Quarterly Status Report April 1, 2013 – June 30, 2013
Submitted by:
The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs and Uganda Health Marketing Group – UHMG CONTENTS
2 ACRONYMS
ACT Artemisinin-based Combination Therapy ANC Antenatal Care ASDE-U Advocacy for Social Development and Environment – Uganda BCC Behavior Change Communication BP Business Plan CCP Johns Hopkins University Bloomberg School of Public Health/Center for Communication Programs COC Combined Oral Contraceptive COP Chief of Party CS Child Survival CHIC Condom & HIV/AIDS Information Centre CME Continued Medical Education CSW Commercial Sex Worker DHIS2 District Health Information System DHT District Health Team EMTCT Elimination of Mother to Child Transmission FP Family Planning GLC Good Life Clinic HCT HIV Counselling and Testing HF Health Facility HCU Humanitarian Care Uganda HCWM Health care waste management IEC Information Education and Communication IPC Interpersonal Communication ITN Insecticide treated nets KAP Knowledge, attitude/perceptions and Practices LLIN Long Lasting Insecticide Treated Nets LTFPM Long-term Family Planning Methods MARPS Most At Risk Populations MNCH Maternal, Newborn and Child Health M& E Monitoring and Evaluation MOH Ministry Of Health MOU Memorandum of Understanding NBMC New Born Mothers’ Clubs NDA National Drug Authority NMCP National Malaria Control Program NMS National Medical Stores OVC Orphans and Vulnerable Children PLHA People Living with HIV/AIDS PMO Product Marketing Officers
3 PMTCT Prevention of Mother to Child Transmission PO Project Officer POP Progesterone Only Pill POS Point of Sale PTC Post Test Clubs PW Pregnant Woman PYVs Park Yard Volunteers RUTF Ready to Use Therapeutic Food SMGL Saving Mothers Giving Lives SS Support Supervision SSECODA Ssese Community Development Association STI Sexually Transmitted Infection TASO The Aids Support Organization UDHS Uganda Demographic and Health Survey UHMG Uganda Health Marketing Group UNFPA United Nations Framework for Population Activities
4 INTRODUCTION
This report covers activities undertaken from April 2013 to June 2013, or the third quarter of fiscal year 2013 (FY13) of the AFFORD Health Marketing Initiative in Uganda, funded by the United States Agency for International Development (USAID) Cooperative Agreement 617-A-00-05-00011-00. The award was made on September 21, 2005 to The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). The AFFORD Health Marketing Initiative that ended its 5 year USAID funded project in September 2010 (AFFORD I) received a 3 year extension until September 2013 (AFFORD II) with the primary responsibility of strengthening UHMG into a sustainable entity.
During the project extension period AFFORD II has the primary responsibility to ensure that UHMG is strengthened to become sustainable and develops cutting edge competencies in technical, marketing, financial and institutional areas.
AFFORD II through UHMG will continue to consolidate its activities and will focus on the 3 key result areas. Specifically, AFFORD II will build on the foundation of AFFORD I to achieve: 1) Increased organizational sustainability of UHMG; 2) Increased availability, affordability of health services and products; and 3) Enhanced knowledge for self-efficacy and correct use of health services and healthy practices.
This report focuses on the performance of the two strategic business units (SBUs) of UHMG—the Product Facility and the Programs Consultancy as well as the cross cutting activities including social marketing, communication, research, human resources and administration, and finance and investment that support the functioning of the two strategic business units. In addition, AFFORD II Capacity Building achievements are summarized below.
Result 1. UHMG Capacity Building AFFORD II Capacity Building is designed to help UHMG to achieve increased financial, institutional and market sustainability. Capacity Building focuses on five organizational and management domains: 1. Strengthening Performance Management and Quality Management systems 2. Improving data utilization and Knowledge Management processes 3. Developing innovative program, product and service strategies 4. Building business development systems 5. Strengthening financial systems
Highlights of Capacity Building achievements are summarized in the table below.
5 CAPACITY BUILDING EVIDENCE OF FY 2013 (Year 3) Achievements OBJECTIVE ACHIEVEMENT 1. PERFORMANCE MANAGEMENT & QUALITY MANAGEMENT Establish Senior Management & MD, Dir Finance and Sr. Mgrs track contract performance supervisors produce clear performance monthly management system performance indicators for enhanced quarterly Performance monitoring tool developed to serve as monitoring and Performance-based Contract Scope of Work; tool supervision by UHMG has been applied by all UHMG Divisions in Qtr 1 - and BOD Qtr 3 Summary review and documentation of all technical indicators conducted quarterly and reported to Sponsors and BOD
Effective, documented HR Audit conducted by AFFORD KPMG COMPLETED, quarterly and annual re-calibrating staff KPIs and strengthening staff review process is linked to performance appraisal practices staff motivation, performance and KRA and KPI quarterly and annual review conducted advancement and system documented Managers hold staff accountable for performance to KRAs and KPIs; trial performance plans on new KPIs tested on six staff and currently being reviewed for roll-out
Promotion, salary increases or recognition linked to achievement of KRAs and KPIs (occurs case by case)
MD, Directors & UHMG operates as a BOD, MD and staff committed to improved stock Operational commercial sector management practices in PF, assisted by managers adopt a company that makes AFFORD/KPMG ‘private sector’ strategic decisions based management practice on profitability as well as Stock-counts conducted routinely; variances risk-reduction and staying at reduced levels stewardship of capital assets, including product Debt recovery practices improved for enhanced stocks cash flow New products assessed for profitability, and adopted accordingly
Profitability analyses conducted quarterly; Business Plan progress tracked quarterly by BOD
6 All strategies generated by All key strategies developed by Senior managers are vetted Management and operational staff through a through organizational consultative process, and vetted by the MD and the approval processes BOD; AFFORD KPMG reviews and assists as needed, especially with the implementation of new strategies such as eMTCT
Quarterly Performance All strategies and their implementation assessed by Reports (programmatic management and operational staff for and financial) submitted to effectiveness and cost-efficiency BOD and Sponsors Deliverables produced and quarterly targets achieved, and assessed by BOD and sponsors against UHMG Business Plan and sponsor- supported Annual Workplan
BOD, MD and Senior Managers seek to take corrective action within next quarter in the event targets are not being met
The product facility PF Profitability analysis conducted quarterly; operates as a profit center profitability improved over FY2011 (see Financial & The programs unit Systems below). operates as a cost- recoverable consultancy UHMG procurement policy manual strengthened business and finalized, and improved procurement planning being practiced by PF to avoid stock shortfalls
Program Consultancy expands technical strategies and actively seeks new funding for programs (see Business Development below)
A Quality Hire internal auditor Internal auditor hired; external A-133-Type audits Management system High level of compliance conducted annually; findings reduced. for enhanced with internal systems and organizational external regulations Risk Management Register completed with AFFORD responsiveness according to compliance KPMG assistance and UHMG inputs conceptualized, and audit reports Recommendations of internal and external audits implemented and Orient staff on use of systematically pursued with BOD and MD support sustained by UHMG mandated protocols and and AFFORD/KPMG assistance, specifically in the staff and Board standards; Orient & coach areas of stock management; human resources; staff on compliance financial management; procurement; and IT Staff monitored for practices compliance every quarter Sr. Mgmt consistently enforce compliance requirements; Sr. Mgmt identifies and takes remedial actions on audit findings within next quarter Staff oriented and coached on compliance principles and practices, with AFFORD/KPMG assistance Internal auditor with Dir. Finance and HR has conducted quarterly compliance audit review;
7 AFFORD/KPMG has conducted quarterly progress reviews
Adapt MOH guidelines and Staff applying MOH quality assessment protocols in protocols for service the field (e.g., with Good Life Clinics) quality assessment Products certified by The PF is in the final stages of obtaining ISO international body (ISO) Certification; now in stage of ISO auditing; No prediction on time of certification.
Quality Management: Improve internal processes Marketing and Strategic Information (MSI) meets Improved internal that inhibit or facilitate with Product facility (PF) to facilitate distribution communication and objective performance coordination MSI meets with Programs Division on budgeting to facilitate local implementation (e.g., Smart Choices, SMGL, GLC Promotion)
MSI meets regularly with finance to facilitate procurement
Senior Level Management (SLM) has regular and open communication with Managing Director (MD) for improved vertical organizational communication (weekly meetings routine)
The Board of Directors is advancing its vision of UHMG sustainability through a focus on meeting business targets, supporting strengthened HR, and reducing organizational risk.
2. DATA UTILIZATION & KNOWLEDGE MANAGEMENT Create a Both strategic business Sr. Mgmt use monitoring and evaluation data in all comprehensive units utilize research data quarterly reviews, including retail Audits, and monitoring and and monitoring tools Audience Reach results. Additionally, BCC Survey evaluation systems to quarterly to design and results have been disseminated internally and to form and assess evaluate all major product, external stakeholders and are being used in project organizational service and program reporting. strategies initiatives Data shared internally through inter-departmental meetings and through shared electronic drives of Implement Data shared internally and archived material Knowledge externally Data shared externally through dissemination Management systems th to share data meetings, such as the June 4 “UGMG Today and internally within the Tomorrow” Stakeholder event. Website populated organization and with updated material. Corporate info-pack created externally among to facilitate external data sharing among UHMG stakeholders stakeholders in various meeting fora Tracking tools used by all Managers utilize tracking tools to monitor activities managers to monitor on a quarterly basis, specifically: Retail Audit; activities and progress, Synovate Media Reach reporting; BCC Survey specifically: product conducted in collaboration with USAID
8 distribution, sales, Implementing Partners (IPs). These studies are availability, program discussed in more detail in the Research section of implementation, media the present report campaign monitoring, USAID Database indicators routinely reported to community activities and USAID activities at GLCs Work-plan Implemented Technical staff develop program plans and submit to Research Advisor for feedback (e.g., Smart Choices, EMTCT, PMI; SMGL; GLC Strategy) Technical staff use program data and research findings to inform programmatic decisions, such as media plans, brand promotions, and field follow-up among GLCs. 3. INNOVATIVE STRATEGIES Ensure mutually All Program Division Product & program linkages inform strategic beneficial and activities link to relevant decisions and outputs, for example, the delivery of effective linkages and health products through LTMs to trained service providers and how it synergy occurs joint implementation plans impacts UHMG CYPs between UHMG’s and reports business units Ensure that all UHMG All strategies based on HIV/AIDS programs in place and judged cutting programs are recent data and edge by stakeholders: for example, in HIV Strategies considered strategic information obtained from for EMTCT UHMG has taken the lead to coordinate and high quality by clients and their communication activities for two regional launches donors, clients and communities with the first lady, while running a national staff campaign with 78% message reach (see Reach Increased involvement of Table in this report) UHMG has also actively clients and communities in cooperated with service delivery IPs to improve UHMG programs health among MARPS (e.g., coordinated promotion and service delivery with STAR-EC, SPEAR, and in Kalangala with private sector partners)
RH/FP programs linking to products and services, e.g., DFID “Smart Choices” Family Planning conducted at scale
Retargeted malaria ‘test & treat’ program coordinated with Stop Malaria Program was launched in Qtr 3
Retargeted MNCH programs operational linking to products and services and integrating HIV services, products and practices, e.g., Saving Mothers Giving Life (SMGL)
Ensure that UHMG Marketing strategies Communication Officers create strategies and marketing strategies developed, documented agencies with limited external support, e.g., eMTCT, are evidence-based and implemented condom promotion, Test & Treat for Malaria and achieve stated Increased market demand targets for services and products Marketing and Brand Mgrs can routinely identify and targets achieved linkages between products and programs; evidenced in joint MSI-PF meetings Establish routine Operational database of MSI & PF routinely use and update database of
9 communication with key customers, used by suppliers and customers customers and product and program suppliers managers Marketing events taking place per Work-plan (relationship Brand managers develop Sales increase slower than anticipated due in part marketing) and functional communication to widespread availability of free products and strengthen related strategy with customers services in the “private sector” marketplace management systems Ensure that all 3-month stock supplies on Stock-outs or shortages in RTP or UHMG Product Facility hand and stock expiry at products: while brief warehouse stock-outs operations are 0%. occurred in Jan (PilPlan) and Feb (Protector), these considered shortages did not affect the retail market, which sustainable and Spot check reports on maintained supplies to the end-user through dependable by compliance of procedures products they had in pipeline (see Retail Audit donors, clients and and systems; quarterly section in Qtr2 Technical Report and in this Qtr3 UHMG staff stock procurement plans in Report). By Feb/March, the warehouse supply had place recovered and the retail market remained stable throughout Qtr3.
Procurement planning and procedure has received increased attention this quarter to avoid procurement lags resulting in shortages
SOM is followed by Product Facility staff to manage stocks
Improve systems to A tracking system in place Sr. Product Facility mgrs and Finance Team review track the flow of in and used to manage supply chain system continuously; staff changes bound and out bound logistics supply chain were made to improve performance stocks Negative findings addressed w/in the quarter 4. BUSINESS DEVELOPMENT Increase and diversify Substantially increase UHMG has applied for NICRA approval from USAID sources of revenue number of sources and as of FY12 with full documentation (with AFFORD/ for both business amount of resources KPMG assistance), and has sent follow-up units generated by both the reminders in FY13. program and product facility business units. UHMG is following its resource mobilization strategy and its investment plan
UHMG has been awarded at least 4 non-AFFORD contracts in the last year; several bid submissions have been developed in FY13, among them proposals to new donors, including private commercial sponsors. The AFFORD portfolio now represents roughly only one-third of UHMG business. UHMG business practices BOD provides active mentoring to UHMG MD and improved, through BOD SLM through the BOD committees and Joint BOD support and the assistance Meetings, guided by Business Plan and USAID of AFFORD (KPMG & Workplans. While the BOD is actively interested in Friends Consult) UHMG and quantifiable results, it tries to leave operational matters to UHMG Management, or the MD and SLM. Only when intervention is sought by
10 UHMG management or needed does the Board act on operational matters External BOD Assessment completed, as per terms of the BOD Manual and organizational best practices Strengthened Stock Mgt through AFFORD/ KPMG assistance Conducted HR Assessment of entire organization with AFFORD/ KPMG assistance Procurement and IT Policies updated and completed with AFFORD KPMG assistance ISO Process for PF completed several iterations; due for completion by FY13 Qtr3. Use of Return To Project (RTP) funds to offset mortgage proposal developed and approved by USAID. 5. FINANCIAL MANAGEMENT Effectively manage Timely financial reports for Finance unit delivers financial reports close to and report on staff all sources of funding due date for all programs time and finances Improved (accelerated) across diversified Expenditure rate across AFFORD grant close to burn rate funding sources 100% Finance & HR teams have staff LOE certification Rare non-compliance with procedures in place donor financial requirements Financial control procedures monitored, and compliance enforced
Improve working Improved debtor’s ratio Aging debt reduced with AFFORD/KPMG assistance; capital management Improved stock currently RTP carrying no debt greater than by the Product management with no or 270days (which is longer than desirable, but is Facility minimal variances thoroughly documented and is being managed with well-known, current customers) Improved working capital management position Variances between system records, bin cards, and stock-on-hand reduced significantly for RTP and UHMG products during routine monthly stock counts
As of Qtr4, 100% of PF operating costs are being covered by revenues generated through PF net margins (excluding MSI Marketing Costs)
Strengthen financial External audits verify that A-133-level Audit for FY2012 finances completed by accountability and UHMG is following E&Y, with JHU/ AFFORD review. Findings minimal; compliance international financial Finance Team produced documented responses to each finding and recommendation; follow-up actions taken.
