VOL. 1 ISSUE 1 2019

UGANDA DEVELOPMENT AND HEALTH ASSOCIATES

N E W SL E T T E R

ABOUT UDHA

Uganda Development and Health Associates (UDHA) is a non-governmental organization founded in 2003 engaging communities to sustain the outcomes of its interventions, expanding its operations, and providing outreach services to the under-served communities in Eastern Uganda. It was established as a multi-disciplinary organization in recognition of the fact that community problems are multi-sectoral, hence the need for integrated approaches with strong community participation in the belief that local problems require local solutions. UDHA works to improve access and increase demand for services aimed at enhancing and expanding health care as well as empower youth, women, and in particular, young mothers and children using sustainable mechanisms. UDHA is a regional role model health promotion organization dedicated to serving the poor and vulnerable in Uganda and beyond. We utilize the strong foundation and experience established to bring our full expertise, set higher standards, and facilitate communities to meet their needs.

CONTENTS

Message from the Editor and Director- 02

Mama Project- 03

COMONETH and SRHR and CHAU- 04

HIV/TB Projects- 05

YRC and Menstrual Dignity Project- 06

Nutrition Project and Naigobya HC-07

Voucher Program and Vitamin Angels- 08

WHO study, EWB, and Naigobya Dental- 09

RHITES- E and RHITES-EC – 10

Intern Program and Location- 11

MISSION

To engage a multi-sectoral and professional approach with strong community participation and ownership for the enhancement of health, rights, and development

VISION

A society that is fully empowered to take care of their health and development needs

VALUES AND PRINCIPLES

Integrity, Quality, Efficiency, Ethical, Equity, Gender Responsiveness, Empowerment of Communities, Transparency in Collaboration and Engagement with Stakeholders, Professionalism and Multi-sectoral approaches

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MESSAGE FROM THE EDITOR

Dear Reader,

I am happy to bring you UDHA’s newsletter recapping the various projects that the organization implements. I am a graduate student pursuing my Master of Public Health degree at Washington University in St. Louis specializing in Global Health. I chose UDHA as my practicum site because I connected with its vision of empowering communities to take ownership for their own health, health education, and rights. I believe this practicum experience will introduce me to and aid me in my understanding of healthcare and healthcare policy obstacles faced in rural and underserved communities. I hope to learn as much as I can as I interact with new people, ideas, and cultures. I know I will continue to grow and learn from the people I work with and projects I work on. I am grateful for this opportunity to learn and look forward to seeing the impact UDHA will continue to make in the future.

-Nicole Romero

MESSAGE FROM THE DIRECTOR

The past year has been exciting at UDHA!!

The 2018 period focused on working to strengthen the building blocks of a vital health system to deliver integrated quality health services, foster strategic social behavior change communication, and target demand generation to maximize service delivery coverage. This was largely done through increasing availability and accessibility to health services, improving quality of health services, and increasing adoption of healthy behaviors. Unlike the years before, the

2018 period had a shift in the program delivery strategy, away from the conventional training methodologies to initiatives that positively influence results and deliver value at the program beneficiary level. It was an exciting experience to see how this shift provided a momentum for results.

As you read, you will discover how specific actions like increasing the role of government, ministries, development partners and beneficiaries in planning for adolescent girls and young women, key and priority underserved populations in Eastern and central Uganda made a difference. The Board and project team appreciate the Government of Uganda for its continued support at the district and sub county levels.

For God and my Country, Moses Kyangwa

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MAMA PROJECT

The Mama and Family project is an initiative that uses simple low-cost interventions for mothers and babies during pregnancy and in the first

1,000 days of a child’s life to improve access to essential and lifesaving health care within and around Mpungwe subcounty in Mayuge district. It is funded by the Swedish Organization for Global Health, working in close partnership with the Uganda Development and Health Associates, Ministry of Health, and the community to bring about behavior change in order to improve the health of mothers and their children. UDHA empowers Community Health Workers (CHWs) and Village Health Teams (VHTs) to assist families in making informed healthcare decisions and adopting beneficial home healthcare practices. UDHA’s services address the needs and deficiencies identified by the communities themselves. The CHWs carry out voluntary home visits and follow up on expectant mothers in the community, carry out community dialogues to improve child health and nutrition, sensitize mothers to go for antenatal care (ANC) visits at Maina Health Center II, and distribute and demonstrate how to use the mama kits.

