Namulaba Annual Report 1 August 2009 To 31 July 2010

Namulaba Health Center
Project
Annual Report
1 August 2009 to 31 July 2010
Date of Report: 11 August 2010

Contact Persons:
Director
Dr Samuel Kalibala
P.O. Box 2598 Kampala, Uganda
Skalibala@hotmail.com.
Uganda Cellphone: 256 772 638 540. Kenya Cellphone: 254 722 514 371
Chairperson Namulaba CBO Network
Mrs Margaret Kizito
Tel +256 751 933 462
Source of Funding: Funded by the kindness of Inger and Claes Ortendahl of
Arholma in Sweden
1
Table of Contents
Executive Summary.................................................................................................... 3
Introduction............................................................................................................. 3
Services provided by Namulaba Health Center Project...........................................3
Detailed Report.......................................................................................................... 5
Service Statistics for the Main Medical Clinic Aug 2009 to July 2010......................5
Service Statistics of Nurses Clinic...........................................................................8
Community Events................................................................................................ 10
Events in the First Six Months (August 2009 to January 2010)...........................10
Climax during the visit of Inger and Claes January 16 th to 18th 2010..................12
Events in the Last Six Months (February to July 2010).......................................13
Conclusions and Way Forward..................................................................................16
Vote of thanks....................................................................................................... 16
Emerging Focus of the Project............................................................................... 16
Proposed Maternity House..................................................................................... 17
Sustainability......................................................................................................... 17
Executive Summary
Introduction
The Namulaba Health Center project is a project that is funded out of the kindness
of a Swedish couple, Inger and Claes Ortendahl of Arholma in Sweden since July
2009. Inger and Claes have made a commitment to fund this project for five years.
This commitment was made during the birthday of Inger. They chose to help
Namulaba as a way of thanking God for her happiness. On behalf of the community
served by this project we are very grateful to Inger and Claes. The project was
started by the Director (Dr Samuel Kalibala) on his farm land in 2005. He was
prompted by the number of patients who would come to him for help whenever he
visited the farm. In February 2007 the project got its first external funding which
came from AVERT, a UK based charity. This funding helped with the purchase of
equipment and the clinic became operative from June 2007. The funding helped
provide services up to February 2008. From that time until the kind gift of Inger and
Claes the clinic operated on a skeleton budget from the founder and all community
activities came to a stop. With the kind gift of Inger and Claes community activities
have resumed and the project is once again a fully fledged primary health care
project.
The project is located in an eight-room health center built on this farm in Namulaba
village. The project serves the Nagojje sub-county which has a community of about
30,000 people living in about 6,000 households. To reach the project you turn left at
a township called Namataba which is located 35 Km from Kampala, the capital city
of Uganda, on your way to Jinja, the source of the River Nile. From Namataba you
drive 8 Km on an earth road to reach Namulaba. The journey from Kampala to
Namulaba takes about 1.5 hours by car if the traffic on the highway is light.
Services provided by Namulaba Health Center Project
The project provides a full range of primary health care services at the clinic and in
the community.
Clinic based services: The clinic operates on Saturdays. On the first three Saturdays
of the month a nurse operates a community pharmacy which enables community
members to purchase medicines for simple illnesses. The pharmacy is managed by
the Namulaba Network of Community Based Organizations (CBOs). The money for
buying the first stock of medicines was obtained from a local fundraising event that
was organized by the CBO Network and attended by the area member of
parliament. The medicines are sold at almost cost price and this enables the
pharmacy to re-stock its supply. The salary of the nurse is paid by our project. The