Internal auditor hired and ongoing reviews taking place
11 Risk register produced
12 1. PRODUCT FACILITY STRATEGIC BUSINESS UNIT
The Product facility achieved variable sales values across three categories of products, with an average against total quarterly sales values of 76%. In the respective product categories, sales values were at 54% for RTP products; 46% for UHMG brands and 124% for commercial products against their respective quarterly targets. Performance for quarter 3 has been summarized in the table below.
VALUE SALES
Product Type April May June Total (Ug. Shs) Quartely Target Efficiency (%) USAID 176,649,950 185,349,850 167,365,100 529,364,900 976,804,930 54 UHMG 181,462,190 141,370,861 125,383,000 448,216,051 969,930,768 46 COMM 357,430,510 126,683,144 816,502,716 1,300,616,370 1,050,000,000 124 Totals 715,542,650 453,403,855 1,109,250,816 2,278,197,321 2,996,735,698 76
The different products categories will be examined and discussed in more detail below.
VOLUME SALES
RETURN TO PROJECT (RTP) SALES:
Targets vs. Actual - Social Marketing Annual AFFORD- Actual Qty in RTP Target Target Qty in pieces % Achieved pieces Product (Units)* Protector 22,250,000 5,562,490 5,720,760 103 Pilplan Plus 2,550,000 637,499 690,660 108 Injectaplan 4,500,000 1,125,000 628,330 55 Including DFID quantities; based on 4 Quarters
a) Protector Condoms. The table below shows the quarterly sales volumes of Protector Condoms. The quarterly performance stands at 103%.
Months April May June Total Quarterly Target (Units) Variance (+/-) Achievement (%) Sales (Qty) 2,230,800 1,769,400 1,720,560 5,720,760 5,562,490 158,270 103
The sales trend will be shown in the graph below as follows:
13 Following a slight stock out in the month of March, production of condoms resumed normally in the month of April thus accounting for the high uptake. Demand throughout the quarter eventually met the quarterly target. Major buyers included wholesale pharmacies and Non-governmental organizations like Uganda Cares, Living goods, International organization for migration(IOM), Walter Reed project, Management Science for Health (MSH), Slam Aids, Astra Pharmacy, Super medic Pharmacy , Zee Pharmacy, Multiple Super Investments, UHMG HIV department to mention but few.
Injectaplan. The table below shows quarterly performance of Injectaplan sales. The quarter only achieved 55% of the target.
Month April May June Total Quarterly Variance Achievement (%) s Target (+/-) (Units) Sales
(Qty) 188,020 268,670 171,640 628,330 1,125,000 (496,670) 55
This performance can also be represented graphically, as follows:
14 The major buyers were wholesale pharmacies like Super Medic, Zee Pharmacy, Humanitarian Care Uganda, Astra Pharmacy, Abacus Pharma, Gittoes, Zarin Pharmacy and Blue Star Pharmacy to mention but few. Injectaplan is widely distributed throughout the country, but overall demand is low, as it has been for the last year (see previous Quarterly Reports).
Pilplan Plus. The quarter registered sales level of 108% achievement of target. The month of June was high due to some bulky orders from some customers like Gittoes Pharmaceuticals, Astra Pharmacy, Zarin Pharmacy, Humanitarian Care Uganda, Super medic and Zee Pharmacy. Sales can be shown in the table below as follows:-
Months April May June Total Quarterly Variance Achievement Target (Units) (+/-) (%) Sales 214,410 119,850 356,400 690,660 637,499 53,161 108 (Qty) The performance will be shown graphically as follows:
15 The month of June showed an improvement in sales resulting from high demand from some Customers like Gittoes Pharmaceuticals who signed up as distributors.
UHMG Brands
The table below shows the quarterly sales trend for UHMG brands as follows:
UHMG Brands Qtr targets(Units) Actual qtr 3 % Acievement Variance (+/-) Cotramox 1,975,000 970,740 49 (1,004,260) Condom O 375,000 359,280 96 (15,720) Zinkid 2,500,000 1,187,600 48 (1,312,400) RestORS 500,001 506,475 101 6,474 Aquasafe 1,350,000 1,176,000 87 (174,000) Moon Beads 1,488 333 22 (1,155) New Fem 10,000 8,720 87 (1,280) Softsure 18,000 13,593 76 (4,407)
The above table shows that O condom, Restors, Aquasafe, Newfem and Softsure scored above 80% of the target. The reasons for this performance shall be discussed. It is also important to consider the performance in terms of contribution of the top UHMG branded products. They are shown in the table below as follows:
Product Value (Ug. Shs)
Zinkid 146,936,100/ Tabs -
Cotramox 95,223,500/-
O 78,894,536 Condom
RestORS 77,346,040
Aquasafe 32,969,700
16 Individual product performances for UHMG products:
Zinkid: The quarterly sales for Zinkid were 48% of the set target. This performance was below fair and major buyers were wholesale pharmacies and a few NGO’S. They include Health Care Pharmacy, Blue Star Pharmacy, Abacus Pharma, Joint Medical Stores, Living Goods and Super Medic Pharmacy.
RestORS: The sales against the target were at 101% which was a good performance. One of the major reasons for this was a stock out of Oralyte a major competitor brand from Medipharm especially in the month of June. Major buyers included wholesale pharmacies like Allied Super Investments in Kasese, Zee pharmacy, Health care, Pharma Health pharmacy, Safestar pharmacy, BRAC Uganda, Super Medic and Abacus Phama.
Aquasafe: The performance of Aquasafe scored at 87% of target. One of the major reasons for this high achievement on target was due to the fact that some pharmacies procured large quantities following the catastrophe in Kasese that left thousands victims of serious floods. A case in point was Pharma Heath Pharmacy that bought Aquasafe and supplied it to World Vision which eventually supplied it to the flood victims. Other major buyers included UHMG Maternal, Newborn and Child health program division, Bru Pharmacy, Medizone Pharmacy, Capital shoppers Nakasero and Astra Pharmacy.
Condom O: The quarter sales recoded were at 96% of the quarterly target. The continued media campaigns have popularized it as brand of choice, though it is popular mainly in the urban towns especially Kampala and a few upcountry towns like Arua. Major buyers include whole sale pharmacies and some NGO’s. They were Eris Ltd, Blue star Pharma, Abacus Pharma, German Development Cooperation, Humanitarian Care, Hima Cement and KGLIS.
Newfem: This Product scored at 87% of the quarterly target. Most purchases are made by a few whole sale Pharmacies and a few NGO’s. A number of wholesale pharmacies have this brand stocked but have repeatedly noted its slow demand. There is still need for detailing this brand if demand is to be realized. Major customers include Humanitarian Care Uganda, Eris Ltd, Matrix Uganda and Maternal, Newborn and Child Health program division at UHMG.
17 Softsure: The sales of this brand throughout the entire quarter scored at 76%. Major efforts have been taken take detail the brand thus accounting for increasing sales. An example is Eris Ltd which carries out detailing work among hospitals and major clinics around Kampala. The major buyers noted during the quarter include multiple super Investments, Humanitarian care Uganda, Matrix Uganda, Super Medic, Astra Pharmacy, UHMG program division and KGLIS project at UHMG.
Moon Beads: This product has scored at only 22% of the set target. This performance is considered low. The major buyers included walk in customers, UHMG staff especially carrying out route sales, KGLIS project at UHMG and the maternal, newborn and child health program at UHMG. This product is hardly stocked in pharmacies. Continuous detailing is still required to increase awareness on use of the product.
Cotramox: Quarterly sales scored at 49% of the set target. This particular brand is preferred among NGO’s. It is currently facing completion from other brands like Cotriech which is a jar of 100 tablets. The jar of 100 tablets is cheaper than the pack of 30’s. The major buyers included Joint medical stores, Humanitarian care Uganda, Program division of maternal, newborn and child health, Equus Enterprises Ltd and Zaa drug shop. There is need to consider other convenient packs that could be sold among the wholesale pharmacies.
Non-UHMG Brands
This product category scored at 124% of its quarterly target. The right product mix, consistent supply and monopoly in determining selling price are all essential ingredients for conducting good business. During the quarter, the commercial Division managed to sign up as a distributor for Adcok Ingram range of products and a country representative was also chosen. We shall examine the top performing products and perhaps draw some useful conclusions.
Product Quantity Value (Ug. Shs) % of total value Determine 2,308 disp 516,624,000 45 Mosquito nets 3,999 64,511,350 6.5 Dawanol 7,053 disp 49,415,000 4.9 Lignocaine Injection 41,471 vials 48,573,160 4.9 Statpak 893 disp 47,600,000 4.8 Lumartem (24’s , 12’s & 6’s) 2,334 dozes 44,519,400 4.5 Unigold 299 disp 38,170,800 3.8
18 From the above table, it can be noted that Determine which is a high value product contributed to over 45% of the sales value from the commercial product. The major buyers for this were the program division of UHMG, namely, HIV department and KGLIS project.
Commercial Sales
Month Target (Ug. Shs) Actual Variance % Achieved April 350,400,000 357,430,510 7,030,510 102 May 350,400,000 126,683,144 (223,716,856) 36 Jun 350,400,000 816,502,716 466,102,716 233 Total 1,051,200,000 1,300,616,370 249,416,370 124
The quarterly sales recorded at 124% of the target and were boosted by the availability of products like Determine, Lidocaine Injection, Dawanol which was available in June, Lumartem, DIPI tablets, Bendex, mosquito nets to mention but few.
RETAIL AUDIT
AUDIT
During FY12, AFFORD/UHMG initiated for the first time an independent, scientific monthly Retail Audit to measure the presence and movement of its products in private sector outlets. This retail-level information complements sales data to provide an more accurate picture of what is reaching retail outlets. The study sample of 1,100 is drawn from a total universe of all registered private sector medical outlets in Uganda, numbering 9,111 (based on the outlet census of 2012). The distribution of outlets (clinics, pharmacies and drug shops) in the sample is proportional to the distribution of such outlets in the total universe, thus making the sample representative of the Ugandan health outlets as a whole. The Quarter 3 results are shown below. The presence of the key products has risen since the first retail audit was conducted inMay 2012, when Protector was in 59% of outlets on average, Pilplan Plus was in 58% of outlets on average and Injectaplan was in 49% of outlets on average. UGMG brand presence in private sector retail outlets (pharmacies, drug shops, clinics) nationwide (Source: WRI Retail Audit 2013)
Brand April, 2013 May, 2013 June, 2013
Protector 79% 79% 79%
Pilplan Plus 83% 85% 85%
Injectaplan 76% 77% 78%
19 Zinkid 49% 52% 52%
Restors 39% 42% 44%
Condom O 17% 18% 18%
Aquasafe 12% 13% 14%
Softsure 8% 8% 9%
Cotramox 5% 5% 6%
Newfem 3% 3% 4%
Moon beads 2% 1% 2%
Key updates We have successfully transferred the Local Technical Representative (LTR) for Adcock Ingram from Phillips pharmaceutical, Supermedic and Shurik to UHMG after winning the regulatory battle at NDA and subsequently launched Locaine and Dawanol following the NDA approval
Launched new LTR negotiation with Seryo Pharma, SD BIOLINE (USA) who are willing to sign agreement and register commercial brands with full plant inspection by NDA. Also, nearly completed supplies relationship negotiation with Maternova (USA) a MNCH product manufacturer for ambulatory and child-mother survival products. Soles distributorship agreements are being reviewed for signing.
Achieved negotiation of alternative sources for zinc sulphate that will bring the price saved by 60% and onward [rice offer cut by 50% from FDC. The registration is ongoing with file fully reviewed by the registration team and more responses submitted for final approval of the registration
Held the annual distributors’ dinner and awards where the attendance exceeded 120 customers. 4 accolades were presented to best customer of the 4 respective categories of trade, NFP, super market chain stores. Customer took to the floor and gave the team valuable feedback and highlighted areas of improvement. Other presents were wall 15 clocks and 83 certificates.
20 Mrs. Emily Katarikawe handing over accolade for the year’s best trade partner to Super Medic pharmaceuticals representative during the Annual Distributors Dinner and Awards night at Silver Spring Hotel in Kampala.
Rt. Rev. Dr. Stephen Samuel Kaziimba, Bishop of Mityana Diocese and Chairperson, IRCU HIV/AIDS and Public Health Board Committee (in collar) receives a plaque (left) and branded wall clock (right) on behalf of IRCU that was voted best UMHG NFP partner for the year 2012-2013 from MsShantalMbabazi, Business Manager UHMG. Mr. Joshua Kitakule, IRCU Secretary General (right) and Mr. Johnson Masiko, Director IRCU HIV/AIDS and Public Health Directorate (2nd left) witness the ceremony.
Completed the recruitment Head of Stores & Operations. The candidate is expected to report on 29th July. This is a major recruitment into the PF structure and which is hoped to bring operation proper system adherence, efficiency and proper segregation of duties.
Purchased a delivery van, which is now being branded (see picture)
21 PF has to date put aside Ugx 500m towards the construction account towards the construction of the new warehouse
The warehouse construction is pending approval by KCCA, all necessary information regarding queries that were raised have been submitted.
ISO training and internal audit completed. External audit is expected soon after bids evaluation July
During the period there have been no significant stock variances that are unexplainable by the stores team
Product Facility performance monitoring table:
Activity 1: PF strategies and business development Activity Description Targets/Outputs Q1 Q2 Q3 Q4 Q3 Comments
Carry out market surveys to reveal gaps, New products: Survey into market trends for potentials and opportunities of entry with Nutrition range, products for key therapeutic areas bottom of the pyramid and new volume movers Analgesics, Anti biotic implemented, will be completed by brand and test kits. end of July
Solicit for local product sourcing Number of local No new deployment taken in the arrangement for sub distributorship with LTRs of contracts signed quarter multinationals Number of local purchase orders placed Limit local purchase to only confirmed after confirmation Ongoing orders from the customers
Supplier search to achieve sources of Increase in the No approval in Workplan for highly reputable and quality products, with the profitability of the international travel Directorate staff of the facility taking visits to product facility suppliers both local and International. Increased
22 product range of commercial brands with detailers fully paid for by manufacturers 2 more suppliers to be signed Collect and analyze information on Knowledge of This is has been included partly in the logistics and customer demand forecast from the market and demand TOR for the ongoing market trends both the public and private sector target trends/survey reports survey going on customers Quarterly rolling forecasts tool developed.
Commercial products have been Update the current marketing tools used PF Website link placed in 4 magazines and on Radio to promote the product facility to reflect the new developed; price lists, One for 4 months. products that have been introduced. These FAQ, and order form The IT team has started work on web include the UHMG website and SMS platform. uploaded to facilitate portal for PF product display, online transaction and ordering, AND FAQs pages that is to information sharing be ready and run by August. Activity Manager: Philip Okello Apira Linkages within UHMG: Marketing and Strategic Information for the website link; Marketing and Strategic Information will help in creating awareness of the products; Programs and Services will help in identification of the product gaps in their areas of interventions and as well forming a channel through which products can be accessed by consumers.
