence Kaddu
Rev. Mutebi Hannington
Rev. Diana M. Nkesiga
Mrs Kityo Vivian
Dr Jeff Sebuyira Mukasa
Eng Proscovia M. Njuki
Mr David Geoffrey Opiokello
Dr Jeff Sebuyira Mukasa Mildmay Uganda - Transforming HIV care
Mr. James Kalibbala
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LIST OF ABBREVIATIONS/ACRONYMS/OPERATIONAL DEFINITIONS
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AB
Abstinence and Being Faithful
Adherence
The level at which the patient follows the prescribed drug regimen
ART
Anti-retroviral Therapy
ARV
Anti-Retroviral Viral (Drugs)
BSc
Bachelor of Science
CBV
Community Based Volunteers
CDC
Centers for Disease Control and Prevention
COP
Country Operational Plan
DFID
Department of International Development
FBC
Full Blood Count
GAP
Global AIDS Programme
GSK
GlaxoSmithKline
HCT
HIV Counselling and Testing
HR
Human Resource
HRIS
Human Resource Information System
IGA
Income Generating Activity
JCRC
Joint Clinical Research Centre
LAN
Local Area Network
MER
Monitoring, Evaluation and Reporting
M&E
Monitoring and Evaluation
MDR
Multidrug-resistant
MICSA
Mildmay International Clients' Support Association
MoH
Ministry of Health
MTT
Mobile Training Team
NSSF
National Social Security Fund
NGO
Non Governmental Organisation
OIs
Opportunistic Infections
OVC
Orphans and Vulnerable Children
PAYE
Pay As You Earn (tax)
PEP
Post Exposure Prophylaxis
PEPFAR
(US) President's Emergency Plan For AIDS Relief
PLHIV
Persons Living With HIV
PMTCT
Prevention of Mother-to-Child Transmission of HIV
Mildmay Uganda - Annual Report April 2009 - March 2010
SQL
Simple Query Language
TB
Tuberculosis
TEDAS
Targeted Evaluation on Drug Adherence and Sexual behaviour risk reduction
UBOS
Uganda Bureau of Statistics
USG
United States Government
VCT
Voluntary Counselling and Testing
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
INTRODUCTION Mildmay International is an independent not-for-profit Christian organisation involved in the provision of HIV and AIDS palliative care services, training in the provision of these services as well as consultancies worldwide. Mildmay International aims to remain at the forefront these specialities by demonstrating relevant, culturally sensitive and innovative models of care and progressive educational programmes for healthcare professionals and other cadres. In 1993 Mildmay International was commissioned by the Ministry of Health in Uganda to develop a specialist AIDS Rehabilitation, Palliative Care and Training Centre in Uganda. Mildmay Uganda (MU): Opened in 1998, to provide and demonstrate quality holistic, comprehensive, outpatient care for patients with HIV/AIDS-related health problems, and to teach and train health workers throughout Uganda and the region in such care. The facility belongs to the Ministry of Health but is run by Mildmay International. Since 2002, Mildmay Uganda has been funded by the United States Government, through the Centers for Disease Control and Prevention (CDC), initially to train Ugandan health workers in HIV/AIDS care and management and later, through The US President's Emergency Plan for AIDS Relief (PEPFAR), to provide care including ART to patients. Since 2004, the funding support from PEPFAR has facilitated the provision of free HIV care and treatment services leading to increased access to these services, the extension of some aspects of training, and the channelling of funds to another CDCfunded project, Reach Out, Mbuya Parish. Mildmay Uganda's Vision Statement: “A world in which everyone with HIV can have life in all its fullness” Mildmay Uganda's Mission Statement: “To improve the quality of life of men, women and children living with HIV primarily in resource-limited settings through provision of holistic care and training others to provide such care and to provide a centre of excellence to demonstrate best practice in HIV/AIDS care to Government, NGOs, health professionals and community programmes and stakeholders”. Mildmay Uganda's Core Values: The core values of Mildmay Uganda are based on the Christian faith which is embraced by the MI Founders, Trustees, Executive Directors and many members of staff past and present and include; ethical clinical standards, a nonjudgmental and non-discriminatory approach to patients as well as honesty and transparency in all our dealings. Administratively, Mildmay Uganda has five Directorates; Clinical Services, Training and Education, Quality Assurance, Resources and Residential Nursing and Day Care, as well as the Country Director's Office which oversees all MU activities.
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Mildmay Uganda - Annual Report April 2009 - March 2010
OBJECTIVES AND ACHIEVEMENTS OF THE YEAR UNDER REVIEW (1 APRIL 2009 31 MARCH 2010) Two main objectives provided the basis for the Mildmay Uganda programmes during the period under review: 1.
To provide HIV/AIDS care and treatment services including basic and comprehensive prevention services, palliative care and ART
2.
To deliver an internationally recognised HIV/AIDS Education and Training programme on the different aspects of HIV/AIDS care at the Centre and in the districts of Uganda
Objective 1:
The Clinical Services Directorate Through its Directorate of Clinical Services, Mildmay Uganda offers holistic care, using a multidisciplinary and family approach to HIV-positive clients and their families. The services include: HIV diagnosis and counselling, specialist medical and nursing care, pastoral care, physiotherapy, occupational therapy, X-ray and ultrasound, a fully equipped laboratory, a well stocked pharmacy, social-welfare services, nutritional advice, dental services and an eye clinic. Mildmay Uganda has developed psychosocial support services for Orphans and Vulnerable Children (OVC) including counselling and spiritual guidance. Mildmay Uganda is now one of Africa's leading specialist centres for the care of children with HIV/AIDS. Other activities at Mildmay Uganda include; provision of Post Exposure Prophylaxis (PEP) for occupational exposure and rape victims, strengthening the Prevention with Positives activities and provision of condoms.
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
Table 1: Key Achievements by the Clinical Directorate Objective 1: To provide HIV/AIDS care and treatment services including basic preventive care, palliative care and ART
21,469
19%
31,547
20%
3,184 9,496
10,009
28%
12,328 2,381
4,415
65%
1,997
23%
6,160
123%
189,533 42
Other Achievements l Opened a fee-for service clinic in June 2010 to cater for clients who can afford to pay for their treatment. Currently, the clinic is run twice a week (Monday and Thursday). l Real time entry of clinic data into RWCAREWare database was fully implemented. l Provision of care continued amidst funding gaps. l Sexual Reproductive Health services fully operational within the clinic with many patients receiving family planning services, cancer screening and treatment, PMTCT services with appropriate referral and STI
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38%
screening and treatment. Rolled out the Integrated Management of Acute Malnutrition (IMAM) in the paediatric clinic. The 7th annual dental camp was successfully held from 25th Jan to 4th Feb 2010 with over 400 children receiving free dental services from a team of 25 volunteers from USA.
