MANAGEMENT CHALLENGES FACED BY NGOs IN PROVISION OF SOCIAL SERVICES TO THE HIV/AIDS I FECTED PERSONS IN NSAMBYA HOSPIT L HOME CARE
A DISSERTATION PRESENTED O?THE SCHOOL OF POST GRADU TE STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS LEADING TO THE AWARD OF MASTER OF ARTS IN DEVELOPMENTADMINISTRATION AND MANAGEMENT OF KAMP LA I TERNATIONAL UNIVERSITY
BY TUMUKUNDE ALOYSIUS MA-I~T-2OO4-O12
OCTOBER 2006 DECLARATION
I Tumukunde Aloysius, declare that this dissertation has never been submitted for the award of a degree in this University or any other institution of higher learning. All the information in this dissertation is based on my own observation unless otherwise stated.
Signed Date APPROVAL This dissertation has been submitted for examination with my approval as the supervisor.
Signed ~~ Dr. OTANGA RUSOKE (3 SUPERVISOR Date ~ DEDICATION
This dissertation is dedicated to my father Joseph Katafa, Mummy Bagashe Elinah, all my brothers and sisters. They have always been a source of joy and inspiration.
111 ACKNOWLEDGEMENTS
This study has been made possible because of the invaluable contribution and tireless assistance of a number of people and organizations whose acknowledgement I give below;
Special appreciation goes to Nsambya Hospital Home Care Managing Director Mr. SSEKIMPI KIWANA for granting me a chance to carryout research in his organization. Also special gratitude goes to all staff members and clients of Nsambya Hospital Home Care for the co-operation rendered to me while collecting data.
My research supervisor Dr. OTANGA RUSOKE deserves special mention here, I do commend him for having spared so much of his time and energy to guide me in my research.
The challenging influence of the Director of Post Graduate School professor PETER JOHN OPIO, Head of Social science DR. MICHAEL MAWA and all lectures who taught me deserve mention, because my endeavor would not have been possible without their challenging scholarly ideas.
I cannot neglect my colleagues whom I studied with in the same class and the typists who made it possible for the final copy to appear as it does and who assisted me in computer processing of my data.
Lastly, special thanks go to all my family members, for their patience and encouragement while carrying out this challenging research and studies. May God bless you all.
iv L~ L’814~J ,*~ TABLE OF CONTENTS 0 DECLARATION APPROVAL ii DEDICATION iii ACKNOWLEDGEMENTS iv TABLE OF CONTENTS v LIST OF TABLES viii LIST OF FIGURES x ABSTRACT xi ACRONYMS xill
C HAP~~ER ONE ~ 1 INTRODUCTION 1.0 Background of the Study 1 1.1 Statement of the problem 3 1.2 General objective of the Research 3 1.3 Specific objectives of the study 3 1.4 Hypothesis 4 1.5 Significance of the study 4 1.6 Limitations of the study 5 1.7 The scope and Delimitation of the Study 6 1.8 Summary of the thesis 6 1.9 Conceptual framework 7 1.10 Theoretical Framework 8
CHAPTER TWO aannannon,gaaanDncbnuannnnnnna GuøncaanDa~nnaubDsDucu~unnnonucønbcueua~oboaubunuuunnonannnuen 11
LITER.ATUR~~ RE~fIEW~q a~a~otac ~ 11 2.0 Introduction 11 2.1 The Review of NGO5 11 2.2 The history of HIV/AIDS in Uganda 14 2.5 Nsambya Hospital Home Care activities 24 2.6 HIV/AIDS and livelihoods 24 2.7 Stigma 25 2.8 HIV/AIDS as an emergency and its implications for relief and development. 26
V 2.9 Hostile social environment. 27 2.10 HIV/AIDS and conflict 28 2.11 Effects of HIV/AIDS 28 2.12 Institutional support 29 2.13 Management of HIV/AIDS patients 29 2.14 Clinical management (care) 30 2.15 Social support 30 2.16 Reduction of Mother to Child Transmission (MTCT) of HIV 30 2.17 Rights-Based Approach to HIV/AIDS victim 32 2.18 Voluntary counseling and testing (VCT) 33 2.18.1 Home-based HIV Counseling and Testing (HBHCT) 34 2.19 HIV Counseling and testing for special groups 35 2.19.1 HCTforchildren 35 2.20 Ongoing counseling 38 2.20.1 Referral and follow-up 39 2.21 HIV Counseling and Testing for couples 39 2.22 Confidentiality 41 2.23 Monitoring quality of services 41 2.24 Strengthening the health care systems 42 2.25 Challenges affecting HIV/AIDS related NGOs 44 2.26 HIV/AIDS and humani~rian programming 46
CHAFFER THREE ~~ 47
M E~T~HODOLOG’Vpqnapnp ~ nUPflUDCUUtflØmCfln 47 3.0 Introduction 47 3.1 Research Design 47 3.2 Area of Study 47 3.3 Study Population 48 3.4 Sample Selection Techniques 48 3.5 Data collection instruments 48 3.5.1 Questionnaire design 49 3.5.2 Interviewing 49 3.5.3 Direct observation 50 3.6 Data Collection from Nsambva Hospital Home Care 50
vi tç~ r LIDSA,~y
C HAP1~ER FOUR ~ ~tn\~oo..t,buuu,,n.n,n,o.o,.n,~u~a, 52 k
DATA PRESENTATION AND ANALYSIS ...... ~...... , ...... ~ UO*flOO~,,,, . .. s... 52 4.0 Introduction .52 4.1 Data analysis 52 4.2 The key actors in the provision of social services to the HIV/AIDS patients.. 75 4.3 Discussion of the results 76 4.4 Introduction 76 4.5 Dependent and independent variables 77 4.6 Social and physical problems faced by the HIV/AIDS Victims 77 4.7 How I-IIV/AIDS patients cope with social problems 79 4.8 Social services provided by the NGOs to the HIV/AIDS patients 80 4.8.1 Ways on which organizational social services helps the HIV/AIDS infected persons 81 4.9 Factors that force social service providers to be friendly to the HIV/AIDS patients 82 4.10 HIV/AIDS victims on confidentiality by NGOs officials 83 4.11 Respondents attitude towards NGOs 84 4.12 How HIV/AIDS is transmitted 85 4.13 Prevention of HIV/AIDS 86 4.14 Management challenges faced by NGO officials 87 4.15 Causes of management challenges in NGOs 89 4.16 Effects of management challenges on daily activities of an NGO 91 4.17 Appropriate ways used to reduce on the management challenges of an NGO. 92
C HAP1~ER 95
SUMMARY, CONCLUSIONS AND RECCOMENDATIONS~~,, ~ 95 5.0 Summary 95 5.1 Conclusion 96 5.3 Further Research 101
vii 102
APPENDICES ~~ ~~ 107
APPENDIX A: INTRODUCTORY LETTERS • 107 APPENDIX B 108 RESEARCH QUESTIONNAIRE FOR NGO’S OFFICIALS 108 APPENDIXC~ 113 RESEARCH QUESTIONNAIRE FOR HIV/AIDS INFECTED PERSONS 113
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viii LIST OF TABLES
Tablel: Shows the basic steps adopted for VCT 33 TabIe2: The protocol undertaken while carrying out Home-based HCT 35 Table 3: Sex characteristic of the respondents 53 Table 4: Age of the respondents 53 Table 5: Religious affiliation 53 Table 6: Different districts where respondents reside/stay 54 Table 7: Sources of sensitizing information on sexual behavior 54 Table 8: Shows social and physical problems faced by the HIV/AIDS infected persons.55 Table 9: Shows some of the ways used to cope with the social and physical problems faced by the HIV/AIDS infected persons 57 Table 10: Social services offered by the NGOs to the I-IIV/AIDS infected persons 58 Table 11: Ways on how organizational social services helps the HIV/AIDS infected persons Table 12: Reasons which attracts/force social service providers to be friendly to the HIV/AIDS patients 61 Table 13: Reasons given by respondents on whether the organization should or should not disclose the information it has on HLV/AIDS infected persons 63 Table 14: Respondents’ attitude towards the NGOs 65 Table 15: ways how HIV/AIDS is transmitted 66 Table 16: Suggested ways on how HP//AIDS can be stopped from being transmitted from one person to the other 67 Table 17: Reasons given by respondents on management challenges in NGOs 68 Tablel8: Reasons given as the major causes of management challenges in NGOs 71 Table 19: Shows the effects of management chaflenges on the day to day activities of an NGO 72 Table 20: Shows the most appropriate ways which could be used to reduce on the management challenges of an NGO 74
ix LIST OF FIGURES
F~gure 1: Conceptual framework 7
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x ABSTRACT This study seeks to investigate the management challenges faced by NGOs in provision of social services to the HIV/AIDS infected persons. It also reveals the most key actors involved in the provision of all kinds of assistance to the HIV/AIDS patients. The study reveals the most appropriate ways used to reduce on management challenges faced by NGOs. The study also shows clearly the social services offered by NGOs to the HIV/AIDS patients as well as social problems faced by them in the due course of sickness.
The study was carried out on 80 respondents from Nsambya Hospital Home Care in Kampala District. It also evaluated respondents’ responses to a questionnaire which included both open and closed ended items,
The research design used was both quantitative and qualitative; it also applied across sectional survey of an NGO. Simple random sampling was also used to select the respondents from the population. Other methods used to collect data from the field include, use of direct observation and face to face interviews.
The study found out that a big proportion of the respondents were in support of the NGOs for the social services given to the HIV/AIDS patients.
It was realized that, the most management challenges of NGOs are caused by daily increase of the HIV/AIDS patients seeking social services. More evidence also revealed that some of the HIV/AIDS patients are abandoned by their relatives, leaving the entire burden to the NGOs care givers. It was also clearly indicated that some of the 1-1W/AIDS patients are not willing to pay user fee of 1000 shillings per month.
xi The study recommends that, there is need for every NGO to strengthen networking with other sister NGOs in the same struggle of fighting against HIV/AIDS scourge, such that referral exercise can easily be conducted, since this can also reduce on the management challenges.
Also the study recommends that, the HIV/AIDS patients should act as examples of those who are still HIV/AIDS free, they should sensitize them how dangerous the scourge is, and what they can do in order to avoid it. It also reveals that, the government should take the responsibility of sensitizing the public about the importance of NGOs towards the welfare of HIV/AIDS infected persons, and as well as the contributions made by them (NGOs) towards the development of the individuals and the whole country at large.
Further more the study recommends that there is need for the church leaders to put much emphasis on sensitizing the Christians about the dangers of the HIV/AIDS scourge and on how it can be avoided.
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xl’ ACRONYMS V AIC AIDS Information Centre AIDS Acquired Immune Deficiency Syndrome APCP AIDS Prevention and Control Project ART Anti-Retroviral Therapy. BCC Behaviour Change Communication CBO Community Based Organizations CHCT Couples HIV Counseling and Testing HBHcT Home-Based HIV Counseling and Testing HCT HIV Counseling and Testing HIV Human Immune virus MOH Ministry of Health MT~T Mother to Child Transmission NGOs Non-Governmental Organizations OIS Opportunistic Infections OVC Orphans and other Vulnerable Children PHAs People Living with HIV/AIDS PIASCY Presidential Initiative on AIDS Strategy for Communications to the Youth PMTCT Prevention of Mother to Child Transmission of HIV PTCs Post-Test Clubs PWDs People with Disabilities RCS Red Cross Society RTC Routine Testing and Counseling STDS Sexual Transmitted Diseases TASO The AIDS Support Organization UHSBS Uganda HIV/AIDS Sero-Behavioural Survey UN United Nations
xlii UNAIDS Joint United Nations Programme on HIV/AIDS UNCRC United Nations Convention on the Rights of the Child UNGASS United Nations General Assembly special session on HIV/AIDS UNICEF United Nations children’s Fund-Country Programme USAID United States Agency for International Development VCT Voluntary Counseling and Testing WFP World Food Programme. WHO World Health Organization
xiv L ~. DA7~ Si CHAPTER ONE
INTRODUCTION
LO Background of the Study HIV/AIDS was first recognized in 1981 (Centers Disease Control, 1981),and since then ‘the number of infected persons has continued to rise especially among heterosexuals in Africa and Asia (UNAIDS and WHO, 1998). The estimates by joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization, (WHO,1998), indicate that by the beginning of 1998 over 30 million people world wide were infected with HIV/AIDS, and that 11.7 million people around the world had already lost their lives to the disease (UNAIDS and WHO, 1998). One of the worst consequences of AIDS is the fact that it creates a number of children infected with AIDS whose parents die from HIV/AIDS. According to the UNAIDS/WHO source estimates shows that in 1998 alone, 5.4 million people were newly infected with HIV world wide, According to this report, already 18.8 million of people around the world have died of AIDS and 3.8 million of them are children.
According to the US census Bureau (Hunter and Williamson, 2000), 15.6 million children were estimated to have lost either one or both of their parents by 1998, and it is anticipated to increase to 22.9 million by 2010 within 23 countries heavily affected by HIV/AIDS. Of these countries 19 are in Sub-Sahara Africa, whereby the year 2010 these orphans and yet have AIDS will comprise up to 8.9% of children under 15 years. In rural areas of east Africa, 4 of every 10 children who have lost either both their parents by the age of 15 years have been orphaned by HIV/AIDS.
By the end of 1997, Uganda had accumulative totel of 53,306 AIDS cases. Out of these cases, 92.7% were adults aged 12 years and above, while 7.3% were children below 12 years (STD/AIDS control programme, 1998). Uganda has been greatly affected by HIV/AIDS leading to the disruption of family life. AIDS is creating Immune suffering in
1 Ugandan families and generating large numbers of children living with AIDS. The 1991 Uganda Population and Housing Census recorded L5 million children below the age of 19 years who had lost either one or both of the parents and even infecting those with AIDS, 65% of these were due to AIDS (Uganda AIDS Commission 1998).
According to Action Aid international Uganda’s (2005), journal, two decades after the first reported case in Uganda, HJ.V/AIDS still remains a serious public health and socio economic challenge contributing significantly to morbidity and mortality. Preliminary results from the recent national HIV/AIDS sero-behavioural survey 2004/2005 indicate that prevalence rate of HIV infection stands at 7% among adult women and men in Uganda. Currently, close to an estimated number of one million people are infected with HIV, out of which a significant proportion are considered to be in a status of immediate need of Anti-Retroviral Therapy (ART), but many can not access the life-prolonging services, because of very many challenging factors.
Therefore, this research focuses on the management challenges faced by Non Governmental, Organizations (NGOs) in provision of social services to the HIV/AIDS infected persons in Nsambya Hospital Home care, Uganda.
Nsambya Hospital Home Care is one of the most active NGO in the provision of social services to the HIV/AIDS infected persons, though it meets different management challenges in its performance while rendering services.
However, it is important to note that HIV/AIDS infected persons needs all kinds of social support in order to make them feel comfortable and be able to stay with HIV/AIDS for along time, because they are still important to their families and the whole country at large.
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2 Li Statement of the problem In Uganda, many Non-Governmental organizations (NGOs) have come up to provide social assistance to the HIV/AIDS patients, despite the fact that the services these NGOs provide have many problems which need to be studied and solved. Some of their programmes are questionable and therefore there is a need to create public trust in the work of NGOs, and to assess how their services can become sustainable and continuous.
There is inadequate clarification of the social services provided by NGOs counselors and social workers. There is lack of proper approach by the HIV/AIDS patients to the right specialists (NGOs counselors/social workers), for instance the patients are not well advised to whom they should approach for the services.
Therefore, the researcher was interested in studying how these problems affect the services they provide to the HIV/AIDS infected persons in Uganda, with a particular analysis of the activities of Nsambya Hospital Home Care.
L2 Genera’ objective of the Research The general purpose of research is to examine the management challenges experienced by Non-Governmental Organizations (NGOs), in an attempt to offer social services to the HIV/AIDS Infected persons.
L3 Specific objectives of the study The following were the main objectives of the study, which aims at improving the wellbeing/welfare of the HIV/AIDS infected people. To find out the social problems faced by the HIV/AIDS victims. To know the kind of social services offered by NGOs to HIV/AIDS infected persons
3 To examine the management challenges faced by the Non-Governmental Organizations in provision of social services to the HIV/AIDS infected people. To establish strategies adopted by NGOs to improve on their management challenges.
L4 Hypothesis The negative attitudes of the general public affects the delivery of social services to the HIV/AIDS infected persons by Non-Governmental Organizations (NGO’s)
The null hypothesis The Non-Governmental Organizations are ill prepared in their delivery of social services to the HIV/AIDS patients.
L5 Significance of the study
The researcher became interested in the study because of the out cry about the HIV/AIDS scourge, a fatal disease, among Ugandans and the whole world at large.
The results of this study will be used to supplement on already existing efforts to combat AIDS among Ugandans. This will be done through sex education to all Ugandans including the youth, since they are the future leaders.
The research study will help the community members, relatives and guardians of HIV/AIDS infected persons to understand the nature and social problems experienced by HIV/AIDS patients, and thereafter be able to provide a helping hand to them, but not looking at them as misfortunes who can not be of any use to the community and the country as a whole.
4 :~roSTGRAr UATE~ ~ LIBRARY ~j 6 N DATE:—~
Also the research study will benefit the policy makers to understand the social problems experienced by HIV/AIDS infected persons, and as a result be able to design a good policy which favours them.
The research will help the public to understand the big roles (s) played by the NGOs towards the well-being/welfare of the HIV/AIDS infected persons, and later be able to stop criticizing NGOs, that they do not offer adequate social services to those people in need (HIV/AIDS patients), that instead they (NGO’s officials) divert the resources to meet their own interest.
The research study will also help the researcher to understand, acquire more knowledge and skills about how to carry out research and emulate issues in the right manner.
The research will help the people responsible(like relatives of the HIV/AIDS victims) to provide the social services to HIV/AIDS patients to under the implications of refusing to take care of l-IIV/AIDS patients, and thereafter be able to handle them so well, like any other person suffering from any other disease apart from HIV/AIDS.
The research will also help the researcher to understand clearly the nature of social problems experienced by HIV/AIDS patients, social services provided to them by NGO’s and the management challenges experienced by NGO’s in the provision of social services to HIV/AIDS infected persons.
L6 Limitations of the study Initially the researcher faced a problem of appearing like a sUanger to the respondents. This could force them to hide some of the important information that could add more value in the research study, However, this was later solved by creating friendship and introducing to clients the purpose of the research.
5 The researcher could not establish the figures of people who died of HIV AIDS in Nsambya Hospital Home Care since its inception up to the date when the research was being done. The reasons given by the respondents were that, it is confidential.
The researcher experienced a problem of interviewing respondents very late. This was because they had to be weighed first, and pick their medical treatment cards from the counselors / social workers, and this exercise could take almost one hour. Hence, because of this the researcher could not be able to interview some of the potential respondents with in the planned period of time. However, the researcher had to over
come this problem by extending on the scheduled period before, from 30th June ~7th July 2006, in order to interview all the intended potential informants.
