Running a charitable health clinic in Uganda

The experiences and the ongoing challenges and enjoyment of managing a philanthropic health facility. Watching it grow through active community support and helping through coordination with national programmes, local NGO and groups and international like-minded people.

Saturday, June 04, 2011

#AIDS2011 Thirty years of HIV in Uganda

Hope Clinic Lukuli and more importantly the members of the community we serve have spent an enjoyable day with a reporter from Reuters looking at Uganda's experiences over the past 30 years. The United Nations General Assembly are holding a High Level Meeting in New York in the coming week. Reuters want to hear from the communities about how the reality of HIV has changed.

Policy - Partnerships - People
The success story for Uganda, and also for other countries but at a different pace, has been to develop the policy framework, form the partnerships, and most recently to think about the HIV and AIDS-related needs of the people. The policy framework and specifically the Government of Uganda's acknowledgement of the risk to the population of HIV led to openness, national awareness campaigns and the 'Zero grazing' guidance. That willingness in the late 80s and early 90s of the government to inform its populous was a key start. Consider the countries which only began to publicly speak about a need for action in the past decade - look at the prevalence rates in their populations.

Partnerships and the need to bring together education, health and research within the country and development partners was another key step for Uganda. In the past 10-15 years, the coordination has been improving - family planning sites now offer PMTCT services; most government hospitals provide HIV testing as a routine part of admissions; the Global Fund granted Uganda HIV funding since 2003; US PEPFAR identified Uganda as one of the 15 focus countries with funding since 2004. Meanwhile, the Government and civil society in Uganda was getting on with the awareness work, the information on prevention and accessing services, the actual delivery of care and support and the constant challenge to bring together stocks of ARV and the households that need them. In the majority of instances, a household that does not have the financial capacity to buy ART.

Which brings the conversation to the People. Policy - Partnership - People is about planning the HIV services for the person, whether negative or positive, whether alone or in an affected household. The design of HIV services that is working is where it is client focussed. Removing the Stigma of only finding the services at a site with 'HIV' painted on the walls and logo; reducing the Time away from their smallholder farm or market stall or employment, and bringing the services to the place they already visit for fevers and maternity care; addressing the Inertia through community level information and committed people who will engage and motivate people with accurate information and can share the promise of services for those affected by HIV; reducing the Cost of travel to the HIV service site, the cost of the test, the cost of the mosquito net or water filter to reduce opportunistic infections; lastly address lack of Knowledge, or the wrong information being held. Shaking hands is safe, cleansing rituals and showers don't work as PEP, babies can be born HIV free if the mother is tested and she and baby are treated.

This STICK, acts like the children's game in Africa. The wheel they roll along is the comprehensive HIV services working. The STICK can be good, to keep the services going, or bad and put it into the wheel and it stops - services fail.

Partnerships have led to projects - start it up, staff it anew, buy the equipment, wait for the clients, close the budget, close the service, file the donor report. These are the stigma-rich sites where people don't want to get off the bus, they are not community based, but cluster around already busy government sites, they are narrowly doing testing, another does ART, another does PMTCT. The client is expected to travel from place to place, away from home and their place of employment.

Hope Clinic Lukuli uses the good STICK.
Support to the community and the staff to appreciate why the services are necessary and how they fit into the general health care the clinic provides. Hosting HIV services reduces the stigma, the clinic's people/ patients visit for fevers, reproductive health or child immunisation. Each group provides HCL staff with the chance to calmly talk about HIV and knowing one's status.

Training not just in the specific service of that medic or that grant support but a wider understanding of how the client's feel and the pressures of time and culture that could affect their decisions to visit the clinic. We have clients, like Gaudencia, who know their status, have not had to brand themselves in public with it, and yet are asked for advice and refer and encourage people to the clinic. The training is ongoing, with supportive supervision discussions, encouragement and the reward of a grateful community.

Infrastructure is a great motivator of staff and unpaid volunteers. It means they have the tools of their work and the confidence that when they refer a person to become a patient, the counsellors, the laboratory staff and the drugs will be there. Through being a Government of Uganda accredited ART site, the drugs are funded by local tax collections or the Global Fund or purchased by the Clinton HIV/AIDS Initiative with CHAI being funded by UNITAID. The 'sustainability' that projects crave, is achieved as Hope Clinic Lukuli is now 11 years old, when US funds stopped supporting new HIV positive clients, the Ministry of Health supported Hope Clinic, with these partnerships, to continue to serve. Today over 650 HIV positive clients are supported at Hope Clinic: half of those who receive ART are on MoH/GoU drugs from the non-US partners to Uganda.

