In the name of God the Most Gracious Most Merciful

Faith-based organizations and Government Partnerships: experience from Uganda on

the successes and challenges in implementing the Global Plan to eliminate

New HIV infections among children.

Presentation From Uganda

Presenter: Prof. Magid Kagimu, MBChB, M.Med, MSc, PhD.

Chairman, Islamic Medical Association of Uganda (IMAU), and Director, Postgraduate Programme,

Department of Medicine, Makerere University College of Health Sciences.

Best Teacher Award 2010/2011

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Introduction Uganda is implementing option B+ and HIV Treatment for

eMTCT through the Public Private Partnerships for Health (PPPH) approach Public Health Sector (Central & District Local Governments)Private Not For Profit health providers (PNFP-FBOs) Private Health Practitioners (PHP) “Traditional and Complimentary Medicine Practitioners

(TCMP)” The health sector Faith Based Organization fall under four

umbrella organisations Uganda Catholic Medical Bureau (UCMB), Uganda Protestant Medical Bureau (UPMB),Uganda Muslim Medical Bureau (UMMB), and Uganda Orthodox Medical Bureau (UOMB).

Together these bureaus represent over 75% of the 863 PNFP health units while the remainder fall under other humanitarian organisations and community-based health care organisations.

IntroductionThe FBOs provide health services to the

population from established static health units/facilities and work with communities and other counterparts to provide non-facility-based health services and technical assistance.

The FBO-PNFP sector presently has over 863 health units (64 Hospitals, 15 HC IVs, 264 HC IIIs and 520 HC IIs). These facilities are largely found in the rural areas (86%).

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IntroductionMoH operates 2,844 (63 Hospitals, 170

HC IVs, 916 HC IIISs and 1695 HC IIs). Of the 48 health training schools in the

country, 20 are operated by FBO-PNFP organisations.

GOU through MoH seconds Staffs to FBOs

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Introduction HIV/AIDS Funding to the private sector is

largely through the AIDS Development Partners

GOU through the National Ware house (Joint Medical Stores, and Medical Access Uganda Limited), provides ARVs, HIV test kits and lab Reagents free of charges to the private sector

In addition GOU supports non-facility based services through national programmes such as Community and Environmental Health and Communicable Diseases Control.

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Experiences with service deliveryModels used by the FBOs incorporate Faith as an important component of HIV/AIDS prevention, treatment and care. An example from IMAU is the “Faith-based approach to accelerating delivery of comprehensive HIV/AIDS Prevention, Treatment and Care services (FABAPTCA)”. This contributes to all four prongs of PMTCT:

1.Prevention of HIV infections among potential and actual mothers and fathers

2. Prevention of unwanted pregnancies among HIV positive women

3.Prevention of HIV transmission from HIV positive mother to the child

4. Prevention of AIDS- related illness and death among HIV positive mothers and their children

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The ProblemHIV new infections continue to rise every year from 84,000 in 1994 to 130,000 in 2011.

HIV prevalence rose from 6.4% in 2005 to 7.3% in 2011.

HIV/AIDS is the leading cause of adult deaths.Everyday 353 new HIV infections and 175 deaths. Every one death, 2 new HIV infections occurMulago Ward 4A, where I work, death certificate books from Jan – July 2012 showed 134/194 (69%) deaths due to AIDS, majority 81/134 (60%) women.

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Faith-based Approach to accelerating delivery of comprehensive HIV/AIDS Prevention, Treatment and Care Services (FABAPTCA)

Benefits of 5-pillar faith-based approach to HIV/AIDS prevention Each of its five pillars has empirical scientific data

supporting it from our research study done among 15-24 year old youth in response to the challenge that the FBAA was unscientific and not evidence based.(1) Believing in God and His messengers (The Messengers of God include Angels, Prophets, Parents and Religious leaders) Feeling guided by God in daily activities is associated with lower HIV infections.

