WHO-HAC May 05.Pub
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Health Action in Northern Uganda Health Newsletter W orld Health Organization–Health Action in Crisis Issue 3 May 2005 Editorial I NSIDE THIS The theme for this edition of ISSUE : E CHO a nd HIV/AIDS the newsletter is HIV/AIDS. Universal precautions 2 After consultations with Member States in the I n 2 0 0 2 , the AIDS Control in the Health Unit Humanitarian Aid Committee, the Directorate General Program (ACP) sentinel setting for Humanitarian Aid (ECHO) of the European s u r v e i llance site at Lacor Comprehensive HIV/ 2 Commission, has published a ‘Concept Paper’ and ‘Model Hospital indicated that the AIDS training Guidelines’ to be used as reference points for possible prevalence of HIV among ECHO financing of HIV/AIDS activities. This followed a mothers attending the ANC ECHO and AIDS 3 review by ECHO of its approach to the HIV/AIDS continued pandemic in response to a need to clearly articulate was between 10 and 12%, much lower than that of 1993; PMTCT in Kitgum/ 4 ECHO’s position in this respect. Pader 27.1% and higher than that of ECHO fully recognises that HIV/AIDS is a major factor 2001; 11.3%. Recent and Upcoming 5 of vulnerability in areas of humanitarian crises and events therefore, this is an important issue for ECHO to S o me may be quick to blame address. The ‘Concept Paper’, thus, recommends that this on the conflict situation- ECHO adopts a two-pronged strategy with an aim to: sexual violence and displacement– but this could Mainstream do-no-harm measures, with a focus on be disproved. awareness and to avoid the spread of the virus by ( www.humanitarianinfo.org/ negligence wherever relevant; and iasc) ñ Fund selected activities to mitigate the effects of HIV/The need for more HIV/AIDS AIDS in humanitarian emergency situation, as a services is still particularly big complementary component of already existing multi- in the IDP camps where most sector programmes. people have no access to VCT and therefore are ignorant of The ‘Model Guidelines’ set out vari- their sero status. ous activities for ECHO and its partners in the fight against HIV/Also important is the issue of AIDS – ranked from essential to prevention of new infection to; strongly recommended in addition health workers, caretakers, to various non-core activities that babies, partners, adolescents, should be undertaken only subject victims of rape/ defilement etc. to strict pre-conditions. The social aspect of HIV/AIDS It is, however, also reiterated that that includes planning of safe the issue of HIV/AIDS does not fall water points, safe camps and within ECHO’s specific mandate and others is another area that cannot per se become an entry/exit needs to be focused on. criteria for ECHO’s engagement in a country. The ‘Concept Paper’ places HIV/AIDS is vast area that ECHO’s position among other EC needs a consolidated effort for instruments combating the disease. any improvement to be seen. The principal EC contribution and This includes coordination at Staff at the ANC clinic funding aimed at fighting HIV/AIDS is made to ‘The all levels. at Gulu Referral Hospital Global Fund to Fight HIV/AIDS, TB and Malaria’. Continued on page 3 DDHS, Gulu Page 2 Volume 1 Issue 3 Training in Universal Precautions in Health Unit Setting Universal precautions are essential to prevent transmission of HIV, Hepatitis B and other infectious diseases from patient to health worker, as they are to prevent patient to patient and health worker to patient transmission. And yet health workers have often depicted a perception of being invincible as exemplified by their misplaced readiness to work in environments that are strewn by blood spills and other body fluid spills that are potentially infectious without making efforts to decontaminate and mop up the offending spills. UNFPA sponsored a two week Life Saving-Skills course., which benefited 12 health workers from Gulu district. The course had a big cross cutting topic on infection control; knowledge and skills on Universal Precautions against HIV transmission. More training that targets imparting skills and positive attitudes towards Universal Precautions are needed so as to protect our precious human resource from nosocomial transmission. This is so especially in circumstances where the patient loads are overwhelmingly as occurs in IDP units and referral hospitals in the north. People working un- der pressure are more likely to have work related accidents and to cut corners in sterilization techniques. In addition the participants were able to perform five of the six signal functions of basic Emergency Obstetric Care S (basic EmOC), namely; ability to administer parental antibiotics, anticonvulsants for eclampsia and pre-eclampsia, D Oxytocics, ability to perform manual removal