Namulaba Annual Report August 2010 To July 2011 FINAL Draft 8 Sept 2011

Namulaba Health Center
Project
Annual Report
1 August 2010 to 31 July 2011
Date of Report: 2 September 2011
Contact Persons:
Director
Network
Dr Samuel Kalibala
P.O. Box 2598 Kampala, Uganda
Uganda Cellphone: 256 772 638 540
Kenya Cellphone: 254 722 514 371
Skalibala@hotmail.com
Chairperson Namulaba CBO

Mrs Margaret Kizito
Tel +256 751 933 462
Source of Funding:
Funded by the kindness of Inger and Claes Ortendahl of
Arholma in Sweden plus a number of friends
Our friends Claes and Inger during winter in Sweden. Even in this snow, they
still think about the hot dusty village of Namulaba.
Table of Contents
Executive Summary.........................................................................................4
Introduction..................................................................................................4
Services provided by Namulaba Health Center Project.................................4
Detailed Report................................................................................................7
The Midwives House....................................................................................7
Service Statistics for the Main Medical Clinic Aug 2010 to July 2011............9
Service Statistics of Nurses Clinic..............................................................15
Community Events......................................................................................20
Conclusions and Way Forward.......................................................................26
Emerging Focus of the Project....................................................................26
Sustainability..............................................................................................27
Evaluation...................................................................................................28
Vote of thanks.............................................................................................29
Executive Summary
Introduction
The Namulaba Health Center project is located in an eight-room health
center built on a farm in Namulaba village. The project serves the Nagojje
3
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.
The project 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 in 2009. 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. Inger and Claes have
been joined by a number of friends who contribute to the project especially
to the building of the maternity building. The contributors are listed in the
vote of thanks at the bottom of this report. They include the 65 residents of
Arholma Island, Sweden, where Inger and Claes live as well as other friends
of theirs including those living in Germany. We are grateful for these kind
hearts.
The project was started by the Director (Dr Samuel Kalibala) on his farm land
in February 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.
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 last Saturday of the month, the
main clinic takes 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. 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.
Summary of Services provided on the main clinic day (August

2010 to July 2011)
1,440 patients received general medical care
260 received HIV counseling and testing at the clinic
497 received testing for malaria
Summary of Services provided by the Nurses Clinic (August

2010 to July 2011)
189 patients received general medical care
99 women received family planning
37 women received antenatal care
21 women received postnatal care
351 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 2010 to July 2011
5 female netball matches

8 male football matches
4 Auntie/Uncle meetings
15 School seminars
4 VCT events in the community
Detailed Report
The Midwives House
This project is the main highlight of this reporting period. We are grateful to
Claes and Inger for extending beyond their original commitment and making
extra personal contribution of money to ensure the construction of the
midwife house. In addition to the personal contribution, they have gone out
of their way to raise money from their 65 neighbors on Arholma Island in
Sweden plus other friends in Sweden and Germany. This contribution started
at Ingers birthday party in 2009. When she told her neighbors about the Gift
she and Claes had given to Namulaba, the neighbors reacted by contributing
the equivalent of US $ 2,300. This was the money used to start the
foundation of the building. Part of the building is now ready for use and it is
anticipated to start admitting mothers in mid-October 2011.
Midwife House in August 2011:
Inger and Claes have continued to work hard and raise funds for Namulaba.
Please see list of donors at the end of this report. One of the methods Inger
has used is to host a tea club and at the end of it, the guests make a small
contribution in a cup. In May 2011, we received Swedish Kronna 1120 from
the tea club.
7
The Tea Club Members, the Arholma Syjunta:
The cup used to collect the contributions:
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 was 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 family caregiver who will cook
for and care for them using their own resources. Once labor begins, the
midwife will formally admit the pregnant woman into the maternity. After
delivery, the mother will be transferred to another room in the house to
recover before she is discharged. The midwife will be given standby money
(about 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.
Service Statistics for the Main Medical Clinic Aug 2010 to July 2011
The main medical clinic takes place once a month on the last Saturday of the
month.Table-1 below shows the service statistics for this clinic.
Patients Treated:
In the funding period August 2010 to July 2011 a total of 1,440 patients
received care at the health centre of whom 643 (34.6%) were males and
1,217 (65.4%) were females. This represented an average of 125 clients
seen at each last Saturday of the month.
HIV testing:
In the twelve months period of August 2010 to July 2011 a total of 260 clients
were tested for HIV in the clinics of whom 14 were HIV positive (5.4%).
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 1, they are
started on ARVs at that hospital. In the reporting period we paid for nine CD4
tests.
Malaria Testing:
In the twelve months period of August 2010 to July2011 a total of 492
patients were tested for malaria of whom 257 (52.2%) had a positive malaria
slide and 47.8% were negative for malaria even though they had symptoms
which prompted the clinicians to test them for malaria. This means that if we
did not have the malaria lab test we would have treated 47.8% 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 2010 to Jul 2011
Males
Femal
Total
es
28th Aug 2010
All Clients (Medical + VCT)
55
92
147
Clients who received Medical Care
53
91
144
Clients who received HIV counseling and
10
19
29
16
31
47
12
20
25th Sept 2010

