Annual Report October 1, 2011 – September 30, 2012

(Including Quarter 4 Results)

Submitted by:

The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs and Uganda Health Marketing Group – UHMG

TABLE OF CONTENTS

ACRONYMS ...... i

INTRODUCTION ...... 1

I. PRODUCT FACILITY ...... 6

II. PROGRAMS CONSULTANCY STRATEGIC BUSINESS UNIT ...... 22

A. Malaria ...... 22 B. HIV ...... 28 C. MCH ...... 40 D. Family Planning (FP) ...... 42 III. CROSS CUTTING ACTIVITIES AND SERVICES ...... 47

A. MARKETING AND STRATEGIC INFORMATION (MSI) ...... 47

1. MSI - BRAND ACTIVITIES ...... 47 2. MSI - COMMUNICATION CAMPAIGNS ...... 56 3. MSI - CORPORATE & EXTERNAL RELATIONS ...... 64 4. MSI – RESEARCH & EVALUATION ...... 65 B. FINANCE AND ADMINISTRATION ...... 65

C. HUMAN RESOURCE AND ADMINISTRATION DIVISION ...... 67

D. TECHNICAL ASSISTANCE ...... 76

ACRONYMS

ACT Artemisinin-based Combination Therapy ASDE-U Advocacy for Social Development and Environment – Uganda BCC Behaviour 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 FP Family Planning HCT HIV Counseling 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 LLIN Long Lasting Insecticide Treated Nets KAP Knowledge, attitude/perceptions and Practices MARPS Most At Risk Populations 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 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 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

INTRODUCTION

This report covers the activities of the AFFORD Health Marketing Initiative in Uganda during Fiscal Year 2012, from October 1, 2011 through September 30, 2012. AFFORD is funded by the United States Agency for International Development (USAID) Cooperative Agreement: 617-A-00-05-00011- 00.

The AFFORD I award was made on September 21, 2005, to The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). The AFFORD I Health Marketing Initiative ended its first phase in September 2010, and received a 3 year extension as AFFORD II, through September 2013. AFFORD II has the primary responsibility during this extension period to ensure that the Uganda Health Marketing Group (UHMG) is strengthened to become sustainable and develops cutting edge competencies in technical, marketing, financial and institutional areas.

AFFORD II, with UHMG, addresses three key Results Areas, specifically:

Result 1: Increased organizational sustainability of the Uganda Health Marketing Group (UHMG);

Result 2: Increased availability, affordability of health services and products; and

Result 3: Enhanced knowledge for self-efficacy and correct use of health services and healthy practices.

This report addresses annual achievements in all three Results Areas, with special focus on the performance of the two strategic business units (SBUs) -- the Product Facility SBU and the Programs Consultancy SBU -- as well as the cross cutting activities that support the SBUs, including social marketing, communication, research, human resources and administration, and finance and investment.

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 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 below.

CAPACITY EVIDENCE OF FY 2012 (Year 2) Achievements BUILDING ACHIEVEMENT OBJECTIVE

1. PERFORMANCE MANAGEMENT & QUALITY MANAGEMENT Establish performance Senior Management & • MD, Dir Finance and Sr. Mgrs track contract performance management system for supervisors produce clear monthly enhanced monitoring and performance indicators quarterly • Performance monitoring tool developed to serve as supervision by UHMG and Performance-based Contract Scope of Work; tool has been BOD applied by all UHMG Divisions in Qtr 1 - Qtr 4

• Summary review and documentation of all technical indicators conducted quarterly and reported to Sponsors and BOD

• Staff appraisals based on KRAs and KPIs strengthened with help of KPMG HR Assessment

Effective, documented quarterly • KRA and KPI quarterly and annual review conducted and system and annual review process is documented; Managers hold staff accountable for KRAs and linked to staff motivation, KPIs performance and advancement • HR Audit completed by AFFORD KPMG to re-calibrate staff KPIs and strengthen staff performance appraisal practices

• Promotion, salary increases or recognition linked to achievement of KRAs and KPIs (occurs case by case)

MD, Directors & UHMG operates as a commercial • BOD, MD and staff committed to improved stock management Operational managers sector company that makes practices in PF, assisted by AFFORD/KPMG adopt a ‘private sector’ strategic decisions based on • Stock-counts conducted routinely; variances reduced management practice profitability as well as risk- reduction and stewardship of • Debt recovery improved for enhanced cash flow capital assets, including product • New products assessed for profitability, and adopted stocks accordingly

• Profitability analyses conducted quarterly; Business Plan progress tracked quarterly by BOD

All strategies generated by • All key strategies developed by Senior Management and managers are vetted through operational staff through a consultative process, and vetted by organizational approval processes the MD and the BOD; AFFORD KPMG reviews and assists as needed

• All strategies and their implementation assessed by management and operational staff for effectiveness and cost- efficiency

• Deliverables produced and quarterly targets achieved, and

assessed by BOD and sponsors against UHMG Business Plan and sponsor-supported Annual Workplan Quarterly Performance Reports (programmatic and financial) • BOD, MD and Senior Managers take corrective action within submitted to BOD and Sponsors next quarter in the event targets are not being met

The product facility operates as a • PF Profitability analysis conducted quarterly; profitability profit center & The programs unit improved over FY2011 (see Financial Systems domain below). operates as a cost-recoverable • Program Consultancy expands technical strategies and actively consultancy business seeks new funding for programs (see Business Development domain below)

A Quality Management Hire internal auditor • Internal auditor hired; external A-133-Type audits conducted system for enhanced annually organizational • Recommendations of internal and external audits systematically responsiveness pursued with BOD and MD support and AFFORD/KPMG conceptualized, assistance, specifically in the areas of stock management; implemented and human resources; financial management; procurement; and IT sustained by UHMG staff High level of compliance with practices internal systems and external and Board • Sr. Mgmt consistently enforce compliance requirements; Sr. regulations according to Mgmt identifies and takes remedial actions on audit findings compliance and audit reports within next quarter • Staff oriented and coached on compliance principles and

practices, with AFFORD/KPMG assistance

Orient staff on use of mandated • Internal auditor with Dir. Finance and HR conduct quarterly protocols and standards; Orient & compliance audit review; AFFORD/KPMG conduct quarterly progress reviews coach staff on compliance

Staff monitored for compliance every quarter

Adapt MOH guidelines and • Staff applying MOH quality assessment protocols in the field protocols for service quality (e.g., with Good Life Clinics) assessment • The PF has been accepted into the process of ISO Certification, and the ISO process under way Products certified by international body (ISO)

Quality Management: Improve internal processes that • Marketing and Strategic Information (MSI) meets with Product Improved internal inhibit or facilitate objective facility (PF) to facilitate distribution communication and performance • MSI meets with Programs Division on budgeting to facilitate coordination local implementation • 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 • The Board of Directors is advancing its vision of UHMG sustainability through unified, rather than project-driven approaches to management, including unified technical strategies, a unified Management Structure (merger of special projects with Programs), and application of unified financial and administrative systems across projects.

2. DATA UTILIZATION Create a comprehensive Both strategic business units • Sr. Mgmt use monitoring and evaluation data in all quarterly monitoring and evaluation utilize research data and reviews systems to form and assess monitoring tools quarterly to organizational strategies design and evaluate all major product, service and program initiatives

Tracking tools used by all • Managers utilize monitoring tools and research activities to managers to monitor activities inform programs on a continuous basis. The following R&E and progress, specifically: product Activities were conducted in FY12: • distribution, sales, availability, PilplanPlus sales study, Quarter 1; • Initiation of a independent and scientific Retail Audit; program implementation, media • Initiation of Media Reach Analysis through IPSOS/Synovate, campaign monitoring, community allowing UHMG to document the unduplicated population activities and activities at GLCs reached by its media campaigns for the first time. • Study of birthing and delivery practices for Saving Mothers

Giving Life project; • formative research for the Smart Choices Family Planning campaign; • Coordination and initiation of the Behavior Change Communication Survey conducted jointly with JHU/HCP and other USAID Implementing Partners (IPs). • These studies are discussed in more detail in relevant sections of the present report Work-plan Implemented • Technical staff develop program plans and submit to Research Advisor for feedback • Technical staff use program data and research findings to inform programmatic decisions. 3. INNOVATIVE STRATEGIES Ensure mutually beneficial All Program Division activities link • Product & program linkages inform strategic decisions and and effective linkages and to relevant health products outputs synergy occurs between through joint implementation UHMG’s business units plans and reports

Ensure that all UHMG All strategies based on recent • Refined HIV/AIDS programs in place and judged cutting edge by programs are considered data and information obtained stakeholders: e.g. HIV Strategies for PMTCT, MARPS and Sexual strategic and high quality from clients and their Network campaign scale-up. by donors, clients and staff communities • Retargeted RH/FP programs operational linking to products and services, e.g., DFID “Smart Choices” Family Planning strategy; full implementation under way

• Retargeted malaria programs operational linking to products Increased involvement of clients and services, e.g., roll-out of “Power of Day One” Malaria test- and communities in UHMG and-treat campaign programs • Retargeted MCH programs operational, linking to products and services and integrating HIV services, products and practices, e.g., Saving Mothers Giving Life (SMGL); Integrated MNCH/FP ‘1000 Days’ Approach

Ensure that UHMG Marketing strategies developed, • Brand Officers and communication officers create strategies marketing strategies are documented and implemented with limited external support, e.g., MNCH/FP ‘1000 Days’ evidence-based and Approach achieve stated targets • Marketing and Brand Mgrs can routinely identify linkages between products and programs; evidenced in joint MSI-PF Increased market demand for meetings and in quarterly reports services and products and targets achieved

Establish routine Operational database of key • MSI & PF routinely use and update database of suppliers and communication with customers, used by customers customers and suppliers • Marketing events taking place per Work-plan (relationship marketing) product and program managers and strengthen related • Sales increase slower than anticipated due to debt collection management systems and implementation of a ‘closed’ distribution system

Brand managers develop functional communication strategy with customers

Ensure that all Product 3-month stock supplies on hand • No stock-outs or shortages in RTP or UHMG products Facility operations are and stock expiry at 0%. considered sustainable • SOPs followed by Product Facility staff to manage stocks and to and dependable by develop procurement plan donors, clients and UHMG staff Spot check reports on compliance of procedures and systems; quarterly stock procurement plans in place

Improve systems to track A tracking system in place and • Sr. Product Facility mgrs and Finance Team review supply chain the flow of in bound and used to manage logistics supply system quarterly out bound stocks chain • Negative findings addressed w/in the quarter

4. BUSINESS DEVELOPMENT Increase and diversify Substantially increase number of • NICRA application has been submitted, with AFFORD/KPMG sources of revenue for sources and amount of resources assistance both business units generated by both the program • UHMG awarded at least 3 non-AFFORD contracts totalling and product facility business minimum $2m/year units. • UHMG develops and submits a proposal for a USAID grant as a prime contractor for the first time, and is awarded the contract: KGLIS, to expand HCT demand and services in Kampala. UHMG business practices • Working with the BOD on the UHMG Business Plan (Business improved, through BOD support Plan orientations conducted for BOD and UHMG staff; and the assistance of AFFORD implementation of Business Plan through BOD Committee (KPMG & Friends Consult) Meetings) • Strengthening Stock Mgt through KPMG assistance • Conducted HR Audits of PF through KPMG assistance

• Strengthening Procurement and IT Policies and Procedures • ISO Process initiated • Use of Return To Project (RTP) funds to offset mortgage proposal developed and approved by USAID. 5. FINANCIAL MANAGEMENT Effectively manage and Timely financial reports for all • Finance unit delivers financial reports by due date for all report on staff time and sources of funding programs finances across diversified Improved (accelerated) burn rate • Burn rate across all grants increased to 80% of targets funding sources Rare non-compliance with donor • Finance & HR teams develop staff LOE certification procedures financial requirements • Financial control procedures monitored, and compliance enforced, with several examples during the year

Improve working capital Improved debtor’s ratio • Aging debt reduced between January and September by 48%, management by the with AFFORD/KPMG assistance Improved stock management Product Facility with no or minimal variances • Credit committee in place and customers vetted by SOP standards Improved working capital • Variances between records and stock on hand reduced management position significantly for RTP and UHMG products by end-June

• 72% of PF operating costs covered by revenues generated through PF net margins (excluding Marketing Costs), in preparation for PF to cover 75% of its own costs in FY2013.

Strengthen financial External audits verify that UHMG • Finance Team produces documented response to each financial accountability and is following international financial audit finding and recommendation; actions taken in FY12 on all compliance audit items

I. PRODUCT FACILITY

Sales and distribution

The table below shows overall annual performance of RTP products under AFFORD.

RTP Brands performance against annual targets:

Annual AFFORD- Annual AFFORD- RTP Target RTP Actual USAID brands (Units) (Units) % Achieved (+/-) Protector 16,000,000 15,237,492 95.2% (762,508) Injectaplan 2,800,000 1,640,980 58.6% (1,159,020) Pilplan Plus 1,600,000 2,123,190 132.6% 523,190

Quarter 4 Trends: Quarter IV presented a better performance of the brands sales and distribution over the previous quarter. Whereas q3 experienced sales decline due to immense focus on debt recovery and credit control, in which customers with outstanding debts were not served with product supplies, q4 saw a relief from the shock of the intervention and more customers were supplied, thus generating performance improvement. Also, key products were received in the period which included O condoms and Lumartem, and purchasing from the program division was increased.

The quarterly brand performance is given in the graphs following each brand.

Protector: The sales scored at 125% of the quarterly target. Major buyers include Non government organizations like Health Alert, various projects under UHMG, National Youth Organization for development and the trade distributors Supermedic, Zee Pharmaceuticals, Blue star Pharmacy to mention but few. There were increased sale activities from the MSI teams that helped with secondary shelf off take from the distributors premises to the smaller retail drug shops. KPI secondary packaging activity was kept to good performance without furtehr down tuime of macjhione breakdowns. The quarterly performance is shown in the table below, as follows:

6,000,000

5,000,000

4,000,000 Qtly targets (Units) 3,000,000 Actual sales (Units) 2,000,000

1,000,000

- Qrtr 1 Qrtr 2 Qrtr 3 Qrtr 4

Injectaplan: The sales scored at 76% of the quarterly target. This was achieved through various interventions as volume bonus discount, routes sales by the use of non-conventional sales team, secondary stock uptakes and merchandising above the mass media campaigns. However, it will be noted that Injectaplan demand has dropped in this year compared to previous year rend – an issue under investigation

The sales trend is graphically shown below.

700,000

600,000

500,000

400,000 Qrt Target In vials 300,000 Actaual Sales in vials 200,000

100,000

- Qtr 1 Qtr 2 Qtr 3 Qtr 4

Pilplan Plus. The sales of Pilplan scored at 92% of the quarterly target. The annual target stands at 133%. However, with the exception of quarter 1, there is notably a declining trend in performance throughout the other quarters. In quarter 1, there was an evident lack of family planning pills in the market thus creating an unusually high artificial demand. Major buyers included trade distributors namely Zee, Super medic, Astra Pharmacy and Byansi Pharmacy. As more stock was poured into the trade, less demand were subsequently realized. This too, is a marketing intelligence.

1,200,000

1,000,000

800,000

Qtrly Target in units 600,000 Actual sales in units 400,000

200,000

- Qtr 1 Qtr 2 Qtr 3 Qtr 4

UHMG Brands

UHMG Annual Brand performance can be summarized in the table below as follows:

Actual Qtr 4 UHMG Brands Qtrly Target sales % Achieved Variance (+/-)

Cotramox 7,900,000 8,775,360 111.0% 875,360

Condom O 1,500,000 1,283,703 85.6% 216,297

Zinkid 10,000,000 7,990,300 79.9% 2,009,700

Restors 2,000,000 770,945 38.5% 1,229,055

Aquasafe 5,400,000 3,270,720 60.5% 2 , 129 ,280

Moon Beads 3,600 3,435 95.4% 165

NewFem 40,000 15,880 39.7% 24,120

Softsure 72,000 33,980 47.2% 38,020

Quarter 4 Trends: Q4 was much better than Q3 with significant value and quantity sales contribution realized from key brands: Zinkid, Cotramox and O condom. Zinkid customers were Joint Medical stores that distributes to the mission hospitals and PNFP and PFP, Astra Pharmacy that distributes to segments of PNFP that were not reached by UHMG directly and Cotramox customers were represented by Elizabeth Glaser Pediatric Aids foundation, Interreligious Council of Uganda among others where O condom sales increased into the trade and corporate organizations in the private sector.

The comparative Bar graph below shows the quarterly trends of UHMG brand performance:

900,000,000 800,000,000 700,000,000 600,000,000 500,000,000 UHMG Brands 400,000,000 Targets 300,000,000 200,000,000 100,000,000 0 Quarter 1 Quarter 2 Quarter 3 Quarter 4

Individual UHMG brands performances explained as follows:

Zinkid: The quarterly sales for Zinkid were 64% of the set target. Key prospect in the sales projection was the tender to supply the public sector through NMS that did not happen due to loss of bid to a competitor on price point. Zinkid then traded mainly through the trade channels. However main customers for Zinkid were Joint Medical stores, Astra Pharmacy, Super Medic and other whole sale Pharmacies. Zinkid is facing great pressure due to the need to upscale the distribution against high cost but in the face of great opportunity for rolling out mass campaign for increased access and rational diarrhea treatment with x=zinc and ORS as guided by the pneumonia and diarrhea policy. UHMG is positioning itself to providing equitable distribution through mass media campaign and leveraging supply chain while sourcing Zinkid from a low cost manufacturer.

