NESH II PROJECT

The NESH (National Expansion and Strengthening of Sustainable HIV/TB services in Uganda) project at Rugarama Hospital was initiated in October 2012. This is a Centers for Disease Control and Prevention (CDC) funded-project with Uganda Protestant Medical Bureau (UPMB) as the prime grantee and Rugarama Hospital as the sub-grantee.

The project was integrated into the already existing structure of service provision at the hospital. For effective running of the project, a Project Coordination Team was constituted to coordinate the project’s activities.

ACTIVITIES CARRIED OUT FROM OCTOBER 2012 TO PRESENT

 

  1. ORPHANED AND VULNERABLE CHILDREN (O.V.C)
  2. COMMUNITY
  3. OUTREACH
  4. PREVENTION
  5. SAFE MALE MEDICAL CIRCUMCISION (SMC)
  6. HIV/ART CLINIC
  7. M.T.C.T
  8. FAMILY PLANNING
  9. TUBERCULOSIS
  10. LABORATORY AND PHARMACY
  11. STRATEGIC INFORMATION
  12. CONTINUOUS QUALITY IMPROVEMENT

 

O.V.C (Orphaned and Vulnerable children)

Working with orphaned and vulnerable children has been a new focal area for Rugarama Hospital. An O.V.C is defined as:

  • An HIV positive child (including those above 18 years) who were enrolled at our ART clinic before the age of 18 years, OR
  • HIV positive or negative siblings to an HIV positive child enrolled at our ART clinic, OR
  • HIV positive or negative child below 18 years whose guardian is enrolled at our ART clinic, OR
  • HIV positive persons above 18 years but who are still in school and enrolled at our ART clinic.

We provide the following services in the O.V.C focal area:

  • Secondary school and vocational training scholarships to needy O.V.Cs (We have so far sponsored 2 OVCs for vocational training and 11 OVCs for secondary school scholarships)
  • Scholastic materials to all O.V.Cs in school.
  • Training of community volunteers in comprehensive O.V.C care and support.
  • Sensitizing O.V.C caregivers and the community as a whole on child protection – through radio shows, outreaches, child special days and health education within the hospital.
  • Training of volunteers and later O.V.C caregivers and PLHIV support groups in VSLA methodology.
  • Providing farm inputs to O.V.C households.
  • Availing child friendly corners and child special days where we provide psychosocial support. The child special day was created to bring together infected and affected O.V.Cs and guardians/caretakers for psychosocial support and sensitization of O.V.Cs and their caregivers on child protection.

 

COMMUNITY

Community-FSG meeting
FAMILY SUPPORT GROUP

The community arm of the project is a growing focal area and a work in progress. The activities we are engaged in at community level are as below:

  • Establishing and running of support groups: PLHIV support groups and Family support groups.
  • Home visiting for very ill and challenging patients
  • Recruiting, training and supervision of Community Resource Persons/Volunteers.

We so far have a total of 7 dedicated volunteers who work within the ART, E.I.D AND P.M.T.C.T clinics as well as within the community. The volunteers’ overall roles are:

  • To mobilize and sensitize the community on various health topics.
  • To work with health care workers within the hospital’s clinics to ensure provision of the best care in a timely manner.
  • To act as a link between clients and health workers.
  • To follow up clients in the community including making home visits to the very ill.
  • To refer clients from the community for care at the hospital.
Community - volunteers
OUR COMMUNITY RESOURCE PERSONS
Community - vsla
THE VILLAGE SAVINGS AND LOANS ASSOCIATION

 

Some of these volunteers have been working at the hospital for years but were officially recruited under the NESH program in March 2013. The volunteers, through UPMB, have been provided with bicycles which enable them to carry out the above activities. They continue to undergo training in various areas such as basic HIV care, VSLA, Child protection and EMTCT.