L7 The scope and Delimitation of the Study The research was carried out within Kampala city on the management challenges to NGO5 in general, and to Nsambya Hospital Home Care in particular.
The research focused on finding solutions that reduce the management challenges, which makes it difficult for NGOs to help the HIV/AIDS infected persons to improve on their quality of life.
L8 Summary of the thesis~ This chapter (chapter one), discusses the theory used in the study of management challenges faced by NGO5 in the provision of social services to the I-IN/AIDS infected persons in Nsambya Hospital Home Care.
The second chapter reviews the studies done which are related to the topic under study.
The third chapter is on methodology and it includes a full description of the sample, the sample area, sample size and the instruments used. ~ ~
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‘(I / In chapter four results of the study are presented, analyzed and interpreted, and also results are discussed under this chapter.
Chapter five includes summary, conclusions and recommendations.
L9 Conceptual framework The research was guided by the conceptual framework which was developed by the researcher during the study. Figure 1: Conceptual framework
The NGO5 that provide the social services to the HIV/AIDS infected persons constitute the independent variable, since they control the lives of their patients and determine the decisions on how social services are to be provided to the HIV/AIDS patents.
The patients (HIV/AIDS infected persons) constitute the dependent variable since they depend on the NGOs for treatment and other social amenities.
Therefore, the research was concerned with how these two variables affect the provision of social services in one way or the other, for instance the NGOs officials may affect the provision of social services negatively, if they fail to advise properly the HIV/AIDS patients on how to use the social services provided, and also the [IIV/AIDS infected persons may affect negatively the social services provided to them by the
7 NGOs officials if they fail to utilize fully the social services (for examples treatment like ARVs) provided to them.
In addition, the NGOs are conditioning the HIV/AIDS infected persons, and for that matter Ivan Pavlov’s theory of classical conditioning provides the theoretical frame work to study the relationships between these two independent and dependent variables.
Lb Theoretical Framework This research study is based on Ivan Pavlov’s theory of learning and conditioning (1979). Learning is defined as a relatively permanent change in behavior that occurs as the result of prior experience. This change may not be evident until a situation arises in which the new behavior can occur.
Learning could be defined more simply as “profiting from experience”, but it should be noted that some learning does not “profit” the learner; useless and harmful habits are learned just as useful one are.
How do organisms learn? There is no simple reply to that question, but one can begin a discussion by examining associative 1earning~ Making a new association or connection between events in the environment is the most basic form of learning.
Psychologists distinguish between two forms of associative learning; classical conditioning and operant conditioning.
In classical conditioning, an organism learns that two stimuli tend to go together. For example, a baby learns that the sight of a nursing bot~e (one stimulus) is associated with the ~ste of the milk (another stimulus).
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8 Also under classical conditioning Pavlov taught or conditioned the dog to associate the light with the food and to respond to it by salivating.
Whereas in operant conditioning, an organism learns that some response it makes, leads to a particular consequence. For example, a baby learns that raising a bottle to his or her mouth (the response) brings milk (the consequence).
Learning therefore, is basic to understanding behavior. The psychological study bears upon the fundamental problems of social behaviour and personality. Learning helps individuals to adopt new behaviors; Pavlov argued that children learn to perceive the world around them, to identify with appropriate sex, and to control the behaviour according to adult standards. Therefore, basing on the above, Ivan Pavlov’s theory of learning and conditioning, the Non—Governmental Organizations tries to teach and condition people on how they can adopt new behaviors, and thereafter use the learned new behaviors to use condoms or abstain from sex, such that they can be able to avoid being infected with HIV/AIDS scourge.
Therefore, earlier preventive methods used to prevent people from catching HIV/ATDS are necessary, even by using the same Pavlov’s theory of conditioning and learning. For example, using the very sick HIV/AIDS infected persons to sensitize those ones who are HIV/AIDS free. This can also help them to be conditioned and learn from the HIV/AIDS infected persons and later be able to abstain from sex.
However, to some extent, the Non-Governmental Organizations providing social services to HIV/AIDS patients have failed to condition the people to adopt new behaviors of having a negative attitude towards having sex or unprotected sex (the response) such that they can avoid being infected with HIV/AIDS scourge (the consequence). This is so because, though the Non-Governmental Organizations try to
9 teach or condition the people to refrain from having unprotected sex, but some fail to adopt the new behavior, and they continue having unprotected sex, and the end result here, they are infected with HIV/AIDS scourge.
Sometimes, it is also difficult for the Non-Governmental Organizations to condition the people who are not yet infected with HIV/AIDS, because the type of conditioning used induces either fear or anxiety, but it does not automatically force the individuals to comply to the favoured conditions by the trainer (NGOs).
Also some times, Non-Governmental Organizations providing social services to the HIV/AIDS infected persons, have failed to teach or condition the people to learn new behaviors against fighting HI~//AIDS, because of corruption, whereby the huge sums of money supposed to be used to fight against HIV/AIDS, are taken by the Non Governmental Organization’s top officials to meet their own interests.
Nevertheless, if Ivan Pavlov’s theory of learning and conditioning could be fully adopted by the Non-Governmental organizations while sensitizing the people about the consequences of acquiring HIV/AIDS scourge, and later be put into practice by the people themselves, then the people are most likely to change their behaviors permanently, by following what they are taught to do, and later be able to avoid the acquisition of HIV/AIDS scourge.
10 CHAPTER TWO
LITERATURE REVIEW
2~O Introduction This chapter basically concentrates on what other scholars, academicians and philosophers have written on the subject matter under investigation. k’s a review of the available literature that is relevant to the study area, for example “The management challenges of NGOs in provision of social services to the HIV/AIDS infected persones in Nsambya Hospital Home Care”. This information was generally enlisted from the primary source (Interviewing respondents), and secondary sources, for example original documents, journals/Annual reports, Periodicals, Internet, and Textbooks as well, where for example the theoretical framework of this research, was generated from Ivan Pavlov’s book of introduction to psychology (1979). The theory used is about learning and conditioning. Where learning is defined as relatively a permanent change in behaviour that occurs as the result of prior experience.
Under this (learning), psychologists distinguish between two forms of associative learning, and these are classical conditioning and operant conditioning.
Under classical conditioning Pavlov taught or conditioned the dog to associate the light with food and to respond to it by salivating. Whereas in operant conditioning, an organism learns that some response it makes leads to a particular consequence, So with this, the Non-Governmental organization tries to condition the people to learn new behaviors against HIV/AIDS, in order to avoid it.
2.1 The Review of NGOs
Non-Governmental Organizations are voluntary organizations. They came up as the 3Id sector following the public and private sectors.
11 Non-Governmental Organizations also refer to the legally constituted non profit making organizations in areas of relief, development and advocacy. NGOs are principally value driven and oriented towards meeting the needs of the poor in order to improve on their welfare/wellbeing.
However NGOs are defined variedly, depending on the context. According to Dicklitch (1998), he defined NGOs as “mainly voluntary or Non-Profit Organizations that are found in the realm of outside the state and private commercial sectors”. The World Bank defined NGOs, as “groups and institutions that are entirely or largely independent of government and characterized primarily by humanitarian or cooperative, rather than commercial objectives”.
According to the Non-Governmental Organization registration statute of 1990, section 13, defined an NGO as the entity established to provide voluntary services including religious, educational, literary, scientific, social or charitable services to the community or any part thereof. An NGO can also be referred to as a body of people who come together to provide help to those who fail to accumulate sufficient resources to survive. An NGO is a private, not for profit institution dedicated to influence the working structures of government and ensure the greater welfare of its citizens.
John Clark (1990) however categorized NGOs into six categories. These are relief and welfare agencies, mainly involved in relief work and social welfare of people affected by disasters. He also included world food programme (WFP), Red Cross Society (RCS), another category is the technical innovations organization which provides new ideas and approaches by trying to solve socio-economic problems. Public service contractors are other categories which work closely with governments to implement their objectives. Others include, popular development agencies, grassroots development
~ /~ I 12 (~PosTcF?~~DuATE~d!il *~, ~ LISPARY \~, DATE:~, \t~ organizations and the advocacy groups and networks, all these have different functions in their lives of goals and objectives.
However, we need to answer the question why NGOs proliferate in the last two decades in Uganda? According to Bazaara and Nyango (1999), there is a tendency by some scholars to present NGOs in a historical and essentialist term. These scholars contend that NGO’s have special qualities that may not easily be found in other organizations
NGOs originated from the need to provide relief especially after World War II when economists unanimously recommended that the government of the newly independent states should not get involved with income and assets distribution. They argued that the government should engage in building the social infrastructure, which was to be a further development of their countries.
The industrial revolution was also a factor that led to the rise of NGOs. The emergency and industries in Europe came up with attendant problems of exploitation of the poor by the rich. To address the problem the trade unions were formed and forced to come in and rescue the suffering of workers.
Before 1980s NGO5 as a sector was not visible in Uganda with the exception of the church and related missionary activities. As soon as they were introduced in Uganda very many people perceived NGO5 as relief and welfare organizations which were to help the destitute especially during the time of disasters. This was because the social sector was dominated by the state, besides the environment that existed in 1970s which could not favour the establishment of NGOs in Uganda. Before 1980s Uganda operated as a closed economy with very little external influence. It was therefore difficult for many international and intermediary organizations to smoothly operate in the country.
13 However, it should be noted that Non-Governmental Organizations providing social services to the HIV/AIDS patients, were established after HIV/AIDS was identified as a dangerous diseases early in 1980s. Some of these NGOs were offering other services to the people but later they adopted the programme of providing social services to the HIV/AIDS victims.
2~2 The history of HIVIAIDS in Uganda According to the STD/AIDS programme (2003) National condom policy and strategy prepared by the ministry of health, AIDS was first recognized in 1982 in Rakai district in south western Uganda, around the shores of Lake Victoria, where there has traditionally been cross-border trading, and where there had also been considerable troop movement by both the Tanzanian and Ugandan military in the Late 1970s and early 1980s. Even before the name “slim” was used to describe unexplained deaths in young adults, the population of this area recognized that there was probably some link between this new illness, associated to the movement of traders, fishermen, and soldiers, and the social and behavioral disruptions traditionally associated with war and civil disturbances. After identification of the virus early in 1980s, it is clearly known that HIV/AIDS prevalence peaked in 1992, at an estimated 18%. But according to the preliminary results of the recent, Uganda HIV/AIDS sero-behavioral survey (UHSBS) of 2004/5, the national prevalence of HIV is currently estimated at 7%. There are indicators, however, that declines in prevalence have began to stagnate over the past four years, and that massive inputs to combat the spread of HIV are not keeping pace with the evolution of the epidemic,
In 1983 the Ugandan ministry of health sent a team to investigate a mysterious new disease in the fishing village of Kasensero, on the western shores of Lake Victoria, To their own surprise, the investigators later found out that the new disease was AIDS which was affectin~,peopie~at a high rate. //~
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~92~ KK~~’~ Also in 1983, scientists in France and the USA had identified the human immune deficiency virus, HIV as the cause of AIDS. By this time, HIV was already spreading rapidly in Uganda and other parts of East and Central Arrica, and was also making inroads into west and southern Africa.
At that time, there was little the Ugandan government could do to come to grips with the new disease, which was known locally as “Slim” because people in the advanced stage became extremely emaciated. The country was in the throes of a civil war, the economy was in ruins and health facilities were decimated by many years of violence, plunder and economic chaos. In any case, there was very little scientific information available about HIV and AIDS and the most appropriate strategies for coping with the epidemic.
In January 1986 a new government came to power, and President Yoweri Museveni was among the first African leaders to confront the AIDS epidemic with Condor and activism. By 1986, the Ministry of Health (MOH) had established an AIDS control program, and a national HIV sero-survey was carried out in 1987/88, one of the first efforts in Africa to document the extent of H1V infection. Based on the data collected in this survey, the Ministry of Health (MOH) projected that 600,000 Ugandans were infected at that time. These projections have continued to rise, and in 1994 the MOH estimated that accumulative total of 1.9 million had been infected.
In 1986 Uganda’s newly appointed minister of health, Dr.Ruhakana Rugunda, shocked delegates to the World Health Assembly in Geneva with a simple, frank admission. “Fellow delegates, I have to inform you that we have a problem with AIDS in Uganda, and we would like the support of the international community in dealing with it,”
At the time, AIDS was widely believed to affect mainly gay men in the Western world. Dr. Rugunda’s fellow ministers of Health, especially those from sub-Saharan Africa,
15 were stunned to hear him claim that Uganda was affected by a disease which was associated with homosexuality, stigma and shame.
It is believed that, many people in Uganda responded by denying the reality of AIDS and by stigmatizing those believed to have the disease. By 1993 an estimated 1.5 million Ugandans about 15% of adult population were living with HIV. However, the denial and stigma which had characterized the start of the epidemic in Uganda began to wane thereafter. The public attitudes were marked by a growing degree of openness about the reality of HIV and increased acceptance of people living with HIV/AIDS.
In the Mid-1990s, surveillance reports from the ministry of health indicated that HIV prevalence was beginning to decline in Kampala and some other urban areas. By the late 1990s there was firm evidence of significant changes in sexual behaviour, especially among young people, and further declines in HIV prevalence were reported from several different parts of the country. Researchers in Uganda believe that these declines in HIV prevalence are linked to changes in attitudes and sexual behaviour, which in turn are related to the openness that has characterized Uganda’s national response to the HIV epidemic.
This explains how in Uganda, openness about HIV has been translated into action at the level of the individual, the family, the community and the nation. It describes how dedicated individuals, political leaders, civil society organizations and government agencies have breached the wall of silence surrounding the HIV epidemic, reduced stigma against people with H1V, and so made the HIV epidemic an open secret (Noerine J, Namulondo k, Kalinaki D and Glen w 2000). Uganda is in leadership position in HIV care provision with many other low resource countries. Services are increasingly becoming accessible to people with HIV/AIDS in many parts of the country. There are numerous NGOs, CBOs, community groups and government institutions providing varied forms of AIDS care in Uganda.
/ 16
// Jr~
/ -
~_~JI, ~_- Guidelines developed by the ministry of health, on “Continuum of care for people with HIV” recommended the promotion of broad care package, including clinical, nursing care, counseling and social support, all across a continuum from the home, community, peripheral health unit up to the district Hospital (s).
In line with the interest of providing care to HIV/AIDS infected persons, the innovative AIDS prevention and control project (APCP) was implemented in January 1991 with a $12 million grant from USAID, and later extended to January 1996 with additional funding for a total of $16,400,000. The major objective of AIDS prevention and control project (APCP) was to reduce the transmission of HIV/AIDS in target populations of Uganda.
The country began providing VCT services in 1990 and VCT remains the main model of implementation in 2005. In 2003, AIC reported that fewer than one million people had tested for HIV in its fourteen years of existence. Even today about 15% of the adult Ugandan population had access to HCT and know their HIV status; but still 70% want to test (Uganda, Ministry of Health, 2005).
Faced with this enormous demand, the government of Uganda determined to make every effort to expand the range of testing services. This revised policy, reflects that determination. The government remains committed to assuring that these expanded HCT services are ground in Human Rights and that, HCT clients and patients have access to HIV prevention messages, commodities and services. However, sometimes government programmes combat HIV AIDS are interrupted by the shortage of funds, and this hinders proper delivery of social services to the HIV/AIDS patients.
2~3 The NGOs strategies in pre~ention and care of HIV/AIDS The NGOs, government of Uganda, and partners, private enterprise have set prevention strategies of sexual transmission of HIV/AIDS, accounting for 90% of the total infections in the country, mitigation of the personal and community impact of AIDS, and
17 building institutional capacity to manage the HIV/AIDS epidemic as major priority areas. The three major priorities have been doing well in an attempt to control HIV/AIDS in the workplace as well as in the general population.
Pro-abstinence-only, organizations are increasingly using Uganda as an example to indicate the success of their methods. But this is inappropriate, since the multiplicity of prevention methods used in Uganda mean that the decline in HIV prevalence was certainly not due to abstinence-only messages. Uganda’s success was based not only on encouraging abstinence until marriage, but also on encouraging fidelity, and condom use. It involved pragmatic discussion of risky sexual behaviors, strong governmental leadership and condom distribution. The open and frank discussion of the sexual means of HIV transmission that took place is certainly not a feature of the pro-abstinence-only agenda. The ABC approach in Uganda involved more than only abstinence, but a large cut of the money is still being channeled through Christian organizations. The plans drawn up by some of these faith-based groups tend to be ideological rather than abstinence until marriage without looking at these issues is a recipe for failure, and Uganda’s example can not be allowed to be misused in this way.
Unfortunately, there is no easy solution to an HIV epidemic Uganda may have decreased its HIV prevalence, but there have been many deaths in the country, and will be many more yet. There is no simple way to reducing the number of new infections-a number of different interventions are required. Foremost among these are a balanced ABC approach, committed political leadership, a willingness to discuss openly the ways in which HIV transmission can be prevented, and a vigorous response from communities across the country.
Another strategy adopted by NGOs is voluntary, counseling and testing (VET), this has been shown to be too useful for the public health intervention. In Uganda persons who know their HIV sero-st~tus ~re more likely than those who do not know their HIV sero
18
-I DtTF / status to change their behaviour. Studies at (VCT) centre show that people who know their HIV sero-status are more likely to use condoms and reduce the number of sexual partners. Currently, the STD/AIDS control program and an NGO known as the AIDS Information Centre (AIC) are sensitizing the general population including persons in the workforce to go for VET, because of the expenses involved, these services are only available in some districts of the country. Care and support of infected and affected persons with HIV/AIDS, although most workplaces have programs of presenting HIV, very few have programs for offering medical care and counseling for HIV infected employees. The infected employees are expected to receive care and counseling from government health units and NGOs with this component. From community level up to district hospital level, various cadres of people are trained in care of persons with AIDS, including counseling and home visiting.
Another strategy is sensitization of the public like promotion of safer sexual behaviors using electronic and print media, drama, songs, videos, films, small group discussions as well as face to face personal interactions (peer educators) is one of the major strategies for checking spread of I-IIV/AIDS in the workplaces as well as in the general population. Appropriate and focused information, education and communication (IEC) messages for target populations for example police, army, factory, long distance drivers and population workers are developed.
NGOs also use the strategy of networking among themselves which will help them increase, and promote different forms of co-operation and co-ordination aimed at sharing operational experiences, building networks and broad coalitions for effecting change and influence those with resources and power. Developing and evaluating the effectiveness of an interactive internet programme or HIV prevention models the research arena to NGOs in developing countries with high HIV incidence will highlight areas of improvement. Kelly (2000) this study will incorporate internet-based dissemination methods to establish a technology transfer approach that is rapid, widely applicable and cost-effective for national and international public health organizations
19 including networks of NGOs. Beckmann (1991) explains that most networks link like- minded organizations to share information, plan joint activities and make a united response to political pressure from government agencies. He further argues that NGOs become more concerned about the sustainability of local development initiatives. They also become more conscious of detrimental consequences of the many existing development policies and institution and the need for collective advocacy efforts. According to Kelly, previous research, found that technology transfer methods that provide intervention manuals, face-face staff training, and individualized consultation for implementing research-based HIV prevention interventions facilitate their adoption by service providers. The researcher will use the knowledge of Beckmann and Kelly to argue for proper networking systems so that they can achieve success in their programs.
