Poor health can be a barrier to education, productivity in the economy and overall livelihoods. Lack of sanitation, clean water, and immunization lead to outbreaks of waterborne and communicable diseases; shortage of nutrient-rich food exacerbates disease; wide-spread depression and anxiety lead to drug abuse; sexual violence leads to a rise in HIV and sexually transmitted infections (STIs); an inadequate health services leads to increase in mortality. PARC tries to reach the poorest of the poor through advice and support, equipping them with the knowledge and means to ensure they can access good quality healthcare, and empower them bail themselves out of poverty trap and lead health lives.
SEXUAL AND REPRODUCTIVE HEALTH
Three areas of health that we focus on are Sexual and Reproductive Health, and Water, Sanitation, and Hygiene. PARC does this by supporting government health centres and through our own medical clinic.
Reproductive health (SRH/SRHR) is a human right. Reproductive health education is also important for adults and young people helping to raise awareness about puberty, sexual violence, sexually transmitted diseases including HIV/AIDS, family planning, and maternal health. It empowers women and men to make informed decisions about their bodies, improve general health and well being and overcoming inequality – it helps people to break the vicious cycles of poverty.
Uganda’s young population is 52% of the population and this is the age that is most affected by HIV/AIDs. The high risk sexually active women account for 16% of the youth, while high risk sexually active men account for 36%. Related to these behavioral challenges are unwanted pregnancies, sexually transmitted infections and cross-generational sex that are grossly exploitative, especially for the girl child. Attitudes towards menstruation and inadequate hygiene facilities have a detrimental impact on girls’ ability to make decisions about their sexual health and well-being. The inability of a girl’s right to make decisions about their sexual health and well-being increases their vulnerability to teenage pregnancy, HIV/AIDS and other sexually transmitted infections (STIs).
Girls who have received a low or limited education are 5 times more likely to become a young mother than those with higher levels of education. In Uganda, girls as young as 14 years old are dying while giving birth. Many of these girls are uneducated, lack of access to sexual and reproductive health education, and unware of their sexual and reproductive health rights.
Reversing the trends:
PARC works to ensure that adults and young people have access to adequate and accurate information to be able to make informed decision about their bodies, prevent unwanted pregnancies, sexually transmitted infections including HIV/AIDS, finish education and get out of the poverty trap. To achieve this, we;-
- Train in and out of school youth, teachers, and the community on legal, sexual and reproductive rights including menstrual hygiene management (MHM) and work with local leaders to challenge practices that may facilitate the spread of HIV and AIDS.
- Closely engage the village health teams (VHTs) who serve as a link between the community and Ugandan health facility – helping to provide referrals as needed for ARV /ART as well as follow-up the patient under this project.
- Promote access to sanitary protection by distributing menstrual hygiene materials (reusable sanitary pads) in schools and teaching girls how to manage their periods so they feel confident and stay in school. By breaking the stigmas around menstrual hygiene management, we are helping girls stay in school and decide their futures without discrimination.
- Promote awareness and advocacy on menstruation through celebrating the on the 28th May each year as the International Menstrual Hygiene Day and International Day of Action for Women’s Health. By raising awareness on sexual and reproductive health, we support the decisions they make about their futures and bodies — so they can avoid teenage pregnancy.
- Support community awareness on sexually transited infections (STIs) including HIV/AIDS and Hepatitis B. We also incorporate voluntary testing and counseling (VCT) in social projects and a mandatory part of medical clinic tests (as required by the Ugandan government).
- Advocate for community support to HIV+ people in the community, train and support the affected people (at-risk children, caretakers/ guardians, and HIV/AIDS patients) in new approaches to HIV/AIDS management – Differentiated Service Delivery Model (DSDM). We also provide HIV/AIDS patients with transport to access ART/ARV for better health.
- Provide integrated support so that the families can better plan for their future. This involves training of zonal volunteers in OVC care, who then train caregivers and reinforces better care with OVC caregivers during home visits. Additionally, children (OVC) are trained in peer to peer counseling so that they may acquire cognitive skills that will enable them to realize their potential and also improve their interpersonal skills.
WATER, SANITATION AND HYGIENE (WASH)
In recent years, the Ugandan government has spent millions of dollars carrying out campaigns geared toward the provision of clean water and better sanitation as a way of promoting health and hygiene, focusing on preventing cholera, bilharzia, and other water-borne diseases. However, about 60% of Ugandans, particularly in remote rural villages still lack access to safe drinking water, and 65% of Ugandans have no toilet in or around their homes
One of the most critical gaps in ensuring that children and schools remain safe is lack of access to water, sanitation and hygiene (WASH) facilities. Clean water, basic toilets and good hygiene practices are essential for the survival and development of children. Approximately 23,000 Ugandans, mostly children, die each year from diarrheal diseases – with nearly 90% of cases directly attributed to poor water, sanitation and hygiene. For children under five years, water and sanitation related diseases are one of the leading causes of death.