LESSONS LEARNED/THEMES

Maternal health issues are viewed as women’s matters so there is a lack of involvement by men

Cultural guidance in childbirth participation is needed because culture as well as male’s employment status are factors that affect male partners’ involvement in maternal health care services

LOOKING AHEAD

Overall conclusion is that health workers with whom we engaged have adopted a perfect strategy that “Unless you come with your partner you will be sent back home”

Distribution of birth kits (mama kits) to expectant mothers at Maina H/C who have completed four antenatal visits

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COMMUNITY IN WHICH MOTHERS AND NEWBORNS THRIVE (COMONETH)

In collaboration with Makerere University, the COMONETH project targets the mother, her unborn baby (to prevent stillbirths), and the newly born baby (to reduce neonatal deaths) in Luuka district. It aims to design and implement a community owned but facility-linked district-wide intervention that promotes high coverage with preventive care and improves the quality of clinical care so as to impact maternal, perinatal and neonatal mortality. Activities include meeting with District stakeholders, VHT listing and training (total of 256), registration of household members (household listing), sample selection, training of research assistants, and a qualitative baseline survey conducted through interviews.

SEXUAL REPRODUCTIVE HEALTH RIGHTS (SRHR) UMBRELLA AND COMMUNITY HEALTH ALLIANCE UGANDA (CHAU)

SRHR Umbrella and CHAU responds to SRHR and HIV needs of vulnerable populations in Iganga, Jinja, and Kamuli District. Target populations include young people living with HIV, orphans, street children, children with disabilities, slum dwellers, sex workers, truckers, fisher folk, and men who have sex with men. This project provides an integrated SRHR/HIV service package aimed at reducing new HIV infections and improving SRHR indicators. Services provided to clients include SRHR education, modern family planning, condom education and distribution, sexually transmitted infections (STI) screening, cervical cancer screening, post abortion care and post gender-based violence care. HIV related services include HIV education, HIV testing services, Anti-Retroviral Treatment (ART), and safe male circumcision services.

RESULTS ACHIEVED

8,924 people from the target population reached with integrated SRHR/HIV services in SRHRU program districts through outreaches

13 people tested, confirmed HIV positive, linked to care, and initiated on ART

13,158 young people reached with individual/ small group level HIV prevention intervention

5,562 condoms distributed to end users

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HIV/TB PROJECTS

UDHA with funding from Global fund through TASO Uganda is implementing a project on HIV/TB with the objective of reducing new HIV infections among Adolescent Girls and Young Women (AGYW) by 2020. The interventions address factors associated with vulnerability of the AGYW to HIV infection such as early age of sexual debut, teenage pregnancy, child marriage, and sex for gain (sex work), as well as aim to improve life skills (resilience) and livelihood skills among the young people.

ACTIVITIES

Identify and profile potential beneficiary AGYW in groups of 12-15 persons per subcounty

Provide vocational skilling, enterprise development assistance, and second chance education for girls

Raise awareness among parents, religious, cultural leaders, and other community gate keepers about the long-term benefits of educating girls and other AGYW interventions Implement “Protect the Goal Campaign” by organizing netball tournaments with links to SRH/HIV service delivery

Organize SRH/HIV knowledge through music, dance, drama (MDD), essay, and debate contests

Roll out thematic campaign episodes on radio talk show

LESSONS LEARNED

Working with the District leadership and the community stakeholders has helped to simplify mobilization, planning, and community buy-in, hence igniting project ownership and ensuring sustainability

Forming groups has great influence in building the AGYW self-esteem and their decision-making capacity. AGYW are more willing to study from their local environment than going for institutionalized type of training

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YOUTH RESOURCE CENTER (YRC)

The Youth Resource Center works to provide adolescents and teachers with the sexual and reproductive health knowledge necessary to empower individuals to make informed choices and advocate for their health and safety. Information is shared in the form of sensitizations, where groups of male and female students learn together about adolescence, consent, substance abuse, HIV/AIDS, life skills, sexual violence, menstruation, and STIs through engaging presentations led by the Youth Resource Center Coordinator. Sixteen students are chosen annually by their peers to be Peer Health Educators for their school, 22 teachers are also selected to be Patrons to support the Peer Health Educators at their schools and provide information to primary school students.