Further more, collaboration with community-based organizations (CBOs) is another strategy adopted by NGOs. According to the World Bank (1994) points it that, the changing role of NGOs from that of direct implementation to that of capacity builders of local community based groups. The advocates set up by NGOs can be eventually taken over by CBO5 and user communities at the end of the project period. In addition, to expect CBO5 to take facilities set up by NGOs obscures the conditions on the ground. Most NGOs heavily depend on generous funding from outside, and on expatriates for managerial responsibilities. Further more, the cost structure and incentives extended to their staff and volunteers, is beyond the capacity of CBOs to sustain those facilities and services even for a very short period. The above view assumes that there are local based groups whose capacity provides bias for strengthening such projects. It does not however, concretely reveal the true nature and potential for community-based groups and the type of services that can be effectively carried out by these groups. Moreover, many CBOs lack the legitimacy from the local point of view Clark (1991). Well, this study therefore investigates the management challenges faced by NGOs in provision of social services to the HIV/AIDS infected persons.
•1’ ~≤ Avoiding risky behaviours like drinking alcohol, young girls/boys walking at night alone, unnecessary intimacy with members of the opposite sex, this is another strategy adopted by the NGOs, in order to prevent HIV/AIDS scourge from being spread from one person to the other (Home care Namirembe Diocese, Journal Volumel, 2004). However, although drinking too much alcohol and young people walking alone at night, exposes the people to be infected by HIV/AIDS, but it should be noted that very many people falls victim of the HIV/AIDS, when they are not drunk, and young people are infected with the scourge by their boy and girl friends while at school respectively.
Another strategy developed is that people should avoid blood contacts and unsterilised contaminated equipments, in order to prevent HIV/AIDS spread.
Another strategy to prevent HIV/AIDS is that pregnant women and those preparing to give birth should seek help of a professional medical birth attendant, such that vertical transmission of the virus can be stopped.
Another strategy adopted is resource mobilization; Clark contends that the growing NGO sector is associated with increased financial transfer from developed countries to developing countries. Clark (1991). In 1992 alone the NGO sector attracted US$6.4 billion from donor’s countries. Ministry of finance and economic planning (1992).Well, this flow of resources has been mainly channeled through international NGOs, because of their world wide connection and experience in fundraising and advocacy for the spread of HIV/AIDS. However, the Ugandan government, in spite of its early and swift action to address the HIV/AIDS epidemic, has been accused of placing too high emphasis on purchasing weapons, instead of AIDS drugs. In May 2004, foreign donors including European Union threatened to stop all foreign aid to the Ugandan government unless it channeled resources away from defense spending which has grown by 48% over the past two years. Christian aid has noted a dangerous drift towards channeling money intended for HIV/AIDS spending in Uganda towards the ‘War on terror’
21 essentially, military budgets. Of recent, the Global Fund money intended for the fight against HIV/AIDS, Malaria and Tuberculosis (TB) was misappropriated by the officials in the ministry of health which is still under Justice Ogoola probe commission. All these raise the need for more specific and focused study on the collaboration among the NGO5 operating in the area.
Prevention and control of sexually transmitted disease (STDs) is another strategy adopted by NGOs, this is because of overwhelming evidence linking the transmission of HIV and STDs, prevention and control of STDs in workplaces as well as in the general population form an important strategy for preventing the spread of HIV infection. The health personnel both in private units and clinics that see the general population and workers, as well as health personnel in government units are trained in comprehensive syndrome management of STDs. In Uganda, a significant proportion of patients with STDs and other illness go to traditional healers and traditional birth attendants. In efforts to improve the STDs health seeking behaviors, those traditional birth attendants and healers are sensitized on early recognitions and referral of patients with STDs drugs to health units, both government and some private clinics.
Finally, research is another strategy, many professional for example health, social workers have been involved in research to study, knowledge, attitude, practices, HIV infection trends, natural history of HIV etc which has resulted in all that we know about HIV/AIDS in Uganda. However, little research has been done about the workers themselves, specifically the impact of HIV/AIDS on workers in all sectors. This strategy needs to be strengthened.
In conclusion, therefore, HIV/AIDS remains a major public health, socio-economic as well as a developmental issue in the work places in Uganda. Although the story in Uganda is encouraging as shown by the recent change in sexual behaviors and declining HIV infection rates. There is need for concreted efforts and sustainability of 4~ATIö~f\
i~3~ 22
N 1~ ‘N00 ~ the strategies that have shown success and for addressing HIV/AIDS related problems in the country.
2~4 Government responses towards the prevent~on of HIV/AIDS The government of Uganda has responded positively towards the prevention of HIV/AIDS problems as the following.
The government of Uganda recognizes that, the HIV/AIDS disease is a grave national problem requiring urgent attention. The government in 1986 adopted an open policy. Therefore the attitude of openness and high degree of political commitment has made it possible for the development of various effective programmes and evolution of an innovative national strategy.
The government of Uganda encouraged Multi-sectoral approach to join the struggle of fighting HIV/AIDS scourge. This approach calls for the active involvement of all members of society in both the private and public sector.
The idea of encouraging different sectors to join the struggle of fighting HIV/AIDS is good, but what should be noted is that mobilization of all disciplines and branches of knowledge from all sectors within or outside Uganda is a very important aspect of the strategy, if it is to work so well.
Structures for coordünat~on: The government of Uganda established AIDS control programmes in the ministry of Health, to handle the health and medical aspects of HIV/AIDS. This has achieved assurance of safe blood supply, patient care services, sentinel surveillance, definition of natural history of HIV infection and has made an initial in put into information, education and communication,
The Uganda AIDS commission was established under the office of the president in 1992 to facilitate coordinated implementation of multi-sectoral AIDS control strategy. The
23 main mission of Uganda AIDS commission is to enhance HIV/AIDS activities of communities, government and private organizations in Uganda. The Uganda AIDS commission is mandated to oversee, plan, coordinate, and formulate policies for HIV/AIDS programmes. It is the control reference point for all relevant HIV/AIDS activities throughout the country.
The government of Uganda therefore has responded so much towards the prevention of HIV/AIDS scourge, although sometimes its implemented programmes against HIV/AIDS scourge are not worked upon adequately due to lack of enough resources.
2.5 Nsarnbya Hospita~ Home Care actñvft~es
It started in 1987, Nsambya Hospital Home Care has a client caseload of over 7,000 of which over 560 of these are children. By February 2006, 1299 clients had accessed free ARV5, of whom 118 are children. The program visits patients in their homes and over 1,600 clients benefit from this activity. Over 400 orphans and vulnerable children are being supported in schools: primary, secondary, and vocational training. They are supported with tuition, scholastic materials, and counseling services. Community capacity building workshops are held every month, to equip communities with skills to provide basic care and support, like treatment adherence and nursing skills. Over 400 care givers have been trained in such skills. The program will continue to prioritize such capacity building program, so as to enable communities and beneficiaries fully participate in the care of people living with HIV/AIDS. Nsambya Home Care now has 59 full time staff: doctors, nurses, counselors, social workers, adherence staff, data staff, administrative support staff; pIus 50 community volunteers.
2.6 HIVIAIDS and Hveflhoods
The huge scale of the HIV/AIDS epidemic and its unique characteristics mean that it is having a profound impact on peoples livelihoods, particularly in the wor~t;affected
24
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countries of sub-Saharan Africa. HIV/AIDS affects people’s livelihood assets and the policies, institutions and processes that influence livelihoods. In turn, livelihood strategies are being adapted in response to HIV/AIDS, sometimes in erosive or destructive ways. At a macro level, HP//AIDS reduces overall levels of economic growth, erodes public services such as health and education. All these, sometimes makes it hard for households to have a stable income generating activities, because of the situation in place, and also hinders the economic development of the whole country in one way or the other (Human Rights watch on HIV/AIDS 2003)
23 Stigma
The question of how to target households affected by HIV/AIDS without adding to the stigma that these families might be facing is a difficult and critical issue. Stigma relating to HIV/AIDS may take different forms. For example, there is a risk of self exclusion, where people are too ill or too a shamed to participate in community meetings and are therefore left out of relief programme.
There is also, of course, the possibility of active discrimination, where people known or thought to be HIV-positive or who are chronically sick are deliberately excluded from assistance.
One of the ways in which organizations are approaching this problem is to work with existing community organizations already dealing with HIV/AIDS affected households. For example WFP states that it will support established community based organizations when carrying out HIV/AIDS activities in order to avoid the negative consequences associated with HIV stigma (WFP 2003). However, what should be noted is that, this a raises problems of scale, capacity and the equity of community-based targeting, for example existing CBOs are unlikely to be able to reach large numbers of food-insecure people and at the same time living with HP//AIDS.
25 2.8 HIVIAIDS as an emergency and its impHcations for relief and development The core of the humanitarian agenda commonly understood to be the humanitarian imperative to save lives and alleviate suffering. In this sense, HIV/AIDS is clearly a humanitarian problem. Huge numbers of people are dying from and suffering with HIV/AIDS in sub-Saharan Africa.
Labeling, HIV/AIDS as an emergency may be useful in trying to generate additional action. For example, for national governments, declaring HIV/AIDS an emergency may serve particular purposes, such as demonstrating political commitment or allowing the importing of generic drugs to treat the disease. Calling something an emergency also has important practical implications for aid agencies and donors in terms of what funding is available, from which budget lives and with what sort of timelines and conditions attached. Perhaps the best way to describe the challenges presented by the HIV/AIDS epidemic is as along term crisis(Paul Harvey 2004). However, it should be noted that whatever label applied, HIV/AIDS Clearly requires both a humanitarian response to suffering, and a long term perspective, in order to keep on availing social services to the HIV/AIDS infected persons for along time.
Also, a response across entire countries and regions over a period of decades is obviously ill-suited to the ways in which humanitarian aid is currently delivered, based as it is on short-term time horizons and funding cycles. But what we should note is that the core business of humanitarian relief should remain focused on saving lives and alleviating suffering in response to acute crises. In doing this the context of an HIV/AIDS epidemic, it is important to apply an HIV/AIDS lens to humanitarian programming across the different sectors of response and across the program cycle.
26 2~9 Hostile social environment At the onset of the epidemic people were accused of sexual immorality by their communities. This view also affected their families and kin which led to rejection of people with HIV/AIDS. However, what should be noted is that, through massive information, education, communication and counseling attitudes have changed though discrimination still pervades communities. Well, we should not forget that people with HI/AIDS are, shunned by society, condemned on moral grounds, feared as source of infection and this affects HIV/AIDS victims negatively.
The most difficult situation of people living with AIDS is the attitude of the families and loved ones towards their plight. These are the people from whom they expect love and sympathy and when this is denied then it creates a strong desire to end their lives.
Fear of being labeled as HIV suffers in hospitals; some people refuse to go to hospitals at all whenever they exhibit any symptoms of AIDS and would rather visit a traditional healer.
The initial reaction of people living with AIDS to news of their infection is one of shock followed by fear of death, which inevitably kills them earlier than the disease itself, although they try to counsel them but counseling may not completely remove the fear of some of the HIV/AIDS victims. There is usually denial of employment and training on grounds of HIV infection which in itself constitutes discrimination (Uganda Network on how, ethics and HIV/AIDS training manual 2004). Well, this has made very many HIV/AIDS victims to fall victims of poverty because most people living with AIDS complain that their problems would have been less painful, if they are financially independent. Most of them can not work and in most cases have no one to look after them. Getting Money therefore becomes their problem and this affects the entire family members in one way or the other, most especially if the HIV/AIDS infected person is the breadwinner.
27 2~iO HIV/AIDS and confHct
This link between HIV/AIDS and conflict are also at a relatively early stage of exploration and research (Khaw et al, 2000, Halmes, 2003). Conflict related displacement leads to increased poverty, dependency and powerlessness. This in turn can increase the likelihood of sexual coercion or bartering, sexual violence and consensual unprotected and unsafe sex. Women are more likely than men to suffer from rape and sexual violence and consensual unprotected and unsafe sex. Women are more likely than men to suffer from rape and sexual violence (Holder, 2003).
Generally HIV/AIDS in most cases causes conflicts between the married couples, such conflicts may be due to denial of sex by one of the partners to the other, poverty and lack of adequate care to the HIV/AIDS patient by the family members.
2q11 Effects of HIV/AIDS AIDS is a disease which negatively affects families, communities and the whole couniry as outlined under. Large amounts of resources are spent on mourning burials, care and support. The epidemic disorganizes the process of national development as it affects the most productive age group. AIDS and poverty are now synonymous. AIDS causes withdrawal of productive labour due to frequent illnesses or death resulting in reduced productivity and earnings for the affected families, hence abject poverty. Increased number of children being looked after by the elderly adults. Therefore, the effects of HIV/AIDS leads to too much suffering of HIV/AIDS victims, since they have to spend much on medical care. Further more these effects lead to suffering of the children who are left behind by their parents without enough care.
28 2~i2 Institutional support For the institutional Support the following are considered important H TV/AIDS clients. Time and privacy, contacts with other people where the situation needs you to be helped, giving practical support like home care visits, food staff provision, soap, meeting travel expenses etc. All these services helps the HIV/AIDS infected persons to improve on their health conditions and hygiene as well although not every patient gets access to all the above mentioned services in time. This is so because some of the institutions fail to offer social support to the HIV/AIDS patients in time because of various reasons which include financial, lack of enough human resource personnel and among others.
2~i3 Management of HIV/AIDS pat~ents The term management refers to a process of optimizing human, material and financial contributions for the achievement of the organizational goal. However, the management challenge is to maintain control over the processes of an organization while at the same time leading, directing and making decision on all sorts of matters. The difficulty is that there can never be any single correct solution to any management problem or any all embracing system which will carry one through a particular situation or period of time (Tim Hannagan 1998), whereas concerning the management of HIV/AIDS patients, since there is no cure or vaccine for AIDS, they are managed by providing them with services like, vaccine for AIDS, counseling, provision of care and support, provide hope to a number of people affected by HIV/AIDS. However, there is a need to ensure a comprehensive and sustainable care by the family, community, health workers and welfare system at all stages of epidemic (Home Care Namirembe Diocese Journal Vol.1, 2004). Therefore, comprehensive care is composed of.
29 2~i4 Clinical management (care)0
This implies early diagnosis, and follows up of illness related to HIV infection and disease. This care promotes and maintains body environmental hygiene. It includes provision and maintenance of nutrition, sensitization and education of individuals and families on HIV prevention and AIDS care. However, what should be noted is that, nursing care can be provided both in hospital clinical areas and at home. In addition some of the services indicated above can not be accessed by some people, most especially those who live deep in rural areas and yet are HIV/AIDS positive.
2~i5 Social support
This is care in the form of provision of accurate information and referral advice to both infected and affected persons. Hence comprehensive care services extends from home to the hospital and thus, it decreases social impact of AIDS, enhance the reduction of secondary spread of infectious disease (s), maintains working capacity of people living with AIDS, and helps to strengthen the existing health care system.
However, although clinical care and other related social support services are important to the HIV/AIDS victims, but sometimes these services are not fully provided to every HIV/AIDS victim, some benefit much more than others, while others do not have the opportunity to be registered with the social service providers (for example NGOs),and even net working of the organizations is so poor, a situation which makes the referral exercise difficult.
2q16 Reduction of Mother to Child Transmission (MTCT) of HIV
At a special session of the UN General Assembly in 2001, heads of state and representative of governments committed themselves to reduce the threat posed by Mother to Child Transmission (MTCT). Targets were set for counti~i jta~-attain, most of
\ /c:’ ~4;i~
30 - —
5_li -L \~_ p, ~j —\ which for 2005 including the reduction of Mother to Child Transmission (MTCT) by increasing availability and accessibility of prevention of mother to child transmission of FIIV (PMTCT) services. Uganda’s efforts to reduce mother to child transmission started before the coming into effect of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) commitments. The program was initiated in 2000 with support from UNICEF. Over the years, the country has registered progress in attainment of the target of reducing transmission of HIV from mothers to children either during pregnancy, labour/delivery or through breast feeding.
Coverage was expanded to cover 56 districts as of end of 2004. The districts of Kotido, Lira, Pallisa, Jinja, Mukono, Bushenyi, Rukungiri, Hoima and Kibale had covered all the hospitals, health center IVs facilities as well as health center Ills. Another 19 districts had initiated Prevention of Mother to Child transmission of HIV (PMTCT) services covering between 76-100% of their health center IV facilities. Six districts had ai±ained 51-75% of their facilities up to health center IV level while another 18 had achieved coverage of 26-50% of all their hospital, and health center IV facilities. Only (4) districts namely Mbale, Kamuli, Iganga and Kabale had less than 25% coverage of their hospital and health center IV facilitates providing the Prevention of mother to child transmission services.
To ensure effective implementation of the program, policy guidelines and manuals have been developed and disseminated. Service providers particularly laboratory technicians and health workers continue to be trained on [IV testing, prevention of mother to child transmission of [IV counseling and integrated infant and young child feeding counseling respectively. Sensitization regarding the importance of PMTCT services continues to spread, mostly through radio talk shows, spot messages and a few television programs.
31 However, it should be noted that although the above health centre facilities are in place to reduce on mother to child transmission of HIV, but what we should not forget is that poverty, stigma, gender and power relations complicate women’s decision making on whether to breast feed or not. Facilities for Prevention of Mother to Child Transmission of HIV(PMTCT) services are also still inadequate in relation to the targets. For example in Lira, PMTCT services are only available only at 2 sites namely Lira referral hospital and Dokolo health center IV. The rest of the vast district has no services. Similarly, in Soroti district, the service is only functional at the main hospital; health centre IVs only serves as referral centers. Health center IVs like Arapai are inadequately facilitated with PMTCT equipment and drugs to provide the service. In the same way, the attainment of the target of reducing Mother To Child Transmission (MTCT) is constrained by cases of drug stock-outs.
2~.17 Rights-Based Approach to HIVIAIDS vktüm
HCT services in Uganda conform to the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) Policy Statement on HIV Testing (June 2004) which states that HIV testing: must be grounded fri sound pub/ic health practice and respect, protection, and fulfillment of human r,~’hts norms and standards and that consent and confidentiallty in testing must remain at the heart of all HIV policies and programmes, both to comply with human r,~’hts princioles and to Ensure sustained public health benefits.
The Ugandan Government has adopted the UNAIDS/WHO recommendations that HCT policies incorporate the following factors: 1. Ensuring an ethical process for conducting the testing, including defining the purpose of the test and benefits to the individuals being tested; and assurances of linkages between the site where the test is conducted and relevant treatment, care and other services, in an environment that guarantees confidentiality of all medical information;
32 ~POSTGR~~ L~UAE, ~ LIBRARY ~
DATE:—~~ \ooO~~ 2. Addressing the implications of a positive test result, including among others, human rights and access to sustainable treatment and care for people who test positive 3. Reducing HIV/AIDS-related stigma and discrimination at all levels, notably within health care settings; 4. Ensuring a supportive legal and policy framework within which the response is scaled up, including safeguarding the human rights of people seeking services; 5. Ensuring that the healthcare infrastructure is adequate to address the above issues, and that there are sufficient trained staff in the face of increased demand, for testing, and related services.
