MOBILE AIDS HOME CARE, ORPHANS AND EDUCATION …



KITOVU MOBILE AIDS HOME CARE AND ORPHANS PROGRAM

MASAKA, RAKAI, SSEMBABULE

ANNUAL REPORT 2000

INTRODUCTION

Over the past 13 years that Kitovu Mobile Home care and Orphans Program has been in operation, it is worth saying that a lot has been achieved in the struggle against HIV/AIDS and the effects it has had on the community.

During the Program’s various interventions, it has been continuously observed that HIV/AIDS is not only a health problem but also one that is at the very heart of development. It has a profound effect on the society as it strikes predominantly at the main providers of food, income and care plus increasing the vulnerability of children and the elderly. Many people have got involved in responding to HIV/AIDS because the disease has affected them personally or some one close to them. This program works with over 750 Community volunteers who are involved in the care for people infected and affected by the deadly disease.

In the Program’s half-year progress report, we clearly explained the new millennium hopes/fears and the impact they had on the targeted communities/people and the program’s activities in general. It suffices to say that all the hopes melted like snow and everything went back to normal though living a number of scars on some people’s lives. However, as mentioned in that report, the program had to continue as normal as possible up to the end of the year amidst all the challenges that availed at the time.

This year we were privileged to be one of the few Programs that hosted the Executive Director of UNAIDS, Peter Piot on the World AIDS day before he proceeded to the National Celebrations at Kasaali Sub-county in Rakai District. With the theme of the year: AIDS: MEN MAKE A DIFFERENCE, he noted that: “The time is ripe to start seeing men not as some kinds of problem, but as part of the solution”.

The HIV/AIDS situation

Statistics concerning the situation of HIV/AIDS and the resultant effects are continuously being presented to the World. This year, 3.8 million Africans were infected by HIV compared to 4 million in 1999 (UNAIDS). Sub Saharan Africa now accounts for 25.3 million of the 36.1 million living with HIV or AIDS globally (New Vision 30/11/00). A total of 16.3 million people have died since the epidemic began. Of these, 12.7 million were adults, 6.2 million being women, while 3.6 million were children below 15 years (UNAIDS).

Uganda in particular was estimated to be having 1,438,000 people living with HIV/AIDS by June 2000. However, the infection rate is said to be dropping from 30% in 1991 to 10% in 1999. Despite the decline, the infection rates are still unacceptably high. The risk of a future rise in prevalence should not be discounted and therefore there is a need to continue and deepen the health education efforts to sustain the fall in prevalence.

As such statistics are being discussed and reviewed from time to time, it is important to remember that behind every statistic is a real person, real family or real community. In real sense, these figures may certainly mean nothing to the orphans/teenage school dropouts and elderly grandparents who have lost their dear ones due to AIDS and are suffering the consequences.

A reality is the growing numbers of destitute orphaned children over the world. Globally, 13.2 million children had lost their mothers to AIDS before they turned 15 years and 90% of the estimated number according to a UNICEF report live in Africa, south of the Sahara (New Vision 20/09/00).

In the same vein, it is said that Uganda has the biggest number of orphans (between 1-15 years) in Africa with the registered total at 1.7 million where by 1.1 million are as a result of AIDS, which killed their parents (New Vision 21/06/00). As for Masaka District alone, 60% of the children population are AIDS orphans (Chairman L/C 5 – Masaka). In this program alone, the AIDS clients who died left 1,583 orphans behind. These percentages actually represent only a small percentage of a far larger tragedy.

Research indicates that if people do not use their skills to prevent the spread of HIV/AIDS, the number of orphans will rise to 2 million by the year 2001 (New Vision 21/06/00).

Within the African society, and Uganda in particular, the enormous numbers of orphans have always been incorporated within the extended family system. Unfortunately, this system is rapidly integrating. In this case, the country is likely to see more child-headed households and this has far reaching implications for the already poor economy. Not only will there be more school-dropouts, there will also be an upsurge in the streets.

Therefore, extended families should be supported in order to care for the many destitute children. This Program has overtime tried to alleviate the situation within the targeted areas though the work is still enormous and being aggravated by poverty, limited funding and other psychosocial and moral problems.

The work that enhances gender awareness, sensitivity and development should focus on the needs of both women and men. On the side of HIV/AIDS, (see theme for World AIDS campaign 2000) it is important to enhance the strategies aimed at working with men in the straggle against the virus. Helping them to change their attitudes and behaviours will have a positive effect on the epidemic.

On the other side of the coin, there is need to deal with the more difficult aspects of HIV such as the status and position of women in sexual relationships if we are to control HIV further.

Programme Goal

□ To mitigate the psychosocial and economic consequences of HIV/AIDS among the targeted communities.

Target Groups

□ People living with HIV/AIDS

□ Orphans and their families

□ Teenage school dropouts and their families

□ The Youth and Women

□ Community Workers

The Programme Activities in General

• HIV/AIDS Home care

← Medical and palliative care

← Counselling

← HIV testing

← HIV/AIDS awareness / Health education

← Social/material support

• Orphans care/Family support

← Training teenage school dropouts in sustainable modernised organic farming

← Formal education and vocational training

← Income Generating Activities (IGA) for orphans’ families

← House construction/repair for needy families

• HIV/AIDS preventive education/behavioural change process and training to all targeted people/communities.

• Psycho-social/counselling support

← Individual/group/family counselling

← Peer counselling

← Bereavement counselling

← Training counsellors

A. HIV/AIDS Home Care

The Home Care team continued to care and support the AIDS clients by offering medical, palliative care, counselling, social support, HIV testing and TB identification and treatment plus HIV/AIDS awareness / health education at patient care centres and within patients’ homes.

In September 2000, the Home Care team resumed its activities in Rakai District although two Sub Counties of Kifamba and Kasasa were dropped due to the tight budget approved by the District. Activities were resumed in Byakabanda, Lwanda, Nabigasa, Rakai town Board, Lyantonde urban and rural, Kaliiro, Kinnuka and Mpumudde Sub Counties.

On board, is a Doctor who joined the Program in June 2000 specifically to deal with more complicated cases referred by nurses/counsellors in addition to palliative care and TB diagnosis and treatment.

During the course of work we encountered many social cases, some with medical problems such as Vesicle Vaginal Fistula and a big number of orphans left behind by our AIDS clients.

A.1 Project Objectives

1. To prolong the lives of people living with HIV/AIDS and allow them to die with dignity.

2. To help the targeted families cope with the challenges of the HIV/AIDS epidemic.

3. To increase awareness of HIV/AIDS preventive measures and health education among the target communities.

A.2 Brief description of the current local, regional and national situation and how this affects both beneficiaries and the implementation of the project.

( The Government in collaboration with other partners on HIV/AIDS developed a 5-year strategic framework for HIV/AIDS activities in the country. In order to implement activities of the strategic framework, the Government has already embarked on a resource mobilisation drive. The implementation of this strategic framework shall cost the country US $ 181 466 030. Inspite of the Government’s commitment to mobilise resources, all other partners including NGOs have to mobilise resources to implement planned activities.

( Similarly, Government and the World Bank have negotiated a loan with concessionary terms to support efforts to reduce the rate of HIV transmission, and mitigate the socio-economic impact of the epidemic at household and community levels. This project also recognises the need to take the struggle in the community by supporting orphans, child and elderly headed households to be able to cope with challenges of the epidemic; through the community led HIV/AIDS initiative (CHAI), which will be entirely community based.

( As mentioned in the introduction part of this report the HIV/AIDS situation in the country and in particular the Program’s operational area is still worrying although a drop in the prevalence rate is observed. We still experience a high turn up of new AIDS cases at the patient care centres within the targeted areas.

( Most of the HIV/AIDS infected and affected are vulnerable people and this calls for a need to care and support them. With the existing available resources, most actors in this field do not have enough capacity/resources to cater for the many needs of this group.

( TB is also spreading rapidly as a result of HIV/AIDS. It is reported that every other person with TB infects 14 people per year! So you can imagine soon or later we may all get infected with the disease. The Government is trying to devise means of Community Based system -Direct observation Treatment System (DOTS) to control the infection. This will ensure that a client has taken the treatment witnessed by community trained personnel, and will reduce the incidence of defaulters.

