An insider's perspective

Kait Maloney has been UVP's Managing Director since January 2013. As her contract with UVP ends, she's moving to an M&E position with IntraHealth in Kampala, Uganda. She shared how she's seen UVP grow in the past few years and what makes us successful.

For the past two and a half years, I have had the privilege to work with UVP in Iganga. I came to UVP in January 2013 on a one-way ticket not really knowing what I was getting myself into. Would I like living in small town Iganga? Would be contributions be significant as a young, white female that had never been to Uganda? Would I ever learn my way around the twisting roads with no street signs? 

The learning curve was steep, but I persevered, truly believing in our mission and approach to community-based work. I have witnessed the challenges -- power outages, washed out roads, resistant community members, and bureaucracy -- and the successes of grassroots public health work and I would like to share three key things that I believe make UVP successful in our mission.  

First, UVP partners with villages for a three-year program (read more in the article below!) implementing a wide range of health programs including malaria, HIV, reproductive health, fistula, hygiene and sanitation, and clean water. As we all know, change does not happen overnight and health behavior change is especially hard to see in a short time. UVP staff is committed to working with the community members over these three years to show how better health can improve their family's and community's lives, and supporting them to work with the government for sustainability purposes.

Second, UVP has a staff of four dedicated Ugandan program managers who run the show. They understand the culture, speak the local language, and care deeply for the people of Iganga. Each staff member works tirelessly to ensure the communities are well served. 

Third, we focus on partnerships and work very closely with the government structures: health facilities and district offices. This is challenging, but essential to build capacity within the government system to ensure communities can seek out and receive the services they want when UVP finishes work in a village. 

We've made a lot of progress in the past two and a half years. Just one example is the expansion of our fistula program. When I came to UVP, the Fistula Ambassador program was only an idea. Our staff had a great idea for increasing our reach, identifying more patients, and providing more support to patients pre- and post-surgery by training some of the fistula survivors who we'd brought for surgery to become Ambassadors in their communities. We applied for grants and in late 2013, we found out that we received UVP's first-ever large grant from the Fistula Foundation -- a huge accomplishment that meant we could implement the Fistula Ambassadors program as well as our usual fistula programming in 2014. Since then, the Ambassadors have gone above and beyond our expectations. They have reached thousands of people with messages about fistula prevention and treatment, formed partnerships with health centers, and identified almost 100 women with fistula who will soon be able to receive surgery.

Through my time with UVP, I've struggled through the challenges of community-based NGO work. I've collaborated with other staff members to find creative solutions to these challenges, and we have celebrated successes big and small. The Fistula Ambassadors work is just one example of how our long-term commitment, our amazing staff, and our focus on partnerships has helped us accomplish great things. I look forward to following the continued growth and success of UVP in the years to come. 

Graduation fairs: More than just a fun afternoon

Last week, Uganda Village Project’s graduation fairs brought community members together to celebrate the successes they've had over the three years we've worked with them. Beginning in the early morning, children camped out underneath the roof of the primary school and watched as we set up tents, connected speakers, and organized tables for the various health services that will be at the graduation fair. The men and women, dressed in their Sunday best, arrived in a steady stream as soon as the music started.

For two days last week, UVP staff worked with health center workers and small community organizations in two villages to test and counsel people

for HIV, test and treat community members for malaria, provide women with family planning services, immunize and deworm children, and perform drama shows highlighting how to prevent HIV. Loy wandered from tent to tent giving educational talks about preventing fistula. Maureen walked through the crowds to identify women who have attended family planning sessions in the past or who seemed interested in starting a new method. Titus and Patrick interrupted the music on occasion to greet the community and inform them of the services available. Orrin and Kait gave out vitamins to the kids, and Julius sold mosquito nets. The Village Health Teams (VHTs)

made sure everything ran smoothly and helped cook lunch for all of the workers and volunteers who attended. Kids ran to get their friends so they could all enjoy the sweet deworming pills (we mark their hands with an X after they get their first dose so they don’t keep coming back). To further engage the community, a children's brass brand walked from the center of the village to the fair, bringing another influx of people to participate in the health activities.

The graduation fairs have many purposes. They give us a chance to publicly recognize the hard work of the Village Health Team members who will continue to help improve their community. They provide health services that people in the village don’t have access to and inform them where they can go to get similar services next time they need them. The fairs allow us to congratulate the community members on the progress on public health they’ve made throughout the three years UVP has worked with them. It is a great feeling to celebrate Kazigo A for increasing the percentage of households in their village with latrines from 69% to 100%, or to tell Kidaago B that over three years 554 people were tested for HIV in their community, or to announce in Namunkesu that 290 people bought malaria nets. These villages are different than they were three years ago, and we’re grateful to the community for what they've done to help 

make those changes. The fairs also offer a chance to reflect on what has happened in a village over three years. The early-arriving children and the women in their shiny dresses are now a community that knows the importance of taking care of their health, and their participation in the graduation fair shows they’ve received the message.




