Uganda AIDS Commission. National HIV/AIDS Stakeholders & Services Mapping. Report. August 2009

Transcription

1 Uganda AIDS Commission National HIV/AIDS Stakeholders & Services Mapping Report August 2009 Contact: Jim Arinaitwe Global Fund Coordinator, Uganda AIDS Commission

2 Foreword With the changes in the nature and dynamics of both the HIV/AIDS epidemic and responses to it, the type of stakeholders and range of interventions are increasingly becoming multiple and multifaceted. This brings to the fore the need to institute and ensure an effective coordination mechanism in line with the principle of three ones. As part of its oversight role for HIV/AIDS Response, Uganda AIDS Commission sought to engage consultants to support staff of the Commission to undertake the mapping of stakeholders involved in providing/supporting HIV/AIDS services in the country. This report is the outcome of the exercise involving mapping of all actors to establish their number, location, coverage of interventions and resources. A similar exercise was undertaken in 2004/5 and revealed glaring gaps. The data presented in this report and also available on the web-based geo-database at the Commission will be used to regularly update the inventory and track progress, challenges and best practices in the National Response. The ultimate outcomes of this undertaking are expected to promote a coordinated and aligned implementation of the National Response to realize equity and national coverage for greater impact. In the immediate term, the results of this exercise provide invaluable input in designing a robust capacity building strategy for the National Response in order to increase coverage, equity and promote cost effective approaches. The Commission shall undertake to disseminate, rollout and provide feedback to the respondents/agencies the outcome of this geo-mapping and indeed all the capacity building exercises. Together we share the challenge. Dr. David Kihumuro Apuuli DIRECTOR GENERAL, UGANDA AIDS COMMISSION August 2009 i

3 Acknowledgements The Uganda AIDS Commission wishes to thank the HIV/AIDS Partnership and all staff of the Commission for their contribution towards the planning, organization and successful implementation of this mapping exercise. In particular, the Technical Subgroup is acknowledged for the immense effort, guidance and participation in the development of this exercise up to its logical conclusion. All the partner agencies of the Commission that contributed to financial and logistical support are recognized in a special way. The Commission is indebted to the Consultants, Swizen Kyomuhendo (Makerere University), Bernard Muhwezi (UBOS), Anthony Matovu (UBOS) and Andrew Balyeku (Independent Consultant) and the team of data collectors and data entrants. Most thanked and acknowledged are the stakeholders who provided the information vital for this exercise. August 2009 ii

4 Acronyms AIDS ART ARVs CBO CCM CMF CSD CSF CSO FBO GF GFATM HAT HCT HIV HRC ICA IEC IGA LA LFA LTIA M&E MIS MoFPED MoH NGO OVC PAF PC PEPFAR PHA PMMP PMTCT PMU PPDA PR PS SR STI UAC USAID Acquired Immune Deficiency Syndrome Antiretroviral Therapy Anti Retrovirals Community Based Organization Country Coordinating Mechanism Care taker Management Firm Condom supply and distribution Civil Society Fund Civil Society Organization Faith Based Organization Global Fund Global Fund against AIDS, Tuberculosis and Malaria HIV and AIDS Training HIV Counseling and Testing Human Immunodeficiency Virus HIV Resource Centre Institutional Capacity Information Education and Communication Income Generating Activities Lead Agency Local Fund Agent Long Term Institutional Arrangements Monitoring and Evaluation Management Information System Ministry of Finance Planning and Economic Development Ministry of Health Non Government Organization Orphans and other vulnerable children Poverty Action Fund Palliative Care Presidential Emergency Plan for AIDS Relief in Africa Persons with HIV and AIDS Performance Measurement and Management Plan Prevention of Mother To Child Transmission Programme Management Unit Public Procurement and Disposal of Public Assets Principal Recipient Psychosocial Support Sub recipient Sexually Transmitted Infections Uganda AIDS Commission United States Agency for International Development August 2009 iii

5 Table of contents FOREWORD...I ACKNOWLEDGEMENTS... II ACRONYMS...III TABLE OF CONTENTS... IV LIST OF TABLES... VI LIST OF MAPS... VII LIST OF FIGURES...X EXECUTIVE SUMMARY... XI DEFINITION OF KEY CONCEPTS... XIV SECTION ONE: BACKGROUND AND METHODOLOGY INTRODUCTION LONG TERM INSTITUTIONAL ARRANGEMENTS (LTIA) RATIONALE OVERALL OBJECTIVE FOR THE ACTIVITY METHODOLOGY...ERROR! BOOKMARK NOT DEFINED Overall design Key identifiers among HIV/AIDS stakeholders Mapping Indicators for HIV/AIDS stakeholders Methods of data collection Data processing, analysis and presentation... 8 SECTION TWO: PREVENTION OF HIV/AIDS BEHAVIOR CHANGE Information, education and communication Condom services Training HIV COUNSELLING AND TESTING SERVICES Schools-based interventions BLOOD SAFETY STI SERVICES PMTCT SERVICES SECTION THREE: MITIGATION AND CARE INCOME GENERATING ACTIVITIES ORPHANS AND VULNERABLE CHILDREN CARE/SUPPORT PALLIATIVE CARE PSYCHOSOCIAL SUPPORT ANTIRETROVIRAL TREATMENT SECTION FOUR: NATIONAL CAPACITY RESOURCE TRACKING Amount of funds from Government and donors INFORMATION BASE SECTION FIVE: DISTRICT PROFILES SECTION SIX: CONCLUSIONS AND LESSONS FOR NATIONAL CAPACITY BUILDING SUMMARY OF RESULTS FROM PROGRAMMATIC AND GEO-MAPPING EXERCISE August 2009 iv

6 6.2 CONCLUSIONS REFERENCES APPENDICES...ERROR! BOOKMARK NOT DEFINED. August 2009 v

7 List of Tables Table 1: Type of stakeholders mapped... 4 Table 2: Mapping indicators and their attributes... 7 Table 3: Number of beneficiaries of IEC activities by district during Table 4: Number/proportion of sub counties that received condoms during Table 5: Number of participants trained on HIV/AIDS by district during Table 6: Number/proportion of sub counties with agencies providing HIV/AIDS related training during Table 7: Number/proportion of sub counties with HCT services during Table 8: Number of teachers trained to support school-based HIV/AIDS interventions Table 9: Number of clients/patients offered STI services by district during Table 10: Number of clients offered PMTCT services by district during Table 11: Number/proportion of sub counties with PMTCT services during Table 12: Number/proportion of sub counties with Income Generating Activities during Table 13: Number of beneficiaries for OVC support by district during Table 14: Number of clients offered palliative care by district during Table 15: Number/proportion of sub counties with palliative care services during Table 16: Number of clients offered psychosocial support during Table 17: Number/proportion of sub counties with psychosocial support services during Table 18: Number of clients offered ARVs by district during Table 19: Number/proportion of sub counties with agencies providing ARVs during Table 20: Amount of funds stakeholders received by district during Table 21: Number/proportion of sub counties with resource centers with HIV/AIDS materials during Table 22: Thematic Intervention August 2009 vi

8 List of Maps Map 1: Distribution of stakeholders per district... 5 Map 2: Distribution of stakeholders by type per district... 6 Map 3: Performance of stakeholders involved in IEC activities by district Map 4: Distribution of IEC beneficiaries by Sub County during Map 5: Distribution of stakeholders involved in condom support services by district18 Map 6: Distribution of stakeholders involved in condom education by district Map 7: Distribution of condoms by Sub County during Map 8: Distribution of stakeholders involved in training on HIV/AIDS by district Map 9: Distribution of stakeholders involved in the provision of HCT services by district Map 10: Distribution of stakeholders providing child counselling services by district 31 Map 11: Distribution of HCT beneficiaries by Sub County during Map 12: Distribution of stakeholders providing school based interventions by district 36 Map 13: Distribution of teachers trained by Sub County during Map 14: Distribution of agencies providing/supporting blood transfusion services. 42 Map 15: Distribution of agencies providing STI services Map 16: Distribution of STI service beneficiaries by Sub County during Map 17: Distribution of agencies providing PMTCT services Map 18: Distribution of PMTCT service beneficiaries by Sub County in Map 19: Distribution of agencies providing IGA support Map 20: Distribution of IGA beneficiaries by Sub County during Map 21: Distribution of agencies providing OVC care and support Map 22: Distribution of beneficiaries of OVC care and support services during Map 23: Distribution of agencies providing palliative care Map 24: Distribution of palliative care service beneficiaries by Sub County during Map 25: Distribution of agencies providing psychosocial support Map 26: Distribution of psychosocial support service beneficiaries by Sub County during Map 27: Distribution of Agencies providing/supporting ARVs Map 28: Distribution of ARV beneficiaries by Sub County during Map 29: Distribution of funds by Sub County during Map 30: Distribution of Agencies with own resource centre with materials on HIV/AIDS Map 31: Distribution of resource centres by Sub County in Map 32: Distribution of services by Sub County in Abim District Map 33: Distribution of services by Sub County in Adjumani District Map 34: Distribution of services by Sub County in Amolatar District Map 35: Distribution of services by Sub County in Amuria District Map 36: Distribution of services by Sub County in Amuru District Map 37: Distribution of services by Sub County in Apac District Map 38: Distribution of services by Sub County in Arua District Map 39: Distribution of services by Sub County in Budaka District Map 40: Distribution of services by Sub County in Bududa District Map 41: Distribution of services by Sub County in Bugiri district August 2009 vii

9 Map 42: Distribution of services by Sub County in Bukedea District Map 43: Distribution of services by Sub County in Bukwo District Map 44: Distribution of services by Sub County in Buliisa District Map 45: Distribution of services by Sub County in Bundibugyo District Map 46: Distribution of services by Sub County in Bushenyi District Map 47: Distribution of services by Sub County in Busia District Map 48: Distribution of services by Sub County in Butaleja District Map 49: Distribution of services by Sub County in Dokolo District Map 50: Distribution of services by Sub County in Gulu District Map 51: Distribution of services by Sub County in Hoima District Map 52: Distribution of services by Sub County in Ibanda District Map 53: Distribution of services by Sub County in Iganga District Map 54: Distribution of services by Sub County in Isingiro District Map 55: Distribution of services by Sub County in Jinja District Map 56: Distribution of services by Sub County in Kaabong District Map 57: Distribution of services by Sub County in Kabale District Map 58: Distribution of services by Sub County in Kabarole District Map 59: Distribution of services by Sub County in Kaberamaido District Map 60: Distribution of services by Sub County in Kalangala District Map 61: Distribution of services by Sub County in Kaliro District Map 62: Distribution of services by Sub County in Kampala District Map 63: Distribution of services by Sub County in Kamuli District Map 64: Distribution of services by Sub County in Kamwenge District Map 65: Distribution of services by Sub County in Kanungu District Map 66: Distribution of services by Sub County in Kapchorwa District Map 67: Distribution of services by Sub County in Kasese District Map 68: Distribution of services by Sub County in Katakwi District Map 69: Distribution of services by Sub County in Kayunga District Map 70: Distribution of services by Sub County in Kibaale District Map 71: Distribution of services by Sub County in Kiboga District Map 72: Distribution of services by Sub County in Kiruhura District Map 73: Distribution of services by Sub County in Kisoro District Map 74: Distribution of services by Sub County in Kitgum District Map 75: Distribution of services by Sub County in Koboko District Map 76: Distribution of services by Sub County in Kotido District Map 77: Distribution of services by Sub County in Kumi District Map 78: Distribution of services by Sub County in Kyenjojo District Map 79: Distribution of services by Sub County in Lira District Map 80: Distribution of services by Sub County in Luwero District Map 81: Distribution of services by Sub County in Lyantonde District Map 82: Distribution of services by Sub County in Manafwa District Map 83: Distribution of services by Sub County in Masaka District Map 84: Distribution of services by Sub County in Masindi District Map 85: Distribution of services by Sub County in Mayuge District Map 86: Distribution of services by Sub County in Mbale District Map 87: Distribution of services by Sub County in Mbarara District Map 88: Distribution of services by Sub County in Mityana District Map 89: Distribution of services by Sub County in Moroto District Map 90: Distribution of services by Sub County in Moyo District Map 91: Distribution of services by Sub County in Mpigi District August 2009 viii