A.3 HOME CARE ACTIVITIES CARRIED OUT IN 2000

A.3.a) Medical care

( A total number of 2,320 individual clients were attended to. This was an average of 17,823 repeat visits. Of these, 60% (1,401) were female, 28% (643) male and 12% (276) children. The new clients 56% (1,289) were slightly more than the old clients 44% (1,031). Majority of the clients treated had diarrhoea, oral thrush, pain due to peripheral neuropathy, headache and fevers and most of them responded positively to treatment. The numbers of clients treated this year dropped by 23% compared to those of 1999 due to a cut back in the areas served in Rakai District.

( Reflexiology as well played a big role in the relief of pains such as headache, backache, anxiety, joint pains, muscle pains etc for those patients that received this treatment regularly.

( Herbal medicine has also been used to complement the western medicines and it has been found to be effective in some conditions such as herpes zoster, oral thrush, ulcers, otitis and skin conditions. It was observed that almost 80% of our clients use herbal medicine on top of other medicines.

Statistics for AIDS clients treated/counselled in 2000

Table 1

|Area |New |Old |Male |Female |Child |Total repeat visits |

|Masaka Municipality. | | | | | | |

| |207 |287 |121 |303 |70 |4,233 |

|Masaka & Ssembabule | | | | | | |

|Districts |851 |396 |349 |741 |157 |9,135 |

|Rakai District | | | | | | |

| |229 |350 |174 |358 |47 |4,455 |

| | | | | | | |

|Sub total |1,287 |1,033 |644 |1,402 |274 | |

| | | | |

|TOTALS |2,320 |2,320 |17,823 |

Statistics for AIDS clients Died in 2000

Table 2

|Area |Dead Male |Dead Female |Dead Child |Orphans left |

| | | | |(Under 18 years) |

|Masaka Municipality. | | | | |

| |41 |63 |15 |283 |

|Masaka& Ssembabule Districts | | | | |

| |148 |205 |18 |893 |

| | | | | |

|Rakai District |86 |90 |12 |417 |

| | | | | |

|Sub total |275 |358 |45 | |

| | | |

|TOTALS |678 |1,593 |

A.3.b) Palliative care

( In August 2000, Dr. Carla Simmons took up a full time position as advisor to the Home Care nurses. Pain relief using the WHO Pain Relief ladder has been a priority. Twenty-six patients were treated with Morphine for pain relief or diarrhoea by the end of 2000.

( Over the past two years there has been a small element of palliative care in the Home Care Program. In 1999 two patients were started on Oral Morphine Solution for the relief of pain. Both patients had AIDS, one complicated by extensive Karposis Sarcoma and the other with Cancer of the Vulva. The second patient died within two months of starting treatment. She received great relief from the medication brought by the Home Care team, both pain relief and relief from the unpleasant odour from her cancer. The first patient was on Morphine for 22 months. In the latter part of his illness he had one leg amputated. He improved after surgery but subsequently died three months later. The fact that this patient in the last year of his life was cared for solely by his young children made it imperative that we keep him as comfortable and pain free as possible.

Statistics for patients treated with Morphine in 2000

Table 3

|Patients treated with Morphine |Home |Hospital |Type of Morphine |Length of treatment |

|HIV/AIDS |17 | _ |Morphine Liq. |Ave. 4.5 weeks |

|Cancer | 6 | 1 |MST or Liq |Ave. 5 weeks |

|Painful Medical Condition | _ | 2 |MST |Ave.1 week |

( The patients with HIV/AIDS had several painful conditions. The most common was Kaposi Sarcoma. Others had Cryptococcal Meningitis, Genital Herpes and Generalised pain. Morphine was also used to control diarrhoea in the terminal phase. All of the HIV/AIDS clients were referred for palliative care by the Mobile Home Care team. They were all treated in their homes.

( Patients suffering from Cancer had Cancers of the liver, the stomach, oesophagus, ovary, bladder and bone. Of the seven patients, three were referred as in-patients in the hospital and subsequently treated in their homes. The other patients were self-referred or referred by family when they learned that palliative care was available.

A.3.c) Tuberculosis Cases

( In 2000, 412 patients were tested for TB. 37 were positive as compared to 209 patients tested in 1999 with 26 positive. HIV/AIDS patients who tested positive elsewhere also received their TB treatment from the Home Care nurses, as did those patients diagnosed clinically with TB despite the negative sputum results. Actually, bringing the TB medicines to the patients every two weeks in their home areas ensured that they always got their medicine and did not have the added expense of travelling to hospital to get it. In a few cases, help was given in the form of food or funds to enable patients to buy food as taking the medications without having an adequate diet was very unpleasant and could cause patients to default.

Statistics for TB clients treated in 2000

Table 4

|TB clients treated in 2000 |166 |

|Clients continuing from 1999 | 48 |

|New clients |118 |

|Completed treatment | 52 |

|Died | 28 |

|Defaulters | 12 |

Note: In 2001 it is hoped that we will have funding to do more extensive contact tracing. Testing and follow up as well as institute prophylaxis for children under five living with sputum positive adults.

A.3.d) HIV Testing

( Many clients came seeking medical care, some with full blown AIDS and others with minor or no signs at all, but just worried of their status. Through counselling, nurse/counsellors identified cases for testing. After pre-test counselling, a blood sample was collected from the client and taken to Kitovu Hospital Laboratory for testing. A total of 374 samples were tested out of which 58%(218) were negative and 42% (156) were positive. See details of the results in table 5 below.

Statistics of HIV Tests done in 2000

Table 5

| |Masaka and Ssembabule Districts |Rakai District |Masaka Municipality |Grand total for all Districts |

|Sex |Neg |Pos |

|YEAR |NEW |OLD |TOTAL |Repeat visits |MALE |FEMALE |CHILD |

|Lwengo |28 |1 |11 |- |- |1 |5 |

|Kisekka |43 |1 |8 |2 |- |- |10 |

|Kabira |45 |1 |8 |2 |2 |- |56 |

|Kyanamukaaka |68 |1 |17 |5 |3 |4 |1 |

|Lwankoni |52 |6 |5 |- |- |- |- |

|Totals |236 |10 |49 |9 |5 |5 |72 |

B.5.f) Start up assistance

( As explained in the June 2000 progressive report, this was a special fund from Mr & Mrs Ketter from Germany who visited this project towards the end of 1999. During their visit, they volunteered to help the trainees initiate viable projects. At least 65% of them have benefited from this grant.

Statistics of all trainees’ projects resultant from the Start up Assistance

Table 8

|Sub-county |Cattle |Piggery |Goats |Cultivation |Rehabilitation of |

| | | | |seasonal crops |plantations |

|Lwengo |10 |10 |10 |10 |10 |

|Kisekka |10 |10 |10 |10 |10 |

|Kabira |10 |10 |10 |10 |10 |

|Kyanamukaaka |10 |10 |10 |10 |10 |

|Lwankoni |10 |10 |10 |10 |10 |

|Totals |50 |50 |50 |50 |50 |

( By and large, the projects have helped the trainees to raise some income and also to trap manure from the animals. The latter has lead to improvement on soil conservation and fertility resultant in increased yields.

B.5.g) Market Research

( Trainees were encouraged to form co-operative groups where by their produce could easily be sold in bulk. To this effect, a number of trainees have already initiated groups and this has some how made it easier for them to sell their produce.

( As a means of supporting trainees and encouraging them to produce more, the program tried its best to search for possible markets. St. Jude Busense was one of the few that provided market for the trainees’ produce mainly vegetables. Other occasional markets were Kitovu Hospital, the program staff and visitors. Most of the produce was sold locally within the local market and among community members. However, marketing still remains a big challenge.

B.5.h) Extra curricular activities

(As usual, the trainees involved themselves in several other activities outside farming such as games and sports, music, dance and drama. They also exchanged visits between sub-counties and held competitions in the above fields. Similarly, some of them participated in domestic work for example handcrafts, making doughnuts, chapati and simsim cakes.

B.5.i) MFS Final Exams

(The MFS final exams were conducted between September and October for all the 5 sub-counties. It was such an exciting but tough moment for most of the trainees. The exams were both written and practical. The theory exams were set in consultations with the two officials in charge of production/agriculture from the two Districts of Rakai and Masaka. The practicals were periodically assessed throughout the training and the final mark was an average of the total marks gained throughout the training period. However, some trainees completed the course but did not do either all or some of the written exams for unknown reasons. Only those that did their exams and graduated are reflected in table 9 below.

