Introduction
When traveling on Uganda's roads, you see billboards educating about HIV and AIDS scattered from one end of the country to the other. The billboards attest to Uganda's forthright, intensive campaign against the deadly virus. So much of what has been accomplished in waging that campaign is less conspicuous, however. In countless ways, great and small, Uganda's government and its people have been confronting the HIV and AIDS crisis by promoting behavioral changes to prevent the disease and treating and supporting people who have been infected or affected by it.
Despite Uganda's exemplary record among African nations in responding to the epidemic, its progress in combating HIV and AIDS in its communities has been hindered by a scarcity of resources.
As of 2001, basic services to prevent HIV and care for people affected by the disease were neither widely nor easily accessible, nor well coordinated outside the capital city of Kampala. Those conditions prevailed in most of the country's districts. The capacity to expand access and improve the quality of already available services at the district and sub-district levels was generally limited.
The AIDS/HIV Integrated Model District Program
Since 2001, AIM has been working with local governments and civil society to overcome these barriers. Funded by the U.S. Agency for International Development through the U.S. government's President's Emergency Plan for AIDS Relief, the effort has been one of the largest, most diverse technical-assistance programs of its kind in Africa.
AIM was implemented by JSI Research & Training Institute and World Education. Through AIM, JSI and World Education were instruments for supporting Uganda's decentralized response to the HIV and AIDS epidemic in 16 districts, reaching about 30 percent of the population.
AIM was a collaborative partnership driven by needs identified by the selected districts. AIM focused on:
- Enabling districts to plan, implement, and manage their own HIV and AIDS and tuberculosis (TB) programs.
- Integrating improved comprehensive prevention, care, and support services at the district and health sub-district levels.
- Streamlining referral mechanisms.
- Supporting improved quality of HIV/TB prevention, clinical, community and home-based care, and social support services for people infected and affected by HIV and AIDS, including orphans and youth.
With the gradual movement of decisionmaking from Kampala to district governments, AIM helped strengthen district support and management of HIV and TB services while helping to refine district public and private sector responses to social development challenges. Providing grants to local groups became a powerful incentive to bring people and organizations into the decentralization process.
The AIM Program awarded 459 grants to a variety of organizations in 16 districts. The average grant was small in size—about 40 million Uganda Shillings ($22,000)—but large in impact. Most were awarded to small, community-based groups.
AIM supported grants for well-defined, district-based interventions with continuous technical assistance linked to measurable, performance-based outcomes. JSI/AIM's grant process promoted the development of District HIV and AIDS Committees and gave them a tangible role in Uganda's effort to respond to the HIV epidemic. Working with and through District Committees, AIM provided funding and technical assistance to service providers to strengthen service delivery and community groups, enabling them to broaden their reach and deepen their technical expertise. This approach devolved the technical review and decisionmaking processes dramatically, empowering local groups, while allowing AIM to retain fiscal oversight.
Outcomes of AIM's granting activities include:
- Increased number and scope of HIV and AIDS prevention, care, and support service delivery sites in selected districts.
- Strengthened ability of District HIV and AIDS Committees to manage the grant solicitation and review process, thus building the expertise of a body that increasingly plays a critical role in scaling up HIV services.
- Allowed active communication and sharing of technical proposals and cross-sector approaches.
- Enhanced public/private and private/ private linkages.
AIM also awarded a number of grants to national-level organizations. In some instances, these grants funded innovative programs that can serve as examples of promising practices. These grants helped develop the organizational capacity of key institutions that have branches or programs in the districts.
Much of AIM's legacy is already quantifiable. With AIM's support, the 16 districts have established 114 sites for HIV and AIDS counseling and testing and 84 sites for the prevention of the transmission of the virus from mother-to-child. AIM has been pivotal in launching district-wide networks of people living with HIV and AIDS involving 60,000 people, in 15 of the 16 districts. Over 317,000 people have been tested at these testing sites and 5133 mothers have benefited from services to prevent HIV transmission to their children. A total of 18,000 TB patients have received community-based directly observed treatment.
Not everything of lasting value is reducible to statistics. From the very beginning, a central goal of AIM was sustainability—supporting services and organizations that would continue to operate effectively after the program ended in May 2006. The enhanced capacity of AIM's partners to manage their organizations and seek other sources of funds, the closer coordination among the many agencies and groups that compose the Ugandan health care system, and an emboldened spirit among Ugandans drawn to the HIV and AIDS cause through AIM-supported programs are examples of gains that are hard to measure but exceedingly important.
The diverse stories that follow in this booklet describe 15 initiatives supported by AIM. The stories and photos illustrate some of the gains with examples taken directly out of the lives of people with whom AIM partnered.
JSI and World Education would like to thank the many groups who have worked with us and the many people who willingly give of their time and energy every day to battle HIV and AIDS—and those who kindly spoke up and contributed to this publication.
MED MAKUMBI, AIM CHIEF OF PARTY and all the staff at AIM
Acknowledgements
AIM is deeply grateful to the grantees featured in this document. They have generously taken the time to share their stories with us. AIM has been privileged to work with them and over 200 others to improve the quality of life of the people in their community, district, and nation.
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The Uganda AIDS/HIV Integrated Model District Program (AIM) was implemented by JSI Research & Training Institute and World Education and primarily funded by the U.S. Agency for International Development.
This document was developed and produced by JSI and World Education. Stories were written by Joe Rosenbloom and AIM staff, including Emily Katarikawe, Dr. Samson Haumba, Frank Rwekikomo and Caroline Turyatemba, and Monique Boivin, AIM intern.
Editors: Penelope Riseborough and Joe Rosenbloom
Print Design: Marina Blanter
Web Design: Gibbs Studios