Activity 2: Strengthening Product Facility operations Activity Description Targets/Outputs Q1 Q2 Q3 Q4
Strengthening of PF and regional . Ease of processing Sales and debtors reports and other pharmacy operations reports e.g. business reports shared monthly, consolidated sales with weekly updates. reports, debtors. Done PF attains increased operational autonomy Clear operational status ISO Certification process is on course. Train warehouse staff to improve their External bids received. External audit skills in stock and warehouse management by august. Dates changed due to ISO certification internal challenges of creating a attained broad based ISO knowledge amongst Regularly review SOM for further staff revision and follow up of implementation Warehouse staff Warehouse construction is on course trained and oriented to with construction plan nearly Construct another 600sqm warehouse the new challenges achieving approval by KCCA and we on UHMG land have saved aside 70% of the cost Sales force ready for start up. empowered to make a difference in their activities and contribute to achieving overall sales objectives
Capacity of warehouse staff Training did not take place due to Warehouse staff trained staff turnover and attention to A team of professional, proactive members of and oriented to the new workload staff developed challenges Warehouse staff trained and oriented to the new challenges Sales force empowered to make a difference in
23 their activities and contribute to achieving overall sales objectives Warehouse Management Reviews of SOM done. Staff trained on ISO Quality Management System Train warehouse staff to improve their skills in stock and warehouse Manual ready for board review and stock and warehouse management management guidance. Regularly review SOM for further revision and Warehouse staff follow up of implementation trained and oriented to the new challenges Extend the warehouse capacity through constructing an extension from the existing warehouse structure Consult on business portfolio management ISO Certification Implementation of the draft SOM is ISO certification ongoing, auditing completed Finalize implementation and auditing for attained internally and awaiting contract to be certification within the year awarded to external auditors for completion of the process (as above) Other activities Regional warehouses still share data Performance terrestrially. Plans are underway to Link and use the networked of data sharing links management system in install a web based reporting in the between the warehouses and the main place next year warehouses The proposed re-structuring scenarios Institute a performance management system as were discussed by management. The in line with the private sector approaches to implementation of it did not take managing performances place as it depended on may factor- some of which were legal. Postponed for next FY after the expiry of employment contracts Activity Manager: Philip Okello Apira Linkages within UHMG: HR/Admin Finance Activity 3: Strengthening management and financial systems Activity Description Targets/Outputs Q1 Q2 Q3 Q4 Financial management 90% done but continuous Streamline ledgers in the system and structure of the Tally system Tally software designed to meet the Continuous reporting needs of the Continue to train users in tally to product facility Implemented optimize the its functionalities Continuous Sound financial Establish and implement working management and guidelines for the credit policy in place reporting (both cash and Done inventory) regularly disseminated Install the commission remuneration to the sales force to enforce the management of Done cash flow strategies Debt management procedures in place Done and Continuous Develop cost drivers and cost absorption strategies to show growth in capacity Credit officer is now on board
Recruit a credit controller in PF Debt recovery up to 60% within the sales period Done Credit ceiling by aging analysis and debtor
24 days Management of the product streams as business portfolio to allow for commensurate remuneration of the performance while tracking Building Dollar the profitability of the products bank balance for over sea supplies payment
Renegotiate supplies payment terms
Monthly stock counts and variance management
Recruit a credit controller
Product profitability tracking
Monthly statements will be issued Good relationships with customers and Accurate and timely suppliers perceived resulting from accurate and statements for timely statements customers and suppliers Working Capital management Done but continuous progress Debt management Debt management procedures in place procedures in place Debt recovery up to 80% within the sales period Daily banking of cash and cash equivalent Credit ceiling by aging analysis and control Monthly stock counts Daily banking of cash and cash equivalent and variance Payments largely done from USD a/c Selling and invoicing in US Dollars management Being done but continuous Building Dollar bank balance for overseas Done on a monthly basis supplies payment Renegotiate supplies payment terms Monthly stock counts and variance management Activity Manager: Moses Kafeero Linkages: IT skills from UHMG HR/Admin; Systems audit by internal auditors/external auditors Finance and Investment Department/Product Facility Operations
Activity 4: Sales and distribution Activity Description Targets/Outputs Q1 Q2 Q3 Q4 X Recruitment of key account manager Market segmentation will be A customer relationship was done in quarter 3. strengthened, where the client relationship officers allocated to activities will focus on relationship selling among Client portfolio all key customers. Emphasis will be placed on IPs, Presence and Institutions, NGO’s and corporate organizations percentage of the sales as these contribute a significant portion of the revenue from key sales account sales grow to 20% of overall sales achieved x X Three CME’s were held. One at Continued Medical Education (CME’s) At least one of each per Nakaseke hospital for Pentasure DM and round table conferences will be a to focus on month. in regard to Diabetic patients.
25 especially the new product ranges development Another CME held at ERIS Ltd in regard to Betapayn and Compral brands and Another CME held at Rotary Kampala Club in regard to use of Ovachek. x x Arua and Mbale Pharmacies now fully Empower the regional pharmacies in PF to expedite the operational and active in distributing Arua and Mbale to operate as fully fledged sub sourcing for the regional USAID, UHMG and other products. A distributor for the product facility Pharmacies. vehicle for distribution has also been given to Arua Pharmacy to assist in distribution and sales. x x Plan Uganda has reversed the To extend the distribution reach to cover Another Pharmacy to be decision to open a Pharmacy in Gulu. for all project commodity distribution in the opened in Gulu. 2 GLC Coordinators have been project districts appointed i.e. Under KGLIS project To carry out social distribution in only and UHMG Programs. Over 60 good the Good Life Clinics where an officer will be GLC coordinator life Clinics were invited to UHMG and assigned to take care of the channel assigned the roles 2 CME’s done for a range of products i.e. UHMG brands and commercial brands. x A distributor’s award dinner was held Support and evaluate the distributors to Continuously in quarter 3. improve efficiency in distribution and evaluate the distributors relationships on a quarterly basis. Frequent business meetings x A retail audit was carried out that Market survey for outlet audits and gaps Market survey revealed performance of USAID and identification in market share and reach for for outlet audits UHMG products in terms of reach. commercial division conducted
x x A product Budget developed and Sales Targets 70% of targeted revised to 6.0 billion excluding USAID outlets stocking products and DIFD Project commodity sales. distributed by Commercial Division - At least two (2) sales trainings are planned for in Annual Sales quarter 4 target of 6.0 Billion UGX - To-date at least 5.8 billion achieved excluding USAID in sales revenue has been brands realised against the Gross Margins of revised target of 4.2 billion at least 30% for UHMG for the year excluding brands and 20% for USAID and UHMG brands. commercial brands - An average gross margin Three skills for UHMG and commercial trainings for the sales products has been at force about 15%. It is expected to grow with increasing Retain at least range of products. 95% Customers Activity Manager: Paul Kagumire Linkages: Link with brand and research teams for better synergies in demand creation and market intelligence Human Resource department for staff recruitment and motivation Link with programs department for uptake of products Link with public relations activities for relationship building and networking Link with finance team for financing activities
Activity 5: Supply chain management Activity Description Targets/Outputs Q1 Q2 Q3 Q4
26 Prepare a . CPT memo Contracts in dynamic sent to and place for procurement approved by secondary plan for all USAID packaging and products . Running packaging contracts in materials place for key suppliers Monitor . Up to date The procurement procurement procurement on a weekly plan available plan is in basis by for discussion place entering at the end of consumption each month and receipts data Procure . Finished There is packaging products buffer stock materials and available for for instruction sale Injectaplan products for . Buffer stock of There has generic three months been products in place for consistent supply of Put in place a Protector, Pilplan Plus secondary Pilplan Plus , packaging and Injectaplan There has contract with been Kampala uninterrupte Pharmaceutical d production Industries of Protector condoms ; all orders were serviced Procure . No stock outs There were products of any product no stock outs according to due to poor for USAID performance performance products. There was of the . No over stock stock out of procurement due to bad Cotramox plan procurement caused by practices sudden increase in demand. RestORS stocked out in the first week of June because the price was reduced Activity Manager: Rachel Apio (with R. Kitonsa for regulatory matters) Linkages: Accurate consumption data from Finance team Timely payments to suppliers by the Finance team Accurate stock status reports from the warehouse team Sales forecasts from MSI department and PF sales team Pre-alert shipping information from JSI/USAID
27 Way forward for quarter 4 Work closely with Adcock Ingram to aggressively promote their product range and launch 4 more in the next quarter.
A lot of attention will be given to selling products with short shelf life in stocks products like Ova-Chek and others. Route selling in the regions will also be encouraged to improve sales and cash flow.
Continuously stock viable commercial products like Lumartem, Bendex, Dawanol, Ceftriaxone to mention but few.
Integrative marketing and sale activities; Route selling in the regions will also be encouraged to improve penetration.
Recruit a replacement for the northern regional sales representative.
Target corporate for CSR and staff uptake of products like Ova-Chek, Condom O and others.
Continuously stock viable commercial products like Lumartem, Bendex, Dawanol, Ceftriaxone to mention but few.
Rigorously control debts below 90 days, use legal means to collect debts above 90 days
To ensure ISO certification completed by the new quarter
28 2. PROGRAMS CONSULTANCY STRATEGIC BUSINESS UNIT
The Directorate of Programs is responsible for partnering with and supporting the private health sector (through the Good Life clinics) in implementation of the following programs and sub-components: HIVAIDS Control Services, notably: o Prevention targeting Couples, Youth & Key Populations (MARPS) o HCT, care, PP and PMTCT through GLC Malaria Control Services including: o Malaria in pregnancy Services o Case management services Maternal & Child Health Services Family Planning services Cross cutting & Health systems strengthening, such as: o Technical support supervision, Quality assurance, Health Management Information System (HMIS), and ensuring integration of HIV, MNCH, Family Planning and malaria service delivery.
2.1 HIV/ AIDS PREVENTION AND CONTROL
HIV/AIDS Services UHMG supports community and facility based interventions in HIV/AIDS prevention, care and treatment services among specific population. GLC based services are HCT, PMTC, chronic care and positive prevention services for people living with HIV/AIDS. Community interventions support services linkages to the GLC among people from the communities served by GLCs. Specific population groups targeted include: pregnant women, PLHAs, Most at risk Populations (Fisher Folk, Commercial sex workers – CSW, and Truckers), individuals in long term relations and young unmarried youth who are out of school including young positives. Services provided include: referrals for HCT, Safe male circumcision (SMC), STI management, and promotion of family planning and condom use.
HIV/AIDS Control Services In line with national strategies for HIV prevention care and treatment, UHMG AFFORD supports implementation of HIV controls services targeting key most at risk populations (MARPS) and the general population through communities approaches; and HCT, PMTCT,
29 HIV Care and Treatment through GLCs. HCT is the entry point to HIV prevention, care and treatment services as well as PMTCT.
Q3 Activity Highlights In Q3, UHMG continued to strengthen the quality of HIV service delivery through the supported GLCs. Additionally, community interventions were supported to increase demand for HIV control services, products and healthy practices and behaviors. The following activities were implemented in Q3: i. HCT services both at GLC static sites and outreaches targeting vulnerable communities
ii. PMTCT services roll out in GLC
iii. HIV Care Services for People Living with HIV (PLHIV)
iv. Support services quality improvement in GLC
v. HIV Prevention targeting MARPS and other population groups
vi. Promotion of condom use for HIV prevention vii. eMTCT campaign to generate demand for PMTCT services in general based on 4 prongs and option B+, specifically. viii. Partnership with MOH and NuHites to conduct regional eMTCT launch in Northern Uganda
HIV/AIDS Annual Work Plan Matrix Tracking Table
HIV FY 2012-2013 WORK PLAN MATRIX Activity Indicator Target Quarterly Outputs Comments Q1 Q2 Q3 Cum% 1: Strengthen HCT Services in Private Clinics Distribute test kits to Number of 300,000 0 75,000 73,500 50% Ongoing GLCs accessed through determine test JMS kits distributed Support GLCs to Number of 60 0 16 51 NA Ongoing conduct out integrated outreaches reaches conducted by
30 GLCs
2: Healthcare Waste management Distribute safety boxes Number of safety 2400 0 1800 75% Re supply in to new GLC enrolled for boxes distributed Q3 HTC services. 3: Sexual and Other Risk Prevention-Truckers Reach truckers with IPC Number of 3,850 1000 1227 1,002 84% Ongoing truckers reached HCT outreaches Number tested 9000 3000 10,688 152% Ongoing Reach CSWs for IPC No. of CSWs 2000 600 616 608 91% Ongoing reached Social market condoms Packs of 3 sold 60,000 7980 13,96 120% Ongoing 50,000 9 4: Sexual and Other Behavioral Risk Prevention – Fisher Folk Reach fisher folk with Number of FF 20,900 3920 3310 7,262 69% Ongoing IPC reached Conduct HCT Number tested 5,000 723 315 1125 43% Ongoing outreaches for Fisher and received folk & CSW results Reach CSWs with IPC Number of CSWs 1000 187 165 581 93% Ongoing reached Promote condoms Number of 50,000 8008 7651 17372 66% Ongoing condoms sold 5: Sexual and Other Behavioral Risk Prevention – Married couples and discordant couples Conduct IPC activities Number of 150,000 3594 36235 61,50 89% Ongoing on HIV prevention individual 1 1 reached Conduct CHCT Number of 45,000 1351 1351 7242 22% Ongoing outreaches individuals tested as couples tested Integrate FP in HIV Number of new 5000 1739 1853 72% Ongoing prevention among FP acceptors couples 6: Sexual and Other Behavioral Risk Prevention – Youth Conduct IPC activities Number of youth 50000 1838 20676 13,55 105% Ongoing on HIV prevention reached 4 3 among youth Carry out HCT outreach Number of youth 5000 414 3622 950 100% Ongoing targeting youths. tested 7: HIV Care & Positive prevention Services Provide PHAs with HIV Number of PHA 19,000 1,595 1,296 1978 26% care & positive reached prevention services supported 8: PMTCT Train HWs on PMTCT Number HWs 74 42 12 73% Activity on from 50 GLCs to trained on going provide ANC PMTCT
31 Quarterly on-job Number of HWs 74 0 67 108 NA Ongoing mentorship Train mother mentors Number of 50 To start in Q3 on PMTCT from 50 mother mentors GLCs trained 9: Support VMMC services Demand generation & Number of men 81,100 2,149 727 69% Ongoing referral by sub- mobilized for 2,778 grantees to GLC MMC
HCT Services GLCs were supported to provide HCT through static and outreach approaches targeting clients at GLC, through provider initiated testing and counseling (PITC) and vulnerable populations in the communities, respectively. HCT targeted individuals and couples. UHMG continued to support data management and reporting through distribution of relevant HMIS tools. Safety boxes were also provided as part of health care waste management. GLCs were provided with buffer stocks of HCT kits and laboratory consumables leveraging on the administrative costs provided by the GLCs. During this quarter HIV logistics which was distributed include test kits (determine, Startpack and Unigold and lab consumables.
HCT Outreaches: UHMG supported 23 GLCs to conduct integrated health outreaches to provide servcies in the areas of HIV, FP, MNCH and malaria. In total, 10,688 people were counseled and received results of which 495 were positive. All individuals who tested positive were initiated on Cotrimoxazole prophylaxis and provided with supplies for positive prevention such as condoms, family planning products and Aquasafe water purification tablets based on their individual needs.