B.5.j) The Graduation ceremony

( The occasion was segmented into the District boundaries. Before the graduation ceremony took place, the certificates were prepared in consultation with the District production officials who later endorsed them. For Rakai, the occasion took place at Kabira sub-county headquarters and was presided over by the chairman LC 5. In Masaka District, the venue was at Mbirizi Primary School and the occasion was presided over by the District extension co-ordinator delegated by the chairman LC 5 who was out of the county at the time. Several other dignitaries from the District/local government, religious and funding representatives plus the guardians of the trainees and other community members were also present.

Statistics of trainees who graduated plus their results per sub-county

Table 9

|Sub-county |No. Sat |THEORY |PRACTICAL |

| | |

|Secondary schools |155 |

|Technical schools |50 |

|Teachers Training Colleges & N T C |70 |

|Nursing schools |10 |

|Vocational schools |90 |

|Commercial schools |30 |

|University |5 |

|Primary schools |90 |

|Totals |500 |

B.7 Community Support

B.7.a) House construction

During this period, some vulnerable families who had no shelter/whose houses were in bad condition got financial support to construct new houses. As usual, the number of families that qualified for such support out numbered the available resources. Worse still, because of the rampant poverty and famine in the area, the beneficiaries/ communities were not able to meet what was budgeted for as community contribution.

This constrained much on the budget allocations. By the end of the year, 40 new houses had been put up, 1 repaired, 2 latrines and 2 kitchens constructed. The beneficiaries were grateful to KNH and Mr & Mrs Ketter for this assistance that rescued their lives.

B.7.b) Family IGAs

( The program continued with its integrated support to the targeted HIV/AIDS stricken families. Support through training and finances have been granted to promote self-reliance and in particular food security within the targeted vulnerable families. There is a number of on going Income Generating Activities (IGAs) within the families and this year the program was able to support 10 families with new IGAs.

( Orphan-headed households in particular have been offered paramount care. They have been helped psychologically, socially and financially. Individual/family counselling has contributed a lot to the social well being of these families. In this year alone, 16 families of this kind were helped to acquire land and descent housing, and are able to grow enough food for home consumption.

B.8 Community Workers’ Projects

( As mentioned in the previous reports, the CWs received financial assistance in kind of grants to initiate IGAs. They formed 40 co-operative groups with 253 members and these groups have continued to operate scattered all over the program areas. Most of the groups are doing well except for some few that are still weak mainly due to sickness and old age of some members.

( Generally, the IGAs have helped to improve on the social and economic well being of the members particularly those that are doing extremely well. More so, these groups have promoted solidarity among the CWs and motivated them as well.

( The groups are regularly monitored by CWs themselves, field co-ordinators and the Orphans’ co-ordinator. The latter visited them once this year and advised them on how to sustain the groups in good performance. The program agriculturists occasionally visited them for technical advice and input on farming skills.

B.9 Implemented activities, which were not planned and/changes according to plans

Most of the activities were implemented according to plan except for a few as mentioned below:

• The inauguration of the MFS was not done due to some bureaucracies at District levels.

• Some of the topics in the MFS were not fully exhausted due to funding constraints. For example, the topic on “Food Processing” was covered theoretically but the skills could not be implemented due to shortage of funds to avail the simple machines and equipment required. For the “Adaptable irrigation system”, only one of the methods (use of polythene bags) could be practically done but the one with drip irrigation kit was not possible due to a similar problem.

• As regards promotion of food security, the trainees produced enough food to be stored but unfortunately, we could not assist with food security facilities like granaries and solar dryers due to shortage of funds. This lead to selling of their produce at an earlier stage before they could get spoiled. This had an impact on the selling price and the possible incomes in general.

Statistics for Farm School Trainees / Monthly attendance per sub county for year 2000

Table 11 - CN Supported area

|Month |Kabira |Lwengo |Kisekka | |

| |Male |Female |Male |Female |Male |Female |TOTALS |

|Jan. |52 |19 |47 |19 |54 |15 |206 |

|Feb. |52 |19 |47 |19 |50 |17 |204 |

|March |50 |19 |46 |17 |50 |17 |199 |

|April |51 |16 |46 |15 |47 |17 |192 |

|May |50 |14 |46 |13 |45 |16 |184 |

|June |49 |14 |44 |12 |40 |17 |176 |

|July |48 |13 |44 |13 |40 |17 |175 |

|Aug. |47 |13 |43 |11 |40 |17 |171 |

|Sept. |47 |13 |43 |11 |40 |17 |171 |

|Oct. |FINAL EXAMS |

|Nov |FINAL EXAMS |

|Dec. |GRADUATION CEREMONY |

Table 12 - KNH supported areas

|Month |Kyanamukaaka |Lwankoni | |

| |Male |Female |Male |Female |TOTALS |

|Jan. |75 |19 |47 |23 |164 |

|Feb. |75 |19 |47 |23 |164 |

|March |73 |18 |45 |20 |156 |

|April |72 |19 |45 |18 |154 |

|May |70 |19 |42 |17 |148 |

|June |70 |18 |40 |17 |145 |

|July |63 |18 |39 |16 |136 |

|Aug. |60 |14 |39 |16 |129 |

|Sept. |60 |14 |39 |16 |129 |

|Oct. |FINAL EXAMS |

|Nov. |FINAL EXAMS |

|Dec. |GRADUATION CEREMONY |

Total Beneficiaries of the Farm School for the year 2000

Table 13

|Sub County |Trainees |Other children | | |

| | | |Guardians |Other Adults |

| | |In school |Not in school | | |

| |F |M |F |M |F |

B.10 Achievements of Project Goals according to Indicators

( Out of the 370 trainees that were in training at the beginning of this year, majority 88% (299) managed to complete their course in modernised sustainable organic farming. This is approximately 75% of the total number that began the course in August 1998.

( The trainees had their graduation in December 2000. For all those that successfully passed the exams, certificates of adoption were granted. Those who excelled in performance received prizes. Similarly, all the girls that persevered to the end of the course received prizes as a motivation to them and to the future group. (For details of performance, see table 9).

( Majorities of the graduates have adopted the new and modern farming techniques and systems. In the struggle to become self-reliant, many went beyond practising skills and managed to produce enough for consumption and reserved some for income. This income has had a huge impact on the social and economic well being of these young people. In the same vein, around 15 % of the trainees managed to generate income and bought land for permanent settlement. (See table 7 for IGAs initiated by the trainees with support from the program).

( Similarly, the start-up assistance that was offered to at least 52% of the trainees to initiate viable projects has helped to promote self-reliance among the group. Integration and diversification of farming enterprises has been observed. Many trainees have come to recognise farming as a business. (See table 8 for statistics of projects initiated from this fund).

( Generally, development within the targeted families has been realised and this is seen from the beneficiary’s ability to meet basic needs. Food security has been realised as well, and because of the emphasis on vegetable growing, diet within these households has greatly improved.

( The trainees have gained status and respect within their communities. They have become very hard working aiming at personal development. Some of them have turned out to be model farmers within the community, who are always being called upon to advise other farmers. The targeted communities in general have also benefited from this training and many people have adopted the skills from the trainees.

( The topic on environmental protection has promoted the culture of planting trees with a slogan ‘’cut one, plant three’’. At the same time, the soil fertility was further improved resultant from the application of organic fertilisers, use of natural pesticides, digging of trenches and of course planting trees.

( During this period, several families received animals for rearing i.e. cattle, pigs and goats in order to obtain manure in the short run and cash in the long run. The manure has helped to improve on the quality and quantity of the yields.

( At least 75% of the trainees managed to improve on their reading and writing skills. Record and book keeping has been adopted and put into practice. The latter has helped the trainees to ascertain profit and loss when dealing with farm business.

( The program has managed to help 500 orphans to attain higher levels of education and vocational skills by paying their school dues and other school requirements.

( During this period, 40 vulnerable families have been supported to get reasonable housing facilities, which has played a big role to improve on their health status. Similarly, another 10 households received funding for IGAs, which helped to improve on their socio-economic status.

B.11 Obstacles and Problems and how they were resolved/Plan to be resolved

( As it was in the previous years, the weather was unpredictable hence leading to loss of crops and famine in some areas.

( The planned period of one week for the MFS class work ended out to be short relatively to the lesson plans. This came about because the trainees used to arrive a bit late on Mondays due to long distances, then on Fridays, they had to live a bit early to arrive home in time. Therefore, during the next intake, arrival time will be Sunday evening and departure will be Saturday morning to give an allowance of five full days of class input and demonstration work.

