John B. Mugisa MD, MPH

COUNTRY DIRECTOR

ALLIANCE OF MAYORS AND MUNICIPAL LEADERS ON HIV AND AIDS IN AFRICA

AMICAALL - UGANDA CHAPTER

2011 CLG CONFERENCE

STRENGTHENING URBAN COMMUNITY INTERVENTIONS FOR ORPHANS AND VULNERABLE CHILDREN THROUGH

LED INTERVENTIONS AMICAALL UGANDA - CASE STUDY

2011 Commonwealth Local Government Conference

Cardiff, Wales, UK.

16, March 2011

COUNTRY BACKGROUND

Total population approx. 32 million people Total population approx. 32 million people Population growth rate (annual) is 3.5%Population growth rate (annual) is 3.5% Fertility rate, total (births per woman) 7.1Fertility rate, total (births per woman) 7.1 HIV prevalence 6.4% among the adult population (15 -HIV prevalence 6.4% among the adult population (15 -

49) years49) years HIV prevalence among children 0.7%HIV prevalence among children 0.7% MTCT contributes approximately 20% MTCT contributes approximately 20% HIV prevalence is significantly higher in urban areas HIV prevalence is significantly higher in urban areas

(10.1%) compared to (5.7%) in rural areas(10.1%) compared to (5.7%) in rural areas AMICAALL Uganda Chapter launched in November AMICAALL Uganda Chapter launched in November

2000. Has a membership of2000. Has a membership of 140 LGs (Municipalities 140 LGs (Municipalities and Town Councils) and 34 Municipal Divisionsand Town Councils) and 34 Municipal Divisions

3

Trends in the median Antenatal HIV prevalence among urban and rural sentinel Sites in Uganda (1989 – 2005)

0

5

10

15

20

25

30

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2005

Urban sites Rural sites

Source: Ministry of Health AIDS Control Programme (ACP)

URBAN-RURAL HIV PREVALENCE IN UGANDA

10.1

12.8

6.7

1.4

5.7

6.5

4.7

0.6

0

2

4

6

8

10

12

14

All Females Males Children <5yrs

Urban Rural

Source: Uganda HIV/AIDS Sero Behavioural Survey 2004/05

AMICAALL LED PROGRAM OVERVIEW

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In 2007 AMICAALL Uganda Chapter with the support of Ministry of Gender Labor and Social Development (MoGLSD), USAID (Core Initiative), Global Fund and UNDP initiated a LED program ‘Strengthening Urban Community Interventions for Orphans and other Vulnerable Children (SUCIO)’

The overall Goal of the program was to provide effective interventions that lead to improved quality of life of orphans and other vulnerable children living in urban and peri-urban areas in Uganda including upholding their basic rights.

AMICAALL LED PROGRAM OVERVIEW 2

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The main objective of the program was to provide 190 OVC households and caregivers with basic entrepreneurship skills and capital inputs for small scale business enterprises by 2009

The program mainly targeted the most needy vulnerable children (poorest of the poor) living in urban slums in 14 urban authorities in Uganda. Altogether 1500 OVC were targeted of which 350 directly benefited from LED interventions.

Beneficiaries were selected through a community led consultative process using a selection criteria provided by the Ministry of Gender (MoGLSD) - Beechman-silva, 2003Beechman-silva, 2003

AMICAALL LED PROGRAM OVERVIEW 3

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The program was implemented through five distinct but complimentary stages;

Stage I: Identification and profiling of viable LED interventions through a consultative process based on the needs assessment

Stage II: Capacity building for local authorities and the selectedbeneficiaries based on identified capacity gaps and choice of LED interventions before capital inputs

Stage III: Mentoring and coaching to continuously address deficiencies and bottlenecks

Stage IV: Monitoring and Evaluation to track LED activities and outputs, and assess progress

Stage V: Designing of exit and sustainability strategies with each implementing urban

authority

SELECTED OVC LED INTERVENTIONSSELECTED OVC LED INTERVENTIONS

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Apprentice training (6 -12 months) in various skills; motor mechanic, hair dressing, tailoring, bakery etc.

Provision of startup kits (tools) and capital input to enable trained OVC to initiate own small businesses

Poultry farming Piggery Cattle and goat rearing Hair dressing Knitting and sewing Catering and bakery Urban farming and crop marketing

ACHIEVEMENTS

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Majority of the benefiting OVC households reported improved household income and socio-economic livelihood in many ways. OVC school drop outs resumed schooling and were able to feed and clothe normally as well as access other basic necessities. Promotion of self-reliance as opposed to dependency

Beneficiary OVC households through mutual collaboration formed beneficiary support groups to initiate village banks thus promoting the culture of saving which is critical for LED growth and expansion

Good performing OVC households were introduced to Microfinance institutions to access loans for enlarging their business enterprises.