HCT Services Utilization Data Summary
Target Q1 Q2 Q3 Q4 %age
32 Number of Individuals 338,14 45,875 54,583 43,890 42.69% counseled 5 Number of Individuals 338,14 43,674 51,729 42,985 40.93% tested 5 Number of Individuals who 338,14 41,826 49,934 42,331 39.65% received HIV test results 5 Number of Individuals who 23,670 2,528 2,871 2,072 31.56% tested HIV positive HIV positive cases started 19,000 1,595 2,139 1,207 26.01% on Cotrimoxazole preventive therapy (CPT) Number of individuals who 45,000 4,702 5,745 3,894 31.87% were Counseled and Tested together as a Couple Number of individuals who 45,000 4,459 5,567 3,649 30.39% were Tested and Received results together as a Couple Number of individuals with NA 774 1030 333 NA Concordant positive results Number of individuals with NA 265 361 236 NA Discordant results
PMTCT
Q3 PMTCT Activity Highlights Program support for HIV control interventions target both community responses and quality services delivery at the health facilities – the GLC network. A summary of activities implemented in Q3 are listed below.
HIV/AIDS/PMTCT Annual Work Plan Matrix Tracking Table HIV FY 2012-2013 WORK PLAN MATRIX Activity Indicator Target Quarterly Outputs Comments Cum Q1 Q2 Q3 % 1: Strengthen HCT Services in Private Clinics 8: PMTCT Train HWs on Number HWs 74 42 12 73% Activity on PMTCT from 50 trained on going GLCs to provide PMTCT ANC
33 Quarterly on-job Number of 74 0 108 NA Ongoing mentorship HWs Train mother Number of 50 A total of 21 mentors on mother mother PMTCT from 50 mentors mentors have GLCs trained identified from ten GLCs who are awaiting Training in Q4
PMTCT services are a new intervention that has provided opportunities for UHMG AFFORD project to scale up HIV/AIDS interventions. Uganda has adopted option B+, as the best approach to eliminate mother to child transmission, with a target of reducing new incidences of infection from current 23-30 0 to <5% by 2015. UHMG is part of this noble initiative.
Q3 Achievements a. Scale up training for GLC health workers in other regions, as part of option B plus roll out: This quarter, UHMG has supported 18 GLCs in Option B +, assessed 10 KGLIS sites for possible accreditation to offer PMTCT Option B + and the process is still ongoing. b. Support GLCs to use MTRAC for prompt reporting of PMTCT data: All UHMG program staff received a one day CME on MTRAC weekly reporting for option B + that was coordinated by MoH as such , 36 health workers from the 18 PMTCT sites including a PMTCT focal persons were trained in MTRAC reporting and to-date 10 sites are reporting weekly: These include: Community health Plan Uganda- Kawempe, St Stephen’s Dispensary Luzira, Kingdom Life Maternity and Medical Center, Bushikori Christian Center; Kolonyi Hospital; Soroti Medical Associates,. Boroboro HC II; Iceme NGO, Mukwano Medical center and Lira Medical center. c. Continue with on-site training and mentorship: A total of 108 health workers have received on site CME and mentorship. d. Support GLCs to transport CD4s and DBS to the testing hubs: All 18 have been supported to transport CD4 and DBS to the district testing hubs. e. Strengthen mother-mentor groups and scale-up their activities to new PMTCT sites: During mentorship; all 18 sites were supported to initiate or operationalize family support groups and mother-mentor groups. f. Support GLCs to work closely with government health facilities that provide ART and other comprehensive HIV/AIDS services as a referrals: This is an ongoing activity
34 g. Support GLCs to start ordering ARVs from JMS as part of the transition plan: All 18 facilities were supplied with initial ARVs from JMS and they have all been supported to order ARVs and other OI drugs directly from JMS and a total of 144 HIV positive mothers have been initiated on ARV. h. Support the regional EMTCT launches nationally in collaboration MOH: UHMG in partnership with MOH led the development of the national eMTCT campaign, activities for the campaign included building the capacity for eMTCT services at health facility level, mobilization of communities, communication and demand generation, using multimedia approaches. The campaign celebrations were held on June 28th in Lira Golf Grounds and the event was graced by the 1st Lady, the national eMTCT champion. i. Highlights of UHMG participation in the Northern eMTCT campaign at Lira Golf Grounds, below:
Left: the First Lady receiving an eMTCT info pack at the UHMG stall, with her is the State Minister of Health -General Duties
j. Reproduce job aides for PMTCT Option B+: UHMG was tasked to review the flip chart for health workers and community volunteers (VHTs) in both the public and private sector. This was done in collaboration and support from Ministry of Health. The draft has been printed and a final version is still being printed for use. In addition, UHMG participated in the curriculum review for community volunteer to include eMTCT.
PMTCT Services Data (from 15 GLC) Indicator Target Q1 Q2 Q3 Q4 %age
35 New ANC Clients 6000 445 603 17% ANC Clients receiving HCT 5400 441 846 24% Pregnant women who are HIV Positive 560 21 41 11% HIV Positive pregnant women initiated on HAART 360 22 28 14% (Option B+ ) Number of HIV exposed infants receiving ARV 360 22 21 12% Number of HIV-exposed infants who had a 360 27 15 12% serological/rapid HIV test at 6 weeks Number of HIV-exposed infants who had a 360 8 23 9% serological/rapid HIV test at 18 months Number of HIV-exposed infants who had a 560 2 4 1% serological/rapid HIV test at 18 months and are positive
HIV Care Services for People Living with HIV (PLHIV): All GLC providing HCT services provide care and positive prevention services to HIV positive clients. UHMG supported GLCs with supplies for startup care packs for newly diagnosed HIV sero positive individuals consisting of septrine, condoms, Aquasafe, FP products for.
Support services quality improvement in GLC: As part of integrated activities for UHMG supported services in malaria, MNCH and family planning, quality improvement for HCT, HIV/AIDS care and Positive prevention services was done. Specific emphasis was laid on data management and reporting, health care waste management and logistics management especially for supplies provided or marketed by UHMG.
UHMG targets truckers, fisher folk, CSWs and youth out of school as key MARPS populations through prevention interventions implemented by four sub-grantees. For the fishing communities, UHMG works in partnership with SSECODA in the central districts around Lake Victoria landing sites (Kalangala, Masaka, Mpigi, and Wakiso); With NAYODE in Western Uganda (Kasese) and Health Alert in Northern Uganda (Gulu, Nwoya, Amuru, Oyam), it supports interventions targeting youth out of school and truckers along major high routes and hot spots with major truck park yards and stops. Intervention targeting couples in long term sexual relationships including married and cohabiting couples are implemented in partnership with Humanitarian Care Uganda in in the nine districts of Kabale, Kanungu, Lira, Wakiso, Mukono, Kamuli, Kyenjojo, Mbale and Kabarole. CSWs on the other hand are supported across all the key MARPS program interventions.
Sexual and Other Prevention: Truckers and CSWs
36 Interventions for truckers follow the Condom HIV Information Centres (CHIC) model with key interventions such as outreaches, moonlight HCT camps and provision of behaviour change information to truckers, CSWs and their immediate communities through interpersonal communication (IPC) by trained park yard volunteers (PYV) and Peer educators at various hot spots where large number of truckers station to rest from their long journeys or await border point clearances as well as hotels and bars. NAYODE and Health Alert PYVs and PEs educators mobilized and sensitized over 2,907 were counseled and tested for HIV. Those found positive were registered, given a start dose of Cotramox and referred to nearby GLCs or public health facilities providing HIV services. Using the IPC methodology the sub-grantee PEs interacted with over 1,002 truckers and 608 CSWs to raise awareness and demand generation for HIV prevention care and treatment services, including linkages and referrals to health facility base services. Emphases were made on HIV/AIDS prevention messages to encourage risk reduction strategies that include consistent and appropriate use of condoms. The target MARPS were also counseled and supported with information to demand and utilize HIV services at partnering GLC. These included HCT, as the entry point to HIV prevention, care and treatment, STI management, safe male circumcision, and linkage for care and treatment for identified HIV positive MARPs. Approximately 174 were referred and followed up received STI treatment and/or SMC services and other HIV services at selected GLCs and health facilities in their vicinity
Sexual and Other Prevention: Fisher Forks Truckers and CSWs Programs for fisher folk and CSWs are delivered through operations of the “Safe Sailing Boat” project implemented through SSECODA. Approximately 8724 fisher folks were mobilized and sensitized by trained PEs, local leaders attached to beach management and district offices using focus group discussions, community dialogues, drama shows and IPC one on one methodology.
In Kalangala CSWs are now hiring rooms in their hot spots on the landing sites where peer educators find them for interactions. These are basically called “OBUGGI” which literally means that anytime a client can push the door and enter to be served. Trained CSW PEs use this as an opportunity to create awareness and sensitize their peers and clients on HIV in private. Last quarter, the PE educated reached over 581 CSWs and 7,262 fisher forks with HIV preventions messages, sell condoms and provide referrals for HCT, SMC, and other health services using IPC.
A total of 1125 fisher forks were mobilized, counseled and tested; of whom 427 were referred to and received STI treatment, FP services and SMC at the recommended health
37 facilities. Continuous care and positive prevention care was also provided to 643 PHAs that are followed up and supported by SSECODA.
Sexual and Other Prevention: Youth Working in partnership with Health Alert Uganda (HAU) and NAYODE as sub grantees, UHMG AFFORD supports HIV prevention among youth. HIV prevention services awareness to the youth is provided through youth clubs coordinated by peer educators. Youth are encouraged to adopt the ABC strategy persistently. In partnership with GLC and government health Facilities, youth are referred for HCT, FP and Safe Male Circumcision (SMC). For clients who are tested HIV positive, support for HIV care and treatment is provided to them at the HCT sites. Referrals for ART eligibility and enrolment for those in need of treatment is done at health facilities with ART services.
During the quarter health Alert was able to reach over 12,596 youth with various messages for combination prevention stipulated in the table below. The awareness creation was conducted through peer to peer (interpersonal communication approach) and small group sessions. During the HCT outreaches, mothers were able to immunize their children giving it a comprehensive component of services delivery as the outreach was a one stop centre for various services among which included referrals for Family planning mapping of the positives and referral to the nearest ART centers.
HIV Prevention – Couples
Through the FAITH Project (Fighting AIDS in the Home) implemented by Humanitarian Care Uganda, an AFFORD- UHMG sub grantee, HIV/AIDS prevention services were delivered to couples in long term sexual relationships; both married and cohabiting. HCU reached over 61,501 people (29,646 males and 31,855 females) with HIV prevention, care, and support and treatment messages including emphasis on being faithful, couple HCT, modern Family Planning (FP) methods and eMTCT services. These were implemented through community leaders, “hero couples”, good life promoters and UHMG supported private health facilities popularly known as the Good Life Clinics (GLCs) to increase access to HIV prevention, care, and treatment and support services.
In partnership with the GLC, couples were referred for couples HCT, SMC, FP services uptake. Safe motherhood and child survival strategies were also promoted. This was done through encouraging expecting mothers to seek ANC services and prepare to deliver at health facilities under skilled assistance. As a result over 3,621 couple were counseled and tested.
38 Of these 104 (representing 2.87%) were found to be living in discordant relationships, 153 (representing 4.22% were living in concordant positive relationships while 3,364 (representing 92.9% were in concordant negative relationships. HERO Couples actively participated in the National EMTCT launch in Ntungamo as well as the Northern regional launch in Lira were they marched, provided HIV prevention and positive living testimonies and skits through music, dance and drama at the events.
Provide GLCs with buffer stocks of HCT supplies
Train linkage facilitators to link facility and community based interventions for PLHAs
Support GLCs with subsidized HIV prevention and care products such as cotrimoxazole, family planning and condoms
Conduct integrated quality improvement visits to GLCs for all supported service areas
Scale up training for GLC health workers in other regions-option B plus roll out.
Assess new sites for PMTCT scale up
Scale up training for GLC health workers the newly assessed facilities and old GLCs whose trained health workers have left the facilities as part of option B plus roll out.
Continue with on-site training and mentorship
Continue to strengthen support GLCs to transport CD4s and DBS to the testing hubs
Strengthen mother-mentor groups and scale-up their activities to new PMTCT sites
Support GLCs to work closely with government health facilities that provide ART and other comprehensive HIV/AIDS services as referrals
39 Support the new GLCs and the old GLCs to continue ordering ARVs from JMS as part of the transition plan
Continue support the regional EMTCT launches nationally in collaboration MOH
Reproduce job aides for TB, PITC, HIV Care, PMTCT and other M & E data tools
Training on electronic data management, using MTRACT for new PMTCT sites
Support new and old GLCs to use MTRAC for prompt reporting of PMTCT data
Support sub grantees to provide community based HIV prevention among selected population groups
2.2 MATERNAL, NEWBORN AND CHILD HEALTH
Goal To contribute to the national goal of reducing maternal mortality from 435 to 131 per 100,000 live births by 2015 and child mortality by 2/3 by 2015.
Strategic Objectives i. To increase the availability, accessibility and utilization of quality skilled care for maternal, neonatal and child health services in the Good Life clinics. ii. To improve appropriate and timely health care seeking behaviour for maternal, newborn and child health services at community level iii. To increase knowledge, access and correct utilisation of appropriate maternal, newborn and child health services and health products.
Activity highlights
Integrated outreaches: Owing to the tendency for outreaches delivered with an integrated package of services to attract a large turn-up of the community, UHMG organized for and carried out an integrated outreach comprising of Antenatal Care, Postnatal Care, child immunization, management of common childhood illnesses, Family Planning (method-mix), HIV Counseling and Testing, and STI treatment.
During this quarter, clients seeking MNCH services in 23 integrated outreaches were as reflected in the table below:
40 INDICATOR TOTAL CLIENTS SERVED IN 18 OUTREACHES 1 NO. OF ANC CLIENTS 800 2 NO. OF CHILDREN DE-WORMED 2,327 3 NO. OF CHILDREN TREATED FOR 1,933 ILLNESSES 4 NO. OF CHILDREN IMMUNIZED 394 5 SCREENING CERVICAL CANCER 79
Procurement of LLITNs, cervical cancer screening kits, and Maama kits: UHMG has already procured the LLITNs and screening kits for cervical cancer ready for distribution to 50 GLCs.
Development of the Flipchart on MNCH and eMTCT: UHMG has been tasked with spearheading of the eMTCT campaign and as such reviewed the available job aids to develop one that would ably address the needs of a service provider to educate the community on eMTCT. The available flip chart on MNCH was reviewed to also cover eMTCT and it is to be used by both the VHTs and the Health workers in the public and private sector. The flip-chart is being printed.
Scaling up the Safe Deliveries and Newborn Care through Health Facility Delivery Campaign Radio programs: UHMG has developed draft messages for use to drive a SMGL campaign in districts outside the original 4 SMGL districts.