( The program was not able to set-up live stock demonstration facilities at the training centres due to logistic problems. Such an activity required full time personnel to be responsible for the animals throughout the training, which was not possible at the time. In future, we hope to have this organised within homes of trainees on agreed terms with the families. Hopefully, this will succeed, as the trainees together with the family members will take responsibility.

( We experienced some inconveniences at the training centres such as insecurity resultant in loss of property, lack of proper accommodation and training facilities. At the demonstration plots, crops were either stolen by unknown people or destroyed by animals. Poor storage facilities also lead to theft of the equipment and farm tools. Similarly, lack of / poor training and accommodation facilities for both the trainees and the facilitators caused interruption during the training period.

( Some trainees experienced destruction of their produce due to poor housing facilities at home (leaky houses). During a rainy season, most of the harvested crops got destroyed e.g. maize and beans. In some cases, some trainees were forced to quickly sell off the produce at a very low cost in order to avoid such destruction. This we had planned to address by building communal granaries between families but failed due to financial constraints. Similarly, the trainees experienced marketing constraints worsened by price fluctuations.

( Almost 15% of the trainees failed to implement the farming skills due to domestic problems e.g. no access to land, sickness and loss of guardians.

( Throughout the training period, at least 25% of the trainees dropped out of the training due to various problems. Some were girls who left because of unwanted pregnancies, early/forced marriages and other domestic problems. A big number of boys also left due to various reasons e.g. no access to land, lack of interest and other family problems. A blessing in disguise some left to continue with formal education after raising some income from farming.

( Orphan-headed households were another challenge to both the programme and the orphans themselves. Trainees from such families found it difficult and at times impossible to regularly attend a week’s residential training because of the responsibility at home. When at school, thieves stole their property and crops were either destroyed or stolen.

( Inflation within the Country during the year had an impact on the budgets and the relevant activities of the Program. There have been soaring fuel prices, which the 2000/2001 Country Budget did not address.

( The number of orphans requiring support in kind of school fees, this includes those in primary under Universal Primary Education (UPE) who fail to attend school due to other necessary school requirements not catered for under UPE is on increase. Similarly, the number of needy families requiring support for house construction and IGAs is increasing from time to time.

B.12. Future Plan

□ To mobilise and sensitise the concerned people with an aim of formulating a memorandum of understanding between various stakeholders in administering the future Mobile Farm Schools. This is in response to one of the recommendations of the MFS evaluation.

□ To recruit and register new trainees basing on the selection criteria and available resources.

□ To conduct training for the new groups of MFS trainees beginning with March 2001, the facilitation will be based on the designed curriculum, which will be revised as per the recommendations of the evaluation

□ To improve on the training facilities/venues provided by the community to suit the training needs.

□ To continue following up the pass-out trainees if funding is available, encourage/help them to form co-operative groups and recommend them for financial support from the district if need arises.

□ To develop a school anthem for the next phase of training

□ To continue supporting some orphans in formal and tertiary education

□ To construct some houses for vulnerable families using the available resources

□ To conduct orphans and guardians' meeting once a year to sensitise them on various developmental issues

B. 13 General Information affecting childcare and youth programme

B. 13 (1-2) The political economic, employment, population growth, and the situation of the child in society - events/changes.

There were no major changes in most of the areas mentioned above, however:

• A political referendum was conducted in June 2000 but had no effects on the lives of people and in particular the orphans/children. However, the persistent wars that have been waged in the country for almost 21 years now have left children physically, sexually and psychologically abused. They have been forced to kill and many have been traumatised. According to the UNICEF report 1998, over 14,000 Ugandan children had been abducted between 1987-1998 from Northern Uganda. Nevertheless, this problem has not yet affected children within the Program’s operational areas, thank God!

• Uganda is said to have one of the most developed poverty alleviation programs in Africa (UNDP report 2000). It is said that the number of people living below the poverty line will have fallen below 10% from the current 46% by year 2017. However, the report says the poverty in Uganda will not be defeated unless wars and other forms of insecurity are stopped.

• Economically, the purchasing power of the Uganda shilling has depreciated by 2,450 percent of value or 188.46 percent per year since 1987 inspite of the told over story that the economy of the country has been growing at an annual rate of over 6 percent (The Monitor 18/04/00). Drought was expected to drastically slow the growth in food and cash crop production to 4.6 percent and 1.4 percent respectively in 1999/2000 from the average of 6.7 percent and 8.6 percent of the last decade (New Vision 18/5/00). Therefore, there has been retarded growth due to serious drought resultant in a lower real GDP of 5.1 %, which is below the targeted 7 %.

• Unemployment is still on the increase. However, for the employed, there was a 5% minimum salary increase across the board. There was a 10% salary increase for lower ranks among primary school teachers, police and prison staff. The salary/lunch allowances for medical staff are consolidated and new systems for cumulative calculation of pay as you earn taxes (PAYE) for employees were introduced.

B. 14 Programmes and services of the state available to children and youth

• Information as in the previous report.

B.15 Important legal or personnel changes in our organisation.

• There were no major changes in this area except that two Agriculturists were recruited to fill the vacant posts mentioned in the 1999 report.

B.16 Developments/benefits in the child/youth care ministry/community

• Under section B, C & D (Orphans / family support, Psychosocial /Counselling support plus Education/Training sections) is all the information regarding developments and benefits in the child/youth care ministry/community.

C PSYCO-SOCIAL SUPPORT/COUNSELLING PROGRAMME

Since the inception of this program, counselling has been considered to be an important component of both care and prevention and apparently an effective link between the two. The counselling support offered by the Program, strives at reducing peoples’ vulnerability and tries to alleviate the epidemic’s psychosocial impacts.

There is no doubt that HIV and the resultant problems have a profound negative effect on development with the communities. During this year, on top of the planned activities the Program expanded its counselling services to involve training of counsellors within Kitovu Health Care Complex and bereavement counselling to orphans and their guardians. The former intervention aimed at improving patient care within the Hospital (holistic) and the latter was to address the stresses resulting from failure to grieve properly.

The main goal is to mitigate the short and long-term psychosocial problems of the targeted communities.

C.1 Specific objectives for this period

□ To relieve psychological trauma and emotional stress among beneficiaries.

□ To raise awareness on problem solving and management.

C.2 Planned activities for the year

□ To continue facilitating peer, individual and group counselling.

□ To introduce art therapy to the trainees in the MFS.

□ To make necessary referrals for specified management and to ensure good relationship with other bodies in the community.

□ To continue visiting families for counselling and follow up of specific cases.

C.3 Expected outputs/indicators

□ Number of individuals/families or groups attending counselling sessions.

□ Beneficiaries are able to identify their own problems and deal with them accordingly.

□ Appropriate thinking and expression of feelings among the beneficiaries.

□ Self esteem built among the beneficiaries

□ Ability to role-play, perform music and art as a therapy.

C.4 Activities carried out in the year 2000

C.4.a) Facilitation of peer counselling

( For the past years peer counselling was done in form of facilitation. During this year, it was reviewing the covered topics and follow up of already formed peer counselling groups every Thursday. Facilitators have been supervising groups, while the trainees listened to one another. In the 5 Sub Counties, 47 peer counselling groups were formed. Each group has between 6 – 20 members.

( The trainees actively participated during group discussions learning from each other’s experience on how to solve problems. Among the problems experienced by the trainees were poverty/ lack of home basic needs, loss of parents, nasty behaviours, low standards of education etc. Although peers helped themselves to deal with problems, facilitators also came in when need arose.

Peer counselling groups in each Sub-County

Table 14

|Sub-county |Male |Female |

|Lwankoni |6 |3 |

|Lwengo |6 |3 |

|Kisekka |6 |2 |

|Kyanamukaaka |8 |3 |

|Kabira |7 |4 |

| | | |

|Sub total |33 |15 |

| | |

|Grand total |48 |

C.4.b) Family Counselling

( A number of 66 families were identified for counselling, i.e. 15 in Kyanamukaaka, 10 in Lwankoni, 7 in Lwengo, 19 in Kabira and 15 in Kisekka. These families were visited regularly, however, some families were dropped as the problem reduced or had coped positively.

( Some of the psychological problems, which were experienced by the families are overburden from orphans (orphan / aged guardians headed households), bereaved families paralysed with continuous loss, loneliness, social problems such as poverty, being rejected by paternal relatives, food shortage, property conflict, land disputes, sickness, poor housing etc.