2q18 Voluntary counselling and testing (VCT)
VCT has been and remains the primary approach for delivery of HCT services in Uganda. VCT is client-initiated and can be offered in stand-alone sites or as a specialized service in health centres or outreach sites. VCT clients are assured of full confidentiality that is, HIV test results linked to the client’s name are only known by the counselor. The client may request the counselor to provide results to a third party, but otherwise there is no sharing of results
Tablel: Shows the basic steps adopted for VCT.
Voluntary counselling and testing protocol Protocol step Description Initial contact Registration General health education session Pre-Test Session Pre-test counseling Offer of HIV testing Client consent obtained and documented HIV testing Rapid test Same-day results if possible Post test session Post-test counseling Referral and follow-up During post-test counseling session
Source: Uganda National PolIcy on HIV Counsellng and Testing (2005).
33 2J.8i. Home-based HIV Counseling and Testing (HBHCT)
Home-based HIV Counseling and Testing is a modified model of Voluntary Counseling and Testing (VCT) provided to individuals and families in the home environment. Home- based HIV Counseling and Testing (Ha), also called “family-based HCT”, may be initiated through different entry points. Two approaches in Uganda are; i) Home-to-home campaigns, in which residents of all homes in a selected area are offered testing, and ii) HIV counseling and testing service provision for families of people living with HIV/AIDS (PHA5) enrolled in treatment and care programmes, such as antiretroviral therapy. Home based counseling and testing improves access to services and adherence to Anti-Retroviral Therapy (ART) for people with HIV whose families participate in home based HIV counseling and testing. With any home-based approach, normal procedures for entry into the community should be observed.
- I 1IO//~ 1
34 // POSTGRADUATE ~\ k:!~. L~E~ARY DATF: Table2: The protocol undertaken while carrying out Home-based HCT
Home~based HCT protocol ~ Protocol step Description Initial contact Household education session Identify those for testing and divide into groups •:• Adults aged 18 and above + Children ages 12 to less than 18 •:~ Children under age 12 Registration Pre-Test Session Delivered to individuals, couples or groups according to categories listed above. Each session includes + Pre-test counseling •:~ Offer of HIV testing + Client consent obtained and documented HIV testing Rapid test Same-day results if possible Post test session Post-test counseling for individuals or couples Referral and follow-up During post-test counseling session Source: Uganda Ministry ofHealth Report on HIV/AIDS (2005).
2~19 HIV Counseling and testing for special groups 2ä9~1 HCT for children Principles
In Uganda, a child is an individual under 18 years of age. HIV counseling and testing services for children in Uganda are guided by the UN convention on the rights of the
35 child (UNCRC). Specifically, any intervention for children should be done in the best interest of the child and should be aimed at improving health, development, and social well-being. HIV counseling and testing services providers must also protect a child’s rights to privacy and access to appropriate information while respecting the rights and duties of parents and guardians to guide and direct children in the exercise of their rig hts.
Informed consent for children: Children aged 12 and older may receive HIV testing services at all HIV/AIDS sites without knowledge or consent of their parents or guardians provided they have the capacity to understand the implications of the results of the HIV test. Children aged 12 and older may be provided services if they seek the services freely and without coercion on the part of parents or others. Youth receive their results according to the protocol and results are not shared with parents or guardians except at the request of the child.
If a child presents for HIV counseling and testing with his or her parents, providers should encourage the child to involve the parents or guardians and facilitate the child to disclose his/her results to parents and guardians if requested by the child to do so.
For children below l2years of age, consent by parents or guardians must be documented. For children below l2years of age without a parent or guardian, the head of the institution health centre, hospital, clinic or any responsible person may give consent.
When children are brought for testing by parents or guardians, the HIV antibody test is to be done only to facilitate the medical care of the child. Testing must be clinically indicated or a health provider must concur that a risk of infection is present. The test is not to be used to screen children, or to satisfy the curiosity of parents, guardians, providers or care takers.
36 Counseling children who are sexually abused: Child sexual ~b~use—’--is ~the involvement of a child any sexual activity that occurs prior to the legally recognized age of consent (age 18). Child sexual abuse occurs when a child is used by an older person or more knowledgeable child for sexual pleasure. A child must be tested for HIV if infection from sexual abuse is suspected. In such situations the counselor must; Give appropriate information to the child where possible, give honest answers if the child asks a question, discuss with parents/guardians what information you have given the child. Sometimes there is need to meet with legal personnel or other persons involved in the investigation of a criminal offence, for example the police or the probation officers. If the child has been defiled, counselors on their own discretion should refer to the appropriate agency. The counselor should however make a follow-up of the referred cases, where possible and continue with the counseling thereafter.
However, not all the sexually abused children get a chance of being counseled, because some of theni stay deep in rural areas and their parents some times are so poor not to afford transport to take such children to counselors, and even others are so ignorant to the extent that they do not know that counseling services for a child who is sexually abused are there. In addition some parents of such children do not mind to report to the police for assistance, some prefer solving such problems with the abuser locally, so longer as the abuser gives money to the parents of the child then the parents ceases to report the matter to the legal personnel, not knowing that they affect negatively the social life of their child/children in one way or the other.
Disclosure of NW test resul~: Providers plan how test results will be disclosed before conducting testing. Providers should determine with the parent or guardian in advance whether the result will be disclosed to the child and, if so, how it will be done. If there is no parent or guardian involved, the provider must determine the child’s readiness to receive results and arrange for the child to have a support person of his or
37 her choice present at the post-test session, if appropriate (Ethiopea,National AIDS Council Secretariat 2000).
Results may be provided to children who are 12 years and above at their request, after proper counseling and if the provider judges them to be capable of dealing with the result (especially a positive result). Providers should always Encourage a child to involve the parent or guardian if appropriate. Children below 12 years of age should be given results only with consent of parents or guardians and, again, with proper counseling.
Well before disclosing results, the counselor should assess if the parent or guardian is willing to discuss HIV and the test results with the child openly. If the child is HIV positive the counselor should work with the parent of guardian to plan for the child’s future care. For children who can not clearly understand the results, the parent or guardian may choose to disclose results at a later date. The counselor should provide ongoing support and counseling until the child is old enough to understand the results. In no case should the provider or parent/guardian lie to a child of any age about their I-IIV results.
2.20 Ongoing counseling After disclosure of results, ongoing counseling sessions may be scheduled as necessary, and are particularly important in the case of an HIV-Positive result. All HCT services should make every effort to provide adequate ongoing counseling services as counseling provided at the time of disclosure (especially disclosure of a positive result) may not be fully effective. The same standards for confidentiality must be maintained in ongoing counseling. All qualified HCT service providers may provide ongoing counseling.
38 4
2 20 1 Referral and follow-up -~ One of the main reasons HCT is conducted is to facilitate access of HIV-positive people to treatment services and/or other care and support services. For this reason, all models of HCT require conscientious referral and follow-up of client or patients as per elements of Uganda’s “Comprehensive HIV care package”. H~T providers should ensure access to or refer for these services through ongoing counseling, post-test clubs (PTCs), and medical and psycho-social care and support services(lEritrea, Ministry of Health (2001).
Referral should be made for services not available at the HCT site including PTCs. The referring provider should explain to the client the purpose of the referral and what takes place at the referral site. A referral slip should be filled with the client’s name and the reasons for referral. The information must also be entered in a referral register. In some cases a client may need to bring written documentation of his or her HIV test results in order to access care from the referral site. The provider may provide written results if the client request is documented. Mechanisms for feedback between referral sites should be in place. All referrals should be addressed to institutions, departments or units rather than individuals.
Not~fkadon to schoo~s and ~nstftutöons No one except the child’s parents or guardians and the provider has a need to know the child’s HIV status. The family has no obligation to inform school authorities. If the family chooses to inform school authorities in the best interests of the child, the child’s right to privacy must be assured. Teachers must be trained and should be prepared to handle knowledge of the status of the children. Teachers and schools must respect the confidentiality of children and young people under their care.
2~2i HIV Counseling and Testing for couples Research shows that involving both partners in HIV Counseling and Testing (Ha) increases the support for and adoption of desirable behaviors such as condom use in
39 discordant couples. The number of couples that come for couple HCT is still low. HIV Counseling and Testing sites should support couple counseling and encourage couples to come for testing together.
Pre-test counsellüng for couples 1. The counselor established conditions for couple counseling In the pre-test counseling session the counselor should review the conditions for couple counseling and document that both partners have agreed to accept the conditions. A primary condition is that participation in the counseling and testing session must be voluntary by both partners.
Other conditions the couple should agree to include Open discussion of their HIV risk issues and concerns, receive their HIV test results together, respect the confidentiality of their partner’s result, and make a mutual decision about disclosure of results to any other person.
2. The counselor informs clients of the expectations, roles and responsibilities of each partner. Specifically, each partner is expected to: Treat the other with respect and dignity, encourage equal participation of the other, listen and respond, engage in candid and open discussion, provide understanding.
3. The counselor reviews the test process and meaning of result-especially discordance and concordance.
4. The counselor assesses the client’s readiness to receive the test results-especially discordant test results.
Post-test counse~ng for coup~es: When both partners in a couple have the same results, providers should follow the protocol for the appropriate post-test session. When
40 the results are discordant, the provider should follow the protocol for HIV discordant couples. The major objectives of counseling discordant couples are:
•:~ To help the couple develop a plan for keeping the HIV-n~gative partner uninfected + To help the couple plan for ongoing care and support of the HIV-positive partner + To assess the likelihood of violence or abuse and develop strategies for avoiding it
2.22 Confidentiality H~T services must assure that information gathered from testing or counseling of individuals during H~T is kept strictly confidential. HIV test results and patient records should be kept in a locked file with access limited to HCT personnel. The HCT site will not release test results to anyone other than the client unless the client requests such release in writing or a court order requires it. Counseling must be conducted in an area where privacy and confidentiality can be assured. (Joint United Nations Programme on HIV/AIDS 2003).
2.23 Monitoring quality of services Monitoring quality of services is the responsibility of all members of the health team but always requires support from supervisors and managers. HIV Testing quality control must be performed in all HCT sites through collection of 3% of positive and negative samples.
Other methods of monitoring quality of services are described below but the details are in the policy implementation guidelines. Analysis of service statistics Supportive supervision ~ Observation of counseling sessions
D Client satisfaction assessment Supervision of laboratory personnel
41 External validation of test results by higher-level laboratories
° Validation of test results by mobile laboratory quality teams
If all these methods of monitoring can be done properly than the quality of services has to improve, but unfortunately some times you find that some of the above mentioned methods are not always carried out properly, because of lack of enough human resource personnel to do the work effectively and efficiently, and even some of the HIV/AIDS testing and counseling sites lack enough laboratory machines to use while testing HIV and availing results to the people in time.
2.24 Strengthening the health care systems
Strengthening of the health care systems in the context of HIV/AIDS was envisaged in terms of the country’s public and private health facilities being in position to provide progressively and in a sustainable manner, the highest attainable standard of treatment of HIV/AIDS including the prevention and treatment of opportunistic infections (O/S) and effective use of quality controlled ART in a careful and monitored manner to improve adherence and effectiveness; the target was set for 2003 for the countries which signed United Nations General Assembly Special Session on HIV/AIDS (UNGASS) commitment(Monitoring the UNGASS Commitments 2005). However, it should be noted that, in Uganda this has not been possible enough, because the public health care system for instance, still faces challenges of drug shortages, and human resource incapacity, and this leads to offering inadequate health services to the HIV/AIDS patients.
2~24~i Training skills of care givers
According to the journal (Volume 1, 2004) of Home Care Namirembe Diocese Health department, argued that for the case of HIV counseling, means dealing with an individual who is confronted by an incurable disease and often stigmatized. This is a
( 1d, 42 /~
challenging situation and therefore it needs skills of personal qualities, training skills and institutional support.
Counselors who are trusted, respected and expected of auvice by a client, emotional support and making informed decision need to be highly skilled in different areas pertaining the situation that is HIV/AIDS knowledge, about voluntary and counseling, treatment opportunities and others.
Talk about sex and sexuality in a non-judgmental manner that encourages a client to express freely him/her self without the act of stigmatization. Listen and give the client time to talk.
Ask questions that do not encourage a particular response, but instead prompt a client to talk more about what she/he feels, giving him/her the opportunity to think about own life and relationship with others.
Understand how the client feels in that situation without imposing personal values and thoughts (empathy). Give psychological support that will enable the client explore his/her reactions, feelings and emotions. Help a client to make realistic decisions and to find ways to adjust to change by drawing upon one own resource (and those around him in terms of people and services). Establish trust and keep confidentiality.
Well, all the above training skills for the care givers are so important since they can enable the HIV/AIDS patients get most of the good services expected from the social service providers. However, what should be noted is that some times the care givers fails to fulfill some of the training skills as they were trained to do. That is, some of them fail to keep confidential issues of the clients; some fail to consider time and even
43 some organizations/institutions fails to co-ordinate with others, because of various issues which may be as a result of competition and having different backgrounds.
2~24~2 Personal qualities This involves self respect, and respecting other people including clients, emotional stability (not likely to break down in the session), ability to keep confidentiality, good listening, non-judgmental, able to appreciate clients problem (s), ability to emphasize ideas and facts clearly, and in the simplest form (sharing experience and information) ability to emphasize (put your self in the foot of the client (s) and ready to work with client (s)) and fulfilling appointments as the last personal quality. All these personal qualities are so good to be exposed to the client (s) since they attract clients to gain confidence from the social service provider.
2~25 Challenges affecting HIVIAIDS related NGOs
Crane and cars well (1990) argues that these activities depend on a highly motivated and culturally sensitive staff, and that where staffs intensify and motivation can not burn out. Since NGOs often operate with volunteer or modestly paid staff, they risk the likelihood of erosion due to burn-out. They need to maintain a balance between paid and volunteer staff in order to maintain project continuity, while preventing attrition which is especially common in the emotionally demanding field of combating HIV/AIDS. They argue that it has often been the case that NGOs work in isolation, reluctant to collaborate with each other or with the government. This leads to limited sustainability, which does not focus on developing local capacities to carry on without NGO or other external support. This challenge obscures NGO projects which are highly successful on a small scale. Early successes of a project are often found to be related to unique characteristics within the community or the NGO and may not be replicable on a large scale Johnson and Soderholm (1994).
~~_/1 /~;\\~~
I, 44 \
* I)A,7~ \~-~ V~). \~. fir.,. Actually, there is lack of proper networking among most NGOs. There seems to be notable lack of networking among instructions working on HIV/AIDS. Most NGOs are involved in the same type of activities, related to HIV/AIDS and culture, inevitably targeting the same population groups This also explains why most of their activities undertaken by the NGO5, even though they address cultural aspects, are not based on research findings in this area, as there is no link between research work and institutional activities. This lack of networking could also be explained by the fact that most NGOs working on HIV/AIDS target the same donors.
UNESCO (1999) observes that duplication of efforts; due to lack of networking most institutions are involved in the similar activities related to I-IIV/AIDS and culture. This could be advantageous if carried out in different parts of the country, because of the similarity of some cultural factors. Duplicating efforts is a waste of resources, since the curbing of HIV/AIDS depends on the efficient use of available resources, especially countries, where rampant poverty is the hardest. This challenge of lack of networking may also lead to other problems which must be experienced by the organizations when they compete for the same resources, and referral exercise of NGO clients might end up being difficult. Finally, most activities do not last for generations; the activities are limited and confined in few places. According to Conink and Riddel, NGOs programs of sustainability are problematic in various ways. They argue that despite the beneficiaries’ participation, the general level of participation ranges from mediocre to poor. The second one is that project success is critically related to the quality and input of the current staff serving the projects. Well, if the desire to incorporate target groups and staff commitment can not ensure the long term sustainability of programs, neither can they guarantee the sustainability of the operation of NGOs themselves (Conink and Riddel 1992).Then this means that the NGOs are bound to collapse with in a short time, and this means that the HIV/AIDS victims have to suffer a lot since they will have no where to depend for their socia~ services.
45 2~26 HIV/AIDS and humanitarian programming
The HIV/AIDS epidemic presents a set of difficult challenges for humanitarian assistance; the southern Africa crisis has raised a series o~ practical questions around the programming of Humanitarian aid in the context of an HIV/AIDS related stigma affects participation in relief programmes. This report finds that HIV/AIDS issues need to be mainstreamed by aid agencies both internally, in terms of training and organizational policies, and externally as well.
46 CHAPTERTHREE METHODOLOGY 3~O Introduction
This chapter explains in specific terms how the research study was carried out, and it tackles all the methods which were used during the exercise of carrying out research.
3~i Research Design The researcher carried out across sectional survey of an NGO, in this case which is Nsambya Hospital Home Care, whereby both the NGO officials and HIV/AIDS infected persons were surveyed.
This method was appropriate for the study because the researcher got a chance of interviewing the clients closely, and this enabled the researcher to obtain true and first hand information from the client.
3~2 Area of Study The study was carried out from a Non-Governmental organization, which is Nsambya Hospital Home Care. This organization acted as a representative of other NGOs involved in the same struggle of fighting against HIV/AIDS scourge. Nsambya Hospital Home Care is found in Kampala, Makindye division. The choice of NSambya Hospital Home Care being sampled as the area of interest was guided by the following considerations .First and foremost, the researcher had a degree of acquaintance with Organizational administrators. Such acquaintance was an important pre-requisite for smooth data collection. Finally the area proximity to the researcher in light of time and resource limit necessitated the choice of Nsambya Hospital Home Care.
47 33 Study Population Nsambya Hospital Home Care has a client caseload of over 7,000 and 59 full time employees including volunteers, it is out of this number where eighty (80) respondents in total were selected from both Nsambya Hospital Home Care staff members, and HIV/AIDS infected persons. Whereby staff members were twenty (20), then 18 HIV/AIDS Infected males, 22 HIV/IDS Infected females, and 20 HIV/AIDS Infected children. The sample sizes were obtained randomly from the above indicated groups.
3.4 Sample Selection Techniques A sample is a selection of some parts of the population of which the measurement is made; small enough for convenient data collection; large enough to be truly representative of the population from which it had been selected. As stated by Kothari (1999), most surveys use representative samples from the assessment and generalizations may be made about the much larger population.
So due to the fact that, the researcher was not able to cover all the HIV/AIDS infected persons, and Nsambya Hospital Home Care staff members, the researcher used simple random sampling methods to select the sample from the population. This made it possible for the researcher to list down properly the collected data from all the groups with in the Organization. This gave equal chances to all the groups to be part and parcel of the sample.
