Meeting Point : Local CBO in Uganda

By Fiona Mitchell, GOAL, and Mary Corbett, ENN

A Meeting Point staff member with a young child

Fiona Mitchell is the Development Programme Coordinator, GOAL Uganda

The authors would like to acknowledge the contributions of Veronica, the whole Meeting Point team and members visited during the ENN field trip, Stefano Antonetti, AVSI, and Jackie Katana and Annet Achago, GOAL Uganda.

Hoima District is in the mid-western region of Uganda, 200kms from Kampala. It borders the districts of Kibaale to the south, Kiboga to the east, Misindi to the north and Lake Albert and the Democratic Republic of Congo to the west. The population is predominately rural, with a mainstay of agriculture and fishing. The main food crops are maize, millet, cassava and to a lesser extent, matoke and rice. The main cash crops are tea and tobacco. The population is largely dependant on subsistence farming with many households living in poverty.

The HIV/AIDS pandemic in Uganda has had a major social, economic and health impact on the population over the last 18 years. There has been large loss of life, leading to an estimated 1.7 million orphaned children. Property grabbing¹ has further exacerbated the plight of extremely vulnerable women and children, in particular. Stigma over the years has been particularly problematic and difficult to address.

In Uganda, many national non-governmental or community-based organisations (NNGOs /CBOs) have emerged in response to the overwhelming problems created by HIV/AIDS in their communities. A good number of these indigenous organisations have grown substantially in strength and have the capacity to access international funds to fight HIV/AIDS and implement quality activities. However, many NNGO/CBOs lack the organisational capacity to implement activities based on recognised best practice or to access funds that are available to stronger NNGO/CBOs. Through support from international NGOs, small but committed organisations, often formed from PLWHAs themselves, are able to access financial, technical and organisation support to assist them to implement appropriate and quality interventions. Meeting Point Hoima is a good example of a grass roots organisation, formed by PLWHAs, who has benefited substantially from such support from GOAL, AVSI (Associazione Volontari per il Servizio Internazionale) and the World Food Programme (WFP).

Meeting Point

Meeting Point Hoima is a local CBO, founded in 1991 and registered as a CBO in 2002. It started out with 30 founding members, all people living with HIV/AIDS (PLWHAs), of whom only five remain alive today. Meeting Point now has 1,424 HIV positive members, of whom 82% are women and 18% are men. Between 1991 and 2003, Meeting Point were predominately involved in informal group counselling support to members, home visiting the chronically ill, orphan support and medical care through AVSI. Its activities have substantially increased over the last few years, which now extend over the whole district.

Partnerships

Strong supportive partnerships with AVSI, and GOAL have contributed to a more comprehensive support package for people living with HIV/AIDS.

Nutrition support and food security

WFP food assistance support to PLWHAs first became available in Hoima through a partnership with AVSI in April 2003. Meeting Point and AVSI work in partnership to identify beneficiaries and distribute monthly food rations to 500 PLWHA's and 50 mothers on PMTCT. The initial criteria for inclusion in the food aid programme was membership of Meeting Point (i.e. being HIV positive). However, as time went on, the criteria were modified to target the most vulnerable households within this group.

WFP is soon introducing an eligibility format. This tool will provide the possibility to phase out current beneficiaries whose household has reached food security other than introducing criteria of selection. Moreover, when a primary beneficiary dies, the remaining family members will receive food for a further three months and then will be discharged from the programme.

To complement the existing food aid programme and increase longer term food security, GOAL, in partnership with Meeting Point, funds sustainable livelihood interventions, such as smallscale agriculture/animal initiatives. This is in the form of agricultural inputs and technical support to 150 families of the 500 beneficiaries currently receiving food assistance through AVSI and WFP.

Case studies

During a field visit in February 2005, four case studies of Meeting Point members were compiled, highlighting the unique problems created by HIV/AIDs, poverty, stigma, and in particular, female vulnerability.

Case Study 1

Mary, in her mid to late fifties, is a grandmother and a member of Meeting Point since 1992. In 1989, Mary's husband died, leaving Mary and three other wives widowed. At this time, Mary lost all her property and was forced to move with her four children to Hoima town, where she resided with a friend and generated an income by selling tea. Through psychosocial support, food assistance and sustainable livelihood interventions, Mary is now food secure, living well, and in her own home with income generating from a variety of crops/vegetables growing in her garden, pigs and chickens. In 2003, Mary became a Community Counselling Aide (CCA) with Meeting Point Hoima where she supports other PLWHA's through her HBC visits. Mary pays for her own prophylaxis for opportunistic infections (Septrin), which costs about $1 a month, and does not require antiretroviral medication (ARVs) at this time. Through the CCA training Mary received, she explained that she is now better able to prepare and use local available foods to achieve a well balanced diet.