Patient Care Outpatient care is provided to all patients in care and the clinic is open four days a week with the exception of Wednesday. The clinical directorate handled 74,834 (23% by children) patient visits through the main site. Most of the stable patients
Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
have been referred to the community outreach clinics thus decongesting at the main site. During the year, a total of 5,751 patients were enrolled into care at the various sites. Enrolment into care was limited by funding during the 3rd and 4th quarters but HIV positive children and HIV pregnant women and their families were given priority.
New Patients enrolled into care by site (Apr 09-Mar 10)
*17% of the new enrolments were children below 18 years.
Specialised Clinics Specialised services including mental health, eye care, dental care and Sexual and Reproductive Health (SRH) have continued throughout the year and have reduced the need to refer patients to other centres for such care. The Mental health/psychiatry clinic In May 2009, the psychiatry clinic was shifted from Tuesday afternoon to Tuesday morning every week after realising that patients were waiting for long hours after being seen in the general clinic. A total of 861 (21.3% children) patients were seen in this clinic recording
Mildmay Uganda - Transforming HIV care
(a 14% increase - compared to 604 seen last year). Depression remains the commonest ailment treated in this clinic. The Dental Clinic This year, the dental clinic continued to offer care to children only .The dental clinic was shifted to Kwagala house - a more spacious area. The 7th annual dental camp by the visiting US dentists was successfully held in February 2010 with 472 children receiving care bringing the total patient attendances at the clinic to 3,643. Dental caries remains the commonest diagnosis at the clinic. The clinic received a donation of dental
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MILDMAY Transforming HIV Care
materials from Henry Schien Company. The materials included consumable (gloves and cotton) and non-consumable (a dental-kit carrier and cleaner) materials. These were useful in the operations of the clinic especially in the first quarter and significantly contributed to the costs of running the clinic. The dentist also visited Naggalama and Mityana satellite clinics to assess the level of dental services at these sites and to identify areas where MU could work with the sites to scale up access to dental care at the HIV/AIDS clinic. Subsequently, monthly visits by the dentist were initiated at these sites to assist them with screening and treating patients but using the resources available at those sites. The Eye Clinic The eye clinic held on Fridays serves patients with eye complaints and those at risk of getting eye complications of HIV. The goal is to assess for, treat and prevent (where possible) eye complications associated with HIV/AIDS so as to improve the individual patient's quality of life. Priority is given to patients with low CD4 counts and those presenting with eye complaints. Fewer patients, 578 (compared to 799 seen last year) were seen in the clinic because the sessional eye doctor was busy conducting eye care camps around the country organized by the Ministry of Health. The common HIV/AIDS related eye
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conditions causing severe visual impairment were: uveitis, cataracts, optic neuropathy and chorioretinitis/ chorioretinal scars. Other diagnosis included allergic conjunctivitis and dry eye Syndrome. One male 15year old patient (first child seen at Mildmay main site with active CMV retinitis) had both eyes affected. CD4 count was 26 cells/mm3.The right eye was already blind (NPL) with retinal detachment while the left had vitreoretinitis with moderate visual impairment. He has so far received 5 doses of intravitreal ganciclovir. Vision in the left eye was restored to normal (from 6/18 to 6/4) and was started on ART. Mildmay Uganda Private Clinic In June this year, MU opened an outpatient private wing in an effort to extend services to those who are able to pay. The main objective of this new venture is to deliver managed HIV care of the highest standard to an expanding community of people living with HIV mainly in th urban towns. These services are currently being offered in a conducive environment at its main site in Lweza by well-trained, highly motivated and caring multidisciplinary teams. The clinic is open Monday and Thursday every week and provides comprehensive care and treatment to both adults and children. TB Care programme The main site managed 510 patients for TB. Cohorts of patients starting TB treatment are followed up and a report
Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
compiled at 12 months. Those failing on treatment are restarted and those diagnosed with MDR-TB started on second line drugs. In partnership with Medecins Sans Frontiers France (MSF), provision of second line drugs for one MDR-patient has continued. The patient has completed 12 months of the initial phase and is currently doing well on continuation phase. All follow-up sputum examinations were negative and the patient resumed normal working activities. In partnership with MĂŠdecins Sans Frontiers (MSF), MU managed to start a 40 year old male patient, diagnosed with MDR-TB in the last quarter, on second line regimen for TB. On the initial phase of his treatment he is doing well and a follow up sputum sample was sent to the national TB laboratory pending results. The second patient with MDR-TB, diagnosed the third quarter died before starting treatment. A sputum specimen for a patient from a Satellite clinic was sent to the national TB laboratory for TB culture and sensitivity and results are pending. TB-HIV collaborative care activities have continued involving intensified case finding and infection control interventions have been intensified both at HCT and in the general clinic. Home visits to TB patients and linking of newly diagnosed re-treatment cases to private clinics for DOT during the initial phase of treatment is done by the Home care department in liaison with the TB office. The district administration has continued to supply us
Mildmay Uganda - Transforming HIV care
with TB drugs, laboratory reagents, specimen containers and stationary (registers) needed for TB activities. Allied Health Services (AHS) Division The Allied Health Services Division exists to provide quality diagnostic, rehabilitative and pharmaceutical services to all clients attending Mildmay Uganda main site and its supported sites. The AHS Division is comprised of four departments: Pharmacy, Therapies, Radiography and Laboratory. l 6 Physiotherapists have trained on the principles of aromatherapy, greatly improving the rehabilitation services for Persons Living with HIV (PLHIV). l O n e L a b o r a t o r y Te c h n o l o g i s t received training on Best Microbiological Practices conducted by Center for Development and M a n a g e m e n t ( C D M ) Tr a i n i n g Solutions, a member of South Africa Quality Assurance Institute. l Mildmay Uganda Laboratory safety manual was developed and the Laboratory is now enrolled on the Global AIDS Programme (GAP) for HIV-1 DNA DBS Proficiency Testing. l The pharmacy receives ARV and Cotrimoxazole donations from Clinton Foundation HIV/AIDS Initiative (CHAI) and ARV and other drugs from the Ministry of Health (MoH). This has increased the number of children on ART.
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MILDMAY Transforming HIV Care
Pharmacy technicians compounding creams for external use by clients The Therapies Department The therapies department comprises of physiotherapy, occupational therapy and nutritional rehabilitation. Physiotherapy is offered for patients with residual or acute pains, limited joint motion, muscular pains/imbalances, nervous disorders, cardio/vascular disorders, respiratory imbalances and skin lesions. The patients are helped to regain normal or near normal independence or function. During the period, the department registered 6,544 (31% by children) physiotherapy attendances. Most of the respiratory conditions presented among children while most of the muscularskeletal dysfunctions were among the adults. Although skin conditions have been the most common, neurological disorders have been the most disabling to patients.