Community is essential to ensuring that the design and delivery of HIV services and AIDS-related services is efficient. Clients can access the services near them, priced at a level that removes financial barriers to access. The community relies on the catalyst of friends and information channels that will influence usage, reduce stigma, and steadily bring those who still refuse but are visibly ill into the comprehensive care. Hope Clinic Lukuli thanks Gaudencia, Margaret and Stanley for this work as volunteers.

Knowledge that is accessible, relevant to that community and in the format that promotes its understanding and action is the key. The Policy is macro level, the Partnerships are a bridge through country coordinating mechanisms and partnership framework agreements to match need to funds. The People are the keepers of the knowledge of how they want the services delivered.

The thirty years of AIDS has seen great development of policy, with it being more clearly informed by affected populations. The partnerships have years of experiences to draw from. The current challenge is to get the funds to the last organisations that serve the people. Hope Clinic Lukuli uses Support, Training, Infrastructure, Community Catalysts and Knowledge to design and deliver the comprehensive HIV and AIDS services that Makindye needs. We do it for and with government, our clients benefit from UNITAID, Global Fund, CHAI, national taxes and US PEPFAR resources.

As the world marks #AIDS30 and the UN GA HLM #AIDS2011 meets in June, the civil society organisations that get on with the work should be considered. Advocacy has shaped the Policy, The Global Fund, PEPFAR and innovative financing like UNITAID are funding the Partnerships. The People are the clients to be, the patients on the register, the community they live in and the community-based health providers that they already rely upon for fever management, maternal health and childhood healthcare. We are here, on the ground, with the clients. Where are you?

Wednesday, February 09, 2011

Our strategy for the clinic 2009-2013 with updates

Our strategy for 2009-2013 to continue to serve the needs of our community

To ensure the affordable medical treatment from good and friendly staff for which Hope Clinic Lukuli is recognised and relied upon in the community can continue, our strategy includes:

1. Continue the strong relationship with the community, Makindye Division, Kampala City Council and the Ministry of Health and their funding partners;

2. Strengthen the internal management and reporting systems of the clinic beyond the already established medical case records and patient care;

3. Maintain financial self-sufficiency for the out-patients, maternity and admissions services and support integration of these general health services with the free-to-client services;

4. Develop new and expanded grantee and programme relationships with Government, companies, private donators and international granting bodies to expand the free to client services as part of Uganda’s national health priorities;

5. Improve reporting of our achievements and model for a package of care for decision making and for our partners through monitoring and evaluation feedback and timely grant reporting that recognises their support.

Hope Clinic Lukuli is a registered NGO in Uganda and maintains its links to charities registered in the UK through which it can receive donations with Gift Aid.

None of the founders or trustees of the NGO receive any fee or income from the clinic or NGO and the clinic premises constructed in 2005 are owned by the NGO. Hope Clinic Lukuli is registered as a charity with the Uganda tax authorities. The clinic operates from land donated in a 25 year lease to 2030 and so has few overhead costs

Read the full strategy document at http://www.hcluganda.org/HCL Strategy 2009-13.pdf

Wednesday, May 19, 2010

Social Media and new Websites

Hope Clinic Lukuli is participating in the online discussions regarding availability of ARVs in Uganda (Hope Clinic's patients are not missing out, due to our network of supporters) and the ways to improve PMTCT accesss for pregnant women. We TWEET!

In the meantime, we are very grateful to TheValueWeb for their ideas and to Sita for the new Strawbags website. The graphic skills of TheValueWeb and London designer, DeathBeforeDishonour will be delivering the Hope Clinic experiences at the International AIDS Society 2010 conference in Vienna in July.

Tuesday, September 01, 2009

Strawbags – so many benefits for makers, users and the environment

List the things you know about plastic:

• It is made from fossil fuels (oil) and so each new bag is from a finite resource
• Governments encourage us to use fewer bags – some ban their importation
• Shops help us change our habits by charging us for thin bags
• Cheap, thin bags break and go in the bin
• Things you put in the bin are burnt or buried – both are bad for the environment
• Drop a bag on the ground and it blocks a drain or chokes an animal

Remember what a responsible person should do? It is ‘Green’ and saves you money:

Reduce the use of resources that are finite
Re-use items, find a second or third job for things you own
Recycle, efficiently, what can’t be re-used anymore

Kinawataka Women’s Initiative is based in a village that has become a suburb of Kampala, in Uganda. As well as thin plastic bags blocking the drains - that are so necessary in fertile Uganda with two rainy seasons – the women found plastic drinking straws that had been used for locally made juices in a bag as well as commercial soft drinks and beer. These straws are gathered, sorted and sterilised in a big drum before being rinsed and sun dried.

