THE DISCIPLESHIP PROGRAM

The Discipleship program was launched in August 2005 with the recruitment of 55 disciples of people living with HIV; this was the criteria we used for the recruitment into discipleship program.

Training Program

The Training component was designed to prepare the group to meet the challenge of the field work a head of them. Their major task was to recruit, assist, guide and convince members of their communities to know their status through counselling and testing. Using their experience and the knowledge they were to acquire, they would identify their fellow HIV patients who were still in denial to go for testing and be able to receive free drugs being offered by the ministry of Health through Early Intervention clinic and others. The following Training skills were offered for two month:

Ø       General and specific HIV counselling skills

Ø       Community mobilization and Small groups leadership skills(discipleship and mentorship)

Ø       Elementary skills of HIV clinical and opportunistic infections

Ø       Elementary communication skills related to their task

Ø       Mentorship skills etc.

The program outcomes

The program outcomes were guided by set objectives for the M&E Benchmark.

The program objectives

The program objectives were being guided by the overall mission of the organization i.e.

To reduce the HIV prevalence from the present 6% to 0%. In this respect, mentorship activities were deemed more effective because of their cultural, social, and communal relevance. They have effectively addressed the problem of stigmatization and disclosure, affecting most individual persons living with the virus.  The active and openness attitude displayed by the mentors has created an opportunity for disclosure and willingness among the people living with HIV to seek medical help without waiting to fall sick as is usually the case among HIV patients in denial stage. The outcomes followed these guidelines

• The program outcomes indicators were benchmarked on the field results such as the number of clients recruited to take HIV test by a mentor in a month.
• The number of clients receiving counselling taking CD-4 count
• Groups of disciples formed in a given area and regular meetings attended by group members
• The positive response of the mentors in the programs designed for them.
• Regular attendance in the training programs designed for the purpose
• Observable behaviour change in the mentors attitude towards mentorship activities
• Consistent cooperation between the mentors themselves and the staff of the clinic
• Observable enthusiasm to participate in HIV activities publicly.
• Attending Radio talk shows without desire to hide their identities from the public.

Monitoring and Evaluation

The above Benchmarks set performance standards to guide the monitoring and evaluation process.

Ø       Field visits and mentors weekly meetings were used to monitor and evaluate the activities

Ø       Mentors Note books were given to mentors and assistant mentors to record:

Ø       Weekly visits and location visited

Ø       Date of the visit and the conditions of the household members

Motivation of Mentors

A weekly allowance for transport was given at the beginning of the week. Although this incentive was small, it was meeting some of their financial needs. For the first time some of them received some kind of income to live on since they were relieved of their jobs due to being tested positive.

Continuity and zealousness of mentors

Despite the fact that we do not provide any monitory incentive when mentorship activities are not being done, mentors still commit themselves to the organization as members of one family. This is an indication that this program is serving their cause.

The School and community children Program

It has become apparently clear that any initiative to eradicate HIV that does not involve the children is bound to fail. Children must be insulated from HIV infection by intensive education program designed in an empathetic format, rather than the formal traditional education system. In this system pupils study to pass examination. On the other hand, in the new approach children learning are intended to develop skills that will help them to overcome life problems now and in future, these skills are known as life skills. The programs are to be carried out in communities for the children who don’t attend school as well as the primary schools within the Kampala district.

Discipleship program has designed another program to address the needs of the children.

This is in agreement with our strategy of eradicating HIV through education of the children as well as adults. IBES can be meaningful only if the needs of the children are addressed.

Community Children

By community children we mean those children who do not attend any school. Mentors being assisted by the members of their community are mandated to mobilize children for various children activities which must include life skills techniques and mentorship.

Main Activities

Ø       Mentoring and sensitizing Children about the HIV and its prevention.

Ø       Organize activities to motivate children to respond to group activities designed for mentorship

Ø       Mobilization of the community leaders, parents, and any willing adult to engage and promote programs and activities intended to reduce early sexual behaviour which leads to early pregnancies, STDs and HIV infections

Ø       Linking children and the parents in facilitating open dialogue for the benefit of easing communication between parents and their children in order to develop trust and openness which are key factors in the parent to child dialogue. The parents must come out and play their role as the authority-figure in the life of their children.