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The Nutrition Unit provides a comprehensive package including; nutritional assessments, nutritional education and counselling, dietary planning, food security interventions and education and support. Various patient categories are served including pregnant women, lactating/nursing mothers and infants among others. The unit registered 1,734 (52% by children) patient visits. 665 patients received food assistance packages, 345 patients received nutritional education and four patients received seeds for kitchen gardening. Hands-on training for caretakers on the ward in preparation of infant therapeutic feeds such as F100, high energy porridge and kitobeero (a mixture of locally available feeds to make a nutritious meal) was done. The unit received 16kgs of rice and 26kgs of sugar from Zain and four
Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
cartons of Combined Minerals and Vitamins (CMV) from MoH. Occupational therapy is offered to people with physical, mental, emotional and developmental disorders through
SUCCESS STORY: Physiotherapy helps to improve a patient's functional independence NH, a 38 year old widow was first referred to Physiotherapy Department on 2 July 09 by a Doctor with severe peripheral neuropathy in the lower limbs and swollen feet. She was in severe pain and cried with a simple touch on her leg. She could hardly stand and therefore using a wheel chair supported by her mother with whom she lived at that time. Physiotherapy was initiated with the aim of increasing her functional independence especially in walking, transfers and lifting. Initial assessment indicated that it was difficult to intervene given the severe pain. Cryotherapy (use of ice) and aromath-
Satellite Clinics Division The Satellite Clinics were established to help scale-up sustainable access to quality HIV and AIDS care for initially rural populations. Mildmay Uganda uses a systems strengthening approach through partnerships with both MoH and other NGO facilities. Currently, Mildmay Uganda partners with nine sites in six districts, Mpigi (Buwama HC III), Kamwenge (Ntara HC IV), Luweero
Mildmay Uganda - Transforming HIV care
purposeful and therapeutic activities. The Occupational Therapist (OT) helps patients learn new skills or relearn lost skills (as a result of illness e.g. in HIV infection) to manage daily living.
erapy were administered for pain relief. Effleurage massage was administered and a range of motion exercises done to reduce swelling in the feet. As the pain reduced, she was also started on weight bearing exercises, walking in parallel bars and stair climbing. She attended the centre gym in addition to counselling and occupational therapy provided both at home and the centre. NH can walk with the support of a walking frame provided by Mildmay. She has resumed her role of full time home maker and is able to fend for her four children. She continues to receive care at Mildmay and is being prepared for ART initiation. She is grateful for the care provided by the Mildmay teams.
(Bishop Asili Kasana, Holy Cross Kikyusa), Mityana (Mityana Hospital, Kyantungo HC IV), Mukono (Mukono Church of Uganda HC IV, St. Francis Naggalama Hospital) and Wakiso (Kabubbu HC II). During the year, Mildmay procured laboratory equipment for 5 of the nine sites. Each of the site was to get a biosafety cabinet for processing of TB samples, haematology analyser, CD4 8
MILDMAY Transforming HIV Care
analyser and a chemistry analyser. The sites are responsible for creating the space for the equipment, a stabilised power source as well as installation of an air conditioning unit. Three of the 5 sites have already fulfilled these requirements with the subsequent delivery and installation of the equipment. These are Naggalama Hospital, Kasana and Mukono health centres. This has also resulted in the reduction in turnaround time for results at these sites as well as a reduction in volume of samples processed at Mildmay main site. Below are some pictures of the new equipment installed in Bishop Asili
Kasana Health Centre III laboratory. The Adherence and Social Welfare (ASW) Division The division supports PLHIV in care and their families through monitoring adherence to treatment regimens, counselling, pastoral care, overseeing the provision of OVC services and other social support services to improve clients' quality of life. l During the year under review, the Mildmay Uganda staff, Noah's Ark Choir and Positive Speakers Club carried out sensitisation and awareness campaigns.
Noah’s Ark Choir together with their leaders outside South Walk Cathedral in London, UK
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Mildmay Uganda - Annual Report April 2009 - March 2010
l The choir participated in discussions on Radio Star and WBS TV and also attended the 21st Anniversary celebrations of Mildmay International in London in October. Staff participated in activities to mark the World AIDS Day 2009. l Staff and children registered in care attended the National HIV Conference in November where a children memorandum was written. l 280 clients received PMTCT counselling, 31,547 received HIV counselling and testing and 3,706 sessions were held for on-going support counselling. l Mildmay Uganda staff together with Positive Speakers Club members sensitized the youth in schools and communities about stigma and discrimination. 970 students were reached with life skills development training and HIV sensitisation. l In October 2009, Mildmay Uganda Children's Choir entertained guests at the 21st Anniversary of Mildmay
International at South Walk Cathedral in London, UK. l Hosted 120 children from Apac District who were addressed by the Mildmay Uganda positive speakers on HIV and AIDS, the importance of HIV testing, stigma and discrimination. l The Kisakye Youth Centre, an Adolescent Sexual Reproductive Health Unit at Mildmay Uganda opened to the OVC in September 2009 to address sexual and reproductive health needs of the 10 24 year olds. At the Centre, young people meet and interact with peers and they get and also share their health related and other problems with health care professionals. l Networking with other organisations continued; the division worked with Watoto Child Care Ministries, National Guidance and Empowerment Network of People Living with HIV/AIDS (NGEN+), A-Z Charity, Namasuba College of Commerce and Cherish Uganda.