The next stage is to flatten the straws – this is a skilled task as the correct pressure must be applied in order to squeeze out all of the air, generate enough heat to create a crisp edge to the sides of the straw but not stretch its length. The younger members of the Kinawataka group are out-of-school children and orphans in the care of the Women’s Initiative. Their earnings from the manufacture of the bags contribute to their school materials so that they can attend a few classes in the next term.

The next task is the skill that Benedicta Nabingi, the founder, has developed and refined and now taught to other women in the group. The straws are woven, as you would with grasses and natural straw, to form a long strip in the shape of a thick belt. These strips are the basis for the original plastic straw mats – used for kids to play on and in several of the local mosque. By joining several strips and sewing corners to attach flat panels together, Benedicta started making purse handbags, shopping bags and now with zips, the parents’ bag and sports holdall.

The different stages: strip making, joining to make mats or panels, stitching to form bags and the finishing each provide a direct income to the member of the group that provided that time and labour.

And the result is a range of bags which provide an income to the community members that make them; remove plastic waste from the environment and enable it to be re-used; it reduces the use of disposable plastic bags which would be torn and discarded or burnt; it protects the water-course for drainage and the new drinking water; the bags actually work.

We use them to carry large bags of flour or stacks of pineapples. They are strong enough to carry bottles and jars without breaking, resist water and wet swimming kits and can be washed after the muddy soccer boots

Strawbags - Money from old plastic

Helping People, Helping the Planet

"At least I have my health” – a joke said for hard times in the US and Europe. In Uganda health is not so much a personal description of well-being but a day to day concern that requires nutrition, the time to visit the over-crowded and under-resourced government facility, or money to visit a non-government clinic. For women living in the Kinawataka village in Kampala, Benedicta Nabingi saw her retirement from over 20 years of public sector work as the start of her challenges.

Benedicta and other retirees have looked at their households and watched the large houses being built around them, the city’s roads getting busier and new shopping centres built; covered with adverts for designer clothes, mobile phone companies and new types of soda drink. Around the village the green hills of Kampala are testimony to the rains that allow the countryside to feed a rapidly growing population – but in the urban areas the ‘shambas’ for growing food are being taken for roads and kiosks to sell phones, beer and soft drinks. The waste from these kiosks include plastic drinking straws and disposable ‘kavera’ or bags. These bags are so thin and weak that they are used once, become the night-soil and then fill the waterways. The abundant rains then come, the waterways are blocked, the paths fill up and the basic households with marginal nutrition are at risk from all the diseases of poor sanitation. Worse still, the urban setting means the government health unit is far away and over-crowded.

Kinawataka Women’s Initiatives (www.kwiuganda.org/showroom) took all these features of urban life and developed a solution to discarded plastic bags, reducing the landfill needs of waste plastic drinking straws, allowing women to develop a skill, earning an income and supporting not only their own children and household but the orphans from HIV and internal displacement….Weave the drinking straws into bags.

One of the new members, we shall call her Jane, says: “I can sit here for the day with my baby next to me. I flatten the straws which we washed yesterday. I then weave a long strip of straws and I can choose to make the strip into a bag tomorrow or sell the strip to the Kinawataka group today and I receive enough money to buy eight meals”. And how does this compare to growing vegetables in the shamba and selling them to neighbours? “If I grow something to sell, I can lose that thing when it goes soft or if there are other people selling the same thing – I lose my stock and all my effort. With the straws, there a hundreds of them, they don’t go bad and my work has value today or next week. I will learn how to join the strips into a whole bag and can sell it for enough to buy 25 meals. My friends make three bags a day”. Kinawataka is working with Hope Clinic Lukuli to train more women so that they have the money for food and healthcare

Tuesday, August 25, 2009

Income generating activities - volunteer intern wanted

http://www.volunteerabroad.com/listingsp3.cfm/listing/69114

Description: Hope Clinic Lukuli and Kinawataka Women's Initiative have formed a partnership to expand the number of women and households who can prepare and weave waste plastic drinking straws into lengths of 'material'. This material is then used to make mats and shopping/ sports bags to replace disposable plastic bags. All sale proceeds from the products are paid to the weavers/ bag makers.

