the decentralized response to hiv/aids in uganda : progress, challenges and lessons learned patrick....

THE DECENTRALIZED RESPONSE TO THE DECENTRALIZED RESPONSE TO HIV/AIDS IN UGANDA :HIV/AIDS IN UGANDA :

Progress, challenges and lessons learnedProgress, challenges and lessons learned

Patrick . K. MutabwirePatrick . K. MutabwireAg. Director Local Government Administration/Ag. Director Local Government Administration/

Chairperson, Decentralized Response EntityChairperson, Decentralized Response EntityMinistry of Local GovernmentMinistry of Local Government

Lake Victoria Serena ResortLake Victoria Serena Resort27 April 201027 April 2010

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The HIV Situation at LG Level – The HIV Situation at LG Level – BackgroundBackground

The impact of HIV/AIDS on the community is noticeable at The impact of HIV/AIDS on the community is noticeable at individual, family and community levels.individual, family and community levels.

At individual and family level, nearly every family has been At individual and family level, nearly every family has been affected by the epidemic in some way. affected by the epidemic in some way.

Most of these individuals live in the rural areas where access to Most of these individuals live in the rural areas where access to basic social services is extremely low basic social services is extremely low

Moreover support to communities to enhance their competence in Moreover support to communities to enhance their competence in dealing with the epidemic is extremely inadequate, despite dealing with the epidemic is extremely inadequate, despite communities being closest to the people.communities being closest to the people.

Variations and disparities in HIV prevalence exist in different Variations and disparities in HIV prevalence exist in different regions and districts, with urban centers reporting the highest regions and districts, with urban centers reporting the highest prevalence rates – 10.1% as compared to 5.7% in rural areas prevalence rates – 10.1% as compared to 5.7% in rural areas (MoH, 2005). (MoH, 2005).

The current National HIV/AIDS Strategic Plan emphasizes the need The current National HIV/AIDS Strategic Plan emphasizes the need to deepen the AIDS response to the lower levels based on the fact to deepen the AIDS response to the lower levels based on the fact that this level is closest to the population, and as such best suited that this level is closest to the population, and as such best suited to understand the challenges they face, and in return support to understand the challenges they face, and in return support them design appropriate strategies to address the AIDS them design appropriate strategies to address the AIDS

challenges.challenges.

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The Policy Framework (1)The Policy Framework (1) The HIV/AIDS response in Uganda is guided by the The HIV/AIDS response in Uganda is guided by the

Decentralization framework. Implementation and coordination of Decentralization framework. Implementation and coordination of the epidemic follows the decentralization policy.the epidemic follows the decentralization policy.

This is because Decentralization is a key vehicle for improving This is because Decentralization is a key vehicle for improving service provision, promoting democratization, and ensuring good service provision, promoting democratization, and ensuring good governance.governance.

The LG Act 1997, mandates LGs to directly manage and monitor The LG Act 1997, mandates LGs to directly manage and monitor delivery of services, including those for HIV/AIDS within their areas delivery of services, including those for HIV/AIDS within their areas of jurisdiction of jurisdiction

The Act also under Section 81, also provided for the delegation of The Act also under Section 81, also provided for the delegation of responsibilities from the higher to lower LGs, as long as any extra responsibilities from the higher to lower LGs, as long as any extra obligation is fully financedobligation is fully financed

The response in LGs has over the years evolved from small, The response in LGs has over the years evolved from small, spontaneous self-help initiatives to a now structured responsespontaneous self-help initiatives to a now structured response

The structured AIDS response dates – as far back as 1995 - The structured AIDS response dates – as far back as 1995 - ACP ACP desk created in the Ministry.desk created in the Ministry.

ACP Desk -since been the reference point for the coordination & ACP Desk -since been the reference point for the coordination & management of HIV/AIDS activities in the Sector and also linking management of HIV/AIDS activities in the Sector and also linking with the Line Ministries Self-Coordinating Entity under the AIDS with the Line Ministries Self-Coordinating Entity under the AIDS Partnership coordination arrangement Partnership coordination arrangement

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Policy Framework (2)Policy Framework (2)

Sector developed first strategic plan in 2000. This has guided the Sector developed first strategic plan in 2000. This has guided the sector’s HIV/AIDS efforts since sector’s HIV/AIDS efforts since – World Bank Support– World Bank Support

2000- MoLG , UAC and stakeholders developed and issued LG 2000- MoLG , UAC and stakeholders developed and issued LG HIV/AIDS coordination guidelines HIV/AIDS coordination guidelines

2006 - HIV/AIDS was made part of the LG Sector Strategic 2006 - HIV/AIDS was made part of the LG Sector Strategic Investment Plan (a 10 year Investment Plan), - aim to ensure that Investment Plan (a 10 year Investment Plan), - aim to ensure that resources required to manage the epidemic in the LGs are resources required to manage the epidemic in the LGs are mobilized.mobilized.