MNCH Performance Indicators Performance indicators are summarized in the table below:
Activity Key Indicators Annual Performance Target Annual Q 1 Q2 Q3 (cumulative) 1: Capacity building of Good Life clinics to provide quality and integrated MNCH services Conduct trainings for 50 No of health 100 0 0 0% service providers from the 50 workers trained (2/GLC) GLCs on Goal oriented Antenatal care and Emergency Obstetric and newborn care Post training follow up of 188 No of health 188 0 138 - 73% IMCI trainees at their workers mentored workplaces on a quarterly basis Procure and distribute basic No. of GLCs 50 0 50 Procure 50% MNCH supplies (MUAC tapes, equipped with basic GLCs supplied d LLITNs delivery sets, Mama kits, MNCH supplies with & Cxal
41 Activity Key Indicators Annual Performance Target Annual Q 1 Q2 Q3 (cumulative) LLITNs, and distribute them delivery cancer to 50 GLCs sets. screenin g kits for 50 GLCs. Maama kits are being procured by PF. Conduct quarterly No. of health 100 - 85 HWs - 85% Continuous Medical workers reached HWs Education sessions with the through CME 50 Good Life clinics on sessions selected topics in partnership with MOH Conduct community No. of integrated 50 - 34 23 114% outreaches by the 50 GLCs (1 community GLCs outreach outreach each per GLC) outreaches suppo es. es supported, ANC 1 rted to &ANC 2 attendance, do the 202 ANC children<5 seen, outrea clients, 371 ANC post natal ches 156 clients, attendance children 1087 immuniz children ed, 110 de- children wormed, were 236 treated children and de- treated, wormed 189 children immuniz ed Finalize development of, print Flipchart and distribute the Flip Chart was pre- on ANC integrated with tested eMTCT. and reviewe d, with inputs from key stakehol ders at national, district and service delivery levels.
42 Activity Key Indicators Annual Performance Target Annual Q 1 Q2 Q3 (cumulative) 2: Community sensitization and demand creation for MNCH services
Formation of 50 mothers’ Number of mothers 50 - 35 - 70% clubs and support monthly clubs oriented who mothers’ clubs activities in 50 are actively GLCs engaged in community MNCH services demand generation and submit timely monthly reports 3: Scaling up the Safe Deliveries and Newborn Care through Health Facility Delivery Campaign Radio programs Number of radio 1000 13783 138% spots aired Number of talk 100 41 41% shows aired TV ads – 1 TV station( 1spot Number of TV adds 100 buy package on NTV) Bill boards – 13 bill boards No. of bill boards 40 (block figure) Printing Promotional pieces of IEC, job 1000 50 sets materials, IECs and Job aids printed of job Aids( lump sum) aids for 50 GLCs were printed and distribut ed.
Key Outcome Indicators
MONITORING MNCH INDICATORS Annual Quarterly Performance %age target (annual cumulative) MATERNAL HEALTH Q1 Q2 Q3 Q4 Number of mothers attending the first ANC visit at the 40,000 8,028 6,112 6700 52.1% GLC Number of mothers attending the 4th ANC visit at the 25,000 4,658 2,992 2832 41.9% GLC Number of mothers who received IPT 1 at the GLC 35,000 6,684 4,929 4886 47.1%
Number of mothers who received IPT 2 at the GLC 30,000 5,309 3,262 3782 41.2%
Pregnant women counseled, tested and received HIV 30,000 7,700 6,342 6182 67.4% results at GLC
43 MONITORING MNCH INDICATORS Annual Quarterly Performance %age target (annual cumulative) MATERNAL HEALTH Q1 Q2 Q3 Q4 Number of mothers delivering at GLC by skilled HW 28,000 5,241 3,200 3096 41.2%
Number of women receiving post natal services 20,000 3,443 2,318 5683 57.2%
CHILD HEALTH Children under 5 years treated for malaria & other 200,00 59,81 37,22 4652 71.8% common childhood illness 0 7 6 0
Plans for Quarter 4 Orient health workers from 50 GLCs on Focused ANC, care of the newborn, AMTSL and cervical cancer screening. Distribute cervical cancer screening kits to GLCs that will have been trained on cervical cancer screening. Engage the GLC service providers to support the Maama’s Clubs in mobilization of clients for MNCH services at the GLCs and use Maama kits and LLITNs to attract women to deliver in the GLCs. Conduct integrated technical supervision. Finalize printing of the integrated ANC, eMTCT, and Child Health flip chart use it during mentoring of HWs in GLCs.
2.3 FAMILY PLANNING
UHMG with additional funding from DFID has been implementing for the last 2 years an expanded range of family planning services (the short term and the long term FP methods). ARC project aims at increasing the availability of and demand for reproductive health products especially long term methods. Activities are focused on increasing reproductive health commodity security in the private sector at most rural and urban districts private outlets. The focus is on capacity building of the private sector service providers in all method FP service provision especially long term methods (IUCD and Implants), logistics and stock management, distribution and demand generation. ARC largely focuses on social marketing and end mile distribution of long term FP methods (IUCD and Implants), to cater for informed choice a comprehensive FP mix. UHMG currently distributes its products through the private sector franchise network called the GOOD Life Network where currently238 facilities are offering LTFPM.
Project Goal:
44 Contribute to the improvement of national CYPs by 1,030,584 CYPs. General objective: To increase the number of Women of Reproductive Age (WRA’s) using FP methods especially LTFPM (IUCDs and Implants)
Expected Project Output: Attain 1,030,584 CYPs
Broad Program result areas
• Result area 2: • Increased availability, affordability of FP services and products • Result area 3: Demand Creation; increased knowledge and promotion of Healthy behaviors and lifestyles among individuals of reproductive age especially rural and hard to reach populations.
Performance indicators, Targets and achievements in quarter 3 Activity Annual target Quarterly achieved comments target Result area 2 Strengthening infection 300 100 clinics 138 control and quality assurance in clinics and hospitals Support GLCs to conduct 300 100 outreaches 69 Fewer outreaches were outreaches. outreaches conducted in June due to lack of FP supplies. Support joint District 90 30 35 coordination of FP activities (quarterly)
Disseminate MOH guidelines 300 100 clinics 138 and job aids for quality standards to network providers
Summary of family planning services conducted in the quarter May 2013 April 2013 June 2013 Total CYPs achieved Implants 402 800 115 1317 5004.6 IUCD’s 135 203 6 342 1573.2 Injectaplan 233 332 31 591 147.75 Pills 339 403 10 752 50.384 Moon beads 39 28 0 67 44.89
45 6820.824
Total number of outreaches conducted in April 2013 =40 outreaches Total number of outreaches conducted in may 2013 = 23 outreaches Total number of outreaches conducted in June 2013 = 6 outreaches Total number of outreaches in the quarter = 69 outreaches Results areas 3 demand generation Achievements
Smart Choices - Family 3646 radio mentions & spots on Coordinate scheduled talk shows to address planning media CBS, Super FM, Sun FM, Mama FM, HITs, Radio knowledge gaps. campaign Buddu, NBS, Open Gate, Aura one, Etop FM, Voice of Lango, Radio West , Liberty FM 46 TV: NTV, Bukedde, NBS 23 Radio talk shows for one month 27 Billboards 9 Roadsters
Other activities under result area 3 that was planned but not carried out are; Recruitment, training and facilitation of good life clinic promoters to create demand for FP products.
Challenges • Myths and misconceptions about IUCDs hence the low uptake • Service provider bias coupled with lack of skills on IUCD and implant insertion • Consumer bias coupled with no demand creation activities. • Human resource attrition at health facilities trained. Lessons learnt Demand creation activities are paramount to drive product consumption
Inter-personal communication is important in addressing myths and misconception
Way forward Implementation Strategies/activities to increase uptake of -IUDs and Implants in quarter 4.
46 Result 2: Increased availability, affordability of services and products especially short, mid and long term FP products. a) Plan to increase the number of GLC franchises offering IUDs and implants from 41 to 300 by the end of the September 2013. Trainings have been planned to take place within Kampala for KLIS clinics. A total of 2 to 3 trainings shall be conducted.
b) To ensure that 100% of GLC franchised providers do not experience any stock outs of essential IUD and implant supplies. Social marketing of FP methods and End mile distribution of products especially long term FP methods will be conducted.
c) To increase availability of FP services through support of outreaches.
Result 3: Demand Creation; increased knowledge and promotion of Healthy behaviors and lifestyles among individuals of reproductive age especially rural and hard to reach populations. a) To increase % of both women and men in target districts who have positive perceptions of the IUD and implant through:
I. Interpersonal communication strategies
II. Mass media campaign III. Community Mobilization
IV. Advocacy to Address Consumer Biases against IUDs and Implants
2.4 MALARIA CONTROL SERVICES
During the third Quarter of FY2013, UHMG programs in partnerships with NMCP and the districts supported health facilities and drug shops and GLCs in malaria case management services in the districts of Soroti, Kumi, Ngora, Katakwi, Serere, Kaberamido, Palisa, Apac, Lira, Amolatar and Dokolo. Malaria services delivery was also improved across all the rest of the GLCs in the country in bid to promote delivery of integrated service delivery.
Q3 Activity Highlights Key activities implemented included: i. Quality improvement and support supervision facility visits: Through on-job mentorships, health workers from GLCs and drug shops previously trained in malaria diagnosis and case management were provided with on-job trainings to consolidate the previously acquired knowledge and skills in malaria case management.
47 ii. Increasing access to malaria control commodities: RDTs and ACTs were also marketed and sold during the above facility visits as wells through sales by the product facility.
iii. Demand Generation for Malaria Control Services Utilization: UHMG conducted phase II of the Power of Day One to increase demand for parasitological testing for malaria with microscopy of RDTs to confirm the diagnosis before initiating treatment
iv. UHMG participated in the World Malaria day implementing activities as part of the world day event on April 25, 2013 in Sooty and May 10, 2013 in Soroti and Serere district.
Activity Progress A summary of annual work plan progress, during Q3 is summarized in work planning tracking matrix, presented below:
48 Malaria Work Plan Activity Tracking Matrix Q3 Annu Activity Indicator Annual Q1 Q2 al% Remarks 1.1: Malaria Case Management Training of new health Number of GLC 100 48 35 69 152% Completed workers on case supported in Q3 management across all GLC/s Reorientation of drug Number of drug 300 175 117 106 133% Completed shops members on case shop supported in Q3 management Production and Number of job 3000 - 500 distrib 167% Completed distribution of malaria aids reproduced 0 uted in Q3 case management job aids Procure and distribute Number of RDTs 150,00 0 0 10,000 N/A Target too subsidy RDTs sold 0 high for funds allocated for RDT subsidy 1.2: Malaria In Pregnancy Training of new health Number of 150 - - For Q4 workers on MIP health workers integrated integrated in ANC for trained with MNCH GLC with ANC Printing and distribution Number of 500 - 300 200 100% ongoing of integrated RH registers registers produced Distribute subsidized Number of ITNs N/A N/A Commercial ITNs through ANC distributed sales. Free nets available through GFATM 1. 3. Demand generation activities Produce and distribute Number of 0 Power of malaria posters posters Day 1 Phase distributed 1,000 2 ran in Support radio spots & 1417 Qtr3. talk for malaria Number of radio 354%
49 Key outputs
World Malaria day:
A health worker from St. Martin Amakio providing health education to mothers
On 11th May 2013, UHMG joined the rest of country in commemorating the national World Malaria day event in Soroti. The Uganda Health Marketing Group along with other partners participated with partners in the fight against Malaria participated in this year’s World Malaria Day activities with the Theme “Invest in the future: Defeat Malaria” This year’s National event was hosted by Soroti district with President Museveni as the Guest of honor. The day was combined with the launch of over 15.5 million long lasting insecticide-treated nets that will be distributed to at least more than half of 30 Million Ugandans with the support of the Global Fund to Fights AIDS, Tuberculosis and Malaria, making it the largest malaria prevention campaign this year. Key activities included the following: Printed and distributed 200 T Shirts to district officials, GLC service providers and community members who attended the national event
Conducted community dialogue meetings for 147 people in six meetings and home visits for 59 households
Supported VHTs to conduct integrated outreaches in which 449 people were provided with free malaria testing with RDTs and ACTs were prescribed and dispensed for those diagnosed with malaria
Supported district to provide supervision field visits to UHMG program sites which was acknowledged by the Soroti LCV chairman in his speech at the national event
Exhibitions: UHMG showcased Malaria programs at the National event in Soroti district
Supported Soroti district drug shop association to participate at the national event
Social Marketing of Malaria Control Commodities:
50 In addition, UHMG malaria control products were sold to members, through the drug shops associations. Provision of services delivery skills, adherence to service standards and provision of affordable quality prices through joint procurement that enables economies of scale are the main reasons the district drug shop associations are supported by UHMG Programs, through AFFORD project.
Quarterly Support supervision and on-job mentorships:
Lab technician: Reading a test result at Soroti Medical Associates
UHMG partnered with NMCP and 11 districts to conduct support supervision in GLCs and drug shops in the 11 focus districts. Team comprised of technical persons from NMCP, the district task force (district health office, district master trainers and executive of the district drug shop associations. Support visits were aimed at improving the quality of service delivery. Key activities included: 69 health workers from GLCs and 106 drug shop operators were oriented on malaria case management during these visits. Reviewed service delivery data and mentorships in areas where gaps were identified UHMG supported GLCs with HMIS registers including: OPD registers, integrated reproductive health registers and integrated ANC registers to collect malaria related data as part of integrated service delivery Sold subsidized RDTs to GLCs and drug shops. Buyers were provided with free gloves for all purchases as part of infection control. Distributed 1250 job aides on diagnosis using RDTs; and a guide on steps to take in case a client comes with a fever and but with a negative RDT test Conducted quality assessment and improvement in malaria service delivery in GLCs and drug shops
Key findings from assessment done in GLCs are summarized in the table below: Score Perce
51 nt HEALTH FACILITY OPERATIONS CAPACITY 12.0 72 SERVICES AT THE HEALTH FACILITY 76.0 76 INFECTION CONTROL MEASURES 24.0 85 DATA MANAGEMENT AT THE HEALTH FACILITY 13.0 88 OTHER SERVICES 15.0 49 WORKING AREA 11.0 74 JOB AIDS FOR QUALITY SERVICES DELIVERY 5.0 54 PATIENT SATISFACTION 7.0 68 HUMAN RESOURCE AT THE HEALTH FACILITY 14.0 85 Total Score 117.0 Proportion (%) 73
Demand Generation for Malaria Control Services: Phase 2 of the Power of Day One campaign was launched in the 11 PMI focus districts. Activities included radio talk shows, radio spots, bill boards and details are summarized in the marketing and strategic information section of the report.
