Select Committee on International Development Written Evidence


Memorandum submitted by PROMPT UK[16]


  In considering issues for the promotion of management of patients' health of PLHA, PROMPT is of the opinion that the important issues are nutrition, hygiene, management of opportunistic and other infections including STIs, behavioural change and counselling/support.


  At the centre of delivering any package is poverty which often makes it difficult for any patient to access any or all of the above care and support packages. Some organisations like Concern Worldwide in western Uganda have included traditional medicine as an alternative relief therapy in areas where orthodox medicines are not accessible. This was first proposed by the community themselves. It is suggested that interventions should build on what the community already have.

  In rural areas, there is very little care and support in all its forms for PLHA in terms of access to VCT services, treatment, psycho-social support community care etc.

  PROMPT notes with concern that patients do not follow up to complete their treatment especially for STDs or cases where partners may not co-operate to have both treated. Outreach may have to be more intensive and client-oriented and sensitive.

  High expectations from patients are still looming especially in the wake of precedents set by initiating organisations that were giving free nutrition supplements, free treatment etc.

  High costs/poverty are prohibiting access to appropriate care and support. Many organisations have looked locally for alternative relief packages such as traditional medicines etc adding weight to the point that total involvement of the community through their health committees in identifying what care and support could be sustainable and their responsibility for PLHAs is very important.


  What people need is advocacy for behavioural change through community motivation, knowledge and skills acquisition for the individual. Advocacy and information can best be delivered by the existing health workers. This may pose a few shortcomings but is in most cases the only existing structure. What community health workers need is training. It is also important to develop the concept of positive living to make it relevant to our community in light of new scientific and other developments eg regarding issues around behavioural change.

  The linkage between grassroots organisations and the mainstream researchers and practitioners is seriously lacking. Grassroots voices are quite silent in these national and international occasions.

  The issue of interference from religious leaders, local politics etc, in for example promoting condom use and family planning is also an issue for advocacy work.

  The importance of peer education/training/support and community motivation in promoting behavioural change should also be promoted.


  Creation of basic safe environments for people to access services is another area of concern. Eg very few public and private health units in the country have private rooms where a person could request for examination for STIs or seek family planning services. They are usually attended to in the open.

  Provision of safe environments where people will confidently and confidentially seek health services is important in increasing the chances for people to seek the services. Such privacy is missing in almost all Uganda's health units.

  Stigmatisation is still a big stumbling block despite of the sensitisation done already.


  The decentralisation of services to district level (eg the STIP project in Uganda) is yet in its early stages and its effectiveness has not been fully assessed in terms of lesson sharing. However the Uganda Aids Commission is about to put in place a system which would enable lessons learnt to be shared. This might be an annual conference bringing together researchers and users. This has not been happening before.

  Learning about the experiences of particular successful community based initiatives, what has been tried and what has been proven effective.

  These and many others have to be reviewed in terms of future service provision.


  In a recent Situational Health Survey conducted by PROMPT, Africare and the Mifumi Project in Mifumi village, a remote rural area in Tororo District, East Uganda, the following findings on HIV/AIDS was revealed. (See Dr. Okoth, A: Mifumi: A Situational Health Survey, 2000) Full report available.


  33 per cent of respondents did not know what HIV was.

  70 per cent of respondents had never received any education on HIV/AIDS.

  96 per cent respondents believed there was no form of treatment at all for HIV/AIDS.

  65 per cent of respondents had no idea at all how one could tell if s/he had an HIV infection.

  50 per cent respondents were not aware that HIV could be transmitted through breast milk.

  54 per cent of respondents, the majority, thought the best way to help somebody with AIDS was by health education. This may partly reflect their wish for more knowledge about HIV and AIDS.

  33 per cent thought the best way was by provision of food and only 13 per cent thought medicine was the most helpful.

  39 per cent respondents reported ever having had a sexual transmitted disease (STD) and 18 per cent of them had practised self medication. This could easily be inadequate, incorrect and may not involve treatment of the spouse.

  99 per cent respondents thought people were having sex outside marriage without using condoms and an additional problem in HIV control is that the Jopadhola still practice wife inheritance from deceased brothers as a cultural norm.


July 2000

16   Working in partnership with the Mifumi Project, Uganda. Back

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