RestORS: The quarter experienced better sales than the previous quarters which performance was a response to the price revision made to the brand from UGX 310 to UGX 180 as subsidized by the profit margin on Zinkid. However sales in the last financial year were low and scored at only 39%. Restors face a stiff competition from locally manufactured brands and flavored brands. The product has also a weakness due to high cost of sourcing that does not enable it be competitive without the subsidy.

Aquasafe: This product performed largely as an Institutional product especially and taken by NGO’s. Wholesale pharmacies that purchased significant quantities usually supplied NGO’s which UHMG could not reach directly. Major buyers in quarter 4 were Plan Uganda – Kamuli which bought 5,653 dispensers, Humanitarian care Uganda, Bluestar Pharma, Pharma Health which bought 1,000 dispensers in August 12 among others. A big distribution achievement was registered when supermarkets started accepting to stock the brands. This product is now available in super markets like Capital shoppers. However use of this product in major towns like Kampala may not be extensive given the numerous safe water alternatives. This has made the stocks to stagnate on the shelves. Notwithstanding, Schools which hitherto expected to be a major route have also not been major buyers of the same despite the various merchandizing campaigns carried out.

Condom O: The quarter sales recorded 121% achievement of the quarterly target. There has been increased demand registered among the wholesale Pharmacies. A few NGO’s and corporate organizations like GIZ and Stanbic Bank have significantly contributed to increased demand. The ongoing television adverts helped create a pull effect desired to move the supplies down the chain and played a big contributing factor to the increases sales.

Newfem: This Product scored at 55% of the quarterly target and 40% overall annual target. Most purchases are made by pharmacies and in small quantities and usually not more than a carton. It was introduced in January 2012 and little or no demand creation activities have taken place to stimulate demand to aid secondary shelf off take.

SoftSure: The sales of SoftSure have been low throughout the entire quarter. Only 33% of the quarterly target was achieved. The annual sales against the set target scored at 47%. Sales of this product are usually in small quantities and hardly reach a carton for a single customer. There is low demand for this product among Pharmacies as many have sighted ignorance about usage. Brand promotion activities and detailing activities have been low in the quarter 4 and most of the year but which are highly recommended for better results to be attained.

Moon Beads: This product has scored at 263% against the set target. There has been increased uptake of this product especially NGO’s in the sub grantee awards as Humanitarian Care Uganda, International Medical Foundation and a few Pharmacies like Blue star Pharmacy which bought in

small quantities. Increased merchandizing activities have helped in generating demand for this product and which has been evidenced from orders that have been streaming through.

Cotramox: Quarterly sales scored at 195% of the set target. The overall performance against annual set targets stands at 111%. Major buyers are mainly NGO’s namely Inter Religious Council of Uganda, and Elizabeth Glaser Pediatric Aids Foundation and the reseller customers as Quality Chemicals. It is important that these accounts and many more especially the USAID implementing partners be managed well to solicit future orders and for this, a plan is in place to recruit a key sales staff to manage the subsector.

RETAIL 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 market dynamics 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 results for the July through September period are shown below. The presence of the key products has risen from May 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 2012)

Brand July August September

Protector 81% 81% 83%

Pilplan Plus 72% 73% 74%

Injectaplan 68% 69% 70%

Zinkid 47% 49% 50%

Restors 41% 41% 44%

Condom O 12% 12% 12%

Aquasafe 11% 11% 11%

Softsure 6% 7% 7%

Cotramox 3% 4% 5%

Newfem 2% 2% 3%

Moon beads 1% 1% 1%

PERFORMANCE MONITORING TABLE: PRODUCT FACILITY

Activity 1: PF strategies and business development

Activity Description Targets/Outputs Q1 Comments Q2 comments Q3 comments Q4/Annual comments

New products New products Sprinkles arrived, SPRINKLES COMPRAL from Betapyn from AI launched: launched Nutributter certification Adcock Ingram, launched Restors+Zinkid samples received process started; to Aminosof syrup combination kit, awaiting market make it ready for DIPI, and Aminofer Sprinkles, survey and public and NGO syrup from Nutributter distribution plan buying Medinomic,; Dazel Kit from Ajanta;

RESTORS+Zinkid Survey on kit to be planned Nutributter not Nutributter market for next yr yet done, will be survey completed done in new and price quotation quarter requested

Increase in the Increased Positive trends Audit is ongoing to Gross profitability profitability of the profitability of the observed. The be reported by has been product facility product facility ongoing Auditing mid April maintained at 23% exercise to report of gross turnover position

Operational Prospect suppliers In place, building Building further Database in place. Database in database of potential negotiations further and re- with new New suppliers in place. New suppliers indicating documented and evaluating achievements in active negotiation suppliers in status of tracked in negotiation negotiations and are Akacia of south active negotiations operational positions contract reviews Africa, Athena and negotiation are database Medicamen of India Akacia of south and to sign Africa as carried agreement before forward from Alere dropped New ones: September previous quarter interest in Wellshare, WHOPES for RDT, Athena, Daewon, we are Mission Pharma considering new are ongoing prospects

Increase in the Increased product In progress, as Local purchased MEDINOMICS AND AI okayed product range of range of above and other products Adcock Ingram will recruitment of a commercial brands commercial commercial continued to vary be meeting retainer detailer for their with detailers fully brands with products in line according to the costs and staff brands on their paid for by detailers fully paid with sales plan varying analyses remunerated by 3% cost manufacturers for by done on the sales commission manufacturers volume mixes. on sales closed. Staff recruitment is ongoing.

2 sales staff have been recruited on commission basis to handle VF,

Hexagon and Naari AG products

Four (4) new 4 new MOUs with None in last Q1. At a half a year, no Adcock Ingram Athena Drug Memoranda of suppliers Negotiations and final MOU has contract received. Delivery signed, Understandings market survey been signed yet others are still signed between done for Daewon, but Mission being negotiated UHMG and the Korea. Pharma, Athena, for suppliers of pharmaceutical Negotiations are Daewon and brands underway for Seemankit have Cipla OTC and received drafts surgicals and reviewing for possible signing within this FY

Carry out market Market surveys 1 done. Next is in Survey was Nutributter survey A contract has surveys to reveal conducted Jan completed for completed. been signed with gaps, potentials and Daewon, products Extended market Research World opportunities of were trend survey international to entry with a brand recommended for planned for July – carry out market (November) registration September period. survey for AI products potential in October- November

Limit local purchase Ongoing and Limited local Local purchases are Local purchases to only confirmed routine product purchases to still done, though are still done, orders from the sourcing strategies confirmed orders on confirmed though on customers and only for short orders or clearly confirmed orders term foreseeable projected sales or clearly sales prospects, or turnover. projected sales to meet MOQ turnover.

Supplier search to Prospect suppliers Ongoing and back Trip planned, Supplier searches A visit to India achieve sources of trips conducted and forth postponed to end carried out through was undertaken highly reputable and communications of May. A repeat contacts and online. by a team quality products, are ongoing with request to be Visit will be taken in composed of with the Director of potential supplies placed July. managing the facility taking visits to suppliers director, director inside and outside of product facility Uganda (December) and the pharmacist and made to 6 suppliers with great negotiation and business development discussions

Collect information Logistics and To be done in q2 Not done. 3PL This survey if for Not done due to on logistics and customer demand business will be July – September inadequate customer demand forecast kept only in period, next funding. The forecast from both information perspective for quarter. prospective the public and collected this FY. We were consultants private sector target customers pre-occupied with advised for (December-March) MOH distribution higher budget and KPMG operations reviews

Update the current Current marketing Ongoing; CME done, Commission selling, Commercial

marketing tools used tools updated marketing plan for funding is limited riding on socially marketing plans to promote the with new products Ova-Check, launch to run a marketed brands (Naari, Hexagon) product facility to plan for Hexagon continuous CME. are the common have been reflect the new We are talking to strategies being implemented products that have been introduced suppliers to assist used (October-March) in the promotion budget

Create a link on the Link on UHMG Planned for Q2. Not done, kept in Websites has not Website pages UHMG web site for website Profile is under perspective been reviewed, are under orders and enquiries established review, to upload redesigned. A reconstruction, (Jan-Mar?) in Jan - Feb knowledge including manager is coming designing on board to help product list and UHMG achieve this product activities enquiries

Activity 2: Strengthening Product Facility operations

Activity Description Targets/Outputs Q1 Comments Q2 comments Q3 comments Q4/Annual comments

Legal consultation on Legal assessment TOR to be The board advised The activity has Not done. restructuring conducted developed, sent on co-existence become obsolete Became obsolete strategies for PF as a out in Jan. under the same after the directive commercial division Consultants to be corporate name to maintain the 2- of UHMG contracted by Feb for mutual strands as Siamese benefits between twins health consulting and PF Consultation planned for Feb

Establishment of Establishment of As in line with Not done, and will This plan has Status stands increased HRA and increased HRA and operation not be done as in become obsolete as same as for Procurement Procurement autonomy line with the we diversify previous quarter functions within PF functions above report procurement to report admin directorate except for inventories.

Cost analysis Cost analysis Done. Will be a Will be done Cost of MSI Cost analyses for conducted of MSI conducted routine activity before April 15, activities been marketing and (Brands) and every month together with projected in profit operations are Programs & Services financial reporting and loss calculation done and shown contributions to PF of quarterly finance in the finance Sales reports report

PF attains increased PF attains Autonomy plan in Autonomy in This development Status stands as operational increased perspective as in operations has has been stagnated per last quarter autonomy autonomy line with the improved, but will due to reverse report above legal advice not improve more advise on attaining and the boards significantly due autonomy directive to strategic move against autonomy

PF Systems and Clear operational Consultant bids KPMG operations With ISO Systems and SOP Standard Operating status established evaluated, best reviews done, intervention, KPMG are being turned Procedures (SOPs) selected. Contract implementation of system reviews, into manual. established and in

use to be signed in recommendations SOP is being revised Under review till Jan. Training to has started (in bin to keep alive end of start end of Jan cards updating on importance updates November a daily basis, stock within our take operations procedures....) as processes. maybe reported in a separate section.

Activity 3: Strengthening management and financial systems

Activity Description Targets/Outputs Q1 Comments Q2 Q3

Financial management Tally software Finance manager FM recruitment Finance manager None. designed to meet recruitment to be delayed, but will recruited, in place. Hire and install a the reporting completed by end report on duty by professional and needs of the of Jan, as in line May 2 skilful finance product facility with the HR audit. manager to manage Tally usage the finances of the reviewed, rights division Staff trained in More training and security control Design tally to meet Tally software Done. the needs of the System offered to3 given according to product facility Financial reporting improvement will finance assistants needs and activity

regularly be in line with ISO for PF, Arua, and processes Conduct more Recommendations Mbale disseminated training of Tally and the system financial software audit to be done

(see below). Tally training done Implemented the for specific staff,

25% cost coaching and Develop cost drivers sustainability drive troubleshooting and cost absorption Training in report have been a strategies to show

growth in capacity writing was done. continuous activities Sales staff are in-

Deploy a sales daily charge of the debt collector A sales daily debt debts, discussions collector – in- are going on to ISO Certification

house staff to be find a debt training ongoing, appointed. collector/credit with evaluation Sound financial controller completed. None. management and reporting (both cash

and inventory) regularly disseminated ISO Certification Quarterly financial training started, report prepared reviewing the and presented for work-operations discussions processes

Sustainability test in Quarterly financial progress report prepared and presented for discussions

Good relationships Accurate and Implemented, to Implemented, Ongoing Ongoing with customers and timely statements improve as with needs strong re- suppliers perceived for customers and above re- enforcement by resulting from

accurate and timely suppliers orientation financial authority statements Capacity of warehouse • Warehouse Training done. Training not done No further training Warehouse and staff staff trained More specific in this quarter was conducted stock training A team of and oriented trainings planned conducted in professional, to the new for Feb 2012 KPMG conducted relations to ISO challenges proactive members reviews in stocks training

of staff developed Sales force management, HR, Sales target in force Warehouse staff training not done, Finance and and being reviewed trained and oriented planned for Feb debtors, for performances to the new tracking challenges procurement and Interviews sales and made Restructuring conducted and valuable plans are Sales force selection done for recommendations empowered to make RSR – North which are being underway to a difference in their implemented change sales activities and Commission sales staff into contribute to agents commission sales achieving overall overhauled: 2 new staff sales objectives staff taken on Sales force board received written sales targets

Warehouse Staff trained on 1 training done. KPMG Planned coaching Management stock and More training recommendations and mentorship for warehouse planned for Feb are being the warehouse staff Training and Train warehouse management reviewed, but which has only review of SOM staff to improve their including revision delayed. Will be have been skills in stock and of SOMs undertaken. aligned to ISO warehouse Review of SOM training and management done, new edition implementation Regularly review incorporated good SOM for further revision and follow return, secondary Need for specific up of warehouse warehouse implementation practices, and the consultancy is Purchase land and comments from diminishing, SOW construct another USAID will have to be 600 sqm warehouse reviewed by and no longer rent KPMG before Purchase of land Consult on business has been halted portfolio committing to the Consultation of and an option to management need of it construct Consult TransAid for business portfolio training and management warehouse installation of done, specific extension necessary systems proposal hatched, for effective logistics submitted – to be underway management reviewer

Warehouse and Also, TransAid distribution SOW will include operations not both business viewed as 3PL portfolio mgt and model and with system limited funds, no strengthening further plan for Transaid consultation was retained.

ISO Certification ISO certification Contract finalised, ISO certification Process reviews Implementation attained training will start exercise has been completed, delayed due to Finalize TOR and in Jan, exercise to implemented, entering into stage

contract the get completed by entering into 3 – implementation delayed reviews consulting firm October stage 2 – reviews/audits Start to process of September processes reviews ISO Certification in the year: Training, Reporting, Auditing, Certification and Follow up Working Capital Debt management Debt management Debt management Debt management Ongoing as per management procedures in plan in place procedure in system in place, previous place place, quarter-Debt Debt management Debt recovery Credit control management procedures in place target not Debt recovery is committee in place system in place, Debt recovery up to achieved still low, to 80% within the sales Daily banking of improve External debt Credit control period cash and cash Credit limit not yet collector assigned committee in Credit ceiling by equivalent set in Tally 3 times weekly to collect difficult aging analysis and place control banking, to debts and carry out Daily banking of cash Daily banking improve to daily debtors legal status External debt and cash equivalent achieved, except with better analysis collector still Selling and invoicing Monthly stock for some days staffing working to in US Dollars counts and Cash banking takes collect difficult Building Dollar bank variance Selling and Selling in dollars place daily debts and carry balance for overseas management invoicing in $ is done as and when out debtors legal supplies payment done selectively acceptable by Dollar account status analysis Renegotiate supplies eg with world client active, but no payment terms vision payment in dollars Monthly stock Cash banking counts and variance 100% and monthly received in the takes place daily management Suppliers payment stock count done quarter terms always Dollar account negotiated as and active, when we make procurement Supplies terms renegotiations Monthly stock are ongoing count done,

Other activities Performance Personnel yet to Director in charge Director in charge Director in management be identified and charge of mgt Identify personnel to system in place assigned Activity of staff Staff skills will be report be in charge of skills reviews reviewed by KPMG management reports HR audit will depended on Sales force Review the skills and answer to this by KPMG Draft Balance restructuring attitudes of staff at end of Jan intervention, in Scorecard in place, discussed and the product facility will be to identify gaps and progress agreed upon by subsequent gap Review of implemented in management filling performance mgt Private sector October and will be Institute a style will be in line approach to benchmarked performance with operations managing with the private management system restructuring performance has sector models as in line with the been private sector implemented approaches to managing partially performances Put in place a staff structure for the Product Facility based on positions, not individuals

Activity 4: Sales and distribution

Activity Description Targets/Outputs Comments Q4/Annual comments

Re-organize the Reorganization of Key account The position is not Status quo remains. KPMG human current sales current sales position in an present in the Major restructuring resources review structure to include structure acting position – current to be done with the ongoing. the position of a key completed to be reviewed for organogram. help of KPMG HR Restructuring is account manager the correct skill However the reviews planned for first who will focus on relationship selling mix by end of Jan position is quarter of new among Institutions functional with a FY like NGO’s, dedicated sales Corporate among staff. This position others. will be affirmed by KPMG.