( In the presence of all these problems, the counsellor’s role was to listen, understand and guide them on positive living, problem solving, and referring to relevant bodies where necessary. So far there were 12 cases with land disputes, two were referred to the probation officer and 10 to their elders. 11 had collapsing houses and were referred to their Sub County Co-ordinators. Three girls were forced into marriages and Community Workers and LC officials dealt with this. Two cases of rape were referred to the probation officer in Masaka. Those who required school fees were referred to relevant NGOs. The above mentioned cases have been continuously followed up and have shown a remarkable improvement as regards their psychosocial wellbeing.

C.4.c) Individual Counselling

(Any trainee who could not express his/her feelings to the group was given individual counselling. Some had sensitive issues or needed physical support, which fellow trainees could not manage. Similarly, at least ten staff from Kitovu Health Care Complex also benefited from this service having been referred for psychological support/counselling.

(In the MFS, 240 trainees received individual counselling and some of the problems expressed were abuse in form of hard labour/exploitation, discrimination in a family, forced marriages and rape. Others were rejection by paternal relatives, multiple losses e.g. of parents, property, dropout of school/(low levels of education, premature responsibility at home, poor living conditions, stigma and many others.

C.5 Implemented activities not planned

C.5.a) Bereavement counselling

( Kyanamukaaka and Lwankoni Sub Counties were chosen as pilot Sub Counties for bereavement counselling. This was carried out every after 2 weeks targeting the Farm school trainees and their guardians. It was done in form of guidance and listening to pains of loss. Clients were helped to identify the many pains caused by loss and death through expression of feelings and emotions. Outcomes and positive coping ways were also identified/discussed.

Statistics per Sub County

Table 15

|Guardians | |

|Sub-county |Male |Female |Children |

|Kyanamukaaka |18 |42 |75 |

|Lwankoni |27 |23 |30 |

| | | | |

|Total |45 |65 |105 |

C. 6 Training of Kitovu Health Care Complex staff in Basic Counselling skills

( As a result of collaborating with other departments in Kitovu Health Care Complex, the program assisted in training the Hospital staff in basic counselling skills. The purpose of this was to impart knowledge and skills for effective communication between staff and patients. The details of this activity are found in another report (Psychosocial and Pastoral care department).

C.7 Achievements

( Beneficiaries are able to share out some of their problems to a group and those who did were helped to solve or live positively with their problems.

( Trainees have devoted to individual counselling especially those with severe psychological problems and this has greatly helped them to cope. 80% of the Farm School trainees have benefited.

( 47 peer counselling groups were formed among Farm School trainees and they actively support each other socially and psychologically.

( 215 bereaved clients responded positively to bereavement counselling. This was noted through regular attendance and participation and sharing positive coping mechanisms.

( Orphans have developed positive coping mechanisms through individual counselling and peer support groups. They are now able to perform role-plays and compose songs relating to the present reality and some of these songs and plays were performed on their graduation day aiming at educating others.

( The counsellors have apparently shared their counselling skills through training others and hope to continue by developing a full time training program for participants from within and outside the program.

( More than 30 cases with various psychosocial problems such as land disputes, rape cases, forced marriages, poor housing and lack of school funds were identified and referred to the relevant agencies where they received support to solve their problems.

C.8 Constraints

( Limited time and manpower to address all the many psychosocial problems among the targeted communities.

C.9 Future plan

• To facilitate peer counselling in the Mobile Farm Schools

• To conduct individual/family counselling to guardians and Farm School trainees within the targeted Sub Counties

• To extend bereavement counselling to other targeted Sub Counties

• To training peer counsellors

• To conduct refresher courses for trained staff in basic counselling skills

• To develop a Counselling Training manual and to liaise with other NGOs, District Health Officials and Central Counsellor Training Program in the area of counselling/training

D. BEHAVIOUR CHANGE AND TRAINING PROGRAMME

( “The more we know about the AIDS epidemic, the worse it appears to be. The main message is that AIDS epidemic is far from over. In fact, it is far far worse “ (Peter Piot, executive Director, Joint United Nations program on HIV/AIDS (UNAIDS), December 1997).

( According to the 1997 HIV/AIDS surveillance report of the MOH, between 75-80% of new infections are through heterosexual contact with infected partner. It was noted that 80% of Africans below poverty line will suffer from syphilis adding that 70% of them are carrying HIV without their knowledge (New Vision 21/06.00).

( With this information at the back of each ones mind, the Program continued with its interventions aimed at reducing the spread of HIV/AIDS within the targeted areas. Since HIV/AIDS awareness / information alone can not be considered an effective strategy in the prevention of the disease, the Program endeavoured to integrate various strategies with the aim of promoting sexual behaviour change thus reducing the spread of HIV/AIDS and other STDs.

( The focus was not simply on HIV/AIDS information but also by understanding the many factors that influence one’s behaviour, e.g. attitudes and beliefs, using a variety of participatory methods of education, which are culturally applicable and appropriate.

( The program as well recognised the particular vulnerability of women and young people as regards HIV/AIDS and targeted them with special interests. Women are particularly vulnerable to HIV infection for many reasons including biological vulnerability, lack of decision-making ability and financial dependency on men.

D.1 Aim

To empower the targeted communities with knowledge and skills necessary to reduce on the incidence of HIV/AIDS

D.2 Objective for year 2000

• To continue updating the community with HIV/AIDS and other related information.

• To promote attitude/sexual behaviour change among the targeted groups.

• To train community volunteers and other community members in Home care management.

D.3 Planned activities for the year

• Provide up to date HIV/AIDS and other related information to the targeted community.

• - Facilitate altitude/behaviour change among the targeted communities by covering the following topics.

- Sexuality

- Addiction

- Intimacy

- Relationships

- Values, culture and social interaction

- Gift of life

- Secondary virginity

• Conduct a Training of Trainers course (TOT) in Behaviour Change Process (BCP) among the youth.

• Conduct competitions in extra curricular activities among the youth and women clubs.

• Conduct courses and train Community Workers and other people with in and outside the Program area.

D.4 Expected outputs

• Increased knowledge about HIV/AIDS among the target community.

• Ability for the target community to change their attitudes/ behaviour positively in all circumstances particularly HIV/AIDS.

• Well-trained and active Community Workers.

D.5 Activities done in the year 2000.

D.5.a). Refresher courses for CWs

During this period, 239 CWs turned up for refresher courses. Of these, 38%(90) were female and 62% (149) were male. A total of 11 courses were conducted and the topics covered in this course were:

• Family planning

• Sexually Transmitted Diseases (STDs)

• HIV/AIDS update / behaviour change process review

• Management of IGAs/Self-reliance

At the end of every course, the CWs planned to disseminate this knowledge to the AIDS clients, the guardians of orphans/parents and the entire community. Emphasis on Family Planning would help to promote attitude/behaviour change among the children/youth by preventing unwanted pregnancies, abortions and STDs.

Attendance of Community Workers for refresher courses by Sub-county

Table 16

|Area /Sub County |Males |Females |Totals |

| | | | |

|Masaka District. | | | |

|Kabonera |12 |9 |21 |

|Kyanamukaaka |11 |11 |22 |

|Bukulula/Lukaya |11 |17 |28 |

|Mateete |13 |17 |30 |

|Kisekka |17 |7 |24 |

|Buwunga |19 |7 |26 |

|Ndagwe |16 |12 |28 |

|Makondo |41 |13 |54 |

| | | | |

|Sub-total |140 |93 |233 |

| | | | |

|Rakai District | | | |

| | | | |

|Kabira |23 |7 |30 |

|Kifamba |13 |4 |17 |

|Kabula |14 |5 |19 |

| Sub-total |50 |16 |66 |

| | | | |

|Grand total |190 |109 |299 |

D.5.b) Training of new Community Workers in Masaka Municipality

( Out of the 200 CWs who began the course on Home care management, 61% (121) completed and were awarded certificates. Of these, majority 86% (104) were reported to be active and practising the skills taught within their communities. The first two phases were done in 1999 and the last phase was conducted this year and covered/reviewed the following subjects:

• Basic counselling skills

• Behaviour change process.

• Psychological impacts of AIDS on orphaned children and child care.

D.5.c) Facilitation of Behaviour Change Process

(Behaviour change process was facilitated to various target groups as mentioned earlier on and particular emphasis was put on the Mobile Farm School trainees, the youth and women. The following subjects were the centres of discussions during this year;

Life skills

▪ Sexual development

▪ Self awareness and esteem

▪ Friendship formation.

▪ Resistance to negative peer groups

▪ Decision-making.

▪ Assertiveness.

▪ Positive attitudes towards work

▪ Dangers of alcohol and drug abuse.