3~5 Data collection instruments The researcher used different instruments while collecting data and they include self administered questionnaires and face to face interviews. Whereby questionnaires included both structured and unstructured questionnaires. The open ended items enabled the respondents to reveal the motives and attitudes as well as indicating the tentative conditions upon which their objective choices were based
48 - I I 3.5i. Quest~onnaüre desügn The study was designed to generate both quantitative and qualitative data of a NGO officials and HIV/AIDS infected persons. Multiple source of information was necessary to provide a holistic view of the NGOs management challenges in an attempt to provide social services to the HIV/AIDS victims.
Two questionnaires were developed, the first focusing on the NGO officials, and the second on the HIV/AIDS infected persons, and other tools were also developed while collecting data. Both quantitative and qualitative methods were designed in order to enhance the confidence and interpretability as well as strengthening the over all completeness of the study objectives. Permission for interviewing the HIV/AIDS infected persons were obtained from executive director of Nsambya Hospital Home Care, and each person who participated in the study was first approached for individua permission.
Both open and closed questionnaires were sent to the intended respondents from the study population. This was done because; it could be difficult for respondents to avail the researcher with all the necessary time for interviews, since some of the respondents were literate ( the NGO Officials who were able to read and write), therefore questionnaires were of great value for availing the information to the researcher about the management challenges of Non-Governmental Organizations.
3~5~2 Interviewing An interview is a two-way systematic conversation between an investigator and an informant, initiated for obtaining information relevant for specific study. It is a scheduled set of questions, which are administered through verbal communication in one-to-one relationship between the interviewer and the interviewee (Kothari 1999). The questionnaire designed for the interview of HIV/AIDS infected persons, was some times translated into local language in order to facilitate clear communication with the respondents.
49 Interviewing exercise was used along side with questionnaires, which helped the researcher to get the necessary information about the management challenges faced by Non-Governmental Organizations in provision of social services to the HIV/AIDS infected persons. The technique also has the advantage of enabling the researcher to observe overt and corresponding body language among the interviewees. Under this method, face to face interviews were used and the information obtained was recorded down on the designed questionnaire during the interviewing exercise.
3~5~3 Direct observation Direct observation was used and valuable to obtain information, most especially when the researcher was interviewing both the HIV/AIDS infected persons and employees of Nsambya Hospital Home Care. The researcher observed that some of the HIV/AIDS victims were so weak with a lot of skin rushes due to HIV/AIDS scourge coupled with lack of adequate food to complement on the treatment. This helped much more the researcher to understand the data collected from the field,and how HIV/AIDS dangerous it is. Also through observation one compares and contrasts verbal and behavioral answers. This method was applied along with the questionnaire-related interviews.
Other Data Sources~ Secondary data, including documentary sources, were used to complement the primary data, in order to enrich the understanding of the problem under study. Accordingly, information from journals, textbooks and other sources was used to test the reliability of data generated from field experiences.
3~6 Data Collection from Nsambya Hospital Home Care The researcher visited Nsambya Hospital Home care in person. On the first day to report for research at the organization, the researcher was attached to one of the social workers who helped him to separate organizational clients who had taken long getting social services, from those who had just started getting social services a few months before the period of carrying out research. ~ I ~4~\
50 -L i—~i \~. D47~f~: The researcher picked respondents randomly from the clients who had taken along period getting social services. However, the researcher had solicited permission for this exercise some days before. The researcher carried out face to face interview with the organizational clients while noting down all the answers given on the questionnaire. While other questionnaires were given to the Non-Governmental organizations management officials to fill them. The researcher went with all the filled in Questionnaires on completion. After casually going through all the 100 questionnaires, twenty of them which were either partly filled in or badly filled in were eliminated. A total of eighty questionnaires qualified for analysis. Given the nature of the study this was on acceptable number of respondents, since they were all fairly representatives of sex, age, groups and religious affiliation.
51 CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
4~O Introductbn
This chapter presents the results of the study, in relation to the study objectives. Data was presented beginning with the respondents background information, in this case which is the Non-Governmental organizations management officials and NGO clients (HIV/AIDS infected persons), and then a discussion of hypothesis, dependent and independent variables was done.
4~i Data analiys~s The researcher analyzed the enlisted data both quantitatively and qualftatively, In here the questionnaires were revisited and edited as well. Responses from interviews were broadened and also given true meaning through exhaustive explanations.
Analysis of the data was done in simple ways. This included editing coding, tabulation and discussions, were all used to analyze the management challenges of Non Governmental organizations in the provision of social services to the HIV/AIDS infected persons.
Codes were given according to the responses on the questionnaire for the interest of proper analysis of the data. Coded responses were used in series of analysis to compare the various hypothesis indicated in the study inception.
Blo data The bio data depicts descriptive characteristics of respondents. The researcher examined the sex characteristics of the respondents as shown in table 3 below;
52 Table 3: Sex characteristic of the respondents. Sex Frequency Pere~entage Male 34 425% Female 46 57.5% Total 80 100 Source: Primary data. There were more female respondents (57.5%), than male respondents (42.5%) The sample consisted various age groups. Five age groups were predominant; 12-18 years of age, 20-29, 30-39, 40-49 and 50-59.
Table 4: Age of the respondents. Age in years Frequency Percentage 12-18 20 25 20-29 18 22.5 30-39 20 25 40-49 14 17.5 50-59 8 10 Total 80 100 Source: Primary data.
Table 5: Religious affiliation, Religious affiliation Frequency Percentage Protestant 24 30% Catholic 39 48.75 Muslim 7 8.75 Saved 10 12.5 Total 80 100 Source: Primary data.
53 Table 5 shows the majority of respondents having been Christians, whereby the Catholics has the biggest percentage (48.75%) and protestant (30%). These two religions are followed by saved (12.5%), and lastly the Moslems with (8.75%).
Tabile 6: D~fferent d~stricts where respondents res~de/stay, Resildence Frequency Percentage Kampala 55 68.75 Wakiso 16 20 Mukono 5 6.25 Nakaseke 4 5 Tota~ 80 100 Source: Primary data. According to the above table most of the respondents resides in Kampala district (68.75%), followed by Wakiso district with 20% and then Mukono with 6.25%, and lastly Nakaseke with the least respondents (5%).
Tab~e 7: Sources of sensit~z~ng informat~on on sexuall behavüor,
Source Frequency percentage 1. Radios, TVs, Newspapers and posters 15 18.75 2. Friends and school mates 12 15 3. Films 11 13.75 4. Teachers/divinity paper 4 10 12.5 5. Church leaders 7 8.75 6. Parents 5 6.25 7. Social workers/counselors 4 5 8. Political leaders 5 6.25 9. Drama groups 4 5 10. Seminars 3 3.75 11. Novels and magazines 4 5 Totall 80 100 Source: Primary data.
54 r ~F
It is clear from the above table that the majority of the respondents knows that radios, Newspapers and posters (18.75), are the most sources of sensitizing information on sexual behaviors, followed by friends and school mates (15%) as the second most sources of sensitizing information on sexual behaviour, and then followed by other sources, with the lowest percentage of carrying out seminars (3.75%), and this shows that there is need for an improvement in this area.
Table 8: Shows social and physical problems faced by the NW/AIDS infected persons. Social problems Frequency Percentage 1. Lack of good accommodation. 8 13.3 2. Lack ofadequate food. 12 20 3. Constant sickness. 9 15 4. Isolation by friends and even family members. 5 8.3 5. Suffer from stomach pain, malaria, headache, 8 13.3 joint pain, cough and skin rushes and chest pain. 6. Not schooling 4 6.7 7. Lack of proper care by family members. 4 6.7 8. Unemployment. 10 16.7 Total 60 100 Source: Primary data.
According to the content of analysis from the table 8, 13.3% of the respondents of the HIV/AIDS infected persons suffer from stomach pain, constant malaria headache, joint pain, cough and skin rushes, and chest pain, which give them hard time in most cases. Also 13.3% of respondents’ lacks good accommodation coupled with poor sanitation around them and this worsens their living conditions as patients. Again respondents’ insist that unemployment of HIV/AIDS patients’ leads many of them stay with little or no money completely to help them (16.7 %), and this affects their welfare.
55 There is also a problem of constant sickness of some HIV/AIDS patients, and this weakens their health condition which leads to death within a shortest possible time (15%).
The majority of the respondents (20%) from the above table revealed that there is a big problem of insufficient food among the HIV/AIDS patients’ and this affects their nutritional status negatively.
Its is clearly put forward that stomach pain, constant malaria, headache, joint pain, cough and skin rushes are the common problems experienced by HIV/AIDS patients, all these leads to loss of weight and change the skin colour of the HIV/AIDS patients’ (6J%).
Isolation of the E-IIV/AIDS patients’ by community, family members, and friends has been identified as a serious problem, and this leads to loss of hope, comfort and feeling shy by the HIV/AIDS patients’ (83%).
Some respondents (6.7%) also sited a problem of attaining basic education and this increases at the level of illiteracy, dependency and hinder development within a country.
56 ~-OS~GF A~UATE~ ~ UBRfRY DATE:
Table 9: Shows some of the ways used to cope with the social and physical problems faced by the HIV/AIDS infected persons. Ways Frequency Percentage 1. In case of sickness, the HIV/AIDS patient visits 18 30 the_organization_for_medical_services. 2. The organization and some times relatives 12 20 provides food to the HIV/AIDS infected persons though_not enough. 3. For the case of being isolated and distressed 7 11.7 the HIV/AIDS infected persons visits the organization_for_counseling. 4. Some HIV/AIDS patients get some little money 15 25 from doing the petty /small businesses, and others_are_assisted_by_relative. 5. For accommodation it’s the organization and 8 13.3 relatives_which_assists_the_HP//AIDS_patients. Total 60 100 Source: Prima,y data. The biggest number of respondents (30%) depends on the medical services of the organization like ARVs,Traverdor Amoxyl, panadols and septrines,and without them they can hardly survive for along period of time. Then, 25% of the respondents depend on their relatives for financial assistance, although some do petty work which earns them little money which they use to meet the basic necessities.
According to table 9, 20% of the respondents hardly survive without the food assistance from their relatives and organization. In the same way the organization and relatives assists the HIV/AIDS infected persons with an improved accommodation (13.3), whereby some patients stays with their relatives, and the organization provides them with bed sheets, prows, and iron sheets for constructing small structures. This has helped them to improve on their health conditions, otherwise most of them would not be able to buy all the above for themselves. Further more,-11.7% respondents can hardly survive without the counseling services of the organizational social workers/counselors whenever they are isolated by their friends.
57 Table 10: Social services offered by the NGOs to the HIVJAIDS infected persons. Social services provided Frequency Percentage 1. Free hospital medical services (clearing medical 34 56.6 bills) 2. Provision of counseling services 3. Home visiting and packages to HIV/AIDS patients 4. Provision of ARVs 5. Paying school fees for orphans 18 30 6. Provision of clothes, blankets, food, four iron sheets, bed sheets and mosquito nets 7. Provision of scholastic materials 8. Provision of legal services to some clients 8 13.4 9. Facilitates transport to the seriously sick HIV/AIDS infected people Total 60 100 Source: Primmy data~ It is clear from the above table that the majority of respondents (56.6%) said that, the social services provided to the HIV/AIDS patients are free hospital medical services, counseling services, home visit and provision of ARVs as the most services which can enable HIV/AIDS patients stay for a long period without experiencing too much social problems.
This is followed by 30% of respondents, who cited paying school fees for orphans, provision of clothes, blankets, four iron sheets, bed sheets and mosquito nets plus provision of scholastic materials, as services which has helped children of HIV/AIDS patients, attain basic education, together with improved standards of living.
This was followed by another group of respondents (13.4%) who revealed that the organization provides some clients with legal services and transport to the seriously sick people from home to the hospital and vice-versa. All these social services (above) are so important for the HIV/AIDS infected persons, because without them they may hardly survive with the disease for
58 / Table 11: Ways on how organizational social services helps the HIV!AIDS infected persons. Ways ~roup I NGO Group II (NGO client) officials, Frequencies and % their ~requencies and % 1. Enab’es orphans and vulnerable 6 (30%) 20(333%) children to acquire skills after vocational training 2. helps the orphans and vulnerable children to be self reliant after training 3. medical services (ARVs) has helped HIV/AIDS infected people to stay for along_period_with_the_disease 4. Has helped the survivors (widowed or 2 (10%) 13(21.7%) widows) to settle property d~putes of the deceased 5. Has helped HIV/AIDS infected persons obtain good behaviors/ morals 6~ NW/AIDS infected persons have 5(25%) 17(28.3%) gained hope, confidence of themselves due to counseling services offered to them. 7. Helps MW/AIDS infected persons to obtain material support 8. The quality of life has improved tremendously due to the services offered. 9, Seminars and counseling services 7(35%) 10(16.7%) helps MW/AIDS infected people to reduce on stigmatization and too much thoughts 10. Improves on their nutritional status 11,Enables orphans obtain basic education
Total 20(100%) 60(100%) Source: Primaiy data~
59 According to table 11, 30% of the respondents in group I and 33.3% of the respondents in group II, identified three kinds of social services offered by the NGOs to the people, of which two of them enables orphans and other vulnerable children of HIV/AIDS infected persons to live a better life after acquiL~ng skills, and become self reliant after vocational training~ Whereas ARVs helps the patients to improve on their health condition and be able to live/stay for along period.
Then 25%of respondents in Group I, and 283% of respondents in Group II, identified counseling and material support services as important and which has made the HIV/AIDS patients improve on their quality of life, and gain hope and confidence of themselves.
Whereas 35% of the respondents in Group I and 16.7% of respondents in group II, said that seminars and counseling services offered by the NGO to the I-fly/AIDS patients, reduces on stigma&ation and too much thoughts, and food helps them to balance diet whereas educational services enables orphans obtain knowledge and skills which helps them latertoearna living~
Then 10% of the respondents in Group I, and 2L7% of respondents in group II identified two kinds of social services which are provided to the patients, and one of them is legal services which helps widows and widowed to remain with the properties of their deceased spouses daughters/sons, and that some of the NW/AIDS patients have learnt good behaviers/momls due to the counseling services offered to them by the NGO officials. All the above services have helped much to the NW/AIDS patients and without them they would hardly suivive~
60 N Table 12: Reasons which attracts/force social service providers to be friendly I’ to the HIV/AIDS patients.
Reasons 3roup I NGO Group II NGO dient, officials, their their Frequencies and % requencies and % 1. It’s because they do not want HIV/AIDS 3 (15%) 11(18.3%) patients_feet_distressed. 2. Because they do not want HIV/AIDS 6 (30%) 9(15%) patients’_loose_hope_of their_lives. 3. They want HIV/AIDS infected persons 2(10%) 7(11.7%) take drugs (ARVs) properly as advised by the_doctors. 4. They want HIV/AIDS patients reduce on 5(25%) 11(18.3%) their_thoughts. 5. It’s because they want HIV/AIDS 1(5%) 4(6.7%) infected persons keep on visiting the organization for social services, in order to_improve_on their_health_conditions. 6. Because they want the HIV/AIDS 2(10%) 10(16.7%) patients understand how dangerous the scourge is, and later do what is required, in order to stay with the disease without to_much_suffering. 7. To make them (l-IIV/AIDS patients) 1(5%) 5(8.3%) understand the dangers of infecting other. 8. I do not know 3(5%) Total 20(100%) 60(100%) Source: Primaiy data~ The results above shows that 30% of the respondents in Group I, and 15% of the respondents in group II, revealed that social service providers are forced to create friendship to the NW/AIDS patients because of the desire to comfort the patients and enable them remain with hope of their lives.
Also according to the reasons given in the above table, 25% of the respondents in group I, and 18.3% respondents in Group II said that social service providers are
61 forced to be friendly to HIV/AIDS patients, in order to help them reduce on their thoughts, which may cause a distressful situation and sometimes committing suicide may result, if there is no social service providers comfort.
Respondents in group I (15%), and Group 11(18.3%) indicated that social service providers creates friendship to patients because they do not want them feel distressed, since this might be dangerous if they experience it.
Whereas other respondents based their reasons on influencing l-IIV/AIDS patients to take ARVs properly and at the right time, the other respondents revealed that, social service providers have the desire to make sure that patients improve on their health condition after understanding how dangerous the scourge is, to them and to those whom they would want to infect with the disease intentionally. Then 5% of the respondents in group II , had no relevant answer to the question asked.
When the researcher asked the respondents an open ended question about social problems faced by the KIV/AIDS infected persons, the following results were obtained.
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62 Table 13: Reasons given by respondents on whether the organization should or should not disclose the information it has on HIV/AIDS infected persons. Reasons Frequency Percentage 1. They should disclose the information they have 14 23.3 on HIV/AIDS patients, because it helps them to know_how_dangerous_it_is. 2. They should not disclose the information they 2 3.3 have on HIV/AIDS patients, because HIV/AIDS infected_people_may_loose_lovers. 3. They should not disclose the information to 10 16.7 other people, because it makes HIV/AIDS patients_feel_shy,_and_fail_to_fit_in_society. 4. They should not disclose the information, 9 15 because if they do some people may begin laughing_at them. 5. They should not because, it makes HIV/AIDS 15 25 patients loose hope, feel uncomfortable in front of_others. 6. They should not because if they do people may 2 3.3 refuse to buy HIV/AIDS infected persons perishables_e.g._tomatoes,_fresh_fish_and_etc 7. They should not, because if they do it, the 1 17 landlords may happen to know their health status and chess them away from houses whenever_they_fall_sick_for_along_period. 8. They should not disclose the information they 4 6.7 have on patients, because if they do, some people may start backbiting the I-fly!AIDS patients 9. They should not because, if they do it, the 1 1.7 HIV/AIDS infected persons’ bosses may terminate_them_from_jobs. 10. They should disclose the information to other 2 3.3 people only after seeking permission from the HIV/AIDS_infected_persons’. Total 60 100 Source: Primaiy data. According to the results obtained from table 13, a very big percentage (25%) of respondents revealed that, if the information about the I-IIV/AIDS patients’ is disclosed to other people, then HIV/AIDS Patients end up becoming hopeless of their lives and
63 this may cause a distressful situation and even makes them feel uncomfortable in front of others.
Whereas 23.3% of the respondents supports the idea of disclosing the information they have on them to other people, since this sensitizes them so much about how dangerous HIV/AIDS scourge is, and this enables them to abstain from sex or use protective measures wherever having sex. Then 1.7%of the respondents revealed that they should not disclose the information, because if they do it, then the landlords may happen to know that they are HIV/AIDS positive, and chess them away from the houses whenever they fall sick for along period of time.
Further more, 16.7% of the respondents do not support the notion of disclosing the information to other people, since this may be regarded by some people as a shame, hence failing the HIV/AIDS patients to fit in a society/community,
Laughing at HIV/AIDS patients was identified as a common fear for HIV/AIDS infected persons, and this increase on their thoughts, hence it would be bad to disclose the information they have on them to other people (15%), on the other hand backbiting of the HIV/AIDS infected persons, causes fear, loss of hope and shy (6.7%), and because of this there is not any reason of disclosing the information to other people.