In view of the Review of sales Done, in A Nutritionist was We have Skill mix review increasing product skills mix; gaps perspective recruited to redesigned our job is ongoing, with range, there is need identified and through monthly develop the requirements to attendant to review the current training conducted performance nutrition range of demand that a recruitment sales skills mix to feedback products. person with a identify gaps. Gap filling could be medical solved by training, Staff Performance A CME was background be hiring/hiring, or re- appraisal for all to organised in recruited for deployment. be carried out in February and marketing the second week several Retail pharmaceutical of Jan Pharmacies, products. Going Clinics and nurses forward, we shall Hexagon Nutrition were in implement this with Nutritionist/medic attendance. next recruitment. al rep recruited

Operationalize the Increase in Pharmacists The Regional Regional Regional regional wholesale distribution reach recruited, auxiliary whole sale pharmacies are in pharmacies are pharmacies in Arua in Arua and Mbale staff to be Pharmacies in operations with the running well, and Mbale to recruited/intervie Arua and Mbale right staff with increasing increase distribution wed on 17 Jan, were opened in performances reach pharmacies to February, are open by last week operation of Jan

Identify credible Identify credible Done Fourteen Implementation of Operating closed wholesalers/distribut wholesalers/distri Distributors closed distribution distribution ORS that are butors countrywide were system being system for USAID financially sound and selected to start piloted will be brands and 4 have the ability to distributing seven reviewed after UHMG brands. sell large volumes of products. key products. September this These include 3 year. USAID brands and 4 UHMG brands.

Closed distribution system implemented after contracting the distributors

Strengthen channel Channel Gift hamper used Regional Visits to A good regional Conducted 1 relationship by relationships with to recognise key Wholesalers in presence and of regional explicit performance distributors customers, Kampala and UHMG face has distributorship recognition, awards, strengthened Northern Uganda been maintained. meeting. Award and networking have been carried More meetings are will be designed activities with the

distributors during 12 “Good out. A new planned through for new FY the year Distribution” Regional sales regional trips implementation certificates More activities representative for awarded to planned for Jan Northern Uganda distributors during under recognition was recruited and the year awards has been a vital link between UHMG and them.

Market survey for Market survey for Retail audit done, A second retail Retail audit done. Retail audit is outlet audits and outlet audits more specific audit has been Results show more ongoing under gaps identification in conducted survey to be done done and is due reach in the west MSI market share and to reveal for presentation. and lack of reach in reach for commercial commercial These however many locations to division division market are UHMG brands. below 60% position

Vehicles purchased Vehicles Not done. Vehicles have not Vehicles have not No vehicle was for regional field purchased by yet been yet been purchased due staff, per UHMG AFFORD II DFID vehicle in purchased. purchased. to lack of funding budget, facilitating waiting field work Product Facility Sales value Sales achieved = Midyear Quarter 3 period By the end of targets achieved in the 29% achievement is showed a 37.7% quarter 4, annual year – 10 Billion 29% of the achievement of achievement of Uganda Shillings. Budgeted 10 annual target the target was Billion. 59%. Percentage of Analyses not yet Retail audit shows revenue from done about 60% of commercially outlets carrying marketed Commercial UHMG brands Overall products Number products have achievement of of new Retail audit report contributed 7% of Achievement is U.gshs commercial in waiting the budgeted 10 U3.77b out of U10b 5,492,395,916 product suppliers billion. target was noted out of

engaged by UHMG budgeted U.gsh (AFFORD II) Main new 10 billion. Mean self efficacy Commercial survey not done Percentage of product suppliers Market survey not In the quarterly target retail include Quality done for retail audit

outlets carrying chemicals for the commercial survey, it was Cipla Range, distribution due to noted that there UHMG products Population/consu ABACUS with lack of finance was an increase from 50% to 70% mption study not Ajanta Range, in UHMG brands done Mean self efficacy Hexagon Range between 1-4 %. score based on and Naari Range. perception of easiness to obtain Outlet audit Market survey and use UHMG- analysis not done promoted The new retail for commercial products audit done will products not yet show the extent done. However Percentage of of reach of UHMG the product target population products in the facility is who find at least 3 targeted retail negotiating for UHMG promoted outlets. popular products products easy to from both local obtain and International suppliers. 70% of targeted outlets stocking products

distributed by Commercial Division

Annual Sales target of 10.0 Billion UGX achieved

Activity 5: Supply chain management

Activity Description Targets/Outputs Q1 comments Q2 comments Q3 comments Q4/Annual comments

Absence of stock Absence of stock Zero level of stock Zero level of stock Experienced stock All products outs due to outs due to outs due to outs due to out for O, due to were in stock in negligence negligence negligence negligence delay in payment of this quarter achieved achieved advance and not negligence in Implemented fully procurement the procurement plan for the year

Good relationships Refer to activity Done, achieved. Achieved with all Relationship with Our relationship with suppliers sheet #3 UHMG brands and suppliers is good with suppliers is resulting from RTP where a year still in want sharing with them forecasts were because we have the procurement shared with the not streamlined plan in advance and making prompt respective the payment payment suppliers process

Agreements with key Agreements with Ongoing Current All agreements are All agreements suppliers in place key suppliers in Agreement agreements are complete and are in place and place reviewed, new ongoing signed by both the most negotiations are parties suppliers were ongoing No new MOU able to perform signed but 4 more within the period suppliers; Athena, ending Medinomics, September 30, Seemankit, and 2012 Mission Pharma are in advanced negotiation for signing

Prepare a dynamic Procurement of: Procurement plan Procurement Procurements are All procurements procurement plan Procurement of completed plans in place, in process are done for all products RestORS implemented Procurements made O Condom was O condom was Post shipment Procurement of received. It is delivered and testing of Protector Zinkid Procurement for undergoing post NDA has passed the Q1 and Q2 shipment testing all batches for Procurement of done, local distribution Condom O procurement is SoftSure: The based on JIT supplier SoftSure: The Procurement of approach experienced some consignment was Aquasafe delays. The delivered in full Post shipment consignment will be and in good Procurement of testing, tax delivered in July condition Commercial payment, clearing done for O and Aquasafe in under Aquasafe was

Products post testing of production with the delivered and it protector done manufacturer is now being packed

Monitor the Weekly monitor Done, ongoing In progress, Done, ongoing Done, ongoing performance of the the performance updating of RTP procurement plan on of the and UHMG brands a weekly basis by procurement plan takes place updating it with quarterly, for actual consumption figures and goods commercial received brands takes place according to JIT method

Prepare the Contraceptive Done Done in last This is an activity This was contraceptive procurement quarter. Being for quarter four prepared and procurement tables tables prepared implemented submitted to for donated products and submitted to USAID. It was for submission to USAID approved and USAID the orders have been placed

Procure packaging Protector Done. Will Done, including Done for products completed materials and packaging procurement for for the supplies instruction inserts material the extra obtained from Microgynon to be NMS. Injectaplan picked from NMS packaging Planning for the material combination 3 which is yet to Aquasafe come packaging material

Contract the Secondary Contract extended Contract renewed The contract is Kampala pharmaceutical packaging of to cover 2012 Q1, with KPI for the done end of Pharmaceutical company to do Condoms new contract is whole year, being quarter 4 Industries secondary packaging being prepared to monitored performed well Secondary included DFID qty on this contract. packaging of Pills and to sign by mid All secondary They achieved Jan packaging 97% of packing. Secondary activities are As a result we packaging of delivering to have enough Injectables targets except for buffer stock of Protector which finished goods Secondary allowed for only for all products packaging of 86% achievement Water purification of target in the tablets quarter

Other updates for the quarter:

 Procurement and distribution of anti malarial: Held a meeting with global fund coordinator at CHAI and reviewed the orders made and those pending for the whole country to establish UHMG position of the AMFm supplies. We have also placed fresh orders of 500,000 doses which are pending approval and supplies. On the same vein, our own brand – Malact may not be sourced soon as the manufacturer – Medreich has failed to supply all the required data to

support registration application. We have also started talking with the RDT supplier to PMI to enter into agreement with for future supplies into the country  We have been awarded Blanket Purchase Agreement to supply USAID implementing partners (IPs) with pharmaceutical and medical consumables for the safe male circumcision. Our first call off order has been issued for $287,000  We have synchronized the data sharing with regional pharmacies and we are now able to read them on Tally  We have introduced Betapyn and Compral as first 2 Adcock Ingram’s product range onto our commercial range from the latest appointment as LTR in Uganda. Betapyn is moving well and Compral is getting introduced into the market  Conducted retreat and reviewed ISO standard documents and now have the draft operating manual in place. Implementation is underway and further editing is ongoing ahead of grand review and auditing in December/January  We signed agreement, LTR and marketing license with Athena of India for pharmaceutical products; azithromycin, metformin, ciprofloxacin and other. We are still negotiating with Akacia of South Africa for surgical items.  Carried out 100% stock take for end of year stock valuation and the report is underway  We reprimanded and exited one staff on the basis of lack of performance, repeated absenteeism and failure to account for both work time and stocks  Completed and submitted annual plan and procurement plan for the new FY  Warehouse construction for the planned extension is underway. Contractor has been selected and contract being awarded by October 12.

Way forward

• Launch Adcock Ingram marketing plan with effect from October, where medical sales representative is paid for by the supplier, product number increased • Negotiate and obtain alternative supplies of Zinkid from FDC and position for tender in the public facility • Prepare and submit competitive tender to national medical store for the supplies of zinc sulphate and co-pack RestORS • Implement restructuring after KPMG reports on findings and recommendation. The implementation to include balanced score card and performance measurements as a kin to private sector management with increase force working on sales commission basis • Increase peripheral sales and promotional support to the regional pharmacies to enable them grow distribution reach and achieve greater sales • Cooperate and work with MOH, SHOPS project and CHAI on raising the diarrhea Zinkid intervention where UHMG becomes the centre stage for commodity supplies and distribution for the planned global initiative in developing countries • Two staff to attend supply chain training with MCH/SURE to acquire more skills in forecasting, and supply chain follow up and reporting in October • Implement the secondary packaging of combination-3 into Pilplan plus buy November and IUD and implant sticker packages by December • Implement and carry out the distribution of LLINs and SMCK under the USAID funded NU-HITES project for 15 district of northern Uganda beginning by October • To expand in space and grow the warehousing and distribution business for MOH, USAID and other 3PL customer by the year and run it as a complete business portfolio

II. PROGRAMS CONSULTANCY STRATEGIC BUSINESS UNIT

Overview

UHMG’s programs and services department is one of the two main pillars of UHMG’s business plan that contributes towards delivering a good life to Ugandans through proven, innovative and affordable public health interventions. UHMG provides integrated services in the areas of malaria, HIV, maternal and child health and family planning in accordance with global and national priority areas with special emphasis on vulnerable groups and selected populations groups with the greatest need. Service delivery was mainly done through the private health sector in partnership with ministry of health, the district, other implementing partners, civil society organizations as well as target beneficiaries from communities in targeted geographical areas.

This report summarizes achievements for the Fiscal Year 2012 and provides details for quarter 4 results in the following areas:

• Malaria control services, including effective case management and malaria in pregnancy services integrated within the broader maternal health services. • HIV control services with focus on HIV prevention, care and treatment services working through both private health sector, civil society organizations and community approaches. • Maternal and child health, and • Family planning and reproductive health services with emphasis on increasing utilization of long term methods

A. Malaria

Introduction

This program year, UHMG embarked on scaling up interventions made in program year 2011 in strengthening private health sector capacity in implementing the national malaria strategic plan in the areas of malaria case management, management of malaria in pregnancy and increasing demand for proper malaria case management. This was achieved through integration of services into other supported service areas of maternal child health, HIV and reproductive health.

Planned activities for quarter 4

• Promote subsidized RDTs to the GLCs and drug shops • Orient 350 health workers from drug shops on use of drug shop client registers developed by UHMG • Support malaria services data documentation and reporting through HMIS system. • Conduct integrated support visits to GLCs and drug shops • Conduct review meetings for existing drug shop associations in Kumi, Ngora, Serere, Soroti, Katakwi, and Apac districts • Form 5 drug shops associations in Amolatar, Dokolo, Kaberamaido, Lira and Pallisa districts • Create demand for malaria services in the private health sector through radio talk shows • Partner with Stop Malaria Project to scale up “The Power of day One” Campaign nationally

Achievements

Table 1: Activities matrix and achievements against targets under key result areas for the entire program year of 2011/2012 by quarter.

Activities Implementation Progress

Activity Annual Quarterly outputs Comments Targets Q 1 Q 2 Q3 Q4 Improved Malaria case management through the GLC and GLS Conduct field visits to 50 drug 131 Completed in quarter 1 identify drug shops shops and Clinics in each of 5 learning centres the 5 additional PMI 15 clinics identified districts 36 private clinics 95 drug shops were identified Printing and 250 400 Completed in Q1 dissemination of job aides for the GLCs and GLSs Develop, print and 250 1,130 250 Completed in Q3 disseminate job aides for VHTs Adapted and disseminated the MoH existing materials:

500 VHT participants manuals

100 VHT Facilitators manuals

30 VHT Training of trainers guides

500 VHT Job aides Train master trainers 15 23 Completed in Q2 and on support exceed the target by 8 supervision and case because we decided to management more trainers to provide effective support and cater for possible drop outs due to transfers and relocations.

Subsidizing high 20,000 12,37 7,0 On going, supported quality and affordable 5 50 through subsidizing RDT RDTs for the GLCs and GLS Improved prevention and treatment for Malaria in Pregnancy (MiP) in private health sector Facilitate training of Completed in Q2. 250 private health Integrated training in MiP providers at learning 250 286 and Case Management centers on MiP and was done for phase 2 case management PMI districts. Conducting community dialogue meetings Conduct Training of 20 20 Completed in Q2 Trainers (MFP,DHE, HE, HI) & GLCs for community dialogue meetings (fees and MOH travel) Number of 2,388 1,230 Completed in Q2. community meetings Completed in only 5 conducted districts. Subsequent programming was integrated in model village activities. Number of people 49,700 24,25 0 Completed in Q2. that participated in 2 Completed in only 5 the community districts. Subsequent dialogue meetings programming was integrated in model village activities. Formation of Drug Shop Associations Establishment of Not done due to change district based in strategy to ensure secretariat to sustainability by coordinate drug shop associations rather operators project dependent initiative Malaria Communication Conduct Radio talk 30 30 Q3 output; Focused on shows 11 PMI districts-power of day one campaign Conduct Radio spots 400 1040 Q3 output; Focused on 11 PMI districts-power of day one campaign

Monitoring of the 1 Conducted by NMCP communications campaign Reprint and distribute 2000 400 500 250 Reprinted the MoH national guidelines Clinical guidelines and and policies for distribution is planned in Malaria Management the coming quarter. in GLCs Participate in 1 1 Participated in national activities to World Malaria Day commemorate World Commemoration that Malaria day (WMD) was held in Dokolo District.

Malaria service delivery

Oct 2011 to Sept 2012 Malaria Case Management Services

Annual Quarter Q1 Q2 Q3 Q4 Cumm %age Target

Suspected Malaria Cases 132,308 18,752 59,253 41,036 251,349 84% 300,000

Suspected Malaria Cases 68,837 tested RDT/ Microscope 122,505 48,789 96,892 337,023 125% 270000

Cases Positive 50,237 22,204 42,408 30,489

Positivity Rate 41 45.5 43.8 44%

UHMG continued to support private health outlets-drug shops and GLCs to promote diagnosis before treatment as part of malaria case management and management of malaria in pregnancy. Summaries of numbers of beneficiaries of services provided are summarized in the table above.

Table 2 showing monthly results in malaria in pregnancy and case management services

2011-12 Oct -Sept Malaria in Pregnancy Services Utilization Summary Indicator Q1 Q1 Q3 Q4 Total Target %age First ANC visit at 7,145 7,145 8,156 6,339 28,785 40000 72% the GLC 4th ANC visit at 3,415 3,415 4,035 3,176 14,041 20000 70% the GLC Received IPT 1 5,337 5,337 6,205 4,480 21,359 30000 71% at the GLC Received IPT 2 3,729 3,729 3,977 3,299 14,734 25000 59% at the GLC

Integrated support supervision: In partnership with NMCP, UHMG conducted integrated support supervision in all supported GLCs and drug shops. The purpose of this activity was to check for performance of trained health workers in knowledge and skills application in the work. Health workers were also mentored in their respective areas of need in which gaps were identified. HMIS tools were also reviewed for completeness and accuracy in compiling patient records in the health outlets visited. Teams also used these visits as an opportunity for promoting and distributed malaria control products such as RDTs, ACTs, LLINs and gloves. Job aides and HMIS tools were also replenished in health outlets visited that had used up the ones available.

Training drug shop register

Photo 1: A participant filling in the data tool while using the case scenarios given during a group discussion.