10 Map 92: Distribution of services by Sub County in Mubende District Map 93: Distribution of services by Sub County in Mukono District Map 94: Distribution of services by Sub County in Nakapiripriti District Map 95: Distribution of services by Sub County in Nakaseke District Map 96: Distribution of services by Sub County in Nakasongola District Map 97: Distribution of services by Sub County in Namutumba District Map 98: Distribution of services by Sub County in Nebbi District Map 99: Distribution of services by Sub County in Ntungamo District Map 100: Distribution of services by Sub County in Oyam District Map 101: Distribution of services by Sub County in Pader District Map 102: Distribution of services by Sub County in Pallisa District Map 103: Distribution of services by Sub County in Rakai District Map 104: Distribution of services by Sub County in Rukungiri District Map 105: Distribution of services by Sub County in Sironko District Map 106: Distribution of services by Sub County in Soroti District Map 107: Distribution of services by Sub County in Ssembabule District Map 108: Distribution of services by Sub County in Terego-maracha District Map 109: Distribution of services by Sub County in Tororo District Map 110: Distribution of services by Sub County in Wakiso District Map 111: Distribution of services by Sub County in Yumbe District August 2009 ix

11 List of Figures Figure 1: Proportion of stakeholders supporting IEC Figure 2: Type of IEC support stakeholders provide Figure 3: Method of feedback on IEC materials distribution and monitoring Figure 4: Proportion of stakeholders involved in condom support services Figure 5: Type of support for condom services stakeholders provide Figure 6: Sources of condoms stakeholders distribute Figure 7: Method of condom distribution which stakeholders use Figure 8: Proportion of stakeholders involved in training on HIV/AIDS Figure 9: Type of training curriculum/manual used by stakeholders Figure 10: Type/area of HIV/AIDS training carried out by stakeholders Figure 11: Proportion of stakeholders providing HCT services Figure 12: Proportion of stakeholders providing child counselling services Figure 13: Proportion of stakeholders providing free HCT services Figure 14: Proportion of stakeholders providing school based interventions Figure 15: Proportion of stakeholders providing life skills training in schools Figure 16: Types of life skills trainings provided at different education level centers 35 Figure 17: Proportion of stakeholders providing/supporting blood transfusion Figure 18: Source of blood/blood products agencies use Figure 19: Available interventions to improve blood safety Figure 20: Forms of blood screening carried out by stakeholders Figure 21: Place of blood screening used by stakeholders Figure 22: Proportion of stakeholders providing STI services Figure 23: Types of STI services provided by stakeholders Figure 24: Proportion of stakeholders providing PMTCT services Figure 25: Proportion of stakeholders providing IGAs Figure 26: Other HIV/AIDS mitigation activities carried out by stakeholders Figure 27: Proportion of stakeholders providing care for OVCs Figure 28: Type of benefits in OVC care and support offered by stakeholders Figure 29: Proportion of stakeholders offering palliative care Figure 30: Proportion of agencies offering psychosocial support Figure 31: Proportion of agencies providing ARVs Figure 32: Proportion of agencies having a resource center with HIV/AIDS materials 80 August 2009 x

12 Executive summary Background This is a report of the national exercise undertaken to programmatically and geo-map HIV/AIDS stakeholders and services in order to redirect intervention focus and resources for the national response. The stakeholders in this mapping include civil society organizations, central and local government departments and other agencies involved in service provision. This exercise is focused on mapping of stakeholders by locating their physical address (presence), activity scope (interventions) and areas and beneficiaries covered by their interventions. Methodology A self-completion questionnaire was administered to participating agencies while the consultants and/or research assistants provided clarifications on meaning and/or interpretation of some of the questions where necessary. Whereas a census of all agencies was intended, the findings represent the stakeholders that successfully completed the tool in time for the report. Other duly completed questionnaires are still being received and the data will be captured and the database updated as and when more information is obtained. Summary of findings Information Education and Communication More than three quarters of HIV/AIDS stakeholders support IEC activities. Majority of these are involved in distribution and a considerable proportion into promotion and very few into production and financing of IEC materials and activities respectively. The country has a national average performance rate of 82% measured by proportion of agencies supporting IEC and number of beneficiaries reached by the agencies IEC activities. A total of 9,013,423 HIV/AIDS IEC targeted beneficiaries were registered in the whole country during Condoms services Majority (80 %) of the stakeholders support condom services. Among these, many are involved in condom distribution and condom education. Very few agencies however are into procurement. Government is the leading source of condoms distributed by the different stakeholders. Nearly all (90 %) stakeholders are distributing condoms for free. The country is performing well in terms of distribution of agencies supporting condom services across districts. The highest number of condoms distributed in 2008 in one sub-county was about 700,000. In most of the sub counties in the country, less than 30,000 condoms were distributed in Training Nearly more than half of the stakeholders carry out HIV/AIDS training. Majority of the agencies have trained people in life skills development, peer education, VCT, PMTCT and counselling, and few in OIs, ART, STI, IGAs, HBC, counselling/psychosocial support, palliative care, and trainings relating to culture, Gender and HIV/AIDS. Nationally, a total of 2,303,506 participants were trained on HIV/AIDS related issues during West Nile and Western regions have a fair distribution of agencies providing HIV/AIDS training. Some districts however trained as low as less than 100 participants with some extremes recording less than 50 participants. August 2009 xi

13 HIV Counselling Testing (HCT) services About two thirds of stakeholders are involved in HCT services, nearly all at no cost. There seems to be a good distribution of HCT services in the country, the country has a national average of 72% across all regions, measured considering the number of agencies providing HCT services in a district. The North central districts, Far East and some districts in the western and central districts of the country have a fair distribution of agencies providing HCT services. Child counselling is low (43%). School based interventions Nearly half of the stakeholders are providing school based interventions. Out of these, about 40% are providing life skills training, many of them in primary schools compared to the other levels of learning. Little has been done in tertiary institutions. Generally, the national distribution of school based interventions is poor (mean of 40%). A total of 352,247 teachers were trained nationally during 2008 to support school based HIV/AIDS interventions. Blood safety Very few stakeholders support/provide blood donation/transfusion services. The country s blood/blood products are mostly from the blood bank. Agencies supporting blood transfusion services have in a place a number of interventions to ensure blood safety. These include; providing alternative blood products, mobilizing low risk donors, reducing blood wastage in facility and providing HIV/AIDS testing facilities. Most agencies use a combination of interventions to ensure blood safety. STI services A large proportion (71%) of agencies is supporting/providing STI services, mainly syndromic management, lab testing, HIV testing, syphilis screening, education and counselling, partner notification, condoms and prophylaxis. Countrywide, the distribution is relatively high (66%) especially for the districts in the North central, West Nile, North Eastern and a few in the West. In 2008, a total of 4,073,568 STI service beneficiaries were registered. Kampala registered the highest number of STI service beneficiaries, with over a million clients targeted. PMTCT Services A relatively big proportion (60%) of HIV/AIDS agencies is suporting PMTCT services in the country, especially sensitization. This is also true in terms of geographical distribution. Some districts recorded PMTCT clients ranging from 10,000 to 20,000 during 2008 while a significant number of districts registered clients ranging from Some districts that registered less than 900 clients for PMTCT in Income Generating Activities (IGAs) Very few (29%) HIV/AIDS agencies are providing IGAs. There are also glaring gaps in geographical distribution of agencies in the country. A few districts in the central, East and East central have a relatively fair distribution of agencies involved in IGAs. OVC support and care A small proportion of HIV/AIDS agencies is providing some support and care for OVCs, mainly material, education, nutrition, and psychosocial support. Overall, the national mean is 25% in relation to the distribution of agencies providing OVC support. A August 2009 xii

14 significant number of districts however fall below this figure. A total of 358,565 people benefited from the OVC care and support services in Kampala and Kabarole registered the highest number of beneficiaries for OVC support. Most of the districts registered between beneficiaries. Palliative care Very few agencies are providing palliative care in the country (national average is as low as 19%). Most of the districts lie below this mean. In relation to beneficiaries, Kampala registered the highest number (17,292) of clients for palliative care services in Bushenyi and Mukono also registered a considerable number of clients. In terms of distribution of beneficiaries by sub-county, most of them recorded less than 300 clients. Psychosocial support Slightly more than half of the HIV/AIDS agencies are providing some kind of psychosocial support (national distribution is 50%). Districts in Western region have a better distribution of agencies providing psychosocial support compared to districts in the Eastern part of the country. Some of the North central districts and central districts also have a fair distribution of agencies providing psychosocial support. Kampala and Wakiso recorded the highest number of clients in Most of the districts registered clients ranging from for psychosocial support. Antiretroviral services (ARVs) It is evident that the country is performing poorly in this service area. Very few agencies are involved in the provision and support of ARVs. Nearly three quarters of the districts fall below the national mean of 27 % in relation to support and provision of ARVs. A total of 170,907 clients were reported on ART in the whole country. Kampala, Masaka and Lira have the highest numbers of clients on ART ranging from 22,000-52,000. Information Base: Resource centres Very few agencies own resource centers with HIV/AIDS materials in the country. The country has a national distribution mean of 11% of agencies that own resource centers with HIV/AIDS materials. Conclusion Uganda is performing relatively well in HIV/AIDS preventive services, mainly providing and supporting IEC activities, condom services, HCT, STI and PMTCT services. The agencies are also fairly well distributed throughout the country. However poor distribution for child counselling services and HIV/AIDS training is evident. This is also the case for school based interventions and blood transfusion services. Availability and distribution of agencies providing or supporting HIV/AIDS mitigation and care services is significantly limited. Few agencies are involved in the provision of IGAs and care/support for OVCs. A few agencies are also providing palliative and psychosocial support services to PLHA. The distribution and number of agencies is providing ARVs throughout the country is poor and low respectively. August 2009 xiii

