Running a charitable health clinic in Uganda

#AIDS2011 Thirty years of HIV in Uganda

2011-06-04T12:54:00.002+03:00

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?

Our strategy for the clinic 2009-2013 with updates

2011-02-09T16:44:00.002+03:00

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

Social Media and new Websites

2010-05-19T14:27:00.003+03:00

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.

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

2009-09-01T09:16:00.008+03:00

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

2009-09-01T08:35:00.002+03:00

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

Income generating activities - volunteer intern wanted

2009-08-25T11:12:00.002+03:00

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

2009-08-25T10:18:00.001+03:00

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

USG Meeting in Preparation for HIV Implementers

2008-06-02T11:49:00.004+03:00

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

Uganda AIDS Commission - Thank you for the invitation

2008-06-01T19:07:00.001+03:00

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.

Coordinating PEPFAR and other donors

2008-05-20T16:44:00.000+03:00

Hi from Hope Clinic,

This link takes you to our webpage on community and to a link for a 5 minute news feature that appeared on Nation Television on 13th and 14th May. http://www.hcluganda.org/community.html

The feature comes a week after the announcement by Dr Apuuli of the Uganda Aids Commission that the HIV Implementers conference will take place in Kampala. The conference is a global gathering of PEPFAR, Global Fund, UNAIDS, governments and international NGO. The theme this year is partnerships and how scaling up of services, particularly prevention, can be coordinated.

The feature includes three of the clinic’s clients who are now peer educators talking about their HIV experience and how Hope Clinic has and continues to help them. In the film there are other references to/ images of:

- The Ministry of Health/ National Medical Stores test kits for HIV coordinated by the USAID funded DELIVER project;
- The Small Grants office of the US Embassy;
- The NGO facility coordinated by the Joint Medical Stores/ Kampala City Council for Coartem – a modern malaria treatment;
- The CDC/PSI Basic Care Package comprising LLIN mosquito nets and clean water systems;
- Leaflets produced by TASO and JCRC with PEPFAR funding that we have re-produced and use in our mobilisation work;
- The support of DFCU Bank who funded the improvements to our laboratory;
- The visiting staff of JCRC whose services include the CD-4 analysis of the blood samples being taken;

Thank you for your interest, help and support over the years.

Public Private Partnership for health - Ugandan examples

2007-08-01T14:17:00.000+03:00

The Hope Clinic Lukuli continues to increase its linkages to the community level health providers and to be recognised by the city council and Ministry of Health as an important participant in health services provision. Having completed seven years since its foundation, and two years in the new premises, the clinic has a broad range of collaborations. The following are examples of public private partnerships in Makindye Division:

Malaria treatment: Since May 2007, Hope Clinic Lukuli has been able to access the NGO facility for malaria treatment drugs. The new Artemisinin-based Combination Therapy (ACT) drug available in Uganda under the facility is called Coartem. It is provided in four dosage packages and Hope Clinic Lukuli is able to receive it free of charge and provide it to the clients. This means that although the clients still pay half a US dollar for the medical examination and $1.50 for the laboratory testing, the potential cost of Coartem from a drug shop (US$10) can be avoided. Without this public-private cooperation, such free malaria treatment would only be available at government-staffed facilities. The nearest one to the clinic is 3-4km away; yet 50,000 people live within only 2km of the clinic.

Malaria prevention: In December 2005, Rotary International funded a small net retreatment programme which could also make lower quality nets into permanently impregnated nets. The exercise revealed the great lack of nets in households and so in the later half of 2006 and early 2007, Rotary paid for a further 1,500 long lasting impregnated nets (LLINs). The public private partnership in this situation was between the clinic and an international donor (USAID), although the AFFORD health marketing initiative, Malaria Consortium and NetShoppe were the parties we dealt with. The nets were being made available to collaborating partners at a price that was about half that in the retail outlets. This meant we could buy twice as many nets as could have been achieved. The nets were given out free of charge to mothers attending our ante-natal classes and to guardians of children attending child immunisation sessions.