Parental guidance is associated with lower HIV infections.(2) Learning Scientific information: Higher levels of religiosity are associated with lower HIV infections.

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Benefits of FBAA (3) Using faith teachings:

Frequent prayers are associated with lower HIV infections

(4) Forming partnerships with religious leaders: Listening to or watching religious programs on radio and TV is associated with low HIV risk behaviors.

(5) Using concept of self-control: Fasting as a means of self-control is associated with lower HIV infections

All these components contribute to the socialization process of an individual from the religious perspective and have a big role to play in HIV prevention and control

There is data from our research study among the 15-24 year old youth which supports the role of religiosity in HIV prevention

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Association between religiosity and HIV among Christians (Epidemic Stoppers)

Dimension Casesn (%)

Controlsn (%)

Odds ratio

95% CI p-value

Daily spiritual experiences

Feeling guided by God in daily activities High (many times a day) Moderate

Feeling thankful for God’s blessings High (many times a day) Moderate

14 (13)92 (22)

18 (14)88 (22)

95 (87)328 (78)

112 (86)311 (78)

1.90

1.76

1.03- 3.50

1.01- 3.11

0.035

0.042

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Association between religiosity and HIV among Christians

Private religious practicesPraying privately other than

atchurch High (several times a day) Moderate

51 (16)54 (27)

276 (84)145 (73) 2.02 1.30- 3.11 0.001

Dimension Casesn (%)

Controlsn (%)

Odds ratio

95% CI p-value

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Association between religiosity and HIV among Christians

Religious commitmentTrying hard to be patient in dealings

with oneself and others High (strongly agree) Moderate

Trying hard to love God with all one’s heart, soul and mind High (strongly agree) Moderate

26 (15)80 (23)

44 (16)62 (24)

153 (85)270 (77)

223 (84)200 (76)

1.74

1.57

1.07- 2.84

1.01- 2.42

0.024

0.039

Dimension Casesn (%)

Controlsn (%)

Odds ratio

95% CI p-value

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Significant association between religiosity and HIV among Muslims (Epidemic Stoppers)

Characteristic HIV Positive N(%)

HIV Negative N(%)

Oddsratio

95% CI p-value

FastingHigh (≥ 1 month per year) Moderate

SujdaYesNo

21(2)8(5)

6(1)22(3)

1,009(98)156(95)

487(99)651(97)

2.46

2.74

1.07-5.67

1.10-6.83

0.028

0.024

Parental ExistenceBoth parents aliveOne or both parents died

9(1)19(4)

720(99)470(94) 3.23 1.45-7.23 0.003

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Association between religiosity, HIV-risk behaviours and HIV infections on bivariate analysis of combined Muslim and Christian youth

Characteristic High religiosity N(%)

Moderate religiosity N(%)

Low religiosity

p-value

Ever had sex No (abstaining = A) Yes

Ever drank alcohol No Yes

94 (28)240(72)

192(58)140(42)

34(14)210(86)

98(40)145(60)

1 (6)17(94)

6 (33)12(67)

<0.001

<0.001

HIV status Negative (controls) Positive (cases)

Ever used narcotics Yes No

282(84)52 (16)

9 (3)322(97)

183(75) 61(25)

22 (9)218(91)

15 (83) 3 (17)

1 (6)17(94)

0.017

0.004

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Collaboration between Government and FBO

FBOs participate in Policy formulation, revisions and dissemination and in High level fora such as Health Policy and Advisory Committee, Country Coordinating mechanism, UAC Board, etc

Govt. supports FBOs service delivery through:1. Primary health care funds2. Training health workers – in-service3. Supervision of health facility4. Antiretroviral and Anti-TB medicines5. M & E and IEC materials.