15 Definition of key concepts Base layer: Consists of one coordinate for point features, or a series of coordinates for line and polygon features, graphically indicating physical objects like buildings, roads, market places and administrative boundaries Geodatabase: A geographic database that is hosted within a relational database management system and which provides services for managing geographic data. These services include building relationships, editing, creating new layers, spatial analysis and preparing maps. This information is then used to develop a Geographical Information System (GIS). GIS: A Geographic Information System consisting of hardware, software, and data that can be used to compile, store, manipulate, analyze, model and visualize spatial data HIV/AIDS: HIV and AIDS. Local Government stakeholders: Decentralised services/centers under the local government (DDHS, Health centers, Local Government) Mapping Indicator: An indicator derived from one or more indicators of the National Strategic Framework which was considered to be represented in a map Resource Centre: A place where reference material on HIV/AIDS is available to the public Stakeholders: Organizations and agencies involved in HIV/AIDS activities August 2009 xiv

16 Section One: Background and methodology 1.1 Introduction Uganda AIDS Commission (UAC), is the seat of the HIV/AIDS Partnership; the Country Coordinating Mechanism (CCM) for HIV/AIDS component of the Global Fund against AIDS, Tuberculosis and Malaria (GFATM). UAC assumed this responsibility, after the earlier GFATM grants had been suspended following a review by LFA that highlighted anomalies in the implementation of the grant. After the suspension and disbandment of the PMU, Government of Uganda through Ministry of Finance Planning and Economic Development (MoFPED) contracted a Caretaker Management Firm (CMF) to take over the roles of PMU in the interim. The CMF conducted further assessment of the CSO sub grantees of the GFATM and the assessment revealed varying capacities in financial management. Overall 31% of the agencies had sufficient capacity and therefore eligible while 29% had residual capacity modest enough to work in a demoted functional level, leaving 40% recommended for termination. 1.2 Long Term Institutional Arrangements (LTIA) During the interim period, the Government of the Republic of Uganda established Long Term Institutional Arrangement to manage all resources to the National response including the GFATM resources. In line with the Long Term Institutional Arrangements (LTIA), UAC will perform the delegated function of the Principal Recipient (PR) in coordinating the Public and Private Sector. The public sector will be funded through the Poverty Action Fund (PAF) while the Private sector will be funded through the Civil Society Fund (CSF). The funds to CSO sub recipients of the GF will be under the constitutional oversight of Uganda AIDS Commission. The funds to CSF are currently accessed through competitive bidding and process is centralized at national level. 1.2 Rationale The agencies participating in CSF and GFATM application have been found to be an infinitely small number compared to Civil Society Organizations (CSOs) involved in HIV/AIDS in Uganda including Community Based Organizations (CBOs) and community groups. Secondly the funding landscape of the national response for the coming years is currently characterized by competition to access and is becoming performancebased. Thirdly, there is need to increase geographical coverage, ensure equity and equitable distribution not only of services but also of stakeholders and resources to underpin thematic balance of interventions. August

17 UAC intends to use the product of this major mapping to design a national HIV/AIDS database and establish a tailor made and focused capacity building strategy for the national response to HIV/AIDS as a starting point but later widen scope to national service delivery outcomes. Once the capacity trends in the national response are established and documented, a remedial strategy will be mapped out to decentralize funding and granting mechanisms to district level; the operational and implementation level close to the communities and people that are the service consumers. The national response will then take on the pro-people model of HIV/AIDS service delivery to demonstrate programmatic accountability, promote grass root participation, involvement, acceptance, ownership and sustainability through building AIDS competent communities. This exercise was undertaken along other efforts at Uganda AIDS Commission and indeed the AIDS Partnership to develop and up-to-date country data base for monitoring programs and activities for addressing HIV/AIDS in the country and roll out the Performance Measurement and Management Plan (PMMP). The outcomes of this undertaking are therefore expected to contribute to promotion of a more coordinated and aligned implementation of the national response to realize equity and national coverage for greater impact. 1.4 Overall objective for the activity The ultimate objective for activity is to construct a capacity building strategy and plan in order to enhance HIV/AIDS services coverage and equity through cost effective approaches in order to attain universal targets and create more visible impact. As part of this goal, this assignment is an undertaking to programmatically and geomap HIV/AIDS stakeholders and services in order to redirect intervention focus and resources for the national response. The stakeholders in this mapping include civil society organizations, central and local government departments and agencies involved in the national AIDS response. Although the stimuli for this exercise stems from the experiences and lessons learned as agencies grappled with CSF and GFATM in the recent past, the broader intent is to seek practical strategies to accelerate the national response to HIV/AIDS by bringing services closer to those most in need in an equitable and effective way. 1.5 Methodology The overall capacity strategy exercise had five phases including capacity assessment, mapping of HIV/AIDS Stakeholder and Services, capacity building strategy, actual capacity building (including training); and dissemination and feedback, capacity assessment and mapping phase were executed simultaneously, and thus generated a combined dataset. This report provides analysis of the mapping of HIV/AIDS Stakeholders and Services in Uganda 2008/2009. August

18 1.5.1 Overall design This mapping report draws and builds on the dataset obtained during the capacity assessment phase. The design adopted for this exercise is focused on mapping of stakeholders involved in AIDS work by locating their physical address (presence), activity scope (interventions) and areas covered by their interventions. The geo-mapping of HIV/AIDS services was intended to locate who is doing what, where, and with what resources. The outcome of this activity was intended to demonstrate distribution of AIDS service agencies and services in the country. The product presented in this report and the geo-maps is prepared in such a way that it involves redirection of program and response focus. This should provide an opportunity to affirmatively distribute resources to enhance coverage and ensure the principle of equity. The mapping activity extends to the sub-county as the lowest functionally organized entity of implementation. All registered agencies up to CBOs were targeted for inclusion in the mapping. The section presents the process, methods of data collection, analysis and databases design and development. The information in this report was result triangulation of data collection using largely quantitative methodology. The assessment aimed at having a national coverage of all agencies involved in HIV/AIDS services. Data on various capacity indicators for all active public sector institutions and CSOs involved in various areas of HIV/AIDS response at local, sub-county, district and/or national level was obtained. This report provides a census of stakeholders specialized in HIV/AIDS services. It excludes less formal social groups. The overall design provides for the output of the capacity assessment product to be used in capacity building initiative at national, district and agency level, resource management including use, allocation and efficiency. Overall the product is intended ton be used by policy makers, program implementers and funding agencies. While the overall capacity strategy exercise had five phases including capacity assessment, mapping of HIV/AIDS Stakeholder and Services, capacity building strategy, actual capacity building (including training); and dissemination and feedback, capacity assessment and mapping phase were executed simultaneously, and thus generated a combined dataset. August

19 1.5.2 Key identifiers among HIV/AIDS stakeholders Table 1: Type of stakeholders mapped Type of organization Frequency Percent n % Central gov t ministries/depts./agencies Corporate body/parastatal/private Local government service facilities UN/Bilateral/international NGO National NGOs PHA networks/organizations Religious/ FBOs CBOs and cultural groups Research/training agency and others Total 1, August

20 Map 1: Distribution of stakeholders per district August

21 Map 2: Distribution of stakeholders by type per district August

22 1.5.3 Mapping Indicators for HIV/AIDS stakeholders Table 2: Goal Strategy Thematic interventions Prevention Behaviour Information change Education and Communication (IEC) HCT Schools Activities Blood Safety STI Services PMTCT Services Mapping indicators and their attributes Condom Distribution Training of peer educators HIV Counselling and Testing (HCT) Life Skills Training Blood screening Sexually Transmitted Infections (STI) Prevention of Mother To Child Transmission (PMTCT) Mitigation and Care IGAs Income Generating Activities (IGA) OVC Care and Social Support Care and Social Support Orphans and Vulnerable Children (OVC) Palliative Care Psychosocial Support Required data/attributes per theme Who is supporting IEC and type of support? What type of channel of IEC is used? Population and geographical coverage up to sub county Method of feedback on IEC materials distribution and monitoring Who is distributing condoms? What is the method of condom distribution? How many condoms distributed? Who is funding or providing training on HIV/AIDS? Type/area of training and geographical and population coverage Who is providing HCT services and Child counselling services? Area and number of clients served? Who is providing school based interventions? Who provides life skills training in schools? Schools covered and number of teachers trained Who is providing/support blood transfusion services? Interventions in place for blood safety Is the blood screened and from where? Who is providing or supporting STI services? Type of STI services offered Who is providing or supporting PMTCT services? Distribution of PMTCT centres in the country Number of beneficiaries Number of stakeholders that provide IGA support How many families benefit? Other HIV/AIDS mitigation activities carried out How many stakeholders are funding or proving care for OVCs? Type of care to OVCs Number of beneficiaries How many are funding or offering palliative care? Number of beneficiaries Number of organizations funding or offering psychosocial support Number of beneficiaries National Capacity Care and Social Support Anti Retrovirals (ARV) Resource Tracking Number of organizations providing ARVs Number of beneficiaries Source of funding for stakeholders Amount of funds received Information Base Number of stakeholder with resource centres with HIV/AIDS materials Distribution of resource centres in the country August

23 1.5.4 Methods of data collection The data was collected using a structured closed questionnaire to avoid different interpretation by stakeholders, to facilitate uniform interpretation of information and corroborated input into the database. The questionnaire was structured in such a way that it had in-built checks to minimize desirability bias. This self-completion questionnaire was administered to participating agencies while the consultants and/or data collectors provided clarifications on meaning and/or interpretation of some of the questions where necessary. The field responses were triangulated with agency program information products such as reports, minutes, listings, guidelines and legal documents. The tool was developed with input of the mapping questionnaire used in 2004/05, the service availability mapping tool 2007, CSO review tools and in house data requirements based on the National M&E Framework. The tool updated all the fields of the 2005/06 mapping exercise. A hand held Global Positioning System (GPS) device was used to physically locate agencies/institutions presented in this report and in the database. This technology uses satellites to locate places on earth. The device obtains signals from the satellites and transforms them into coordinates and altitude (X, Y and Z) Data processing, analysis and presentation Data input files were exported from the joint dataset of the capacity assessment and mapping to ArcView 9.2 to generate the maps. In comparison with other software, the selected software used was selected based on a number of considerations including the following: o A user friendly Windows based interface o Display of point, line and polygon data layers in different projections o Generate thematic maps with point, line and polygon symbol palettes (ability for classification, graduated colour and graduated symbols) o Location and selection features based on manual identification or through logical searches o General arithmetic operations performed on attribute and spatial data (e.g. addition, subtraction, multiplication); o General statistical operations o Add point, line or polygon features o Editing facilities (add or delete features, generate topology, edit attribute table) o Facility for spatial analysis (overlay, buffer) o Import and export facilities o Linkage with external (relational) database systems o Ability to upload maps to the internet August

24 o o o Basic operations like panning, zooming in and out, querying, adding and removing layers and labeling Compatible with other (major) GIS and mapping software used in Uganda Technical support in Uganda for ongoing development (upgrading) The results of this study in this report have been summarized in text, tables and maps. August