nurse also examines and treats patients who come seeking care. In addition the
nurse provides ante natal care, free of charge. On these Saturdays the clinic is also
used as an outreach post for the ministry of health to provide family planning and
child immunization services. On the last Saturday of the month the main clinic takes
3
place. The staff includes a medical doctor, two clinical officers, two laboratory
technicians, two HIV counselors and three nurses. The services provided include
primary health care and HIV counseling and testing plus a special youth corner that
provides Adolescent Sexual and Reproductive Health (ASRH) services.
Summary of Services provided on the main clinic day (August 2009
to July 2010)
1,860 patients received general medical care
311 received HIV counseling and testing at the clinic
455 received testing for malaria
Summary of Services provided by the Nurses Clinic (August 2009 to
June 2010)
167 patients received general medical care
77 women received family planning
17 women received antenatal care
381 children received childhood immunization
Community Based Services: In the community the project has conducted a wide
range of events to educate the community about HIV/AIDS and reproductive health.
In addition the project has carried out HIV Voluntary Counseling and Testing (VCT) in
community locations.
Summary of Community events August 2009 to January 2010
7 female netball matches
15 male football matches
10 Auntie/Uncle meetings
11 Church seminars
13 Music, dance and drama events
2 School seminars
2 School essay competitions
4 Support group meetings of people living with HIV/AIDS
1 VCT event in the community
Summary of Community events February to July 2010
6 VCT events in the community
91 documented religious counseling sessions for individuals
Detailed Report
Service Statistics for the Main Medical Clinic Aug 2009 to July 2010
Table-1 below shows the service statistics of the main medical clinic which takes
place once a month on the last Saturday of the month.
Patients Treated: In the twelve months of August 2009 to July 2010 a total of 1,860
patients received care at the health centre of whom 643 (34.6%) were males and
1,217 (65.4%) were females.
HIV testing: In the twelve months period of August 2009 to July 2010 a total of 311
clients were tested for HIV in the clinics of whom 31 were HIV positive (11.0%).
Patients who test HIV positive are started on Cotrimoxazole (Septrin) which they
receive daily for life. Our project also pays for them to receive CD4 testing at Kawolo
hospital and if their CD4 count is less than 200 they are started on ARVs at that
hospital.
Malaria Testing: In the twelve months period of August 2009 to July2010 a total of
455 patients were tested for malaria of whom 291 had a positive malaria slide
giving a percentage positivity of (64.0%). This means that if we did not have the lab
test we would treat over 30% assuming they have malaria when actually they do
not have malaria. But with the lab test we are able to exactly diagnose malaria. And
thanks to the kind donation of Inger and Claes we are able to give the correct new
effective medicine of ACT (Artemesinin Combination Therapy) for properly
diagnosed malaria. These medicines are expensive so it is good that we are able to
use them only on patients with proven malaria.
Table 1: Namulaba HC Medical and HIV Testing service Delivery
statistics Aug 09 to July 2010
Male
s
Femal
es
Total
(Medical + VCT in Clinic)
43
60
103
Clients who received Medical Care
40
58
98
Clients Tested for HIV
11
HIV Positive
Patients Tested for Malaria
Patients Positive for Malaria
40
71
111
39
65
104
29th-Aug-09
26th-Sep-09
13
22
HIV Positive
10
19
59
102
161
59
100
159
11
22
33
HIV Positive
16
27
43
11
10
21
66
108
174
61
101
162
10
31
41
HIV Positive
19
28
47
11
19
47
93
140
46
90
136
10
16
26
HIV Positive
27
25
52
15
15
30
55
122
177
55
121
176
24
30
HIV Positive
15
41
56
25
33
64
96
160
64
93
157
31st-Oct-09
28th-Nov-09
26th-Dec-09
30th Jan 2010
27th Feb 2010
26
35
HIV Positive
20
30
50
14
19
33
56
111
167
55
108
163
22
25
HIV Positive
10
25
35
16
25
39
81
120
39
81
120
15
21
HIV Positive
16
22
38
13
12
25
61
152
213
61
152
213
17
24
HIV Positive
10
23
33
18
27
52
105
157
51
102
153
13
15
HIV Positive
10
29
39
12
16
61
116
177
61
113
174
27th March 2010
24th April 2010
29th May 2010
26 June 2010
31 July 2010
22
28
HIV Positive
11
23
34
14
Cumulative Total of All Clients (Medical + VCT)
1,860
Cumulative Total of All Clients (Medical + VCT) Males
643
(34.6%)
Cumulative Total of All Clients (Medical + VCT) Females
1,217
(65.4%)
Cumulative Total of clients who received medical care
1,815
Cumulative Total of clients who received HIV Counseling

