Uganda Red Cross Community Home Based Care (HBC) for PLWHA projects in Kampala South and Katakwi/Soroti

Background

The Uganda Red Cross Society started up a Home Based care program in 2002 with the support of the Norwegian Red Cross. The program is located in two geographical areas - Kampala South and Kapelebyong in Katakwi district, but falling under Soroti branch of Uganda Red Cross. The main objectives of the programme were:
? to build the capacity within the two Uganda Red Cross Society branches and communities for mitigation of the spread of HIV and support of PLWHA, to provide basic counselling support to people living with HIV and Aids and their families,
? to minimize the negative social impact caused by HIV and Aids through material support to PLWHA and their families,
? to sensitize the public and promote positive attitude towards people with HIV and Aids and their families (anti-stigma and anti-discrimination campaign).

Purpose/objective

The Mid Term Review was conduced in order to review the implementation of the project so far, with the view to assess the achievements, lessons learnt and make recommendations on the way forward for the project on the following programme elements:
• Branch Capacity building
• Project Management and Human resources
• Beneficiary selection and support (material and nutritional)
• Collaboration and networking
• Community preventive efforts
• Introduction of ARV

Methodology

The methodology adopted was participatory which included initial discussions with URCS Headquarters staff, project staff, review of literature and programme documents, individual interviews both at URCS Headquarters, Branches and Project areas followed by focus group discussions with all key stakeholders at all levels.

Key findings

• There is a need to improve communication, networking and collaborative efforts at all levels (national, district, branch and community levels) in a bid to promote URCS Home Based Care Program, advocate on behalf of PLWHA and for resource mobilisation. For example, the Kampala South branch could benefit from wider representation on its Project Management Committee.
• More resources should be invested in capacity building especially for the project officers (in areas such as HIV/AIDS communication and basic nursing skills, for example) and the possibility of drawing on the resources of key partners could be explored.
• Good documentation practice of all relevant project documents for monitoring performance should be encouraged including documentation of important decision making processes.
• To improve the success rate of the IGAs, the URCS should provide training to the beneficiaries in the generation of income and management of savings. Promoting successful IGAs through publicity and bonuses could provide incentives for improving on the scheme.
• Psycho-emotional support to HBC facilitators should be further structured and organized into a proper psychological support program for volunteers. In order to guarantee that the facilitators are trained and competent, URCS should provide course curriculum, training manuals and topical handouts for participants (in local languages) to the project officers as well as using case studies from within the project areas to train the volunteers. It is also urgent to equip HBC facilitators with nursing kits, torches, boots, and umbrellas to improve conditions of work. Additionally, secondary care takers should also obtain the basic nursing equipment to ensure proper nursing care in absence of the HBC facilitators.
• Improve on the Home Visit Forms/records to better categorize clients according to their condition especially by incorporating a check list to better appreciate and capture the patient's situation and needs (e.g. his/her medical, socioeconomic, physical and emotional conditions). Improving the quality of this Home Visit Form will make it possible in the future to measure the quality of care provided by HBC facilitators.
• It is imperative now to initiate treatment literacy for volunteers and treatment preparedness for the community in light of the management of opportunistic infections and ARV scale up for PLWHA.
• The program for positive living clubs should be further structured and reactivated to network with the PLWHA forum.
• KAPB study should be carried out and appropriate local IEC messages developed for targeted groups. In order to measure the behaviour change impact of the projects at household and community levels, it's imperative that baseline surveys be carried out.
• Considering the fact that URCS Home Based Care Project areas are already involved in ARV drug initiatives, it is recommended that URCS explores its comparative advantage in the provision of ARVs to the rural communities and starts planning for such implementation in a phased manner.

Comments from the organisation

The Uganda Red Cross took the recommendations into consideration when preparing the 2005 plan and included more training for the volunteers involved, standardised the registration and reporting formats and decided to base the nutritional support on individual needs. In addition - Uganda Red Cross has become one of 6 Red Cross Societies in Africa piloting ARV therapy to the beneficiaries involved in the HBC projects.