 

 

OUTREACH

Outreach
DURING OUTREACH

We have 2 integrated outreaches each month to 2 sites – Ikamiro and Kinyamari. Services provided include:

  • Health education on various topics including ABC, SMC, OVC, Family planning
  • PMTCT/ANC
  • HCT
  • Clinical care
  • Ophthalmology services (Occasionally)
  • Nutritional reviews and referrals
  • Family planning services

We also carry out specific outreaches to churches, schools, universities. Services provided during specific outreaches are as below:

  • Health education on various topics including ABC, SMC, OVC, Family planning
  • HCT
  • Family planning services

 

PREVENTION

The prevention arm of the NESH project at Rugarama Hospital is doing well and services provided under this focal area include:

  • Sensitization of couples in the ABC messages of HIV prevention
  • Sensitization of youth and adolescents on value of life curriculum
  • Sensitization meetings for local leaders to promote ABC
  • Conducting peer led workshops in schools to promote HIV prevention
  • Conducting peer led workshops for couples to reach out to other couples with the ABC messages
  • Linking individuals who tested HIV negative to HIV prevention strategies by category
  • Post exposure prophylaxis

We have been able to use activities like outreaches (integrated and specific), peer to peer workshops in schools and churches, radio shows and health talks within the hospital and community to sensitize community members (adults and youth) on HIV prevention measures. Free condoms are given out and referrals for further counseling and Safe Male Circumcision are given.

From the 26th July to the 2nd of August 2013, we engaged youth through the Peer Led workshops which aimed at promoting HIV/AIDS prevention through implementing behavioural change interventions to minimize sexual risk and increase protection. They sought to facilitate the youth to understand the reality of HIV/AIDS through discussion, and encourage them to change their lifestyles in order to reduce the risk of acquiring the HIV infection.

The workshops were carried out in 4 schools (2 workshops per school):

  • Kigezi High School
  • Kigezi Eden Secondary School
  • Excel High School
  • Hornby High School

On the 10th August 2013, we held a youth football tournament dubbed THE RUGARAMA HOSPITAL ‘FIGHT HIV’ FOOTBALL TOURNAMENT at the Kigezi High Primary School playground. The aim of the tournament was to bring together youth from various schools within Kabale to participate in games as they received the messages on HIV prevention. A total of 8 schools participated in the tournament:

  • Kigezi High School
  • Kigezi Eden High School
  • Kabale Brainstorm High School
  • Kabale Pentagon High School
  • Creamland High School
  • Ndorwa Secondary School
  • Excel High School
  • Andrew’s Secondary School

We also provided free HIV Counseling and testing (H.C.T), general counseling and health education on HIV prevention. The tournament was quite a success as we received more than 150 clients for H.C.T and got to educate the masses on HIV prevention and other services available at the hospital. We received media coverage in some of the local radio stations and newspapers.

A one day Local Leaders Workshop held on 24th May 2013 at the Rugarama Hospital brought together a total of 17 participants, including archdeacons of Kigezi Diocese and Local Chairpersons from Kabale municipality. The workshop aimed to give a platform to our community local leaders for interaction and discussion with health care workers about various issues on HIV prevention, spread and the interventions being made by Rugarama Hospital to reverse this trend. Topics discussed included:

  • HIV prevention – EMTCT, ABC, SMC
  • Family planning
  • Participants’ role in community mobilization

From prior interactions with various local leaders in our community as we carried out our community services, Rugarama Hospital came to appreciate the poor attitude that many of them had towards HIV prevention, especially Condom use, family planning and male circumcision. Due to their leadership positions, these attitudes were being passed on to members of the community which they served, and this led to poor uptake of the services provided by Rugarama Hospital in the above mentioned areas. This workshop was therefore organized as a platform to educate, empower and discuss with the local leaders a way forward on these contentious issues.

From the responses received through feedback forms provided, it was clear that many of them experienced an attitude change towards the various aspects of HIV prevention.