and Testing in the clinic
311
Cumulative Total of patients positive for HIV
31
Percent HIV Positive
10.0%
Cumulative Total of patients tested for malaria
455
Cumulative Total of patients positive for malaria
291
Percent malaria positive
64.0%
Service Statistics of Nurses Clinic

Table-2 below shows the service statistics of the Nurses clinic which is operated on
three Saturdays a month. In the months of August 2009 to June 2010 the nurse
provided services to a total of 643 clients as follows:
General medical care to a total of 167 patients including 57 men, 68 women
and 42 children.
Family planning services* to 77 women
Antenatal care to 17 women
Post Natal Care to 1 woman
Childhood immunization* to 381 children.
12 boxes (288 pieces) of condoms were distributed to the clients
*It should be noted that family planning services and immunization are provided at
our clinic as an outreach of the government health department and hence we do not
pay for the supplies for these services.
Table-2 Nurses clinic statistics August 2009 to June 2010
August 2009
Date
Adult
Adult
Children
Total
Males
Females
General Medical Care
9
4
0
13
Immunization
Family planning (all
10
10
methods)
8
Total
September 2009
Date
Immunization
methods)
Total
October 2009
Date
Immunization
methods)
Total
November 2009
Date
Immunization
methods0
Total
December 2009
Date
Immunization
methods)
Antenatal
Postnatal
Condoms Distributed
Total
January 2010
Date
Immunization
Family planning Injection
Oral contraceptive
Antenatal
Postnatal
Condoms Distributed
Total
February 2010
14
23
Adult
Males
4
Adult
Females
2
Children
Total
Adult
Males
10
Adult
Females
8
Children
Total
3
50
21
50
14
14
10
22
53
85
Adult
Males
8
Adult
Females
11
Children
Total
7
50
26
50
7
7
8
18
57
83
Adult
Males
6
Adult
Females
13
Children
Total
3
35
22
35
4
20
38
64
Adult
Males
2
Adult
Females
8
Children
Total
4
35
14
35
3
6
2
1
0
61
3
6
2
1
2
20
9
39
Date
General Medical care
Immunization
Family Planning
Injection
Oral Contraceptive
Antenatal
Postnatal
Condoms Distributed
Total
March 2010
Date
Immunization
Family planning Injector
Oral contraceptive
Antenatal
Post natal
Condoms Distributed
Total
April 2010
Date
General Medical Clinic
Immunization
Family planning injector
Oral contraceptives
Antenatal
Postnatal
Condoms Distributed
Total
May 2010
Date
General Medical Clinic
Immunization
Family planning Injector
Oral contraceptive
Antenatal
Postnatal
Condoms Distributed
Total
Adult
Males
3
Adult
Females
4
Children
Total
4
45
11
45
5
5
4
3
0
3
16
49
4
3
0
2 boxes (48
pieces)
68
Adult
Males
2
Adult
Females
2
Children
Total
3
38
10
41
7
38
2
4
2
0
2 boxes (48
pieces)
53
Adult
Males
2
Adult
Females
4
Children
Total
1
40
0
2
4
2
0
11
41
7
40
2
2
3
0
1 box (24
pieces)
54
Adult
Males
6
Adult
Females
7
Children
Total
6
42
19
42
3
4
2
0
2 boxes (48
pieces)
70
2
2
3
0
3
4
2
0
6
16
10
48
June 2010
Date
Immunization
Family planning injector
Oral contraceptive
Antenatal
Postnatal
Condoms Distributed
Total
Grand totals
Adult
Males
5
Adult
Females
5
Children
Total
8
46
18
46
3
4
1
0
3 boxes (72
pieces)
72
643
3
4
1
0
5
Medical
=57
13
Medical=
68
FP (all
methods) =
77
ANC =17
PNC =1
54
Medical=
42
Immuniza
tion =381
Community Events
Events in the First Six Months (August 2009 to January 2010)
Summary of Community events August 2009 to January 2010
7 female netball matches
15 male football matches
11 Church seminars
13 Music, dance and drama events
2 School seminars
2 school essay competitions
4 support group meetings of people living with HIV/AIDS
1 VCT event in the community
At the beginning of the program in the first six months of August 2009 to January
2010 the aim of the community events were to educate the community about HIV
and reproductive health and encourage them to seek services such as HIV testing,
primary health care for all diseases and family planning and child immunization. The
events included school essay competitions, church and school seminars as well as
football and netball competitions.
Football and Netball Matches: In August and September 2009 a total of 6 female
netball matches and 14 male football matches were carried out in various villages.
Before the start of each match the Community Health Workers from Namulaba
would conduct s short discussion about HIV/AIDS with the players and the
spectators. This was usually mainly a question and answer session with the
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audience answering most of the questions. On 17 January 2010 the final football
and netball match was held at Nagojje, sub county headquarters. The matches were
attended by Inger and Claes and they gave a gift of a goat to the team that won
football (Kayanja village team) and the team which won netball (Waggala village
team). It was a colorful occasion as the teams wore colored T-shirts with the slogan
For Better Reproductive Health.
Primary School Essay Competitions: The primary school essay writing competition
took place on 11th and 12th August 2009 and seven schools participated with a total
of 34 pupils, equal numbers of girls and boys. The topic was AIDS and each pupil
was free to write their own story about AIDS. A marking team comprising of
teachers from these schools was formed and they marked the essays. Every pupil
who participated was given a gift. The gifts were a package of scholastic materials
like pencils, books and pens. Those who got higher marks in the essays were given
the larger packages. The top most boy (Kasule Sharif) came from Namulaba
Primary school in Primary 7 class. The top most girl (Nanjuki Saidat) came from
Ssezibwa Modern Primary school in Primary 7class.
Secondary School Essay Competitions: The secondary school essay competition
writing took place on the 14th and 15th September 2009. Four schools participated
and each of them was represented by 5 students giving a total of 20 students of