Currently, the MoLG Revised HIV/AIDS Sector Strategic Plan’s Currently, the MoLG Revised HIV/AIDS Sector Strategic Plan’s primary focus is to strengthen coordination mechanisms and to primary focus is to strengthen coordination mechanisms and to ensure that at all levels, capacity to plan, implement and manage ensure that at all levels, capacity to plan, implement and manage HIV/AIDS interventions is builtHIV/AIDS interventions is built

This legal framework presents an opportunity to manage HIV/AIDS This legal framework presents an opportunity to manage HIV/AIDS among other problems facing LGs, but also provides an avenue among other problems facing LGs, but also provides an avenue through which higher LGs or Central Govt could delegate a lower through which higher LGs or Central Govt could delegate a lower LG to undertake certain activitiesLG to undertake certain activities

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The LG AIDS Response - StakeholdersThe LG AIDS Response - Stakeholders A wide range of players in the LG AIDS ResponseA wide range of players in the LG AIDS Response

-- Policy Making/ Legal Framework :Policy Making/ Legal Framework : Ministry of Local Ministry of Local Government, other sectors, UACGovernment, other sectors, UAC-- Local Government AssociationsLocal Government Associations – ULGA, UAAU – ULGA, UAAU-- LGs themselvesLGs themselves – Leading LG response, providing – Leading LG response, providing -- Wide expanse of Civil Society – mainly involved in Wide expanse of Civil Society – mainly involved in Prevention, Prevention, care and treatment and social support care and treatment and social support servicesservices-- The CommunitiesThe Communities - - -- Community GroupsCommunity Groups – community sensitization – community sensitization-- People Living With HIV/AIDSPeople Living With HIV/AIDS – Advocating for the rights of – Advocating for the rights of

PHAs, PHAs, providers and beneficiaries of servicesproviders and beneficiaries of services-- Faith- Based InstitutionsFaith- Based Institutions -- International NGOsInternational NGOs - involved in Prevention, care and - involved in Prevention, care and treatment and treatment and social support services and provision of AIDS social support services and provision of AIDS Development Development assistanceassistance-- The UN and Bi-lateralsThe UN and Bi-laterals - AIDS Development assistance - AIDS Development assistance

All, led by Ministry of Local GovernmentAll, led by Ministry of Local Government

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The LG AIDS Response – Funding The LG AIDS Response – Funding SupportSupport

Government with Development Partners and Civil Society have over Government with Development Partners and Civil Society have over the years supported community responses to HIV/AIDS in various the years supported community responses to HIV/AIDS in various ways, including development of systems and structures that have ways, including development of systems and structures that have resulted into improved responses to HIV/AIDS at LG level. resulted into improved responses to HIV/AIDS at LG level.

Major funders - USAID - one of the largest bilateral support agencies Major funders - USAID - one of the largest bilateral support agencies in the fight against the HIV/AIDS pandemic in Uganda, through such in the fight against the HIV/AIDS pandemic in Uganda, through such projects as AIM, UPHOLD, NUMAT, STAR E, STAR EC, as well as direct projects as AIM, UPHOLD, NUMAT, STAR E, STAR EC, as well as direct support to institutions. support to institutions.

Other donor agencies : Other donor agencies : -- Irish Aid - Under programmes like Irish Aid - Under programmes like “Deepening Mainstreaming “Deepening Mainstreaming of of HIV/AIDS in LGs”HIV/AIDS in LGs”-- the European Unionthe European Union-- DFIDDFID-- DANIDADANIDA-- The Italian Government through AVSI (The Association of The Italian Government through AVSI (The Association of Volunteers in International Service); Volunteers in International Service); -- the World Bank through projects like STI project, Uganda the World Bank through projects like STI project, Uganda HIV/AIDS Control Project, and LGDP. HIV/AIDS Control Project, and LGDP.

Above donors- funded various components of the HIV/AIDS National Above donors- funded various components of the HIV/AIDS National strategic Framework at district level and the Local Government sector strategic Framework at district level and the Local Government sector Strategic Plan, complementing Government efforts.Strategic Plan, complementing Government efforts.