The volunteer post is to 'make this happen'. Support the marketing, liase with customers, help the women organise into production and finishing teams and create links to buyers in Europe and North America

Highlights:
- Living in Kampala, a friendly city in East Africa
- Helping women in households on low income to generate their own earnings for food and education
- Reducing waste that pollutes water sources and block rain drains (that otherwise lead to floods)
- Supporting a philanthropic health centre to address income needs of its community

Qualifications: The volunteer should be a graduate or have over three years of experience in a trading or retail business. The role of Income Generating Activity (IGA) Coordinator draws on skills of customer service, product quality control, marketing to developed world customers and a willingness to build the skills amongst women to access these markets. English would be the language of work.

Languages :
  • English

Cost in US$: 2000

Cost Includes :
  • International travel
Cost Include Description:
Volunteers should plan and pay for international travel to Uganda. Suitable, safe accommodation can be provided near the clinic. Volunteers are asked to pay for their own meals and incidental costs

Experience Required: yes

Experience of planning an income generating activity or business or coordinating a local event/ relief effort

Volunteer Types :
  • AIDS
  • business
  • economic development
  • health
  • income-generation
  • micro-enterprise
  • natural resources
  • orphans
  • small business development
  • women

Typical Volunteer: Graduate or medical trainee, Peace Corps Volunteer or VSO. Some experience travelling in Africa or developing world.

Age Range: adults

This Program is open to American, Asian, Australian, Canadian, European, Kiwi and South African Participants. This Program is also open to Couples and Individuals

Typical Living Arrangements :
  • Home-stays

Participants Travel to Uganda Independently

Typically Participants Work Independently

Application Process Involves:

  • Written Application

Hope Clinic Lukuli's Mission Statement: Hope Clinic Lukuli was formed by six Ugandans and two resident Britons who wanted to support a dedicated midwife in providing services for children and adults, particularly related to fevers, dehydration and pregnancy. Our mission/ purpose has been formalised as: That people living near the clinic receive the medical information and treatment they require at a price they can afford and thereby have an improved medical history and general lifestyle". None of the founders/ managers receive any payment from the clinic or its work. Our website decribes the growth and current programmes as well as including articles and tv features of the impact we are having on people's lives.

Year Founded: 2000

Women and Hope Clinic Lukuli

Joyce Bbosa is an experienced midwife who described at her retirement how she has delivered the village with her own two hands. Joyce, then in her 50s, was working in a two room structure helping children with fevers – whether malaria or not – and helping scared young mothers living in Kampala away from their family support, at home in the village. Hope Clinic Lukuli grew from these two rooms by the work of a women-led committee of non-medics. Small actions by the people living in Lukuli village on the edge of Kampala brought child immunisation to the families; help with oral rehydration to manage the fevers; and access to HIV testing for the pregnant mothers and others to help reduce new infections. www.hcluganda.org

Hope Clinic Lukuli has continued since 2000, and despite Joyce’s retirement in 2004, to become a new facility offering family planning and maternal health, admissions for deliveries, a laboratory and out-patients department. What makes it unusual is that the community expanded the clinic without any expectation of deriving an income from it – the founders are retired teachers, former public sector workers, a shop-keeper, an administrator, a surveyor and an accountant. Social entrepreneurship is talked about in the US and Europe, but in Uganda it is people using their own skills and networks to help others for no personal gain. The clinic has grown in patient numbers and in response to request for services to women in the community. It now caters for child immunisation; nutrition advice and infant food supplements. The reproductive health services range from information to youth and advice on family planning options, the free of charge provision of implants and other FP commodities, ante-natal and PMTCT sessions and continued counselling and support through and after delivery. Through a recent International Women’s Organisation grant, the clinic has replaced the two maternity beds (from the IWO six years ago!) and our mothers-to-be have their own room to prepare and to deliver in.

Hope Clinic Lukuli’s goal is to minimise the physical and financial barriers for women in their own right and as the guardian of children to access accurate and prompt health advice. We maintain the consultation charge at less than $0.50 which is less than the cost of the most basic meal – so hopefully affordable to all. Alongside free immunisation and family planning, we use donations and sponsorship of nurses and midwives to subsidise the laboratory and other costs the clinic incurs to reduce the fees faced by the patient. Hope Clinic is open 24hours a day, every day, with a midwife and a Clinical Officer on duty at night – because that is when the babies come! We deliver an average of 15 babies a month; some to HIV positive mothers, but our PMTCT services means we can protect mother and baby.