SAFE MALE MEDICAL CIRCUMCISION

Safe Male Circumcision
THE SAFE MALE CIRCUMCISION TEAM

Since the initiation of the NESH project at the hospital, our S.M.C client numbers have been steadily increasing over the months. We attribute this to a number of factors:

  • Facilitation from UPMB that allows us to better sensitize and mobilize the community on the benefits of S.M.C and the av
    ailability of theservice at the hospital. This facilitation also enables us to provide the service free of charge.
  • Different communication platforms such as radio shows, outreaches, local leaders workshop, health education talks at the hospital and community, and written messages/ pamphlets enable us to get the message out to the community

ART CLINIC

The ART clinic is a part of the Outpatient Department. Our clinic days are Wednesdays for paediatric clients and Tuesdays and Thursdays for all other clients.

In the day to day running of the clinic, the volunteers play a very vital role. They are involved in linking patients from one point of the clinic to another, retrieval and return of files, registration of patients and follow up of patients who may have missed appointments.

EMTCT

emtct and e.i.d1
TAKING LENGTH OF AN EXPOSED INFANT
emtct and e.i.d
THE ANC NURSE CARRIES OUT AN OBSTETRIC EXAM

Elimination of Mother to Child Transmission of HIV (EMTCT) services are provided at the ANC clinic. In March 2013, we began provision of Option B+, which means ARVs for life for every mother who is pregnant, lactating or delivering, who is found to be HIV positive. These mothers are provided with free ARVs and septrin and their exposed infants, with Nevirapine and septrin syrups. All exposed infants are seen on a regular basis at the Mother-Baby Care Point (MBCP).

All EMTCT mothers are encouraged to enroll in the family support group that runs every month. This group is a psychosocial support group that offers peer support for an HIV positive pregnant or lactating mother. A mother in this group is encouraged to come with her spouse, family members, caretakers of the exposed infant and friends who will act as her treatment supporters.

 

FAMILY PLANNING

Family planning
FAMILY PLANNING NURSE INSERTS AN IMPLANT

Family planning services are available at the hospital’s MCH department. Services provided include:

  • Family planning counseling
  • The different methods of family planning
  • Cancer of the cervix screening
  • Cryotherapy
  • Couples counseling

We have partnered with organizations like PACE in provision of skills training and equipment.

 

TUBERCULOSIS

The T.B unit provides the following services:

  • Screening of patients for T.B
  • Testing for presumed T.B cases
  • Treating all patients with confirmed T.B
  • Continuous Medical Education of hospital staff on T.B
  • Sensitizing the community on T.B

LABORATORY AND PHARMACY

Laboratory
TAKING A BLOOD SAMPLE
Pharmacy
AT THE DISPENSARY

Through the NESH project, the hospital has been able to procure medicines for treatment of opportunistic infections, consumables and laboratory supplies. This has made it possible to provide all HIV positive patients, both in-patient and out-patient, free medicines and laboratory tests.

We are now receiving all ARVs and some laboratory supplies from Medical Access Uganda Limited (MAUL). Other supplies are from J.M.S and N.M.S.

 

 

STRATEGIC INFORMATION

THE S.I OFFICE
THE S.I OFFICE

 

The strategic information unit at Rugarama Hospital has grown and now consists of an M&E  officer, an I.T officer, a records officer and a data clerk.

Two of these staff (M&E officer and  records officer) were trained in the OPEN MRS system which works to track all records for the  health facility.

 

 

 

 

CONTINUOUS QUALITY IMPROVEMENT (CQI)

The ART clinic CQI project has the following goals:

  • To monitor and improve the quality of care for HIV positive adults and children
  • To improve consumer/client satisfaction
  • To improve HIV counseling and testing
  • To improve EMTCT services
  • To improve T.B detection and treatment services
  • To improve nutritional services
  • To monitor and improve Safe Male Circumcision services
  • To improve HIV infection prevention services
  • To monitor and improve HIV testing services

Currently, the CQI team comprised of more than 30 members is tackling 16 project indicators spread through the following topics:

  • Adherence assessment

    CONTINUOUS QUALITY IMPROVEMENT
    CONTINUOUS QUALITY IMPROVEMENT
  • Nutrition
  • Up to date CD4
  • B assessment
  • Linkage into care
  • Initial CD4
  • Retention
  • Client satisfaction
  • Quality of care for HIV positive children and adults
  • Safe Male Circumcision
  • HIV counseling and testing