whom 7 were girls and 13 were boys. The topic was what has the government
done to prevent the spread of HIV/AIDS in Uganda?. Their ages ranged from 15 to
18 years. They were from classes Senior-3 and Senior-4. The highest score was by a
girl (Nakiwala Sanyu age 15 yrs) in Senior-3 from St Kizito Secondary School
Nakibano who got 78% followed by a boy (Wejuli Daniel age 16 yrs) in Senior-3 from
John Kennedy Secondary School in Kayanja who got 72%. Again, all the participants
were given gifts of packages of scholastic materials. Those with higher scores got
the larger packages.
Church Seminars: These were talks given to church members on Sundays by
Community Health Workers of the project who were invited by the religious leaders
of those churches to talk about AIDS. Altogether 6 church seminars were held
between August and December 2009 and the attendance was usually between 30
and 50 members. On 17th January 2010 during the visit of Inger and Claes two
church seminars were held and the Community Health Workers of the project gave
short talks about AIDS but in each church music dance and drama groups performed
to the audience various pieces relating to AIDS and teenage pregnancy.
School Seminars: Two schools invited the Community Health Workers of the project
to provide some form of Counseling and Guidance to the school students about
sexual and reproductive health issues. One seminar took place at a primary school
and it was attended by 60 pupils. Another took place at a secondary school and it
was attended by 50 students.
Music Dance and Drama: In the whole sub-county a total of seven music, dance and
drama (MDD) groups were formed. They each comprised about 10 to 15 members.
They trained and rehearsed their pieces starting in October 2009. The topics were
12
on AIDS and teenage pregnancy. Each time they rehearsed in their own village they
would attract an audience. Finally the team converged and performed at Namulaba
Health Center during the visit of Inger and Claes on 16 January 2010. The audience
on this final performance was large, about 200 people.
Support Groups of People Living with HIV/AIDS: In order to provide close support and
care for people living with HIV/AIDS two support groups for people living with
HIV/AIDS were formed. One group consists of 12 members and the other group
consists of 20 members.
Training of Ambassadors of the Project: In addition to conducting the above
community education events the project trained its ambassadors in the community.
These ambassadors were aimed to be responsible for continuous education and
counseling of community members about HIV and reproductive health. They
included religious counselors, from all faiths, community health workers, youth peer
educators, Aunties (Ssengas) and Uncles (Kojjas). In this culture, the Uncles are
responsible for providing sexual counseling to the boys and the Aunties are
responsible for providing sexual counseling to girls. Traditionally the sexual
counseling was designed to prepare the young people for sexual life during
marriage. Our project trained these Uncles and Aunties on matters of HIV and
reproductive health so that they can provide this information together with the
sexual preparation education. The project carried out 10 training
workshops/meetings for religious workers, 3 for Uncles and 8 for aunties. In addition
one Family Planning training workshop and two workshops on youth reproductive
health were carried out for all the staff and ambassadors of the project.
Community Health Workers (CHWs): These are ambassadors of the project who
were trained from the start of the project in February 2007. They initially attended a
six month course during which they would attend classes once a month. In the
middle of the month they would carry out practical work in terms of community
education and counseling. After the initial six months the group has continued to
meet every month and they have formed a savings and credit society for their own
upkeep because they are volunteers and are not paid a salary by the project. They
continue to provide counseling to clients in the community, to guide them to the
clinic and to facilitate community activities of the project especially community VCT.
Climax during the visit of Inger and Claes January 16th to 18th 2010
These events reached a climax in mid January during the visit of Inger and Claes
when the final football and netball competitions were held, music, dance and drama
was performed at Namulaba grounds and in churches and when Uncle and Auntie
seminars were held in villages.
Inger and Claes started their visit on Saturday 16 th January 2010 at the Namulaba
Health Centre clinic where they observed the clinic in action. Although this was not
the last Saturday of the month, when the main clinic normally operates, a special
clinic was held this day to let Inger and Claes observe the clinic activities. They also
witnessed music, dance and drama events together with an audience of about 200
people from the community. During this occasion, the community gave Inger a
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Ugandan name Nakimuli which means flower and Claes was given the name Kinene
which means the big one for his height. They also dressed them in the Ugandan
traditional attire. Please see pictures available in photo gallery (separate document)
with Inger in a green wrapper dress known at Gomasi and Claes in a white tunic
known as Kanzu. They both joined in the dancing. We were pleased to have with us
Dr Noerine Kaleeba the founder of TASO (The AIDS Support Organization) who
joined the community to thank Inger and Claes for the great gift they had given to
Namulaba people. The events were organized and coordinated by Mrs Margaret
Kizito the chairperson of the Namulaba CBO Network Committee.
On 17th January 2010 a Sunday, Inger and Claes started the day by participating in