In partnership with the district health office, district drug shop associations and the national malaria control program, UHMG trained 307 drug shop operators on how to use the drug shop register that was recently designed by UHMG through half day workshops in Kumi, Ngora, Serere, Soroti, Katakwi, Apac and Pallisa districts. This represented 85.3% of 360 targeted drug shop operators. Drug shops provide a large proportion of the population seek their first point of care for malaria like symptoms from drug shops, the training was aimed at improving the skills of trainees in complete and accurate compilation of client information (especially for malaria) for contribution to the district HMIS

Promotion of RDT subsidy

Table 3 showing RDTs subsidy sales for quarter 3 and 4

RDTs subsidy sales for Quarter 3 and 4 Month GLC Drug Shop Total April 3,400 1,000 4,400 May 750 1,350 2,100 June 5,875 0 5,875 July 2500 0 2500 August 0 0 0 Sept 2500 2050 4,550 Grand total of RDTs sold 19,425

As part of UHMG’s efforts in promoting malaria testing before treatment through the power of day one campaign, UHMG marketed and distributed 19,425 subsidized RDTs to GLCs and drug shops. The subsidy is aimed at reducing the final cost for malaria tests done using RDTs to the target beneficiary. The beneficiaries thus are able to pay for RDT tests because they are comparable the cost of having the test done using microscopy. In addition, 50 pairs of gloves were provided for every 25 RDT kits procured for infection control. These sales were done during support supervision and various workshops conducted by UHMG for health workers from GLCs and drug shops.

6,092 doses of ACTs were also sold during these RDT subsidy sales.

Support to drug shop associations

Review meetings were held for drug shop association in Kumi, Ngora, Serere, Soroti, Katakwi, Apac and Pallisa districts as part of the trainings on data collection. 307 drug shop operators attended these meetings. The purpose of these review meetings was to disseminate findings from support supervisions in GLCs and drug shops, and a platform for members to share best practices and address the issue of sustainability of drug shop association activities.

Photo 2: Members of Soroti district drug shop association at a review meeting

Functionality of district task forces was reviewed and members suggested that their activities get integrated into those of the district support supervision committee.

To improve uptake of UHMG promoted products, association members reviewed the proposed approach for distribution and draft MoU between UHMG and the associations. Associations agreed to work towards scheduled cycles of purchase from UHMG as well as a distribution mechanism that goes up to the parish level.

Increasing demand for malaria services through the private health sector

UHMG continued to run activities to increase demand for malaria prevention and treatment services and products such as demand for diagnostic tests for malaria before treatment within one day of

one experiencing symptoms. In particular, UHMG branded 68 taxis were branded with the “Power of Day One” campaign artwork in the Teso region. Additionally, three bill boards and 7 road stars were erected in Soroti and Kumi.

UHMG also held strategic meetings with Stop Malaria Project (SMP) to develop plans for scale up the “Power of Day One” campaign nationally.

Challenges

• Clients seeking care in private health facilities have many times demanded for tests for malaria diagnosis rejecting clinical assessment because they do not want to spend money • The demand for subsidized RDTs is overwhelming too high for the current funds available for the program in UHMG

Lessons learnt

• Drug shop associations provide a great avenue for improving management of simple malaria and pre-referral management. • Intensive mentorships and partnerships with the district to increase district ownership and enhance adherence to reporting requirements improves private health sector contribution to the district HMIS

Key planned activities for the next program quarter

The main focus of quarter 1 of program year 2012/2013 will be to scale up achievements in strengthening malaria control through the private health sector. The specific activities of this quarter will include:

• Train 350 health workers on malaria case management • Train 100 health workers from GLCs with maternity on malaria in pregnancy • Re-orient 300 drug shop operators on integrated community case management of malaria (ICCM) and pre-referral treatment for complicated malaria • Reproduce and disseminate assorted job aides to 350 GLCs and drug shops • Procure and distribute 5000 subsidized RDT tests • Market and distribute 100,000 doses of ACTs • Conduct quarterly support supervision in all GLCs and drug shops

B. HIV

Introduction

As part of UHMG’s plan for program year 2012, UHMG continued to strengthen HIV prevention, care and support through the private health sector supported health facilities-Good Life Clinics (GLCs) and civil society organizations that were supported as sub-grantees. UHMG focused on integration of services and activities and strengthening linkages, and collaborations with the districts and other implementing partners to increase access to combination prevention and the desired continuum of care.

Plans for the quarter

• Strengthen private health sector facilities-174 GLCs to provide HCT, HIV care and positive prevention • Improve health care waste management in GLCs through procurement and distribution of safety boxes and color coded bins • Support CSOs to provide HIV prevention care and support among targeted population groups • Conduct quarterly integrated support supervision in GLCs

Achievements

A summary of to the FY 2012 HIV intervention services progress, main targets and outputs are summarized in the table below by quarter, thereby followed by summaries of key activities of quarter 4.

Table 1: Summary of Annual Achievements

HIV/AIDS 2012 Activity Tracking Matrix

Key activities Targets Outputs Cumulative

Q1 Q2 Q3 Q4 No %age

1. Strengthen HCT Services in private Clinics – the Good Life Clinics (GLC)

Scale up HCT in GLC 184 174 174 174 174 174 95%

Train HW in couple 100 52 48 n/a n/a 100 100% HCT

Support Post test 5 5 5 n/a n/a 5 100% clubs

Support GLCs to 20 0 19 0 0 19 95% conduct HCT outreaches

Support HCT services 174 174 174 174 174 174 100% quality through quarterly supervision in GLCs

Support printing of 174 0 174 n/a n/a 174 100% HCT services data tools & reporting

People tested 132,000 32800 19556 34,219 26,232 112,807 85%

2.Support infection control, medical waste management (MWM) and disposal

Train HW in infection 100 n/a 82 n/a n/a 82 80% control and MWM

Support GLC for safe 184 174 174 174 174 174 95% medical waste disposal

Procure and 2785 696 693 699 696 2784 99% distribute safety boxes and waste bins

Conduct regular 174 174 174 174 174 174 100% support supervision in GLCs

3. Scale up HIV prevention services for MARPS

IPC for behavior 3,500 0 607 726 1,077 2,410 69% change among truckers

IPC for behavior 19,000 3499 2134 8491 5,508 19,632 103% change among fisher folks

IPC for behavior 1000 89 299 446 535 1369 137% change CSW

Condoms sales 650,000 45,000 5080 175763 198,631 424,474 65% targeting MARPS

4. Scale up HIV prevention among couples

Formation of 4 0 4 4 100% additional couple clubs

Train married couples 48 0 48 48 100% in couple counseling

Train couples in 56 0 56 56 100% positive prevention

Carry out IPC BCC for 150,000 48,278 22,507 20608 58,425 149,818 99.9% fidelity among individuals who are couples

Support couple HCT 19,800 4024 5144 3,748 1067 13983 71% services for married couples

Integration FP,MMC 1500 262 632 265 1159 77% wrap around activities

5.HIV Prevention among Youth

Promote Youth 10 0 10 100% services through GLC clubs

Train Youth peer 80 79 20 99 99% educators for BCC

Condom sales among 100,000 15000 21900 15737 188,089 240,726 241% youth

6. Scale up HIV Care & Positive Prevention Services

PHA receive a least 1 12,500 1814 2118 2485 6417 51% services in care package

HIV Care quality 184 174 174 174 100% assessment in GLC

Support quality care 50 0 50 50 50 100% services in GLC

Support PHA for PwP 10500 659 3032 1182 777 5650 54% services Package.

7. Scale up PMTCT Services

Train HW on PMTCT 100 0 0 0 0% services

Pre accreditation of 50 0 0 32 64% GLC for PMTCT & ART services

Provide PMTCT 700 0 0 0 0% services to HIV+ PW in 50 GLC

Support mothers 50 0 0 0 0% clubs linked to GLC for PMTCT

Train mothers 100 0 0 0 0% mentors in mothers clubs

Design & conduct 1 0 0 0 0% multimedia PMTCT campaign

8. Demand for MMC generation, with DBTA

Referral for MMC 1000 76 332 740 1148 115%

Develop and market MMC disposable kit

9. Scale up prevention services with DBTA

Scale up get off 4 3 3 0 3 N/A sexual network among DBTA’s

Promote condom use 4 3 3 0 3 N/A among DBTA programs

Strengthen HCT Services in private Clinics – the Good Life Clinics (GLC)

HCT SERVICES

Table 2: Quarterly HCT results

Oct-June 2012 HCT Services Progressive Performance

Annual Q4 Category Target Q 1 Q 2 Q 3 Cum Performance

Total counseled 137,400 33,981 20,941 36,416 27,980 127,301 92.6%

Total tested 134,700 33,100 20,511 35,869 26,343 120,708 89.6

Received results 132,000 32,800 15,143 34,219 25,523 117,304 88.9

HIV Positive 2,316 1,298 2,276 7375

Positivity Rate 7.1 8.6 6.7 6 6.3

Tested as 2255 couples 19800 4,024 1,270 3,748 5729 29%

UHMG continued to support Good Life Clinics (GLCs) to strengthen HCT services provision through the private health sector. Specifically, UHMG provided GLCs with logistical supplies and assorted laboratory consumables. These included: buffer stocks of HCT kits and consumables such as Determine, Unigold, Statpak, vacutainers, needles, Cotton wool, and gloves.

To support record keeping in the private health sector and enhance private health sector contribution to the national HMIS, UHMG supported GLCs with various HMIS tool such as HCT client cards and HCT registers. Couple HIV Counseling and Testing certificates were also distributed to GLCs as part of UHMG’s contribution national aspiration to increase number of individuals testing as couples.

In partnership with MOH, UHMG also conducted on-job mentorships in service delivery, record keeping and logistics management during support visits to the GLCs to improve the quality of service provision.

Improving healthcare waste management and disposal

UHMG continued to support GLCs in health care waste management through distribution of safety boxes and color-coded bins. In total, 696 safety boxes were distributed to 174 GLCs for disposal of used/contaminated needles and syringes, while 300 color coded bins were distributed to 100 GLCs to facilitate proper waste segregation, handling and disposal.

Scale up HIV prevention services for MARPS

Sexual and other behavioural risk prevention – truckers

UHMG’s HIV prevention activities for truckers were implemented in the western region in Kasese district, and West Nile region in the districts of Arua, Nebbi and Koboko. Details of activities conducted for this quarter are outlined below.

Western Region: UHMG in partnership with National Youth Organisation for Development [NAYODE] provided HIV prevention services to truckers, commercial sex workers (CSWs) and vulnerable youth in the surrounding communities in the hotspots of Kasese district. Interventions for truckers and CSW were done using the CHIC centre model, moonlight HCT/outreaches and visits by park yard volunteers (PYV) at various hot spots where large number of truckers station to rest from their long journeys or await border point clearances as well as the surrounding communities. Activities for this quarter are as follows:

• 359 truckers and 288 CSWs through the CHIC centre activities were reached with HCT, SMC referrals, STI referrals counseling services, FP information, reading materials, video shows, and interpersonal communication dialogues by the park yard volunteers. IPC focused on integrated HIV prevention with emphasis on consistent condom use, partner reduction, safe male

circumcision, reduction in alcohol consumption and family planning (both long and short term methods) for females. • 166,800 pieces of condoms were distributed and sold by peer educator through social marketing targeting hotspots. Emphasis was on correct and consistent use of condoms by peer educators was one of the key messages given to the recipients of the condoms. Dildos were used in demonstrating correct use. • One additional CHIC centre was opened in Kasese Municipality to provide HIV prevention activities for truckers, CSW and the surrounding communities. • Support supervision and monitoring of the project done by the Director and some members of the board supported by the team from the district health department and NAYODE finance committee which conducted project assets audit. Also, monthly review meetings with peer educators, (PYVs, CSWs) were conducted during the quarter to discuss work progress /challenges and possible solutions, mentoring peer educators on data collection and interpersonal communication. Monthly meetings play a major role in information sharing, self assessment, and review of the implemented activities, dialogue sharing experiences and discussing way forward.

West Nile project: The program has continued support ASDE-U to provide HIV prevention and care services, products and behavior change communication to truckers and CSW and the surrounding communities in the districts of Arua, Nebbi and Koboko and area in which the recent Uganda AIDS Indicator Survey showed a two fold increase in HIV prevalence compared to the previous survey. Interventions are based in the hot spots of Pakwach, Arua Municipality and Oraba. These hot spots are the major stopover points for trucks going to and from southern Sudan and DRC. These areas have attracted high risk sex activities with commercial sex workers and non committal casual sex with “regular partners” of truckers along these routes.

UHMG in collaboration with the district and Uganda Revenue Authority secured land for the relocation and renovation of two CHIC centres’ in Pakwach and Oraba respectively which was UHMG’s efforts to work towards sustainability of the project and enhancement of district ownership. UHMG supported orientation of Park Yard Volunteers in partnership with ASDE-U for conducting interpersonal Communications on HIV prevention and promoting condom use. The counselors based at the CHIC centers refer clients who test positive for treatment and follow-ups. The CHIC centers were supported with HIV test kits and laboratory consumables for clients who come for HCT.

Sexual and other prevention MARPS-fisher folk and CSW

UHMG continued to support SSECODA through a sub-grant to provide HIV prevention services among fisher folk and CSWs on landing sites in Masaka, Mukono, Kalangala and Wakiso districts. Activities conducted included:

• Interpersonal community mobilization for fisher folk: 9,315 fisher folks were reached through interpersonal communication on HIV risk reductions such as reduced sexual multiple partners, and increasing demand and utilization of proven services for prevention such as HCT, SMC, and STI management and consistent correct condom use. This was done through one-on-one contacts and focus group discussions with fisher folks. Peer educators also reached the general population in markets, trading centers, political and health meetings with the HIV prevention messages and activities. • Reduction of Gender Based violence: 8,359 community members at the landing sites were reached with SGBV prevention activities through drama skits to steer discussions and community dialogues as a way of addressing the predisposing factors to HIV prevention.

• 31,831 condoms were distributed during through the new condom outlets created. This was aided by condom education and demonstration and increased awareness of consistent and correct use and for positive prevention among PHAs. • Interpersonal community mobilization for CSWs: 121 CSW in Kalangala were targeted with HIV risk/sexual partner reductions, STI management/treatment and condom promotion and distribution. • Increasing access to HCT services and referral for positive prevention, family planning and STI services for fisher folk: 800 (326 females and 474 males) fisher folk received HCT services through community outreaches on the different landing sites and at its headquarters in Kalangala, Katabi Sub Counties. This was done in collaboration with from the district health officials. Those who tested positive were referred for treatment and chronic care to facilities of their choice. In addition, 384 PHAs were provided with positive prevention services and referral for STI treatment/FP services. 271 males were circumcised in partnership with the Kalangala district health office. • Held four advocacy meetings at four Sub-Counties to enhance collaboration among service providers and the district. These meetings were used for joint planning and activity implementation.

Scale up HIV prevention among couples

UHMG in partnership with Humanitarian Care Uganda during this quarter implemented Fighting AIDS in the Home (FAITH) project in the nine districts of Lira, Kabale, Mbale, Kabarole, Wakiso, Kyenjojo, Kamuli, Mukono and Kanungu. The main objective of this project is to reduce high and rising new HIV infection rates among couples (individuals in long term / stable unions) through strengthening the capacity of Communities to respond to the HIV/AIDS epidemic, promoting behaviour change towards faithfulness and support married couples to popularize and sustain their commitment to fidelity. Key activities implemented during the quarter were:

• 77,006 individuals in long-term stable unions were engaged through interpersonal communication activities to address issues of fidelity, multiple concurrent relations, family planning, sexual gender based violence etc. Of these, 37,068 were males while 39,938 were females. Ongoing couple communication, mobilization and education on fidelity and HIV prevention was done using “Families that Prosper” by HERO couples and community leaders. The focus was to reach couples in long term stable unions with dialogue on issues which affect the union of people in long term stable unions and may lead to infidelity and how these issues can be addressed • Marital counseling: Through fidelity club meetings and community outreaches, 9,167 individuals in long term stable unions were counseled on marital issues and other factors which increase their vulnerability to HIV infections. Of these, 4,230 were males while 4,937 were females. The purpose of these counselling sessions was to promote better relationships, prevent domestic violence, plan for small and manageable families through adoption of family planning methods, and explore available options and make informed decisions based on what can apply in a particular situation. • Couple HIV Counseling and Testing: During the reporting period, 1,067 couples were supported to know their HIV statuses. Of these, 30 couples were found living in discordant relationships representing (2.8%), 61 couples were found living in concordant positive relationships representing (5.7%), while 966 couples representing (90.5%) were found in concordant negative relationships. Through this activity, counselors supported couple disclosure among partners to facilitate joint planning for risk reduction, adoption and maintenance of positive health practices and linkages to prevention, treatment, care and support services

• Safe Male Circumcision: HERO couples continued promoting Safe Male Circumcision (SMC) among uncircumcised adult males in their respective communities. They carried out mobilization and liaised with other partners afield to carry out the procedure. In total 357 adult males undertook the procedure with support from their partners during the reporting period. • Increasing the visibility of the FAITH Project interventions: HCU continued working on increasing easy identification of the FAITH Project in the districts of Kanungu, Kabale, Wakiso Kabarole, Kyenjojo, Kamuli, Mbale, Mukono and Lira. The Project facilitated the planting of 34 Fidelity Club signposts at locations nearest to the meeting places of club members, procured and distributed 1,350 and 450 branded umbrellas to HERO couples, community leaders and staff of GLCs. • Monitoring and Support Supervision: support supervisions were conducted to help project staff identify gaps in project implementation and action areas; and identify capacity gaps for project staff and HERO couples. During the support supervision visits and meetings, project progress was discussed, strengths and weaknesses were addressed, areas for capacity building were identified, gaps and action plans were drawn, monthly and weekly work plans were drawn, best practices were shared, resources identified and areas for improvement and immediate action were identified and addressed and data collection tools (registers) availed to HERO couples.