of the placenta and to perform assisted vaginal delivery-Vacuum ex- I A traction. / V I This will improve upon the number of facilities that provide EmOC per 500,000 people and subsequently improve H our met need for EmOC (proportion of women with obstetric complications delivering at EmOC facilities) in the n i district. Met need for EmOC currently stands at a very low 23.9% nationally –it should be 100%. s p o It is hoped that UNFPA will go ahead and sponsor the Post Abortion Care course as well so that participants get h s the full components of Basic Emergency Obstetric Care. Source: UNFPA Gulu k r o Comprehensive HIV/AIDS training W g In response to the global 3x5 initiative of providing Anti-Retroviral n i Drugs (ARVs) to 3 million People by the end of 2005, the Govern- n i a ment of Uganda through the Ministry of Health, WHO and other r T partners are scaling up comprehensive HIV/AIDS care including ART. Uganda is committed to having 60,000 HIV infected people on ARVs by the end of 2005. The delivery of the ARVs has now been inte- grated into the existing national health care system. The first step in achieving this target is building capacity of the health service providers who are to handle the patients and the drugs. Capacity building of health service providers has been conducted in the 11 Regions including Masaka, Hoima, Arua, Gulu, Lira, Soroti, Mbale, Jinja, Kabale, Mbarara and Central Regions. The training entails both classroom work and clinical sessions/ skills stations, which are facilitated by People Living With HIV/AIDS (PLWA) on ART have experience of living with the disease and drugs. The methods utilized are par- ticipatory in nature hence enhancing an atmosphere of knowledge sharing by the participants and facilitators. Specifically health service providers were drawn from Hospitals and Health centre IV as clinical teams and trained to provide comprehensive HIV/AIDS care including ART. In Gulu and Lira Regions the following health facilities have trained teams: Gulu Hospital, Lacor Hospital, Anaka Hospital, Kitgum Hospital, St Joseph’s Hospital Kitgum, Pajule HC IV, Lira Hospital, Dokolo HC IV, Apac Hospital, Aber Hospital and other NGOs like TASO, Health Alert- Gulu and SOS. The following health facilities have been accredited and are providing ART services: Gulu Hospital, Lacor Hospital, Anaka Hospital, Kitgum Hospital, St Jospeh’s Hospital Kitgum (by CRS), Pajule HC IV, Lira Hospital, Apac Hospital and Aber Hospital. Source: WHO Uganda Health Action in Northern Uganda Page 3 ECHO and AIDS continued As such, ECHO cannot become a frontline agency in the fight against HIV/AIDS, as this is a specific mandate of other organisations and, in addition, ECHO lacks the capacity and sufficient in-house technical expertise on HIV/AIDS. Due to the wide variety of conditions existing in the field, the ‘Model Guidelines’ should be used by partners as a point of reference, rather than as universally mandatory. Electronic versions of the ‘Concept Paper’ and the ‘Model Guidelines’ can be found at: http://europa.eu.int/comm/echo/evaluation/thematic_en.html ECHO Strongly recommended activities wherever appropriate and feasible: Objective: “to contribute to preventing any worsening in the impact of the crisis, saving and preserving life from the effects of HIV/AIDS during emergencies and their immediate aftermath” Sectors Activities Objectives Targeting in priority single, infected and/or elderly caretakers and orphans To ensure adapted and safe distribution mechanisms to Distributions (food Setting up distribution schemes adapted to weaker individuals (more frequent with the affected households/ aid, NFIs, etc) smaller packages) and design sites to minimise risk of rape communities in particular in Using school feeding, take-home rations for children if feasible high prevalence areas Using home-based care services, if no other solutions are available Health Training staff on Syndromic approach for management of STIs To guarantee treatment of Sexually Transmitted Supplying drugs for treatment of STIs Infections (STIs) and Distributing condoms Opportunistic Infections Providing prophylaxis and treatment for opportunistic infections To ensure safe child deliveries Providing clean delivery and midwife delivery kits Nutrition Targeting assistance to affected and at-risk households (infected, single and/or elderly To ensure that PLWHA and caretakers and orphans and communities orphans are included as beneficiaries in nutrition Using guidelines adapted to needs of People Living With HIV/AIDS (PLWHA) (see e.g, programmes Oxfam, SCF, WFP), focusing on women and children Protection against Ensuring that protection activities are cross-cutting through all concerned sectors To contribute to the pre- sexual violence vention of sexual violence Detecting