Ø       Provoke, motivate and encourage community leaders in playing their roles as leaders and parents at the same time. 

Training component

The training for facilitators was designed to equip them with some basic teaching skills in the area of life skills, mentorship and general counselling skills. While there is enough teaching materials for this subject almost in every school, the motivation to utilize them by the teachers is lacking. We therefore feel that it is not enough to acquire knowledge about life skills, but also to gain mentorship skills to help children in:

• Helping them to manage themselves
• Encourage them to achieve goals
• Nurture them and help them build health relationships
• Create openness in order to invite positive response attitude
• Help to improve self confidence
• Help to gain a better self perspective
• Help them understand their world in order to build an assertive personality etc.

It is our intention to popularize these materials and motivate school teachers to use them for the benefit of the Ugandan children who are threatened by the HIV scourge.

The School Facilitators training

We have trained over twenty facilitators who have already identified schools to go to

Two people shall be sent to a school which has already accepted their program.

Depending on the school’s activities, facilitators shall be given three days in a week to teach life skills to children from the age of 6years to 14 years of age.

Life Skills Trainers.

We have identified skilled people among our mentors and staff whom we have requested to share their skills with their fellow mentors.

By using our own people we have been able to reduce on the cost of training.

So far, last year, 2005, we carried out one training session for schools facilitators.

This year we have scheduled for three sessions for each group (6 sessions).

Challenges faced

There is no doubt that we are moving in the right direction. At the moment there is no alternative to revamp this neglected field and yet the most agent in the health sector.

However, to effectively meet this need, funds and motivational materials to children and facilitators are extremely crucial. Teachers must be motivated to provide professional guidance and supervision of these activities in schools.

We solicit for earnest prayer without which all our objectives cannot be achieved.

Prayer for our mentors to be able to contain, persevere and cope with “the thorn in their flesh”.

MEDICAL DEPARTMENT

From January 2005, the clinic has steadily picked from seeing just a few to a number of clients/patients and it is our great joy to be part of a team reaching out to save and improve on the quality of our patients lives.

Despite the numerous challenges we are faced with at the clinic, the focus is still on our mission of reducing the HIV prevalence in our setting, and to achieve this, the EIC joins other health institutions in running its programmes to achieve this worldwide goal.

The EIC is involved in HIV counselling, testing, provision of ARVs, management of opportunistic infections and management of other general patients.

In addition, the clinic trains field volunteers (‘disciples’) who are HIV positive and go out into their communities and schools to positively influence others on issues such as behavioural change with a final goal of reducing the spread of HIV and hence its prevalence.

Its my prayer that this year, 2006 may see us overcome our challenges and reach out to as many people as possible in order to fight the HIV epidemic and promote a better health for all.

B:  Clients seen at EIC 2005 (Jan-Dec)

                                                            Males                     Females                 Children                Total

Total number of clients seen                                                                                                              223

General Patients                                                                                                                                      73

Micro-care Patients                            23                              14                                25                          62

Total number on ARVs                      34                              53                                01                          88

Number on Free ARVs                       33                              52                                01                          86

Those buying ARVs                          01                               01                                 0                          02

Deaths                                                  03                               02                                 0                          05

Number lost to follow-up                    0                               01                                 0                          01

Number of transfers                            02                              06                                 0                          08

Number on TB medication                 03                              08                                 0                          11                                                                                                                                   

NB:  Those transferred were patients who needed reviews by a specialized centre with an equipped laboratory.

C: Achievements

• Being accredited as an ART centre by the Ministry of Health- AIDS Control Programme to provide free ARVs to those eligible.
• The National TB and Leprosy Programme through KCC accredited EIC as a TB centre to provide free anti-TB medication to those infected.
• The EIC has been able to initiate a training programme for volunteer field workers code named ‘disciples’ who after the training are involved in community/school reach-out to positively influence the community on behavioural change with an ultimate goal of HIV awareness and hence reducing its prevalence.
• The clinic through sponsorship from Quality Chemicals has been involved in sensitizing the public on HIV awareness and prevention through numerous Health talk shows which commenced in the month of May 2005.