36
61
97
36
60
96
testing
HIV Positive
Patients Tested for Malaria
Patients Positive for Malaria
The new WHO policy recommends that clients with 350 CD4 cells should be started on ARVs. At the
time of writing this report it was not clear if this policy was already being implemented in Uganda.
10
10
14
10
12
22
12
60
101
161
51
92
143
15
14
19
33

27th Nov 2010
12
14
26
54
69
123
49
60
109
14
22
18
25
43
16
24
31
74
105
31
74
105
15
19
HIV Positive
28
37
14
22
43
98
141
43
98
141
33
40
testing
HIV Positive
30th Oct 2010

testing
HIV Positive

testing
HIV Positive
27th Dec 2010

testing
29th Jan 2011
11
testing
HIV Positive
12
31
33
14
All clients (Medical + VCT)
54
56
110
47
50
97
14
17
17
18
35
13
26th Mar 2011

47
69
116
46
68
114
Clients who received HIV Counseling and
05
13
18
10
23
33
56
71
127
56
68
124

HIV Positive
17
1
21
0
38
1
22
22
44
13
16
29
All Clients (Medical + VCT
55
94
149
55
94
149
11
20

26th Feb 2011

testing
HIV Positive
Testing
HIV Positive
30th Apr 2011
28th May 2011

Testing
HIV Positive
12
19
35
54
14
20
34
42
85
127
42
85
127
14
19
47
66
26
35
39
54
93
38
53
91
14
17
18
35
10
19
Male
572
Femal
924
Total
1,496
(38.2%
(61.8
25th Jun 2011

Testing
HIV Positive
30th Jul 2011

Testing
HIV Positive
TOTALS
%)
547
893
1,440
84
176
260
14
183
309
492
100
157
257

Testing
HIV Positive
Number Mont
hly
Avera
ge
Cumulative Total of All Clients (Medical
+ VCT)
13
1,496
125
Cumulative
Total
of
clients
who
1,440
120
clients
who
260
22
14
received medical care

Cumulative
Total
of
received HIV Counseling and Testing

Cumulative Total of clients positive for
HIV
Percent
Positive
= 14/260
= 5.4%
Cumulative Total of patients tested for
492
41
257
21
malaria
Cumulative Total of patients positive
for malaria
Percent
Positive
=
257/492
= 52.2%
Figure-1 shows a comparison of client volume between the year 2009/2010