Noah's Ark club at one of the Community Clinics (Kajjansi Health Centre III) where adolescents are given life skills Mildmay Uganda - Transforming HIV care
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The Pastoral Team at Mildmay Uganda; L to R Rev David Galimaka, Imam Kamya Jamil, Pastor Ben Muziru and Father Joseph Lugobe
l OVC care has grown, with Mildmay Uganda providing support to children in 8 major core programme areas, namely, socio-economic security, food
security and nutrition, care and support, education, psychosocial support, health, child protection and strengthening capacity of OVCs
The Noah's Ark Choir singing, “He Turned My Mourning into Dancing Again� at South-Hampstead High School, UK
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Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
The Family Welfare Department The Social Welfare Unit continues to follow a family-oriented model in dealing with clients. The purpose is to create harmony between the individual, their family and the community. The department coordinates the school fees programme for children sponsored by Mildmay Uganda, oversees Noah's Ark activities, oversees the OGMAC programme (Our Generation Mildmay Adolescents' Club) and handles family issues affecting adherence to treatment. T h e D e pa r t m e n t h a n d l e d 1 , 7 6 5 patient/client visits with the common issue being need for educational support. The department also registered several success stories. Mildmay Uganda supports an orphan to live positively with HIV MAS (initials), a 17 year old client was initiated into care at Mildmay in 2002 at a time when she was in P.7. After receiving her results, she was devastated, lost hope and gave up on life. She was started on medication and subsequently enrolled for education support. At that time, she did not take the results seriously and never adhered to her medication thinking that she would be healed from the HIV infection. She had been advised by her friends not to take her dugs for they would reduce her life span. She was also scared of being seen by other children as she swallowed drugs every day. It is only when she caught flu and cough that she remembered to take her Septrin. In 2008 (when she was in S.6), she was diagnosed with abdominal TB and started
Mildmay Uganda - Transforming HIV care
on anti TB drugs. Due to non adherence to the TB treatment, she developed other complications and was operated upon twice. She spent six months in hospital and therefore missed her final examinations which she sat for the following year (2009). MU continued supporting her through hospital visits. Through the support counselling, MAS was encouraged and continued living positively. Recently, she wrote to the management and staff of MU appreciating the support given (See appendix 2 a letter of from MAS). Her message to the children is that: 'they should put their hope in God and always take their medication as prescribed by the Doctors in order to live a happy and healthy life'. If sponsored, MAS will join a tertiary institution. Mildmay Uganda in collaboration with other stakeholders help to build a new home for a patient
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MILDMAY Transforming HIV Care
Agnes’ home before intervention Nakitende Agnes is a 33 year old widow with eight children to take care of after the death of her husband. They were both registered in care at Mildmay Uganda. However at the time of his death, Agnes was pregnant and due to the complications she had during pregnancy, Mildmay met all the maternity charges (in special private clinic). The new born baby was also cared for. Agnes’ family was identified by one of our counsellors during a home visit to assess her situation at the same time NTV had broadcasted her story but nobody had yet turned up to help. She lived in an incomplete muddy
The new home structure together with her family. Mildmay worked in partnership with the community, the church; the district probation office, Mukono District and Standard Chartered Bank. Some materials were available for its completion. Mildmay Uganda contributed 350,000/= through its welfare fund. Agnes was referred to senior probation officer who linked her to other partners including Standard Chartered Bank which gave a substantial financial contribution. Through the joint efforts the construction of the home was accomplished. Mildmay Uganda supports one of the
registered Children to continue with her education KS (Initials) is one of the OVCs (total orphan) supported by Mildmay Uganda. She receives educational support. She was best student in her school both at O level and A level. She attained 21 points for her A levels and will be joining Makerere University for procurement and logistics course.
The Civil Society Fund OVC project Mildmay Uganda received funding from the Ministry of Gender, Labour and Social Development (MGLSD) through the Civil Society Fund to implement an 18 months project aimed at strengthening the capacity of service providers to improve access and utilization of quality comprehensive care for HIV positive children in the central region of
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Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
Uganda. The project is funded by The project is being implemented in partnership with the district Local G o v e r n m e n ts a n d C i v i l S o c i e t y Organizations in 14 districts of Central Uganda namely: Wakiso, Kiboga, Luwero, Mityana, Mpigi, Kalangala, Mubende, Rakai, Nakasongola, Ssembabule, Lyantonde, Masaka, Nakaseke and Kampala. l Mapped 2,654 OVC service providers by location and the Core Programme Areas (CPA) of focus and designed district service provider directories. l Mapped 2,517 households (by district, sub-county and parish) caring for HIV positive children and also identified 3,710 HIV positive children to be linked to care. l Established 24 'circles of service providers' (comprising of 3 service
providers per sub-county) to strengthen the OVC referral system. 1,523 HIV positive children were referred within and out of the circle of service providers. l 138 service providers were trained in child counselling and communication and Monitoring and Evaluation. l Conducted an assessment of the priority needs of HIV positive children, compiled and disseminated the findings at various stakeholders' workshops. l The working relationship between the OVC services coordinating bodies i.e. Community Based Services Department (CBSD), the departments of health and District OVC Coordination Committees (DOVCCC) has improved following project activities.
CSF OVC staff during a field visit
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
The Residential, Day Care and Nursing Directorate The Nursing Directorate provides services in the residential and day care units. Services provided include adult and paediatric triages, treatment rooms, nurse led clinic, reproductive health services, a children's activities area known as Noah's Ark and in-patient care (for children in the acute phase of their illness requiring intensive care). l 10 nurses were trained in cervical cancer screening using the visual inspection with acetic acid (VIA) method. Cervical screening at Mildmay Uganda started in July 2009 and 1,144 women were screened during the year, 86 (7.5%) of whom were VIA positive. Of those who were
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l
l
l
l
VIA positive 27 (31%) were referred to Mulago Referral and Teaching Hospital due to extensive lesions, warts and large polyps. There were an increased number of clients utilising family planning services from 174 in the previous year to 349 during the year under review. 186 clients were identified and treated for STIs as a result of the new Reproductive Health Clinic at Mildmay Uganda. 40 nurses (from all sections) and two “play” therapists were trained in Integrated Management of Acute Malnutrition (IMAM). Now all children coming to Mildmay for care are being assessed for malnutrition during triage. Managed 676 admissions and 584 discharges
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Mildmay Uganda - Annual Report April 2009 - March 2010
Mildmay Uganda multi disciplinary team during one of the Ward Round in the Paediatric In-patient Ward
Success story “Hope's Road to Recovery” Hope was born on 14th March 2009 with a birth weight of 2kg to a 19 year old HIV positive mother. Six months later Hope became unwell and was admitted at Mildmay Uganda with severe acute malnutrition, loss of appetite, vomiting, cough and fever and a weight of 3kg. Additional points included; no history immunization, failure to thrive, meningitis and a positive DNA PCR. Hope was given intensive nutrition rehabilitation on 2-hourly therapeutic
Hope on Admission (22/09/2009)
Mildmay Uganda - Transforming HIV care
feeds (F75 for 4 days then F100 for 4 days), high energy porridge, “Kitobeero” (mixture of a plant protein, an animal protein and a carbohydrate) plumpy nut and fruit juice, daily weight monitoring and nutrition education for the mother. Within four weeks after admission Hope gained weight from 3.1kg to 4.3kg. The weight to height ratio improved from below 60% to 80% and the weight for age from 41.3% to 57.3%. Hope's general appearance was good as shown in the pictures below.