HIV counselling and testing: The provision of free-to-client HIV counseling and testing was an early addition to the basic maternity and fever management when the old clinic started. Just prior to the new facility opening in July 2005, the Ministry of Health department for PMTCT was providing test kits when available, but we otherwise had to purchase them. The cost of US$1-2 per test could not be passed on to clients based on experience that even after counselling for an hour and being willing to test, that cost was still a barrier to access health care. In March 2006, the public private linkages with the Aids Control Programme of the Ministry of Health were evidenced by the accreditation of Hope Clinic Lukuli as a Anti-retroviral Treatment Centre and therefore able to access commodity support from the government. They in turn were supported by the Global Fund for Aids, TB and Malaria and by the US Government. In June 2006 we received a six month supply of three different test kits for HIV and our client numbers grew rapidly to over 150 a month by the start of 2007. All free of charge to the client.

HIV Care and Support: Another aspect of public private partnership has been the collaboration between Hope Clinic Lukuli as an independent NGO and the large, national government or donor funded programmes and organisations. Particularly in the HIV sector, the early stages of mobilisation, awareness and post-test care and support is not delivered by government. In mid-2006, The Joint Clinical Research Centre (JCRC) entered into an agreement with Hope Clinic Lukuli to provide the technical skills and experience of the world-renowned JCRC TREAT project to the community in Lukuli. The fortnightly visits quickly revealed a massive underserved population including many who had wished to confirm their expected HIV positive status but had previously been unable to. The partnership between the publicly and donor funded JCRC and the private Hope Clinic Lukuli has meant that we now have 180 PLHA receiving fortnightly check-ups near their homes and in the interim can access Hope Clinic Lukuli for examinations and check-ups. Guardians of children can collect their ARVs from the clinic which have been provided by JCRC.

Maternal and reproductive health: The Hope Clinic Lukuli was recognised by the Kampala City Council as being deserving of financial support for the July 2006 to June 2007 financial year. The public private support has been in three forms from the city. A lump sum contribution to our operational overheads and staff costs was made to the equivalent of one month's net salary for the medical team. A smaller amount was deposited by the city council to the Joint Medical Stores from whom we procure our drugs and medical consumables. The credit line amounts to only 10% of our drug costs but we have applied it to the various items used for maternity ante-natal and deliveries. This helps maintain a low cost of US$15 to deliver a baby including the overnight stay in a private delivery room. The third support is the provision of free family planning items including oral and injectable contraceptives.

HIV and STI medications: Support from the health ministry, donors, large programmes and the city council is coordinated at Hope Clinic Lukuli with support from the private non-health sector in the form of sponsorship of staff and services. The considerable in-kind support from Ugandan companies in 2004 and 2005 enabled the new health facility to be built to a high standard and repeat donations in 2007 are helping maintain its appearance. Each year since 2005, the private, commercial Aggreko international has been supporting our HIV, maternity, child and youth health services. Their donations of funds are critical as, in 2005 and 2006, they paid the salary of the counsellor providing the free HIV counselling and testing service. The kits from the government are only half of the cost facing Hope Clinic Lukuli and so Aggreko ensured we could offer that service free of charge.

The DFCU Group has a strong community interest in HIV within its banking group. They have supported Hope Clinic Lukuli to enhance its laboratory with a complete upgrade from the equipment transferred from the old clinic premises. They also contributed to the cost of a medical VSO who has formalised the clinical protocols for maternal health, fever management, STIs and opportunistic infections associated with HIV.

The 2007 support from Aggreko has been to address an issue identified in community outreach visits from Hope Clinic Lukuli and endorsed by the Assistant Commissioner for Reproductive Health in the Ministry, Dr Twa Twa. The youth were unable to access cash from their parents, and some HIV clients lacked any access to funds with which to seek consultation, testing and any medication for STIs. For the youth, puberty and early sexual activity can lead to a huge risk of STI which either risk future reproductive health problems or more exposure to HIV infection. Once HIV infected, STI are a frequent complaint and can cause re-infection. Aggreko responded to this need and so a private commercial company is funding a government/ publicly endorsed need to deliver a service in the independent NGO, Hope Clinic Lukuli.