▪ Discussions on straight talk magazines.

Factors that influence our behaviour

▪ Attitude and beliefs

▪ Peer Pressure

▪ Community norms.

▪ Gender roles

▪ Culture and tradition

( The program mostly emphasised abstinence and mutual life long faithfulness to one marriage partner as the safest form of behaviour. Other methods like condom use were also discussed to make the participants well informed in case the need to use them arose. The youth and women were particularly sensitised and trained on the importance of family planning and the dangers of STD.

Mobile Farm School trainees

The trainees commented that the above knowledge on behaviour change enabled them to avoid risky behaviours, which would lead them to acquiring HIV, other STDs and unwanted pregnancies. Many started planning for themselves and their families before marriage, while others resorted to self-control. Before the course ended, the trainees were given a written paper on behaviour change process and most of them performed well.

Youth out of school.

Youth from 10 clubs were also sensitised and trained on the above subjects, putting emphasis on family planning and the dangers of STDs. 219 youth turned up for the course (133 male and 86 female). They regularly attended bringing with them new members on each new day. Four workshops each lasting for three days were conducted for the youth.

Statistics for youth turn up per Sub County

Table 17

|Sub County |Female |Male |Number trained |No. of clubs |

| | | | | |

|Kisekka |12 |32 |44 |2 |

|Bukulula |10 |24 |34 |2 |

|Kabira |16 |40 |56 |3 |

|Kyanamukaaka |15 |37 |52 |3 |

|Nyendo-Senyange |33 |_ |33 |_ |

| | | | | |

|Grand total |86 |133 |219 |10 |

Women clubs.

( A number of 181 women from 36 clubs turned up for training during this year from different sub-counties. Similar to the youth, the importance of family planning and the dangers of STDs were emphasised. During the training, a need arose to start up a program for training men on similar issues. This would enable men as well to participate and co-operate with their wives in the fight against HIV/AIDS /STDs and family planning

( “ The time is ripe to start seeing men not as some kind of problem, but as part of the solution”. Said Peter Piot, Executive Director of UNAIDS. Working with men to change some of their attitudes and behaviours has enormous and potential to slow down the epidemic and to improve the lives of men themselves, their families and their partners.

( After this training, a follow up was made and 468 women from 45 clubs were seen. After wards, visits were done to 10 different clubs. During these visits, it was noted that 11% of the members had dropped out, and 8% had died. Out of the 83 women clubs formally sensitised and trained, 38 collapsed. Reasons given for the latter were that some young women remarried. Others migrated to other areas looking for jobs while others were forced to drop out by their husbands who thought that their wives would in the process become unfaithful. Others had high expectations of immediate financial support after the training, which wasn't the case.

D.5.d Follow up of participants trained in Reflexiology

During this year, a follow up was done to 24 women and CWs who were trained in reflexiology. During the process it was observed that a regular follow up and refresher course was required to refresh these people. There was a need as well for a thorough sensitisation of the AIDS clients and other sick community members about the usefulness of reflexiology in pain control. Thus, those who wish to utilise the service could do so and turn up regularly to get the best out of the service.

D.6 Achievements

( 121 new CWs in Masaka Municipality completed their 3rd Phase of training in AIDS Home Care management and were awarded with certificates. Similarly, 241 CWs attended refresher courses and acquired more knowledge to help the community better.

( There is increased knowledge about HIV/AIDS among the targeted communities.

( The youth and teenagers formed peer support groups after analysing risky behaviours like alcohol, drug use and pre-marital sex.

( There is openness about STDs and Family Planning seen from CWs, women and youths/teenagers coming to seek treatment of STDs and Family Planning services.

( Reflexology has supplemented on the treatment offered by the Home Care team especially in problems associated with stress.

Case study on an experience of a woman in Bbanda women club

Bbanda Wofunira is one of the 83 women clubs formally mobilised, sensitised, trained and followed up through women club visits and meetings on HIV/AIDS and behaviour change training by the Kitovu Mobile program. The group is located in Kabira sub-county, formed in 1993 and initiated by one of the Mobile female volunteers. In 1995 the group was selected and sensitised for empowerment. Mrs. Matovu Bruno a member and secretary in this group shares her experience.

“Before joining this group I was in a dark world. I thought that I was leading a normal life like any other married women. I was the type of woman who had never been involved in any developmental activities or gatherings. I only expected learned people plus men and not a rural housewife like me to attend such occasions. My husband could attend but no adequate feedback was given to me. I knew my task was to carry out all the domestic chores and to participate in funerals. Finally we were mobilised by some women to attend a sensitisation workshop which was carried out by Kitovu Mobile program. From this sensitisation, I was so struck by the message and this is when I realised I was lagging behind.

First of all, I had no source of income of my own and I was entirely dependent on my husband who couldn’t provide enough, as he was jobless and a peasant. Secondly, I had never received any form of training and I had very little knowledge on HIV/AIDS. Thirdly, I couldn’t manage to talk in a group of people; I was shy and not confident at all. I also learnt that people in a group can easily be trained and supported. With this information I decided to join Bbanda women’s club.

In this group, we have a cultivation project of groundnuts and sweet potatoes of about 2 acres. We have constructed a pigsty with 6 pigs in it. Each member has a pig of her own at home. We do weave mats and so far we have 20 mats in store. Currently we have an income of 100,000 in our club. At least each member is loaned with 10,000 where a small interest of 1000 is paid back on return of this money.

I do chair meetings wherever there is need for discussions plus supervision of my colleagues during the project work whenever my turn comes. On my village I have been elected as the L.C 1 representative for women. As a group we support each other in sorrowful moments with cooking utensils at hand. I have been able to care for orphans and AIDS clients in my family and to meet most of the basic needs at home. I have had seminars on HIV/AIDS and behaviour change and I have been able to compose songs with the AIDS messages and I also participate in music, dance and drama and other exhibitions launched in my area. With the knowledge on behaviour change; I can help myself and my family, and other people to avoid contracting the deadly disease. According to what I have gained from this club, I hope to continue strengthening the ground rules governing our club so that the remaining members do not drop out. I will also try to solicit funds where possible to expand on our projects and income to ensure sustainability.

D.7 Constraints

( The following activities were planned for the year 2000 and not implemented due to financial constraints:

• Support to women clubs for self-reliance.

• Club competitions in extra curricular activities among the youth and women.

• Refresher courses for community workers of Kagamba, Kakuuto& Kasasa (Sanje), Lwanda, Byakabanda & Rakai Town Board (Kasozi) and Kingo, Buwunga & Kabonera (Bisanje).

( A high drop out rate of club members and collapse of some clubs due to lack of financial support to strengthen their clubs and death of club members due to AIDS.

( The problem of land still exists among women. They rent land for cultivation and after one season owners demand it and this hinders their development.

D.8 Future Plan

← To conduct training seminars on HIV/AIDS and Behavioural/attitude change among women, youths/teenagers and community workers.

← To conduct refresher courses for all the trained groups and follow them up on a regular basis

( To support women and youths groups with Income Generating projects, extra curricular activities and organise study tours.

( To sensitise and train soldiers and their families in Masaka Army Barracks on HIV/AIDS awareness/prevention plus AIDS Home care management.

E COMMUNITY WORKERS’ INVOLVEMENT

( The Community Workers have well organised groups with field co-ordinators as their heads. The role of community volunteers is very crucial in this Program. As usual, they continued to serve the people infected and affected by HIV/AIDS in their areas through the activities of the Program. By the end of the year, the Program was working with 710 CWs and 17 field co-ordinators. The field co-ordinators are responsible to co-ordinate all the program activities within the targeted communities in liaison with the Program staff. This section expresses the work and experiences of the CWs and field co-ordinators in general.

E.1 Planned activities

According to the Field co-ordinators / CWs reports, they planned the following activities to be done in the year 2000.

• Visit AIDS / TB clients in their homes to provide counselling and encourage them seek medical care

• To follow up clients on TB treatment

• To educate AIDS patients on various issues e.g. proper use of drugs, positive living, awareness on STDs, TB, HIV/AIDS Will Making etc.

• To educate the community on HIV/AIDS prevention and care, TB and STDs awareness and prevention.

• Visit orphans’ families, assess problems and monitor progress of implemented activities e.g. IGAs, Orphans care etc.

• To conduct Orphans’ and guardians’ meetings twice a year.

• To follow up orphans who are still supported by the Program in schools.

• To sensitise and mobilise women and youth clubs for training.