D:  Challenges:

• The biggest challenge at EIC has been poor monitoring and follow-up of patients especially HIV infected patients, due to lack of an adequately equipped laboratory.
• Patients concern on some of the costs as compared to the neighbouring centres providing similar services at lower or free costing for tests which include HIV and other tests.
• Need to provide free medication for some of the opportunistic infections such as free Co-trimoxazole (Septrin) as other centres do as this is a WHO recommendation for HIV infected persons.

E:    Recommendations:

i. Immediate;

§         An urgent need for a fully equipped laboratory at the EIC for better management of patients especially the HIV/AIDS clients.

§         Provision of free drugs such as Septrin and fluconazole.

§         To provide free condom distribution at the clinic as this is one of the national strategies in the fight against the epidemic.

§         A need for a Needle-zap machine, a self destruction needle gadget to prevent needle-prick injuries to the health workers.

§         Availability of simple medical literature for clients while at the reception waiting to be attended to.

§         A need for management to put more emphasis on staff trainings to enable them keep abreast with the latest information for the better running of the clinic.

§         A need to seek for funding to enable the clinic to run its programmes more independently.

ii. Long term;

• Acquisition of a medical or clinic van to transport very ill patients to major hospitals and also used for community visits.
• Provide free medication for children.
• Engage in research projects at the clinic.
• Establish a well coordinated community out-reach project.

ADMINISTRATION DEPARTMENT

Personnel:

Ham Byenkya and Agatha Mukanza who were working as Maintenance Assistant and Dispenser respectively left the organisation.  One left for further studies and the other was called back to Quality Chemicals for further deployment.  We got three new staff members; Solomon Kambugu – Maintenance Assistant – full time.  Shem Byenkya a member of our support staff and Peter Echiba a Trainee Counsellor who are serving as volunteers.

Meetings:

We had over 15 staff meetings and over 10 board meetings in the year 2005.    

The Radio program:

The radio program sponsored by Quality Chemicals ran for about 12 months.  In December 2005, the sponsors informed us that they could no longer sponsor the program.  They also informed us that they could no longer give us financial support since they have given us funds to kick off worth over 15 million shillings in kind.

Partnership:

We established partnership with Uganda Network of AIDS Service Organisations - UNASO, Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa - AMICAALL, MILDMAY, Infectious Diseases Institute - IDI, and Kampala City Council – KCC.

Achievements:

1.        We have been able to increase our income base by attracting sponsors and partners in the work

2.        We signed a contract with Microcare to handle part of their clients especially those in Eastern Kampala

3.        The annual gross sales were 14,396,900= of which the Net Cash sales at the foundation were 7,596,600= inclusive of the sales from the HIV book of 565,000=, we also paid Quality Chemicals 2,820,260= and paid SAS Clinic over 2.5 million shillings towards purchase of CD4 reagents and lab costs. As per attached sales log.

4.        Dr. Robert through SAS Clinic has funded us with 20,341,927= from October 2005 to date as payment for the Ultra Sound Machine for SAS Clinic.

5.        We have ensured proper coordination and facilitation of the Medical and Discipleship/ Counselling departments

6.        Organised our first Stake holders workshop that was held in October 2005

7.        Introduced a Leadership Team that helps to manage the work of the Foundation

Recommendations:

1.        A desk top for the Discipleship and Counselling department

2.        Opening of a lab

3.        A monthly pay for Mr. Echiba Peter, and if possible to take him on to help Rev Obed in the Discipleship and Counselling department

4.        Need to get a project proposal writer to come up with a proposal we can present for funding

5.        Financial support for the discipleship program annual budget for Training and deployment worth 21,730,000 Million shillings. As shown in the budgetary notes attached