25 Section Two: Prevention of HIV/AIDS 2.1 Behavior Change Information, education and communication Majority of the HIV/AIDS stakeholders support IEC activities. More than three quarters support IEC. Production, financing, distribution and promotion are the common forms of support provided by agencies involved in IEC activities. Majority of agencies however are involved in distribution of IEC materials, a considerable proportion in promotion and few are into production and financing of IEC materials and activities respectively. Agencies supporting IEC activities have some form of feed back method for purposes of distribution and monitoring. Most (60%) of them monitor their IEC activities through community survey, a few (15%) carry out in-house monitoring and independent/outside monitoring. A small proportion of about 12% monitor and evaluate their IEC activities using a combination of all the above. Generally, agencies supporting IEC activities are performing well across the country. The country has a national average performance rate of 82% measured by proportion of agencies supporting IEC and number of beneficiaries reached by the agency s IEC activities. There is no significant difference in the regional IEC performance; all regions appear to be doing relatively well. A total of 9,013,423 HIV/AIDS IEC beneficiaries were targeted in the whole country during The central districts (Wakiso, Kampala, Mukono, Masaka and Mityana) had more IEC beneficiaries compared to the rest of the districts. Bushenyi in the western part, Lira in the North, Mayuge and Mbale in the East, are the other districts that had a large number of IEC beneficiaries in Districts which had the least number of IEC beneficiaries include; Amuru in the North, Kaliro and Namutumba in the East, Kanungu in the West and Nebbi in West Nile. These had an average of just about 150 IEC targeted beneficiaries in Figure 1: Proportion of stakeholders supporting IEC 13% 87% Support IEC materials Do not support August

26 Figure 2: Type of IEC support stakeholders provide Production Financing Distribution Promotion Figure 3: Method of feedback on IEC materials distribution and monitoring Independent monitoring In-house monitoring Community survey Others August

27 Map 3: Performance of stakeholders involved in IEC activities by district August

28 Table 3: Number of beneficiaries of IEC activities by district during 2008 DISTRICT No. of beneficiaries DISTRICT No. of beneficiaries Abim 5,809 Kitgum 964 Adjumani 27,630 Koboko* - Amolatar 29,197 Kotido 113,099 Amuria 29,434 Kumi 228,558 Amuru 120 Kyenjojo 137,800 Apac 47,211 Lira 749,391 Arua 58,701 Luwero 155,316 Bugiri 71,039 Lyantonde 35,617 Bukedea 15,500 Manafwa 4,200 Bukwa 27,704 Maracha 154,098 Bundibugyo 152,361 Masaka 503,965 Bushenyi 790,467 Masindi 35,010 Busia 103,395 Mayuge 517,898 Dokolo 28,270 Mbale 305,243 Gulu 84,484 Mbarara 151,631 Hoima 236,812 Mityana 238,393 Ibanda 103,527 Moroto 72,115 Iganga 157,379 Moyo 145,605 Isingiro 2,000 Mubende 42,250 Jinja 15,900 Mukono 296,992 Kaabong 3,966 Nakapiripirit 72,750 Kabale 183,520 Nakaseke 4,172 Kabarole 195,785 Nakasongola 23,050 Kaberamaido 22,872 Namutumba 208 Kalangala 6,512 Nebbi 200 Kaliro 378 Ntungamo 41,500 Kampala 411,384 Oyam* - Kamuli 6,337 Pader 67,949 Kamwenge 13,523 Pallisa 11,297 Kanungu 250 Rakai 235,728 Kapchorwa 94,641 Rukungiri 20,826 Kasese 185,086 Sironko 34,821 Katakwi 59,942 Soroti 133,403 Kayunga* - Ssembabule 56,600 Kibaale 14,314 Tororo 77,927 Kiboga 162,314 Wakiso 924,459 Kiruhura 2,000 Yumbe 43,400 Kisoro 26,954 Total 9,013,423 * Information not provided August

29 Map 4: Distribution of IEC beneficiaries by Sub County during 2008 August

30 2.1.2 Condom services Majority (80 %) of the stakeholders support condom services. Among these, majority are involved in condom distribution, condom education and condom financing activities. A few are involved in training condom distributors and very few are into procurement. Government (MoH) is the leading source of condoms distributed by the different stakeholders. A considerable proportion of the agencies distributing condoms obtain them from Donors, very few organizations procure themselves condoms they distribute. Some agencies however, access condoms through a combination of the above mentioned sources. Nearly all (90 %) stakeholders involved in condom distribution give them out for free. A few distribute them through social and open markets. Some of the stakeholders distribute condoms using a combination of all or two of the above. The country has a national average figure of 82% distribution of agencies involved in condom service activities; this average is the same for the distribution of agencies providing condom education. The distribution of agencies supporting condom services in the country is evenly distributed. There is little evidence of regional imbalance of agencies providing condoms services. The eastern region slightly has more agencies supporting condom services than the rest of the regions. There is a 61% condom distribution at sub county level in the country. This is an average 64% sub counties that received condoms in 2008 and 58% of sub counties that supplied condoms in the same year. This data shows that there has been nearly no change in condom distribution at the sub county in the last three years. According to the 2005 service mapping the percentage of condom distribution at the sub county was 60%. Therefore, the country still has a gap of 39% condom distribution at the sub county; this is in contrary with the widely believed notion of universal condom distribution by many. The highest number of condoms distributed in 2008 was about 700,000. These were distributed in a sub county found in Iganga. In most of the sub counties in the country, less than 30,000 condoms were distributed in A few sub counties in the western, central and eastern region districts distributed condoms ranging between 300, ,000. August

31 Figure 4: Proportion of stakeholders involved in condom support services 20% 80% Suppport condom services Do not support condoms Figure 5: Type of support for condom services stakeholders provide Procurement Train condom distributors Condom education Finance condom activities Condom distribution August

32 Figure 6: Sources of condoms stakeholders distribute Government Donors Procurement Ot hers Figure 7: Method of condom distribution which stakeholders use 4% 2% 5% 89% Free Social marketing Open market Others August

33 Map 5: Distribution of stakeholders involved in condom support services by district August

34 Map 6: Distribution of stakeholders involved in condom education by district August

35 Table 4: 2008 Number/proportion of sub counties that received condoms during District SCs served Total SCs Percent District SCs served Total SCs Percent Abim Kisoro Adjumani Kitgum Amolatar Koboko Amuria Kotido Amuru Kumi Apac Kyenjojo Arua Lira Budaka Luwero Bududa Lyantonde Bugiri Manafwa Bukedea Maracha Bukwa Masaka Buliisa Masindi Bundibugyo Mayuge Bushenyi Mbale Busia Mbarara Butaleja Mityana Dokolo Moroto Gulu Moyo Hoima Mpigi Ibanda Mubende Iganga Mukono Isingiro Nakapiripirit Jinja Nakaseke Kaabong Nakasongola Kabale Namutumba Kabarole Namutumba Kaberamaido Nebbi Kalangala Ntungamo Kaliro Oyam Kampala Pader Kamuli Pallisa Kamwenge Rakai Kanungu Rukungiri Kapchorwa Sironko Kasese Soroti Katakwi Ssembabule Kayunga Tororo Kibaale Wakiso Kiboga Yumbe Kiruhura Total August

36 Map 7: Distribution of condoms by Sub County during 2008 August

37 2.1.3 Training Nearly more than half of the stakeholders carry out HIV/AIDS training. Of these, majority use the national curriculum/manual while a few share manuals amongst themselves. Very few agencies carrying out HIV/AIDS training use their own HIV/AIDS training curriculum/ manual. The types of training carried out among agencies that provide HIV/AIDS training include; OI management, ART, Life skills development, peer education, VCT, STI management, PMTCT, counselling/psychosocial support, Home Based Care, palliative care, IGAs, and trainings relating to culture, Gender and HIV/AIDS. Majority of the agencies have trained people in life skills development, peer education, VCT, PMTCT and counselling. Fewer agencies have trained people on the rest of the HIV/AIDS aspects prior mentioned. Yumbe and Arua in West Nile and Kibaale and Kamwenge in the Western region have a fair distribution of agencies providing HIV/AIDS training. The rest of the districts have nearly 50% of their agencies not providing training any on HIV/AIDS related issues. Buliisa and Kaliro have the least number of agencies involved in this aspect. Training on HIV/AIDS is still limited at the sub county level. Only 44% of the sub counties have agencies offering training on HIV/AIDS related issues. There is a gap of 56% of sub counties without services on HIV/AIDS training. Nationally, a total of 2,303,506 participants were trained on HIV/AIDS related issues during Information provided during the mapping exercise indicates that Kampala and Iganga had the highest number with over 100,000 and 200,000 participants trained respectively. A few districts in the South Western and Eastern region trained between 10,000-30,000 participants. On average most of the districts trained about 3000 participants in HIV/AIDS in Some districts however trained as low as less than 100 participants with some extremes recording less than 50 participants. This is the case in Yumbe, Ibanda, Mayuge, Butaleja, Nakasongola, among others. August

38 Figure 8: Proportion of stakeholders involved in training on HIV/AIDS 47.1, 47% 52.8, 53% Conduct training Don't conduct training Figure 9: Type of training curriculum/manual used by stakeholders National curriculum Ow n curriculum Other agencies curriculum August

39 Figure 10: Type/area of HIV/AIDS training carried out by stakeholders OI M gt ART Life skills dvpt Peer Education VCT STI M gt PM TCT counselling HBC Palliative Care IGAS Culture and Gender Other (Specify) August

40 Map 8: district Distribution of stakeholders involved in training on HIV/AIDS by August

41 Table 5: Number of participants trained on HIV/AIDS by district during 2008 DISTRICT No. of participants DISTRICT No. of participants Abim 6,403 Kitgum 5,948 Adjumani 714 Koboko* - Amuria 2,407 Kotido 4,636 Apac 2,357 Kumi* - Arua 177 Kyenjojo 66,212 Budaka* - Lira 3,514 Bududa 814 Luwero 4,136 Bugiri 15,244 Lyantonde 677 Bukedea 5 Manafwa 205 Bundibugyo 22,253 Maracha 1,857 Bushenyi 12,577 Masaka 4,800 Busia 13,538 Masindi 29 Butaleja 14 Mayuge 73 Dokolo 2,775 Mbale 30,340 Gulu 4,600 Mbarara 20,489 Hoima 3,407 Mityana 1,883 Ibanda 83 Moroto 1,500 Iganga 215,275 Moyo 768 Isingiro 2,582 Mpigi 773 Jinja 21 Mubende 130 Kaabong 36 Mukono 5,071 Kabale 1,344 Nakapiripirit 7,069 Kabarole 6,309 Nakasongola 176 Kaberamaido 205 Namutumba 3 Kalangala 6,743 Ntungamo 2,101 Kampala 107,079 Oyam* - Kamwenge 4,145 Pader 11,757 Kanungu 31 Pallisa 674 Kapchorwa 290 Rakai 3,476 Kasese 3,638 Rukungiri 17,555 Katakwi 4,743 Sironko 3,113 Kayunga* - Soroti 10,087 Kibaale 9,999 Ssembabule* - Kiboga 4,314 Tororo 1,337 Kiruhura 206 Wakiso* - Kisoro 11,232 Yumbe 45 Total * Information not provided 2,303,506 August

