HEPS-Uganda

THE PEOPLE'S VOICE UGANDA 2021

This is the third edition of The People’s Voice; the first was published in 2019 and the second in 2020. This People’s Voice on COP21 focuses on the following critical themes: effective management of COVID-19, It also focuses on the promotion of quality, evidence-based, and human rights prevention interventions; expanding biomedical and structural prevention interventions for women and girls including GBV, economic empowerment, and human rights; support for people with disabilities; closing gaps in diagnosis and treatment of children with HIV.

THE PEOPLE'S VOICE UGANDA 2020

Uganda has an estimated 1,392,742 people living with HIV (PLHIV), consisting of 1,296,000 adults aged 15-64 years (6.2% prevalence) and 96742 children aged 0-14 years (0.5% prevalence). Prevalence is higher among women (7.6%) than among men(4.7%) and among young people (15-24 years), prevalence is four times higher among adolescent girls and young women (3.3%) than among adolescent boys and young men(0.8%). New infections are estimated at 80,500 people per year; 73,000 adults and 7,500 children. Approximately 83% of HIV-positive Ugandans currently access HIV treatment. Despite important progress made by the country towards the national target of reaching epidemic control, Uganda continues to face major challenges that are weakening the impact of the national response.

THE PEOPLE'S VOICE UGANDA 2019

This is the "People’s Voice 2019" containing Uganda's community priorities and recommendations for PEPFAR for the Country Operational Plan 2019. The recommendations have been developed by people living with HIV  and health activists using information gathered in February 2019 during community consultations and additionally through facility monitoring carried out at seven PEPFAR supported sited in four high burden districts including Mbale(Mbale Regional Referral Hospital and TASO Mbale), Lira(Lira Regional Referral Hospital and Amach HCIV), Jinja (Walukuba HCIV and JIACOFE), and Tororo (Mukuju HCIV)

CSOs Launch People’s Voice 2021

More than 40 civil society organizations led by ICWEA, HEPS – Uganda, Sexual Minorities Uganda have launched the 2021 edition of “The People’s Voice,” a set of ambitious recommendations describing shifts the U.S.

CAPACITY BUILDING FRAMEWORK: Facilitating the effective implementation of the community – Led monitoring and Engagement Framework

Communities can play a catalytic role in improving health outcomes, service delivery, and overall quality of life and understanding of health within communities. The involvement of recipients of care—and other affected communities—in monitoring their health systems is essential. PEPFAR recognizes the importance of engaging communities in the development and implementation of its programming. As PEPFAR continues to confront the challenges of assuring retention on life-long ART in PLHIV who may not view themselves as sick, collaboration with communities and PLHIV is urgent and critical. This collaboration can help PEPFAR programs and facilities ensure they are providing quality services that beneficiaries want to utilize. Collaboration with community groups, CSOs and PLHIV or beneficiaries can help PEPFAR programs and health institutions diagnose and pinpoint persistent problems, challenges and barriers with service uptake at the site and facility level to effective service and client outcomes at the site. Most importantly this collaboration identifies workable solutions to overcome barriers and ensure beneficiaries have access to services. One approach to this kind of collaboration has been variously referred to as Community Led Monitoring (CLM) among others. The Sustainability Index Dashboard and Responsibility Matrix 2019 indicated poor performance, poor quality of services, poor health workers’ attitudes, health and rights violations, and frequent stock-outs and/or shortages of diagnostics and treatment commodities. While HIV treatment and prevention coverage has steadily improved in Uganda, there are persistent shortcomings in the response. These include; high rates of loss to follow up (LTFU), limited uptake of high impact prevention services such as PrEP, high rates of discontinuation from the DREAMS program, limited access to ‘friendly’ services for HIV positive and HIV negative adolescents/youth, high rates of stigma and discrimination, poor provision of prevention and treatment services for KPs, low community/service recipients’ participation in planning, monitoring and evaluation. Additionally, there is very poor viral load suppression among some groups (paediatrics, pregnant women adolescents, men > 25). As well community and social factors such as stigma, gender and sexuality discrimination, and other social barriers exist. PEPFAR and its IPs have made great progress to realize over 1.2 million on treatment and over 75% virally suppressed. However, there is still need to find the remaining 150,000 HIV infected individuals, link them to treatment and retain all those PLHIV on ART. There is also need to avert new infections especially among risk populations.