What should you do? – offer your time and skills to an existing service near you. Don’t build or set up from scratch, support what the community already uses

Monday, June 02, 2008

USG Meeting in Preparation for HIV Implementers

On 2nd June the US Government delegates from countries implementing PEPFAR and related USG initiatives meet in Kampala. They are following the theme of Scaling Up Through Partnerships that will continue on the 3rd June with the HIV Implementers Conference.

A Critical Barrier to Implementation has been the apparent reluctance for ‘larger’ organisations to engage with ‘smaller’ implementers. Just as general practice medical services are a network of small clinics, medium sized health centres and large hospitals, the provision of HIV services require mentoring and referral mechanisms. The barrier that Hope Clinic needed to, and with great struggle did, overcome was how to make the first contact and be heard by the best practice organisations. For the funders of these implementers, greater flexibility to share training, share materials or provide mentoring support would be a welcome lesson to learn when designing the next intervention.

It is understandable that national or district-specific programmes or donors have priorities. These can be an excessive focus on indicators or seeking the ‘quiet life’ by working again and again with the same partners to a point of saturation. Once everybody has a mosquito net in one location, the next location still has no nets.

An example is HIV counselling and testing – obtaining the HIV test kits for Hope Clinic offered three options: buy them if a supplier can be found; ask the doctor in charge of VCT in the Ministry of Health; become a partner or site of an established HIV testing organisation – in 2000 that was TASO, AIC, Mildmay or JCRC. Hope Clinic wanted to ensure that it was following best practices. The clients attending ANC checks deserved access to a HIV test and PMTCT services. If mothers could have tests, anybody who asked should be able to be counselled and tested. If those that ask of their own volition are learning their status, shouldn’t all clients be helped to appreciate the HIV situation accurately, decide whether they want to test and then have financial access to a test. We were required to deal direct with the Ministry as the only means we could find to obtain tests as we knew our community would see a fee as a barrier to being tested.

Hope Clinic Lukuli now has a comprehensive HIV service which is integrated with our general practice services. This helps Prevention. Clients who visit Hope Clinic for fever evaluation, coughs or maternity check-ups are reached with prevention messages, encouraged to know their status and informed to reduce stigma and promote disclosure and community care and support. The service ranges from outreaches, mobilisation messages and roadshows, through counselling and testing, household counselling for infected persons and the palliative care and support including Cotrimoxazole, to OI testing and treatment and access to ARVs. Positive clients and their households benefit from peer education groups, drama and prayer groups and follow up counselling and CD-4 monitoring.

This is only possible through coordination among HIV implementation partners – Government, donors and the private sector. There are more than 10 projects or collaborators working with Hope Clinic Lukuli in direct support of the HIV services. This is because each have their own area of best practice and none can – or should – try to specialise in all aspects of the HIV response. Hope Clinic is following the national strategy and prevention is a key part of our work. We strongly believe that knowing one’s status is essential and the assurance of financially accessible treatment is a huge incentive to be counselled and accept to be tested. Through our GP character we reduce the stigma of attending Hope Clinic. Our entire HIV service is free to the client because we have formed partnerships. We sustain ourselves with a low cost but efficient GP service.

Hope Clinic had to work hard to coordinate and create links with larger programmes.

Greater openness to meet new partners and work with established but smaller implementers would be a huge boost to prevention services – not only in Uganda.


Schedule of 6 PEPFAR, 2 Global Fund and 5 private grants at Hope Clinic Lukuli

Activity

Intervention

Partner

Awareness/ Prevention

‘Stay Alive’ health and lifeskills education program in schools and for out-of-school children

US grant (Until There’s a Cure) and Ugandan implementer (Reach the Children)

Awareness/ Know Your Status

Road show and drama to lower income/ densely populated communities with onsite counselling

Kampala City Council, Makindye Division and Joint Clinical Research Centre (JCRC/TREAT)

Awareness/ mobilisation to test

Distribution of leaflets in English, Luganda and Swahili on 6 topics of HIV including VCT, prevention, stigma and care for those with HIV

Developed by USAID Business PART, printed by Aggreko International (whose staff also received HIV awareness training from Hope Clinic, following the PART curriculum)

Outreach, counselling and testing

Mobilisation to community, reducing stigma and providing pre and post test counselling at the Hope Clinic

Aggreko paid for 1 year. HCL is a Prime recipient from the US Embassy Small Grants team allowing HCL to keep counselling free.