Whereas some respondents scored the same percentage (3.3%), whereby some said that if the information is disclosed to other people, then HIV/AIDS patients are most likely to lose boy/girl friends, others say that if the information is revealed to other people, then some people will not be able ~ buy their perishables. Some respondents revealed that, the information should be disclosed to other people, on request from the patient(s) 3.3%, because it may affect the social life of the HIV/AIDS Infected persons, if they simply without seeking permission from them.
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Table 14: Respondents’ attitude towards the F1GOs~ Reasons Frequency Percentage 1. NGOs are recognized for being key actors in 10 50 fighting against HIV/AIDS scourge 2. NGOs provides relatively free services 3. NGOs respond immediately to solve most of the social problems, than other actors do. 4. NGOs help very many people infected with the 8 40 HIV/AIDS. 5. NGOs reach deep at the grass root level (villages) 6. There is less corruption in NGOs compared to other companies or to the government. 7. People are happy because of the services offered to them by the NGOs. 8. Negative, because some people think that NGOs 1 5 officials divert the donors funds to meet there needs
9. No relevant answer 1 5 Total 60 100 Source: Primary dada. According to Table 14, the results obtained indicate that, 50% and 40% of respondents are in support of the organization, because of the good and free social services offered to the people who are poor and in need of various types of social services, of which they would not be able to survive for along period without the NGOs assistance. It is also clearly indicated that NGO5 officials always follow up their clients, up to their homes and avail them with services.
Whereas 5% revealed that, some people have a negative attitude towards NGOs, because they think that the money supposed to meet the needs of the NGOs beneficiaries are diverted to meet the interests of individuals (NGO officials). Again 5% of the respondent had no idea about the question asked.
65 Table 15: ways how HIV/AIDS is transmitted~ Ways ~roup I, NGO Group II,NGO Clients, Officials, their their :requencies and Frequencies and % % 1. vertical transmission (mother 20(100%) 56(93.3%) to child transmission) 2. Blood transmission 3. Sexual intercourse 4. Sharing sharp instruments 5. Homosexual transmission 6. Accidents 0 4(6.7%) 7. Some times through nursing HIV/AIDS patients
Total 20(100%) 60(100%)
Source: Primary data. According to table 15, 100% of the respondents in group I, revealed that vertical transmission, blood transfusion, sexual intercourse, sharing sharp instruments, homosexual transmission are the most ways which leads to HIV/AIDS transmission from one person to the other than any other suspected ways. Likewise, 93.3% of the respondents in group II emphasized that the same ways (as indicated in Group I) leads to an increased number of HIV/AIDS victims. Whereas 6.7% of the respondents (the children) puts emphasis on accidents, and nursing of the HIV/AIDS patients as the most ways that HIV/AIDS passes through to infect another person (s).
66 Table 16: Suggested ways on how HIV/AIDS can be stopped from bein ~, transmitted from one person to the other, - - Ways 3roup I, NGO Group II, NGO officials, clients, their Frequencies and % Frequencies and %
1. Abstinence, Be faithful to each other and 4(20%) 10(16.7%) use a Condom (ABC)
2. Avoid all risky areas which can expose 0 4(6.7%) you to be infected with HIV/AIDS
3. Avoid accidents 0 3(5%) 4. Test blood first before transfusion 4(20%) 6(10%) 5. Stop sharing sharp instruments/objects 2(10%) 11(18.3%) 6. Need for increasing awareness among 3(15) 5(8.3%) caretakers on how to nurse HIV/AIDS infected persons. 7. Strengthening public sensitization 0 8(13.3%) programmes about HIV/AIDS scourge.
8. Avoid blood contact and body fluids of 1(5%) 0 infected persons
9. Proper use of condoms 5(25%) 13(21.7%) 10.Need for prevention of vertical 1(5%) 0 transmission (mother to child transmission)
Total 20(100%)) 60(100%)
Source: Primary data. Tablel6, shows clearly the biggest number of 25% of respondents from Group I, and 21.7% of the respondents from Group II, are in support of proper use of condoms as away of avoiding HIV/AIDS scourge.
67 Whereas 20% of the respondents from Group I, and 16.7% of respondents from Group TI, revealed that, abstinence from sex and being faithful to each other, are solutions to end the spreading of the disease.
Since blood transfusion is also among the ways which leads to the spread of the virus from one person to the other, its better to first test the blood before giving it to another person, in order to avoid HIV/AIDS (20% and 10% of the respondents).
The people taking care of the HIV/AIDS patients should learn on how to handle them without infecting themselves, due to blood contact and body fluids of the infected persons. This can be avoided by using gloves properly while nursing the patients (according to 15% of respondents from Group I and 8.3% of the respondents from Group II and 5% from group I).
It was also revealed that some areas, like the bars are responsible for HIV/AIDS increase among the people and therefore, such areas should be avoided (6.7%).
Table 17: Reasons given by respondents on management challenges in NGOs, Management challenges Frequency percentage 1. Break down of social service structures 2. Daily increase on the number of HIV/AIDS patients 3. Difficulties to determine those who are more needy 5 25 than the others. 4. Limited funds to cater for the daily increasing number of HIV/AIDS patients 5. Tight conditions attached on the donations given to the organization. 3 15 6. Difficulties to produce financial expenditures to the funders in time 7. Delay of donor funds 8. Catchments area is so big (2lKms) 9. Clients are so much scattered and visiting all of 1 5 them_is_a_very_big_challenge 10. Delay to release drugs for the opportunistic
68 JL3PARY \~ DAT
infections by the government, for example T.B drugs. 4 20 1 1. Some of the clients fail to concur with what they are told to do 12. Some of the HIV/AIDS patients take over doze of drugs due to illiteracy. 13. Lack of enough doctors and counselors/social workers 14. When some of clients die the organizational officials are not informed by the relatives of the deceased 15. Lack of enough food to give clients in order to complement on the treatment 16. Some patients are unwilling to pay user fees 7 35 17. Most of the clients have been abandoned by their relatives, leaving the whole burden of care upon to the social workers, counselors, managers and doctors 18. Some patients are unwilling to wait, they want to be served first than others who have even come early enough, and this leads to a disorganized flow pattern Tota~ 20 100 Source: Prima,y data. According to table 17, above the higher percentage of respondents (35%) revealed that there is a challenge of having insufficient food to give to clients in order to complement on the treatment. Unwillingness to pay the user fee by some of the HIV/AIDS patients was also indicated as a big problem experienced by the NGO officials. What should be noted is that, failure to pay user fee leads the NGO activities to be at a stand still. The abandonment of HIV/AIDS patients by their relatives has exposed the NGO officials to face very many challenges in an attempt to take care of them (HIV/AIDS victims).
The 25% of the respondents said that the break down of social service structures acts as a challenge. This is due to lack of enough resources to be used in the provision of social services to the HIV/AIDS victims, Also the daily increase of registered HIV/AIDS victims with an NGO has reduced the capacity of the NGO to serve them properly (25%), as it should be and of course this is a management challenge to NGO officials. Then to determine those who are more needy than others among the HIV/AIDS victims,
69 is also a big challenge experienced by the NGO officials. This is due to the fact that the rich people who are positive refuse to reveal their wealth status, and they would want also to take some of the things supposed to be taken by the so poor HIV/AIDS victims.
Insufficient funds were also revealed by the NGO officials (25%) as the biggest challenge which interferes negatively with their day to day activities in an attempt to assist the HIV/AIDS patients.
Then relatively a good percentage of respondents (20%) based their management challenge on having very few doctors, counselors/social workers, who can not handle properly the daily increased number of HIV/AIDS victims.
[n addition to that, whenever, some of the clients are advised to do some of the things or the betterment of their lives, they refuse, for example some refuse to take drugs ~ARVs) on a daily basis, take over doze due to illiteracy and this is a challenge to the ~JGO officials, because they fail to make the clients health conditions improve as early 35 possible, as they would want.
Then delay of releasing drugs for the opportunistic infections for example T.B drugs by :he government are indicated as a challenge. This is so, because it delays doctors to ~dvise patients begin taking ARVs, before curing TB. rhe conditions given by the donors also sometimes hinder the day to day running ~ctivities of an NGO (15%). This acts as a management challenge in one way or the )ther. Also 15% of the respondents revealed that delay of releasing funds by the Jonors acts as a challenge to an NGO officials, because this affects their planning, but n most cases this is due to delay of presenting financial statements by the NGO ,fficials to the funders.
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It is clear from the above table that some of the respondents (5%), based their management challenge on the catchments area (21 kms), whereby the area is a little abit big and on top of this clients are so scattered, this makes it hard for NGO officials to visit all the clients and finish in time.
Tabilel8: Reasons given as the major causes of management challenges in NGOs~ Reasons Frequency Percentages 1. Overwhelming number of HIV/AIDS 3 15 2. Lackof enough funds 4 20 3. Fear of responsibilities 2 10 4. Illiteracy of the clients 2 10 5. Lack of well qualified Human 2 10 resource_personnel. 6. Poor NGO5 policy makers 1 5 7. Donor policies and terms of work 3 15 8. Lack of proper networking with 2 10 other NGOs which helps HIV/AIDS patients
9. No comment/relevant reason 1 5 Total 20 100 Source: Primary data. Depending on the analysis of the above results as shown by table 18, the reasons given ~s responsible for the management challenges of NGOs in provision of social services to Lhe HIV/AIDS infected persons, shows that most of the above given reasons are -esponsible for management challenges of NGOs. However, lack of enough funds ~20%), and overwhelming number of HIV/AIDS (15%), and un favorable donor policies 3nd terms of work (15%) are the predominant reasons, which causes NGOs management challenges, leaving a lot of work at a stand still, and this is followed by tour other reasons with 10% each, whereby among of them, it was clearly cited that, ack of enough well trained human resource personnel to perform very well an NGO 3ctivities, was one of the most challenge, and then poor NGO policy makers and
71 implementers are also dangerous to the smooth running of an NGO (5%),whereas 5%had no relevant answer.
Table 19: Shows the effects of management challhenges on the day to day ~ctivitües of an NGO~ Reasons Frequency fç~n~es 1. Reduces on the quality of services provided 7 35 to the patients. 2. Too much workload on some clinic days, due to the fact that most patients visit the organization on different dates not indicated on_their_medical_cards 3. Failure to accomplish all the organizational 4 20 goals.
~. Affects implementation process of an NGO policies S. Overwhelming numbers of HIV/AIDS patients seeking social services on a daily basis S. Congestion of patients 2 10 7. Conflicts between 1-IIV/AIDS patients and care_providers_(NGOs_employees)
~. Some of the clients fail to get social services 6 30 completely due to limited funds. Cause disorder in patients’ flow, as they are requested to visit the organization on specific days. L0.shortage of drugs L1.No comment/relevant reason 1 5 rotM 20 100 Source: Primary data.
~ccording to the table 19, above a big percentage (35%) of respondents revealed that, he effects of management challenges reduces on the quality of services offered to the IIV/AJDS patients, and that there is too much workload experienced by the social ervice providers, whereas 30% of respondents’ indicated that some clients fail to get ocial services completely, because of limited funds, and this ends up exposing them to
72 social problems. The effects leads to disorder in patients flow to visit the organization in search for social services.
Further more the effects also hinder the management officials of an NGO to accomplish the stated goals/objectives of the organization due to lack of enough funds, and lack of well qualified human resource personnel. Still, because of these effects, there is poor implementation process of NGO policies. There is also a problem of an increased number of HIV/AIDS patients, who visits the organization seeking social services on a ~Iaily basis.(20%).
There is also the effect of having very many HIV/AIDS patients congested at the rganization for the services (10%), due to daily increasing numbers of registered atients and illiteracy .The problem of conflicts between social service providers and :lients a raises, because of the effects of management challenges in an NGO. Whereas 5% of respondents had no idea about the question asked.
73 table 20: Shows the most appropriate ways which could be used to reduce on the management challenges of an NGO,
~easons Freguercy Percentages 1. Need for more funding. 8 40 2. Establishment of more income generating activities/projects. 3. Enroll a specific number of clients who can fit_into_the_NGO_(s)_programmes. 4. Carry out enough sensitization exercise to 3 15 the HIV/AIDS, about the dangers of infecting those who are negative. 5. Need to plan for susta inability of an NGO. 6. Streamline and co-ordinate all AIDS related activities. 6. Strengthen community based sensitization programmes. 7. Ensure regular counseling services to the clients. 8. Encourage home visiting and counseling 3 15 services, in order to ensure disclosure of HIV/AIDS related issues to the family members. 9. Ensure health talks to the HIV/AIDS infected persons whenever they visit the organization. 10.Sensitizing the clients about the importance of user fees 11. Revise policies together with the technical 6 30 staff. 12.Provision of life guards/condoms to the people. 13.Sensitizing the family members of the FIIV/AIDS patients on how to nurse HIV/AIDS_patients ~otal 20 100 Source: Prima,y data. be majority of respondents according to the table 20, emerged with 40% who onsidered soliciting for more funds from various sources, establishment of income enerating activities/projects and enrollment of a specific number of HIV/AIDS infected
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* DATE: * 0 persons, as the most ways which can be used to mitigate on an NGO management challenges. This is followed by 30% respondents who revealed that, there is a need to sensitize the clients about the imporlance of using life guards, revising t’ie organizational policies cogether with technical staff, provision of condoms and sensitizing the people on how to cake care of HIV/AIDS patients, this shows that all these are either missing or not done Droperly within NGO (s), hence there is a need to have them properly done. this was followed by two groups of respondents who scored equal percentages of 15 each, as they suggested their remedies to curb down management challenges of an \JGO, a among them were that, there is a need to co-ordinate the an NGO activities Nith other NGOs in the same struggle of fighting against HIV/AIDS scourge, ensuring egular counseling whenever they visit the organization, such that they can always feel ree and regain hope for themselves, and later be able to change on their behavior in ne way or the other.
~2 The key actors in the provision of socia~ services to the HIV/AIDS atients~ ftlhile analyzing the data, the researcher happened to identify key various actors in the )rovision of social services to the HIV/AIDS infected persons, and these are: The AIDS Support Organization (TASO), Mildmay, AIDS information centre (AIC), ~amwokya Christian Caring Community, Mbuya out reach, Hospice Uganda, Red cross, ‘lulago Hospital, Nsambya Hospital, Kampala City Council, Meeting point International, :hristian Fund, Uganda virus Research Centre-Entebbe, Action Aid Uganda and iacwola.
75 4~3 Discussion of the resuD~
4~4 Introduction the researcher was interested to investigate whether “the negative attitudes of the general public affects the delivery of social services to the HIV/AIDS infected persons by \lon-Governmental organizations”. This objective was stimulated by the fact that despite a fairly high level of AIDS awareness among Ugandans, most NGO5 are still laying a very big role of sensitizing Ugandans about how dangerous HIV/AIDS scourge s, but yet there are some people who have failed to appreciate the work done by \JGOs. There were two hypothesis, and the first one reads that, the negative attitude of :he general public affects the delivery of social services to the HIV/AIDS infected ersons by NGOs, this was rejected because there was enough evidence which shows :hat most of the people are in support of NGOs for the good social services offered to he people in need. rhe second is a null hypothesis which reads that “the Non-Governmental Organizations we ill prepared in their delivery of social services to the FIIV/AIDS patients”. There is ~nough evidence which clarifies this statement, because according to the research indings, shows that although NGO5 offers good services to the people (HIV/AIDS nfected persons) who are in need, but they (NGOs) are ill prepared in most cases to ~ffer adequate services in that they lack enough resources to use while trying to ~rovide social services to the HIV/AIDS patients, even they have failed to convince a ~rge number of population to change their behaviors completely towards the use of ondoms, such that they can reduce tremendously on the rate at which HIV/AIDS atches people. o here the main purpose is to discuss the findings got from the field.
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76 4.5 Dependent and independent variablles~ The study was also based on two types of variables, that is the dependent and independent variables. The dependent variables were considered to be the HIV/AIDS infected persons, because they depend on the decisions made by the NGOs officials, ~nd at the same time they depend on the social services provided to them by the NGOs, and they can hardly survive without such services, hence this qualifies them to be called dependent variables. Independent variables were considered to be the NGO5, because the NGOs takes the decision(s) which must be followed by the clients (HIV/AIDS), and it is also called an ndependent variable in this case, because the HIV/AIDS patients depends on the social 3ervices of the NGO. They (NGOs) are also independent, because they are the ones ~eterrnining the fate of the HIV/AIDS victims.
~6 Sociali and physicall prob~ems faced by the HIV/AID$ Vkt~ms,
~ccording to the analysis made about the social problems faced by the HIV/AIDS )atients, lack of adequate food had a higher percentage (20%) as the most social )roblem experienced by HIV/AIDS victims. Although the organization provide food to ;ome patients, but still food remains insufficient.
~‘1ost of the respondents also have a problem of being unemployed (16.75); this affects hem so much, because many of them hardly get some money which can help them to fleet basic needs. This problem of unemployment is clearly stated in the literature eview, under the sub- topic of problems of people living with HIV/AIDS, where IIV/AIDS victims are denied employment opportunities. This exposes them to poverty; lepend on the NGO5 services, relatives, while others get some little money from the ~etty work they are engaged in.
~ccording to the content of analysis done, about the social problems faced by the IIV/AIDS victims, lack of good accommodation, and problems associated with stomach
77 pain, malaria, headache, joint pain, cough and skin rushes came up with 13.3% of the respondents. All this affects negatively the HIV/AIDS patients, because they can not be able to improve on their welfare when actually they have all these problems.
Constant sickness was also identified as a big problem faced by HIV/AIDS patients ~15% of the respondents). A big number of HIV/AIDS patients are always physically Neak with on and off malaria. [solation is also another serious social problem faced by most of the HIV/AIDS patients ~8.3%); very many HIV/AIDS victims are found of being isolated by their friends and ?ven family members. This problem is also in line with what is stipulated in the iterature review under the sub-topic of problems faced by people living with HIV/AIDS. rhis problem affects them so much to enjoy their social life. This makes them feel ;tigmatized, loose hope of their lives and as a result fail to fit in the society. rhen 6.7% of the respondents have the problem of not being in school, because of lack )f school fees, and yet they have the desire to attain basic education.
~Ihile analyzing the data, it was also clearly found out that, the HIV/AIDS Victims face )ther problems which are psychological and biological as well and which are also andled by the NGO social service providers as follows.
I.6~i Psychological problems lere, the problems which were revealed include: :ear of death, fear of getting weaker now and then, and fear of who will take care of ie survivors (children) after the death. However, all these problems are handled so iell, by the NGO counselors and social workers, where by the HIV/AIDS victims are ounseled and advised in all ways in order to reduce on their fears.
78 .6.2 Biological problems The biological problems which were revealed include; opportunistic diseases, being endlessly sick and inability to feed themselves; therefore NGOs care givers try to solve such problems by giving ARV5 to the HIV/AIDS victims, in order to reduce on their sickness and they are also given food though not enough to feed on it on a daily basis consumption.