By: Leslie Stroud-Romero

The Next Four Months

By: Orrin Tiberi, Global Health Corps Fellow

Where did the last 8 months go? I keep asking myself that question each time I consider that Julius and I, the first Global Health Corps Fellows at UVP, only have four more months left with this great organization.  I suppose part of it went to continually following up with the Uganda National Council for research approval, and another part editing the goals and objectives, and probably another part to data collection.  When I look at each of the goals Julius and I have accomplished over the past 8 months I wonder how we had time to do them all, but looking at the time overall it has flown by.  I hear that is pretty standard though, and am content with our work and looking forward to the next four months.

As many of you know, Julius and I conducted an impact evaluation of the villages where UVP does the majority of their work.  The rest of April will be taken up by entering that data (approximately 5700 individuals were captured in the data), and also collecting more data from the villages we are graduating in May: Namunkesu, Kidaago A, Kidaago B, Kazigo A, and Kazigo B.  We will use the data from the graduation survey, as well as the data we just collected in the 5 year Healthy Villages Survey, in order to gauge the level of progress those villages have made in the past 3 years.  Their graduations are in mid-May, which will be just enough time to enter and analyze all the data.

Just a few weeks after the graduation fairs in June, Julius and I will be introducing the brand new summer 2015 interns to the M&E tools that we have created and the M&E framework of the organization. We hope to be able to provide guidance for the interns as they embark upon a life-changing summer out in the communities.  We have also created a survey tool for the new villages that the intern teams will be able to use to get a picture of the health of the village.  Julius and I are both excited to see the results of that comprehensive data collection!

Our contracts end in July, but before we go we will have the chance to work directly with our replacements from Global Health Corps.  This model, having two weeks together with the old fellows, helps facilitate institutional memory for the fellows and we hope will provide the new fellows with some great jump-off points!

It has been a great experience so far, and I know I can speak for Julius when I say we can’t wait for the many experiences we will have in the next four months!

Combatting Obstetric Fistula

By Julius Kirya, Uganda Village Project Global Health Corps Fellow

Obstetric fistula is one of the most devastating and serious of all childbirth injuries, yet it still remains one of the most neglected issues in women’s health and rights. There are also many misconceptions around fistula, particularly in more developed nations. One friend from china thought it was “one being dirty”, whereas an American colleague understood it as “abnormal connections between various parts of the body”.

    Obstetric fistula is a hole that forms between the bladder and the vagina or between the rectum and the vagina as a result of prolonged obstructed labor. The constant pressure during labor cuts off the blood supply to these tissues, causing the aforementioned hole, leaving urine and feces to leak continuously and uncontrollably through the vagina. In 90% of cases of obstetric fistula the baby dies.

Young, poor women living in rural areas account for most cases of obstetric fistula. These women are at high risk because they have limited power in making decisions that pertain to their reproductive health. Having children before the pelvis is fully developed, coupled with malnutrition, small stature, and generally poor health can all lead to obstructed labor.  Older women who have delivered many children are also at risk. 

If left untreated, fistula can lead to serious consequences such as frequent ulcerations and infections, kidney disease, and even death. Some women drink as little as possible to avoid leaking and become dehydrated. Damage to the nerves in the legs can leave some women unable to walk. Such medical consequences compound social and economic problems and ultimately contribute to a general decline in health and well-being. Misinformation and ignorance create stigma that often leads women with obstetric fistula to be ostracized from their homes or communities.

UVP has addressed this issue and significantly improved these women’s quality of life by organizing three fistula camps a year. This tireless effort has reached over 250 patients who have received fistula repairs, and seeks to reach all women identified with fistula within rural eastern Uganda. The program coordinator stays at the camp and provides support, counseling and guidance.  

UVP fistula program coordinator giving final instructions to patients before returning home after surgery

A fistula patient undergoing surgery

With funding from the Fistula Foundation, UVP supports the patients at the repair camp by providing food for them as well as their care-takers. After surgery, UVP transports the women back home  -which is crucial, because if they return home by motorcycle, bicycle, taxi or walk long distances they risk re-opening their healing fistula.