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The LG AIDS Response – ProgressThe LG AIDS Response – Progress

So many successes registered in So many successes registered in the various aspects of the AIDS the various aspects of the AIDS response at LG levelresponse at LG level

However, focus here is on the However, focus here is on the Coordination and Management Coordination and Management aspect of the AIDS response at aspect of the AIDS response at LG levelLG level

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Coordination and Management of the Coordination and Management of the LG HIV/AIDS Response – Progress (1)LG HIV/AIDS Response – Progress (1)

Establishment of Coordination structures and PartnershipsEstablishment of Coordination structures and Partnerships AIDS Coordination structures established at District, sub-AIDS Coordination structures established at District, sub-

county level and in the Municipalities in 80 Districts in line county level and in the Municipalities in 80 Districts in line with the Partnership principleswith the Partnership principles–UAC, USAID, Irish Aid, –UAC, USAID, Irish Aid, World Bank supportWorld Bank support

CSO District Umbrella bodies established in over 45 CSO District Umbrella bodies established in over 45 districtsdistricts

PHA District Networks and Forums established in over 70 PHA District Networks and Forums established in over 70 DistrictsDistricts

Annual Dialogue at LG levelAnnual Dialogue at LG level Initiation of Annual District AIDS Forums at Local Initiation of Annual District AIDS Forums at Local

Government level since 2008 and facilitation of their Government level since 2008 and facilitation of their implementation implementation –Irish Aid support–Irish Aid support

Coordination and Management of the Coordination and Management of the LG HIV/AIDS Response – Progress (1)LG HIV/AIDS Response – Progress (1)Improving capacity of Office of the AIDS Focal Improving capacity of Office of the AIDS Focal

PersonPerson Improved capacity of the Local HIV/AIDS Improved capacity of the Local HIV/AIDS

Coordination office as a result of provision of Coordination office as a result of provision of computers and accessories to District AIDS computers and accessories to District AIDS Focal offices & Urban Local Coordination offices; Focal offices & Urban Local Coordination offices; as well as provision of monthly communication as well as provision of monthly communication and transport facilitation towards coordination and transport facilitation towards coordination in the Local Governments in the Local Governments –Irish Aid and World –Irish Aid and World Bank supportBank support

Inter- district and Municipal Learning and Sharing Inter- district and Municipal Learning and Sharing VisitsVisits

Improving learning and sharing between Local Improving learning and sharing between Local Governments, through inter-district and Governments, through inter-district and municipal visits - municipal visits - Irish Aid supportIrish Aid support

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Coordination and Management of the Coordination and Management of the LG HIV/AIDS Response – Progress ( 2)LG HIV/AIDS Response – Progress ( 2)Regional Dialogue between LGs and the CentreRegional Dialogue between LGs and the Centre Building a closer relationship with Local Governments, as Building a closer relationship with Local Governments, as

a result of regular interaction with them through such a result of regular interaction with them through such forums as the regional dialogue of the DR SCE - forums as the regional dialogue of the DR SCE - Irish Aid Irish Aid supportsupport

Documentation of Good HIV/AIDS Coordination PracticesDocumentation of Good HIV/AIDS Coordination Practices Documentation of good HIV/AIDS Coordination practices Documentation of good HIV/AIDS Coordination practices

to promote wider learning between Local Governments - to promote wider learning between Local Governments - Irish Aid supportIrish Aid support

Multi-sectoral PlanningMulti-sectoral Planning Improved multisectoral planning and mainstreaming of Improved multisectoral planning and mainstreaming of

HIV/AIDS in Local Governments through development of HIV/AIDS in Local Governments through development of guide for HIV/AIDS Strategic Planning in Local guide for HIV/AIDS Strategic Planning in Local Governments and facilitating development of district Governments and facilitating development of district HIV/AIDS Strategic Plans in 58 districts-HIV/AIDS Strategic Plans in 58 districts-–Irish Aid and –Irish Aid and World Bank supportWorld Bank support

Coordination and Management of the Coordination and Management of the LG HIV/AIDS Response – Progress ( 2)LG HIV/AIDS Response – Progress ( 2)BudgetingBudgeting Resources budgeting and allocation to HIV/AIDS Resources budgeting and allocation to HIV/AIDS

Coordination by sectors in some LGsCoordination by sectors in some LGs Some LGs through own initiatives attracted/ Some LGs through own initiatives attracted/

lobbied and obtained donor funding – by lobbied and obtained donor funding – by committed and pro-active Leadershipcommitted and pro-active Leadership

Budget lines introducedBudget lines introduced

LG MappingLG Mapping Local Governments facilitated to develop own Local Governments facilitated to develop own

local referral inventories of AIDS services in local referral inventories of AIDS services in their localities - their localities - UAC and Irish Aid support UAC and Irish Aid support

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Coordination and Management of the Coordination and Management of the LG HIV/AIDS Response – Progress ( 3)LG HIV/AIDS Response – Progress ( 3)