Church prayers first in the Roman Catholic Church and later in the Protestant
Anglican Church where they observed the community health workers and the MDD
groups educate the church members about HIV and reproductive health. The turn
up in each church was about 100 people. In the afternoon, Inger and Claes watched
the finals of the female netball and male football matches and later handed out the
prizes (goats) one each to the winning team.
On 18th January 2010 a Monday, Inger and Claes visited a distant village called
Kyajja in the morning and another one near the Nagojje sub-county head quarters
called Kasana. At both villages they watched the Uncles and Aunties facilitating
community dialogue about HIV, reproductive health and marriage issues. Each
event was attended by about 40 people who were men and women in the age
ranges of 20 to 40 years.
Thus, Inger and Claes were able to watch and observe a little bit about each of our
community activities. This visit incidentally marked the turning point in our
approach to community activities. At the next meeting of the Network Committee
which sat at the end of the month it was decided that enough community education
had been conducted about the issues of HIV and sexual and reproductive health.
The committee felt that it was now time to turn towards behavior change and action
of individuals to improve their situations. It was decided to take a village to village
intensive approach where one village receives a Uncles/Auntie discussion followed
by VCT the following week. In addition the trained ambassadors of the project would
continue providing counseling to individuals, families and communities. This is the
approach for the last six months of the reporting period as below.
Events in the Last Six Months (February to July 2010)
Summary of Community events February to July 2010
6 VCT events in the community
91 documented religious counseling sessions for individuals
After January 2010 the program moved to a more personal level since the public
was now generally aware of the HIV and reproductive health problems and they
knew what they can do about it.
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Aunties/Uncles Discussion Meetings: The uncles and aunties had been requested, by
the committee, to begin holding their community meetings together so that they
promote dialogue between men and women. Indeed, the meetings held by the
Aunties and Uncles turned out to be more important for community members to air
out issues such as gender and power imbalance which can result into marital
conflicts rather than discussing sexuality issues. The community considered that the
greatest cause of HIV and sexually transmitted diseases was conflicts within
marriage which end up causing people to seek extra marital sexual partners. The
discussions are hot and they touch on crucial matters of gender as shown in the
following quotes:
Others have got bars and send their girls to work as bar maids not knowing theyre
exposing them to hungry men in the bar with some money that can seduce the
children into sex with them. This usually results into early pregnancy and getting
HIV/AIDS. Nakibano Village November 2009
Some parents have a tendency of negotiating with the men who impregnated their
daughter to get a sustenance fee for the pregnancy. But APPCAN (an NGO) has
come in. It has the right to imprison those parents making negotiations. So it
shouldnt be taken for granted that the man will negotiate with parents. Wasswa
Village March 2010
When the man starts quarreling always avoid answering him if he quarrels when
youre not answering him, he will give up. Bubiro Village May 2010.
We find our husbands poor very poor, work together and get some wealth but,
when we get some misunderstandings, they send us away without getting any
share of the things we worked for together.Bubiro Village May 2010.
Parents also suggested mobilizing their children during holidays and bringing them
facilitators to talk to them on different issues concerning their growing up,
HIV/AIDS, relationships and career guidance on their subjects at school. Bulanga
Village June 2010
Lack of respect for each other has also led to misunderstandings in our homes
today. Kisoba Village July 2010
From February to July 2010 one Auntie/Uncle meeting has been held per month at a
different village each month. When the Namulaba committee meets on the last
Saturday of the month they select one village at which the Auntie/Uncle meeting is
to be conducted on the second Saturday of the new month. While the team is in the
village for the Uncles/Auntie meeting they also put up posters announcing the VCT
to take place the following Saturday. This has enabled a large turn up for VCT.
Community Based HIV Voluntary Counseling and Testing (VCT): On the issue of HIV
the Network Committee observed that although HIV testing and counseling was
provided at the Namulaba clinic many people, especially men, were finding it
15
difficult to seek this service probably because of the long lines of other clients
seeking medical treatment. For this reason the idea of providing VCT in community
settings was tested in Nakibano Secondary School on 20 th November 2010 where 96
school students were tested in one day. This testing enabled us to know what
equipment, staff and supplies we needed to conduct VCT in the community. In
February 2010 VCT delivery in community settings begun and up to July 2010 a total
of 576 clients had received HIV counseling and testing in the comfort of their
village. These included 247 (42.8%) men and 329 (57.2%) women. And 23 out of
the total 576 clients tested HIV positive giving an overall prevalence of 4.0%.
Women had a higher prevalence of 15 out of 329 = 4.6% HIV positive while men
had a prevalence of 8 out of 247 = 3.3%. See table-3 below.
Table-3: Community VCT statistics Nov 2009 to July 2010