Through the combination of psychosocial support, food aid, nutrition training and sustainable livelihood initiatives Mary is now food secure, a productive member of her family and community and is presently very well.

Case Study 2

Rose, in her late twenties, was widowed recently and has four children. Due to lack of support from either family and for economic reasons, Rose chose to remarry. Since the death of her first husband, one of her children has died, two now live with her dead husband's family and the youngest remains with Rose and her new husband. Since remarrying and becoming pregnant, Rose joined the Meeting Point/AVSI Prevention of Mother to Child Transmission (PMTCT) programme in 2004 where she has been receiving a single persons food ration. She now has a one-month old baby boy. Since delivery, Rose was sick and admitted to hospital with a fever. Rose was distressed at not having the funds to purchase milk for her baby, yet he is a healthy and well nourished baby (on breast milk only). She was unaware of current best practices, which promotes exclusive breast-feeding and abrupt weaning at 6 months of age. Despite support through the PMTCT programme, Rose and her new family remains extremely food insecure.

Case Study 3

Moses, in his mid to late fifties, is married with five children. Both he and his wife, Ester, are HIV positive. Since August 2004, Moses has been taking ARVs. Ester's CD4 count remains high and therefore she does not require ARVs at present. Despite the relatively low cost of antibiotic prophylaxis, at around $1 a month, Ester is not taking Septrin. Since 2003, Moses and his family have been receiving WFP food rations. Through the Meeting Point sustainable livelihood initiative supported by GOAL, he has been growing more than enough cassava, beans and maize to feed his family.

Moses became a member of Meeting Point Hoima in 1999. Following CCA training in 2003, Moses now heads a team of motivated CCA's in his local area that provide HBC activities to PLWHA's. The main activities encompassed in HBC include psychosocial and practical support to families struggling with the impact of HIV/AIDS on their lives. Although Moses is on ARVs, he is an extremely active member of the community. Through health care support, food aid assistance and sustainable livelihood support, Moses and his family are currently food secure. Due to this comprehensive package of support, Moses and his family are optimistic about their future and hope to support their eldest daughter through teacher training in the next few months.

Case Study 4

Sarah, in her late twenties, was deserted by her husband within the last year. She remains in the family home close to her own family with her three children. Sarah and her husband are both HIV positive. They live in a close knit rural community. It would appear that her husband left due to fear of HIV/AIDS stigma from the neighbours and he now lives in town with a new partner. He supports the family financially on an irregular basis. Sarah is just about to complete a full course of TB treatment and will start ARVs in the very near future. Throughout her TB treatment, Sarah did not receive any food aid support, and was very dependant from day-to-day on food support from her family. At present, Sarah's health remains fragile and she is not well enough to prepare her garden for the coming planting season. Without any active adult members in the household, she and her three children will remain food insecure for at least the next year.

A sign directing people to the local counsellor

Lessons learned

Lesson 1

It is evident that women and children's vulnerability increases when HIV affects the family unit and that vulnerability increases with poverty. It is not uncommon for women in such situations to be abandoned with children to support, divorced, widowed and disinherited.

Lesson 2

Food assistance supports the immediate needs of fragile families.

Lesson 3

Health care support such as TB treatment, prophylaxis for opportunistic infections, PMTCT and psychosocial support through HBC, are necessary along with food aid to support immediate recovery.

Lesson 4

In order to achieve more longer term food security at household level, it is essential to incorporate appropriate sustainable livelihood initiatives along with food aid.

Lesson 5

Nutrition training through HBC increases the knowledge around the use of locally available foods. Changing traditional cooking practices, particularly of vegetables, can increase the nutritional value of food and helps PLWHAs achieve a more balanced diet.

A mother and child involved in Home Based Care

Lesson 6

A family ration would be more affective in supporting a mother through the PMTCT programme since it is expected that any ration taken into the home will be shared.

Lesson 7

Clear information for mothers in PMTCT regarding current best practice for infant feeding is essential.

Lesson 8

There is strong evidence to suggest that prophylaxis for the reduction of opportunistic infections, in combination with nutrition support - immediate and longer term (food aid and sustainable livelihood interventions) - help to keep PLWHA's well, for longer². This may mean CD4 count remains high and progress on to ARVs is delayed.

Lesson 9

Even though prophylaxis for opportunistic infections could be considered a cost effective intervention (approx. $1 per month per beneficiary), it is not currently part of any HIV/AIDS intervention in Hoima.

For further information, contact Fiona Mitchell, email: dpc@goaluganda.com or Mary Corbett, email: corbettmary@eircom.net

¹In patriarchal societies like Uganda, when a man dies, his land typically goes to his male children or to his male kin, reverting back to his clan. Though illegal, property grabbing - when a man's relatives descend upon his widow to claim the household's material possessions - is common.

²See research review, Cotrimoxazole as a prophylaxis for HIV positive malnourished children, in this issue of Field Exchange