Patients after undergoing Surgery at Kamuli Mission Hospital, Uganda

In order to increase the probability of a patient completely healing, the Fistula Program Coordinator follows up with the women after the surgery to check on their healing and social integration as well as monitor for surgical complications. UVP also trains fistula survivors as Fistula Ambassadors who spread the word at the grass root community level, by mobilizing and conducting education sessions, a venture through which more patients are identified.

Fistula is a highly preventable medical condition and its prevalence is easily reducible. Making family planning available to all who want to use it would reduce maternal disability and death. It is also best for pregnant women to always attend antenatal services and give birth in the presence of a qualified medical professional. Emergency obstetric care should be available to mothers who suffer complications during child birth. We should address social issues in the communities where we come from, especially those that endanger women. 

David Kyato: working beyond drug shortages

April 5 – 11 is International Health Worker Week. Every day, dedicated health workers around the world spend long hours—often for very little pay—to keep their communities healthy. For the next week, UVP will be highlighting a few of the health workers we partner with who ensure good health for all Ugandans.

By Kait Maloney, UVP Managing Director

David is a lab technician and nurse who works in a government health clinic in Iganga town. He also works with Uganda Village Project (UVP) to do quarterly community reproductive health outreaches in the rural areas of Iganga. He partners with UVP staff to provide education sessions about family planning and reproductive health. Then, he counsels women and distributes contraceptive methods to those who want them. One of the major challenges he sees as a health worker is the drug stock outs at the health facilities. Because of lack of drugs, people travel to seek treatment but cannot get the services or drugs that they need. Through his work with UVP, David is able to ensure that women have access to the contraceptives that they want.

When asked about his work in the rural communities he said, “I enjoy going out to the communities to offer very urgently needed family planning services to the women because most of them want the services, but can either not afford transport to the health center or their husbands don’t give them permission to go.” 

Hatika Namyalo: inspired by fistula surgeries

April 5 – 11 is International Health Worker Week. Every day, dedicated health workers around the world spend long hours—often for very little pay—to keep their communities healthy. For the next week, UVP will be highlighting a few of the health workers we partner with who ensure good health for all Ugandans.

By Kait Maloney, UVP Managing Director

Hatika Namyalo is trained nurse and current medical student in Uganda who has a vision to help poor and marginalized women in her country. Her passion for medical work was sparked during a church mission trip in 2007 to the eastern region of Karamoja in Uganda, an isolated area with a semi-nomadic population. She saw children dying of pneumonia and women dying in childbirth without access to the critical services they needed. Hatika knew that she belonged in the medical field.

She completed a course in nursing and then began her medical course. During this time she heard about Uganda Village Project (UVP) and our fistula program. Fistula is a childbirth injury that leaves the mother leaking urine or feces uncontrollably; UVP identifies women with the condition and sends them for repair surgery. The surgeries are done by the UK Childbirth Injuries Fund, but UVP helps the surgeons by identifying a local medical student who can assist them during the camps. Hatika began working with UVP in 2012, and while witnessing her first fistula repair she knew that she wanted to specialize as a gynecological surgeon. “There are so many ways medical professionals can intervene to stop fistulas from ever happening: good prenatal care for the mothers, safe deliveries with qualified midwives, and access to quality emergency obstetric care,” she said, acknowledging that medical care for fistula involves not just surgery but also holistic maternal health care.

Being a health worker in Uganda is not without its challenges. Hatika mentioned that low salaries and under-resourced hospitals are the two main challenges she sees for health workers here. However, when asked why she still wants to pursue a medical career even when she knows the challenges, she replied, “The smile you see on a fistula survivor’s face when they are able to sit with others without leaking and talk about their experience is worth all of the challenges.” Hatika has a bright future in caring for the mothers of Uganda. 

Reproductive Health Month

By: Orrin Tiberi, Global Heatlh Corps Fellow

Last month the world celebrated reproductive health, praising and upholding women and their vital role in the perpetuation of humankind.  This year, 2015, is especially important for reflection and festivities. The Millennium Development Goals are set to expire and a new set of goals, the Sustainable Development Goals, will be adopted in September of this year.  

Looking back on the past 15 years, reproductive health has made leaps and bounds in many areas. Ante-natal care, for example, has increased from 65 percent in 1990 to 83 percent in 2012. The need for contraception has decreased as well, though an estimated 222 million women worldwide still lack access and the necessary education to make family planning decisions according to the World Health Organization. Nowhere is the need for contraception education and services more important than Uganda, where many rural communities do not receive family planning services or education in a consistent, comprehensive way.   Uganda Village Project works to fill that gap by providing family planning outreach session four times a year in each of the current Healthy Villages.  I was able to observe one of these sessions and see the incredible impact that giving women education and services can have.