Monitoring and EvaluationMonitoring and Evaluation Standard M&E AIDS Data Collection Tools developed for capturing Data in LGsStandard M&E AIDS Data Collection Tools developed for capturing Data in LGs

– – UAC & USAID supportUAC & USAID support M &E HIV/AIDS Indicator Database for LGs developed M &E HIV/AIDS Indicator Database for LGs developed – UAC & USAID support– UAC & USAID support Joint Monitoring of Local Governments in Some districtsJoint Monitoring of Local Governments in Some districts HIV/AIDS coordination - an assessment area in the LG annual assessmentHIV/AIDS coordination - an assessment area in the LG annual assessment Some LGs undertaken Lot-Quality Assurance Sampling ( LQAS) studies in their LGs Some LGs undertaken Lot-Quality Assurance Sampling ( LQAS) studies in their LGs

( these have assisted in obtaining baseline data and also traking progress on ( these have assisted in obtaining baseline data and also traking progress on achieving targets achieving targets – World Bank and USAID Support– World Bank and USAID Support

Community EmpowermentCommunity Empowerment A lot of community mobilization, empowerment, capacity building and A lot of community mobilization, empowerment, capacity building and

sensitization between 2000-2006 sensitization between 2000-2006 – – with support of the World Bankwith support of the World Bank

National Facilitation TeamNational Facilitation Team Establishment of a National HIV/AIDS Facilitation team, charged with mentoring, Establishment of a National HIV/AIDS Facilitation team, charged with mentoring,

capacity building, technical facilitation, monitoring and support supervision of capacity building, technical facilitation, monitoring and support supervision of Local Governments - Local Governments - Irish Aid supportIrish Aid support

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Coordination and Management of the LG Coordination and Management of the LG HIV/AIDS Response – Challenges (1)HIV/AIDS Response – Challenges (1)

HIV/AIDS Coordination and ManagementHIV/AIDS Coordination and Management

AIDS Coordination structuresAIDS Coordination structures Limited implementation by the district AIDS Coordination Limited implementation by the district AIDS Coordination

structures of their stipulated functions. Despite the nationwide structures of their stipulated functions. Despite the nationwide induction, the structures, and particularly the Political/Policy induction, the structures, and particularly the Political/Policy remain not effectively- blame on the absence of facilitation to remain not effectively- blame on the absence of facilitation to perform stipulated rolesperform stipulated roles

Interaction between the District AIDS Focal Person and UACInteraction between the District AIDS Focal Person and UAC Limited deliberate interaction between the District AIDS Focal Limited deliberate interaction between the District AIDS Focal

Person and UAC, which officer is “supposedly the link between Person and UAC, which officer is “supposedly the link between UAC and the districts as per the district HIV/AIDS Coordination UAC and the districts as per the district HIV/AIDS Coordination guidelines” undermines their ability to spearhead the AIDS guidelines” undermines their ability to spearhead the AIDS agenda at district level, as majority of them remain with limited agenda at district level, as majority of them remain with limited capacity and knowledge on critical prevailing and emerging capacity and knowledge on critical prevailing and emerging AIDS aspects concerning both the National and district levelAIDS aspects concerning both the National and district level

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Planning, budgeting & mainstreaming of HIV/AIDS in LGsPlanning, budgeting & mainstreaming of HIV/AIDS in LGsDistrict Budget allocations and Releases: District Budget allocations and Releases: Districts budget allocations in most cases are not realized. Districts budget allocations in most cases are not realized.

Funds budgeted for are rarely released for implementation of Funds budgeted for are rarely released for implementation of planned and budget activities. In addition allocations for planned and budget activities. In addition allocations for HIV/AIDS coordination activities are still very limited. Districts HIV/AIDS coordination activities are still very limited. Districts still look at HIV/AIDS as “a should-be donor-driven intervention”.still look at HIV/AIDS as “a should-be donor-driven intervention”.

District HIV/AIDS Strategic PlanningDistrict HIV/AIDS Strategic Planning Lack HIV/AIDS Strategic Plans in esp the new districts.Lack HIV/AIDS Strategic Plans in esp the new districts. Expired plans for those based on the last National HIV/AIDS Expired plans for those based on the last National HIV/AIDS

Strategic Framework. Strategic Framework. -- This impacts on effective planning and mainstreaming of This impacts on effective planning and mainstreaming of

HIV/AIDS and reviewing performance in the face of a HIV/AIDS and reviewing performance in the face of a changed environment. changed environment. -- Creation of new districts - require such critical guiding Creation of new districts - require such critical guiding frameworks to facilitate their own local responses.frameworks to facilitate their own local responses.