• To mobilise and monitor activities of the MFS (in 5 sub counties only), at the training centres and follow up trainees in their homes.

• To follow up and monitor IGAs for CWs.

• To construct and repair houses for needy families if funds avail.

• To conduct CWs meetings monthly.

E. 2 Implemented activities/Achievements by Community Workers

E.2a) AIDS patients’ care

(AIDS clients were visited in their homes for ongoing counselling and to encourage new cases to join the Home Care Program. Education was provided to the clients and the caregivers at the centres, in the homes during home visiting and the community at large. Topics such as TB awareness, importance/proper use of drugs, HIV/AIDS awareness, positive living, STDs, nutrition and Will Making were discussed. Clients on TB treatment were followed up to ensure completion of dosage. Some CWs reported a slight increase in the number of clients coming to centres while a few reported a slight decrease as well.

( CWs reported that most clients could now share their HIV status with others. The caregivers have developed a positive attitude towards their sick relatives and provide them with good care. The psychosocial needs of the clients have been addressed from all ends, by the relatives, the CWs and the Program at large.

E. 2 b) Orphans / Family Care.

( The volunteers continued to visit orphans/families within their homes especially those that are still being supported by the Program. Most orphans at the age of Primary level were reported to be under UPE program. Those who completed Primary seven and were unable to continue, for secondary education due to financial problems dropped out. Some who dropped out joined the MFS while others are still at home.

( On a more positive note, some co-ordinators reported having some of their orphans in higher institutions of learning, which they feel, is a great achievement in such areas where levels of education are very low. Some orphans had also completed courses and were working trying to sustain themselves as well as their brothers and sisters. For example in Kifamba s/c (Mannya Parish), 10 orphans qualified as teachers in year 2000, a few others qualified in technical skills, others as nurses while 4 are still under training as teachers. In Kyalulangira Sub County one orphan is in Makerere University, 2 in Teacher Training College and one in Technical. Other field co-ordinators reported similar cases. All these orphans were supported by the Program to reach/achieve this level.

( The Program also provided some working tools to a number of orphans that qualified between 1997/98 which enabled them to put into practice the skills learnt e.g. sewing, brick laying and carpentry.

( The CWs continued to monitor some of the families that received IGAs from the Program in the past years. Most of the IGAs were reported to be doing fairy well. For example, CWs from Kakuuto Sub County (Sanje Parish) reported having monitored 38 IGAs, which were initiated between 1992/95 within their areas. Of these 17 were doing well, 12 fairly well and 9 had perished. The reasons given for the latter were sickness, death and incapable/elderly guardians.

( From Kabonera and Kirumba sub-counties (Kabuwoko Parish), the CWs reported having well maintained group projects for some guardians, who are being supervised by the CWs themselves. This year they planted sweet potatoes, cassava and maize. This food helped to feed some families that were in need of food at the time. In the same area, they have two other group projects of eucalyptus trees doing quiet well. Most of the IGAs reported to be doing very well were mostly those of the MFS trainees/families found within Kyanamukaaka, the MFS targeted area. The CWs also reported having helped in solving some land disputes at local level for the orphans/widows.

(Community Workers were involved in mobilising the community to participate in constructing houses for the needy orphans/families in collaboration with the Program. They also organised and participated in the guardians and orphans meetings.

E. 2 c) Other activities

( The CWS were involved in mobilising the women and youth to attend courses. They as well attended several refresher courses as reported in section D.

( Most of the Community Workers are involved in IGAs within their co-operative groups. They reported most of their projects to be well maintained. Some of the projects are piggery, cattle rearing, coffee growing, seasonal crops, banana plantations, petty trading etc.

“The financial support given by the Program has helped us to at least improve on our financial status. We have as well gained some knowledge on use of banks e.g. some groups have already registered with the Ministry of Co-operative at Sub County level with registration certificates” said Community Workers of Kabuwoko”.

E. 3 Challenges as faced by Community Workers

( Some CWs still lack transport and other financial support to boost their projects.

( There was a serious drought in some areas, which impacted on the level of food security within families especially for AIDS clients, orphans and the elderly leading to poor nutrition. The situation was worsened by the rampant poverty in the area.

( Increased number of orphans in the area resultant from the high numbers of AIDS clients dying from time to time. This has also led to an increase in the number of orphan-headed households.

(During home visiting, CWs noted many houses for orphans and AIDS clients at the verge of collapsing. They also found many bed-ridden patients and aged guardians with poor nutrition and lack of proper sanitation facilities. In this case, advice was given where possible and support was given by the Program to the badly off e.g. food relief, house and latrine construction and palliative care etc.

The numbers of teenage school dropouts are on increase resultant in premature marriages and unwanted pregnancies, particularly for the girl child. Several orphans have dropped out of UPE schools due to lack of scholastic materials and other financial requirements. Some did not do their end of year 2000 exams. The CWs requested the Government to strictly look into this gap with the UPE system and devise means to combat the situation, which could have long-term impacts on the lives of the children of this nation. Similarly, the number of orphans that need support in post primary, tertiary education and vocational training has also risen.

(Some CWs were reported not to be active as expected thus failing to fulfil their responsibilities e.g. monitoring families and their own IGAs, attending monthly meetings, and reporting all activities done etc. During this year, eight of our CWs died (RIP).

(All in all, some activities were not done as planned due to frequent sickness and death in the society accompanied by hunger and poverty whereby CWs spend most of their time working for survival.

E. 4 Future Plans

( To put in more efforts in visiting and counselling AIDS clients as well as following up TB clients. Continue giving health awareness talks at the centres, clients’ homes and in the community using the knowledge acquired from the courses and to mobilise AIDS clients to join the Program and open up new Home Care centres for AIDS clients.

( To follow up and monitor CWs’ projects, rehabilitate plantations to improve on food security, follow up the women and youth clubs and to visit orphans within the families and monitor activities done.

( To organise workshops for school dropouts, to help them learn some modern agricultural skills (Kifamba Sub County)

(To conduct meetings monthly and re-enforce writing of monthly reports by all Community Workers

E. 5 Requests / Recommendations to the Program

( To continue conducting seminars for Community Workers, women and youth and include a topic on modern farming skills plus field trips. Boost the IGAs of Community Workers, guardians, women and youth with financial and material support such as cash, working tools and improved seeds to families for food security.

( Support intelligent orphans in formal education and skills training, including some of the orphans within Community Workers’ homes. If possible, also support the orphans under UPE with necessary scholastic materials and provide tools to orphans who completed Vocational Training.

Establish MFS in other areas with big numbers of teenage school dropouts.

( Rehabilitate/construct houses and latrines for needy orphans plus land purchase for those who do not have. Resume Home Care services for AIDS clients in areas that were dropped e.g. Kakuuto/Kasasa (Sanje /Bigada Parishes) and Kifamba (Mannya Parish).

( Provide bicycles to Community Workers who do not have plus raincoats, boots and diaries.

F. Staff Training/Workshops

During this year, several staff have attended various courses/workshops to refresh/upgrade their knowledge and skills as follows:

□ Five staff attended a TOT workshop on Behaviour Change Process (BCP) facilitated by SR Kay at Kitovu Health Care Complex

□ Two Trainers attended a TOT course on sexual development mainly focussing on fertility awareness

□ Eight staff attended a Leadership and Management Course by UMI

□ One staff attended a course on Project Planning and Management and two attended one on Project Proposal writing and Personnel Management in Arusha, Tanzania

□ Two Nurse/Counsellors had a refresher course on herbal medicine in Arusha , Tanzania

□ Two Nurse/counsellors attended a course in counselling.

□ Two nurses and a doctor attended a palliative care conference.

G. Visitors to the Program

Several visitors from within and outside the Country visited the Program to share and learn from its various components. Among these was the Executive Director of UNAIDS, representatives from GOAL, two people from Malaysia and two seminarians from Kenya all on a study tour, a team from Soroti that wanted to replicate a similar Home Care Program in their area and many others.

CONCLUSION

In conclusion, we are happy to report that majority of the Program activities were implemented according to plan. In the process several achievements were realised and a number of challenges encountered as stipulated in the context of this report. Putting into consideration the set objectives and expected outputs, in a nutshell, it is worth saying that the Program has had a remarkable impact on the livelihoods of the targeted people/communities.

For the Orphans/family support program, the period was of intensive work and the major fruits are the 302 graduates of the Mobile Farm School who have become important farmers within their communities, plus those that qualified in other vocation schools or completed their third level of education.