COMMUNITY-LED MONITORING AND ENGAGEMENT FRAMEWORK FOR HIV/TB & SRHR SERVICES: TOWARDS “INCLUSION AND INVOLVEMENT”, “INPUT AND INFLUENCE” OF PLWH AND KPS IN NATIONAL HIV/TB AND SRHR POLICIES AND PROGRAMS.

As Uganda works to achieve HIV epidemic control, the scale-up of high-quality patient centered HIV/TB and SRH services for persons living with HIV and key populations is critical. Placing communities and patients at the center of the HIV response is critical to controlling the HIV epidemic. Community engagement has been identified as a key pillar to successful and sustainable HIV/TB and SRHR programs. The participation of people living with HIV, including recipients of care and their advocates,in the design, implementation,and evaluation of HIV/TB and SRH initiatives is critical to assure both demand from people living with HIV, key populations and supply of high-quality, contextually appropriate services. The WHO has defined community engagement as “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes.” Health systems in Uganda have embraced community engagements though in a more adhoc way through health unit management committees and village health teams. However, the gap with existing committees is the lack of a structured way of generating feedback and carrying on engagements within the structure of the health system from community-health facility-district-district to national level. This community engagement framework presents a latent opportunity to build and strengthen mechanisms through which persons living with HIV can play a critical role in shaping not only availability, accessibility, acceptability but as well quality of existing HIV/TB and SRHR services. This engagement framework provides a coherent process that links a focused HIV/TB and SRHR monitoring tool to meanignfully developing a constructive dialogue with duty bearers from local government to national-global levels and aligns them in a way that leads to changed conditions and systems for better and effective HIV/TB and SRHR services for PLWH. The community feedback will be used to initiate changes inside the health system and potentially optimize system performance, lead to better-quality, safer HIV/TB and SRHR services for persons living with HIV so as to achieve improved health outcomes at the individual, community and population level. As a practical resource it provides a clear definition of community engagement and importantly sets specific standards for community engagement that all Partners must adhere to. It identifies the first wave of priority actions that must be taken to improve community engagement in the city

Civil Society Guidebook to Community-Led Monitoring for HIV/TB Service Delivery:

This guidebook has been prepared to guide civil society actors and communities, including organizations of people living with HIV (PLHIV), young people and key populations (KPs), in monitoring the quality of the HIV and TB services at PEPFAR-supported sites in Uganda. It provides step-by-step instructions on how to conduct community-led monitoring at the clinic and community levels. It contains basic information about HIV in Uganda and the role of the PEPFAR program; how to gather and capture data, analyze it, and use the findings to come up with solutions to engage duty bearers and advocate for change for the benefit of communities.

CLM Pilot Study Report

Communities and People Living with HIV/ AIDs have a central role to play in HIV response, especially regarding universal access to HIV care. Communities also play a vital role in ensuring accessibility, availability, and acceptability of health services. In particular, collaborating with community members to identify barriers and enablers of utilization of HIV services, as well as holding healthcare providers accountable is crucial to PEPFAR’s client-centered approach. Implementation of community-led monitoring mechanisms has shown to improve service delivery at facility-level, health system-wide infrastructure and health outcomes among recipients of care. The goal of the pilot was to test effectiveness of the tools (both questionnaires and data collection systems) to be used during the main phase Community Led Monitoring and assess for relevance of the questions as well the approaches to be used during the main phase of CLM project implementation.

PEPFAR CLM

HEPS is one of the three core leading Community Led Monitoring (CLM)
implementation in Uganda, HEPS also dubs as the fiscal agency for CLM in Uganda.
Community-Led Monitoring (CLM) also known as the “Iraka Ly’Abantu Project” is a