I traveled with UVP staff member Maureen, a nurse from St. Mary’s Clinic, and the other Global Health Corps fellow Julius to Kazigo A, one of the Healthy Villages in its third year.  We arrived an hour later than planned, but the groups of women that I expected to see waiting were conspicuously absent. They soon started to come in small groups, often shy and reserved, and served as a great reminder to myself and Julius that even though we may be completely comfortable with the idea of family planning and contraception access, much of the world is still not.  Maureen and Robert severd as the best of hosts, and soon each of the women who had come for education or services was put at ease.  A few women were first time visitors for the outreach, and after an extensive counseling session each of them was given a pregnancy test and after a confirmed negative were offered the option for the contraceptive method of their choice.  Kazigo A has approximately 250 households, and over the course of the day an estimated 50 women came for education and services. Though this seems like a small number at first glance, it represents a sizeable portion of the community and could mean that 50 families will not struggle to feed, clothe, or education another child.  That alone makes even one patient valuable.

Monthly donors make a difference!

Alanta Colley is special to Uganda Village Project (UVP) for several reasons. First, she was the Healthy Villages Coordinator years ago, and we’re always proud of the dedicated staff members who have been with us in Iganga. And second, Alanta is one of our amazing monthly donors. UVP is so grateful to the partners who give each month: because of them, we have a source of funds we know we can depend on, and thanks to their support we can run programs throughout the year. Every time we see Alanta's donation come through, we smile, because she dedicates it "to the wonderful UVP staff," and it inspires us to keep working on behalf of rural villages in Iganga.

We caught up with Alanta to see what she’s been doing since her time in Uganda and why she’s committed to giving monthly to UVP.

How did you originally get involved with UVP?

I ended up in Uganda after completing my Masters of International Public Health at the University of Sydney, in Australia. (I'm Australian!) Uganda is very, very far away from Australia. I had wanted to go to Uganda for years, as several of the amazing doctors and nurses in my uni course were Ugandan, I was fascinated by the history of HIV incidence reduction in the country, and I had read it is one of the most biodiverse countries in the world! I started volunteering in a small village clinic in Ibulanku, traipsing through the fields to do sanitation education with communities. This was the first time I heard of Uganda Village Project. 

Julius Ntalo (UVP Fistula Coordinator) and Leah Bevis (UVP Healthy Villages Coordinator) visited the clinic sometimes, and I soon got to meet them, discovering them both to be passionate, intelligent, hard working people dedicated to doing everything they could to support the communities across Iganga district. I was very inspired by both of them. I then moved on to work in an even tinier village in Kenya, Leah called me to tell me that she was leaving UVP, and that they were looking for a new Healthy Villages Coordinator. I still remember the interview over Skype conducted by Alison Hayward, co-founder of UVP and current Chair of the Board, after she had just come off a 48 hour shift on emergency medicine. There are few times I've ever been so nervous; UVP was thoroughly wonderful and I wanted very much to be a part of it. As soon as we got talking Alison put my mind at ease. 

What's your best memory of Iganga?

The villages in Iganga are beautiful. I don't have a single favourite memory, but I loved the culture that whenever you were driving somewhere and it started raining, you would drop whatever you were doing and go sit on the porch or in the living room of the most nearby house. The sense of trust and hospitality is something my community in Australia lacks. I loved being part of community celebrations, I love the Igangan culture of meetings where everyone gets a say. 

My least favourite memory of Iganga was running along the train tracks (one of the few places one can run) to discover a train had offloaded several thousand syringe heads on the tracks. It did give me an incentive to keep light on my toes though!

What has kept you involved?

The work of UVP is evidence based, tangible, practical, and based on priorities devised by the community. I've seen first-hand how passionately committed all the staff and volunteers are, and how well money is used. I think UVP supports communities to have the stable access to health information and services to provide a platform to realize their greater aspirations. 

What motivated you to give a monthly donation?

UVP is focused on making the most of every precious dollar it receives. UVP is very clever in utilizing existing resources, and sustainable appropriate materials. For example the shallow well program used the materials the District has already purchased and could be fixed by community members, unlike the expensive bore holes built by other INGOs that community can't fix. The materials we used in the sanitation campaigns to make tippy taps were extremely cheap, and could be replaced easily by community members. Salaries are the biggest cost often for UVP, but only because of how cleverly inexpensive all the other costs UVP incurs are managed. I have no doubt that in terms of positive impact for Ugandan people in Iganga, donating to UVP enables me to get the best 'bang for buck'. 