Lack of access to WASH facilities contributes majorly to dropping out of school – children will leave their studies due to water-borne disease, caring for sick family members, need to collect water, inadequate safe safes or lack privacy and lack of sanitary protection for menstruating girls as it is impossible to have periods in dignity. Without these basic necessities, the lives of millions of children are at risk.
Why invest in WASH?
- In Uganda, 62% of households in rural areas travel 30 minutes or more to fetch their drinking water, hence Women and girls spend up to about 4 hours a day collecting water.
- Poor sanitation, lack of access to clean water supply and inadequate personal hygiene are responsible for 90% of diarrheal diseases; which is one of the top leading causes of child mortality, particularly the under 5 years of age.
- About 88% of cases of diarrheal diseases can be prevented with the use of safe, clean drinking water and improved hygiene and sanitation practices.
- An estimated over 17,000 children could be saved every year by improving water, sanitation and hygiene (WASH) in the country.
- Poor personal and household hygiene can lead to increased rate of infections — a number of other diseases such as trachoma, etc.
Reversing the trend:
PARC is doing the following to promote WASH;-
- Raising awareness on menstrual hygiene management (MHM) coupled with promoting affordable sanitary pads (reusable sanitary pads) and building sanitary facilities (gender separate toilets and hand-washing stations in schools to improve higher school enrolment of girls.
- Training villagers on environmental sanitation techniques (ESTs) to reduce water contamination both from the source to home and consumption, the importance of household hygiene, and personal hygiene, lowering the risk of sanitary disease outbreak.
- Researching opportunities to partner with organisations to support the development and implementation holistic WASH interventions in different communities we serve.
- Providing safe, clean water access (geographical coverage and quantity per household) using diverse technology (such as low-cost water filtration systems, protected springs, gravity flow systems, etc that is both optimized for long-term development and compliant with local government requirements.
- Trainings at the community level to develop ownership of hygiene and sanitation practices that support health. The participants are trained for specific roles and responsibilities on safe water chain management, the collection and usage of Operation and Maintenance (O&M) user fees, O&M lifecycle costing, preventive maintenance, community mobilization, and communication skills for effectively project execution.
- For sustainability, we introduce sanitation social marketing through and community savings and loans to promote the construction of pit latrines, rain-water harvesting tanks, and access to low-cost reusable sanitary pads.
SUPPORTING GOVERNMENT HEALTH CENTRES
Uganda’s key health and social development indices have been below expectations. The physician density in Uganda is only 0.117 physicians per 1,000 people (compared to 2.74 in UK) and the hospital bed density is 0.49 beds per 1,000 people (compared to 3.1 in USA).
Ugandan health system is organized along geographic levels (region, district, county, and subcounty) which are self‐accounting and autonomous institutions, respectively. Each region has a Regional Referral Hospital ought to be capable of advanced specialized care, Each District has a District Hospital that is ought to be capable of advanced care, County Health Centers have less advanced healthcare options, and Sub-County Health Centers provide a lower level of care still.
The Sub-County Health Centers are rarely capable of providing the healthcare that the system requires. Because these are in rural areas, most not electrified, lack of power supply have an adverse impact on the ability of clinicians and nurses to provide quality care. Under-allocation of national funds and inefficient supply chains cause the health centers to be under-staffed and lacking in supplies and medicine. Even basic necessities like gloves or gauze may be lacking. The villagers (who are often pressed to even find the money for transport to the health centers) are sometimes asked to pay for these basic necessities, or to pay more than they ought to for medicine or care.
The majority of our health programs take place at the village level. However, to make sustainable change in the health levels of our catchment area, we must improve existing, local healthcare services. Therefore, we work to strengthen the government-aided local health centers around Kasese District. Through Health Outreach program, we work at a village-by-village level to address the most pressing healthcare concerns of each community: malaria, HIV/STIs, household sanitation and hygiene practices (which includes latrine coverage), and family planning access.
PARC works to strengthen public health delivery system of rural, stated aided health centres to ensure that there is faster and effective diagnosis for early treatment and increased in-patient intake in five ways:-
- Provide preventative education and workshops on healthcare issue such as malaria, hygiene and sanitation, STI/HIV testing and family planning options, etc.
- Provision of solar system to ensure sustainability lighting and power for refrigerators to store drugs and vaccines.
- Provision of basic essential items (medical supplies and diagnostic tools) to assist in providing the maximum appropriate level of services at the local level.