4.7 How HIVIAIDS patients cope with social problems. [ncase of sickness, the HIV/AIDS patients visits the organization for medical treatment. The organization gives them ARVS like, Traverdor Amoxyl, Panadols, septrines and among others. This was according to 30% of the respondents. rhe study revealed that the organization and relatives of the HIV/AIDS victims, gives :hem food which enable them to have a balanced diet (20%). However, it should be ioted that although the HIV/AIDS patients get food from the NGO and relatives, but ;till it is not enough. Nhenever the HIV/AIDS infected persons feels stigmatized and isolated, they just visit :he organization for counseling services which enables them to coupe with such )roblems. More evidence from the respondents (25%) shows that in case of lack of noney, some of the HIV/AIDS infected persons engage themselves in doing petty work vhich earns them some little money which is used to buy basic necessities (25%).
:ufther more, when some of the HIV/AIDS victims lacks good accommodation, the )rganization and relatives helps them to coupe with such a problem, whereby the )rganization gives four (4) iron sheets, bed sheets, blankets and mosquito nets and the elatives of course decides to stay with them (HIV/AIDS victims 13.3%).
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~••~ ~ 4.8 SociaD services provided by the NGOs to the HIVIAIDS patients~~,lr ~‘_~ ~A N~ The provision of ARVs to the HIV/AIDS patients has been supported and advocated for, by many influential people who have realized their (ARVS) value in combating the scourge of AIDS. the NGO also has the responsibility of clearing hospital bills of some HIV/AIDS patients’ ~according to 56.6% of the respondents); this has helped so much the HIV/AIDS atients who can not be able to meet their medical bills. Counseling services are also rovided to the patients both on ARVS and to those who have not started taking them. :ounseling services helps the patients to feel free, reduce on stigma, and all other sorts f fears that come across the HIV/AIDS victims. rhis issue of counseling service was found to be a common service used by social ;ervice providers to the HIV/AIDS victims in the organization, and this is also clearly ;tipulated in the literature review under the topic of HIV counseling and testing for ;pecial groups and HIV counseling and testing for couples. rhe content of analysis also revealed that, the NGO pays school fees for some children ~ho are HIV/AIDS positive, and this helps them to obtain basic education. Fhe NGO also provides services like clothes, blankets, food, four iron sheets, bed sheets md mosquito nets, all these helps the patients to improve on their welfare.
Some of the HIV/AIDS infected persons are assisted by the NGO with legal services. This is offered to the patients most especially those who lost their beloved ones. This ervice helps them to remain with the properties of the deceased, in case if the elatives attempt to claim them from the survivor. It should be noted that this service as helped many people especially women to remain with the properties of their usbands (according to 13.4% of the respondents). The organization also provides ieans of transport to the seriously sick people, from home to the hospital and vice ersa. This service helps those who are so poor up to the extent that, they can not be ble to transport themselves to the hospitals/health centers.
80 4~8~1 Ways on which organizational sodal seMces helps the HIV/AIDS infected persons~ The analysis of the data revealed that a fairly high percentage of group II respondents (20%) believed that, the educational social services providea to the children who are positive, helps them to acquire skills which enables them to be self reliant and later realize a bright future.
The ARVS provided to the patients help them to reduce on the pain and also enables ~hem to stay for along period. This is so because the ARVS makes the virus dormant 3nd as a result fails to multiply.
urther more the NGO services helps some of the HIV/AIDS infected persons obtain jood behaviors which enables them to work as volunteers in the struggle of fighting -IIV/AIDS. This happens after carrying out counseling to the volunteers and of course 3fter they have gained hope for themselves, then they begin sensitizing the public 3bout the dangers of HIV/AIDS scourge by citing examples of themselves as patients. rhe study also revealed that the HIV/AIDS infected persons obtains material support e.g. iron sheets) from the NGO (28.3%). This helps them to have improved ~ccommodation, which later leads to an improvement on their wellbeing. eminars and counseling services reduces on the stigmatization of the HIV/AIDS nfected persons (16.7%). These services (seminar and counseling) helps the patients educe on the worries and thoughts which are always experienced by most of the )atients. This is clearly stipulated in the literature review under the sub- top “stigma”, vhere the world food programme (WFP), states it clearly that, it will support ~stablished community based organizations when carrying out HIV/AIDS related ictivities, in order to avoid the negative consequences associated with HIV stigma WFP, 2003:12).
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Further more the food provided, improves on the patients nutritional status, and also — helps them to balance the diet (according to 163% of the respondents).
4.9 Factors that force social service providers to be friendly to the HIV/AIDS patien~ The study revealed that social service providers are forced to be friendly to the HIV/AIDS patients, because they do not want the patients’ loose hope of their lives thinking that they are going to die soon. ~Jso 8.3% of the respondents revealed that social service providers do not want the patients feel distressed and also they have the desire to reduce on the thoughts of the HIV/AIDS patients.
[t was clearly found out that, the social service providers have to create friendship with the patients because they want them to understand how dangerous the scourge is for :heir lives and later be able to do what is required of it (AIDS) in order to stay with the lisease without too much suffering. urther more HIV/AIDS patients have to be befriended, in order to induce them keep n visiting the organization for social services for the interest of an NGO to keep on )perating, and also for the interest of improving on their health condition (5% and S.7% of the respondents).
The social service providers have to create friendship to l-lIV/AIDS victims, because hey want them to understand how dangerous it is to infect others intentionally (8.3%of espondents from group II and 5% of respondents from group I). Then 5% of the •espondents could not give any reason as to why social service providers are forced to :reate friendship with the HIV/AIDS infected persons.
82 I~1O HIVIAIDS victims on confidentiality by NGOs offlcials~ Nhen the HIV/AIDS victims were asked whether the organizational officials should keep nformation they have on them confidential or whether they should disclose it to other )eople, the highest percentage of respondents (25%) refused the idea of disclosing the nformation to other people, they revealed that, the information should not be disclosed
:0 other people, because if they do it, then the HIV/AIDS victims end up feeling incomfortable in front of others.
)ther reasons were that if they disclose the information to other people, the HIV/AIDS ,ictims feel shy, and fail to fit in society (16.7%). Further content of analysis revealed :hat the information should not be disclosed to other people, because they may begin aughing at the HIV/AIDS victims (15%). In addition to this (above), when other people c~now much about the status of HIV/AIDS victims, in most cases they begin backbiting hem. rhe study also revealed that when the information is disclosed to other people, then :here are high chances of HIV/AIDS patients to loose lovers (3.3%). Further more 3.3% if the respondents revealed that it leads the HIV/AIDS victims’ loose customers for heir perishables (like tomatoes, fresh fish). t was also noted that there is a fear by HIV/AIDS patients about issues concerning lisclosing the information to other people (1.7%), they stressed that if the information hey have on them is disclosed to other people and their bosses happens to know, then hat they may loose their jobs. This is true because some of the bosses do not respect he rights of I-IIV/AIDS victims to have jobs like any other person who is HIV/AIDS free. ometimes they, tend to harass them and force them to leave the jobs even before hey are seriously sick to the extent that they are unable to work. Vhereas 23.3% of the respondents revealed that, the NGO officials should disclose the iformation they have on them to other people because it helps them to know how langerous the scourge is and later be able to use all methods to
83 * ~ \~ 1)t~fl
3void it. Further more 3.3% of the respondents revealed that, the information about -fly/AIDS victims should only be disclosed after seeking permission from them. Dtherwise if they simply disclose the information about them without permission then it iuts them, feel unhappy and loose trust from the NGO officiaL (e.g. Counselors, social Norkers and doctors).
The issue of being confidential about the information of HP//AIDS victims is in line with Nhat is indicated in the literature review under the sub topic of confidentiality whereby, t is clearly stated that information gathered from testing or counseling individuals luring the HIV Counseling and testing (Ha) is kept strictly confidential. The HCT will iot release test results to anyone other than the client unless the client requests such elease in writing or a court order requires it.
Lii Respondents attftude towards ~GOs~ Nhen respondents were asked their attitudes towards NGOs; the highest percentage :50%) revealed that NGOs are recognized for being key actors in fighting against ~IV/AIDS scourge. Almost in the same way the study showed that respondents’ 3ttitudes towards NGO5 were positive, because NGOs provides relatively free services to :he HIV/AIDS patients. What should be noted is that, it is these services which has ?nables them (HIV/AIDS victims) to survive for along period, otherwise some of them ‘vouldn’t be able to do so.
:t was also revealed that NGOs respond immediately to solve the problems of HP//AIDS )atients compared to other actors which takes part in the provision of social services 50%).
~ccording to the research findings, also the majority of respondents (40%) had a )ositive attitude towards NGOs with the main reasons that NGOs reach deep at the jrass root level while following up their clients and for resettlement purposes. Another
84 reason was that some of the NGO5 officials are less corrupt compared to the government officials who usually divert money to meet their own interests.
However, 5% of the respondents had a negative attitude tc,wards NGOs; the reason given was that some of the NGOs officials divert donors’ funds to meet their own needs. Therefore these respondents (5%) perception of NGOs operation is the same perception they have on other social service providers like the government, where there is rampant corruption, whereas another 5% of respondents had no relevant answer for the question asked.
4~12 How MW/AIDS is transmitted~ According to the data collected from the field, 100% of the respondents from group I, and 93.3% of the respondents from Group II puts emphasis on blood transfusion, sexual intercourse sharing sharp instruments, homosexual and vertical transmission as the most ways which leads to an increased number of HIV/AIDS infected persons. The issue of vertical transmission (Mother to child transmission) is clearly indicated in the literature review under the sub-topic of reduction of mother to child transmission (MTCT) of HIV where a specific session of the UN general assembly in 2001, Heads of States and representatives of governments committed themselves to reduce the threat posed by MTCT. Targets were set to reduce on MTCT by increasing availability and accessibility of PMTCT services.
Accidents and nursing of HIV/AIDS patients were also indicated as the ways which leads to transmission of HIV/AIDS from one person to the other. This happens most especially when there is blood to blood or fluid to fluid contact of different persons of which, if one of them is HIV/AIDS positive. However, it should be noted that these ways (accidents and through nursing HIV/AIDS victims) are so minor in as far as transmission of HIV/AIDS is concerned.
/~
85
I \\ / ~~9uo. ~ 4.13 Prevention of HIV/AID$, When respondents were asked about how HIV/AIDS can be stopped from being transmitted from one person to another, the highest percentage of respondents from group 1(25%) and (21.7%) from group II, supported the metnod of using condoms as the most appropriate way of stopping the transmission of the virus from one person to the other. This is in line with what is indicated in the literature review under the sub topic of NGOs strategies in prevention and care of HIV/AIDS. However, it should be noted that, there is a need to use condoms properly; otherwise if it is used badly one can easily be infected with the scourge.
The content of analysis also revealed that abstinence and being faithful to each other is also another way which can be used in order to avoid being infected with the virus. Therefore faithfulness is an indicator of safer sex, and this requires two partners to stick on each other (this is according to 20% of respondents from group, and 16.7% of respondents from group II).
Sharing of sharp instruments/objects is one of the most ways which can lead to an increased number of HIV/AIDS infect persons, therefore stopping sharing sharp instruments/objects would mean stopping H1V/AIDS transmission from one person to the other (10% from group I and 18.% from group II).
Further more the content of analysis revealed that a fairly high percentage of Group I respondents (20%) and group 11(10%) believed that the more blood is tested before transfusion, the more HIV/AIDS transmission is most likely to be stopped. Therefore these two groups depicted a high intention of having blood tested first before transfusion.
Still strengthening public sensitization programmes about HIV/AIDS scourge is one of the ways which can be used to reduce on the HIV/AIDS transmission. This is don&~ through using posters, seminars, drama presentation and the media. This is related to
86 what is indicated in the literature review, under the sub- topic strengthening the care systems, where it is clearly stated that strengthening of the health care system in the context of HIV/AIDS was envisaged in terms of the country’s public and private health facilities being in position to provide progressively an~ in a sustainable manner, the highest attainable standard of treatment for HIV/AIDS scourge.
On the other hand the risky areas lead easily some people to be victims of HIV/AIDS scourge (6.7%). Therefore such areas should be avoided in order to reduce on the spread of HIV/AIDS scourge. Such areas were identified as bars and fishing grounds.
The study also revealed that an accident leads some people to be victims of HIV/AIDS scourge (6.7% of respondents in group II). This happens when the accident occurs and thereafter blood and body fluid contact of different people takes place. Therefore there is a need for people to stop driving recklessly in order to avoid fatal accidents, which later will lead some people to avoid HIV/AIDS.
4.14 Management chaDilenges faced by NGO offDcialls. According to the content of analysis of reasons given on management challenges in NGOs shows that, there is insufficient food to give HIV/AIDS victims to complement on the treatment, and this is one of the most challenges experienced by the NGO officials (35%). It was clearly revealed that lack of enough food interferes negatively with the quick recovery of HIV/AIDS infected persons’ health conditions.
The rigidity of HIV/AIDS victims to pay user fees (1000=) per month has contributed to the management challenges, because this money is used to buy other basic needs used to run the day to day activities of the NGO, and short of them (contributions), means that the NGO officials have to experience hardships while running the Organization.
It was also revealed that a abandonment of the HIV/AIDS patients by their relatives leads to a big challenge to the NGO officials (still according to 30% of respondents),
87 this is so, because some people neglect the HIV/AIDS patients, and the NGO officials takes the responsibility of looking after them, some thing which is not simple in all ways.
The breakdown of social service structures makes it a little a bit hard for the NGO officials to meet all the needs of the HIV/AIDS patients (25%), this is due to insufficient resources. Also determining those who are more needy than others among the HIV/AIDS patients by the NGO officials has proved to be a challenge, most especially when it comes to distribution of food, sugar, blankets, four iron sheets, basins and mosquito nets, whereby the rich also wants these items, instead of leaving them for the very poor, although both groups (rich and poor) are HIV/AIDS positive. Further more, the increased number of registered HIV/AIDS patients with the NGO has proved to be a burden, because the organization has limited resources which can not be used fully to meet all the needs of the patients.
Whereas 15% of the respondents revealed that the conditions attached to the funds by the donors, are not so much favorable, and because of this, the NGO officials face some challenges while providing social services to the patients. In addition to donor conditional ties, there is attendance of delaying to receive funds from donors.
The NGO officials face a challenge of having very few counselors/social workers (according to 20% of respondents). This problem affects the organization itself and the clients as well because sometimes they (clients) can not be served in time. Then because of illiteracy, the HIV/AIDS victims sometimes fail to take the drugs as prescribed by the physician and this means that the NGO officials are always on a task of sensitizing them about how to use the drugs properly and in time but still some of them (HIV/AIDS victims) fail to concur with what they are told to do (20%) and thus exposes the NGO5 officials to a challenge.
:~i~ ~
88 About the drugs, the respondents revealed that they always face a challenge of havin~’ insufficient drugs (s) for the clients most especially for the opportunistic infections (TB). This delays the HIV/ATDS victims to begin taking ARVS.
Further more,5% of the respondents revealed that the catchrnents area (21km) is too big for them to travel and be able to finish visiting all the NGO clients, since they are even scattered over different areas. All these factors, as indicated above acts as management challenges for NGO officials, and of course these challenges affects negatively the day to day activities of the organization.
4.15 Causes of management challenges in NGOs~ Evidence shows that the biggest management challenge in NGO5 is lack of enough funds (20%) to use in running the day to day activities of the organization. This challenge fails the NGOs officials to complete all their stated objectives in time.
The daily increasing numbers of HIV/AIDS patients (15%) has been also identified as a big challenge, because as the number of clients increase, there is also a need to increase on the resources which can bee used to meet the needs of the registered clients and this is a little abet expensive for most of the NGOs taking care of HIV/AIDS infected persons.
The content of analysis of reasons given on management challenges of NGOs, revealed that, donor policies and terms of work (15%) some times leads to insufficient services offered to the HIV/AIDS victims. For example, there is a condition that before a patient begins using ARVs, the counselors/social work must visit him/her first, and yet some of the clients stays very far and even in scattered areas, and this is not a simple task to do since this exercise is characterized with a lot of tracing the clients residence, and even the NGO lacks motor cycles and vehicles which can be used to reach deep in the rural areas.
89 Further more, illiteracy of the clients (10%), leads the NGO officials experience challenges, this is so because some of the clients are illiterate, to the extent that they can not understand the prescriptions of the doctors. This shows that some of the HIV/AIDS patients do not take the drugs (ARVS) as directed by the physicians.
Some of the respondents (10%), insisted that some of the employees (counselors and social workers), fear to visit clients who are in war torn areas knowing that they may die from there. This challenge affects most HIV/AIDS patients, because they can not be allowed to start taking ARVS before they are visited for. This force some of the NGO officials to refer their clients to other NGO5 operating within their districts of residence, but this kind of referral in most cases is not clear, because the reasons for referring the client to another NGO may not be indicated, and yet it is required that, the referring provider should explain to the client the reasons for the referral, and what takes place at the referral site. This was found to be in line with what is indicated in the literature review as reported by Eritrea, Ministry of Health (2001).
The poor implementation of the NGO policy still remains a challenge (5%), because some of the policies implemented do not favour the NGO employees, and this ends up demotivating the workers to serve the HP//AIDS patients with all the social services they (HIV/AIDS clients) would be in need.
Networking with other NGOs which provides the same service is also a challenge (5%), because poor networking means that referrals of clients to other NGO5 would not take place as required to be done to the clients for services not offered at the organization. This challenge of networking is clearly discussed and in line with what is in the literature review under the sub-topic of challenges affecting HIV/AIDS related NGO5,(Craneand Cars Well(1990).
I
90 4~i6 Effects of management challenges on daily activities of an NGO~ One of the most effect is that the quality of services supposed to be offered to the HIV/AIDS patients, has to reduce (35%), and this affects more the HIV/AIDS infected persons, because this means that some of the patients will have to stay with no or little social services, and this is dangerous to their lives.
Also according to the content of analysis from the results obtained, it is clearly indicated that the NGO employees in most cases experience the effect of having too much workload due to the fact that most patients visit the organization on different dates not indicated on their medical cards and this leads to an overwhelming numbers of HIV/AIDS patients seeking social services on a daily basis (20%),as result of having such big numbers, the NGO employees fails to monitor so well the quality of services offered to the patients. Yet according to the literature review it is clearly indicated that, it is the responsibility of the health team; of course with the support from supervisors and managers and other support staff, to ensure that they always monitor the services offered to the patients, for the interest of having quality services given to the HP//AIDS infected persons.
The content of analysis also revealed that, failure to accomplish all the organizational goals, is among the most effects experienced by an NGO management (20%),and this is due to lack of adequate funds, lack of well qualified personnel and poor implementation process of an NGO policies. All these affect the daily activities of an NGO negatively.