and 2010/2011 which are the first two years of the Claes and Inger Gift.
There was a reduction in the overall number of patients seen from 1,860 to
1,496 and a reduction in the patients who received general medical
treatment from 1,815 to 1,440. Reduction was also observed for clients
receiving HIV voluntary counseling and testing (VCT) at the clinic from 311 to
260. These reductions can be partly explained by the fact that in the year
2009/2010, an extra clinic was conducted on the occasion of the visitation by
Claes and Inger. Looking at the average attendance per clinic, for the year
2009/2010 an average of 143 (1,860 divided by 13 clinics) patients were
seen per clinic. In the year 2010/2011 an average of 125 patients were seen
per clinic. Thus even when we factor in the extra clinic in 2009/2010, the
data still shows a reduction in the attendance. These are only two years and
hence the data is insufficient to make any conclusions.
Although there was
a reduction in the overall attendance, the number of clients tested for

malaria increased from 455 to 492. Again the data is insufficient to make any
conclusions.
These trends will be critically analyzed in the next annual
report.
14
Figure-2 shows that the number of clients tested for HIV decreased and HIV
prevalence among these clients reduced from 10% to 5.4%. For malaria ,the
number tested increased but the prevalence of malaria anong those tested
reduced from 64% to 52.2%. Again it is too early to comment on these trends
but it will be worthwhile to watch out for these trends in the annual report of
the third year of the gift.
15
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 2010 to July
2011, the nurse provided services to a total of 643 clients as follows:
General medical care to a total of 189 patients including 62 men, 78

women and 49 children.
Family planning services* to 99 women
Antenatal care to 37 women
Post Natal Care to 21 women
Childhood immunization* to 351 children.
34 boxes (3400 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 2010 to Jul 2011
August 2010
General Medical Care
Immunization
Family planning (all methods)
Antenatal
Postnatal
Condoms Distributed
Total
September 2010
Adult
Males
Adult
Females
Childr
en
Total
13
10
28
2
1
2
2
1
2
18
10
33
15
16
Immunization
Condoms Distributed
Total
October 2010
Immunization
Antenatal
Postnatal
Condoms Distributed
Total
November 2010
Immunization
Antenatal
Postnatal
Condoms Distributed
Total
December 2010
Immunization
Antenatal
Postnatal
Condoms Distributed
Total
January 2011
Immunization
Family planning Injection
Oral contraceptive
Antenatal
40
40
9
9
10
6
boxes
16
42
64
12
27
7
5
7
5
3 boxes
8
24
39
4
35
14
35
7
5
4
7
5
4
2 boxes
4
22
39
65
Adult
Males
Adult
Females
Childr
en
Total
0
46
10
46
8
2
1
8
2
1
3 b0xes
4
17
46
67
4
0
0
12
0
4
2
2
4
2
2
17
Postnatal
Condoms Distributed
Total
February 2011
General Medical care
Immunization
Family Planning Injection
Oral Contraceptive
Antenatal
Postnatal
Condoms Distributed
Total
March 2011
Immunization
Family planning Injection
Oral contraceptive
Antenatal
Post natal
Condoms Distributed
Total
April 2011
General Medical Clinic
Immunization
Family planning injector
Oral contraceptives
Antenatal
Postnatal
Condoms Distributed
Total
May 2011
General Medical Clinic
Immunization
Family planning Injector
Oral contraceptive
Antenatal
2 boxes
3
15
22
2
38
9
38
5
3
2
1
5
3
2
1
2 boxes
2
16
40
58
3
40
7
40
6
4
3
1
6
4
3
1
2 boxes
0
18
43
61
Adult
Males
Adult
Females
Childr
en
Total
0
30
4
30
3
4
4
2
3
4
4
2
3 boxes
3
14
30
47
1
46
8
46
4
6
4
4
6
4
18
Postnatal
Condoms Distributed
Total
June 2011
Immunization
Oral contraceptive
Antenatal
Postnatal
Condoms Distributed
Total
July 2011
Immunization
Oral contraceptive
Antenatal
Postnatal
Condoms Distributed
Total
2 boxes
4
19
47
70
5
46
15
46
3
6
2
2
3
6
2
2
2 boxes
4
19
51
74
15
10
11
40
36
40
6
8
7
6
51
103
6
8
7
6
3 boxes
15
19
37
Grand
Medical
totals
=62
Medical= 78
Medical= 49
703
Immunization
=351
FP
(all
methods) = 99
ANC =37
PNC =21
Comparison between 2009-10 and 2010-11:

Figure-3 shows that there was a rise in the clients receiving general medical
care at the Nurses clinic between 2009-10 and 2010-11 and this change was
observed among men, women and children. While there was a reduction in
the number of children immunized at the clinic from 381 to 351, there was a
rise in other reproductive health services. Clients who received family
planning (all methods) rose from 77 to 99; the pregnant women receiving
Ante Natal Care (ANC) rose from 17 to 37 and the recently delivered mothers
receiving post natal care (PNC) rose from 1 to 21. This trend is encouraging
at this time when Namulaba Health Center is on the verge of opening a
maternity unit.
20
Community Events
Summary of Community events August 2010 to July 2011
5 female netball matches
8 male football matches
4 Auntie/Uncle meetings
15 School seminars
4 VCT events in the community
The community activities of this funding period started with the completion
of the village by village sessions of Aunties/Uncles plus VCT which had been
started in the previous funding period. These sessions ended in November
2010 when all the major villages selected by the CBO Network had been
visited. In the school holiday of December 2010 to January 2011, preliminary
boys football and girls netball competitions were planned and conducted.
In the second school term a campaign of school seminars was conducted
covering 15 schools during which HIV, teenage pregnancy and sexual
behavior were discussed.
21
Football and Netball Matches: In January 2011 during school holidays, the
preliminary football and netball competitions were held. As shown in table-3
a total of 5 female netball matches and 8 male football matches were carried
out in various villages.
Before the start of each match, the Community
Health Workers from Namulaba conduct a short discussion about HIV/AIDS

and teenage pregnancy with the players and the spectators. This is usually
mainly a question and answer session with the audience answering most of
the questions.
Out of the preliminary competitions, emerged two male football teams and
two female netball teams to compete in the finals. On 21 August 2011,
during the second term school holidays the final football and netball matches
were held at Nagojje, sub county headquarters. The matches were attended
by Local Council-3 Vice Chairperson, other members of the Local Council-3, a
representative of the Member of Parliament for the area, the Chairperson of
the Namulaba CBO Network, the Director of Namulaba Health Center and
other members of the Namulaba CBO Network. The winning teams were
given a gift of a goat each and the run-up teams were each given Shs 20,000
(US$8). Wagala won in football and Mayangayanga won in netball. It was a
colorful occasion as the teams wore green and red T-shirts with the slogan
We work to reduce Teenage Pregnancy and HIV.
Table-3: Namulaba Sports January to August 2011

Date
Teams
Netball
Footbal
15th Jan 2011
Mayangayanga Vs
15th
19th
19th
19th
Jan
Jan
Jan
Jan
2011
2011
2011
2011
Kasozi
Nagojje Vs Wagala
Masiko Vs Nagojje
Kasozi Vs Magada
Nagojje Mayangayanga
23rd
23rd
30th
26th
30th
30th
Jan
Jan
Jan
Jan
Jan
Jan
2011
2011
2011
2011
2011
2011
Vs Masiko
Masiko Vs Wagala
Natyole Vs Nagojje
Magada Vs Nagojje
Natyole Vs Magadda
Wagala Vs Kasozi
Nagojje Vs Magadda
22
2nd Feb 2011
Nagojje Vs
21 August 2011
Mayangayanga
Wagala Vs Nagojje
FINALS
21 August 2011
Nagojje Vs
Mayangayanga
TOTAL
FINALS
Aunties/Uncles Discussion Meetings:

From February to July 2010 one Auntie/Uncle meeting was held per month at
a different village each month to address the needs of out of school youths
and young adults. When the Namulaba committee met on the last Saturday
of the month, they would select one village at which the Auntie/Uncle
meeting was to be conducted on the second Saturday of the new month.
While the team is in the village for the Uncles/Auntie meeting, they would
also put up posters announcing the VCT to take place the following Saturday.
This enabled a large turn up for VCT. In the first half (August 2010 to
December 2010) of the current reporting period, these
sessions were
continued until each major village in the catchments area of Namulaba

Health Center had had a session. Table-4 shows that the four auntie/uncle
sessions held during this period reached a total of 153 people comprising 73
males and 80 females.
Table-4: Aunts and Uncles meeting August 2010 Jul 2011

Date
Place
Males
Females
Total
11th
14th
18th
28th
Dona
Kyajja
Seeya
Kyegala
attended
17
10
10
36
attended
15
19
14
32
attended
32
29
24
68
Sept 10
Oct 10
Oct 10
Oct 10
so
73
80
The following are some quotes from the auntie/uncle sessions:
23
153
Some couples have failed to fulfill the purpose of marriage. We all know
that marriage is to make each other happy sexually but you find that some
men spend a lot of time in their businesses and fail to get enough time for
their wives. If the woman is not patient enough, she will get an outside
partner to satisfy her sexually. Dona Village September 2010
The married people of long ago used to be faithful to their partner than it is
today and the women were humble that even if a man had another woman,
he used to do it secretly avoiding his wife from knowing. But, today men and
women are committing adultery broad day light. Seeya Village October
2010
Community-based VCT: Table-5 below shows that in each village there were
over 100 people tested for HIV in this one-day event.
Table-5: Community-based VCT sessions August to November 2010

Date
Locatio
Male
Male
Femal Femal Total
Total
es
es
teste
+ve
Teste
+Ve
Teste
+ve
d
21 Aug 2010
Kyegalas
18 Sept 2010
Oct 2010
20 Nov 2010
o
Dona
Kyajja
Seeya
Total
d
57
61
118
73
32
105
53
64
117
School Seminars:
24
During the second term of schools, members of the Namulaba CBO Network
led by the Chair person, Mrs Margaret Kizito embarked on a campaign of
school seminars to address the two topics of focus of the CBO Network:
reducing HIV infection and reducing teenage pregnancy.
The table below
shows that in the period June to July, seminars were conducted in 15 schools.
Each school has at least one teacher who is trained in HIV education. In each
school, this teacher was the organizer and coordinator of the seminar and
would provide technical knowledge about HIV. The CBO network member
attending such a seminar would give input regarding sexual behavior of
teenagers from the perspective of an Auntie for the girls or an Uncle for
the boys. According to the tradition in some Uganda tribes, the Aunties and
Uncles are the family members responsible for discussing sexual matters
with adolescents.
Table-6 shows that a total of 1,305 students attended
these seminars of whom 589 (45%) were boys and 716 (55%) were girls.
Table-6 School Seminars Jun 2011 - Jul 2011

Date
School
8th Jun 2011
Ssezibwa Primary School
Boys
Attende
d
55
Girls
Attend
ed
65
Total
Attend
ed
120
10th
Jun Dona Secondary School
44
42
86
2011
15th
Jun Namulaba Primary School
30
30
60
2011
16th
Jun Kanyogoga
Primary 39
54
93
th
2011
16
School
Jun Ananda
Primary 39
45
84
2011
Maga
School
25
17th
Jun Greenland Academy
50
61
111
th
2011
20
Jun Bubiro Primary School
20
21
41
2011
21st
Jun Nagojje Primary School
32
65
97
2011
28th
Jun Mayangayanga
primary 33
49
82
2011
28th
Jun school
Kayanja
Community 47
55
102
2011
28th
Jun School
Quality Junior School
62
59
121
st
2011
31
Jun Nakibano Primary School
39
55
94
59
70
129
Primary 40
45
85
716
1305
2011
7th Jul 2011
St. Kizito Primary School
8th Jul 2011
Mustard
Totals
School
15 Schools
Seed
589
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
including community-based VCT, football and netball.
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 often have
26
communication barriers with their parents, as part of their adolescent