HIV Prevention among Young unmarried people

UHMG in collaboration with Health Alert Uganda this quarter reached 4,044 young unmarried people in the districts of Amuru, Nwoya and Oyam with combination prevention activities such as correct and consistent condom use, benefits of HCT, modes of HIV transmission and prevention, SMC, and PMTCT, Family planning for youth under reproductive age to foster sustainable delivery of integrated HIV prevention and care.

Expert peers were involved in community mobilization alongside the health workers that were trained at the beginning of the project. This linkage has helped streamline referrals and linkages for youth accessing services unavailable in the community. This in the long run has enabled a good proportion of young unmarried people accesses the required services.

Activities implemented during the quarter are as follows:

• Support youth club meetings in the three districts of operation with “benefits of consistent and correct condom use and how to effectively reach the youth even at phase out of the project”

Create demand for prevention services: HCT, safe male circumcision, STI assessment, referral and treatment, and family planning services. 715 people benefited from HCT, 142 young people benefited from SMC and 5 screened for STI were refereed for treatment.

Picture 3: One of the youth being circumcised

• Quarterly stakeholders meeting were conducted to strengthen partnership collaboration and linkages with stakeholders for comprehensive HIV prevention services within the 3 selected districts. • Monitoring and evaluation: Six monitoring visits were conducted by management staffs to health facilities that the young peers consistently refer the young people for various services to access the efficacy of these referrals and whether the need really does exist. From these visits the Health workers put forward the need having a VHT based at the health facilities on particular days that the young people should aware of to cater for the tremendous demand of these youths as they may feel left out yet health centers are so packed all the time that they cannot be accorded the adequate time they may so desire. • In Kasese district as part of the trucker program, 472 (209 male and 263 females) youth were reached by peer educators with combination prevention including information on condoms, FP and referrals for SMC and STI management and treatment at the youth centres in both town councils. As part of this program, young people have continued mobilizing their peers for HCT, counseling, referrals on SMC, STI treatment and information on condom and family planning services in CHIC and youth centres and 52 youth Referrals for STI treatment to the health facilities.

Sexual and other prevention MARPS - Boda Boda Operators

UHMG has continued supporting HIV prevention program targeting youth out of school. This program is implemented through youth groups and boda boda operators. After the launch of the Boda Boda program in the districts of Arua, Nebbi, Moyo, Koboko, Mbale and Jinja, district stakeholder meetings were held in all the districts with the aim of bringing the key district offices and other partners on board to enhance the take off of activity implementations, strengthening

37 linkages for referrals and technical support for the program. The 109 Peer educators were provided with Community based volunteers packages such as T-shirts, condom storage bags and dildos for message dissemination, identification, easy storage and demonstration of correct condom.

Sexual Reproductive Health (SRH) activities were run alongside HCT outreaches in the districts of Mbale, Moyo, Nebbi and Koboko at Boda boda stages and the surrounding communities. A documentary film show of Silent Epidemic was used during these outreaches to open discussions on STIs, their effects and prevention with emphasis on combination prevention, and SMC. Referrals were made for services. This was aimed at empowering Boda Boda cyclists and the surrounding communities to make informed decisions and acquire healthy behaviors. The total number of people reached with SRH services were 521 (347 male, 174 female). 1150 people were tested and counseled for HIV. Of those tested, people who tested positive were referred for treatment and other HIV services. In Nebbi district, mapping of HIV service providers was done and referral directory was produced to strengthen referrals and treatment of people who test positive.

Scale up HIV Care Treatment & Support Services

Positive prevention: UHMG currently supports 126 Peer educators (who are all PHAs) from Good Life Clubs in 32 Good Life Clinics to provide PP services to PHAs served by GLCs. These peer educators worked closely with health workers from the respective GLCs. These peer educators provide people living with HIV/AIDS (PHAs) with the minimum package of positive prevention (PP) as recommended by MOH. In total, 777 PHAs were provided with services.

Health workers being mentored on use of HMIS tools in Fitzmann GLC

Care: During this quarter, UHMG continued supported GLCs to provide PHAs with HIV care services. GLCs were also provided with starter packs comprising one month’s supply of Cotrimoxazole (cotramox), oral contraceptives, water purification tablets as a way to initiate newly diagnosed PHAs on care. UHMG provided support supervision to ensure that peer educators were practicing and perfecting their skills and knowledge they acquired during the past training, practicing the acquired counseling techniques to use with PHAs. These support visits also focused on increasing integration of positive preventions services into work already being done by peer educators such as health education on immunization, family planning, nutrition, sanitation and hygiene.

ART on-job mentorships on use of ART client cards in Iceme

Initiation of ART services in 14 GLCs: UHMG in collaboration with MOH mentored health workers from 14 selected GLCs that will serve as ART sites. This on-job mentorship was followed by accreditation of the sites by MOH to start providing ART to PHAs who are eligible. These ART sites will also serve as part of the 33 PMTCT sites in UHMG’s bid to contribute towards the national goal of scaling up option B plus of virtual elimination of mother to child transmission.

Lessons learnt

• Working with other IPs or partners and collaborating with existing institutions generate a lot of support and quick results. Greater involvement of stakeholders like local and religious leaders in the project is key to its success and program outcomes.

Plans for the next quarter

• Train 100 health workers from 33 GLC PMTCT sites on options B+ EMTCT • Partner with MOH to accredit 33 PMTCT sites • Train 50 mother mentors on community EMTCT

• Reproduce and distribute an assortment of job aides and policy guidelines for HCT, PMTCT, ART and TB, and HIV and family planning • Conduct integrated support supervision • Support four CSOs with sub-grants to provide HIV prevention, care support services among youth, couples, truckers, fisher folk and commercial sex workers • Continue scale up of “get off the sexual network” campaign condom promotion with DBTAs

C. MCH

Introduction The overall goal of the UHMG MCH department is to contribute to the national goal of reducing maternal mortality from 435 to 131 per 100,000 live births by 2015, child mortality by 2/3 by 2015 and increasing the CPR from 26% to 30%. The Strategic Objectives are to: 1. Increase the availability, accessibility and utilization of quality skilled care for maternal and child health services in the Good Life clinics. 2. Improve appropriate and timely health care seeking behaviour for maternal and child health services at community level 3. Increase knowledge, access and correct utilisation of appropriate maternal, child and reproductive health products Overview of the Implementation approaches The MCH activities were implemented through two major strategies; the health facility component through GLCs and the community component through model villages and community structures. At the facility level, the department supported 50 Good life clinics through building the capacity of private health practitioners to provide quality ANC, delivery, post natal care, and child care including care of the new born, growth monitoring, integrated management of childhood illnesses (i.e. malnutrition, diarrhea, Acute respiratory tract infections and malaria, de worming, immunization and micronutrient supplements). On job support supervision and mentoring was emphasized during the quarter especially to the new additional GLCs that were selected for accreditation through the DFID funding. In addition, UHMG supported interventions for community engagement through the model village approach in the districts of Mukono, Mbale, Lira and Serere. Good Life Promoters (GLPs) were engaged in sensitizing households on how to adopt risk reduction behaviors needed to reduce maternal and child morbidity and mortality in the communities.

Service Delivery Outcomes

Oct2011 - Sept 2012 MCH Services Progress Performance

Indicator Annual Quarterly service outcomes Remarks target Q1 Q2 Q3 Q4 % achievement

MATERNAL HEALTH

Number of mothers attending 40,000 6,162 4,214 7375 6,339 73 the first ANC visit at the GLC

Number of mothers attending 13,000 2,904 1,922 3601 3,176 106 the 4th ANC visit at the GLC

Number of mothers who 11200 4,545 3,040 5660 4,480 190 received IPT 1 at the GLC

Number of mothers who 6800 3,445 2,153 3729 3,299 217 received IPT 2 at the GLC

Pregnant women counseled, 11200 2,597 1,907 5518 5,762 191 tested and received HIV results at GLC

Number of mothers delivering at 8000 2,626 1,744 3406 2,771 158 GLC by skilled HW

Babies born with low birth 376 122 81 161 174 170 weight(<2.5 kgs)

CHILD HEALTH

Total OPD attendance of 100000 20727 22068 60185 46,379 198 children under 5 years

Children under 5 years treated 50000 - - 26744 19324 92 for malaria

Children under 5 years treated - - - 4362 - - for diarrhea

Saving Mothers Giving Life campaign

UHMG pioneered the “Deliver at a Health Facility” campaign in Kyenjojo, Kamwenge, Kibale and Kabarole for increasing awareness, changes in attitudes, values and behaviors relating to childbirth and improve health practices that include utilization of health services. UHMG in partnership with US government-funded projects, designed a multichannel (mass media and interpersonal approaches) communication campaign emphasizing the need for pregnant mothers, their partners and the community to prepare for delivery at a health facility.

To support this campaign, UHMG aired two radio spots from July 2012 titled:

• “Baby arrives” • “Time to give birth”

Altogether, 9156 spots & 4578 DJ mentions were aired on seven radio stations, namely:

• Kamwenge FM – Kamwenge District • Endigyito Fm – Kamwenge District • Kibaale Community Fm – Kibaale District • Kyenjonjo Development Fm – Kyenjonjo District • Kyenjonjo FM – Kyenjonjo District • HITS FM - Kabalore District • Better Fm – Kabalore District

Bill board and poster for the saving mothers and giving life

Challenges

Partners competing for the same clinics and hence duplicating services (strides, PACE, Marie Stopes and UHMG).

D. Family Planning (FP)

Overview of FP Program

UHMG/AFFORD received additional funding from DFID to scale up family planning interventions and contribute to the Accelerated Rise of Contraceptive use in Uganda. AFFORD UHMG activities support the Results Areas below.

Key Results Areas

• RO1: Increased financial, institutional and market sustainability of UHMG • RO2: Increased availability, affordability of health services and products • RO3: Enhanced knowledge for self-efficacy and correct use of health services and healthy practices

Activities based on these Results are outlined below.

Result 1: To increase financial, institutional and market sustainability of UHMG

The capacity building section at the beginning of this document details the broad ways in UHMG systems have been strengthened to improve UHMG technical, financial, institutional and market

sustainability. These include improvements in such areas as supply chain management, commercial market distribution, profitability, regional warehousing, market data collection, strategic communication campaign development, media reach measurement, and the delivery of clinical services for long-term contraceptive methods (LTMs).

A key area of systems strengthening that received great attention during FY12 is that of strengthening UHMG partnerships with international pharmaceutical manufacturers. For international liability protection, both Bayer and Merck had a number of legal and service delivery requirements that UHMG had to meet in order to begin receiving and distributing long-term methods, specifically implants. These legal agreements were developed and training requirements met over the course of FY12 Qtr 2 and 3. The process slowed implementation of LTM service and product delivery, but strengthened UHMG’s standing with these firms and established long-term agreements that will allow UHMG to work with them into the future on LTM delivery.

Result 2: To increase access and affordability to quality family planning services and products

The scale up in family planning service utilization is supported through an integrated approach for “demand” and “supply” implemented by UHMG. Result 2 seeks to increase access to family planning by strengthening the supply of family planning services and products.

At present, UHMG’s commercial social marketing model delivers short-term family planning products nationwide. An independent Retail Audit of health facilities, including pharmacies, drug shops and clinics, conducted in September 2012 finds that Protector reaches 83% of outlets nationwide, PilplanPlus, 74%, and Injectaplan, 70%.

The program also seeks to expand Service Delivery coverage in Good Life Clinics (GLCs) from 200 to 560 between project inception in FY2012 and September 2013, expanding geographically from 45 districts to 90. To date 238 clinics have been mapped in the new districts and 116 GLCs trained in the delivery of long-term methods.

Trainings on long-term FP methods

A total of 116 service providers underwent a two weeks training on long-term FP methods (5 days of in-class and 5days of practicum at Mulago Hospital). Upon completion of the course, they were given family planning commodities to ensure a start up of activity implementation.

Service provision (from HMIS reports July –September 2012):

Modern Family Planning Services uptake at GLC Clinics Q1 Q2 Q3 Q4 Total Target %age Family New Users Revisits New Revisits New Revisits New Revisits Planning Users Users Users Methods

Pills 2,265 1,371 2,638 2,330 2,552 2,060 1,370 1,253 15,839 79% 20,000 IUDS 1,250 164 1,083 251 1,037 389 1,998 122 6,294 180% 3,500 Implants 493 209 440 85 757 218 1,071 191 3,464 77% 4,500 lnjectable: 2,208 2,217 2,810 2,842 4,100 3,633 1,860 1,848 21,518 72% 30,000

Commodity security: UHMG supports the Family planning commodities security through product facility operation, which UHMG handles as a specialized department for health products warehousing and distribution. Owing to this unique capacity, UHMG was identified by the Family Planning Working Group to support the Ministry of Health and the National Medical stores to man the private sector supply as an alternative distribution channel for family planning commodities. This channel targets service providers in the private sector (e.g. NGOs, CSOs, private health professional bodies and the private not for profit organizations). It has tremendously improved the ease for access to FP commodities by the private sector and also helped the National medical Stores to de- congest their warehouse.

Result 3: To increase knowledge, awareness, demand and utilization of modern FP methods, including long term methods.

Demand Generation for FP Services: Smart Choices Campaign & Local Outreach UHMG has designed and developed a comprehensive behavior change campaign to increase demand for modern family planning methods in the public private and NGO sectors throughout Uganda. The “Smart Choices” campaign, launched in September 2012, uses an informed choice approach to promote each method category, introducing long-term contraceptives in the process. Media reach analysis conducted by IPSOS/ Synovate finds that as of the end of September, 63% of adults, or almost 10million Ugandan men and women have heard or seen the Smart Choices campaign (see MSI section of current report for further detail on Media Reach). Many channels are used to deliver the message. Specifically, 89 Radio talk shows on Injectaplan aired on 4 local radio stations, 4,123 Radio spots and 132 TV spots aired on Smart Choices, 28 billboards and 63 road stars were erected countrywide, and 70,000 posters were produced.

To reinforcing the Smart Choices Campaign at the local level, several community mobilization activities were carried out to generate demand for Good Life Clinics offering family planning services. Community Resource Persons (Good life Clinic promoters) have been identified for training in expanded community mobilization.

Contraceptive Sales and CYPs

Under the DFID ARC project, one of UHMG’s goals is to increase the CYPs delivered in Uganda. As is shown in the FY2012 CYP tables below, derived from the AFFORD/DFID Technical Application, CYP targets are being generated but below anticipated levels. The first table shows that AFFORD/UHMG is meeting 73.2% of its CYP targets. The CYPs are below target due to low demand for injectables; other methods are performing well.

AFFORD/UHMG

FY12 CYP Achievements Versus Annual Targets

FY 12 Actual: Actual CYPs FY12 Sales Volume derived by of all methods Target: Product excluding in category Product CYP minus sales to sales to Method Sales Conversion Targets CYP other IPs* IPs* %

Condoms 16,000,000 /120 133,333 16,521,195 137,677 103.3 %

2,173,050 144,870 (33,090)* (2206)* Oral Contraceptives 1,600,000 /15 106,667 2,139,960 142,664 133.7 %

1,640,980 410,245 (13,900)* (3,475)*

Injectables 2,800,000 /4 700,000 1,627,080 406,770 58.1 %

MoonBeads 3,600 x1.5 5,400 3,435 5152 95.4 %

IUD 0 x3.3 0 0 0 0

Implant 0 x3.8 0 0 0 0

Totals 945,400 692,263 73.2 %

The second table details the combined AFFORD/UHMG and DFID Targets and Achievements. UHMG is achieving 48.8% of its targets and the following combination of reasons may be contributing to the CYP shortfall. As noted above, Injectable use is lower than targeted, having a significant impact on overall CYPs. Additionally, demand for private sector products is dampened by the introduction and use of free products in private sector pharmacies, drug shops and family planning clinics. Finally, an initial ARC project assumption that short-term-method CYPs would increase proportionally with the geographic expansion of LTM-delivering service facilities may need to be re-examined. UHMG’s short-term methods reached private sector outlets throughout Uganda via commercial distribution channels even when UHMG GLCs covered 40 districts. (For example, an independent Retail Audit of health facilities conducted in September 2012, midway into the ARC Project clinic expansion, finds that Protector reaches 83% of outlets nationwide, PilplanPlus, 74%, and Injectaplan, 70%. While product sales and CYPS are expected to increase with national demand creation campaigns and the expansion of specialized FP service facilities, CYP targets may still need to be adjusted.