Hope on discharge 5/10/2009
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MILDMAY Transforming HIV Care
l Four (4) nurses were trained in Family Planning Methods - Level D (providing condoms, oral pills, information about lactational amenorrhea (LAM) method, injection and moon beads, insertion of implants and intra-uterine devices, as well as information about permanent methods followed by referrals to centres that offer the services). l The Directorate also participated in the following workshops: a. The National Stakeholders Meeting on RH/HIV integration assessment. b. The meeting to share the findings of the study on sexual reproductive health choices for PLHIV c. The Cervical Cancer Stakeholders Meeting during which the Cervical Cancer Strategic Plan was launched.
Objective 2:
The Training and Education Directorate The Directorate of Training and Education aims to develop initiatives that will introduce the knowledge and skills needed to provide comprehensive, holistic rehabilitation and palliative care for People Living with HIV/AIDS in a range of settings. Its long-term aim is to strengthen the educational infrastructure for healthcare professionals in Uganda, thereby improving the existing health systems' ability to provide care. It targets multidisciplinary healthcare professionals who are active in HIV/AIDS
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care in hospitals, health centres, dispensaries and the community. Training programmes are provided for the Uganda Ministry of Health and other government bodies, NGOs, faith-based organisations and companies in Uganda and the surrounding region. It is therefore both a national and a regional training centre. The Training and Education Programme at Mildmay Uganda is done in collaboration with the Uganda Ministry of Health, CDC and other stakeholders, comprising short programmes, clinical placements and modular diploma/degree as well as teaching programmes carried out by the Mobile Training Team (MTT). The Directorate also delivers the Workbased Diploma/Degree course in HIV/AIDS Care and Management, keeping it updated and encouraging students to continue to the degree level. Facility Based Training - Facility based training includes the Mildmay regular scheduled short courses and tailor-made courses prepared on request by various organisations and the course content and design are made to suit the organisation's particular needs. Diploma Programmes - The Diploma Programme is run by the Mobile Training Teams (MTT). The teams offer workbased capacity building programmes for health care workers in the rural districts of Uganda in HIV/AIDS Prevention, Care and Management. The districts included; Wakiso, Mityana, Luwero, Mukono, Kumi,
Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
Bugiri, Kanungu, Mbarara, Iganga, Mayuge, Kabale, Isingiro, Gulu and Kisoro. Work-based Training l A new course on Paediatric Palliative Care was launched with funding from The Diana, Princess of Wales Memorial Fund with a faculty of eight facilitators from within and outside Mildmay. The pioneer group of trainees consisted of 22 health and non-health care workers from both Government
and Private sector with a goal of training a cohort to offer quality comprehensive HIV and AIDS services throughout Uganda. l Two long modular courses were offered; o A Diploma in Community HIV/AIDS Care and Management validated by Mbarara University of Science and Technology (MUST) o An HIV/AIDS Palliative Care Course for 58 nursing assistants from the districts of Bugiri, Kumi,
Table 2: Key Achievements by the Training and Education (T&E) Directorate during the Year under Review. Objective 2: Key Achievements by the Training and Education (T&E) Directorate during the Year under Review. Activities
Target Group
Kanungu and Mbarara. l Also offered short courses for various health care workers and community based volunteers including two short courses for sixty nursing assistants from Ugandan People's Defence Forces 4th Division in Gulu.
Annual Targets
Annual Achievments
% Achievement
modular Diploma course in Community HIV/AIDS Care and Management will graduate in February 2011. The students comprised of Clinical Officers, Nurses, Midwives and Counsellors/Social Workers.
l Fifty-eight students on the long
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
The AID Control Programme Manager, Ministry of Health, Dr.Zainab Akol officiating at a Work-based Diploma Graduation Ceremony; in the centre is Irene Kambonesa, the Director of Training and Education at Mildmay Uganda.
Support Directorates These Directorates support the two core programme Directorates of Mildmay Uganda. They are the Directorate of Quality Assurance (M&E, IT and Data and Research) and the Directorate of Resources (Finance, Human Resource,
and Support Services). Their main objective is to enhance and maintain efficient systems that support Mildmay Uganda's core programme areas to deliver quality HIV services.
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Mildmay Uganda - Annual Report April 2009 - March 2010
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Table 3: Key Achievements by the Support Directorates during the year
Objective 3: To enhance and maintain efficient systems that support Mildmay Uganda's core programme areas to deliver quality HIV services Activities
Targeted Group
Annual Targets
Annual Achievments 1,026 522
271
4 1
53 10 9 4 1,394 11
41 23
2
28
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
The Directorate of Quality Assurance There are three divisions in the Directorate: Information Systems, Monitoring and Evaluation, and Research. The core functions include Monitoring and Evaluation of the various programmes, IT Systems Administration, Data Management, and Research. Information Systems Division The Division is responsible for the information technology infrastructure that links up to 200 personal computers and laptops which are served by a set of seven server computers.
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l l Implemented N-computing technology (use of dumb terminals) for data entry. l Local Area Network (LAN) extensions installed at the newly commissioned
Pinto village and Kiddukiro building. CAREWare launched for real time data entry by clinic staff. Databases for Satellite Clinics and Community Services redesigned. A backup server installed to replicate the file server. New software (Clark Connect) deployed for band width management. Internet upgraded one additional satellite dish & improved bandwidth to support increased data uploads and research. Public folders configured on the MS Exchange Server to enhance filesharing within Mildmay. Skills development for four staff members in network management & database administration was done.
The Data Team responsible for entry and storage of Mildmay data
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Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
Monitoring & Evaluation Division The role of the Monitoring and Evaluation (M&E) division is to track the progress of programme implementation in terms of meeting set targets; ensuring the collection and analysis of data as per set indicators; writing reports and disseminating findings; following up quality improvement issues and coordinating programme evaluations. The division is also involved in needs assessments, strategic planning and programme design and evaluation. l Reviewed data collection tools, Mildmay Uganda report formats and compiled all required reports as per the revised PEPFAR II indicators and new MOH tools. l Designed a strategy to monitor progress of data entry at all points of data generation at Mildmay Uganda and Satellite Community Clinics. l Developed SOP for generic data analysis and data cleaning for the pharmacy, satellite clinics, community programme and PEPFAR databases and a SAS code for adherence monitoring. l Prepared M&E log frames/matrixes for Requests for Funding Applications ( R FA ) t h a t M i l d m a y U g a n d a participated in. l The division hosted 10 student interns from the Makerere University Institute of Statistics and Applied Economics (ISAE) as part of capacity building. This was part of the ongoing placement programme at Mildmay Uganda. The students were trained in
Mildmay Uganda - Transforming HIV care
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design of data collection tools, data collection and analysis, reporting and basic research. Carried out support supervision visits to all Mildmay Uganda supported sites including Reach Out Mbuya Initiative to provide technical support in M&E related issues. Organised training in conjunction with the MoH on the use of the new HIV/ART data collection tools for the Satellite Clinics staff as well as MU staff. Also coordinated the M&E training course run by MU in May 2009. Participated in the quality improvement activities across all areas of operation. Enrolled two M&E officers on the MUSPH CDC fellowship training in Continuous Quality Improvement (CQI). Consequently, MU received funds from MUSPH for the implementation of a quality improvement project (ongoing) focusing on 'Improving HIV care/ART data collection at Mildmay Uganda'.