Male
Female
Total
th
20 November 2009 at Nakibano Secondary School (students)
Number tested for
20
66
86
HIV
Number HIV
0
1
1
positive
19th February 2010 at Namagunga
Number tested for
37
60
97
HIV
Number HIV
1
1
2
positive
20th March 2010 at Wasswa
Number tested for
36
50
86
HIV
Number HIV
1
1
2
positive
17th April 2010 at Magada
Number tested for
38
51
89
HIV
Number HIV
1
5
6
positive
22nd May 2010 at Bubiiro
Number tested for
44
22
66
HIV
Number HIV
2
2
4
positive
19th June 2010 at Bulanga
Number tested for
38
37
75
HIV
Number HIV
2
2
4
positive
16
17th July 2010 at Kisooba

Number tested for
34
HIV
Number HIV
1
positive
Grand totals
Total tested
=247
Total positive= 8
HIV prevalence
=3.3%
43
77
Total tested
=329
Total positive=
15
HIV prevalence
=4.6%
Total tested
=576
Total positive=
23
HIV prevalence
=4.0%
Religious Counseling: The other individual level engagement has been conducted by
the religious counselors. They have continued to provide counseling to individuals,
couples and families with a focus on family conflicts some of which are sometimes
claimed to be due to witchcraft. The religious counselors use their belief in God, as
per modern religions, to address these myths about witchcraft and bring the family
together. The religious counselors also come in handy to unite young people and
their families who develop communication barriers with their parents, as part of
their adolescent behavior. There are two religious counselors who are active and
one of them (Sefoloza) counseled 78 individual clients between September 2009
and May 2010. Another religious counselor (Esther) wrote and submitted 13
counseling case studies during the same period. The following quotes give an idea
of the content of the religious counseling sessions:
One girl had a problem of failing to get a man to marry every man she comes
across is married others do not want to go for HIV testing yet herself has tested
several times. Sefoloza September 2009
I also got a couple which had separated I counseled it and it reconciled. Sefoloza
November 2009
There is one girl who is praying and searching for a man to marry her but she has
not yet identified one. I am praying for her to get a faithful husband. She is faithful
and hardworking; she is 21 years old with one child who is a female by sex. Men no
longer want to marry. Esther May 2010
Conclusions and Way Forward