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Factors responsible for success in FBOs Service Delivery:1. For God and my country ( Uganda

motto),On God’s selfless health service (IMAU mot to), imitate the healing ministry of Christ (UCMB & UPMB)

2. Religious leaders support3. Local council leaders support4. Faith teachings5. Training religious leaders6. Incentives for volunteers e.g. Bicycles,

lunch allowance.7. Supportive supervision through monthly

meetings8. Interreligious collaboration 9. Funding for infrastructure, human

resources and logistics10.Accountability to community and donors.

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Factors responsible for success in Govt/FBO collaboration -1:1. An enabling environment of Public Private

Partnership for health that allows for effective coordination of efforts among all partners

2. Every year the FBO sector qualifies between 500 and 600 nurses/midwives (over 60 % of the total Country annual output). These staff are deployed in both Public and Private sectors.

3. The FBO-PNFP operates 40% of all hospitals and 20% of all lower-level health centres, and currently employs approximately 34% of the facility-based heath workers in the country.

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Factors responsible for success in Govt/FBO collaboration:4. The partnership has enabled the country to

mobilize additional resources to improve the health of the population (from abroad, through user fees, and through various local initiatives for income generation)

5. The total contribution of government of Uganda to the FB-PNFP has been increasing over the years from Uganda Shillings 3bn in 1998 to Uganda Shillings 18bn in 2010.

6. Cooperative Government officers7. Accountability and trust.

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Challenges

FBOs model of service delivery challenges :1. Inadequate funds

to sustain volunteer motivation, through training , supervision and

other incentives, and for regular supply of commodities.

2. High expectations from religious leaders and communities of sustained funding of activities because of poverty.

3. Inadequate scaling up of FBO models for greater impact

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Challenges in Govt/FBO collaboration:4. Bureaucracy causing delays in receiving

government support5. Heavy burden of Parallel M & E Systems 6. Human resource inadequacies & mal-distribution

between urban and rural settings and attrition of qualified staff from PNFPs to public facilities and private practice continues to be a problem.

7. Poor infrastructure especially inadequate laboratory services (EID, CD4, Viral load)

8. User fees increasing with rising cost of service delivery

9. Infrequent and poor Technical Assistance by the public sector

10. Doctrinal stand of the FBOs on certain services e.g. FP and some so called human rights approaches

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Recommendations1. Govt and FBOs should recognize and accept

the value of the faith-based approach to HIV prevention and allow each partner to perform their role in accordance with their belief system.

2. Govt and FBOs should plan, implement and monitor the HIV/AIDS response together.

3. Govt and FBOs should scale up faith-based approaches to HIV prevention such as:

i. Five pillar faith-based approach to HIV prevention

ii. FABAPTCA model of health service deliveryii. Move beyond the ABC strategy to ABCDE.

D=Diini ( religiosity), E= Education

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Recommmendations 4. Govt and FBOs should mobilize funds for

activities to support religious leaders and their assistants including:

i. Training and refresher training in HIV/AIDS service delivery

ii. Incentives – transport, communication, allowances

iii Funding the Religious leaders activities as well, since they contribute to HIVAIDS service delivery and not stop at the religious health institutions

iv. Support supervisionv. IEC materials, media activitiesvi. Income generating activities to address

PID (Poverty, Ignorance and Disease)22

Recommendations5. Govt and FBOs should mobilize funds to support

Health care workers especially providing performance related allowances

6. Govt and FBOs should mobilize resources to support FBOs to champion the faith-based approach to HIV/AIDS activities of:

a)Advocacyb)Coordination c)Information, education and communicationd)Traininge)Health service deliveryf) Monitoring and evaluation e.g. setting up

surveillance sites to monitor the outcome and impact of the faith-based approach to HIV/AIDS on HIV prevention.

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HIV Prevention is better than cure

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Supporting faith with knowledge

The second Epistle General of Peter Chapter 1 verse 5:

And beside this, giving all diligence, add to your faith virtue; and to virtue knowledge.

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Govt/FBO collaboration in knowledge generation

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Govt/FBO collaboration in Knowledge generation

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