ACHIEVEMENTS 2

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OVC households acquired business management OVC households acquired business management skills and developed teamwork, thus enabling HIV skills and developed teamwork, thus enabling HIV affected vulnerable groups become key players in the affected vulnerable groups become key players in the LED and indeed national developmentLED and indeed national development

As a result of economic empowerment ,vulnerable As a result of economic empowerment ,vulnerable OVC households and care givers became more open OVC households and care givers became more open about their HIV status and opted to join PHA support about their HIV status and opted to join PHA support groups leading to improved health seeking behaviour. groups leading to improved health seeking behaviour. This clearly demonstrates that LED interventions can This clearly demonstrates that LED interventions can promote positive living which is critical for enhanced promote positive living which is critical for enhanced HIV/AIDS response particularly, at the community HIV/AIDS response particularly, at the community levellevel

ACHIEVEMENTS 2

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OVC beneficiaries and care givers acquired appropriate OVC beneficiaries and care givers acquired appropriate HIV knowledge and skills empowering them to become HIV knowledge and skills empowering them to become change agents in their communitieschange agents in their communities

AMICAALL LED program was very highly appreciated by AMICAALL LED program was very highly appreciated by urban local authorities. All implementing LGs resolved to urban local authorities. All implementing LGs resolved to integrate OVC interventions in the subsequent urban integrate OVC interventions in the subsequent urban council planning and budgeting cycle and chose council planning and budgeting cycle and chose specifically to support LED initiatives in their local specifically to support LED initiatives in their local budgets. budgets. (change of mind set)(change of mind set).. Budgets for OVC Budgets for OVC interventions has since increased from 4% to 8% in some interventions has since increased from 4% to 8% in some of the urban local governments that participated in of the urban local governments that participated in SUCIOSUCIO program. program.

KEY CHALLENGES

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Some OVC households demonstrated poor record keeping, they lacked book keeping skills. This necessitated refresher trainings to address this gap

Beneficiaries felt that implementation arrangements, guidelines and procedures were too demanding and therefore not user friendly.

There was a tendency for some beneficiaries to deviate from the agreed LED activities particularly those which were labour intensive.

Tapping into capital input before maturity of business and profit making was also uncommon, however this was averted by regular monitoring visits undertaken by urban local government extension workers.

KEY CHALLENGES

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Overwhelming demand for similar LED interventions in other local authorities despite the limited funding base that hindered expansion of the program to other member urban authorities

LED SUCCESS FACTORS

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Good governance hinged on grass root community leadership promoting inclusiveness, communication, coordination, transparency and accountability in program design and implementation

Implementation of the program through the existing LG decentralised and AMICAALL structures which helped to harness and utilize existing core capacity of urban authorities to implement the program

Creation of constructive partnerships and mutual relationships with key LED stake holders and partners, particularly those in the private sector which helped to leverage the needed technical and financial resources

LED SUCCESS FACTORS 2

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Use of indigenous knowledge and resources for local capacity enhancement contributed greatly to sustainable implementation of the program

Adoption of a Human Rights Based Approach in line with the National OVC Policy ensured that pertinent HR issues were addressed .OVC specific bylaws and ordinances were enacted as part of the program

Promotion of gender equity and quality ensured that all LED interventions were gender sensitive

A robust M&E system helped to track LED activities and assess progress. Implementation bottlenecks and deficiencies were identified on regular basis and addressed in a timely manner

LESSONS LEARNED

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LED interventions if well managed can significantly improve the socio-economic empowerment and living conditions of people living with HIV and those affected thus reducing their vulnerability. However if not expanded, these interventions can provide only short term relief (not developmental). Beneficiaries tend to remain vulnerable

Provision of capital inputs in tranches (installments), based on enterprise performance stimulates innovation and competitiveness leading to growth and expansion of LED initiatives

LESSONS LEARNED

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Working closely with the local authorities and other key LED stakeholders helps to leverage technical and financial resources thus creating a conducive and enabling business environment for HIV affected vulnerable populations. For example, local authorities provided technical expertise while other key LED stakeholders in the private sector provided free services and helped to improve market access

A successful LED initiative relies to a great extent on voluntary work (unpaid work, time in meetings, monitoring etc.) of all actors including the public, private sector and the local community

CONCLUSION

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1. LED is an appropriate strategy that can be used to mitigate against the impact of HIV/AIDS epidemic particularly among the affected vulnerable populations.

2. Local governments have the mandate and responsibility to adopt and implement this important strategy through integration of LED initiatives in the local government development agenda for promotion of the local HIV/AIDS response as well as local economic growth.

3. MDGs particularly, Goal 6 and the Universal Access Goal cannot be attained without addressing the economic impact of HIV/AIDS.

THE END

Thank You!

THE END

Thank You!