Summary of Malaria Services Data Indicator Annual Q1 Q2 Q3 Annual Annual Target output Output Output Cumulativ Cumm% e Suspected malaria cases 90,000 29,934 22,959 22,986 75,879 84.3% <5 year Suspected malaria cases 140,00 49,656 31,331 35,923 116,910 83.5% >5 years 0 Lab tests (RDT) cases <5 24,000 8,203 5,500 9,873 23,576 98.2% year Lab tests (RDT)>5 years 33,000 11,898 8,593 14,179 34,670 105.1% Lab tests (BS) cases <5 80,000 30,491 22,202 31,262 83,955 104.9% year Lab tests (BS) >5 years 160,00 56,878 39,532 45,480 141,890 88.7% 0 Confirmed cases (RDT) 10,000 3,730 2,625 4,579 10,934 109.3% <5 year Confirmed cases(RDT) >5 12,000 4,388 3,710 4,468 12,566 104.7% years Confirmed cases(BS) <5 40,000 15,913 14,184 12,873 42,970 107.4% year Confirmed cases(BS) >5 70,000 24,939 17,631 16,382 58,952 84.2% years New ANC attendances 40,000 8,028 6,112 6,700 20,840 52.1%
52 Cases of malaria in 6000 1020 1,308 2,275 4,603 76.7% pregnancy IPT1 35,000 6684 4,929 4,886 16,499 47.1% IPT2 30,000 5309 3,262 3,782 12,353 41.2% % of IPT2 59.3%
Plans for Q4 (July-September 2013) i. Continue implementing the Power of Day 1 Phase 2 multichannel health communication campaign. This campaign provides knowledge and awareness on early malaria seeking behavior, based on policy guidelines on treat, treat and track. In addition to mass media, wworking with community mobilizer, the good life promoters, and households will be empowered with information to generate demand and more utilization of malaria prevention and treatment services.
ii. Train 150 health workers on management of malaria in pregnancy through facility based trainings in selected 11 districts outside the PMI districts
iii. Support MOH officials to provide support to the Power of Day One campaign through field visits
iv. Orient 300 drug shop operators on pre referral treatment of complicated malaria
v. Conduct community dialogue meetings as part of phase 2 of the Power of Day One campaign
vi. Provide malaria control commodities, through social marketing: RDT, LLIN, ACT; Fansida for IPTp; IPTp directly observed treatment (DOT) commodities; water treatment tablets (acquasafe®), clean water storage vessels and dispensing cups through implementation approaches integrated with MNCH. vii. Quarterly support supervision and on-job mentorships of services providers; this will include refresher orientation meetings for newly recruited staff in order to ensure services quality is maintained. viii. Support drug shop association operations for sustainable quality malaria case management by members, as first line health care providers. This will include supporting them to access quality affordable health products, benefiting from economies of scale and credit line facilities. In addition, members will be supervised o ensure that they act professionally in their dispensing practices.
53 ix. Documentation and dissemination of best practices in malaria control services delivered through AFFORD UHMG project.
54 3. CROSS-CUTTING ACTIVITIES AND SERVICES
3.1 Marketing & Strategic Information (MSI) - Brand Activities
Activity Performance Monitoring Table
Brand Activities Qtr 1 &2 Q3 Target Actual Year to- Notes, Qtr 4 plans Targets/Outputs Actual date Cotramox 7,900,000 2,828,160 5,071,840 978,900 3,807,060 48.4% Vs Annual Esther Bulk purchases registered by Atuuse IRCU and Family Hope clinics.
New consignment expected by 10th July and there are advance orders to cover shortfall. Networking w/decision 2 20 3 5 Scheduled to orientation makers in major Family Hope clinics that have institutions and NGOs; lifted the biggest bulk. increase number from 6 to 8 Detailing in health and 988 outlets 744 outlets 3,535 4,523 Sales of 27,030 tablets (901 pharmacy providers; outlets outlets dispensers) were registered posters to improve 721 from detailing efforts. brand visibility providers Regional orientation 2 1 1 Successfully conducted a meetings drug shop and Pharmacy Provider workshop with attendance of over 90 in West Nile to support UHMG pharmacy in the region
Follow up 90 providers oriented in Northern Uganda Brand Activities/Targets/Out Qtr 1 &2 Q3 Target Actual Year to- Progress, Comments puts Actual date Restors 2,000,004 629,800 1,370,200 479,250 1,109,050 55% Vs Annual A +ve trend Restors closed Esther 2012 at 39% and was at 23% in Qtr 3 last year Zinkid 10,000,000 tablets 458,525 9,541,475 353,533 3,914,450 39% Vs Annual These are retail sales. Pursuing institutions
55 Media Running Ended Mid 11 radio Jan – May Placed 2421 spots on 11 May stations radio stations and on leading local TV station for the community audiences to maintain with more sponsorships and presenter endorsements
Partnerships to 2 2 2 4 Wakiso Drug Association strengthen distribution (WADOPA) procured 250 sachets of Restors Uganda Private Midwives Association purchased 1,000 Restors packs and 4 Zinkid dispensers. Detailing 977 outlets 840 outlets 3,535 4,512 Sales of 41,075 sachets covered outlets 0utlets (1,643 dispensers)and 70,100 tablets (701 721 dispensers) providers CMEs Scheduled sessions in July to target over 1000 providers. Brand Activities/Targets/Out Qtr 1 &2 Q3 Target Actual Year to- Progress, Comments puts Actual date Injectaplan 4,500,000 1,167,410 3,425,100 556,280 1,770,070 39 % Vs Annual (Lemi Increased level of effort & Paul) uptake. Injectaplan was at 35% same Qtr last Vs a target of 2,799,996. Participate in 6 1 5 11 Exhibitions conducted with conferences/exhibition Uganda Private Midwives s for visibility Association, (UPMA) Drug Association meeting -WADOPA Rotary Family Health days in Namanve & Bweyogerere and at a Hospice USAID supported event. Coordinate with 31 clinics 6 clinics 37 clinics Hoima, Lira and Masindi. 10 programs community dispensers sold interventions to both promote Injectaplan and sales of Injectaplan through GLCs Detailing and 2,062 4,392 2878 4,940 sales of 28,150 vials (2,815 merchandising outlet outlets outlets outlets dispensers) coverage 943 providers
56 CMEs 1 6 2 3 Conducted CME’s in Mengo hospital nursing school and WADOPA meeting. 5 CMEs planned in partnership with a popular trainer to reach over 1000 providers. Brand Activities/Targets/Out Qtr 1 &2 Q3 Target Actual Year to- Notes. Qtr 4 Plans puts Actual date Pilplanplus 2,549,995 cycles. 602,670 2,266,256 299,460 1,375,290 54% Vs Annual (Lemi Paul) Most outlets now stocked. User shelf off take has slowed with a bias towards LAFPM’s. Participate in 2 5 7 Exhibited in 5 events with conferences/exhibition other brands. s for visibility Mass media (TV, radio) Heritage Route campaign and billboard. running on national & regional stations up to Sept. Detailing and 2,062 4,392 2878 4,940 Sales of 42,600 cycles merchandising outlet outlets outlets outlets Registered. coverage 943 providers CMEs 6 2 8 CME conducted in Mengo hospital nursing school and WADOPA meeting. 5 CMEs planned in July. Brand Activities/Targets/Out Qtr 1 &2 Q3 Target Actual Year to- Notes. Qtr 4 Plans puts Actual date Moonbeads 5,950 1,366 4,584 308 1,677 Dropped at 28% (Lemi Paul) These have been mainly retail through the brand focal person. Advanced discussions with key institutions to lift 2000pcs. Coordinate with 31 6 37 programs to make sales to GLCs and community interventions Increase access through Discussions scheduled with FBOs Uganda Catholic Medical Bureau (UCMB) Detailing coverage 153 outlets 342 outlets 306 459 outlets Generated retail sales of outlets 361 pieces 603 providers CMEs in Nursing 5 6 6 Trainings were held in 5 Schools major referrals. (Mengo, Jinja, Rubaga, Mulago and Nsambya )
57 Brand Activities/Targets/Out Qtr 1 &2 Q3 Target Actual Year to- Progress, Comments puts Actual date NewFem 40,000 cycles 12,740 28,780 9,560 21,460 At 54% Vs Annual (Lemi Major sales registered Paul) through Humanitarian care distributing to GLCs in western Uganda and Kampala pharmacies Mass media Feb - April 600 spots Coverage was in Kampala and and central. To be mentions maintained with presenter on 2 mentions. stations Participate in 2 4 5 7 Exhibited at 5 events. conferences/exhibition s for visibility. Coordinate with programs community interventions to both promote Newfem and sales through GLCs Detailing 1,057 2,160 2878 3,935 Team has sold over 1,064 outlets outlets outlets outlets cycles 943 providers CMEs 5 2 2 CME conducted in Mengo and Jinja hospital nursing schools Brand Activities/Targets/Out Qtr 1 &2 Q3 Target Actual Year to- Notes. Qtr 4 Plans puts Actual date Softsure 72,000 cycles 15,731 59,700 13,432 29,323 At 41% Vs Annual (Lemi There were packaging Paul) challenges with delay of cycle packs. Major sales have been through Eris Pharma, Humanitarian Care and Nakasero Hopsital who ordered for 200 cycles. Increase access to 2 2 2 4 UPMA and WADOPA Softsure through supporting. collaboration with More Institutions orders NGOs and professional prospected from Pathfinder, associations. Malteser, Child Fund and Mengo Hospital Health provider 2 2 3 5 Endorsed through focal recommendations people at Mulago FP unit, through weekly Family Case hospital and Jinja Planning trainings Hospital FP unit midwives.
58 Mass media(Radio 2 months 2040 Coverage was in Mbale, coverage) Feb and spots and Kampala, Gulu and March mentions surrounding towns within a on 5 radius of 200km, Western stations (Kabale, Mbarara, Ntugamo)
Detailing 1,066 2,160 2,878 3,944 Achieved sales of 2,080 Outlet coverage outlets outlets outlets outlets cycles so far
720 943 providers providers CMEs 5 2 2 Conducted in Mengo and Jinja hospital nursing schools
Brand Activities/Targets/Outputs Qtr 1 &2 Q3 Target Actual Year to- Progress, Comments Actual date Condom ‘O’ Sales volume of 1,500,000 802,368 805,632 324,576 1,157,904 At 77% Jeanne Marie pieces A positive trend. O was Nakato at 41% Qtr 3-2012.
Open 4,000 additional ‘O’ 1117 2883 2401 3518 Through merchandising outlets (supermarkets, outlets efforts, 3518 outlets dukas/kiosks, hotels, reached are stocking ‘O’ lodges)
1 mass media campaign (DJ Media extended with endorsements, TV and radio cost effective bumper spots) ads & sponsorship mileage.
12 regional concert Targeting seasonal sponsorships sponsorships
‘O’ theme nights in leading 20 20 16 36 12 theme nights have night clubs/bars per regions been conducted in Eastern and Western region. Output sales:25 dispensers Pursue corporate social Partnership confirmed responsibility collaboration. with dfcu bank to procure condoms.
We’ve also trained 40 peer educators within the bank who are linked reach over 5000 employees.
59 Brand Activities/Targets/Outputs Qtr 1 &2 Q3 Target Actual Year to- Progress, Comments Actual date
PROTECTOR Achieve sales volume of 6,932,280 15,067,720 5,283,660 12,522,780 56% Vs Annual 22,249,960 condoms. More uptake compared to 2012. Sales were at 44% Qtr 3 last year Vs a target of 16M pcs. Market demand healthy to cover gaps. Coordinate activities with Sub-grantees that have MARPS program, Boda Boda purchased condoms- campaign and Boda Boda NAYODE, Health Alert associations Gulu and HCU
Mass media (TV and radio) 15 15 Currently Currently Coverage based on stations stations 6,200 6200 MARPS areas in all spots spots and regions. and mentions mentions have run. Modifying spot ads to have run. Media is 15 secs to increase on going media intensity with a up to end smaller budget. of June. Distribution through 2401 existing networks and retail 0utlets outlets (dukas, pharmacies reached & drug shops Brand Activities/Targets/Outputs Qtr 1 &2 Q3 Target Actual Year to- Progress, Comments Actual date AQUASAFE 5,400,000 tablets sold 1,729,760 1,800,000 1,128,400 2,858,160 53% Vs Actual Jeanne Marie Deficit to be covered Nakato with more institutional engagements and re- stocking of enrolled schools. Performance was at 38% same time last year.
Media Pulsing radio Presenter mentions Promotions Promotions at schools 50 50 50 50 50 enrolled schools in Northern region have been followed up. Qtr will cover Central, East and Western Schools. Increase community 277 277 2746 3023 Focus on GLCs per distribution points to 180 outlets region to stock reached Aquasafe.
60 Brand Activities/Targets/Outputs Qtr 1 &2 Q3 Target Actual Year to- Notes. Qtr 4 Plans Actual date Partnerships with NGOs for 3 1 2 3 World Vision procured institutional sales 128,000 tablets through Pharma Health Care. Uganda Joint Christian Council purchased 80,000 tablets.
Will pursue more purchases from similar prospects. 4 plantation activations & On Plan Workplaces trainings PR during World Water Day, World Water Week and Day of the African Child.
Trainings & Community orientations 2 1 3 4 Oriented communities demos during Rotarian Family Health days, through the USAID/Uganda HCT Kampala activities. Participated in Schools sports at Makerere where over 40 schools within central were involved
CHILD HEALTH - Restors + Zinkid An upward trend registered for Restors whereas Zinkid has slowed with major prospects co-opting for a combined pack. A close competitor has started packaging a co-pack which threatens Restors + Zinkid share if we do not move faster. On another hand, there are opportunities for Restors + Zinkid as the brand that has been fronted in a partnership with Clinton Health Access Initiative and McCann health to increase national provider awareness with a team of Continuous Medical Education trainers.
CHILD HEALTH - Aquasafe Sales are at 55%. Institutional sales constituted the bulk of the quarter 3 sales with World Vision through Pharma Health Care purchasing 128,000 tablets and Uganda Joint Christian Council purchasing 80,000 tablets. Through merchandising and detailing activities per region
61 retail trade 2,746 outlets are stocking Aquasafe. For Quarter 4, focus will be in re-orienting enrolled schools to encourage re-stocking, target major schools days for sampling and demonstrations while working closely with the program teams to distribute to Good Life Clinics.
O’ Condom At 77%, achievement f against annual target, ‘O’ has steadily grown as a brand in the condom market. More sales opportunities through corporate organizations who procure for their employees. The retail audit conducted in April showed that ‘O’ presence within supermarkets and bars increased from 80% to 90%. A merchandising drive is on-going in Kampala, Jinja, Mbale and Mbarara to consolidate this achievement and to maximize visibility for the brand.
PROTECTOR A condom promotion targeting MARPS was successfully conducted to popularize condoms as consumer commodities that users must not be shy to purchase. The drive was through Masaka hot spots while the health camp was at a Lake Victoria major Landing site in the District (Lambo). Over 1,500 fisherfolk were exposed to prevention messages. Other Services; Family Planning: 70- LTM’s inserted, SMC- 20+, HTC- 300+, Condom Sales: 27+ cartons, Sampling- 2 cartons including female condoms. Bar/Discoteque activations- over 50 outlets. Intervention was in partnership with TASO and Medical Research Council. More promotions are scheduled in July along the Lake Victoria Belt in the same region with JHU/CCP, Rakai Health Sciences Program. Current Sales are at 55% and market demand is health to cover deficit in the next Quarter.
Cotramox Sales at 49% with Hope Clinic procuring the largest bulk. A new stock consignment has been ordered and market prospects are high. Deficit anticipated to be closed with advance orders placed.
Pilplanplus Most outlets are stocked with the new combination 3. Uptake has been slow with increasing preference for Long term options. There’s a potential market for pills among young mothers targeted with various activities. To increase provider prescription, Two (2) Family planning CMEs were conducted with nursing students and 5 exhibitions were conducted to create awareness of new combination. The heritage media campaign will continue utilizing radio
62 presenter mentions and talk shows. 5 CMEs are scheduled in all regions with drug shops, pharmacies, midwives and clinicians.
Injectaplan CMEs, exhibitions, detailing and merchandising have been implemented to support along with the ‘Smart choices’ media campaign. Despite increases level of effort, provider prescription of injectables has slown down with major Gyns emphasizing side effects. CMEs and radio talk shows are scheduled to address information gaps. At a strategic level, several options are being discussed with programs.