Additionally, many other community members are trained as Peer Health Educators. The trainings are intensive, and they take place during the first two weeks of July. Each student and patron is equipped with a comprehensive manual, where all information they may need to support their peers is presented in a succinct, organized way. So far, in 4 schools, the Youth Resource Center has supported over 80 sensitizations reaching almost 1200 students with data from the remaining 12 schools still coming in.

MENSTRUAL DIGNITY PROJECT

The YRC also runs the Menstrual Dignity Project in order to reduce fear, shame, and stigma surrounding menstruation. Barriers to maintaining menstrual hygiene practices include feelings of embarrassment, lack of money, poor accessibility of materials, latrine set-up, and rural vs. urban settings. This year, 450 reusable pads were donated by Links Inc., a professional organization of women of color in St. Louis, USA and were distributed at Bulubandi Primary School, King of Kings Primary School, King of Kings Secondary School, and Igamba Primary School. 100% of students interviewed about the project stated that they reaped benefits from the receipt of sanitary pads, including reduced absence from school and reduced school dropout rate due to sanitation. In addition, 92% of students stated that their attitude about menstruation changed because of the project.

The project was extremely successful in its goals, and UDHA looks forward to further expanding the project as it seeks more funding in order to further empower more girls at these schools, as well as other schools in the area.

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NUTRITION PROJECT

The Nutrition Project, based out of Naigobya in Bukooma sub-county of Luuka District, uses a community health worker model to educate and empower families to adopt healthier nutritional practices in an effort to reduce maternal and child morbidity and mortality arising from malnutrition. CHWs conduct both community outreaches and individual household visits to monitor pregnancies and child development, perform cooking demonstrations, encourage home gardening, promote food hygiene, and facilitate dialogues surrounding community health. The project partners with local primary schools, supporting the development of model gardens and health clubs to ensure that children are educated about the importance of nutrition and proper sanitation and hygiene practices from a young age. The project also funds the only health clinic in the community, Naigobya Health Centre III, which provides access to antenatal and postnatal care as well as basic healthcare for all members in the community.

NAIGOBYA HEALTH CENTRE III

Naigobya Health Centre III is complete with a reception, immunization area, ward, lab, maternity room, drug store and consultation area, antenatal room and post natal care. One challenge is the size and appearance of the facility. After asking the mothers what they would like to see improved, it was clear that space is an issue.

It often becomes cramped in the waiting area, especially on ANC teaching days. Additionally, the facility does not have an ART Program and some medicine is not available so patients are referred elsewhere. In the future, UDHA is looking to improve and expand the facility so as to maximize its impact in the community.

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VOUCHER PROGRAM

The voucher project is a Marie Stopes program that emphasizes safe motherhood, maternal and child health promotion, adequate and quality staff, improved infrastructure, increased clinical supplies, proper and widespread family planning usage, and general improved quality services. UDHA currently runs the voucher project in Luuka District under the UDHA Naigobya HC III. In the voucher system, a pregnant mother can purchase a voucher card from a trained VHT at the cost of four thousand Ugandan shillings. In return, the voucher card will guarantee free medical care to the mother and her unborn baby in any voucher partner facility around Uganda from time of voucher card acquisition to up to 6 weeks after delivery. The voucher program has increased the number of mothers seeking care and the majority of the women coming to Naigobya HC III have a voucher.

VITAMIN ANGELS

UDHA is implementing the Vitamin Angels project, funded by the Bill and Melinda Gates Foundation, to combat intestinal worms with deworming treatment and vitamin A in hard to reach areas around the world. The objective is to reach children 6- 59 months in hard to reach areas in Mayuge, Iganga, Bugiri, Namayingo, and Luuka Districts with vitamin A supplements and Albendazole tablets for deworming twice a year.

RESULTS ACHIEVED

In the last calendar year:

a total of 2,247 doses of vitamin A capsule (100,000 IU) were given to infants aged 6-11 months.

a total of 21,649 doses of vitamin A capsule (200,000 IU) were given to children aged 12-59 months.

a total of 27,009 doses of Albendazole (400 mg) were given to children aged 12-59 months in Bulongo, Nawaningi, Waibuga, Bwondha Town Council, Iganga, Namayingo, Bukanga, and Luuka Town Council during static immunization, outreaches to the community, and door to door distribution by the community health workers.