Test Kits

The three types of test kit used for HIV at Hope Clinic Lukuli

Supplied by US Government, routed through National Medical Stores and DELIVER/SCMS project. Alternate supplies through JCRC or Joint Medical Stores (JMS)

Laboratory Services

Improved microscope and centrifuge equipment and safety for lab staff

DFCU Bank financed new equipment and renovation of the laboratory with technical advice from CDC Entebbe.

Basic Care Package (C,S&T)

The boxed kit comprising two LLIN, a water container with purification chemicals and condoms

Funded by PEPFAR through CDC and the PSI contractor. Initially provided to HCL through PREFA project, Muyenga.

Septrin and self-care materials (C,S&T)

Anti-biotic provided at Hope Clinic to all clients confirmed as HIV positive. Positive Living literature, peer groups and outreach home visits

HCL obtained a US grant from Until There’s A Cure (www.utac.org) for first 200 clients. Then self-funded and now provided by JCRC-TREAT partnership. Peer groups funded by PSI.

Testing for opportunistic infections

Positive clients need prompt diagnosis of infections including STI and malaria

Aggreko paid for laboratory staff and reagents for 12 months to allow free to PLHA and free to youth lab testing.

Care, Support and Treatment for OI/ STI

Drugs for treatment of opportunistic infections, including malaria and STI, for PLHA. Mosquito nets to pregnant women and children under 5 years.

Coartem (ACT) from the Global Fund is free to HCL via Kampala City Council. Hope Clinic Lukuli bears the cost of drugs for other OIs. The Safe Injection Project gives syringes.

CD-4 count and ARVs

Monitoring of CD-4 from date of test and access to ARVs when required

JCRC TREAT partnership involves fortnightly visit of team to HCL and free CD-4 counts

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Sunday, June 01, 2008

Uganda AIDS Commission - Thank you for the invitation

Scaling Up Through Partnerships: Overcoming Obstacles to Implementation

“The HIV Implementers conference has set June’s meeting in Kampala to help partners:

- exchange lessons learned and best practices in the scale-up of HIV/AIDS programs

- focus on building the capacity of local prevention, treatment, and care programs

- enhancing quality

- promote coordination among partners.

Dialogue about future directions of HIV/AIDS programs, with a strong emphasis on:

- implementation best practices, and

- the identification of critical barriers”.

Hope Clinic Lukuli is an example of partnerships between: a CBO that became an NGO; local village and city councils; the national Ministry of Health; Ugandan and international companies; and Uganda and international health NGO and development agencies. We say thank you to Patrick Mutabwire and Elizabeth Mushabe who were willing to hear about Hope Clinic's work and agreed that we were a valuable example for the conference to learn about.

Scaling up of health services must be a balance between huge and under-served demand among the community and the technical, human and financial capacity of the health service point that the community relies upon. Hope Clinic developed a network of implementation partners to gradually expand the clinic’s in-house services and to serve the community through collaborations until it was technically and financially capable itself. The financial capacity includes fees from out-patients, sponsorship of health services by Ugandan companies and using community resources to equip and improve the clinic.

Building capacity has also been a coordinated effort to ensure that best practices are adopted and partnerships provide training and mentoring to health providers and peer educators as well as the service for the client. Hope Clinic Lukuli is a general practice health facility encompassing:

- childhood illnesses, especially fevers and other causes of dehydration;

- maternity care including RH, FP, ANC and deliveries and neo-natal care;

- out-patients consultations, laboratory examinations and treatment;

- comprehensive and integrated HIV services from mobilisation and testing to ARV.

The community served by Hope Clinic requires broad medical services and the capacity of Hope Clinic had to be steadily built to address their needs – no government staffed site exists within 3km of Hope Clinic and yet close to 100,000 people reside in that area. The good relationship that the clinic has built with the community and popular opinion leaders means that we are trusted for quality and genuine interest in people’s wellbeing. Using an established CBO/ NGO is the simplest way to scale up HIV service delivery.

The scaling up through partnerships has been the means to build our specific capacity for HIV services. The incremental growth of HIV services has relied on identifying the partner with the best practices, engaging them to recognise that the Hope Clinic and its community needs their services and negotiating the mechanism for an implementation partnership.

Hope Clinic is the most integrated example of PEPFAR, Global Fund, Private Sector and community at a single site. Yet we are a highly transferable example of how to remove the barriers and support Prevention efforts. Call or Email to learn what we did.

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