- Empowering village health teams (VHTs) which function as a community’s initial healthcare contact, and creating referral networks whereby village health team (VHT) members alert PARC if a patient requires specialized care beyond local health facility capacity.
- Bring access to essential medicines such as distributing malaria drugs, pain-killers and anit-bacterials (subsidized by PARC so as to be affordable) to village households, both through direct sales and through setting up supply chains using the VHT.
PARC MEDICAL CLINIC (HEALTH CENTRE)
Ugandan key health and social development indices have been below expectations. The physician density in Uganda is only 0.117 physicians per 1,000 people (compared to 2.74 in UK) and the hospital bed density is 0.49 beds per 1,000 people (compared to 3.1 in USA).
In theory, a state health facility system exist in Uganda offering FREE healthcare related assistance to everyone, but in practice generally, only those with the means to pay their expenses actually can access better healthcare. Furthermore, drug offerings at these health facilities often are very limited or unavailable.
This creates a desperate need for a medical clinic to provide a much needed healthcare services for the poor communities. PARC is planning to initiate and manage a clinic, that will offer primary and preventative healthcare services to the community, targeting the orphans and vulnerable children (OVCs), particularly those children attending our school (-and their families) and all who come in need of healthcare.
PARC Clinic will operate by emphasizing prevention and education alongside medical treatment. The facility will hold a consultation room, a laboratory, treatment room, and a pharmacy. The laboratory will have capability to perform comprehensive microscopic testing and rapid diagnostic tests for malaria, diarrheic conditions, diabetes, UTI’s, filarial (parasitic worm) infections, and beyond. In addition, while few clinics in Uganda have pharmacies attached, our pharmacy will be fully stocked and will provide quality pharmaceuticals (drugs and consumable) at an affordable price.
We will employ entirely Ugandan staff, who will includes 1 clinician, 1 nurse, 1 nursing assistant, 1 laboratory technicians, and a receptionist. The Ugandan staff will be supported by visiting international volunteers (health professionals and elective students).
How PARC clinic operate?
It complements free governmental healthcare system, where it will offer fee-based quality care, but at a reduced cost. This is opposed to the government operated health units in the area, which are free, but face difficulties in providing a consistently reliable service. PARC clinic will be our main social enterprise to meet the health needs of the community; where clients (patients) will pay small fees for clinic visits to help cover operational costs. As a social enterprise, any profits earned are used towards funding our community initiatives, including Education that reaches out to vulnerable children through sponsorship and school feeding program.
CROSS-CUTING HEALTHCARE SERVICES:
Through a working partnership between PARC Medical clinic and other health centres (both government and private), PARC will continuous to ensure that all people access adequate, affordable and effective healthcare services through following;-
A woman will be required to save and maintain a minimum amount for her family’s health through the savings and internal lending community (SILC) group – also known as village savings and lending associations (VSLA). These health savings will be available within the group as a floater fund. In events where one’s savings doesn’t settle the required/ incurred medical bills, the group may take a joint decision to forward an interest-free loan to its members but solely to meet healthcare expenses. This loan has to be repaid with no interest, in time- bound fixed installments.
The local women in their SILC/ VSLAs will pool small amounts of their savings in collective account – savings for health. From these accounts, members can withdraw no-interest loans to cover unexpected health care costs, thereby relieving the financial burden from a single family, allowing them to seek care as soon as symptoms appear.
Health costs in Uganda remain high – a recent study by WHO revealed that Ugandans spend 22 percent of their earnings on health care. A serious or chronic illness of a family member usually means either the death of the person affected, because he has no access to adequate medical care, or the financial ruin of the entire family. The idea of health insurance is largely unheard of in rural Uganda.
The micro health insurance will help families save money and they are able to use it at the time when they fall sick. Every member of the project will able to get his/her money back whenever they need it so it does not work like an insurance company, but rather saves and keeps money for the community health support.
The aim is to insure the vulnerable families and provide crucial aid to the patients through a subsidized care. PARC is working to creating two new independent plans;- one by promoting Equal Health program (an insurance package offered by Kagando Mission Hospital), and one through the proposed PARC clinic; where the patients pay for 50% of their bills, while the micro-insurance covers the other half of all charges incurred for a health visit. This project will be subsidized through funding from the profits made from selling craft products (jewelry, baskets, etc) in the fair trade market and also through fundraising.
Through the clinic, it will be easy to collaborate with local and international health professional (including medical students) to organize mobile interventions (health camps and field patient visit), run family based micro-insurance, and refer those needing ongoing care to government health facilities in the region. Through the Field Patient Program, PARC clinic will offer important medical referral and financial assistance to patients whose health conditions require them to seek outside treatment available at specialized health care facility settings.