Henry Kakande, MB.Ch.B; M.Med- ACQUIRE Project, EngenderHealth, Uganda
November 2007
Henry W. Kakande is a Ugandan who holds a Masters of Medicine (Obstetrics & Gynecology) as well as a Diploma in Obstetrics. Dr. Kakande has over thirty years of progressive experience in health services delivery, research, training, and administration in the public and private sector and has worked in Eastern and Southern Africa, particularly in Uganda. He has successfully established reproductive and child health programs and has been actively involved in the development of reproductive and child health training materials and policy documents for Uganda.
Dr. Kakande has worked for national and international health organizations in various capacities, namely as advisor, trainer, program coordinator, lecturer, senior consultant in obstetrics and gynecology, and as medical officer and medical superintendent. He currently is Technical Manager of the ACQUIRE Project at Engender Health.
The HIV/SRH Integration site interviewed Dr. Kakande about his experiences with providing integrated services in Uganda.
Can you provide background information on the HIV/AIDS and sexual and reproductive health situation in your country?
Uganda population: approximately 27.4 million
HIV seroprevalence: 6.2 %
Maternal Mortality Rate: 435/100,000 live birth
Total Fertility: 6.7
Contraceptive Prevalence Rate (all methods): 24 %
Teenage pregnancy: 25 %
Age at first sex: 16.6 years (women), 18.1 years (men)
Age at first marriage: 17.8 years (women), 22.3 years(men)
Please tell us about a project /program experience integrating HIV/AIDS and sexual and reproductive health services.
The ACQUIRE project working with a local NGO, The Aids Support Organization (TASO), has successfully integrated family planning (FP) into the HIV prevention, treatment, and care services at one of the TASO branches in Mbale, Uganda. A performance needs assessment (PNA) was conducted in early 2006 to identify service gaps and develop an action plan for FP-integrated antiretroviral (ART) services at TASO Mbale. The PNA found that the infrastructure and management systems could support FP services, but only 1 of 55 staff had recently received FP training. Providers were concerned FP would encourage sexual activity among people living with HIV/AIDS (PLWHA), and community members were interested in FP but had concerns about side effects. Program activities included FP training for TASO trainers and later, counselors and providers, to offer a whole range of FP information and initiate clients to combined oral contraceptives (COC), emergency contraceptive pills (ECP), injectables (DMPA), condoms and refer others who opted for methods not available at the centre. Awareness creation was done through community radio shows, health education talks at the centre and engaging FP-trained community nurses. To address the quality improvement issues, COPE [1] was introduced and the centre staff trained in Facilitative Supervision.
How did you decide on the approach to take?
How did you decide on the approach to take?
The ACQUIRE project, together with the staff and clients of TASO/Mbale, decided on the approach through a participatory approach during the performance needs assessment conducted at beginning of the pilot.
What were the dates of the project/program?
The pilot was conducted between April 2006 and July 2007 and evaluation done in November/December 2007.
What was the problem you were responding to when you developed the program?
PLWHA on ARVs were living healthier and longer lives and were facing similar choices as others regarding reproductive health and family planning including avoiding unintended pregnancies.
Who was involved in the discussion and decision-making on the approach to take to address the problem?
Who was involved in the discussion and decision-making on the approach to take to address the problem?
TASO headquarters, MOH, PLWHA attending the TASO/Mbale center, HIV/AIDS care stakeholders at Mbale and surrounding districts and the ACQUIRE project were involved.
Did you involve the community in developing the program?
Yes, we involved the community, including the PLWHA networks.
Yes, we involved the community, including the PLWHA networks.
How did you work with the District Health Office in setting up the program; for example, in strengthening the systems and services?
The office was involved in the PNA and hence the design of the interventions and was involved in the supply of contraceptives as well as FP forms.
Are there links to community support groups?
TASO has 12 community nurses (who are retired midwives, nurses, and clinical medical assistants), as well as field officers. All these provide homebased HIV/AIDS care services,. They have been trained in FP and given FP methods (ECP, COC, DMPA, and condoms).
How do the providers and clients feel about the integrated activity?
Very happy. They wanted the service to be integrated within the routine HIV care services to minimize the stigma clients would get at some of the non-HIV care facilities.
What obstacles did you encounter from a program standpoint and how did you address them?
The supply of contraceptives from the District Office was erratic at times. ACQUIRE has worked with TASO headquarters in Kampala to ensure the organization can access the contraceptives directly from the National Medical Stores(the central government stores for drugs and contraceptives)
What obstacles did you encounter from a program standpoint and how did you address them?
The supply of contraceptives from the District Office was erratic at times. ACQUIRE has worked with TASO headquarters in Kampala to ensure the organization can access the contraceptives directly from the National Medical Stores(the central government stores for drugs and contraceptives)
Did you make adjustments to your approach as you went along? Please describe.
We provided training of the community nurses in FP. This enabled these nurses to provide FP as a comprehensive package for home-based HIV care.The training was two weeks, with the first week covering the theory while the second week covered the practical sessions.
We provided training of the community nurses in FP. This enabled these nurses to provide FP as a comprehensive package for home-based HIV care.The training was two weeks, with the first week covering the theory while the second week covered the practical sessions.
Did you have need for special resources to implement your approach (e.g., funding, staffing, supplies, and consultants)?
Yes. We secured funding to introduce COPE and Facilitative Supervision at the TASO/Mbale centre as well as follow-up of the trained providers including the community nurses.
How did the project team decide on a system to balance work activities (e.g., addition of new activities with existing activities for the purpose of integration)?
Through COPE, the TASO/Mbale staff came up with innovative ways of addressing the issue of human resources including use of PLWHA volunteers at the centre.
Was there training needed in order to be able to offer integrated services?
At the end of the FP training the trainers and the providers as well as the administration agreed on the client flow. Integrated health talks with FP messages were also planned for the clients as they waited for the services.
At the end of the FP training the trainers and the providers as well as the administration agreed on the client flow. Integrated health talks with FP messages were also planned for the clients as they waited for the services.
How did you evaluate the success of your activity?
An independent evaluator, Research International, was hired to evaluate the work. The exercise took place in November/December 2007.The evaluation report is being compiled and the results will be disseminated .
Are there other examples of successful integration activities that you can mention?
An independent evaluator, Research International, was hired to evaluate the work. The exercise took place in November/December 2007.The evaluation report is being compiled and the results will be disseminated .
Are there other examples of successful integration activities that you can mention?
Yes. Currently the ACQUIRE project is working with the SCOT (Strengthening Counselor training for HIV) project to develop training materials for positive prevention. FP is one of the modules in the positive prevention curriculum.
For more information about the ACQUIRE project, see: http://www.acquireproject.org/
Contact Information
Dr. Henry W. Kakande
Technical Manager, ACQUIRE project/EngenderHealth
Plot 143, Kiira Road, Kamokya
P.O.Box 34016,
Kampala, Uganda
Tel #:0752692159(mobile) (+256)414 531400/3/5
E-mail:hkakande@engenderhealth.org
[1] COPE®, which stands for "client-oriented, provider-efficient" services, is a process that helps health care staff continuously improve the quality and efficiency of services provided at their facility and make services more responsive to clients'needs. See http://www.engenderhealth.org/pubs/quality/cope.php.