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Advocacy for HIV/AIDS in Local GovernmentsAdvocacy for HIV/AIDS in Local Governments

District-specific HIV/AIDS advocacy strategiesDistrict-specific HIV/AIDS advocacy strategies Lack of district-specific advocacy strategies - hampers leadership ability Lack of district-specific advocacy strategies - hampers leadership ability

to promote critical HIV/AIDS services and issues. Mainstreaming of to promote critical HIV/AIDS services and issues. Mainstreaming of HIV/AIDS in districts’ development activities is also affected. HIV/AIDS in districts’ development activities is also affected. -- Partly contributed to by lack of a national advocacy strategy Partly contributed to by lack of a national advocacy strategy which which should have been the reference point and also guide for all the should have been the reference point and also guide for all the

country’s advocacy effortscountry’s advocacy efforts-- Districts too have not been availed the opportunity to have own Districts too have not been availed the opportunity to have own

advocacy strategies to aid even simple advocacy efforts at this advocacy strategies to aid even simple advocacy efforts at this levellevel

Data Management, Monitoring & Evaluation SystemData Management, Monitoring & Evaluation System

District-level data collection format and centralized data District-level data collection format and centralized data management systemmanagement system

Non-implementation of the institutionalized standard data collection Non-implementation of the institutionalized standard data collection format and centralized data management system for HIV/AIDS in the format and centralized data management system for HIV/AIDS in the districts - constraining effective data collection, sharing and districts - constraining effective data collection, sharing and subsequently poor planning for HIV/AIDS interventions.subsequently poor planning for HIV/AIDS interventions.

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Streamlining and Coordination of the Decentralized Response Streamlining and Coordination of the Decentralized Response

Capacity of the Central level Decentralized Response institutions Capacity of the Central level Decentralized Response institutions Limited facilitation of the DR SCE to manage the Decentralized Response yet Limited facilitation of the DR SCE to manage the Decentralized Response yet

its activities involve frequent interaction with Local Governments in terms of its activities involve frequent interaction with Local Governments in terms of technical support to programme activity implementation, dialogue with Local technical support to programme activity implementation, dialogue with Local Governments, capacity building and mentoring, as well as support Governments, capacity building and mentoring, as well as support supervision and monitoring. supervision and monitoring.

Transport, communication facilities, as well as a budget line for the Transport, communication facilities, as well as a budget line for the operations of the National HIV/AIDS Facilitation Teamoperations of the National HIV/AIDS Facilitation Team

Social Infrastructure DevelopmentSocial Infrastructure Development Weaknesses in social Infrastructure to mobilize communities and undertake Weaknesses in social Infrastructure to mobilize communities and undertake

actual service provision. Networks of PHAs, Post-Test Clubs, women, men, actual service provision. Networks of PHAs, Post-Test Clubs, women, men, youth and other groups need to be strengthened, empowered to strengthen youth and other groups need to be strengthened, empowered to strengthen their involvement in the AIDS response at community level.their involvement in the AIDS response at community level.

Resources Mobilization and ManagementResources Mobilization and Management Mobilization and Management of HIV/AIDS resources in LGs is largely affected Mobilization and Management of HIV/AIDS resources in LGs is largely affected

by lack of costed HIV/AIDS strategic plans, the lack of resources mobilization by lack of costed HIV/AIDS strategic plans, the lack of resources mobilization strategies, as well as poor resources tracking system at this levelstrategies, as well as poor resources tracking system at this level

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Coordination and Management of the LG Coordination and Management of the LG HIV/AIDS Response – Lessons Learned (1)HIV/AIDS Response – Lessons Learned (1)

Strong coordination is seen to facilitate active Strong coordination is seen to facilitate active involvement of various categories of involvement of various categories of stakeholders in the AIDS response at LG Level. stakeholders in the AIDS response at LG Level.

There is evidence of increased leadership There is evidence of increased leadership involvement especially at sub-county level, involvement especially at sub-county level, following the induction of AIDS Taskforces and following the induction of AIDS Taskforces and Committees at district and sub-county level. Committees at district and sub-county level. PHA involvement has also improvedPHA involvement has also improved

Involvement of PHAs in the coordination role in Involvement of PHAs in the coordination role in LGs enables faster action in addressing PHA LGs enables faster action in addressing PHA needs by district leadership needs by district leadership

Districts have embraced the Annual AIDS Districts have embraced the Annual AIDS partnership approach to HIV and AIDS partnership approach to HIV and AIDS coordination in the districts. It has been coordination in the districts. It has been reported as the beginning of bringing together reported as the beginning of bringing together all AIDS actors in the LGall AIDS actors in the LG


A good number of LGs are allocating an amount A good number of LGs are allocating an amount of money towards HIV/AIDS Coordination in their of money towards HIV/AIDS Coordination in their budgets, and also mainstreamed HIV/AIDS in budgets, and also mainstreamed HIV/AIDS in some sectors – following issuance some sectors – following issuance mainstreaming guidelines to them, as well as mainstreaming guidelines to them, as well as MoFPED directive on a 10%b allocation of funds MoFPED directive on a 10%b allocation of funds by districts.by districts.