42 Table 6: Number/proportion of sub counties with agencies providing HIV/AIDS related training during 2008 District SCs served Total SCs Percent District SCs served Total SCs Percent Abim Koboko Adjumani Kotido Amuria Kumi Apac Kyenjojo Arua Lira Budaka Luwero Bududa Lyantonde Bugiri Manafwa Bukedea Maracha Bundibugyo Masaka Bushenyi Masindi Busia Mayuge Butaleja Mbale Dokolo Mbarara Gulu Mityana Hoima Moroto Ibanda Moyo Iganga Mpigi Isingiro Mubende Jinja Mukono Kaabong Nakapiripirit Kabale Nakasongola Kabarole Namutumba Kaberamaido Ntungamo Kalangala Oyam Kampala Pader Kamwenge Pallisa Kanungu Rakai Kapchorwa Rukungiri Kasese Sironko Katakwi Soroti Kibaale Tororo Kiboga Wakiso Kiruhura Yumbe Kisoro Total Kitgum August

43 2.1.4 HIV counselling and testing services Three thirds of stakeholders are providing HCT services of which 63 % are providing child counselling. Nearly all stakeholders are providing HCT services at no cost, only 4% of the agencies providing HCT services are doing so at a cost. There seems to be a good distribution of HCT services in the country, with a national average figure of 72% distribution of HCT service providers across all regions. The North central districts, Far East and some districts in the western and central districts of the country have a relatively better distribution of agencies providing HCT services. This is measured considering the number of agencies providing HCT services in a district. Nebbi, Adjumani and Kaberamaido have the poorest distribution of HCT service providers in the country. Generally, the distribution of child counselling services is still low. The country has an average of 43%. Districts in the North central and north eastern districts have a better distribution of child counselling services compared to the rest of the districts in the country. Districts in the central, south western and eastern parts of the country have the lowest distribution of child counselling services. The country has 68% coverage of HCT services at the sub county level. 648 sub counties are covered with HCT services, either facility based or through outreaches. This depicts a relatively wide coverage of HCT services though there is still a gap of 22% of sub counties lacking HCT services. There is an increase in HCT service coverage compared to the situation in The country had only 311 VCT service centers in all districts by then (service mapping, 2005). Most of the sub counties recorded less than 2500 HCT service beneficiaries in A few recorded between ,000 beneficiaries and only one Sub County (in Mayuge) recorded more than 35,000 HCT service beneficiaries in These numbers also represent repeat testers. Figure 11: Proportion of stakeholders providing HCT services 26% 74% Support/Provide HCT services Do not support/provide HCT August

44 Figure 12: Proportion of stakeholders providing child counselling services 37% 63% Provide Child counselling services Do not provide Child counselling services Figure 13: Proportion of stakeholders providing free HCT services 4% 96% Provide free HCT services Provide HCT services at a cost August

45 Map 9: Distribution of stakeholders involved in the provision of HCT services by district August

46 Map 10: district Distribution of stakeholders providing child counselling services by August

47 Table 7: Number/proportion of sub counties with HCT services during 2008 District SCs served Total SCs Percent District SCs served Total SCs Percent Abim Kisoro Adjumani Kitgum Amolatar Koboko Amuria Kotido Amuru Kumi Apac Kyenjojo Arua Lira Budaka Luwero Bugiri Lyantonde Bukedea Manafwa Bukwa Maracha Buliisa Masaka Bundibugyo Masindi Bushenyi Mayuge Busia Mbale Butaleja Mbarara Dokolo Mityana Gulu Moroto Hoima Moyo Ibanda Mpigi Iganga Mubende Isingiro Mukono Jinja Nakapiripirit Kaabong Nakaseke Kabale Nakasongola Kabarole Namutumba Kaberamaido Nebbi Kalangala Ntungamo Kaliro Oyam Kampala Pader Kamuli Pallisa Kamwenge Rakai Kanungu Rukungiri Kapchorwa Sironko Kasese Soroti Katakwi Ssembabule Kayunga Tororo Kibaale Wakiso Kiboga Yumbe Kiruhura Total August

48 Map 11: Distribution of HCT beneficiaries by Sub County during 2008 August

49 2.1.4 Schools-based interventions Nearly half of the stakeholders provide school based interventions. Out of these, about 39 % are providing life skills training. Agencies have carried activities in life skills training especially in primary schools compared to the other levels of learning. Little has been done in tertiary institutions. Trainings carried out by agencies providing support in schools include peer education, non-curriculum based IEC, adult/teacher education, and life skills based education as well as orphan support. Majority offer peer education and a considerable proportion provide training on non-curriculum based IEC. Few agencies however carryout adult/teacher and life skills based education. Generally, the national distribution of school based interventions is poor. The country has a national mean of 40% distribution of agencies providing school based interventions. Very few districts have a distribution of these agencies surpassing the national mean. A total of 352,247 teachers were trained nationally during 2008 to support school based HIV/AIDS interventions. Iganga reports more numbers of teachers trained; it registered 60,000 trained teachers targeted. Kabarole and Lira had over 20,000 teachers reportedly trained in the same year while Bundibugyo, Bushenyi, Dokolo, Rukungiri and Rakai, each had about 10,000 teachers trained also. Most of the districts had between teachers supported. Figure 14: Proportion of stakeholders providing school based interventions 47% 53% Provide school based interventions Do not provide August

50 Figure 15: Proportion of stakeholders providing life skills training in schools 39% 61% Provide life skills training Do not provide Figure 16: centers Types of life skills trainings provided at different education level Peer education Non-curriculumbased IEC Adult/teacher led education Life-skillsbased education Orphan support Other Primary Secondary Tertiary August

51 Map 12: district Distribution of stakeholders providing school based interventions by August

52 Table 8: Number of teachers trained to support school-based HIV/AIDS interventions DISTRICT No. of teachers DISTRICT No. of teachers Abim 4,759 Kisoro 803 Adjumani 57 Kitgum 65 Amolatar 48 Koboko 180 Amuria 244 Kotido 26 Amuru 5 Kumi 250 Apac 7,220 Kyenjojo* _ Arua 162 Lira 20,182 Bugiri 5,326 Luwero 100 Bukwa 2,593 Lyantonde 246 Bundibugyo 10,119 Manafwa 310 Bushenyi 11,775 Maracha 214 Busia 1,016 Masaka 1,548 Butaleja - Masindi 64 Dokolo 13,352 Mayuge 145 Gulu 236 Mbale 5,784 Hoima 1,099 Mbarara 4,472 Ibanda 5,304 Mityana 622 Iganga 62,987 Moroto 20 Isingiro - Moyo 210 Kabale 120 Mukono 2,949 Kabarole 23,054 Nakapiripirit 365 Kaberamaido 186 Nakaseke 55 Kalangala - Nakasongola 144 Kampala 5,775 Nebbi - Kamuli 40 Ntungamo 3,663 Kamwenge 548 Pader 1,942 Kanungu 40 Pallisa 254 Kasese 1,390 Rakai 12,483 Katakwi 1,057 Rukungiri 14,539 Kayunga 30 Sironko 297 Kibaale 419 Soroti 2,375 Kiboga 491 Ssembabule 69 Kiruhura 26 Tororo 1,984 Total * Information not provided 352,247 August

53 Map 13: Distribution of teachers trained by Sub County during 2008 August

54 2.2 Blood Safety Very few stakeholders support/provide blood transfusion services. Nearly 90% of stakeholders do not support blood transfusion services. Majority (80%) of the agencies involved in blood transfusion services access blood/blood products from blood banks. Only 11% of the agencies individually use local donors as a source of blood. 8% of the agencies use a combination of the two as sources of the blood/blood products they use. Agencies supporting blood transfusion services have in a place a number of interventions to ensure blood safety. These include; providing alternative blood products, mobilizing low risk donors, reducing blood wastage in facilities and providing HIV/AIDS testing facilities. Majority however provide blood transfusion services and HIV testing facilities as measures to ensure blood safety. A considerable proportion of agencies mobilizes lower risk donors and reduces blood wastage in facilities as interventions for blood safety. Some agencies use a combination of some or all the interventions mentioned above. Most of the agencies providing blood transfusion services also carryout blood screening while other do not the blood again with the expectation that the original source must have screened the blood in the first place. Agencies mainly conduct blood screening for HIV, Hepatitis, blood grouping and syphilis. Most of the blood is screened from either the Blood bank or at hospital level. Very few agencies have their blood/blood products screened from clinics, pharmacies and nursing homes. The distribution of agencies providing blood transfusion services in the country is generally poor. The national average figure for blood transfusion services is as low as 10%. Arua is one the few districts that have fairly considerable (38%) distribution of agencies supporting blood related services in the country. Figure 17: Proportion of stakeholders providing/supporting blood transfusion 12% 88% Provide/support Do not provide/support August

55 Figure 18: Source of blood/blood products agencies use 11% 8% 81% Blood bank Local Donors Others Figure 19: Available interventions to improve blood safety Blood transfusion services Alternative products Mobilising lower risk donors Reducing blood wastage HIV/AIDS testing facilities Others August

56 Figure 20: Forms of blood screening carried out by stakeholders Hepatitis HIV Syphilis Blood group Others Figure 21: Place of blood screening used by stakeholders Blood bank Hospital Clinic Pharmacy Nursing Home August

57 Map 14: services Distribution of agencies providing/supporting blood transfusion August

58 2.3 STI Services A large proportion (71%) of agencies is providing STI services. Among the agencies proving STI related services, the common services offered include syndromic management, lab testing, HIV testing, syphilis screening, education and counselling, partner notification, condoms and prophylaxis. Majority of the agencies however carryout HIV testing, education and counselling, syphilis screening, offer condoms and do syndromic management. Few agencies offer the other services prior mentioned. Most of the agencies providing STI services offer just some of the different types of services mentioned above, but very few do provide all the different types of services. Generally, the distribution of agencies providing STI services in the country is relatively high (66%). Most of the districts in the North central, West Nile, North Eastern and a few districts in the West have considerable numbers of agencies providing STI services. Moroto and Nebbi have the least distribution if agencies providing STI services in the country. In 2008, a total of 4,073,568 STI service beneficiaries were registered in the country. Kampala registered the highest number of STI service beneficiaries, with over a million clients being registered. Masaka and Mbale also registered big number of clients in the same year; about 500,000 clients were recorded to have accessed STI services in each of these districts. Between 100, ,000 clients were registered in Lira, Kumi and Iganga in A significant number of districts registered between 10,000-50,000 clients, while a few registered less than 1000 STI service clients in Most of the sub counties registered less than 9000 STI service beneficiaries in 2008, very few sub counties recorded more than 10,000 beneficiaries and nearly none registered over 100,000 STI service beneficiaries. Figure 22: Proportion of stakeholders providing STI services 29% 71% Provide/support STI services No STI services August