Local partnerships: The Hope Clinic Lukuli has benefitted from a four month community outreach programme to identify HIV peer educators and support groups as well as private sector drug shops and self-employed midwives. The resulting referral network has encouraged midwives offering ANC services to refer women to deliver at the clinic as well as to visit the clinic for their PMTCT HIV test. Drugs shops who feel they have exhausted their medical treatment or diagnosis capacity can refer patients for a check-up. The public private partnership here is also a three way cooperation with government and the clinic as an NGO. The referred patient is examined and diagnosed at Hope Clinic Lukuli but then encouraged to take their prescription for medication back to the drug shop thereby ensuring that they maintain their trade. This is a good example of competitive advantage as some referred clients also get to access the free services available at Hope Clinic Lukuli and pay for the laboratory but still get syrups and tablets from the local shop.

Philanthropic Trustees

2006-08-09T16:15:00.000+03:00

The recent months work at Hope Clinic Lukuli has reinforced the belief that creating linkages and using personal and professional contacts is often more effective and has greater long term impact than just paying over a sum of money. From a forum of other philanthropists, we found a health management expert, they visited Uganda at somebody else's expense but had time to visit the clinic. They brought two trainee doctors who provided ideas and encouragement and reference to an electives organisation.

The funding is still important, but in case potential supporters don't want to give funds which they cannot monitor, they can be encouraged to advocate for the programme and use their skills. Many people have an experience or professional skill which to them is simple and easy to replicate elsewhere - but to you seems highly technical and very expensive to buy.

The concept of Philanthropic Trustee is more active than a normal charity trustee which receives proposals and reviews reports. These are more active in their participation and combine use of their skills and oversight with a 'for no personal reward' position to link the programme to larger organisations. They act as brokers, character references and an assurance of propriety.

Perhaps next time somebody asks for money from you, or who you are about to ask for funds, consider their skills and contacts that they could be prompted to bring to you.

FANTA - Food and Nutrition

2006-06-05T16:25:00.001+03:00

One aspect of the growth of Hope Clinic Lukuli has been realising that lots of good projects are set up and funded by bilateral donors and then close with the materials slowly depleting their stocks and the resource being lost. World Bank projects such as CHILD and NECDP in Kampala both had good materials, still admired by the Ministry of Health, but for which almost no copies remain for use.

The FANTA project was running with USAID funding under AED a US company and its materials cover infant health and nutrition. I have made contact with the US base who referred me to:
Robert KN Mwadime (MSc., MPH, Ph.D)
Regional HIV/AIDS Specialist
Food and Nutrition Technical Assistance (FANTA) Project
Academy for Educational Development
c/o Regional Centre for Quality of Health Care, Medical School, Mulago
P. O. Box 29140, Kampala, Uganda.
Tel: +256-41-530888 (w), +256-77-517438 (c)
Fax: +256-41-876

He is based in Kampala, but has a regional remit, and so referred me to Samalie working in the Ministry of Health, in room 2-d-208. In mid to late June she will have printed copies of the FANTA materials and I can approach her for copies for the clinic. Her number is 0772 491551.

Engineering Missionaries International

2006-06-02T13:29:00.000+03:00

Their website says:
"Engineering Ministries International (eMi) is a non-profit Christian development organization made up of architects, engineers and design professionals who donate their skills to help children and families around the world step out of poverty and into a world of hope".
What this means is that professionals in the design, architecture and construction field have realised that their skills can benefit other people and ensure that good ideas and intentions can be carried out with a cost effective and correctly designed and planned structure.