The absence of advocacy strategies at district The absence of advocacy strategies at district level has resulted into adhoc, piecemeal, and level has resulted into adhoc, piecemeal, and disjointed efforts in responding to HIV/AIDS and disjointed efforts in responding to HIV/AIDS and this therefore impacts on Local Governments’ this therefore impacts on Local Governments’ attitudes, especially the leadership to the attitudes, especially the leadership to the epidemic, many of who still do not yet epidemic, many of who still do not yet appreciate HIV/AIDS as a serious development appreciate HIV/AIDS as a serious development issue. This in return impacts on the issue. This in return impacts on the mainstreaming, budget allocations, and service mainstreaming, budget allocations, and service delivery at Local Government level-increase in delivery at Local Government level-increase in dialoguedialogue

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Mapping of HIV/AIDS interventions by districts facilitates building Mapping of HIV/AIDS interventions by districts facilitates building of resident capacity, and generation of data for reference on of resident capacity, and generation of data for reference on service provision, guides planning, monitoring of HIV/AIDS service provision, guides planning, monitoring of HIV/AIDS activities, guiding resources allocation and facilitates easier activities, guiding resources allocation and facilitates easier information sharing within the districts. This should be information sharing within the districts. This should be institutionalized so that it can be done regularly by Local institutionalized so that it can be done regularly by Local Governments. Governments.

The involvement of LGs in the management of HIV/AIDS The involvement of LGs in the management of HIV/AIDS resources and programmes, builds their capacity, interest, and resources and programmes, builds their capacity, interest, and ownership of the response. With their capacities built and ownership of the response. With their capacities built and interest vested in the response, LGs are in position to take the interest vested in the response, LGs are in position to take the response forward even when external resources wane.response forward even when external resources wane.

In light of the large expanse of LGs, the National Technical In light of the large expanse of LGs, the National Technical Facilitation Team has proved a very beneficial approach to Facilitation Team has proved a very beneficial approach to providing technical support to LGs. Several activities can be providing technical support to LGs. Several activities can be implemented at ago with the use of this team, making it implemented at ago with the use of this team, making it possible to produce many outputs in a short time.possible to produce many outputs in a short time.

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In-district interactions can create greater In-district interactions can create greater impact, build targeted capacity and also impact, build targeted capacity and also enhance ownership of a problem. This can be enhance ownership of a problem. This can be seen from such interventions as the Annual seen from such interventions as the Annual District AIDS Forums, which have been District AIDS Forums, which have been embraced by LGs as very innovative and useful embraced by LGs as very innovative and useful fora which provide a unique opportunity for fora which provide a unique opportunity for districts to meet as an entity, dialogue, plan and districts to meet as an entity, dialogue, plan and review performance jointly at a limited cost.review performance jointly at a limited cost.

LGs currently face a big resources gap, LGs currently face a big resources gap, particularly for the management of the AIDS particularly for the management of the AIDS response in their localities as well as response in their localities as well as mobilization of communities for service delivery mobilization of communities for service delivery and uptake.and uptake.

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Coordination and Management of the LG HIV/AIDS Coordination and Management of the LG HIV/AIDS Response – Which Way to Go? (1)Response – Which Way to Go? (1)

Strengthening coordination structures and partnerships at all LG levelsStrengthening coordination structures and partnerships at all LG levels

Facilitating the stipulated HIV/AIDS Coordination functions:Facilitating the stipulated HIV/AIDS Coordination functions: A unanimous A unanimous call for the Central government to provide conditional grants to the DLG for call for the Central government to provide conditional grants to the DLG for HIV and AIDS Coordination activities, so as to boost government’s watch dog HIV and AIDS Coordination activities, so as to boost government’s watch dog role in the AIDS responserole in the AIDS response

Emphasize the building of capacities and involvement of the Political/policy Emphasize the building of capacities and involvement of the Political/policy body as the body responsible for decision making in the districtbody as the body responsible for decision making in the district

