Friday, October 31, 2014

Article 25: Global Day of Action

By Orrin Tiberi, Global Health Corps Fellow

Though not a holiday anywhere, October 25 has been enshrined by the United Nations as the Article 25 Global Day of Action to promote health as a human right.  More than 65 countries celebrated with rallies, marches, health promotion, and advocacy.  Julius and I were lucky enough to help coordinate and participate in an Article 25 event on Kaaza and Serinyabi Islands in Lake Victoria both to gather signatures requesting better health access and to provide basic health services on the islands. Uganda Development and Health Associates, a public health NGO based in Iganga that provides periodic health services on the islands, orchestrated the event and funded much of our time there.

Article 25 is just one of the 30 articles that comes to us from the United Nations Declaration of Human Rights.  It states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

The basis of the Day of Action is to confront the inequities and injustices in global health and foster the movement for health equity that has been gathering momentum around the globe. Because many of the issues with health are man-made, there should also be human-centered solutions to the same problems.  For more information on the aims of their program you can check out their website here.

Uganda Village Project was able to donate two boxes of condoms to the events on Kaaza and Serinyabi islands, providing access to condoms for more than 600 individuals.  This is extremely important in an area where there is very little health access and the nearest clinic is a forty-five minute boat ride away - a ride that can cost up to 40,000 shillings for emergency trips.  For fisher folk who live on the islands that cost is prohibitively expensive, and because of the physical and financial barriers to health services the fishing islands of Lake Victoria have some of the highest rates of maternal mortality in Uganda.  Being so isolated from services, they also have very high rates of HIV, TB, and other preventable diseases that regular check-ups can diagnosis and provide treatment for. 

Regular access to antiretroviral therapy (ART) is also a problem for many of the islanders that have HIV.  The district officials come once a month to distribute the therapy, but the dates of each visit is not a consistent 30 days, and they only hand out a months supply each time.  This leaves all HIV+ individuals missing 5 to 10 days of their treatment each month, which may have profound impacts on the future of HIV treatment on the islands.  With each cycle of non-adherence the islanders are allowing the HIV in their body to adapt to the current regime they are given and become drug-resistant.  If the HIV is then spread to a new individual it means that they will have to be on a completely different set of ARTs for the desired effects, which usually means a more costly treatment.  By building a health center in a more proximal location it would allow the medications to arrive on a consistent basis, and keep a budding problem from emerging any further.

Though a collaboration of Uganda Development and Health Associates, Mercy Clinic, Uganda Village Project and Global Health Corps (the organization that is sponsoring both Julius and I), we were able to test and counsel more than 350 people for HIV, provide ANC for expectant mothers, give immunizations to newborns, and have a great time getting to know the community and their lives.  In addition to the health services provided, we gathered more than 1,600 signatures to request a health center be built in closer proximity to the island communities.  Our days on the island were but a jumpstart to the momentum that needs to be built to motivate the local government to construct and fund a health center.  It will not be an easy process, as the government of Uganda is already underfunded and over stretched, but it can be done.  With the passionate voices and stories of all the amazing individuals we came to know in our short time on the islands, and in the Uganda in general, I have high hopes of a future for Uganda that includes the voices of such populations in determining healthcare choices and access.

Tuesday, October 28, 2014

Creating High-quality Goals and Objectives

Written by: Julius Kirya, Global Health Corps Fellow 2014-2015

Many projects’ successes are measured based on the degree to which the different deliverables meet the set goals and objectives. Exaggerating while setting organization/ project goals is irrational because it results in setting ambiguous targets which in turn leads to a perceived failure of programs/projects. Orrin and I have spent the past one and a half months focusing and brainstorming how to revise Uganda Village Project (UVP)’s goals and objectives for the next 5 years, as we measure their impact of programs that have been under implementation since 2009.

Communication is key when designing program objectives. We needed to involve many stakeholders before and during the entire process of setting objectives. These include funders, program coordinators, supervisors, implementers, politicians, partners, and beneficiaries. Without their immense support, many programs are bound to fail. We’ve worked extremely hard over the past month and half, moving to the district headquarters for inquiries, writing to funders, getting taskforce feedback, meeting with program supervisors, getting verbal consultations from program coordinators and reading beneficiary reports to craft our objectives.