59 Figure 23: Types of STI services provided by stakeholders Syndromic mgt Lab testing HIV testing Syphilis screening education and counselling Partner Notification Condoms Prophylaxis Others All August

60 Map 15: Distribution of agencies providing STI services August

61 Table 9: 2008 Number of clients/patients offered STI services by district during DISTRICT No. of clients DISTRICT No. of clients Abim 14,992 Kiboga 41,435 Adjumani 6,436 Kiruhura 9,789 Amolatar 12,462 Kisoro 5,321 Amuria 17,506 Kitgum 10,627 Amuru 2,219 Koboko 2,391 Apac 27,180 Kotido 25,257 Arua 62,112 Kumi 137,504 Budaka 3,348 Kyenjojo 16,749 Bugiri 1,076 Lira 216,521 Bukedea* - Luwero 22,154 Bukwa* - Lyantonde 10,734 Buliisa 547 Manafwa 35,324 Bundibugyo 14,725 Maracha 12,282 Bushenyi 55,273 Masaka 587,119 Busia 3,207 Masindi 956 Butaleja 697 Mayuge 10,483 Dokolo 1,180 Mbale 589,180 Gulu 80,600 Mbarara 17,424 Hoima 36,765 Mityana 12,354 Ibanda 19,719 Moroto 14,429 Iganga 109,226 Moyo* - Isingiro 16,093 Mubende 3,655 Jinja 2,806 Mukono 77,009 Kaabong 505 Nakapiripirit 26,837 Kabale 64,510 Nakaseke 17,125 Kabarole 12,923 Nakasongola 8,448 Kaberamaido 5,325 Namutumba* - Kalangala 118 Nebbi 90 Kaliro 27,167 Ntungamo 2,875 Kampala 1,019,557 Oyam 35,677 Kamuli 96,360 Pader 14,076 Kamwenge 52,729 Pallisa 6,903 Kanungu 1,055 Rakai 60,865 Kapchorwa 3,632 Rukungiri 1,906 Kasese 30,405 Sironko 10,259 Katakwi 6,666 Soroti 51,913 Kayunga* - Ssembabule 415 Kibaale 49,909 Tororo 635 Total * Information not provided 4,073,568 August

62 Map 16: Distribution of STI service beneficiaries by Sub County during 2008 August

63 2.4 PMTCT Services A relatively big proportion (60%) of HIV/AIDS agencies are involved PMTCT services in the country. This is also true in terms of geographical distribution. Even Amuru, Bukedea Buliisa and Bukwo districts have considerable number of agencies providing PMTCT services. Most districts have less than 50% distribution of agencies involved in the provision of PMTCT services. There is evidence of wide coverage of PMTCT services at the sub county. 70% of the sub counties have PMTCT service providers. 648 sub counties were found to be having PMTCT services. There is a considerable increase in the coverage of sub counties by PMTCT service compared to 2005 when the country had only 184 PMTCT centres in all the districts. Kampala and Lira are among the districts that registered high numbers of PMTCT clients, about 40,000 and 60,000 clients were registered respectively. A few districts recorded PMTCT clients ranging from 10,000 to 20,000 while a significant number of districts registered clients ranging from It has to be noted that some districts registered less than 900 clients for PMTCT in Most of the sub counties recorded less than 6000 beneficiaries for PMTCT services during Significantly, a sub county in Oyam registered over 30,000 beneficiaries of PMTCT service in the same year. Figure 24: Proportion of stakeholders providing PMTCT services 40% 60% Provide/support PMTCT services No PMTCT August

64 Map 17: Distribution of agencies providing PMTCT services August

65 Table 10: Number of clients offered PMTCT services by district during 2008 DISTRICT No. of clients DISTRICT No. of clients Abim 4,155 Kisoro 224 Adjumani _ Kitgum 3,334 Amolatar 10,786 Koboko 233 Amuria 3,691 Kotido 3,777 Amuru 715 Kumi* - Apac 5,566 Kyenjojo 4,647 Arua 9,853 Lira 64,010 Budaka 1,525 Luwero 4,780 Bugiri 597 Lyantonde 757 Bukedea 875 Manafwa 2,722 Bukwa 1,061 Maracha 2,947 Buliisa 2,264 Masaka* _ Bundibugyo 3,934 Masindi 102 Bushenyi 19,480 Mayuge 12,435 Busia 892 Mbale 4,564 Butaleja 2,780 Mbarara 5,262 Dokolo 4,363 Mityana 1,284 Gulu 14,389 Moroto* _ Hoima 13,824 Moyo* _ Ibanda 4,843 Mpigi 4,597 Iganga 3,705 Mubende 1,036 Isingiro 9,299 Mukono 7,571 Jinja 1,280 Nakapiripirit 782 Kaabong 4,045 Nakaseke 5,245 Kabale 6,525 Nakasongola 250 Kabarole 3,724 Namutumba 1,693 Kaberamaido 2,793 Nebbi 509 Kalangala 1,058 Ntungamo 7,520 Kaliro 1,998 Oyam* _ Kampala 42,135 Pader 13,786 Kamuli 6,765 Pallisa 14,698 Kamwenge 7,642 Rakai 5,458 Kanungu 1,717 Rukungiri 8,283 Kapchorwa 1,790 Sironko 12,927 Kasese 10,229 Soroti 8,923 Katakwi 5,235 Ssembabule* - Kayunga 481 Tororo 4,350 Kibaale 34,398 Wakiso 15,045 Kiboga* - Yumbe 5,090 Kiruhura 3,552 Total * Information not provided August

66 Table 11: Number/proportion of sub counties with PMTCT services during 2008 District SCs served Total SCs Percent District SCs served Total SCs Percent Abim Kisoro Adjumani Kitgum Amolatar Koboko Amuria Kotido Amuru Kumi Apac Kyenjojo Arua Lira Budaka Luwero Bugiri Lyantonde Bukedea Manafwa Bukwa Maracha Buliisa Masaka Bundibugyo Masindi Bushenyi Mayuge Busia Mbale Butaleja Mbarara Dokolo Mityana Gulu Moroto Hoima Moyo Ibanda Mpigi Iganga Mubende Isingiro Mukono Jinja Nakapiripirit Kaabong Nakaseke Kabale Nakasongola Kabarole Namutumba Kaberamaido Ntungamo Kaliro Oyam Kampala Pader Kamuli Pallisa Kamwenge Rakai Kanungu Rukungiri Kapchorwa Sironko Kasese Soroti Katakwi Tororo Kayunga Wakiso Kibaale Yumbe Kiboga Total Kiruhura August

67 Map 18: Distribution of PMTCT service beneficiaries by Sub County in 2008 August

68 Section Three: Mitigation and care 3.1 Income Generating Activities Only 29% of the HIV/AIDS agencies provide Income Generating Activities. These organizations also offer other mitigation activities such as advocacy to reduce stigma and discrimination, home based care, direct material support to targeted HIV/AIDS infected and affected people, psychosocial support to HIV/AIDS infected and affected people, scholastic materials for OVCs, training in vocational skills and food security support. Majority of the agencies are however involved only in advocacy and psychosocial support. Nationally, the mean distribution of agencies providing IGAs is low (24%) and therefore this area is still lacking. Only a few districts such as Masindi score fair in number of agencies involved in IGAs. Some of the districts in the central, East and East central are among the few districts with a fair distribution of agencies involved in IGAs. The coverage of Income generating activities is by sub county is also limited. Only 44% of the sub counties have IGAs. This demonstrates a gap of 56% coverage of IGAs at the sub county. The situation was no different in 2005 when the IGAs coverage at the sub county was 45%. In terms of the distribution of IGA beneficiaries, most sub counties registered less than 9000 targeted beneficiaries during Figure 25: Proportion of stakeholders providing IGAs 29% 71% Provide IGAs Do not support IGAs August

69 Figure 26: Other HIV/AIDS mitigation activities carried out by stakeholders Advocacy Home Based Care Direct Material support Psychosocial support Scholarstic materials for OVCs Training in vocational skills Food security support Others August

70 Map 19: Distribution of agencies providing IGA support August

71 Table 12: during 2008 Number/proportion of sub counties with Income Generating Activities District SCs served Total SCs Percent District SCs served Total SCs Percent Amuria Kyenjojo Apac Lira Arua Luwero Bugiri Lyantonde Bukedea Manafwa Buliisa Maracha Bundibugyo Masaka Bushenyi Masindi Busia Mayuge Dokolo Mbale Gulu Mbarara Hoima Mityana Ibanda Moyo Iganga Mpigi Isingiro Mubende Jinja Mukono Kabale Nakapiripirit Kabarole Nakaseke Kaberamaido Nakasongola Kalangala Namutumba Kaliro Nebbi Kampala Ntungamo Kamuli Oyam Kanungu Pader Kapchorwa Pallisa Kasese Rakai Katakwi Rukungiri Kayunga Sironko Kiboga Soroti Kisoro Ssembabule Kitgum Tororo Koboko Wakiso Kumi Total August

72 Map 20: Distribution of IGA beneficiaries by Sub County during 2008 August

73 3.2 Orphans and Vulnerable Children Care/Support Considerably, most HIV/AIDS agencies (64%) provide some form of support and care for OVCs. The main types of support offered by stakeholders to OVCs include material, education, nutrition, psychosocial and various other programs area support. Majority of the agencies however offer education and psychosocial support to OVCs. A few offer nutritional support to OVCs. Overall, the distribution of agencies providing care and support in the country is low. The national mean is 25% and a significant number of districts fall below this figure. Nationally, a total of 358,565 children benefited from the OVC care and support services provided by HIV/AIDS organizations in Agencies in Kampala and Kabarole registered the highest number of beneficiaries for OVC support; each district registered 50,000 and 45,000 beneficiaries for OVC support respectively. Agencies in Lira, Bushenyi and Kabarole registered nearly 30,000 beneficiaries for OVC support in the same year. A considerable number of actors in other districts registered between beneficiaries for OVC support and care. Within sub counties, majority registered less than 160 beneficiaries for OVC support and care. Significantly, some sub counties in the central districts registered beneficiaries for OVC care and support ranging from Figure 27: Proportion of stakeholders providing care for OVCs 36% 64% Provide care/support for OVCs Do not support OVCs August

74 Figure 28: Type of benefits in OVC care and support offered by stakeholders Material Support Education Support Nutrition Support Psychosocial Support Programmes Areas (CPA) suppo August