AFFORD/UHMG - DFID

FY12 CYP Achievements Versus Annual Targets

FY 12 Actual: FY12 Target: FY12 Sales Volume Method Target: Product CYP FY12 Actual: % CYP of all methods All UHMG Conversion in category CYPs derived Product minus sales to by excluding Sales other IPs* sales to IPs*

Condoms 23,100,040 /120 192,500 16,521,195 137,677 71.5 %

2,173,050 144,870 (33,090)* (2,206)* Oral Contraceptives 2,462,000 /15 164,133 2,139,960 142,664 86.9 %

1,640,980 410,245 (13,900)* (3,475)*

Injectables 4,350,000 /4 1,087,500 1,627,080 406,770 37.4 %

MoonBeads 3,600 x1.5 5,400 3,435 5,152 95.4 %

IUD 310 x3.3 1,023 4,351 14,358 1403.5 %

Implant 400 x3.8 1,520 703 2,671 175.7 %

Totals 1,452,076 709,292 48.8 %

Other activities

UHMG in partnership with Marie Stopes international (MSI) participated in a community event at Wakiso health centre IV, Wakiso district to showcase to the two consulates (UK and USA) who are reportedly new to get acquainted with the Accelerating the Rise in Contraceptive Prevalence project in Uganda that their countries are supporting at UHMG and Marie Stopes.

Challenges and Lesson learned

• Demand creation activities, especially below line activities for clinics need scale up, to support the multimedia communication campaign for increased services utilization • Delays from the manufacturers in granting approval of branding of the 2 long term family planning products (IUDs and Implants) affected supply • Services data management need more support to ensure timely data management and reporting, in line with HMIS reporting requirements

Planned activities for the quarter 1, 2013

• Close follow up of KPI to ensure branding of the two long-term family planning methods (IUD and the Implants) • Identification and Training of community Health workers to ensure increased demand and utilization of FP services at GLC • Promotional activities for the FP services and products to increase GLCs-based FP service utilization and use of the FP products • FP Outreaches at selected GLCs to boost utilization of the GLCs and promote the products • Continuous airing of radio talk shows, radio spots and TV adverts on Family planning. • End mile distribution and social marketing of all 5 FP products • Regular Support supervision and on job mentorship by the contracted reproductive Health trainers of all GLCs (both trained and not yet trained) to ensure quality of care • Document best practices for scale up

III. CROSS CUTTING ACTIVITIES AND SERVICES

A. MARKETING AND STRATEGIC INFORMATION (MSI)

1. MSI - BRAND ACTIVITIES

Activity Performance Monitoring Table

Brand Activities/Targets/ Q1+ Q2 + Q3 Q4 Actual Progress, Comments Outputs Achieved

Cotramox Annual target 4,923,490 3,851,880 111% Vs Annual Esther Atuuse 7,900,000 Quarterly target 1,975,000 Networking 6 institutions IRCU and STAR SW lifted w/decision makers in the largest amount of stock major institutions and through repeat orders NGOs; increase number from 4 to 8

Detailing to health and 1449 pharmacies & 1512 Pharmacy Detailing ended in August pharmacy providers; drug shop calls made provider calls & 1912 2012; there’s still great merchandising with health provider calls need to improve delivery of 2146 Health posters to improve providers calls orders booked by the brand visibility medical representatives from the distributors to the smaller outlets. Regional CMEs and 9 product To be carried out this FY. orientation meetings orientation meetings In the Eastern Region – 556 health Distribution through 8 6 Institutions bought IRCU and STAR SW lifted institutions and NGOS, RHU, the largest amount of stock pharmacies and health through repeat orders as centres IRCU,ICOBI well as IRCU, ICOBI and STAR SW, JCRU JCRU. Brand Activities/Targets/Out Q1, Q2 & Q3 Q4 Actual Progress, Comments puts Achieved Restors Advocate with MOH Contacts made Follow ups Paediatrician endorsements +Zinkid targeting DHOs, DHEs, through an MOH in a mass campaign started. promotion & POLs and VHTs on workshop on uptake in benefits of Protect, Prevent and Currently working with combination combination use Treat. MOH on a partnership for use (UHMG brand) the mass media campaign Initial contact with to increase public Esther Atuuse CHAI made on the acceptance. possibility of a partnership.

Follow up meeting with CHAI delegation on way forward on how to engage UHMG and other partners on the increased accessibility of Zinc in the market.

Detailing to health 2399 health 1512 pharmacy/drug Detailing stopped in August providers on providers calls made shop provider calls & 2012; combination use. 1449 pharmacies & 2216 Health provider drug shop calls made calls

Develop materials for Brochures and racks Distribution on going New material (ABS boards, detailing and POS were produced with 50 racks so far posters, brochures and placement. placed in outlets flyers) with the doctor endorsement to be produced in the new FY.

Media: Use radio, TV Concepts for new Restors/Zinkid ads Working on bringing MOH and billboards for campaign route began running on on board in the campaign. demand creation to developed; Radio, TV mass media - TV, Budget needed to maintain run all year and Outdoor radio, and suburb media for at least another 3 production was done signs months to create and achieve impact.

Participate in health conferences for brand visibility

Achieve annual sales 472,068 172,225 39% Vs Annual of 2,000,000 sachets for Restors

Achieve sales volume 4,913,991 1,582,900 80% Vs Annual of 10,000,000 tablets for Zinkid

Improve brand Campaign Awareness campaign awareness of the development began with the combination completed launch of the media campaign in the Increase availability, month of August accessibility and visibility of BCC survey yet to RESTORS/ZINKID start through 387 (75%) of pharmacies and 1,583

(60%) of drug shops in UHMG database

Trainings & CMEs and trainings of 7 CMEs conducted in 1 CME conducted in Out of 145 providers CMEs for 1,000 HCPs in public & central region; 204 Gulu; 41 providers targeted for training in QTR Restors/Zinkid private sectors on attended trained 4, 92 providers were diarrhoea trained. Product orientation 1 CME conducted in Esther Atuuse management and meeting for drug Arua; 65 providers combination use. Achievements against the association meetings were trained annual target: in Eastern region; 4 CMEs were 556 providers were conducted in the 947 providers trained Vs trained. eastern region – in 1000 1 CME conducted in Jinja (37 providers the Northern & West attended), Tororo (40 Nile regions with 95 providers attended), providers in Pallisa (7 providers attendance attended) and Soroti (8 providers A total of 855 attended) – a total of providers were 92 health providers trained were trained Brand Activities/Targets/Out Q1, Q2,Q3 Achieved Q4 Actual Progress, Comments puts

Condom "O" Open 4,000 additional 1121 287 outlets Hindered target increase promotion ‘O’ outlets due to stock out of ‘O’ in (supermarkets, Q3. Jeanne Marie dukas/kiosks, hotels, Nakato lodges)

Sales volume of 639,938 607,824 86% Vs Annual 1,500,000 pieces

1 mass media Radio – 7 stations A countrywide mass Sponsorship of TV news campaign (DJ running + TV (NTV) media condom headlines & an endorsements, TV and promotion was endorsement in the Africa radio spots) developed and Cup of Nations on NBS. awaits execution.

POS placement of Carried out Limited merchandizing 10,000 posters and placement because of stock out in 5000 metal plates countrywide during most outlets affected MITs across central, getting to 100%. eastern and northern region as well as field trips with over 150 outlets reached.

12 regional concert 2 Vision Group in April – sponsorships Western region – Ekinihiro in Western Uganda & sponsorship of the CECAFA tournament.

8 ‘O’ theme nights in 23 1 theme night at the These are to resume with leading night THATCH-Eastern the ‘O’ promotion. clubs/bars per region Region.

Weekly supervision Trade visits were done in visits to monitor Central, Eastern and activities. Northern region.

Pursue corporate Meetings with MTN held to social responsibility engage staff and DFCU bank collaboration. – we await feedback.

Brand Activities/Targets/Out Q1, Q2, Q3 Achieved Q4 Actual Progress, Comments puts

PROTECTOR Achieve sales volume 10,234,152 5,003,340 95% Vs Annual promotion of 16,000,000 condoms.

Coordinate activities 1 done NAYODE-supply and with MARPS program, distribution of Boda Boda campaign 163,200 pcs of and Boda Boda condoms associations

Conduct mass media Radio interview No funds for mass Carried out to support (TV and radio) carried out on Step media Boda-Boda launch – general and NBS stations mass to start Q1 –12/13

Procured and distribution on-going with field teams across programs, MSI & 5,000 ABS boards at Mini MITs have been special projects. POS, 20,000 t-shirts on going with focus and caps for trade and on distribution and consumer promotions placement of POS materials in retail outlets (208 outlets from Eastern, central and West Nile region)

Distribution through Ongoing through the MITs carried out in Central existing networks and 15 distributors of region over 15 trading retail outlets (dukas, UHMG countrywide. centres in the month of July pharmacies and drug and in August as well as the shops regional MITs.

Brand Activities/Targets/Out Q1, Q2, Q3 Achieved Q4 Actual Progress, Comments puts AQUASAFE 5,400,000 tablets sold 2,322,560 948,160 61% Vs Annual promotion

Jeanne Marie Promotions at schools 103 Follow ups and School workshop was Nakato distribution of IEC hosted for the Northern materials and POS regions. 53 head teachers materials in 19 were oriented schools in Northern region, 12 in central region and 15 schools in Eastern region.

Increase community 153 46 community Neighbourhood distribution points to distribution points Communities have also 180 created around the been oriented and over 200 Aquasafe schools (1 outlets stocked. community per school)

Activities carried out Integration of activities with in 3 towns alongside MCH on plan for Mbarara, MCH to create Gulu and Masaka starting in product awareness. conjunction with Maternal and Child health. Partnerships with Exhibition at the Other partnership - with NGOs National Science SNV in west Nile in regards Week funded by to Sanitation in 13 schools World Bank with over and surrounding 20 schools. communities - Oriented the communities around Kikajjo behind Aga NGO visits have been Khan university with KPI. made to 6 prospect organizations- Interaid, Goal, Plan Uganda, AMREF, BRAC 1 plantation 6 conducted 2 Working with HIPPS to activations communities, covered Tullow Oil (Kaiso, Hoima). & Water points set up for over 100 staff at Uganda Fishnet, Capital Shopper’s Workplaces trainings Supermarkets oriented,(50 staff) UWASNET, Akright Estates. Vision Group has also confirmed a staff orientation this Qtr. PR during World 2 New Vision article Water Day, World endorsing Aquasafe for Water Week and Day schools during the World of the African Child. water week. The team also sampled Aquasafe during the National event in Kanungu-(W.Uganda)

Pictorial of the CSR partnership between Vision

group and UHMG

Mass media using 7 stations and Media running in key towns radio spots, talk shows outdoor and areas around and billboards. supporting supermarkets.

Trainings & Community 5 3 Training of PEWOSA women demonstration orientations. in remote areas of Kampala s for Aquasafe on financial management - savings using Aquasafe

In partnership with School Jeanne Marie of Public Health- training of Nakato 60 community leaders in Kikoza, Mukono Training of health workers on water safety in Bududa in partnership with Foundation for International Medicine for child health. Brand Activities/Targets/Out Q1 Achieved Q4 Actual Progress, Comments puts Injectaplan 2,800,000 vials sold 1,107,380 533,600 59% Vs. Annual promotion (650,000 CYP)

Paul Lemi/Joshua Mass media (radio talk Carried out on 7 No budget for Q4 37 Radio talk shows have shows) for Side effects stations been conducted on 7 radio management stations

w/providers

5,000 providers 2027 Health trained on counselling Providers trained clients. through detailing on side effects management as well as a Mengo Hospital during CMEs. Detailing to providers 1,250 1,977 Health (gyn., midwives, providers detailed to nurses, drug shops, and 1512 outlets pharmacies)

POS material: 5,000 Produced and Materials distribution on- posters, 10,000 distribution on going going. provider brochures, through field 8,000 consumer visits/MITs and brochures. Detailing.

Participate in 6 Eureka with sub-grantees conferences/exhibitio training, ns for visibility UPMA & RHU youth day celebrations, MUBS orientation for first year students mainly about

sexual and reproductive health, Makerere University School of Public Health (MUSPH) FP Golden moment, Full woman Health camp – Monitor.

Coordinate with MCH GLCs - promotion on-going community with a special price list for interventions to both GLCs and teams going to promote Injectaplan the fields being encouraged and sales of to move products there. Injectaplan through GLC and GLS.

Increase access to UPMA Meeting is yet to be held to Injectaplan through discuss MOU and conclude collaboration with this. NGOs and professional associations.

CMEs 7 done RHU, UPMA, FP Golden moment (MUSPH), MUBS, Sub-grantees

Exhibitions 6 Full Woman health camp

Brand Activities/Targets/Out Q1,Q2, Q3 Achieved Q4 Actual Progress, Comments puts Pilplanplus Achieve sales target of 1,753,380 369,810 133% Vs. Annual promotion 1,600,000 cycles

Detailing of 5,000 928 & 1572 outlets 1,977 Detailing shall continue to providers Health providers create demand detailed to and 1512 outlets Exhibit at health 5 6 done RHU, UPMA, FP Golden conferences moment (MUSPH), MUBS, Full woman health camp, Sub-grantees

Mass media (TV, radio) Smart Choices on and billboard going to support pills.

POS, promotional and T shirts have been IEC materials, 10,000 procured other provider brochures, material awaiting to 8,000 consumer include Comb 3 on leaflets. the artwork – flyers, brochures. 8,000 POS posters,1,000 t-shirts 1,000 lab coats,1,500

pens

Collaborate with HCP, RHU, FHI, MSH, MOH, ENGAGE, UNAM- Uganda Nurses and midwives assoc, UPMA to increase access. Paul Lemi Trainings & CMEs for 10 conducted with 9 conducted with 367 Jinja RRH, Mbale RRH, Pilplanplus 954 providers health providers Tororo RRH, Arua RRH, Kuluva Hospital, Lacor Hospital, Teso safe motherhood, Louise MMC, Mengo Hospital.

Brand Activities/Targets/Out Q1, Q2, Q3 Achieved Q4 Actual Progress, Comments puts Moonbeads Achieve sales of 3,600 1,065 2,370 95% Vs. Annual. Promotion

Distribute 200 per 50 quarter though JMS

Orient HCPs/Trainings 320 HCPs oriented - Tororo RRH, Arua RRH, and CMEs 2 CMEs Kuluva Hospital, Teso safe motherhood, Louise MMC, Mengo Hospital.

Coordinate with MCH Paul Lemi program in community interventions

Increase access 1 conducted, with 47 Lacor Hospital through FPOs (UCMB) health providers

and schools

Exhibitions 6 carried out RHU, UPMA, FP Golden moment (MUSPH), MUBS, Full woman health camp, Sub-grantees.

Brand Activities/Targets/Out Q1,Q2, Q3 Achieved Q4 Actual Progress, Comments puts

NewFem Sales target of 40,000 10,400 5,480 40% Vs. Annual promotion cycles

Detailing to providers 1,704 health Detailing is currently on in selective providers detailed to going countrywide; there’s distribution points need to help in delivering orders booked by the medical representatives from the distributors

Activations at Vision group with corporate workplaces Mama Tendo and using direct marketing awaiting invitation at KCB and dfcu banks.

Mass media (radio, TV, 3 Radio stations + 1 No budget for media Run on TV & Radio billboards. TV in central running

Exhibitions 7 6 carried out RHU, UPMA, FP Golden moment (MUSPH), MUBS, Full woman health camp, Sub-grantees

Exclusive—middle Conducted sales drive for class—outlets stocking central region with outlets NewFem. getting stocked in middle class outlets around Game, Kisementi, Garden city.

Brand Activities/Targets/Out Q1,Q2,Q3 Achieved Q4 Actual Progress, Comments puts Softsure 72,000 cycles (4,800 28,000 5,980 47% Vs. Annual promotion CYPs)

Paul Lemi Activations at ANC, 5 carried out Mengo hospital, Kalerwe maternity homes and HCT, Lira-Maracha hospital, hospitals Gulu independent hospital and Arua regional referal

Target of 10 hospital In progress follow up with maternity centers Mengo and Nakasero promoting Softsure Hospitals to stock up and allow us access to present in the antenatal unit Detailing to HCPs 26 providers reached Countrywide detailing on- (gyn., midwives, going. nurses, pharmacy dispensers) at private sector clinics

Radio and TV adverts Media run till July Radio ads on 7 stations

Participate at FP 6 executed RHU, UPMA, FP Golden exhibitions for moment (MUSPH), MUBS, visibility Full woman health camp, Sub-grantees

Link Mothers clubs to Discussions held with RHU ANCs with hospital- and UPMA. RHU has based activations ordered. UPMA is setting up a meeting to discuss MOU

Collaborate with MCP 7 CMEs Conducted in the North, program for VHTS and West Nile and Eastern community Uganda interventions

Access through MSU, RHU, ´NGAGE, FHI, MSH, HCP

Partner with fast- moving goods company targeting same audience (young mothers,breastfeeding mothers)

Trainings & CMEs for 9 conducted, 367 Jinja RRH, Mbale RRH, Softsure among HCPs providers reached. Tororo RRH, Arua RRH, Kuluva Hospital, Lacor Hospital, Teso safe motherhood, Louise MMC, Mengo Hospital.

POS, promotional and Brochures, t-shirts Distribution at distributor IEC materials procured level, retailers/pharmacies, hospital activations.

2. MSI - COMMUNICATION CAMPAIGNS

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. Findings show that in Qtr 4, 80% of adults or 12.6 million men and women were exposed to a USAID- supported UHMG health campaign. During the course of the year, more than 10million adults were exposed to each of the following campaigns: Get Off the Sexual Network, Family Planning (mostly Smart Choices in Q4) and HIV Prevention (HCT & Condom Promotion). 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 telephony and food and beverage advertisers in Uganda.