On the side of Home Care for PLWAs, palliative care and counselling was very crucial because it made people with AIDS live long with minimal suffering/pain. The AIDS clients wished that the counselling and medical, palliative care should continue since it is their only hope. As for them, there is no hope in the sophisticated anti retroviral drugs (ARVS) which are beyond their capacity. In this case, they called the Government and the International community at large to help promote home care programs for people living with HIV/AIDS but living under absolute poverty. In addition, all health workers should continue providing the people and adolescents in particular with all possible information concerning sexual behaviour change, so that they are protected from HIV and other STDs.

Psychosocial support should always be part and partial of the HIV/AIDS care to help prevent or reduce on the long term psychological effects of the disease. In this respect, child and bereavement counselling should be given an upper hand in addressing the impacts of HIV/AIDS in the community.

Last but not least, we would like to appreciate all those that have worked head and tail to make this program what it is today. In particular the Funding agencies, to the District officials, local and religious leaders, other sister NGOs and the community volunteers, we are indeed very grateful for all the support.

The HIV infection figures are still too high for us to sit back and say we have done a good job. We should use the present successes to work harder!

The struggle continues as before!

Signed:

________________

Robina Ssentongo (Mrs)

Programme Director

April 2001

Appendix 1

Stores 2000

|Item |B/F |Received |Total |Issued |Balance |

| | | | | | |

|Farm School. Items | | | | | |

|News Print (sheets) |4,250 |16,000 |20,250 |1,7565 |2,685 |

|Cello tape |16 |65 |81 |80 |1 |

|Black books |__ |70 |70 |68 |2 |

|Makers |24 |396 |420 |408 |12 |

|Black board rulers |7 |__ |7 |__ |7 |

|Students' desks |3 |__ |3 |__ |3 |

|Musical drums (set) |1 |__ |1 |__ |1 |

|Mattresses |27 |__ |27 |20 |7 |

|Torches |2 |__ |2 |__ |2 |

|Jerry cans |3 |__ |3 |__ |3 |

|Slashers |19 |__ |19 |__ |19 |

|Big spoons |2 |__ |2 |__ |2 |

|Plates |15 |__ |15 |__ |15 |

|Cups |9 |__ |9 |__ |9 |

| | | | | | |

|( Text Books | | | | | |

|Prim. Agriculture For Uganda | | | | | |

| |1 |__ |1 |__ |1 |

|K.C.S.E. Book 2 |1 |__ |1 |__ |1 |

|K.C.S.E. Book 3 |3 |__ |3 |__ |3 |

|K.C.S.E. Book 4 |4 |__ |4 |__ |4 |

|Principles Of Agriculture 1 |7 |__ |7 |__ |7 |

|Principles Of Agriculture 2 |7 | |7 |__ |7 |

|Success in Farming |2 |__ |2 |__ |2 |

|'O' Level Agriculture |7 |__ |7 |__ |7 |

|Farm Structure |6 |__ |6 |__ |6 |

|E.A. Agriculture |8 |__ |8 |__ |8 |

| | | | | | |

|( Scholastic Items | | | | | |

|Exercise books |1,446 |4,752 |6,198 |5,883 |315 |

|Pens |10,551 |__ |10,551 |4,552 |5,999 |

|Duplicating papers in Rims | | | | | |

| |__ |10 |10 |10 |__ |

|Duplicating Ink |__ |3 |3 |3 |__ |

|Pencils |119 |__ |199 |58 |61 |

|Manila papers |2,924 |__ |2,924 |394 |2,530 |

|Box files |10 |25 |35 |30 |5 |

|Mathematical sets |59 |__ |59 |34 |15 |

|Sewing machines |25 |__ |25 |10 |15 |

|Hand saws |12 |__ |12 |8 |4 |

|Trowels |23 |__ |23 |8 |15 |

|Building square |23 |__ |23 |8 |15 |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

|Stores cont. | | | | | |

| | | | | | |

|Tape measures |8 |__ |8 |8 |__ |

|Crow hammer |13 |__ |13 |8 |5 |

|Try squares |13 |__ |13 |5 |8 |

|Plane No. 5 |12 |__ |12 |8 |4 |

|Chisels 6 mm |9 |__ |9 |8 |1 |

|Chisels 10 mm |19 |__ |19 |8 |11 |

|Chisels 18 mm |10 |__ |10 |8 |2 |

|Chisels 25 mm |17 |__ |17 |8 |9 |

|School chalk (pkts) |14 |__ |14 |__ |14 |

|Footballs |__ |15 |15 |15 |__ |

|White wash |__ |10 |10 |10 |__ |

|Stencils |__ |96 |96 |96 |__ |

|Njize okusoma 1 |29 |__ |29 |__ |29 |

|Njize okusoma 2 |1 |__ |1 |__ |1 |

|Njize okusoma 3 |25 |__ |25 |__ |25 |

| | | | | | |

|( Working Tools | | | | | |

|Wheel barrows |__ |30 |30 |25 |5 |

|Watering cans |__ |100 |100 |100 |__ |

|Folk hoes |__ |100 |100 |100 |__ |

|Spray pumps |14 |__ |14 |13 |1 |

|Folk spades |__ |100 |100 |75 |25 |

| | | | | | |

|( Food Items | | | | | |

|Rice in kg |62 |160 |222 |219 |3 |

|Beans |__ |200 |200 |200 |__ |

|Maize flour |__ |19,600 |19,600 |19,585 |15 |

|Sugar in kg |30 |16,620 |16,630 |16,619 |11 |

| | | | | | |

|( General Goods | | | | | |

|Soap (bars) |69 |3,035 |3,104 |3,104 |__ |

|Hoes |436 |__ |436 |367 |69 |

|Blankets |13 |75 |88 |86 |2 |

|Bicycles |49 |__ |49 |3 |46 |

|Iron sheets |184 |__ |184 |184 |__ |

|Spring files |12 |115 |127 |127 |__ |

|Ruled papers |590 |1,180 |1,770 |1,770 |__ |

|Tea leaves in ( Kgs) |__ |9 |9 |9 |__ |

|Toilet paper rolls |__ |520 |520 |520 |__ |

|Vim (5 mls tin ) |6 |__ |6 |3 |3 |

|Envelopes (small) |90 |300 |390 |390 |__ |

|Envelopes (medium) |__ |100 |100 |100 |__ |

|Envelopes (large) |109 |200 |309 |309 |__ |

|Staple (pkts)s |__ |30 |30 |26 |4 |

|Paper clips (pkts) |__ |6 |6 |6 |__ |

Appendix 2

AREAS OF OPERATION

|County |Church Parish |Sub County |District |

| | | | |

|Kalungu |Bukulula |Bukulula |Masaka |

| | | | |

|Bukoto |Kyamaganda |Kisekka |Masaka |

|“ | | | |

| |Mbiriizi |Lwengo |Masaka |

|“ | | | |

| |Bisanje |Kkingo | |

| | |Buwunga |Masaka |

| | |Kabonera | |

|“ | | | |

| |Kabuwoko |Kabonera |Masaka |

| | |Kyanamukaaka |Masaka |

| | |Kirumba |Rakai |

| |Makondo |Nabigasa |Rakai |

| | |Ndagwe |Masaka |

| | | | |

|Masaka Municipality |Kimaanya |Kyabakuza |Masaka |

| | |Kimaanya | |

|“ |Kimaanya |Katwe |Masaka |

| | |Butego | |

|“ | | | |

| |Kitovu |Nnyendo |Masaka |

| | |Ssenyange | |

|Buwunga |Kitovu |Buwunga |Masaka |

| | | | |

|Buwunga |Narozali |Buwunga |Masaka |

| | |Kyanamukaaka |Masaka |

| | | | |

|Kyotera |Lwaggulwe |Kyanamukaaka |Masaka |

| | |Lwankoni |Rakai |

| | | | |

|Kyotera |Mpambire |Kabira |Rakai |

| | | | |

|Kooki |Kasozi |Lwanda | |

| | |Byakabanda |Rakai |

| | |Rakai Town Board | |

| | | | |

|Kooki |Lwamaggwa |Kagamba |Rakai |

| | |Lwamaggwa | |

| | | | |

|Kabula |Kijjukizo |Lyantonde Urban | |

| | |Lyantonde Rural | |

| | |Kaliiro | |

| | |Kinnuka |Rakai |

| | |Mpumudde | |

| | |Kasagama | |

| | | | |

|Mateete |Katimba |Mateete |Ssembabule |

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