75 Map 21: Distribution of agencies providing OVC care and support August

76 Table 13: Number of beneficiaries for OVC support by district during 2008 DISTRICT No. of beneficiaries DISTRICT No. of beneficiaries Adjumani 72 Kitgum 424 Amuria 1,391 Koboko* - Apac 781 Kotido 824 Arua 777 Kumi 1,067 Budaka 1,534 Kyenjojo 1,175 Bugiri 4,723 Lira 32,425 Bundibugyo 6,623 Luwero 3,644 Bushenyi 24,242 Lyantonde 599 Busia 1,862 Manafwa 18,683 Dokolo 2,021 Maracha 209 Gulu 2,165 Masaka 2,876 Hoima 1,903 Masindi 1,391 Ibanda 408 Mbale 13,278 Iganga 7,072 Mbarara 2,611 Isingiro* _ Mityana 437 Jinja 2,100 Moyo 870 Kaabong 36 Mpigi* - Kabale 7,031 Mubende 3,116 Kabarole 45,836 Mukono 19,753 Kaberamaido 161 Nakaseke 20 Kalangala* _ Nakasongola 17,296 Kaliro 30 Nebbi* - Kampala 51,501 Ntungamo 848 Kamuli 27,418 Pader 3,457 Kanungu 1,558 Pallisa 704 Kasese 7,227 Rakai 1,145 Katakwi 5,282 Rukungiri 2,477 Kayunga 208 Sironko 10,121 Kiboga 4,236 Soroti 2,750 Kiruhura 150 Ssembabule* - Kisoro 596 Tororo 4,780 Total 358,565 * Information not provided Wakiso 2,625 August

77 Map 22: 2008 Distribution of beneficiaries of OVC care and support services during August

78 3.3 Palliative Care Very few agencies offer palliative care in the country. The national average distribution of agencies providing palliative care is as low as 19%. West Nile, Jinja, Mukono and Masaka are among some of the districts with a fairly good distribution of agencies providing palliative care. Most of the districts lie below the mean prior noted. By Sub County, palliative care services are still limited in the country. Nationally, 26% of the sub counties have such services, depicting a gap of 64%. The situation has been the same since Kampala registered the highest number (17,292) of clients for palliative care services in Bushenyi and Mukono registered a considerable number of clients as well; about 9000 clients were registered in each of these districts. Some of the districts registered as low as less than 500 clients. In terms of distribution of beneficiaries by Sub County, most of them recorded less than 300 clients. Figure 29: Proportion of stakeholders offering palliative care 24% 76% offer palliative care Do not August

79 Map 23: Distribution of agencies providing palliative care August

80 Table 14: Number of clients offered palliative care by district during 2008 DISTRICT No. of clients DISTRICT No. of clients Abim 404 Koboko 28 Adjumani 45 Kotido 660 Amolatar 85 Kumi 240 Apac 448 Kyenjojo 23 Arua 2,613 Lira 1,159 Bugiri* _ Luwero 1,153 Bundibugyo 416 Lyantonde 2,385 Bushenyi 9,729 Manafwa* _ Busia 300 Maracha 687 Dokolo 211 Masaka _ Gulu* _ Masindi 8 Hoima 481 Mayuge 2,353 Ibanda 1,410 Mbale 776 Iganga 5,786 Mbarara 193 Jinja* _ Mityana 2,570 Kaabong 287 Moyo 80 Kabale 150 Mukono 9,268 Kabarole 3,427 Nakaseke 1,370 Kaberamaido 440 Nakasongola* - Kampala 17,292 Pader 3,810 Kamwenge 70 Pallisa 272 Kanungu 750 Rakai 5,205 Kasese 912 Rukungiri* _ Katakwi 226 Sironko 114 Kayunga* - Soroti 1,356 Kibaale 5,340 Tororo 2,000 Kiboga 3 Wakiso 538 Kiruhura 230 Yumbe 29 Kisoro 24 Kitgum 268 Total * Information not provided August

81 Table 15: during 2008 Number/proportion of sub counties with palliative care services District SCs served Total SCs Percent District SCs served Total SCs Percent Abim Koboko Adjumani Kotido Amolatar Kumi Apac Kyenjojo Arua Lira Bundibugyo Luwero Bushenyi Lyantonde Busia Manafwa Dokolo Maracha Gulu Masaka Hoima Masindi Ibanda Mayuge Iganga Mbale Jinja Mbarara Kaabong Mityana Kabale Moyo Kabarole Mukono Kaberamaido Nakaseke Kampala Nakasongola Kamwenge Pader Kanungu Pallisa Kasese Rakai Katakwi Rukungiri Kayunga Sironko Kibaale Soroti Kiboga Tororo Kiruhura Wakiso Kisoro Yumbe Kitgum Total August

82 Map 24: during 2008 Distribution of palliative care service beneficiaries by Sub County August

83 3.4 Psychosocial Support Slightly more than half of the agencies offer psychosocial support to persons infected and/or affected by HIV/AIDS. The national distribution of agencies providing psychosocial support is 50%. Districts such as Kibaale, Bundibugyo, Kyenjojo and Kabarole in the West report a better distribution of agencies providing psychosocial support compared to districts in the Eastern part of the country. Some of the North central districts and central districts like Mpigi, Masaka and Mubende also have a fair distribution of agencies providing psychosocial support. Overall, 45% of the sub counties have stakeholders providing psychosocial support services. In comparison with the data of 2005, there has been a reduction in the coverage of the service at the sub county level. According to the 2005 service mapping, 49% of the sub counties were covered with stakeholders providing psychosocial services. Kampala and Wakiso recorded the highest number of clients (over 100,000 each) for psychosocial support in Oyam, Kumi and Lira are the other districts that registered considerable number of clients for psychosocial support. Most of the districts registered clients ranging from for psychosocial support. Most of the sub counties registered less than 2000 clients for psychosocial support; a few registered clients ranging between Figure 30: Proportion of agencies offering psychosocial support 43% 57% Offer Psychosocial support Do not offer August

84 Map 25: Distribution of agencies providing psychosocial support August

85 Table 16: Number of clients offered psychosocial support during 2008 DISTRICT No. of clients DISTRICT No. of clients Abim 2,153 Lira 52,535 Adjumani 1,514 Luwero 3,479 Amolatar 214 Lyantonde 8,118 Amuria 14,028 Maracha 2,844 Amuru 77 Masaka* - Apac 1,668 Masindi 1,483 Arua 1,953 Mayuge 2,696 Bugiri 27,222 Mbale 3,613 Bukwa - Mbarara 1,528 Bundibugyo 6,135 Mityana 4,503 Bushenyi 18,936 Moroto 598 Busia 3,047 Moyo 209 Dokolo 1,226 Mubende 2,077 Gulu 9,591 Mukono 3,097 Hoima 1,779 Nakapiripirit 324 Ibanda 3,488 Nakaseke 1,370 Iganga 4,905 Nakasongola 5,962 Isingiro 20 Namutumba 36 Jinja 13,006 Nebbi 856 Kaabong 1,402 Oyam 3,791 Kabale 16,250 Pader 72,121 Kabarole 4,944 Pallisa 615 Kaberamaido 59 Rakai 1,119 Kaliro - Rukungiri 12,043 Kampala 108,369 Sironko 12,103 Kamuli 762 Soroti 8,253 Kamwenge 309 Ssembabule* - Kanungu 845 Tororo 100 Kapchorwa - Wakiso 105,398 Kasese 2,376 Yumbe 32 Koboko 100 Kotido 7,740 Kumi 50,840 Kyenjojo 2,421 Total *Information not provided August

86 Table 17: Number/proportion of sub counties with psychosocial support services during 2008 District SCs served Total SCs Percent District SCs served Total SCs Percent Abim Kitgum Adjumani Koboko Amolatar Kotido Amuria Kumi Amuru Kyenjojo Apac Lira Arua Luwero Bugiri Lyantonde Bukedea Maracha Bukwa Masaka Bundibugyo Masindi Bushenyi Mayuge Busia Mbale Dokolo Mbarara Gulu Mityana Hoima Moroto Ibanda Moyo Iganga Mubende Isingiro Mukono Jinja Nakapiripirit Kaabong Nakaseke Kabale Nakasongola Kabarole Namutumba Kaberamaido Nebbi Kaliro Oyam Kampala Oyam Kamuli Pader Kamwenge Pallisa Kanungu Rakai Kapchorwa Rukungiri Kasese Sironko Katakwi Soroti Kayunga Ssembabule Kibaale Tororo Kiboga Wakiso Kiruhura Yumbe Kisoro Total August

87 Map 26: Distribution of psychosocial support service beneficiaries by Sub County during 2008 August

88 3.5 Antiretroviral Treatment Only 1/4 of the agencies are involved in the provision and support for ARVs. It is clear that the country is performing poorly in this HIV/AIDS service area. Nearly three quarters of the districts fall below the national mean of 27 % in relation to support and provision of ARVs. Ibanda and Mbale are among the few districts with a relatively fair distribution of agencies involved in the provision/support of ARVs. Jinja, Mpigi an Amuru districts also have a considerable distribution of agencies providing ARVs. Nationally, 27% of sub counties have stakeholders supporting or providing ARVs. A total of 234 sub counties are mapped to be covered with agencies providing ARVs. Though there is still a big gap of 63% of sub counties not served, there has been an increase in the number of agencies providing ARVs in the country. In 2005, the country had only 62 centers providing ARVs. Agencies active in ART reported a total of 170,907 clients on ART in the whole country during Kampala, Masaka and Lira registered the highest numbers of clients on ART in 2008 (ranging from 22,000-52,000). Most of the districts registered less than 1000 ART clients in 2008 although a considerable number of districts registered ART clients ranging between In terms of distribution of ARV beneficiaries, most of the sub counties registered less than 300 clients. Figure 31: Proportion of agencies providing ARVs 26% 74% Support/provide ARVs Do not support August

89 Map 27: Distribution of Agencies providing/supporting ARVs August

90 Table 18: Number of clients offered ARVs by district during 2008 DISTRICT No. of clients DISTRICT No. of clients Abim* - Kisoro 254 Adjumani* - Kitgum 543 Amolatar 1,926 Kotido 430 Amuru 17 Kumi 635 Apac 140 Kyenjojo 374 Arua 1,306 Lira 22,017 Budaka 330 Luwero 250 Bugiri* - Lyantonde 502 Bukwa 13 Manafwa _ Bundibugyo* - Maracha* _ Bushenyi 535 Masaka 33,720 Busia 191 Masindi 205 Butaleja 824 Mayuge 235 Gulu 5,600 Mbale 1,103 Hoima 2,204 Mbarara 1,409 Ibanda 412 Mityana 263 Iganga 785 Moyo* - Isingiro 40 Mpigi 2,444 Jinja 636 Mukono 1,828 Kaabong 287 Nakapiripirit 23 Kabale 623 Nakaseke 625 Kabarole 2,128 Nakasongola 252 Kampala 52,111 Namutumba* - Kamuli* - Ntungamo 2,850 Kamwenge 3,726 Oyam 313 Kanungu 490 Pader 2,252 Kapchorwa* - Pallisa 1,908 Kasese 4,645 Rakai 4,415 Katakwi 216 Rukungiri 1,446 Kayunga 106 Sironko 21 Kibaale 4,592 Soroti 1,418 Kiboga 149 Ssembabule 84 Kiruhura 2,031 Tororo 256 Total *Information not provided Wakiso 2,556 Yumbe ,907 August