In any monitoring and evaluation effort (see Orrin’s post for more information about monitoring and evaluation) an M&E plan needs to be drafted prior to implementation. The most effective tool in m & e is the logical framework, commonly known as the “log frame”. This matrix displays by row the major stages in the projects life, emanating from resources, activities, outputs, outcomes and impacts all in pursuit to measure the program, goals and objectives; the column addresses objectively verifiable indicators, means of verification, assumptions/risks for the row entries.
This framework is key in assessing loopholes in the set objectives and goals, because it displays the entire project at a glance on a page. We use it to make sure that all objectives can be objectively measured and verified. For a couple of weeks now, Orrin and I have tirelessly been working on the log frames for UVP’s various programs. We thank the Uganda Village Project staff and Board members for their continued support to ensure that we successfully play our role.

Tuesday, October 14, 2014

Research in the Morning, Research in the Evening, Research at Supper Time!

By Orrin Tiberi

Hello again!  Once again this is your M&E specialist writing to you from the lovely Iganga, Uganda!  Rainy season has officially started with a bang, or an appropriate boom of thunder, and I think it is a great improvement on the relentless sun that usually beats down on the UVP compound.  The afternoon storms do seem to kick off the power for all of Iganga north of the main street, but a few hours spent in pitch-black reflection are not bad.  I have gotten use to the sun setting and rising at the same time, and am still enjoying exploring the red dirt roads that branch out in every direction from the town center.  All of this comes at an important time for both Julius and myself - we have officially been Global Health Corps fellows for 3 months, or ¼ of the total time we will be here.  Scary but exciting!

As you may have guessed, we have been concentrating for the past month on getting a research proposal up, running, and submitted.  We finally were able to send in the documents, all 8 of them, to The AIDS Support Organization’s Internal Review Committee, or the TASO IRC.  IRC approval is needed for our research project, which hopefully will be starting early January, as we will be working with human subjects and also looking to publish.   The research project, entitled The Evaluation of the Impact of Uganda Village Project in the Iganga District, is an approximately 100-question survey that will be conducted in the graduated, current, and future Healthy Villages.  We hope to be able to compare villages that have received the Healthy Villages program with those that have not to compare health outcomes. Lets back up to IRC approval and see why this is necessary for UVP.

Circa 1932 there was a researcher than wanted to know the effects of syphilis on the human body.  At the time penicillin has not been approved for human use, so there was no cure for most of the bacterial infections, like syphilis, we are able to treat so effectively today.  The research team was based in Tuskegee, Alabama, and they were able to find a rural population nearby that already had high levels of syphilis and were willing to participate in the study for the monetary and perceived health benefits.  Though not 100% ethical (they never told the participants that they had syphilis), there was definitely a need at the time to understand the course of the disease on the human body.  In the 1940s, however, when penicillin was validated for curing syphilis the ethical position of the research team became clear.  The study team decided to withhold the treatment to finish up their research project for an undetermined amount of time.  The study continued for thirty more years, until in 1972 when the story became a huge scandal for the blatant disregard for human suffering.  The idea of IRC, or IRB, approval was born from this episode, now known as the Tuskegee Syphilis Experiment.

Today, in order to conduct any kind of research with human subjects the research team needs to be able to provide evidence that they will not be harming the participants in any way.  Beyond the physical harm of potential participants, IRB also mandates that the research team proves that they will not be collecting any data that could potential be harmful to the participants, or de-identifying the data sufficiently that it cannot be traced to the original participant.  This clause is extremely relevant to Uganda Village Project as many of the questions on our survey ask about health status and sexual history.  In our IRC proposal, we had to explain the process of protecting participants from any information leakage that could result in their detriment.  For example, one question is about sexual activity.  If an unmarried 18 year old responds positively and the mother comes across the study, there could be problems.  Another question asks about current health problems such as HIV or cancer.  A family finding out a relative is HIV positive through a survey is not appropriate and could put that family member in real danger from their families’ reaction.  UVP’s solution to these issues is to destroy the location information directly after the survey is validate and check for completeness.  We will also be storing the paper copies in a secure location on the compound.

The main objective of the research project, as you may have guessed, is to evaluate the effectiveness of the Healthy Villages program and looks for bright spots in the Healthy Villages. Bright spots are villages or people that have excelled in any section of the program, and appropriately are the areas that we will be concentrating on in our focus groups to see the driver of such positive change. Hopefully we will find some that can be replicated in other villages with not as good performance. Besides evaluation, the Uganda Village Project also hopes to be able to publish academic manuscripts from the research project.  This is another of the IRC oversights and we will be working directly with the board as we write publications.  As I said in my last post, it is going to be a busy, and exciting, year!

Orrin is one of Uganda Village Project's Global Health Corps Fellows this year. You can find him on Twitter @otiber or on Instagram @ofteted. Any questions or comments you may have can be directed to his email