The Research Division The Research Division (RD) spearheads all research related activates and conducts surveys and evaluations to inform the design of interventions for service delivery as well as continuous quality improvement in all of Mildmay Uganda's activities. l Coordinated and managed the following major studies: o Effect of depression & its treatment on the impact of ART on health
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MILDMAY Transforming HIV Care
outcomes funded by the RAND Corporation Corporation o Psychosocial needs of children living with HIV/AIDS o The Targeted Evaluation to Reduce Risk and Improve Adherence (TEDAS) o Mildmay paediatric HIV Palliative Care programme evaluation (Diana Fund) o Assessment of legal needs for patients and palliative care providers in collaboration with the African Palliative Care Association (APCA) o Prescribing and dispensing practices for medicines in selected MOH accredited ART sites in Uganda in collaboration with Medical Access o Adverse effects of second-line highly active antiretroviral therapy (HAART) among HIV infected adults and children treated at Mildmay Uganda o Factors Affecting Enrolment and Retention into Paediatric HIV Care Services In Wakiso District in collaboration with the Uganda AIDS Commission o Equipping parents/caregivers and service providers to address the psychological and social challenges of caring for HIVpositive children l Reviewed, coordinated and submitted several abstracts to scientific conferences (See list of abstracts and conference in Appendix 2). o Eight abstracts were accepted for
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The Vienna International AIDS Conference Four were presented at The Uganda Society for Health Scientists Conference One was accepted for the German Lung Cancer Conference One for the APCA Conference in Namibia One for the Makerere University Conference on Human Capital Development in the 2010s Decade.
l Participated in writing research proposals; o An assessment of the clinical characteristics and outcomes of c a r e a m o n g H I V- p o s i t i v e individuals attending The Mildmay Centre in Uganda o Improving mental health services in low income countries submitted to DFID o Evaluation of dried blood spots (DBS) for HIV-1 resistance testing in antiretroviral treated (ART) patients o Performance evaluation of the Clondiag HIV NAT test in venous whole blood l Conducted evaluations and a needs assessment; o A needs assessment for Mildmay HIV/AIDS palliative care satellite clinic in Wakiso Health Centre o Two clients satisfaction surveys at Mildmay and at Ntara satellite clinics O The final evaluation of the
Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
Zimbabwe/Mildmay Nuffield VT/ A RPTa P ae H I V /H AIR ed i adti raitcr i cTTr r aai innii n g programme l Participated in building capacity for conducting research through training Mildmay staff and students on placement in research, proposal development, research ethics, data analysis, monitoring, evaluation and reporting. l Participated in the Mildmay training programme by teaching on operations research methods, HIV and AIDS research updates in the era of ART and participatory planning, monitoring and evaluation. l Reviewed Mildmay Staff research protocols and provided other forms of support to advance and implement their protocols. l Coordinated submissions of protocols for review and or approval by the relevant stakeholders prior to
conducting research. l Submitted applications for the accreditation of Mildmay Uganda Research Ethics Committee to Uganda National Council for Science and Technology.
The Directorate of Resources Human Resources Division The Human Resources (HR) Division is responsible for providing HR support to all departments including personnel management support, volunteer services and placements administration. l Throughout the year, staff establishment gender ratio stagnated at 1:1.7 (Male to Female) and employee turnover was 8%. l A total of 23,650 volunteer-man-hours were realised and 3,080 work days put into direct administration of the 749
Mildmay Tanzania Transport officer and Operations manager (the two on the left) receive a vehicle from Mildmay Uganda
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
Mildmay Uganda staff donate blood to the Nakasero Blood Bank
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persons on placement. The Division conducted seven staff awareness meetings; six general staff meetings and organised 13 varied short courses and other employee related activities. The team created awareness among staff on the new organisation structure as well as HR manual/policies after restructuring. A new staff Performance Appraisal system was launched. The number of locum staff was reduced from over 75 to less that 10 as a cost cutting measure. As part of corporate social responsibility, the HR division mobilises staff for a blood donation exercise every quarter. On average, 35 staff turn up for the exercise every quarter. Two blood donation exercises were done and 48 units of blood collected.
The Support Services Division (SSD) This division ensures that all the requirements for the smooth implementation of the organisation's core programmes are met. This is through the provision of transport, hospitality, security, maintenance and storage services. l The division acquired and fitted the power stabiliser for equipment protection against destructive power surges. l A site energy audit was conducted to cut down the utility costs and its implementation has partly been achieved. l The sanitation system was improved by converting the pit latrines into waterborne toilets. l A power backup was provided in
Mildmay Uganda - Annual Report April 2009 - March 2010
A newly opened block at Ntara HC IV, Kamwenge District constructed by Mildmay Uganda with financial support from The Samaritan's Purse
Elizabeth Ward to help ensure l continuous power continuous powersupply supplytotothe thein-inpatient ward. l Successfully supervised the l construction of the Ntara HIV/AIDS Clinic building and handed it to Kamwenge District Administration. l
The Finance Division Finance and accounting department exists to support Mildmay Uganda with providing funds to enable activities as planned and to report on those activities to the decision makers and stakeholders. l The first joint financial accounts of Mildmay Uganda were sent out to UK following the merging of the MPCC and TMC accounts since April 09 l Three of the Division staff enrolled for the professional accountancy exams from the Association for Certified Chartered Accountants l Trained three work-based placements in the purchase ledger procedures initiated the documentation of a risk management policy and budget performance reviews between the heads of departments and budget holders for improved budgetary control
Mildmay Uganda - Transforming HIV care
Budget preparation for the year 2010 11 was initiated with the senior management team A Procurement Committee was set up to further strengthen the procurement system and Participated in the budget preparation for the RFAs submitted by Mildmay Uganda.