Moonbeads CMEs have been held in Mengo and Jinja hospital nursing schools to introduce nurses and midwives to Moonbeads as potential advocates. Further, Rubaga and Nsambya Hospitals that are faith based have been partnered with to hold daily trainings to mothers attending Family planning services. We are supported by Mulago hospital Family planning unit who also receive several prospects of Moonbeads. Though government endorsed the moonbead as a reliable method, they do not stock them. Finalizing discussions with Catholic Medical bureau for a bulk order will be conducted in the next quarter.
Softsure Retail sales increased through mono packs and have been attractive to users who cannot afford the dispenser packaging. Midwives during trainings and CMEs have used samples of Softsure to enable attendants know what the pills look like. Several institutions contacted offering MNCH services are promising bulk purchases. These have included; Pathfinder, Malteser, Child Fund and Mengo Hospital.
63 Newfem Various premium outlets continue to stock NewFem as a result of increased outlet reach by the merchandising and detailing teams coupled with the media and recommendation support from Mulago Hospital Family planning unit, Jinja Hospital FP unit. Targeted mass media awareness conducted on 2 stations, 600 spots. Merchandising and detailing services contributed 1,120 cycles through direct sales and the rest. Majority of the sales were through HCU 1,980 dispensers and the distributors. The next quarter we have scheduled more workshops with health providers, supporting distributor shelf off take through detailing and merchandising services and continuous partnerships with midwives/gyns to recommend in Case hospital, paragon hospital, International Hospital, mengo Hospital and Mulago FP unit.
Good Life Clinic (GLC) Summary Performance
Focus Area Activities/ Q2 Actual Q3 Targets Year To-date Comments/Qtr 4 Plans Targets/ Outputs Product Availability 150 facilities to 25 GLCs were 50 83 stocking Increase consistent be fully stocked stocked availability in at least 100 facilities. Linkage of 2 homes and 10 work plans received to communities to GLC’s Kakira linked to conduct outreaches. ( Demand Creation) GLC’s for services. Worked with Mbuya Reach Out and AAR Daily contacts & Establish Visited 30 50 100 have been To continue. follow ups through quality levels & visited. Guided SMS, visits provide on areas of feedback. improvement. Data Collection & To create HMIS focal 25 data officers To continue working with Management support linkages for people in 11 committed to community structures for cost effective districts signed support. data collection. data collection to support 30 GLC’s 50 mentored so mentored in far data mgt IEC/Promotion Distributed in 50 80-100 received materials 30 materials Physical branding 150 fully 100 Review 100 Get feedback and branded progress address errors. Identify credible facilities that are interested in the partnership.
64 3.2 Marketing & Strategic Information (MSI) – Communication (BCC)
UHMG Campaign Reach During FY2012, AFFORD/UHMG was able for the first time to obtain data for the total population reached by various media campaigns. This customized analysis was performed by the leading market research firm IPSOS/Synovate, merging data from media monitoring with their national Media Use Survey to provide a measure of the unduplicated population reached by each campaign. Please see the table below for details. This scale of message reach in a population is very high by world standards and ranks UHMG alongside the leading advertisers in Uganda.
Note: Malaria campaign is implemented in 11 Districts, but Reach Data is only available against national population denominator.
Campaigns/Activities Achieved Next Quarter Planned Mariettah
65 EMTCT Coordinated implementing partners Developed and disseminated campaign Organizing the EMTCT materials launch in Lira district. Scaled up Campaign scale to the North Replicate previous success for Documentation of the Guided 20 IPs on campaign roll out. Tororo and Karamoja EMTCT Launch in Lira Produced TV spot of first lady and aired launches. on selected TV stations ( NTV, UBC ) Radio spots aired on 13 radio stations Lead national communication campaign Posters -11,000 printed sub-committee Fliers- 4000 Folders-300 Coordinate National media Fact sheets-500 campaign Leaders Handbooks -1150 ( 4 languages;4R, English, Luganda) Production & Client leaflets -2000 Dissemination of IEC Tear drops -12 materials Pull-up : 2 1 PVC banner with wooden poles 1 back drop banner with eyelets Bandanas-3000
Outdoor: 11 billboards in Kampala, 10 upcountry Billboards Newspaper inserts: 75,000 inserted in the The New Vision and Daily Monitor) Event: Northern launch successfully done on 28th June 2013 SCIPHA (Ritah Mwagale) Documented project activities in 19 Publish the SCIPHA news letter SCIPHA districts. Documentation Establish and maintain SCIPHA website
Maintain SCIPHA SMS chartroom
UNFPA(Ritah Mwagale) Coordinated the UNFPA funded Condom Coordinate the rapid assessment promotion TV and radio campaign. for the impact of the campaign. Condom Campaign Document the campaign
Running radio and TV spots
Social Pages Registered over 502 visitors Incentives to get more contributions are proposed. Pages also needs to be promoted on all materials Sarah Mutesi Smart Choices - Family 3646 radio mentions & spots on Coordinate scheduled talk shows to planning media campaign CBS, Super FM, Sun FM, Mama FM, HITs, address knowledge gaps. Radio Buddu, NBS, Open Gate, Aura one, Etop FM, Voice of Lango, Radio West ,
66 Liberty FM 46 TV: NTV, Bukedde, NBS 23 Radio talk shows for one month 27 Billboards 9 Roadsters
SMGL 24 talk shows On-going up to end September. 5859 (May - June) (Kamwenge fm, Endigyito Fm, Kibaale Community Fm, Kyenjojo, Liberty FM, HITs Fm 8 Billboards 20 Roadsters Lea Bwanika Test & Treat – Malaria Translation of Test and Treat messages in Flag Poles to be erected in Lira, Campaign Luo, Atesot, Runyoro, Luganda Soroti, Mbale, Pallisa, Kumi, Apac Flag poles erected in Lira and Amuria. (15 poles in each town) Production of campaign Outdoor and electronic materials completed. 67 Taxis Branded with Test and 1417 Radio Spots aired and 297 bonus Treat Campaign Messages mentions Treat Messages in Local languages 12 Talk shows aired on 6 Radio stations in Pallisa, Kumi,Soroti,Apac and Lira
3.5 MSI Cross-Cutting Activities - Corporate & External Relations
Planned Outputs Next Quarter Corporate Relations Implemented National Rotarian Compile UHMG resource mobilisation Marietah Katende, Francis Health day launch with Coca- Cola pack/presentation to present to more key Nsanga and AAR prospects. In partnership with dfcu to promote health education at the workplace. Knowledge Management 5th Annual publication Published, disseminated. Finalize content for 6th annual publication.
Other Documentation SPEAR report SCHIPHA report Information Pack AR, UHMG profile, folder, one Activity reports pager, success story Success stories
E-filing Campaigns on the server -50% E-filing 100% to be achieved within the next quarter Archive data on K4Health
67 Intellectual Property from On-going To archive working files. agencies
Other Corporate materials Produced Banners, Profiles, One Finalize end of year Good Life materials. pager, success story produced to promote the Good Life agenda.
Website-Maintenance Ongoing updates and Refurbishment and ongoing update refurbishment Product Facility to be better represented Compiled feedback to guide improvement of the entire website
Events UHMG Events Hosted a Swedish delegation (SWECARE) Held a successful UHMG Today & Tomorrow Conducted 4 Tent Model mentorship for STAR-EC- About to launch in 2 districts National events eMTCT National Launch Scheduled Heath Outreach with -dfcu World Malaria Day Celebrations- AGM- August Soroti Partnership Events MoH Malaria Day Colloquium- Outreaches Sheraton Media Coordination AFFORD Event coverage Achieved coverage on Nation Pursue Clips and archive (Lea Bwanika) Media, Monitor, New Vision, and 2 radio stations.
3.3 MSI - Research
Monitoring & Evaluation Report The M & E supports different departments through provision of timely and reliable data to guide performance review, planning, reporting and evaluation of interventions.
Q3 Activity Highlights These include: i. Bi-annual PEPFAR HYBRID data reporting was carried out
ii. Mentoring of GLCs in data management and reporting carried.
68 iii. Generation of work plan for mentorship and support supervision by district bio- statisticians/HMIS focal persons was carried.
iv. Production and distribution of data management tools was carried out
v. Data verification was carried in selected facilities.
Support data management and reporting by GLC GLCs were used to the quarterly reporting. Monthly reporting by the GLCs has been emphasized. Reminder SMS messages are sent to the GLC staff and this has proved to be an effective means of communication. Collection of monthly reports was integrated in other program activities before the decentralization process is completed. This is intended to reduce on operational cost and at the same time provide for immediate opportunity for data verification. However, reports do not come in as expected.
UHMG database update UHMG database update is a continuous process. Data verification was also carried out with emphasis on reports from service outlets which had figures which were questionable.
MEEPP Bi-annual Reporting and quarterly reporting to USAID The quarter was opened with the Bi-Annual PEPFAR reporting through MEEPP HIBRID online database. The online reporting system was modified and as a result had its own challenges. Unlike previous reporting where monthly data was aggregated into a six month report, data from the health facilities were entered on a monthly basis. This was more challenging as the system was opened late and it was new. The system was opened in May for continuously update of data collected on a monthly basis. This will minimize errors created through hurried data entry to meet strict deadlines. It also gives room for cleaning after entry.
MEEPP planned a Data Quality Assessment (DQA) during the quarter for service outlets supported to provide PMTCT services. However, implementation is planned for July 2013. The selected sites for AFFORD II project are not UHMG PMTCT sites but UHMG had reported MNCH data from those sites because of the strong program intervention.
UHMG Database enhancement The UHMG database enhancement to cater for program demands was implemented during the quarter. The database was also expanded to capture data generated by the PMTCT addendum, quarterly reports which collects data on Care and ART and generate appropriate reports.
69 BCC Survey The M & U unit supported the BCC survey through provision of administrative support. The field work was completed and data processing is going on.
M & E Performance Indicators
Activity Indicator Annual Q1 Q2 Q3 Q4 % Comments 5.1 Collection of Data from Quarterly visits for data 4 1 1 1 50% Ongoing GLCs quality validation 5.2 planning meeting with 1 1 100 Completed district Bio-statisticians 5.3 Conduct monitoring Support supervisory 4 1 1 1 50% Ongoing activities for sub grantees visits
5.4 Training of GLCs staff in Number of GLC staff 120 120 100 Mentoring HMIS trained in HMIS on going 5.5 Reproduction of data Management tools NA NA Replenish management tools produced ment ongoing 5.6 Designing of online Online reporting for GLC 1 1 100 Completed reporting system for GLCs in place 5.7 Quarterly Review Number of review 4 1 1 1 50 Ongoing meetings Staff, Sub- meetings held grantees 5.8 Quarterly feedback to Number of Reports sent 4 1 1 1 Ongoing districts and GLCs to districts, GLCs 5.9 Capacity building of M Number of M & E staff 4 4 NA NA 100 Completed & E staff trained % 5.10 AFFORD II end of AFFORD II end of project 1 1 1 Field work Project evaluation evaluation completed
Challenges: i. Some of the facilities supported by UHMG were missing in the PEPFAR online reporting system and they could not be verified before the end of the reporting period. In addition much of the data for the month of March had not been collected. This led to underreporting.
ii. The service outlets are many and spread in many districts. This makes it difficult to provide close support by the M & E office. Efforts are being made to make the support integrated in the programs activities. In addition working with the district is another option being explored.
iii. Many of the GLCs being supported in the different intervention areas have other USAID supported partners. This leads to double reporting. MEEPP has raised this
70 issue since it coordinates PEPFAR reporting. This is being addressed but it will affect AFFORD/UHMG performance since all the service outlets were considered during the targeting.
Planned activities for 4th Quarter i. Provide support supervision to sub grantees ii. Collection, compilation and capture data for program monitoring, planning and reporting. iii. Annual PEPFAR reporting through MEEPP iv. Carry out DQA in selected GLCs v. Support continuous mentoring of GLCs in data management and reporting by Bio- statisticians HMIS focal persons vi. Develop annual work plan for the unit for M & E unit for the year 2013/2014. vii. Quarterly/Annual data reporting to USAID through the online reporting.
Market Research on Outlets
During the Quarter, we also continued to track outlet presence through an Independent audit. The audit has guided marketing teams on where to focus efforts.
A summary of overall Product performance for a period (May 2012- April 2013):
May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May - 13
Protector 59% 77% 81% 81% 83% 82% 80% 79% 81% 80% 80% 79% 79% Pilplan Plus 58% 69% 72% 73% 74% 73% 73% 72% 74% 74% 77% 83% 85% Injectaplan 49% 60% 68% 69% 70% 70% 69% 69% 70% 69% 73% 76% 77% Zinkid 31% 43% 47% 49% 50% 51% 50% 48% 51% 47% 48% 49% 52% Restors 29% 39% 41% 41% 44% 43% 41% 41% 43% 41% 41% 39% 42% Condom O 8% 11% 12% 12% 12% 13% 15% 15% 17% 16% 17% 17% 18% Aquasafe 8% 9% 11% 11% 11% 11% 13% 13% 13% 14% 14% 12% 13% Softsure 5% 7% 6% 7% 7% 6% 6% 6% 7% 5% 6% 8% 8% Cotramox 2% 3% 3% 4% 5% 5% 6% 5% 5% 4% 5% 5% 5% 960mg Newfem 2% 2% 2% 2% 3% 2% 2% 2% 2% 4% 3% 3% 3%
Moon beads 1% 1% 1% 1% 1% 1% 1% 1% 2% 1% 2% 2% 2%
71 72 3.4 Human Resources, Governance and Procurement
Human Resources Management and Development
The following staff changes occurred during this quarter:
Recruited staff
No. STAFF NAME POSITION START DATE
1. Anthony Waiswa Driver April 3rd 2013 2. Ali Muwonge Temporary Driver April 3rd 2013 3. Michael Kyaligonza Temporary Driver April 3rd 2013 4. Ismail Tibasiima Temporary Driver April 3rd 2013 5. Shantal Mbabazi Business Manager – Key Accounts April 4th 2013 6. Emirinah Nabachwa Temporary Finance & Administrative May 1st 2013 Assistant 7. Roland Sanya Credit Officer May 1st 2013 8. Hudah Muleme Data Assistant May 23rd 2013 9. Edward Ruhweza Rujumba Driver May 23rd 2013 10. Anne Kyomugisha Sales & Distribution Coordinator May 23rd 2013 11. Rebecca Nakyazze Data Entry Assistant June 1st 2013 12. Eva Nabiddo Community Participation Officer June 1st 2013 13. Barbra Kyobutungi Supplies Assistant June 1st 2013 14. Joseph Ewatu Pharmacy Stores Assistant - Arua June 17th 2013
Exited staff
No. STAFF NAME POSITION REASON 1. Barbra Rwamibazi Brands Manager Resigned effective June 4th 2. Patrick Sando Data Officer (West-Nile Region) Resigned effective April 30th 3. Beth Naluboka Masangah Finance Officer Resigned effective June 28th 4. Emmanuel Oretta Pharmacy Stores Assistant Absconded on April 29th 5. Ismail Sulaiman Semakula Stores Assistant Absconded on May 15th 6. Irene Kakyo STRIDES Project Assistant Contract ended on May 20th
The general public was notified about the staff who absconded.
Annual Insurance Covers Both the Medical and the Group Personal Insurance covers expired on 30th April 2013 and 12th June 2013 respectively. The Medical insurance was renewed with Sanlam Life Insurance Uganda Limited effective 13th June 2013 to 13th June 2014. They held an orientation session
73 with staff on 5th June 2013 on the medical insurance benefits. Sanlam Life Insurance Uganda Limited were also contracted to cover Group Personal Accident and the Group Life Assurance for staff effective 21st June 2013 to 21st June 2014.