In all Districts, establish District level Networks of PHAs, CSOs and FBOsIn all Districts, establish District level Networks of PHAs, CSOs and FBOs Attention to sub-county and lower levels AIDS Coordination structures to Attention to sub-county and lower levels AIDS Coordination structures to

boost the link between the district and the communitiesboost the link between the district and the communities Strength Public-Private Partnerships in delivery of HIV/AIDSStrength Public-Private Partnerships in delivery of HIV/AIDS

Office of the District AIDS Focal Person :Office of the District AIDS Focal Person : Issue clear and standard ToRs and procedure of appointment of District AIDS Issue clear and standard ToRs and procedure of appointment of District AIDS

Focal Persons, as a gateway to strengthening HIV/AIDS coordination in Local Focal Persons, as a gateway to strengthening HIV/AIDS coordination in Local GovernmentsGovernments

Strengthen link between the district and urban LGs to facilitate ease of Strengthen link between the district and urban LGs to facilitate ease of sharing available resources, as well as flow of information in a District LGsharing available resources, as well as flow of information in a District LG

Urban LG HIV/AIDS Coordination structures also require critical attention.Urban LG HIV/AIDS Coordination structures also require critical attention. Provide more support beyond that provided by the AMICAALL programme to Provide more support beyond that provided by the AMICAALL programme to

ensure a more comprehensive response in these Local Governmentsensure a more comprehensive response in these Local Governments

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Coordination and Management of the LG HIV/AIDS Coordination and Management of the LG HIV/AIDS Response – Which Way to Go? ( 2)Response – Which Way to Go? ( 2)

Monitoring the HIV/AIDS Response in Local Governments:Monitoring the HIV/AIDS Response in Local Governments: Emphasize joint monitoring for the public private partnership approach. Emphasize joint monitoring for the public private partnership approach. Strengthen and establish trust with CSOs and PLHIV organizations to ensure Strengthen and establish trust with CSOs and PLHIV organizations to ensure

adequate information sharing, joint monitoring and evaluation and adequate information sharing, joint monitoring and evaluation and harmonization for interventions to avoid duplication and wastage of harmonization for interventions to avoid duplication and wastage of resources. resources.

Regularly update District, and AIDS service organization directoriesRegularly update District, and AIDS service organization directories District proactively perform its monitoring role of the existing NGOs and their District proactively perform its monitoring role of the existing NGOs and their

areas of operation and interventions on HIV and AIDS.areas of operation and interventions on HIV and AIDS.

District Budget allocations and Releases:District Budget allocations and Releases: Districts need tougher assessment and monitoring to ensure greater Districts need tougher assessment and monitoring to ensure greater

allocation and the actual use of funds for the planned HIV/AIDS coordination allocation and the actual use of funds for the planned HIV/AIDS coordination interventions interventions

Equip all Districts without HIV/AIDS Strategic Plans and support the review of Equip all Districts without HIV/AIDS Strategic Plans and support the review of those that have expired to align to the changed situation and the current those that have expired to align to the changed situation and the current National HIV/AIDS Strategic plan National HIV/AIDS Strategic plan

Advocacy and resources mobilization:Advocacy and resources mobilization: Support Districts to develop own advocacy strategies to boost their ability to Support Districts to develop own advocacy strategies to boost their ability to

lobby, mainstream HIV/AIDS and also resource HIV/AIDS resourceslobby, mainstream HIV/AIDS and also resource HIV/AIDS resources

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Coordination and Management of the LG HIV/AIDS Coordination and Management of the LG HIV/AIDS Response – Which Way to Go? ( 3)Response – Which Way to Go? ( 3)

Collection, Analysis and use of Collection, Analysis and use of accurate data for planning local HIV/AIDS interventions accurate data for planning local HIV/AIDS interventions Institutionalize data capture, management and sharing in LGs, with central Institutionalize data capture, management and sharing in LGs, with central

data/information management units established , preferably strengthen the data/information management units established , preferably strengthen the HIV/AIDS Focal Point Office to play this role.HIV/AIDS Focal Point Office to play this role.

Induct all relevant sectors and District stakeholders on the standard data Induct all relevant sectors and District stakeholders on the standard data collection format, and indicators of performance at district level to ease data collection format, and indicators of performance at district level to ease data collection, sharing and reportingcollection, sharing and reporting

There is need for a sustainable training strategy which will professionalize There is need for a sustainable training strategy which will professionalize M&E through involvement of National Institutions of Higher Learning as one of M&E through involvement of National Institutions of Higher Learning as one of the outcome of the National Capacity development strategy.the outcome of the National Capacity development strategy.