They were working in Uganda on a larger project in Jinja town and met us in 2004 to review our very bad drawings for a new health centre. John Sauder and later, Chad Gamble, went away and came back with full AutoCad architectural sketches with dimensions, cut away of walls, specifications for roof construction and even plans for the latrines and soakpit. Before EMI invest their time and skills they have the understandable need to be convinced that you can fund and complete their planned construction in the coming weeks or months and, as noted on their application form, that:

+ The project ministers to the needs of the poor.

+ There is a direct and ongoing proclamation of the gospel of Jesus Christ.

+ The property on which the project is to be built is owned by the ministry

+ There is a planned method of funding project construction and operation.

Our landlord in Lukuli is the Church of Uganda who recognised the services we provide to the community, however we equally serve the Born Again churches, the Catholics and the Muslim groups around us. In Uganda the various Christian branches of the church are treated as separate entities anyway. Our staff revert to the spiritual strength felt by our patients during sickness and particularly for the HIV counselling and testing services and Care and Support to those living with HIV/AIDS.

Mango - management accounting for non governmental organisations

2006-06-02T13:12:00.000+03:00

Before I give you some information on Mango - I hope that readers don't confuse these posts as attempts to get commercial gain for Hope Clinic Lukuli's owners or the organisations referred to. Mango, for example, is a repository of posts and resources from accounting, administration and field staff around the world who are sharing their ideas and experiences. They don't get paid for it, no matter how much their good ideas are used or adopted.

This blog is trying to follow the example set by Mango and GoodwillGallery where somebody who has developed an idea offers it to another person to save their time and effort - which means they can concentrate on their skill areas and perhaps share their ideas.

As for the owners of Hope Clinic Lukuli - none of the eight of us take any money or financial benefits from the clinic's operations. (I had to amend that as I almost said benefits of any type. I must admit to a pride in managing to achieve this and a good feeling when the people around where we live say they like the clinic, the staff there and its services).

So, Mango. In Uganda it is best known as a telephone service, secondly as a great food! But for finance people working for small NGO or charities, trusts or clubs, mango org uk should be a place to know. You can get advice on accounting software, free examples of accounting cashbooks and vouchers to control the business/charity/trust and even enroll to pay for training courses in the country where you are working. The link is on the blog front page

Working with Kampala City Council

2006-06-01T12:48:00.000+03:00

Kampala City Council is the District authority responsible for health service provision in the city centre and the surrounding residential areas. Our area of Lukuli Nanganda, in Makindye Division is therefore under its jursidiction and guidance.

KCC are considering Hope Clinic Lukuli on two fronts, one as a Makindye Teenage Information and Health Centre similar to another one on the other side of the city, the other as part of KCC's response to HIV service needs. The HIV Focal Point person is Dr Sendagire and he is discussing with Dr Penninah and Ms Thayer of IDI about their coordinated development of services in the city. We shall see during June how we get on

Why start a blog about managing the clinic?

2006-06-01T12:00:00.000+03:00

Hi,

The clinic started over six years ago when a set of friends agreed that a small community health clinic was struggling to continue to function and could be helped. An elderly and very dedicated midwife was tending to the needs of her patients and doing so with little pay or supplies of materials or drugs. More background can follow later.

What has been nice about Hope Clinic Lukuli and its growth is that we have achieved it without any of the management committee being medics and with skills ranging from a small shop keeper to civil engineer, a local council member to a teacher, an accountant to a retired civil servant. The community, village, people around the clinic have alternative places to seek medical advice and treatment but choose Hope Clinic Lukuli and return to it with friends.

The task of managing the growth between the eight of us on the committee has made very clear that lots of support in terms of materials, advice, best ways of acting and groups to work with already exist. They just don't know about you and your needs and they are not always as approachable as they could be - or you don't know they want partners.

This blog will be the memo pad for what I and the others continue to work on for the clinic. It will also be a history of our challenges but more usefully for readers, a record of how we overcame them, who we found ourselves talking to and working with. We have a website but this may be an easier thing for me to update.