behavior. There are two religious counselors who are active Sefoloza and
Esther. The following extracts from the religious counseling reports give an
idea of the content of the religious counseling sessions:
On 13th /11/2010, there is a boy I counseled, he was in love with a school
girl, I told him that he is in trouble because if he impregnates her, he is going
to be imprisoned since the girl is still young and at school. But the boy did
not mind much. I asked the girl whether her parents are aware that she is in
love with that boy, she replied that they are not aware but her mother said
that if gets pregnant never to inform her just to go straight to the husband
who owns the pregnancy. I asked how old she is, she said 14 years but she
wants to have a baby even the boyfriend wants too. These two are still
young to have a baby. I told the girl to forget and put aside this boyfriend, go
for HIV testing and know her current status. This will encourage her to take
extra care and make a good decision. She promised to come and test at
Namulaba Health Centre NANTALE SSEFOLOZA
One married man got attacked by a serious Sexually Transmitted Infections

(STIs) around his private parts, his wife leant about it and is now planning to
divorce .The man came to Namulaba Health Centre and got treatment. We
are praying that the wife does not divorce. The man informed me that ever
since he got treatment his situation is improving, it was necessary for him to
come back to the Health centre. OLYA ESTHER
Concluding Remarks and the Way Forward

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
27
as such the project is a natural experiment guided by what happens. At the

moment it 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 way forward. As
mentioned above, at the time of writing this report, we are on the verge of
starting the Midwives house which we hope will greatly increase access
for the mothers of this village to skilled attendance during labor and
delivery.
Another key service for reducing maternal morbidity and
mortality is to ensure that each pregnant woman receives ante natal care
(ANC) as well as post natal care (PNC) including family planning (FP). The
data from the Nurses clinic has shown that the number of clients
receiving these services has increased tremendously, especially post natal
care which rose from one case in 2009-10 to 21 cases in 2010-11. And
this was by a nurse who was available only on Saturdays. We believe that
the presence of at least one midwife at the midwife house seven days a
week will greatly improve the availability of ANC, PNC and FP.
28
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 a form of health insurance system.
Community-Based Health Insurance: Thoughts on this issue are still in their

infancy. However, the basic principle would involve giving work to community
members on the farm and saving their income as vouchers to pay for health
care when they become sick. The health center is based on a farming
property of the Director. This farm can be used as the experimental ground
for the community based health insurance. The Namulaba community has
one main source of income i.e. farm labor. Community members work as
laborers on their own pieces of land, on other peoples land and in the
nearby sugar cane and tea plantations. Other members of the community
earn
living
from
providing
services
such
as
transport,
schools,
entertainment, bars, restaurants and selling house supplies such as salt,

sugar, kerosene to the rest of the community. The farm on which the health
center is based employs a number of community members as laborers. In
dry periods, the farm also employs community members to fetch water for
the farm animals from a distant river and grass from distant locations.
We want to experiment with a system where community members can come