Can you share a little information about yourself?

I'm Alanta, I'm Australian, and I'm 32. Since working for UVP I've returned home to work with Engineers Without Borders, coordinating a program supporting Aboriginal communities and engineering organisations to work collaboratively. I love cycling, comedy and gardening.  I love Uganda Village Project and always will :-)

A Day in the Life: UVP Enumerators

By Orrin Tiberi, GHC Fellow

The research enumerator team is now in their third week of data collection, meaning they have collected data from 28 villages out of a total of 72. We’re slowly making our way through the villages where Uganda Village Project (UVP) has worked and control villages to determine UVP’s impact on health in each village. Each day the enumerators gather at the UVP office at 7:30 am to head out in the field early to catch potential interviewees before they move out to their fields. That is especially important now with the coming end of the dry season as many community members spend the relatively cooler morning and evenings in the field preparing for planting. Though the fields are usually within walking distance of the house, the added wait time for someone to return home often means the difference between returning at 4 pm or hours later.

UVP enumerators heading to their next house for data collection

Each team of four enumerators goes to one village, collecting information from a randomly drawn sample of 15 households that will represent the village during analysis. Julius and I have been out in the field each day with the team, getting a much better picture of the community makeup in the Iganga District and viewing first hand many of the challenges to healthcare that rural communities face. We have also been able to enjoy rural hospitality, and the whole enumeration team has enjoyed jackfruit and traditional dishes at the invite of different community members.

The research team is made up of eight enumerators, many of which have been associated with UVP previously. The two team leads, Reagan and Simon Peter, were both interns with UVP for numerous years and intern leaders for many of those. We also have a former intern, Jairus, who worked in Buwerempe this past summer.  Finally, we have a former UVP-supported student Robert as an enumerator.  

Robert interviewing a household member

UVP took Robert on as a student in our Orphan Support Program in 2004 when he was starting secondary school. UVP paid for Robert school fees until 2013 when he graduated from Kyambogo University with a Bachelor’s degree in Community Rehabilitation. Since graduation, Robert has been working with NGOs in Iganga including Uganda Parents of Persons with Intellectual Disabilities and ANPPCAN where he has been advocating for and providing direct support to persons with disabilities and their families. Robert is passionate about making positive change in the communities in Iganga. At enumerator training, Robert mentioned he was happy that he could contribute to the work of the organization that made his dream of graduating from university possible. He is committed to working hard on these hot dusty days to get quality data to inform our programs.

We’re glad to work with these four young people who have been associated with UVP, as well as the other four enumerators who are showing great promise. Despite the tiring days, it’s been a great experience to interview rural households and gain a better understanding of how UVP has affected communities. 

The Necessity of Rigorous Research

By Julius Kirya, Global Health Corps Fellow

Before any program intervention, it's always advisable to conduct rigorous research about how to best make an impact in a given area. This notion cross cuts many different sectors. Businesses conduct research to determine how to create economies of scale. States and governments review evidence-based research before implementing large-scale programs. The research itself informs the nature of the interventions and how they will be implemented.

The success of a program in one village does not guarantee success in another. Communities differ in their topography, climate, tradition, culture, demographics, education, etc. Without systematic and rigorous research, programs will never understand these factors or be able to plan for appropriate interventions. 

Monitoring involves systematic, coherent and continuous collection and analysis of interventions and using the resulting information to determine how a program should proceed. It also helps provide stakeholders with relevant information about the strengths and weaknesses of a program's implementation. Evaluation, on the other hand, assesses a project/program to determine what impact has been made. In combination, monitoring and evaluation is greatly indispensable for the success of any intervention.

As part of UVP's impact evaluation, an enumerator interviews a respondent in Kitukiro Village Iganga

Earlier this month Orrin (my co-fellow) and I began a monitoring and evaluation process that will help Uganda Village Project reach its five-year goals. Iganga is one of the least served regions of Uganda and it is critical to implement effective programs. We set out to perform an impact evaluation survey in the Healthy villages in Iganga: we have a total of 24 "intervention" villages (those who UVP has been working with for the past five years) and 46 "control" villages which have yet to benefit from UVP programs.

Some of the concerns in the survey: Household access to safe and clean water. (Bulowooza Village)

The data is intended to provide formative feedback to UVP and develop recommendations for activities to reach desirable goals related to malaria, HIV, reproductive health/family planning, obstetric fistula, WASH (Water, Hygiene and Sanitation) and VHT training. This will guarantee strategies that will propel health care services in Iganga. 

Edited by Tiffany Hsieh