Role of the DR SCE, MOLG, and Associated Institutions (ULGA, AMICAALL, Role of the DR SCE, MOLG, and Associated Institutions (ULGA, AMICAALL, UNASO, NAFOPHANU, IRCU ) UNASO, NAFOPHANU, IRCU )

Strengthen the monitoring and support supervision of LGs, to ensure that Strengthen the monitoring and support supervision of LGs, to ensure that planned activities are implemented and in line with set guidelinesplanned activities are implemented and in line with set guidelines

More facilitation is required for especially MoLG, UAC, AMICAALL, ULGA, UAAU, More facilitation is required for especially MoLG, UAC, AMICAALL, ULGA, UAAU, UNASO, and NAFOPHANU in terms of transport to effectively monitor Local UNASO, and NAFOPHANU in terms of transport to effectively monitor Local Government performance. ULGA as the secretariat to the DR SCE should also Government performance. ULGA as the secretariat to the DR SCE should also be equipped well enough to enable in effectively perform its rolebe equipped well enough to enable in effectively perform its role

The National Technical facilitation team’s method of work requires further The National Technical facilitation team’s method of work requires further streamlining, especially in terms of regular interactions, to share experiences, streamlining, especially in terms of regular interactions, to share experiences, review performance and capacity building of the teamreview performance and capacity building of the team

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ConclusionConclusion The sustainability of the response to the HIV/AIDS The sustainability of the response to the HIV/AIDS

epidemic requires the involvement of Local epidemic requires the involvement of Local Governments because they are closer to the local Governments because they are closer to the local communities where service delivery takes place communities where service delivery takes place and, therefore, are best suited to manage HIV and, therefore, are best suited to manage HIV prevention, care, social support services, as well as prevention, care, social support services, as well as capacity building and monitoring of HIV/AIDS capacity building and monitoring of HIV/AIDS activities. activities.

Need to therefore equip/ build the capacities of Need to therefore equip/ build the capacities of institutions at this level, to match the demands at institutions at this level, to match the demands at the levelthe level

This should be matched with the necessary Policy, This should be matched with the necessary Policy, technical and monitoring guidance from the technical and monitoring guidance from the National levelNational level

ConclusionConclusion

Rallying PointsRallying Points One coordination body-District One coordination body-District

councilcouncil One planning framework-District One planning framework-District

Development Plan linked to NDPDevelopment Plan linked to NDP One M&E framework- District basedOne M&E framework- District based Harmonized financing frameworkHarmonized financing framework

2525

2626

District AIDS TaskforceChair: District Chairperson Secretary: CAO Membership: max 23; District executive, RDC, Speaker, reps of CSOs, PHAs, FBOsMeets: At-least twice annually

District AIDS CommitteeChair: CAOSecretary: District AIDS Focal PersonMembership: max 23; heads of departments, reps of CSOs, PHAs, FBOsMeets: At-least Quarterly

SC AIDS TaskforceChair: Sub-county ChairpersonSecretary: Sub-county chief Membership: max 15; SC executive, speaker, reps of CSOs, PHAs, FBOsMeets: At-least twice annually

Sub-county Level SC AIDS CommitteeChair: Sub-county ChiefMembership: max 15; heads of sub-county departments, reps of CSOs, PHAs, FBOsMeets: At-least twice annually

Parish AIDS TaskforceChair: Parish ChairpersonSecretary : Parish ChiefPolitical and administrative arm combined.Membership: max 15; Parish executive, representatives of PDC, CBOs, PHAs, FBOsMeets: At-least twice annually

District HIV/AIDS Coordination StructuresDistrict HIV/AIDS Coordination Structures

Village AIDS TaskforceChair: Village ChairpersonMembership: max 15; Village executive, representatives of VDC, CSOs, PHAs, FBOsMeets: At-least twice annually

District Level

Parish Level

Village Level

2727

AIDS PARTNERSHIP FORUMAIDS PARTNERSHIP FORUM

Structure of the Uganda AIDS Partnership

4 Permanent Representatives4 Permanent Representativesand Representatives from all SCEsand Representatives from all SCEs

MINISTRIESOF GOV’T

UN & Bilaterals

Research, Academia

& Science

Decentralized Response

PHA Networks

FaithBased

Organizations

PrivateSector

InternationalNGOs

NationalNGOs

Youth

SELF COORDINATING ENTITIESSELF COORDINATING ENTITIES

Uganda AIDS CommissionUganda AIDS Commission& Secretariat& Secretariat

THE HIV/AIDS PARTNERSHIP THE HIV/AIDS PARTNERSHIP COMMITTEECOMMITTEE

Media

the decentralized response to hiv/aids in uganda : progress, challenges and lessons learned patrick....

Documents

hivaids response

family level

impact of hivaids

aids challenges

decentralization framework

decentralization policy

community levels

rural areas moh