100 Percent of Adults Exposed to UHMG Messages(n=15,911,131) 7878 80 80 75 69 69 65 65 65

60 55 52 54 50 43 40 3940 40 40 36 40 34 Quarter 1 :Oct-Dec 2011 % of of Viewers % 24 26 Quarter 2: Jan-March 2012 21 1617 18 Quarter 3: April-June 2012 20 13 151513 Quarter 4: July-Sept 2012

0 Get off the Sexual Sexual the off Get FP YouthFP Prevention HCT Prevention Maternal and Child Child and Maternal Total UHMG Malaria RestORS Zinkid RestORS F P Total P F HIV Combined Combined HIV Campaigns Network Health - GeNext

CAMPAIGN/THEME

UHMG’s FY 2012 strategic communication campaigns are detailed in the Performance Monitoring table below.

Communication Performance Monitoring Table:

Campaign Mass Media Interactive Media/Interpersonal Activations Small families-GeNext Mobile branding: 90 taxis branded Targeted 60 Genext advocates trained Radio spots 6,620 46,367 people reached with message on Lea Bwanika/Daudi 418 DJ mentions smaller families through community dialogues.Target was 43,200 people. 126 GENEXT clubs set up. Target was 120 clubs. 15 mobilization drives and Film shows conducted reaching an estimated 5,000 people Advocates conducted 6 community forum theatres in 7 districts.

GENEXT advocates participated in World Population Day where they spoke to more than 60 youth on having smaller families.

Genext advocates participated in The International Youth Day utilising the DSW youth truck to pass on messages on

smaller families to an estimated 3000 people over 1 5 day period.

With support from DSW’s Healthy Action Project, 5 GENEXT advocates conducted community diaologues with 500 youth (In and out of School Youth) who attended a Games and drama gala in Mityana District. Conducted support supervision and Monitoring in the districts of Tororo,Busia,

Jinja, Iganga, Mbale, Wakiso, Kampala

GENEXT also participated in the 3rd Annual Leadership conference organized by the Makerere Business School with the Theme The Millennium Development Goals: The Role of leadership and a sub theme of Youth in Leadership transformation.

ANC Maintained 20 bill boards (single face) Conducted 30 six tent model activations Aired 20,067 spots and mentions on 13 and the numbers reached include; (Lea Bwanika/Daudi) local stations. o 7,786 clients were tested for HIV with 302 testing HIV positive, 420 tested as

couples, 687 received ANC, 513 received PMTCT, 230 received family planning services, 160 tested for TB, 304 circumcised and 18,380 clients received risk reduction messages. o 26,956 male condoms, 9,077 female condoms distributed, 2,935 SMC posters, 1,472 ANC posters, 360 couple certificates, 16,437 SMC brochures, 3,720 sexual network posters were distributed. Recruited 500 PLHIVs to the database.

Power of Day One No activity conducted as UHMG Interactive communication via SMS with awaited confirmation from Stop Malaria various drug shop operator associations (Lea/Daudi) on Nationwide Scale up of Power of Day informing them of planned RDT, ACT and One campaign. other UHMG sales drives.

Sexual Network Continued implementing the fidelity Conducted sexual network game at all six Campaign scale up and campaign (sexual network); tent model activations to help target condom promotion – o Aired radio skits, spots audience understand what a sexual Star- SW and mentions on 15 network is and its dangers. local radio stations (Daudi/Mariettah) (6,300 spots/mentions Reached 6,174 people with and 225 skits 3 options; risk reduction messages

commercial sex through video workers, truck drivers halls/markets/boda stages and Boda boda riders) activations. Star- EC o Maintained 20 billboards (single face)

Production of IEC materials on Get off the sexual network. Oriented team on the sexual network game which is being Concepts for truckers, fisher played in activations folk were developed and pre-tested in Naluwerere truck stage and Lugala landing site. At stage of shooting and then production.

Concepts for police and prisons were developed and pre-tested in 3 districts. At re-design stage and shooting.

MCH/FP Daudi/Sarah Mutesi

Saving Mothers Giving

Lives 9,156 Radio spots on safe on aired on seven radio stations in 4 districts 4578 Dj mentions aired on seven radio stations in 4 districts 8 billboards erected in 4 districts

16 road stars erected in 4 districts

Production and distribution of IEC materials 1000 posters produced. Process to start production and distribution of additional IEC materials initiated

These include;

• ANC Flip chat for health workers

• Fact sheets

Smart choices campaign 89 Radio talk shows on Injectaplan 27 CORPS identified from 8 aired on 4 local radio stations districts, 3 from each district to be trained on FP demand 4123 Radio spots aired on Smart creation. Choices

132 TV spots on all family planning brands 28 billboards erected countrywide

63 road stars

70,000 posters produced

Process to start production and distribution of other Promotional materials including FP Flip chart for health workers, FP booklet for youths/ CORPS, T-shirts for the FP promoters and aprons for health workers

PMTCT Message concepts developed

(Daudi/Ritah Mwagale)

Eliminating Mother To Child transmission

UNFPA Message concepts developed.

(Rita Mwagale/Daudi) Draft communications strategy Condom promotion developed campaign

Good Life Promoters Drafted peer educator guide – support ( Clinics, , pending pre sub-grantees like test, peer educators, volunteers, health Developed assorted BCC stickers on providers) HCT, SMC, alcohol abuse and condom use. Pre-tests were done (Mariettah) and stickers are ready to be printed by different sub-grantees

Developed DVD on condom use incorporated with adverts for sexual network and protector

Distributed 150 Good life promoter T-shirts to boda-boda peer educators in eastern and West Nile region.

Distributed 180 sacks of assorted IEC and data collection materials to 180 GLCs.

Trained sub-grantees on writing success stories, developing IEC materials and taking action photographs. Distributed 470 condom brochures, 320 STI brochures, 150 sexual network posters, 30 fisher folk

participant guides

3. MSI - CORPORATE & EXTERNAL RELATIONS

Activity Description Outputs Progress, Comments

Corporate social responsibility Held 4 planning meetings with AAR. Sourced and got sponsorship from Quality chemicals, Pepsi, Kalangala district health office, Bidco

2 day health fair to take place on 21st and 22nd October

Knowledge Management Well documented Had 3 knowledge management clinics on writing success and stored MSI stories, taking photographs, online filing of information BCC team information Shared folders for brands and BCC developed on server. Still under development

Started Good Life Newswire

Production of PR promotional Production & Took stock and re-organised resource centre materials (Mariettah) dissemination of diaries, Calendars Printed and distributed 450 annual reports and 500 and others. folders to key stakeholders Good life pens have been distributed amongst key stakeholders and partners

Concepts for diaries, calendars are being developed

Good Life (GL)umbrella brand Develop and T. shirts for Advocates produced and are being worn revamp Implement every Friday and during events. Corporate shirts are in strategies to production revamp the GL platform Good life starts at home. Oriented staff on condom use and corporate hygiene

Event management Oversee major and Held 2 events in this quarter; AGM, ARC project calendar days showcase at Wakiso events Preparations were made for USAID deputy mission visit, health fair in Mayuge and Kalangala. All activities are scheduled for October

Media relations Organised and managed press for the Wakiso DFD showcase.

Provided information to journalist from Chinese New Agency on the topic of Family planning and adolescent health.

Participated in Day Of African Child activities and featured in New Vision pictorial alongside partners like New Vision.

4. MSI – RESEARCH & EVALUATION

The following Research and Evaluation activities were conducted during FY2012. These, in addition to the ongoing pretesting of messages, provided the evidence base used to inform UGMG programs in Marketing and Strategic Information Division, the Product Facility, and the Programs Division. The results have been discussed in previously quarterly Reports or in the relevant sections of this report. • PilplanPlus sales study (FY12 Quarter 1 Report); • Initiation of a independent and scientific Retail Audit (FY12 Quarterly Reports; Current Report-PF Section); • Initiation of Media Reach Analysis through IPSOS/Synovate, allowing UHMG to document the unduplicated population reached by its media campaigns for the first time. • Study of birthing and delivery practices for Saving Mothers Giving Life project (FY12 Quarter 2 Report); • formative research for the Smart Choices Family Planning campaign (FY12 Quarter 2 Report); • Coordination and initiation of the Behavior Change Communication Survey conducted jointly with JHU/HCP and other USAID Implementing Partners (IPs) (FY12 Quarter 1 Report).

B. FINANCE AND ADMINISTRATION

Fourth quarter highlights:

• NICRA submission: UHMG worked very closely with KPMG and CCP to finalise the documents which have now be submitted to the USAID Contracts Officer awaiting confirmation of receipt and hopefully approval. This will take UHMG a long way towards having a pool of funds that can be spent on other direct costs but we cognisance of the fact that cost effective measures have to be applied. • Got the Taxation Exemption Certificate: By the end of the quarter UHMG had been awarded a tax exemption certificate for 2 years. This is a milestone which waives the corporation and withholding taxes thus saving the worry of taxing the grant income and the PF revenue. • 3 Projects were brought on board with budgets amounting to USD 10,000,000 for 3 years. • Internal Controls: Emphasis on compliance was made through hiring a full-time Internal Auditor, sharing in the all-staff meeting compliance policies for to adhere. • 8 Financial Reports were submitted to different donors including CCP-AFFORD, Star South West-EGPAF, Strides-MSH, Access Medicines-MSH, Stop Malaria-PMI, SCHIPHA-CSF-JCRC, Reproductive Health-UNFPA project, and Spear Project-World Vision. • The Product Facility FM: (i) Systems strengthening continued at the Product facility whereby debtor’s management has greatly improved through receiver of old debts by 70% and setting limits for all customers. (ii) Stock management continued with surprise stock counts conducted and end of year stock count conducted. The report has been finalised for management discussion. The variances have greatly reduced in comparison to last quarter and financial year. (iii) PF Financial reporting has greatly improved, the cash budget for 2012-2013 as finalised and discussed with management and JHU-CCP this clearly demonstrated how the PF shall facilitate 75% of its total costs. The 25% for the year 2011-2012 has been fully paid up. (iv) Tally usage: All financial reports are being produced form Tally both at the warehouse and in the Regional pharmacies.

• Grant management and the Funding Grid: UHMG currently runs 10 projects and this has well- handled during the year, this strongly demonstrates UHMG’s road to sustainability. The cost share across the projects is well managed with a Funding Grid produced and used every month. • Sub-Grantee management: A training was conducted during the quarter whereby 15pax were trained form the 6 sub-grantees of UHMG under the AFFORD project. This is part of capacity building as indicated in the sub-award arrangement. • Warehouse Extension: As part of expansion of UHMG warehouse business, the board approved the move to construct an extended warehouse. The process ahs began and we hope to start the construction during the quarter July – September 2012. This will allow UHMG have more warehouse space and hence realize more revenue from this wing. The search for tenants is on going for the remaining space of the UHM g office building. Prospective tenants have visited the premises and are hopeful to realize some income. Management took a decision to rent the available space to the warehouse section Of UHMG as a way of making some money instead of giving it to another Landlord. Total funds made from rental income during the quarter amounted to USD21, 600 from space of 500sqm. • Risk Management: The Risk management committee that is chaired by the Managing director met during the quarter and agreed to review UHMG’s risk framework. The committee agreed to meet on 29th October for mentorship by the UHMG Audit and Risk committee chairperson as a way of strengthening its Risk management portfolio. • Technical support: We received technical support on financial management from JHU by the Senior Financial Analyst, Kellie Klein.

The Activity Performance Monitoring Table

Activity Description Targets/Outputs Q1 Q2 Q3 Q4

Financial management and systems strengthening and professional/timely • Improved budgeting reporting for projects and budget monitoring √  Guide and standardize budgeting • Monthly, quarterly and coding systems and Annual financial

 Produce periodic financial reports reports produced for management, board and donors • Funding Grid  Update the funding Grid with new updated and in use project funds for HR and • 3 staff trained and √ √ √ √ management’s use skills enhanced  Identify and send Finance staff for • Tally fully utilized for training to enhance their Financial reporting performance √ √ √ √  Train staff in Tally use

√ √

Strengthen Internal Controls within • External Audit firm √ UHMG to ensure value for money approved by UHMG

 Engage a professional AGM External audit firm to conduct • Internal Audit reports

end of year audit available and used by  management to Work on a quarterly basis √ √ √ √ with internal auditors to improve systems • Sub-Grantees skills in streamline any internal √ √ control weaknesses financial management  Take action on all audit improved √ recommendations • Field support reports  Conduct periodic sub-grantee filed √ √ field visits and capacity • Stock variance reports building discussed and action √ √ √  Conduct monthly and taken by management quarterly stock counts • Cash count certificates √  Finalize and seek approval of filed the Risk framework and • Debtor’s portfolio √ √ √ guideline improved to 80%  Monitor debt collection on a monthly basis Grow UHMG Investment Portfolio • An investment policy √ √ √  Produce and seek approval of in place and fully the investment policy approved  Coordinate the construction • Warehouse extension of the warehouse extension in place and storage  Submit the NICRA for space improved approval • NICRA documents  Collect rental income and submitted to USAID clear the mortgage • Mortgage liability reduced to USD400k by end of year

C. HUMAN RESOURCE AND ADMINISTRATION DIVISION

HUMAN RESOURCE:

Human Resource Management

Recruitment staff No. POSITION STAFF NAME START DATE 1. Sales Representative Josephine Rose Asio July 1st 2012 2. Brand Officer Paul Lemi July 23rd 2012 3. Office Assistant Aminah Nalunkuma August 12th 2012 4. Procurement Intern Barbra Kyobutungi August 16th 2012 5. STRIDES Project Assistant Irene Kakyo September 5th 2012 6. Regional Community Mobilization and Nelson Afeku September 17th 2012 Engagement Officer (West Nile Region)

7. Head Reproductive and Child Health Jennifer Wanyana September 17th 2012

Exited staff No. POSITION STAFF NAME END DATE 1. STRIDES Project Assistant Hadija Adam Kibirige July 20th 2012 2. Key Accounts Representative (Central) Richard Asiimwe September 7th 2012 3. Finance Officer Irene Atukunda September 17th 2012

Promoted staff No. POSITION STAFF NAME EFFECTIVE DATE 1. Deputy Project Manager Scovia Nabbanja September 1st 2012 2. Regional Project Coordinator James Okweny September 1st 2012 (West Nile)

Performance Reviews: Annual staff performance appraisals continued during the quarter for all directorates, as well as probation appraisals prior to confirmation of employees in their roles.

HR Capacity Assessment: KPMG, the consultancy firm hired by AFFORD, started their HR Capacity Assessment exercise in July 2012 by holding discussions with Management and the HR & Admin Board Committee on avenues to improve the overall capacity of UHMG. Areas of focus included job roles review, knowledge/skills/attitude assessment, performance measurement, and organizational structure and work relationships – all geared towards improving efficiency and effectiveness of the entire organization in program implementation that will drive UHMG to the desired level of attaining increased financial, institutional, and market sustainability and delivering a ‘Good Life’.

Statutory Deductions: Following the amendment of the PAYE (Pay As You Earn) thresholds for the fiscal year July 2012 to June 2013, and the subsequent announcement by the Minister of Finance during the budget speech in Parliament in July 2012, the PAYE deductions to the payroll were adjusted accordingly. All statutory deductions were deducted during the quarter, and remitted accordingly to the respective authorities.

Staff accident: On September 23rd 2012, one of our field-based staff (Josephine Asio) was involved in an accident while on official duty in Moyo district. She was admitted in Moyo hospital and was later transferred to Kampala for further medication. Her condition has, since, improved.

Insurance Cover (GPA and Medical): Updates (on the new, promoted, and exited staff) were regularly submitted to CHARTIS Uganda Limited, our current service providers on group personal accident insurance cover for staff. Updates (on the new and exited staff) were also submitted to Jubilee Insurance Company Limited, our current service providers on medical insurance cover for staff and their authorized dependants.

Staff Birthdays: We continued to recognize staff birthdays as well as babies born to our staff during the quarter. This has motivated staff to belong and feel attached to the UHMG family.