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WHO IMMUNIZATION STUDY

This research aims to evaluate the role of leadership strategies in facilitating the transition of a successful vertical immunization program into an integrated and sustainable district program in Luuka district, Uganda. A mixed methods study design was used. Data collection included literature reviews, key informant interviews, focus group discussions, observations, and case studies.

Findings: District leadership was not engaged in planning, management and evaluation of immunization; Parallel district structures; Cultural/political leaders are influential (e.g., consumption of immunization services)

RECOMMENDATIONS

District Health teams (DHTs): participate in annual budgetary process

Planner: integrate immunization in all sector plans

Chief prince (cultural leader Busoga), the Busoga Parliamentary caucus, and the Speaker of Parliament to advocate for prioritization and additional funding for immunization services

ENGINEERS WITHOUT BORDERS (EWB)

UDHA is excited to partner and establish a relationship with Engineers Without Borders Student Chapter from Washington University in St. Louis. The EWB team, with support from UDHA, is working closely with Bulubandi community primary school to address health, hygiene, and sanitation challenges. While they were here in May, the EWB team met with community to assess their specific needs, took measurements and elevation levels of the school, and tested the water of nearby sources.

NAIGOBYA DENTAL PROGRAM

In February 2019, Dr. Mayra Rujano Rangel spent 3 weeks working with UDHA in 3 schools- St. Paul School, Naigobya Primary, and St. Jude School providing education on the mouth and oral hygiene. A total of 254 kids participated in the dental activities consisting of games and hands-on activities. Due to donations from Colgate, 144 toothbrushes and 170 toothpastes were given out.

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RHITES- E

Under the USAID RHITES-E project, Intrahealth provides financial, technical, and coordination support to Uganda Development and Health Associates to implement activities and interventions that will contribute to increased availability and utilization of high-quality health services in the 2 districts of Tororo and Kibuku. Community health structures will be used to increase the demand and continuous utilization of high-quality health services. Activities included mapping the health facilities and service providers to establish the specific services provided by each and conducting dialogue meetings in the communities on reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services, teenage pregnancy, TB, HIV associated stigma and discrimination, and condom use

RHITES- EC

University Research Co., LLC, a US-based public health organization, is implementing the USAID Regional Health Integration to Enhance Services in East Central Uganda activity (USAID RHITES- EC). The purpose of this project is to support the implementation of a comprehensive, integrated investment in regional health, HIV/AIDS, and nutrition assistance. UDHA is working with USAID/ RHITES-EC, districts, and partners to plan, implement, monitor, and evaluate community and facility-based interventions that address gaps in uptake of critical services and behaviors HIV; maternal, newborn, and child health (MNCH); TB; Malaria; water, sanitation, and hygiene (WASH); and Nutrition.

LESSONS LEARNED

Working with all partners (including district leadership) in collaboration is beneficial, as it reduces duplication and conflict

RESULTS ACHIEVED

Facilitated and supervised the 53 oriented community mobilizers to identity and address barriers and mobilize the most affected community members to practice the promoted health behaviors using guidance provided by USAID RHITES-EC, DHTs, health assistants, and health facilities

UDHA worked with USAID RHITES- EC and DHTs to identify and orient

8 peer facilitators on the Stepping Stones curriculum at Buyinja Health Centre 4 in Namayingo district

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INTERN PROGRAM

UDHA supports capacity building through internship in the course of mentorship and coaching. We welcome international and local students for a life changing experience in a community-oriented service organization. Currently, we have interns from GlobeMed at Washington University in St. Louis, practicum students from the Brown School at Washington University in St. Louis, interns from the Swedish Organization for Global Health, and local Ugandan interns from various universities.

LOCATION

Uganda Development and Health Associates is located in Iganga District, Iganga Municipal Council, Northern Division, Nkono village, Bulamu Road.

ADDRESS

Plot 7-11 Bulamu Road, Iganga Municipality, P.O. Box 77 Iganga, Uganda

WEBSITE

www.udha-uganda.org

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