Payroll upgrade Following the completion of software installations and trainings preparation of the monthly payroll was upgraded from the manual MS Excel version to the electronic Pay Master version in April 2013.
Job Descriptions upgrade During the quarter, KPMG provided capacity building support in re-aligning job descriptions to departmental Key Result Areas (KRAs) and Key Performance Indicators (KPIs).
Performance Management The performance appraisal tool revised by KPMG was utilized to assess staff performance.
Internal Restructure Due to the work overload on the HR Directorate over time, on April 12th 2013 the Board recommended the transfer of Administration, ICT, Property Management, and Fleet Management to Finance. The HR Directorate retained HR, Governance, and Procurement. This was affected on May 1, 2013.
Capacity building Human Resource Management Information Systems (HRMIS) and Pay Master trainings continued during the quarter Endeavour Africa Uganda Limited on May 14th & 15th 2013. Orientation on the new Procurement policy manual training was conducted by the KPMG Consultant on April 12th 2013 as pictured below.
74 Paul Kalumba of KPMG facilitating the new Procurement Policy orientation session in April 2013 Orientation for all staff on the new Strategic Plan was facilitated by the Managing Director on April 23rd 2013. Staff were requested to think through UHMG’s future as pictured below.
Formation of Groups to further discuss UHMG’s core intervention areas during the All-Staff Strategic Plan Training /Orientation in April 2013
Emily Katarikawe, the Managing Director (pictured above and below) facilitating the All-Staff Strategic Plan Training/Orientation session in April 2013
75 Staff from UHMG, JHU/CCP, and ICOBI attended a Value For Money training conducted by SMART Consult (U) Limited on May 7th 2013 as pictured below.
Governance
Board meetings The Board of Directors (BOD) continued to provide further guidance to Management on UHMG’s strategic direction. The Board Chairman held monthly briefing meetings with the Managing Director on May 7th and June 20th 2013.
Strategic Plan meetings Quarterly meetings for the Board Committees and Board of Directors were not held this quarter in preference for the Strategic Planning process. Meetings were held as follows: April 18th to 20th 2013 – Management Retreat April 23rd 2013 – All staff brain-storming training/orientation May 10th and 12th 2013 – Board and Management Retreat June 15th 2013 – Board and Management review of the new Strategic Plan (draft)
During these sessions (some pictured below), the board members, board committee members, senior and middle-level management staff thought through UHMG’s strategy, considering the changes in the political, economic, social, and technical environments during UHMG’s 6 years of implementation since 2007. The purpose was to develop UHMG’s Strategic Plan for the period 2014 to 2019.
Management discussions in April 2013 on the new Strategic Plan 2014-2019, below:
76
Board, Committees, & Management Strategic Plan brainstorming sessions in May 2013 (stakeholder analysis above left and SWOT analysis above left ) Procurement Management
New Procurement Committee: After receiving nominations from staff, a new Procurement Committee was appointed by the Senior Management team on June 28th 2013 to serve for the next 2-year term (July 1st 2013 to June 30th 2015). The following staff were appointed to the new committee:
No. Names Designation 1 Dr. Julian Jane Atim Byaruhanga HIV/AIDS Program Manager 2. Bruno Sserunkuuma Bagenda Driver Product Facility 3. Phillip Twesigye Administration Manager 4. Specy Kakiiza Grants and Compliance Manager 5. Esther Atuuse Brands Officer 6. Joseph Ssenkumba Finance Officer 7. Francis Nsanga Knowledge Manager
The previous committee served for the period July 1st 2011 to June 30th 2013.
Project Procurements:
77 USAID/UGANDA Good Life Integrated HIV Counseling and Testing Kampala Project Organization Two consultants Henz Management and Capacity Building Services and Capacity Jeninah Kabiswa were selected in June 2013 to carry out OCA Assessment (Organization Capacity Assessment) for the prime (UHMG) and sub- (OCA) Grantee (ICOBI) respectively. They expected to start the assessment in the second week of July 2013. Out-door bill Two service providers were identified in June 2013 to provide bill board board services services in the five divisions of Kampala district. The bill boards are expected to run for 3 months initially and will be run in July 2013. The contracts will be renewed depending on the approved plan for the next financial year. 2 Vehicles Two vehicles (van and Jeep Cherokee) were procured from Tata (U) Limited and Spear Motors respectively. Both vehicles (pictured below) were branded are now being used for program implementation, including reaching communities in Kampala district with HCT services.
Branded van during an HCT program outreach
JEEP CHEROKEE – rear view JEEP CHEROKEE – side view
AFFORD II Project Procurement Following the review by KPMG and approval by the Board of Directors of Manual review the revised Procurement Policy, orientation for staff was held on April
78 and Staff 12th 2013, and the manual became operational in May 2013. orientation Construction While COSTA Construction Services Ltd was recommended as the of the contractor for the warehouse extension in February 2013, Warehouse commencement of the works was delayed due to absence of KCCA extension (Kampala Capital City Authority)’s approval. Several follow ups with the authority were made by the Architect (Dezyn Forum) and our Clerk of Works during the quarter. Approval is expected in the first week of July 2013. Development Imprint (U) Limited was selected in May 2013 as the consultant to of the develop UHMG’s strategic plan for the next 5-year period (2014-2019). Strategic Plan Review meetings and interviews with key stakeholders were held all 2014-2019 through May and June 2013. Tax exemption The first consignment of 250,410 shoes from TOMS Shoes Inc. arrived on and customs 30th May 2013. Under the USAID-GoU bilateral agreement, USAID clearance of granted UHMG tax exemption through the AFFORD Project on June 25th TOMS Shoes 2013. The tax clearance process is still on-going with Uganda Revenue Authority, and release of the consignment is expected in the second week of July for distribution under the Water and Sanitation program.
NUHITES (Northern Uganda Health Integration for Enhanced Services Project Shelving for G1 LOGISTICS was selected to supply shelving for 40 health facilities in 15 Health districts of Northern Uganda. The shelves are expected by 30th July 2013. Facilities Branding of Signages were procured for the first batch of 17 Good Life Clinics in Good Life Northern Uganda in June 2013. The clinics were branded was done Clinics accordingly.
KASESE HIV/AIDS PROJECT (KAP) 2 Motorcycles Two motorcycles were procured from Honda (U) Limited and tax consideration sought through Ministry of Health. The tax application was accepted by Ministry of Finance, and plans are underway to register the motorcycles under UHMG’s Memorandum of Understanding with MoH. 30 Bicycles The 30 bicycles procured from GNMK Enterprises Limited in March 2013 were delivered to the project in Kasese in May 2013. The bicycles are intended to help VHTs (Village Health Teams) in community mobilization activities.
79 PRODUCT FACILITY 1 Vehicle The second delivery van for the Product Facility was procured from TADASHI Auto City Trading Co. Ltd in May 2013. It will be branded in July 2013 after completion of the artwork.
Plans for Quarter 4 (July to September 2013):
Human Resources Management Review and renew staff contracts expiring on September 30th 2013 Conduct an All-staff meetings on July 26th and September 27th 2013 Continue practical on-the-job trainings on the HRMIS and payroll electronic software modules Complete Paymaster customizations and Tally integration in order to link both software for timely reporting Conduct staff capacity development sessions with KPMG Finalize and roll out the new performance management guidelines and performance management cycle in August 2013 Complete Annual Training Plan for all staff Conduct Risk Management Training in August 2013 Recruit staff and/or redeploy current staff with required skills to new projects
Governance Finalize the approval of revised policies (Board Manual, Sub-Grantee Manual, PF Operations Manual, and the Risk Management Manual)
Review final version of the Strategic Plan on July 27th and complete UHMG’s next 5- year Strategic Plan for the period 2014 to 2019
Firm up the legal implications, organizational structure, and HR Framework for the new strategic plan business models.
Hold the Quarterly meetings for the Board Committees and Board of Directors in the first and third weeks of July 2013
Hold the Annual General Meeting (AGM) on August 23rd 2013
Procurement Management
80 Continue to emphasize compliance to procurement policies in order to realize value for money
Finalize the orientation process of all staff on the reviewed Procurement Policy manual
Finalize the procurement, registration, and branding of the second van for the USAID/UGANDA Good Life Integrated HIV Counseling and Testing Kampala Project to be utilized by the sub-grantee (ICOBI – Integrated Community Based Initiatives) in expanding HCT services in Kampala district
Complete tax exemption process and registration of the Kasese HIV/AIDS Project motorcycles with Ministry of Health and Uganda Revenue Authority
Complete the procurement for support services in condom promotion, GLC service delivery, and shelving of health centers under the NUHITES project
Complete clearance of the TOMS shoes consignment and contract services for transportation, storage, and distribution of the shoes to the beneficiaries
81 3.5 Finance and Administration Directorate
Below are some of the highlights under financial and administrative directorate that were realised during the quarter.
Quarterly Financial Performance and Reporting During the quarter the UHMG demonstrated an improvement in its sustainability strategy based on the two sources of revenue i.e. 79% from the NGO and 21% from Product Facility (PF) including warehousing and distribution. Regarding PF, the revenue for quarter three reduced from 67% in quarter two to 33% as demonstrated in the tables and charts below. Key achievements included: signing of a grant from Tom’s Shoes of USD 75,123 for 1 year, signed a two year project of USD 770,000 with TASO through the Global Fund and improved business revenue through warehousing and distribution.
Several Financial reports for the quarter April-June 2013 were submitted on time to different donors including CCP-AFFORD, USAID Kampala HCT Project, Star South West-EGPAF, Strides- MSH, Access Medicines-MSH, SCHIPHA-CSF-JCRC, Reproductive Health-UNFPA project, and Spear Project-World Vision. The Board will approve both the two quarterly reports for January - March and April - June 2013 in a meeting due to take place on 12 July 2013.
A Revenue and Expenditure for the Quarter April - June 2013 NGO PF Revenue 7,739,223,900 – 79% 2,116,881,429-21% Expenditure 7,444,791,874 -78% 2,075,531,712-22%
82 Revenue and Expenditure for the Quarter April - June 2013
B PF's Revenue and Expenditure per Quarter Quarter 2 Quarter 3 Revenue 3,711,172,123-67% 2,116,881,429 -33% Expenditur e 2,939,696,378-59% 2,075,731,712 -41%
PF's Revenue and Expenditure per Quarter
Policies A draft sub grantee manual has been presented to the Finance and Planning Board committee for review and has now been submitted to the Board of Directors for approval.
Working Capital Management i. Credit control continued to be at the centre, the internal debt recovery has been well tracked with 40% recovery by end of June. ii. Stock management continued with surprise stock counts conducted once in the quarter and the routine monthly stock counts. The stock variance report has shown a lot of improvement with minor stock variances in the system figures and the physical stock figures which are explainable. iii. The payroll is now computerised unlike the manual excel generated old payroll. With full integration which is at an advanced stage will improve the data quality, report processing and accounting information for analysis.
Grant management and the Funding Grid UHMG currently runs twelve projects and this is being well-handled, which strongly demonstrates UHMG’s road map to sustainability. Some projects’ contracts ended during the quarter and new ones came on board such as the Malaria and TB Project under Global Fund, Tom’s Shoes and implementation has already started during the quarter. Staff LoE is being tracked through a funding grid and this is shared on a monthly basis and has eased reporting.
Sub-Grantee management
83 Quarterly field support visits continued, and generally their accountabilities and reports have improved over the period. A two-day capacity building training workshop was conducted during May 2013 for UHMG sub-grantees. With the approval of the manual, there will be a lot of improvement in sub grantee management.
Mobile Money services A procurement to have cash payments through mobile money is at final stage to minimize cash movements and transfers. This will help UHMG mitigate risks during cash withdrawals and payments.
New Warehouse Extension UHMG’s plan to build a new warehouse extension has been stalled due to the bureaucracies under the Kampala City Council Authority where the approval to commence construction has not been granted. UHMG has also submitted a request to AFFORD-USAID for funds to complete the construction as included in the budget.
Property Management During the quarter, the Head Office and the Product Facility (PF) warehouse exterior were face lifted in preparation for the AFFORD close out day held on 4th June 2013
Fixed Asset Verification and use of the Asset Master This exercise has continued and a consultant has been outsourced to complete to finalize the exercise. The Asset master is being updated and targeting the integration with Tally by 31st July 2013.
ICT Operations Manual The manual was completed and approved by the UHMG Board. This document includes a Disaster Recovery Plan for UHMG, a UHMG ICT Assets Acquisition and Disposal plan and a UHMG ICT Incident Management Plan.
Risk Management Management has continued to create awareness in risk management in various areas; strategic, Business, Operational and Governance. The internal auditor is leading on this issue. The risk framework was revised with support from KPMG and the Internal Auditor. The board has also given their input in the manual and the document is now ready for approval. This will be presented for approval in the upcoming Board meeting.
Board Committee meetings One committee meeting was held for the Finance and Planning to look at the draft manual for Sub-grantee and the Audit and Risk committees of the board. It is anticipated to have this manual approved in the next quarter.
84 ICT Management Challenges In June we encountered an internet shut down that paralyzed most of UHMG work. Our IP address was de-registered from the network due to detection of some inconsistencies but this was however, reinstated
Internal Audit Quarterly Performance
Planned Activities Activities Performed Key Result Areas Key Performance Planned Activities July Indicators to September 2013 1. Performance Draft Report done Key Result Areas in Draft Report Financial Management Management and shared with updated job produced and shared Audit in UHMG UHMG Management descriptions of all review in with the key staff stakeholders UHMG Targets which are smart set for all staff Programs and Services Rewards and Audit especially in sanctions Action report done Monitoring and implemented in for implementation Evaluation. UHMG Continuous of recommendations. improvement implemented in Corporate Governance UHMG operations Value for money Rewards and demonstrated in sanctions put in place within agreed UHMG activities Quality Assurance in timelines. PF with regard to ISO certification and implementation. Value for money to be demonstrated in quarterly reporting on outcomes and impacts.
2. Advisory Draft Report done for Board to pronounce Accountability and services to the the Board Business itself on the findings responsibility for the Committee and Board and recommendations UHMG mishap owned. Audit and Risk of the Report on the Management Committee on: two issues (1) Lost HIV test investigated. kits Remedial actions taken to deter future (2) Expired occurrences.
85 products
Trained and skilled staff deployed to do UHMG work and are properly facilitated.
3. Operational Draft report done and Value for money to be Best practices shared Management discussed at SLM and demonstrated on the between the the stakeholders in funds spent on the Audit: Media agencies and UHMG. this process. agencies by the Auditing review of : Contract review through legal audit Value for money demonstrated for all stakeholders to Remuneration as appreciate agreed is tied to performance criteria agreed upon before Action plan drawn up job execution. for implementation with timelines and persons responsible. Financial management of third parties is properly done.
4. Risk Draft Risk Manual and Risk Manual and Risk Risk Manual Management: Risk Register Register approved by operational by discussed at SLM and the Board. Risk Manual, appointing a Risk internal Risk These documents are Cordinator and Risk Risk Register Committee. To be owned and discussed at the implemented by all officers in UHMG. Board Audit and Risk staff in UHMG Committee on 10th especially the Board July 2013. and SLM. Risk Registers made operational in all UHMG processes.
Ownership and reporting on risks becomes a culture in UHMG.
86 END OF REPORT
87