The conflicts between HIV/AIDS infected persons and social service providers (NGO employees), it was found out that some of the HP//AIDS patients develop conflicts against their care providers(1O%),and this is because some of the patients think that, some of their fellow patients are favoured in one way or the other, in as far as
91 provision of social services is concerned, and this affects the day to day activities of an NGO, because sometimes its hard to convince some of the clients as to why their fellow clients get more social services than them. For example some of the HIV/AIDS patients are given food and 4 iron sheets while others are not given ar~y of these. Such conflicts between the patients and NGO employees also leads to conflicts between the l-IIV/AIDS patients and their family members, because of the failure of NGO employees to get closer to all the family members of the patients and provide all the necessary assistance, and this leads to increased problems within most of the HIV/AIDS infected persons families. This issue of conflicts is almost in relation with what is indicated under the sub-topic of HIV/AIDS and conflict in the literature review whereby it is clearly stated that conflicted related issues leads to increased poverty, dependency, powerlessness, bartering and sexual coercion. Therefore there is a need to solve conflicts among HIV/AIDS infected persons together with their families and relief agencies, in order to reduce on the management challenges faced by NGO5 officials. Then 30% of the respondents demonstrated that because of the challenges experienced in NGO management leads to an effect of shortage of drugs (ARVS) for the patients, and this is dangerous to their lives, since most of them depend on ARVs for survival. Further content of analysis also revealed that because of the challenges faced leads to an effect of disorders in patients’ flow, to visit the organization on specific days due to illiteracy coupled with careless of some of the patients.
4~17 Appropriate ways used to reduce on the management chaNenges of an NGO~ The respondents’ views were that, there is a need for the NGO to have more funding agencies, or the government, and other well wishers who have the interest of helping HIV/AIDS infected persons. This one has to solve the problem of lack of enough resources. Further more the NGO officials should enroll a specific number of HIV/AIDS infected persons who can fit into the NGO programmes, but not enrolling a big number /c,~ /~“~ 92 DATE ~ who can not be served with the available resources, this was according to 40% of ti2221~7 respondents.
The provision of life guards is also considered as an important factor which can act as an appropriate way to reduce on management challenges (30%). The respondents (30%) suggested the provision of life guards to both the HIV/AIDS positive people and as well as the negative people, because life guards reduce at the rate, at which people can be infected with the virus. Therefore this would reduce on the number of HIV/AIDS infected persons who would seek social services from the NGOs.
The local NGOs and donor policies should be revised in consideration of the technical staff, such that all departments within the organization can present their ideas which can reduce on the challenges, and later leads to development of an NGO. Still this is according to 30 % of the respondents.
The clients should also be sensitized about the importance of paying user fees such that all of them can be able to pay willingly without hesitation (15%).
The analysis of the data revealed that, home-based visitation; HIV counseling and testing to the HIV/AIDS infected persons, together with their family members is the best way which can reduce on the management challenges in an NGO (raised by 15% of the respondents). This helps so much because the family members are advised on how to handle the HIV/ATDS patient without mistreating him/her, and they are also advised to test for HIV/AIDS. However, normal procedures for entry into the family should be observed by the social service providers. Home based and HIV counseling is clearly indicated in the literature review, whereby it is clearly stated that home based HIV counseling and testing is a modified model of voluntary counseling and testing provided to individuals and families in the home environment.
93 CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECCOMENDATIONS
5~O Summary In here the researcher made a clear summary of the research findings as follows; The study revealed that the problem of daily increase of HIV/AIDS infected persons creates a big challenge to most of the Non-Governmental organizations. The HIV/AIDS patients are people who need much assistance since they are always found of being sick for along period of time, because of this HIV/AIDS victim in most cases they become the victims of poverty, unemployed and yet most of such people are heads of the families.
If the HIV/AIDS is to reduce, then sensitization programmes are required for both the I-IIV/AIDS infected persons and to those who are HIV/AIDS free, this makes it easy for every body to understand the dangers of infecting other people who are negative and also makes it easy as well for most of the people to know how the dangerous the scourge is, and later try to forge ways on how to avoid it by using protective measures.
The study revealed that Non-Governmental organizations respond immediately to the needs of the HIV/AIDS infected persons than any other actor(s) do, and this has helped them (HIV/AIDS victims) to improve on their social life, because of the social services they get from NGOs, and as a result they are able to stay for a long period than they would do, when there are no NGOs.
The government and other well wishers need to take a greater interest in as far as the financial assistance to the NGOs is concerned. This will give a chance to the Governmental organizations to serve better the HIV/AIDS infected persons.
95 The big proportion of the HIV/AID infected persons revealed that most of them suffer from stomach pain, malaria, headache, joint pain, cough, skin rushes and chest pain. All this makes their life condition difficult to improve quickly. Therefore some of these constant sicknesses contribute much towards the HP//AIDS irfected persons death. The study revealed that some of the relatives of HP//AIDS infected persons neglects them whenever they fall seriously sick, leaving all the burden to the Non-Governmental Organizations care givers, a situation which creates a very big challenge for NGO5 to meet all the needs of such people, with the limited resources they some times have.
The study revealed that the delay of the government to release drugs for opportunistic infections (like Tuberculoses TB) to the Non-Governmental organizations, makes it difficult for the NGO5 Officials to recommend the HIV/AIDS victims to start taking ARVs before curing other diseases a long side HIV/AIDS Scourge.
Many HIV/AIDS patients are not willing to pay the user fee of 1000 shillings per mother, and this acts as a challenge for the NGOs because they can not be able to meet some of the needs to use, in an attempt to cub down HIV/AIDS. This leads to some of the HIV/AIDS positive stay without enough drugs food and other related social service, a situation which exposes their life into terrible conditions.
Poor Non-Governmental organizations policy makers were identified as the major challenge faced by NGOs. What should be noted is that the poor policy makers lead all the stakeholders of an NGO to suffer in one way or the other. Thus, any Non Governmental organization having such a problem needs to rectify it, in order to serve its clients and employees as expected.
5~i Conclusion The purpose of this paragraph is to draw appropriate conclusions and suggest recommendations for the future action. FC~r>., 7— \ I— i;~j 96 Here the researcher has made general conclusions from the study findings. The conclusion follows the hypothesis that was proposed and verified. The hypothesis stated that “the negative attitudes of the general public affects the delivery of social services to the HIV/AIDS i~,tected persons by Non-Governmental Organizations (NGOs)”~ Results indicates that very high percentages of respondents’ attitudes are positive towards the NGO5, because of the good services offered to the HP//AIDS patients; apart from 5% of respondents who had a negative attitude towards NGOs. However, what should be noted is that, the number of respondents which had a positive attitude towards NGOs out weighs the number of respondents which showed a negative attitude towards the NGOs.
On the null hypothesis, the researcher would venture to suggest that, according to the data analyzed, the NGOs are not well prepared, they lack enough resources to use while providing social services to the HP//AIDS infected persons, they depend on donations, and in case of any delay of the funds and other resources, means that the NGO5 daily activities will be at a stand still.
Still on the null hypothesis, NGOs are not well prepared because although they offer good services to the HIV/AIDS patients, but not all the social services provided are followed and fully utilized by the patients; for example most of the HIV/AIDS infected persons are advised to use condoms by the NGO officials, but not all of them adopts the advise of using the condoms, in order not to acquire more viruses or not to infect those who are HP//AIDS free. This means that NGO officials need to add in more effort in as far as convincing all their patients / clients to adopt a positive attitude towards the use of condoms.
It is important to note that, although there are many challenges experienced by NGOs, but they have thed to solve them in order to remain in the system of helping the HIV/AIDS victims, such that they can improve on their social life.
97 Therefore, the role played by NGOs in provision of social services to the HIV/AIDS victims, in prevention of HIV/AIDS transmission, and encouraging healthy sexual intercourse should not be under estimated, because without them, most of the people would not be able to survive for a long period with the virus. :t is therefore important to appreciate the work done by the NGOs in an attempt to fight against HIV/AIDS scourge, since they do this willingly, in order to ensure improved health condition of the HIV/AIDS victims.
Generally in an attempt to fight against HIV/AIDS scourge, there is a need for the government to assist the NGOs with funds in order to enable them overcome some of the challenges they face while offering social services to the HIV/AIDS victims.
The government also should ensure the provision of free medical care, social security like other countries do (like Sweden), so that the health conditions of the HIV/AIDS victims can depend on the care of the country.
5~2 Recommendations Analysis and interpretation of the data for this research as depicted in chapter four has exposed the following areas as potential weaknesses of an NGO programmes in an attempt to provide social services to the HIV/AIDS infected persons and therefore recommendations are suggested as follows:
The study findings established that the organization registers many males compared to females. Therefore there is a need to balance both sexes as they register the HIV/AIDS infected persons, so that all of them get a chance of being supported by the organization. Even the registration of new clients should cover people out side Kampala district, other than providing social-services to big numbers of people from Kampala district compared to other districts.
98 The study also found out that the organization suffers from having few doctors and counselors/social workers, a situation which delays the social services to be offered to the I-IIV/AIDS infected persons in time~ Therefore the organization should make every thing possible to address this problem, and even the couns€lors/social workers should be given tags to dress for easy identification by the HIV/AIDS patients.
The issue of net working in Non-governmental organizations was found to be a very big challenge as they offer social services to the HIV/AIDS infected persons. This has left some of the HIV/AIDS victims without getting some of the social services, because some of the NGOs do not know each other and the services offered. So the Non Governmental organizations should strengthen networking with each other in order to make the referral exercise easily conducted.
While analyzing the data the study revealed that the Non-Governmental organizations some times experience problems of how to develop a good method which can be used to identify the HIV/AIDS infected persons who are much more needy than others, such that other social services a part from ARVs can be distributed according to the level of poverty. Therefore, Non-Governmental organizations should ensure that a good method is developed such that some of the social services are provided to those who really deserve them instead of giving much more social services to those who already have a lot and leave out the needy suffering.
The Non-Governmental organizations some times lack enough funds to use while providing social services to the HIV/AIDS infected persons, this problem affects much the day to day activities of an organizations (s); the government should therefore provide financial support to the NGOs in order to avail them with enough resources to meet most of the needs of the HIV/AIDS victims. This may improve on their health conditions, since some of them suffer from malnutrition a condition that makes it difficult for the medicine to work against HIV/AIDS.
99 The study revealed that some of people from the general public do not appreciate the big role played by the NGOs towards the wellbeing of the HIV/AIDS infected persons, and to the development of the whole country at large. So the government should take the responsibility of sensitizing the public about the importince of non-governmental organizations, instead of despising the NGOs officials that they aim at diverting the money of the donors to meet their own needs.
Stigma was revealed as a psychological social problem faced by the HIV/AIDS infected persons. So the Non Governmental organizations counselors/social workers should make sure that regular counseling services are provided whenever HIV/AIDS patients visit the organization, instead of counseling them after along period of time as they do in most cases.
Some of the HIV/AIDS infected persons fails to utilize the services provided to them fully as guided by the physician (s), for example some fails to take ARVs in time and this was revealed that, some do it intentionally because of being tired to take them on a daily basis. However, this exposes their lives at risk; they should therefore concur with what they are advised to do by their care givers; if they are to stay with the virus for along period of time.
Further more the study revealed that the HIV/AIDS infected persons can act as the major people to stop the HIV/AIDS transmission, they should therefore work as example to those who are HIV/AIDS free, by sensitizing them using the radios, drama and among others, about how dangerous the scourge is and what they can do in order to avoid it, but not to infect them intentionally.
Some of the HIV/AIDS patients are chassed away from their jobs by their bosses even before they become too weak not to work, therefore they should not be stopped from working so long as they can be able to perform their duties like any other person
100 L
not HIV/AIDS positive. This is so because they also need to earn a living in order stay for along period of time with the virus.
Finally the church leaders should put much emphasis on sensitizing the Christians about the dangers of the HIV/AIDS scourge and on how it can be avoided.
5.3 Further Research 1. The findings of this exploratory study are just a representative sample of the area under study. So the hypothesis developed, and verified still remains to be tested and verified in the whole of Uganda by interested future researchers.
2. This study has mainly concentrated on management challenges in NGOs in the provision of social services to the HIV/AIDS patien~ at Nsambya Hospital Home Care, in Kampala district, as a representative of other NGOs. Therefore there is need to seriously consider a study, of this same nature in other organizations with in and outside Kampala district. This will establish similarities or differences in results.
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104 Uganda AIDS Commission (1998), Annual Report on HIV/AIDS.
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Evolution of the epidemic and Reponses - Uganda. Uganda AIDS Commission, Measures Evaluation (2003), AIDS in Africa, During the Nineties in Uganda.
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Reproductive Health - UNFPA New York.
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105 World Food Programme (2003), Annual Report on HIV/AIDS Scourge
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I I
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106 APPENDICES
APPENDIX A: INTRODUCTORY LETIERS
TUMUKUNDE ALOYSIUS KAMPALA INT. UNIVERSiTY P.O.BOX 20000 UGANDA
8TH JUNE 2006
Dear Sir/Madam,
RE: REOUEST FOR RESEARCH INVESTIGATION
I hereby wish to submit my request to you, for the above mentioned subject. Am a student at Kampala International University, registration number MA DAM-PT-2004- 012; and offering a masters degree in Development Administration and Management. I wish to carry out research on “Management challenges faced by NGOs in provision of social services to the HIV/AIDS infected persons in Nsambya Hospital Home Care”. This is one of the requirements which will enable me to finish the course. Therefore feel free to furnish me with any kind of information as much as you could. The information given will be treated with utmost confidentiality.
Thanks Yours faithfully,
TUMUKUNDE ALOYSIUS
107 P.Q.BOX 20000 KAMPALA- UGANDA. KAMPALA TEL:-041 -266813 INTERNATIONAL UNIVERSITY
OFFICE OF THE ASSOCIATE DIRECTOR SCHOOL OF POST-GRADUATE STUDIES
25th June, 2006
The Executive Director Nsarnbya Hospital I-Tome Care KAMPALA
RE: !N~ DUPTPRYLET1~? PT..2oO4-Oi~ uKtJNp E ALoY~~M~flAM
The above mentioned, is our student in the School of Post Graduate Studies. He is doing a Masters of Arts in Development Administration and Management (MA DAM).
Aloysius is currently doing his research on “Management Challenges Faced by NGOs in Provision of Social Services to the HIVIAIDS Infected Persons in Nsambya Hospital Home Care” as a final requirement for the award of Masters of Arts in Development Administration and Management of Kampala International University.
Any assistance accorded to him will be highly appreciated.
Thank you very much for your services.
DR. AN~3ELITA l~ESCADERO-CANENE AssocIate Directpr~ SPGS /~:r~ /
\- N / /
APPENDIX B:
RESEARCH QUESTIONNAIRE FOR NGO’S OFFICIALS
This questionnaire is designed by MR. TUMUKUNDE ALOYSIUS a student of a Master of Arts in development administration and management of Kampala International University. This instrument is meant to gather data about the above mention topic and the information will be used in the Masters Degree research project. Kindly assist to fill in this questionnaire as faithful as you could. It is not meant to test your knowledge, but rather gather necessary information about the above mentioned subject under study. It is for academic purposes and any information given will be treated with utmost confidentiality. You do not need to write your name.
1. Name of the organization 2. Your department 3.a)Sex: MaleEEl Female ~ b) Age 20-29 ~ 30-39 ~ 40-49 50-59 ~j 4. a) What kind of management challenges do you face as you try to offer social services to the HIV/AIDS infected persons? b) What are the causes of the above mentioned management challenges?
c) What effects do they (management challenges) have on the day to day activities of the organization? d) What could be the most appropriate ways used to reduce on the management challenges (indicated above in No.4) of NGOs?
108 5. Is the public attitude towards NGOs Positive or negative? If positive or negative, why?
6. Are there social services offered to HIV/AIDS infected persons by your organization? Yes No b) If yes what are they?
c) If no, why?
7. How does your organizational social service help the HIV/AIDS infected persons?
8. a) How many counselors and social workers do you have in your organization? Counselors
109 4:
Social workers b) What is their qualification? Degree LEI Diploma Certificate EJ c) Do you think these counselors/social workers keep the information of the HIV/AIDS infected persons confidential?
If yes, how does it help both the social workers, counselors and the HIV/AIDS infected persons respectively.
i) What are the effects of disclosing the client’s information to other people?
9) What could be the factors that attract/force social service providers to be friendly to the HIV/AIDS victims?
10. a) What is the source of funds for your organization?
110 c ‘~
(~POS1 ~ADUATE~fl LIBRARY ~1 DATF~
b) Are there some conditional ties attached to the funds provided?
i) If yes, what are they?
11 a) Do you co-ordinate/network with any organization providing social services to the HIV/AIDS infected persons here in Uganda or outside Uganda? Yes No
b) If yes, what are they?
c) If no, why?
12a) what are the known figures of people who have died of HIV/AIDS, in Nsambya Hospital Home Care, since its inception up to date?
111 13. a) According to your organizational research, shall there be an increase or a decrease of people infected with HIV/AIDS persons within the 10 years to come?
b) If there will be any of the two (increases or decrease) what will be the anticipated figures?
14. a) Do you know all the ways how HIV/AIDS is transmitted from one person to an other? If yes state those you know.
b) How can it (HIV/AIDS) be prevented/controlled?
15. Do you have any thing you would want to tell me apart from what I have asked you?
Thank you so much for committing your valuable time in responding to this questionnaire.
112 APPENDIX C:
RESEARCH QUESTIONNAIRE FOR HIV/AIDS INFECTED PERSONS
This questionnaire is designed by MR. TUMUKUNDE ALOYSIUS a student of a Master of Arts in development administration and management of Kampala International University.
The questionnaire seeks to collect data from the HIV/AIDS infected persons, about the social services they are offered by Non-Governmental Organizations. It is for academic purposes and any information given will be treated with utmost confidentiality. So feel free to give any kind of information as you could. It is not meant to test your knowledge, but rather gather information about the above mentioned subject matter under study.
You do not need to write your name anywhere on this questionnaire. Kindly tick/fill in a blank space where appropriate 1. Name of the organization 2. a) Sex; Male ~j Female ~ b) Age 12-18 EEl 20-29 EEl 30-39 EE 40-49 [El 50-59 [EE d) Religious affiliation e) Place of Residence f) Source of sensitizing information about sexual behaviors
113 What kind of social services provided to you from Non-Governmental Organizations NGOs)?
What is the interval period between the visits to the organization? everyday [Zj ii) twice a week ~ iii) after a week i) After two weeks ~ v) once in a month ~ vi) Twice a month Are those social services received/offered useful to you? ~es ~ Jo a) If yes, how?
Are the social service providers friendly to you? ‘es EEl lo
) If yes, in your own thinking, what could be the factors that force them to be friendly to you?
F no, what do you think could be the problem with them?
114 Do you trust the organization? I yes why?
I no why?
ia). what could be the social problems faced by you as HIV/AIDS patient, dealing with he NGOs?
low have you tried to coupe with the above mentioned problems if any?
) What could be your (HIV/AIDS) attitude towards the use of condoms?
0) In your own thinking, how can HIV/AIDS be stopped from being transmitted from ne person to the other?
1. Do you think social workers/counselors keep the information you give them onfidential? es lo
115 .2. Should the organization disclose the information it has on p3tients like you? f yes explain why?
f no explain why?
.3. What is your recommendation (s) about Nsambya Hospital Home Care?
.4. Do you have any thing you would want to tell me apart from what I have asked rou?
hank you so much for committing your valuable time in responding to this luestionnaire.
/ 9~( D~’~ ~
116 ~.