Country Director's Office Advocacy and Public Relations Division This department has three main objectives: to enhance the effectiveness of Mildmay programmes and networks through advocacy and raise the profile of Mildmay in Uganda regionally and internationally; resource mobilisation through enhanced knowledge of the donor environment, trends and influences and promote and maintain the mutual relationship between Mildmay Uganda and its stakeholders including clients. l The Division developed strategies for
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MILDMAY Transforming HIV Care
Advocacy and Resource mobilisation; Client engagement; Rights-based Client engagement; Rights-based approach to HIV programming and Programme sustainability. These strategies will be used as guiding documents during the design and implementation of programme activities. l A team from Crown Agents, a UK based organisation and Mildmay Uganda staff planted 15 trees at the Mildmay Uganda main site to mark the United Nations Environmental Day. l Facilitated the publication and dissemination of the Mildmay Uganda brochure, quarterly internal bulletin; Mildmay Uganda calendars (2010),
clients' calendars (2010), client information leaflets and Mildmay Uganda best practises in The New Vision newspaper and the AIDS Today Magazine. l Negotiated and placed the Mildmay Uganda advert in the Health Care Directory of 2010, Uganda AIDS Commission and Ministry of Health 2010 year planners. l Mildmay Uganda staff collected some items to support the landslide victims in Bududa.
The Director of Nursing at Mildmay Uganda, Margaret Awori hands over donations of non-food items for Bududa landslide victims to the Red Cross Coordinator, Kampala South, Richard Walimbwa
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Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
The Mildmay Uganda Open Day The Advocacy and Public Relations Division coordinated the activities of Mildmay Uganda Open Day that included a memorial service for all Mildmay Uganda clients that died in the course of the year. The function was attended by the relatives of the deceased clients; representatives from government Ministries, Diplomats, Sister Organisations, Faith-based Organisations, the Late Honourable Manuel Pinto's family, the Katikiro of Buganda and Mildmay Clients and other stakeholders. The Guest of Honour was the Minister of State for Primary Education, Honourable Kamanda Batarigaya.
Retired Archbishop Mpalanyi Nkoyoyo lighting the first candle during the Annual \Memorial Service for Mildmay Uganda clients that died during the year
On the Open Day ceremony one of the office blocks ' Pinto Village' was officially named after the Late Emmanuel Pinto one of the key pioneers of Mildmay in Uganda at a function which was attended by his family and friends
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
The widow of the late Hon Pinto and Dr Dumba cut the ribbon to open Pinto Village at Mildmay Uganda. Looking on is the retired Archbishop Mpalanyi Nkoyoyo (r) and the Katikiro of Buganda (L)
Mildmay Uganda staff pose for a photograph with the Queens Baton relay as it traversed Common wealth nations including Uganda. Mildmay Uganda had an opportunity to experience unique and memorable moments on 31 December 2009 during a guided relay around the main facility.
Mildmay Uganda staff pose for a photo with the queen's baton relay as it traversed common wealth nations.
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Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
Major issues/challenges 1.
Funding gaps leading to changes in staffing levels especially affecting data management, reporting, reduction in staff fringe benefits, reduction in patient care packages, halts in routine enrolment onto ART and limits on the new enrolments into care.
2.
Lack of a full time physician in the clinic
3.
Endoscopy unit did not start because the surgeon whom we had identified was unable to come due to changes in her work schedule
4.
Increasing number of patients with socio-economic concerns needing support in form of IGA start-up capital; school fees/scholastic materials and emergency food.
5.
Limited Laboratory space increasing vulnerability to occupational hazards & leading to delay of the laboratory accreditation process.
6.
Ensuring paediatric adherence to ART.
7.
Implementation of the CSF (OVC) project challenged by: a wide geographical and activity scope yet with limited funds and a short period of time; delayed release of funds and staff turnover among the partner service providers including those recently trained to provide psychosocial support to children.
8.
Shortage of personnel at the satellite sites despite the new strategy whereby Mildmay Uganda will mainly play a technical support role.
Planned activities for FY 2010/11 1.
Continue with prevention, care, treatment and training activities
2.
Compile the CDC funding agreement close-out report
3.
Accomplish and implement the programme strategy for the new CDC corporate funding agreement.
4.
Scale up the private clinic for clients who can afford to pay for their care.
5.
Commence Primary prevention of cancer of the cervix with support from Gardasil Acess programme.
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
Financial Information for Mildmay Uganda 2010 Mildmay Uganda's 5 year cooperative agreement with CDC was extended to 30 September 2010. CDC grant in the year 2009-10 accounted for 83% of income. The surplus of income over expenditure
in the year ended 31 March 2010 of UGX2.9bn was required to cover in part the period April to September 2010.The year the level of grant received in the year was planned to cover the extended CDC grant period to 30 September 2010. Income and Expenditure UGX x 1,000,000 Mar 31, 10 Mar 31, 10 Income
Balance sheet UGX x 1,000,000 Mar 31, 10 Mar 31, 10
Client Income
352
236
1,674
124
Grants CDC
26,443
21,982
Grants MOH
-
192
-
2,181
Donations
ASSETS Non Current Assets
6,143 7,845
3,787
Grants Global fund
13,989
9,774
Grants Other
681
743
Other Income
146
320
Training Income
996
629
30,291
26,407
Employee Expenses
6,748
9,056
Overhead costs
4,514
2,349
Drugs & Lab Supplies
7,507
6,716
827
835
Other Direct Costs
1,772
2,361
Reach Out Mbuya
5,994
5,793
Total Expenditure
27,363
27,110
2,928
(703)
Current Assets TOTAL ASSETS
5,987
LIABILITIES Funds & Liabilities
10,860
7,992
Current Liabilities
3,129
1,782
13,989
9,774
TOTAL
Total Income Expenditure
Direct Training Costs
Surplus/(Deficit)
Percent Expenditure by Client Category Other Income Training Income Income 0.5%
3.3%
1.2%
Percent Expenditure by Category Reach Out Mbuya 21.9%
Donations 5.5%
Grants Other 2.2%
Employee Expenses 24.7%
Other Direct Costs 6.5%
Direct Training Costs 3.0% Grants CDC 87.3%
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Overhead costs 16.5% Drugs & Lab Supplies 27.4%
Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
ACKNOWLEDGEMENTS Mildmay Uganda acknowledges the various stakeholders who play diverse roles MILDMAY UGANDA FUNDERS COMPANIES l Uganda Ministry of Health l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
The Centers for Disease Control a n d Prevention (CDC) & PEPFAR African Palliative Care Association Africom Net Baylor College of Medicine Cardno Emerging Markets USA Century Bottling Co. Ltd Commonwealth Foundation Civil Society Fund Clinton Foundation Diana, Princess of Wales Memorial Fund Mildmay UK PACE International Fund RAND Corporation Fund- Depression Study Makerere University School of Public Health, Fellowship Programme IAVI (International Aids Vaccine Initiative) Oslo School - Norway Samaritan's Purse UK Keymed (ACCT) PACANET HIPS Hospice Palliative Care Association Hospice Uganda Infectious Diseases Institute Inter Religious Council of Uganda International Childrens' Palliative Care Network Social Responsibility Fund of Mildmay Uganda staff Intrahealth HIV Clinical ServicesRwanda Irish Embassy The University of Manchester
Mildmay Uganda - Transforming HIV care
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UAP Insurance Uganda Dental Mission Uganda Martyrs University-Nkozi World Health Organisation World Vision Uganda
INDIVIDUAL DONORS l Mr. And Mrs Atkins l Christopher and Jodi Blackham l Cohen Gary l Education Fund- UK and Uganda l Armstrong Sue l Berry Clare l Carney Laura l Caudle Claire l Cooper Mary l Danter Claire l Davidson Ian l Margaret Doy l Elspeth J & Farthing Trust l Gooch Kim l Good Josh l Griffiths E&D (Trust) l Mr. And Mrs John Humphrey l Mr. Herber Martin l Jones Emma l Luckey & Pearsons l Sue and Kevin O'Connor - UK l Panahpur Trust l Paul Bateman - UK l Simpson Helen - UK l Roger and Jean Tripp l VETABAILEY l Tim Elliots l John Hopkins
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MILDMAY Transforming HIV Care
Partners in the implementation of Mildmay Uganda programme l Ministry of Health l Uganda AIDS Commission l Programme for Accessible Health Communication and Education (PACE) l Regional AIDS Training Network (RATN) l The University of Manchester l Mbarara University of Science and Technology (MUST) l The Local Governments in the districts where Mildmay Uganda runs HIV/AIDS care clinics, and training activities. Mityana, Kamwenge, Wakiso, Mpigi, Mukono & Luwero Districts l The Infectious Diseases Institute (IDI), Mulago l Baylor College of Medicine l AIDS Information Centre l Joint Clinical Research Centre l The Uganda Cancer Institute l The National TB and Leprosy Programme Programme beneficiaries l The beneficiaries (PLHIV and their families) l The beneficiaries of the training programmes including care givers, health care workers and other professionals Appendix 1: List of presentation made and abstracts accepted at conferences Mildmay Uganda abstracts presented/accepted for presentation in 2010 Vienna International AIDS conference 1. Mbeetah Sarah Kazibwe, Dr. Yvonne Karamagi, Alice Bakunda, Rhoda Suubi; 'The Need for Sexual and Reproductive Health (SRHh) Services Provision to HIV Positive Adolescents In Uganda'. 2. Esther Kawuma, Irene Kambonesa, Dr. Ekiria Kikule, Joyce Achan, Dr. Emmanuel Luyirika Boniface Okello; 'Outcome evaluation of Mildmay Training on Human resource capacity Development for Palliative Care in Uganda'. 3. Dr. Barbara Namata-Mukasa, Dr. Josephine Nabukeera, Dr. Agnes Bukirwa, Jolly Nakintu, M. Rugyendo , Esther Kawuma; 'Reducing cost of care, stigma and increasing access to HIV/AIDS care in resource poor settings using a community approach: Mildmay Uganda Experience'. 4. Joan Nangiya, William Musoke, Margaret Sekyondwa, Margret Awori, Richard Batamwita, Ekiria Kikule, Emmanuel Luyirika, Esther Kawuma; 'Cervical cancer screening (CCS) at an HIV/AIDS care centre; The Mildmay Uganda Experience'. 5. Boniface Okello, J. Achan, J. Muhangi, P. Busingye, E. Kikule, E. Luyirika 'Using medical records data to assess patient retention on ART - Mildmay Uganda'. 6. W. Katubakire, E. Luyirika, E. Kikule, J. Tripp, J. Muhangi, E. Kawuma, E. Nantongo, H. Namusoke; 'HIV/AIDS Care for Healthcare-givers: Mildmay Uganda Experience'.
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Mildmay Uganda - Annual Report April 2009 - March 2010
MILDMAY Transforming HIV Care
7. Mary Odiit, Dr. Ekiria Kikule, Dr. Emmanuel Luyirika Esther Kawuma; 'Mildmay Uganda's Experience in Rolling outout an an Electronic Medical Records System'. Uganda's Experience in Rolling Electronic Medical Records System'. 8. Sarah Nalule Lwanga, Irene Kambonesa, Stella Ongorok, Esther Kawuma; 'Child counselling skills, a training need for health professionals in Uganda'. German Lung Conference Accepted 1. Richard Batamwita, Henry Nsobya, Ali Tibaku, Esther Kawuma, Sarah Kazibwe, Muhangi Justus, Dr. Ekiria Kikule, Dr. Emmanuel Luyirika; 'Using Voluntary Counselling and testing data to estimate the prevalence of Tuberculosis among first time clients at Mildmay Clinic'. Uganda Society for health scientist Conference- June 2010 1. Esther Kawuma, Dr. Ekiria Kikule, Emmanuel Luyirika ( Mildmay Uganda), Joseph Bitature, Kezia Mukasa, Monja Minsi ( Uganda Reach the Aged association), 'Situation Analysis of Home Based Care Services for Older Persons: A Policy and Legal Provisions Assessment'. 2. Richard Batamwita, Esther Kawuma, Wilber Katubakire, Oliver Zawedde, Ekiria Kikule, Joyce Achan, Emmanuel Luyirika; 'Task shifting approaches during current financial crisis; Implications to HIV/AIDS institutions in Uganda'. 3. Joyce Achan, Esther Kawuma, Dr. Ekiria Kikule, Dr. Emmanuel Luyirika; 'Patient satisfaction Measurement as a way of quality improvement of health care at Mildmay Uganda'. 4. Joyce Achan, Boniface Okello, Lilliane Nabiddo, Dr. Emmanuel Luyirika, Dr. Ekiria Kikule; 'Improving the Patient Management system at Mityana Hospital HIV clinic' APCA NAMIBIA Conference accepted for September 1. Richard Batamwita, Busiinge Phiona, Esther Kawuma, Sarah Kazibwe, Mary Odiit, Margaret Kasirye and Ekiria Kikule; Palliative care in Sub Saharan Africa in the 21st Century: How practical is the family-centred approach? Lessons from Mildmay Uganda 2. David Kavuma, Dr. Jane Nakawesi, Esther Kawuma, Dr. Ekiria Kikule, Dr. Emmanuel Luyirika, Irene Kambonesa, Dr. Barbara Mukasa and Richard Batamwita; Carers' and children's perceptions and attitudes towards pre bereavement support in palliative care: Implications for Health workers
Mildmay Uganda - Transforming HIV care
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MILDMAY Transforming HIV Care
To partner with us, contact;
MILDMAY Transforming HIV Care P.O. Box 24985, Kampala Tel: +256 312 210200 Fax: +256 312 210205 Email: mailbox@mildmay.or.ug Website: www.mildmay.org
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Mildmay Uganda - Annual Report April 2009 - March 2010