Trainings: • As part of the Human Resource Capacity Assessment exercise, the Performance Management training was conducted by KPMG Consultants on September 6th and 7th 2012 for the Senior and Middle Level Management teams. This was aimed at improving the individual performance evaluation and accountability system for staff in UHMG. The directors and managers will then impart skills learnt to the officers and assistants. • As UHMG grows to become a prime organization, William (Bill) Glass, Program Director at the Center for Communication Programs at Johns Hopkins Bloomberg School of Public Health (JHU/CCP, facilitated a training on Business Development with Senior and Middle-Level management on

September 17th 2012. Topics discussed included; Reflections on UHMG’s business development experience to date (what we have done so far, what has gone well - wins, what the challenges have been – losses); Ongoing tasks that need to be undertaken "year round" in business development, whether a bid is at hand or not; Bid decision-making criteria and the team that makes those decisions; Intelligence gathering – who is involved, what tools are available; Bid preparation - team assignments, roles and responsibilities, calendars and deadlines for Sub versus prime, carrying capacity of primes per year, cost issues, review teams; From bid to implementation - the importance of the first few steps upon award, and proper "handover" from bid preparation team to program management team. • An International Light & Heavy Vehicle Fleet Management workshop on September 5th to 7th 2012 was attended by the Transport Officers of the Head Office and Product Facility • Three Administration staff attended a Customer Care Training from August 23rd to 24th 2012, while ISO Training and Customer Care training for the Product Facility staff also occurred in September 2012

ADMINISTRATION:

Governance BOD meetings: In order to provide further guidance to Management on UHMG’s strategic direction, quarterly meetings for the Board Committees’ were held between July 17th and 20th 2012. The Board of Directors’ meetings were held on August 3rd and 7th, 2012. We also held the 5th Annual General Meeting (AGM) on August 10th, 2012. All the above meetings took place and UHMG Office premises. Pictured below are the participants of the AGM, who included the Founder members, Board members, Board Committee members, and the Senior Management Team of UHMG.

Pictured below (in their Friday corporate wear of Good Life Advocate T-Shirts) are the staff of UHMG who hosted the Founder members, Board members, Board Committee members at the AGM event.

Employee Recognition: During the AGM event August 10th, 2012, staff were recognized for the outstanding performance and conduct. Categories for recognition included; Best Employee (Scovia Nabbanja - Regional Community Mobilization & Engagement Officer), Second Best Employee (Emmanuel Seruwagi – PF Driver), and adherence to our core values, i.e. Excellence & Professionalism (Oscar Nageri – ICT Officer), Flexibility (James Okweny – Project Support Coordinator), Integrity (Morshid Kayiga – Transport Officer), Leadership (Joachim Kabaisera – Finance Manager), Team work (Richard Kitonsa – Pharmacist/Technical Support Manager), Transparency & Accountability (Noel Murekezi – Procurement Officer). Also recognized were the best staff per directorate; Finance & Investment (Rebecca Nsamba – Finance Officer), HR & Administration (Eliab Kwikiriza – Driver), Marketing & Strategic Information (Sylvia Mariettah Katende – BCC Officer), Product Facility (Emmanuel Seruwagi – PF Driver), Programs and Services (Dr. Julian Jane Atim – HIV Program Officer), and Special Projects (Scovia Nabbanja - Regional Community Mobilization & Engagement Officer).

Administration Management: Office security: During the quarter, we monitored the services provided by Security Group. An additional Intruder Access control system was installed on ground floor to strengthen security. The new security measures that were put in place in the previous quarter were observed.

Hotel Survey: The country-wide survey (that started in March 2012) to review the corporate agreements with hotels, and identification of new facilities continued during the quarter. During this time, two regions were surveyed, i.e. West Nile and South Western Regions, as well as Kalangala District.

Property Management: Maintenance: Proper management of our new office premises was ensured and minor repairs done on plumbing, and office doors. General cleaning of the entire office premises was done by Quality Clean Ltd, and the compound and gardens were maintained by Green Pasture Services. Rental space: As part of UHMG’s sustainability avenues for revenue generation, a new tenant (Spring Uganda) was obtained to occupy 300 sq mtrs on second floor for the period October 2012 to September 2013, renewable.

Assets Management: Assets stock count: A physical verification of assets was carried out in July 2012, and a comprehensive report prepared on all project assets. New assets procured or acquired during the quarter were included in the register.

Insurance cover: The asset insurance cover and the vehicle comprehensive insurance cover were renewed in September 2012 with Insurance Company of East Africa for all vehicles, furniture, and equipment.

Staff meetings: The All-Staff meeting scheduled every two months was held on August 31st, 2012 were staff were introduced to new banking products by DFCU bank officials, road safety tips by Auto Mobile Association of Uganda officials, financial resilience and mind-set change tips from IFE Consultants, documentation skills by the in-house documentation consultant, and USAID & UHMG brands and guidelines orientation by staff from the Marketing & Strategic Information directorate. A meeting with all staff was also held on July 20th 2012 to emphasize the need to comply to policies and guidelines. The Senior Management team also held a retreat in Entebbe from July 5th to 7th 2012 to discuss progress of the organization in relation to the Strategic Plan and Business Plan milestones.

TRANSPORT:

Transport and Fleet Management • Transport was provided for the various field activities, and staff requested to share vehicles when travelling to the same districts in order to minimize operational expenses.  The disposal process of the accident vehicle UAK 309Z was completed, following receipt of USAID’s approval. Insurance Company of East Africa removed the salvage from our office premises in September 2012.  The valuation process of the two Nissan Double-Cabin pick-up vehicles (UAP 705P and UAP 099Q) to be disposed was completed in August 2012 by Aliwali Diamon Engineers. Their report will be submitted to the Finance & Planning Board Committee in October 2012 for prior approval to dispose the vehicles.  The fuel control measures were strengthened and fuel performance of the vehicles improved  Vehicle management controls were also strengthened and a daily check list form introduced and used.  Canopies were procured and installed on the two new vehicles received during the last quarter, and they were subsequently branded as shown below. The trucks were also re-branded to include the USAID logo.

Fleet Availability  During the quarter, the availability of the fleet greatly improved, as illustrated below, due to the efficiency and responsiveness of our service providers, i.e. Kalumba Elijah and Patrick Samanya Auto Engineering, Toyota Uganda Limited, and Wamuco Motors.

20%

Availability 80% Down time

 Follow up was made with AFFORD/JHU on the procurement of the vehicle to replace the accident vehicle (UAK 309Z), as well as the two vehicles budgeted for under DFID.

Maintenance and Repairs Reg. No. Km as at Km as at Distance Fuel Consu- Target Variance % Service and 1st Jul 30th Sep covered used mption Repairs cost 2012 2012 (UGX) (km) (ltrs)

UAA 912X 60696 62115 1419 165 8.6 12 -39% 673,336

UAA 667Y 97092 100350 3258 325.5 10 12 -20% 2,644,038

UAJ 034Y 93891 101535 7644 684.3 11.17 12 -7% 2,822,686

UAJ 032Y 79266 89006 9740 789.4 12 12 0% 308,668 UAP 632G 74042 76805 2763 300 9.2 12 -23% 581,504

UAK 303Z 119446 128722 9276 1009 9 10 -8% 862,080

UAJ 214Z 193315 203335 10020 1245 8 10 -24% 837,127 UAR 141G 3170 14056 10886 1143 10 10 0% 391200

UAR 186G 3171 13975 10804 1025 11 10 9% 391,200

UAB 178Z 194524 200743 6219 985.8 6 7 -11% 1,376,116

UAN 166F 182837 187149 4312 578 7 8 -8% 1,180,000

UAJ 030Y 103226 108301 5075 725.8 7 8 -14% 304,558

UAJ 396Y 128320 133938 5618 683.5 8 8 0% 372,880

UAA 262Z 235100 240803 5703 958.4 6 6 0% 3,119,920

UAN 430N 14995 21337 6342 1031 6 6 0% 2,583,037

UAA 935N 15262 21025 5763 931.6 6 6 0% 2,650,254

UAA 942N 13303 15706 2403 520.5 5 6 -20% 635,000 UDM 901R 16581 18060 1479 127.3 12 30 -150% 235,000 UAP 705P NIL NIL To be UAP 099Q NIL NIL Not in use disposed

• Vehicles Reg. Nos. UAR 186G, UAR I41G, UAA 942N, UAN 430N, UAA 935N were categorized under the green dotted area because they are still new with lower fuel, maintenance, and repair costs. • Vehicles Reg. Nos. UAJ 030Y, UAJ 396Y, UAK 303Z, UAJ 032Y, UAJ 034Y, UAA 667Y, UAA 912X, UAP 632G were categorized under the orange dotted area because their fuel, maintenance, and repair costs have not varied greatly. • Vehicles Reg. Nos. UAJ 214Z, UAA 262Z, UAN 166F, UAP 705P, UAP 099Q and UAB 178Z were categorized under the blue dotted area because their mileage is beyond 150,000kms and have the highest fuel, maintenance, and repair costs. Due to their age and condition, they are due for replacement as they are less efficient.

PROCUREMENTS:

Procurement Management: Annual Procurement Plans: Drafts of the annual procurement plans continued, with the inclusion of new projects needs. The consolidated procurement plan will be finalized once all the directorate plans are submitted.

Procurement of HRMIS: Data Care, a consultancy firm, which was recommended by the Human Resource and Administration Board committee to review the Human Resource Management

Information Systems TOR for procurement. Data Care will also support UHMG in the review of the cost and technical proposals received during the next quarter.

Procurement of two Double Cabin pick-up trucks: The procurement of the two pick-up trucks continued, and was managed by AFFORD and JHU/CCP who provided a Local Purchase Order to the selected supplier, Toyota Uganda Limited. The vehicles are expected next quarter.

Procurement of the solar back-up system: The solicitation and analysis process of the solar back-up system was finalized, and MK Electricals Limited selected as the preferred supplier. The system will be procured in the next quarter, and is expected to help reduce our electricity-related expenses.

Construction of the Warehouse extension: Solicitation and analysis of the cost and technical proposals for provision of architectural services was finalized and a consultancy firm, De-Zyn Forum Limited selected as the preferred service provider to support UHMG in overseeing the works of the contractor during the next quarter.

INFORMATION COMMUNICATION & TECHNOLOGY (ICT)

ICT Management: ICT Risk Assessment: An ICT Risk Assessment exercise was carried out by KPMG in August 2012 as a part of UHMG’s overall risk assessment strategy. Primarily this entailed risk identification through the analysis of the operations of the various ICT technologies currently in use, the security of the ICT assets, adherence to standard health and safety guidelines, and the presence and observance of ICT policies and procedures, and their relevance to the organization.

E-Mail service migration: The email services were migrated to a new server hardware from computer desktop in September 2012. This was done to mitigate systems redundancy and minimize security and data loss risks commonly associated with computer desktops. In addition, this will also enable ICT resources to easily scale upwards with increase in demand from users.

Equipment maintenance: Maintenance of ICT hardware and related infrastructure continued during the quarter, to cover the workstations, printers, servers, copiers, software and other ICT-related assets.

LEGAL MANAGEMENT

Legal Management Reviewed contracts: Over 50 Contracts/Memoranda of Understanding with were drafted and reviewed to ensure compliance and liability exemption. These agreements were between UHMG and distributors, sub-grantees, Good Life Clinics, service providers, and the new tenant (Spring Uganda). Opinions were also given on the terms of the tenancy agreements already in place. In addition, a law firm, Kasirye Byaruhanga, and Company Advocates, was given correspondence on following through our occupancy permit with KCCA.

Registration of documents: Resolutions of the Board of Directors were drafted and submitted to the Registrar. These included an amendment of the number of board members, and new bank accounts for the new projects, i.e. KGLIS and NUHITES.

CONTRAINTS AND CHALLENGES IN OPERATION:

Administration Management • Storage space for materials and products

Procurement Management • Delays in supplier payments that hinder our business relationship

Legal Management • Delays in the review of our tax returns for the year 2006-2012 at the company registry • Inability to meet the lawyer and landlord of the Mbale pharmacy (despite appointments made) to discuss operational challenges caused by construction works and lack of electricity and water

Transport Management • Our service provider, Total Uganda Limited, experienced fuel shortages during the quarter all over the country, and this greatly affected implementation of some activities.

PLANS FOR NEXT QUARTER (FY-2013 Qtr 1)

Governance  Actualize Board Manual and Memarts (Memorandum and Articles of Association)  Hold the 1st quarter board of directors and board committee meetings in Oct/Nov 2012

Human Resource Management and Development  Carry out all-staff team building retreat  Work with KPMG to finalize the HR Capacity Assessment exercise  Recruit staff for the new projects, i.e. KAP, NU-HITES, and K-GLIS, and the Director of Community Linkages and Demand Generation for the STAR-SW project  Hire a Company Secretary to manage and coordinator Board governance issues and operations  Start change management and resilience sessions for exiting staff of AFFORD II  Implement the annual performance-based salary increment for staff  Initiate the performance objective-setting exercise for all staff for the FY 2012/2013  Hold the end-of-year all-staff meeting, and end-of-year event.

Administration Management  Obtain alternative office space (at the Koboko District Headquarters) for the West Nile Regional office to save on operational costs  Close and hand-over the Koboko field office, and remove all assets  Procure a walk-through metal detector to strengthen security checks  Continue with the all-staff and departmental meetings as per 2012 schedule  Improve administration management systems and operations with KPMG support and guidance • Finalize country-wide hotel survey in Central region and share final report with all staff. • Finalize and share draft policy on Office Procedures and Guidelines with board committee • Undertake reminders on adherence to policies & procedures, core values & ethics, and desired behavior (have a code of conduct).

Procurement Management • Procure furniture and equipment for the new projects, i.e. KAP, NU-HITES, and K-GLIS, and two vehicles for the KGLIS project • Continue to emphasize compliance to procurement policies in order to realize value for money

• Finalize the directorate and consolidated procurement plans for 2012-2013 that will guide the procurement, administration, and transport departments in planning for requests in advance • Procure two (2) additional vehicles for our field operations • Finalize the procurement of a contractor for the warehouse extension

Property Management  Finalize the occupancy process of the new tenants, Spring Uganda and KGLIS, on the second and ground floor respectively  Start construction of the warehouse extension

ICT Management • Setup the Human Resource Management Information System to help streamline the operations of the Human Resource and Finance departments • Integrate Server Virtualization Technologies to the UHMG network infrastructure to optimize the use of ICT resources and lower the ICT budget expenditure • Actualize the asset disposal policy guidelines, and dispose off the obsolete and unused equipment • Install the Human Resource Management Information system, and work with Data Care on the staff orientation process and after-sales support • Continue to orient staff on better file and document management with the new file server • Finalize the identification process for an off-site data back-up provider • Carry out quarterly equipment maintenance and service • Procure two overhead ceiling mounted projectors • Work with supplier of our telephone intercom to time out-going calls so as to save on communication costs

Transport Management • Continue to improve the control measures in place for fuel consumption and vehicle maintenance to realize value for money • Submit valuation report to the Finance & Planning Board Committee, and actualize the asset disposal policy guidelines, and dispose off two vehicles (UAP 705P and UAP 099Q) after receipt of board approval • Complete the branding of 8 vehicles (UAJ 030Y, UAA 935N, UAJ 034Y, UAA 912X, UAN 430N, UAA 262Z, UAJ 214Z, and UAK 303Z0 to include the USAID logo • Organize an in-house training for all drivers in basic fleet control and customer care • Continue to improve fleet management systems with KPMG support and guidance

Legal Management • Renew contract with the organization’s legal firm on a reviewed retainer terms • Follow up with the media houses under UMOA (Uganda Media Owners Association) to clear any claims • Complete process of filing all tax returns for the year 2006-2012 at the company registry

D. TECHNICAL ASSISTANCE

During the year, in addition to providing technical assistance to UHMG through local staff, JHU∙CCP provided technical assistance to UHMG in the following areas:

Capacity Building and End-of-Project Documentation Mr. William Glass, CCP Director Strategic Communication Programs, traveled to Uganda September 9-21, 2012: 1. Assisted with review and presentation of FY13 Work-plan to the BOD and USAID. Met with KPMG (financial consulting firm) representative and Ron Hess to discuss organizational development accomplishments in the past year and priorities for the coming year. 2. Assisted with UHMG capacity-building activities including: a) Conducted a ½ day training session on business development b) Held two substantial discussions with senior management and key program staff on the direction that HIV/AIDS programming should take in the 2012/13 program year. Mr. Glass’s trip coincided with the release of the 2011 AIDS Indicator survey, which served as the basis for data-driven decision-making on priorities. c) Met with UHMG management staff on data utilization, specifically knowledge management with linkages to outside resources d) Met with UHMG finance staff on financial systems strengthening (adherence to best practices and compliance) 3. Provided assistance to AFFORD Resident Management Advisor and Program Officer to discuss and provide feedback on plans for end-of-project documentation

BCC and Social Marketing Joan Yonkler, CCP BCC and Social Marketing Senior Advisor, provided technical assistance (January 29 through February 17, 2012) primarily to the MSI staff (some activities included all of the staff). Ms. Yonkler provided technical guidance on the following activities: 1. Selection of communication channels and timeline for scale up the Sexual Network campaign for the USAID IPs 2. Design of a condom promotion for USAID IPs 3. Design the PMTCT campaign 4. Design of the FP BRANDS campaign (including long term methods) 5. Design of phase-II of the GeNext campaign 6. Assisted with Restors + Zinkid campaign 7. Guided the process of reviewing advertising agencies 8. Conducted two seminars on BCC strategy development for MSI staff and on Social Marketing for UHMG brand managers

Finance Kellie Klein, Johns Hopkins Senior Financial Analyst, provided technical support on financial management to the Product Facility and Finance staff of UHMG.

Research Maria Elena Figueroa, JHU∙CCP Director of Research, travelled to Uganda Oct 7-12, 2012: 1. Review the training protocol and meet with the interviewer trainees for the BCC Survey (household survey and MARPS communication research) in compliance with JHU IRB Requirements