91 Table 19: during 2008 Number/proportion of sub counties with agencies providing ARVs District SCs served Total SCs Percent District SCs served Total SCs Percent Abim Kitgum Adjumani Kotido Amolatar Kumi Amuru Kyenjojo Apac Lira Arua Luwero Budaka Lyantonde Bugiri Manafwa Bukwa Maracha Bundibugyo Masaka Bushenyi Masindi Busia Mayuge Butaleja Mbale Gulu Mbarara Hoima Mityana Ibanda Moyo Iganga Mpigi Isingiro Mukono Jinja Nakapiripirit Kaabong Nakaseke Kabale Nakasongola Kabarole Namutumba Kaberamaido Ntungamo Kampala Oyam Kamuli Pader Kamwenge Pallisa Kanungu Rakai Kapchorwa Rukungiri Kasese Sironko Katakwi Soroti Kayunga Ssembabule Kibaale Tororo Kiboga Wakiso Kiruhura Yumbe Kisoro Total August

92 Map 28: Distribution of ARV beneficiaries by Sub County during 2008 August

93 Section Four: National Capacity 4.1 Resource Tracking Table 20: Amount of funds stakeholders received by district during 2008 DISTRICT Amount (Ushs.) DISTRICT Amount (Ushs.) Abim 43,663,383 Kiboga 2,891,239,719 Adjumani 578,255,062 Kiruhura 547,342,700 Amolatar 35,686,787 Kisoro 66,015,201 Amuria 1,344,828,700 Kitgum 1,659,972,399 Amuru 8,588,000 Koboko 64,000,000 Apac 219,792,114 Kotido 19,944,822 Arua 96,966,192 Kumi 585,356,439 Budaka 91,868,000 Kyenjojo 507,362,161 Bugiri 716,103,108 Lira 1,103,902,295 Bukedea 27,323,693 Luwero 166,158,487 Bukwa 3,600,000 Lyantonde 474,200,000 Buliisa 57,393,900 Manafwa 16,450,000 Bundibugyo 977,582,199 Maracha 2,623,447,944 Bushenyi 1,659,559,934 Masaka 27,069,769,820 Busia _ Masindi 683,900,000 Butaleja 5,640,000 Mayuge 46,893,312 Dokolo 20,400,000 Mbale 590,965,270 Gulu 1,098,311,190 Mbarara 568,145,920 Hoima 3,986,638,884 Mityana 106,066,214 Ibanda 337,534,932 Moyo 399,851,972 Iganga 1,109,784,000 Mpigi 2,360,000 Isingiro 24,000,000 Mubende 150,709,000 Jinja 32,062,000 Mukono 1,880,702,809 Kaabong - Nakapiripirit 1,051,033,621 Kabale 184,000,000 Nakaseke 279,639,000 Kabarole 1,052,766,176 Nakasongola 72,100,000 Kaberamaido 142,925,935 Namutumba 1,636,000 Kalangala 745,300 Nebbi 20,289,283 Kaliro 51,179,048 Ntungamo 4,185,545,925 Kampala 31,116,835,269 Oyam 183,865,303 Kamuli 6,992,548,901 Pader 575,860,000 Kamwenge 176,500,000 Pallisa 497,367,818 Kanungu 245,172,221 Rakai 1,048,131,827 Kapchorwa 16,004,745 Rukungiri 650,523,113 Kasese 1,895,357,229 Sironko 83,692,649 Katakwi 1,397,747,623 Soroti 939,410,393 Kayunga 12,000,000 Ssembabule 30,200,000 Kibaale 18,000,000 Tororo 503,011,403 Wakiso 3,759,259,346 August

94 4.1.3 Amount of funds from Government and donors Map 29: Distribution of funds by Sub County during 2008 August

95 4.2 Information base Very few agencies own resource centers with HIV/AIDS materials in the country. Nationally, the distribution of agencies that own resource centers is poor; with a national mean as low as 11%. Masaka, Mpigi, Kampala and Jinja are among some of the districts that have a fair distribution of agencies with HIV/AIDS resource centers. The distribution of resource centers in sub counties is still low. Only 20% of the sub counties have resource centers with HIV/AIDS materials. However, while there is a big gap of 70% sub counties lacking resource centers, the country has registered an increase of the centers since In 2005, only 11% of the sub counties had resource centers. There has been therefore an increase of 9% distribution of resource centers with HIV/AIDS materials in sub counties nation wide. Figure 32: materials Proportion of agencies having a resource center with HIV/AIDS 15% 85% Have a resource centre Lack a resource centre August

96 Map 30: HIV/AIDS Distribution of Agencies with own resource centre with materials on August

97 Table 21: Number/proportion of sub counties with resource centers with HIV/AIDS materials during 2008 District SCs served Total SCs Percent District SCs served Total SCs Percent Adjumani Kyenjojo Amuria Lira Apac Luwero Arua Masaka Bugiri Masindi Bundibugyo Mayuge Bushenyi Mbale Dokolo Mbarara Gulu Mityana Hoima Moyo Iganga Mpigi Isingiro Mubende Jinja Mukono Kaabong Nakaseke Kabale Nakasongola Kabarole Oyam Kalangala Pader Kampala Pallisa Kamuli Rakai Kamwenge Rukungiri Kanungu Sironko Kasese Soroti Katakwi Tororo Kayunga Wakiso Kisoro Yumbe Kitgum Total Kumi August

98 Map 31: Distribution of resource centres by Sub County in 2008 August

99 Section Five: District Profiles Besides national and regional indicator maps, this atlas also contains detailed district maps up to sub county level, presenting mapping indicators. Each sub county is drawn according to a colour scheme indicating population distribution. Each sub county is also labeled with its name, type of stakeholder and services provided. The type of service have been abbreviated and described in the table below; Table 22: Thematic Intervention Thematic intervention Anti Retrovirals Condom supply and distribution HIV Resource Centre Information Education and Communication Income Generating Activities Orphans and Vulnerable Children Palliative Care Prevention of Mother To Child Transmission Psychosocial Support Sexually Transmitted Infections HIV and AIDS Training HIV Counselling and Testing Abbreviation ARVs CSD HRC IEC IGA OVC PC PMTCT PS STI HAT HCT August

100 Map 32: Distribution of services by Sub County in Abim District August

101 Map 33: Distribution of services by Sub County in Adjumani District August

102 Map 34: Distribution of services by Sub County in Amolatar District August

103 Map 35: Distribution of services by Sub County in Amuria District August

104 Map 36: Distribution of services by Sub County in Amuru District August

105 Map 37: Distribution of services by Sub County in Apac District August

106 Map 38: Distribution of services by Sub County in Arua District August

107 Map 39: Distribution of services by Sub County in Budaka District August

108 Map 40: Distribution of services by Sub County in Bududa District August

109 Map 41: Distribution of services by Sub County in Bugiri district August

110 Map 42: Distribution of services by Sub County in Bukedea District August

111 Map 43: Distribution of services by Sub County in Bukwo District August

112 Map 44: Distribution of services by Sub County in Buliisa District August

113 Map 45: Distribution of services by Sub County in Bundibugyo District August

114 Map 46: Distribution of services by Sub County in Bushenyi District August

115 Map 47: Distribution of services by Sub County in Busia District August

116 Map 48: Distribution of services by Sub County in Butaleja District August

117 Map 49: Distribution of services by Sub County in Dokolo District August

118 Map 50: Distribution of services by Sub County in Gulu District August

119 Map 51: Distribution of services by Sub County in Hoima District August

120 Map 52: Distribution of services by Sub County in Ibanda District August

121 Map 53: Distribution of services by Sub County in Iganga District August

122 Map 54: Distribution of services by Sub County in Isingiro District August

123 Map 55: Distribution of services by Sub County in Jinja District August

124 Map 56: Distribution of services by Sub County in Kaabong District August

125 Map 57: Distribution of services by Sub County in Kabale District August

126 Map 58: Distribution of services by Sub County in Kabarole District August

127 Map 59: Distribution of services by Sub County in Kaberamaido District August

128 Map 60: Distribution of services by Sub County in Kalangala District August

129 Map 61: Distribution of services by Sub County in Kaliro District August

130 Map 62: Distribution of services by Sub County in Kampala District August

131 Map 63: Distribution of services by Sub County in Kamuli District August

132 Map 64: Distribution of services by Sub County in Kamwenge District August

133 Map 65: Distribution of services by Sub County in Kanungu District August

134 Map 66: Distribution of services by Sub County in Kapchorwa District August

135 Map 67: Distribution of services by Sub County in Kasese District August

136 Map 68: Distribution of services by Sub County in Katakwi District August

137 Map 69: Distribution of services by Sub County in Kayunga District August

138 Map 70: Distribution of services by Sub County in Kibaale District August

139 Map 71: Distribution of services by Sub County in Kiboga District August

140 Map 72: Distribution of services by Sub County in Kiruhura District August

141 Map 73: Distribution of services by Sub County in Kisoro District August

142 Map 74: Distribution of services by Sub County in Kitgum District August

143 Map 75: Distribution of services by Sub County in Koboko District August

144 Map 76: Distribution of services by Sub County in Kotido District August

145 Map 77: Distribution of services by Sub County in Kumi District August

146 Map 78: Distribution of services by Sub County in Kyenjojo District August

147 Map 79: Distribution of services by Sub County in Lira District August

148 Map 80: Distribution of services by Sub County in Luwero District August

149 Map 81: Distribution of services by Sub County in Lyantonde District August

150 Map 82: Distribution of services by Sub County in Manafwa District August

151 Map 83: Distribution of services by Sub County in Masaka District August

152 Map 84: Distribution of services by Sub County in Masindi District August

153 Map 85: Distribution of services by Sub County in Mayuge District August

154 Map 86: Distribution of services by Sub County in Mbale District August

155 Map 87: Distribution of services by Sub County in Mbarara District August

156 Map 88: Distribution of services by Sub County in Mityana District August

157 Map 89: Distribution of services by Sub County in Moroto District August

158 Map 90: Distribution of services by Sub County in Moyo District August

159 Map 91: Distribution of services by Sub County in Mpigi District August

160 Map 92: Distribution of services by Sub County in Mubende District August

161 Map 93: Distribution of services by Sub County in Mukono District August

162 Map 94: Distribution of services by Sub County in Nakapiripriti District August

163 Map 95: Distribution of services by Sub County in Nakaseke District August

164 Map 96: Distribution of services by Sub County in Nakasongola District August

165 Map 97: Distribution of services by Sub County in Namutumba District August

166 Map 98: Distribution of services by Sub County in Nebbi District August

167 Map 99: Distribution of services by Sub County in Ntungamo District August

168 Map 100: Distribution of services by Sub County in Oyam District August

169 Map 101: Distribution of services by Sub County in Pader District August

170 Map 102: Distribution of services by Sub County in Pallisa District August

171 Map 103: Distribution of services by Sub County in Rakai District August

172 Map 104: Distribution of services by Sub County in Rukungiri District August

173 Map 105: Distribution of services by Sub County in Sironko District August

174 Map 106: Distribution of services by Sub County in Soroti District August

175 Map 107: Distribution of services by Sub County in Ssembabule District August

176 Map 108: Distribution of services by Sub County in Terego-maracha District August

177 Map 109: Distribution of services by Sub County in Tororo District August

178 Map 110: Distribution of services by Sub County in Wakiso District August

179 Map 111: Distribution of services by Sub County in Yumbe District August