Vote of thanks
The Director and the Chairperson would like, on behalf of the Namulaba community
to express their gratitude to Inger and Claes for the five year commitment to fund
17
Namulaba activities. We would also like to thank our friends from AVERT UK for the
seed funding that enabled us to function during the first year of our project. We are
also grateful to all the friends of Namulaba who have visited us and encouraged us
to push on.
Emerging Focus of the Project
As mentioned before this project was started because the Director was
overwhelmed by people seeking medical help from him. Because of this type of
emergency beginning there was no strategic planning for the project and as such
the project is a natural experiment guided by what happens. At the moment is can
be said that the project has two emerging areas of focus:
a) Primary health care: This involves diagnosis and treatment of common
illnesses as well as educating the community to prevent them. The two major
illnesses of focus of the project are malaria and HIV. We feel we are making a
difference in the lives of the little children and women and men who we
accurately diagnose malaria in and provide the highly effective new ACT
medicines for malaria. In the area of HIV we feel we are making a difference
in the lives of people who we enable to know their HIV status, positive or
negative. Further, we feel we are helping those who are HIV positive to
prevent opportunistic infections by keeping them on Cotrimoxazole (Septrin).
We are also helping by treating opportunistic infections as soon as possible.
Further, we are helping them to access ARVs by paying their laboratory fees
for CD4 testing. In summary, the project is addressing two of the three
diseases of greatest public health importance in the developing world today:
HIV, Malaria and TB.
b) Reproductive Health: The project is increasingly strengthening its work in
family planning, the well child clinic for immunization and growth monitoring
as well as antenatal care. The project is also gaining strength in its work in
adolescent sexual and reproductive health (ASRH) services. However, we
remain weak in safe motherhood and neonatal care because we do not have
maternity services. This is part of our ways forward.
Proposed Maternity House
There is much suffering in the community when it comes to labor and delivery and
this is because there is no public car transportation to take a mother in labor to
Kawolo Hospital. The only motorized transport available is motor-cycle taxis Boda
Boda which is certainly not suitable for a woman in labor. To address this need, the
community has appealed for a maternity service at Namulaba Health Center.
Consequently, a project named Midwives House has been started. This house will
be the residence of a midwife. We plan to have one midwife live in for three days of
a week and another to live in for four days of a week. Women in advanced
pregnancy will be given room in the outer house where they will live with their own
18
family caregiver who will cook for and care for them using their own resources.
Once labor begins the midwife will admit the pregnant woman into the main house
where there is a labor room. After delivery the mother will be transferred to another
room in the main house to recover before she is discharged. The midwife will be
given standby money (Shs 50,000) to hire a taxi, if the mother has obstructed labor,
to take her to Kawolo Hospital. Using a mobile phone she can call a taxi from
Kawolo. Construction of the house has already started thanks to a collection by
residents of Arholma Island in Sweden where Inger and Claes live. This collection
started during Ingers birthday party and the residents have continued to make
personal donations as they are kept informed of the progress by Inger and Claes.
Sustainability
The question, what happens after this donation ends? remains a major issue for
all of us involved in this work of community development and social services. In
Namulaba there are a few signs of support from government in terms of the
supplies for family planning and childhood immunization. The political leadership
also demonstrated support by participating in the fundraising that resulted in the
community pharmacy. Indeed, the fact that the community pharmacy has been
running for more than a year implies that it is breaking even and is another sign of
sustainability. It should also be noted that the community is paying a user fee which
is equivalent to 10% of the cost of delivering care to them. They pay Shs 1000 when
on average the care for one person at the clinic costs Shs 10,000. This collection is
being kept on the Namulaba account and can help to sustain the services. However,
there is still need to look for more sustainable sources of funds for these services.
One idea is to consider giving work to community members on the farm and saving
their income as vouchers to pay for health care when they become sick.
19

Namulaba Annual Report 1 August 2009 To 31 July 2010

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Namulaba Annual Report 1 August 2009 To 31 July 2010

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Namulaba Health Center

Date of Report: 11 August 2010

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

30th Jan 2010

27th Feb 2010

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

Clients Tested for HIV

Patients Tested for Malaria

Patients Positive for Malaria

(Medical + VCT in Clinic)

Clients who received Medical Care

27th March 2010

24th April 2010