and work on the farm and the farm gives them vouchers to use for medical
care at the Community Pharmacy. Currently, when the farm workers and
29
their families are sick, in the period between the main clinic days, they
attend the Community Pharmacy and the farm pays the pharmacy, once a
month. Indeed the farm is one of the best customers of the community
pharmacy. So we feel that it is feasible to extend this system to any
community members who can come in as causal laborers on the farm. It can
be started by the Community Pharmacy Nurse telling clients who cannot pay
but are sick that she could treat them on credit as long as they sign an I
owe you note to the farm to come and work on the farm a few weeks later
after the illness. This will show the community that the farm trusts them.
Once this works, we can move to the next stage of trust, i.e. the community
trusting the farm. By this we mean the community members having the
confidence to come and work on the farm, and the farm paying them in
vouchers for future medical care at the Community Pharmacy. If this
experiment works, it will be a great stride towards ensuring sustainability of
services after the end of the kind gift of Claes and Inger.
Other ideas are welcome: In addition to this idea of the community based
insurance ,we are still brainstorming and are open to further ideas of
sustainability.
Evaluation
Namulaba Health Center has been in operation since June 2007 but the
community mobilization activities started in February 2005. A quick and dirty
community survey was carried out in December 2006 as a form of baseline.
Since then we have delivered medical services for at least four years and
conducted a high number of community education activities including
training and deploying of community health workers, community-based VCT,
auntie/uncle sessions, school and church seminars, sports, music, dance and
drama competitions, essay competitions and others.
It can be imagined
that these activities have had a positive impact on the community especially
in the three areas of focus: primary health care, HIV and reproductive health.
For this reason, Namulaba Health Center would like to conduct an evaluation
of its impact during this financial year 2011-12. The evaluation will be timely
30
in that it will come at the beginning of a new phase when the Midwives
house is being added to the services.
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 Namulaba activities. In addition, we are very thankful
to the following friends who have made donations to us through Inger and
Claes:
Members of the Arholma Syjunta (Arholma Tea club)
Hella and Jrgen Richert from Grnwald Germany
Mrs. Kerstin Lindgren and Family of Sundsvall Sweden
Ingela rtendahl of Enskededalen Sweden
Kristina and Torbjorn Paulin of Stenhamra Sweden
Dr. Susanne Richert of Gauting Germany
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. Last but not least, we are grateful to the people of Namulaba
who have let us join them to work together to make a difference in peoples
lives.
31

Namulaba Annual Report August 2010 To July 2011 FINAL Draft 8 Sept 2011

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Namulaba Annual Report August 2010 To July 2011 FINAL Draft 8 Sept 2011

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Namulaba Health Center

Date of Report: 2 September 2011

Chairperson Namulaba CBO

sub-county which has a community of about 30,000 people living in about

Services provided by Namulaba Health Center Project

Clinic based services:

managed by the Namulaba Network of Community Based Organizations

The nurse also examines and

Summary of Services provided on the main clinic day (August

260 received HIV counseling and testing at the clinic

497 received testing for malaria

Summary of Services provided by the Nurses Clinic (August

99 women received family planning

37 women received antenatal care

21 women received postnatal care

351 children received childhood immunization

Community Based Services:

Summary of Community events August 2010 to July 2011

5 female netball matches

Midwife House in August 2011:

The Tea Club Members, the Arholma Syjunta:

The cup used to collect the contributions:

There is much suffering in the community when it comes to labor and

Using a mobile phone, she can call a taxi from

Table 1: Namulaba HC Medical and HIV Testing service delivery

Clients who received Medical Care

Clients who received HIV counseling and

25th Sept 2010

Clients who received Medical Care

Clients who received HIV counseling and

All Clients (Medical + VCT)

Clients who received Medical Care

Patients Tested for Malaria

Patients Positive for Malaria

All Clients (Medical + VCT)

Clients who received Medical Care

All Clients (Medical + VCT)

Clients who received Medical Care

Patients Tested for Malaria

Patients Positive for Malaria

All Clients (Medical + VCT)

Clients who received Medical Care

Clients who received HIV counseling and

Clients who received HIV counseling and

Clients who received HIV counseling and

29th Jan 2011

Clients who received HIV counseling and

All clients (Medical + VCT)

Clients who received Medical Care

26th Mar 2011

Clients who received Medical Care

Clients who received HIV Counseling and

All Clients (Medical + VCT)

Clients who received Medical Care

Clients who received HIV Counseling and

Patients Tested for Malaria

Patients Positive for Malaria

All Clients (Medical + VCT

Clients who received Medical Care

Patients Tested for Malaria

Clients who received HIV counseling and

28th May 2011

Clients who received HIV Counseling and