CASE STUDY THE CLOSED USER GROUP Leveraging Technology to Strengthen Child Protection and HIV Outcomes for Uganda’s Vulnerable Children THE CLOSED USER GROUP (CUG) CASE STUDY About the Bantwana Initiative of World Education, Inc. The Bantwana Initiative of World Education, Inc. (WEI/Bantwana) was launched in 2006 to address the comprehensive needs of children and families made vulnerable by HIV and other adversities. WEI/Bantwana harnesses and strengthens the talents, creativity, and commitment of communities, governments, and other partners to develop innovative models of care that build family resilience and well-being. Working closely with government, WEI/Bantwana strengthens health and social welfare delivery systems by working with actors from community to national levels to improve the capacity, coordination, and delivery of integrated, high-quality services. USAID/Uganda Better Outcomes for Children and Youth in Eastern and Northern Uganda Under the USAID/Uganda Better Outcomes for Children and Youth in Eastern and Northern Uganda (BOCY) project, WEI/Bantwana and local partners deliver differentiated services to 137,000 children, youth, and caregivers across 22 districts to build resilience and to mitigate the risks and impact of HIV and violence. Aligned with the INSPIRE framework and Uganda’s development objectives, BOCY delivers services within an integrated referral network and case management system to ensure that children and families receive the services and follow-up support they need and that children protection cases are addressed and closed in a timely fashion. 2 BANTWANA INITIATVE OF WORLD EDUCATION TABLE OF CONTENTS ACRONYM LIST Executive Summary ............................................................4 ART Antiretroviral Therapy BOCY USAID/Uganda Better Key Findings .........................................................................5 Outcomes for Children Introduction ..........................................................................7 and Youth in Eastern and Northern Uganda Methodology ..........................................................................7 CDO Community Development Officer Findings ...................................................................................7 CUG Closed User Group Response Timeliness ............................................... 8 DAC District Action Centre Response as Prevention: The CUG FGD Focus Group Discussion Strengthens Early Intervention ............................ 9 GBV Gender-Based Violence Rapid Response: Swift Action for Positive Resolution .................................................10 GoU Government of Uganda Improving the Quality of Responses HIV Human Immunodeficiency Virus by PSWs ......................................................................11 LC Local Council Strengthening Clinic-Community Coordination to Improve HIV and Child Protection Outcomes MGLSD Ministry of Gender, Labour and Social Development for Children Living with HIV ................................12 OI Opportunistic Infection Challenges ............................................................................14 OVC Orphans and Vulnerable Conclusion & Next Steps ...............................................15 Children PEPFAR The U.S. President’s Emergency Plan for AIDS Relief PSW Para-Social Worker RTRR Reporting, Tracking, Referral and Response UCHL Uganda Child Helpline USAID The U.S. Agency for International Development VAC Violence Against Children VCCMC Village Child Case Management Committee WEI/ The Bantwana Initiative of Bantwana World Education, Inc. 3 THE CLOSED USER GROUP (CUG) CASE STUDY EXECUTIVE SUMMARY Resulting from a partnership Outcomes for Children and Youth in Eastern and Northern Uganda (BOCY) project, the between WEI/Bantwana and Bantwana Initiative of World Education, Inc. MTN Uganda, the Closed User (WEI/Bantwana) and local and government Group (CUG) is an in-service partners2 deliver a holistic package of services phone network enabling free to 137,000 children and caregivers across 22 texts and calls between multiple districts to build resilience and to mitigate the child protection, health and social risks and impact of violence and HIV while services actors1 at community and strengthening community and district delivery systems. district levels. Services are coordinated and delivered by In 2016, Ugandans reported over 200,000 para-social workers (PSWs) who sit at the child abuse cases to the National Child center of a referral network and community Helpline. However, understaffing and weak case management system3 linked to formal links between districts and communities district protection structures. PSWs respond resulted in slow response and poor follow up to and follow up non-statutory, but important, of critical cases. child protection cases at the community level, Under the USAID/PEPFAR-funded Better freeing up already constrained district staff to CHILD PROTECTION SERVICE DELIVERY IMPROVEMENTS OVER ONE YEAR AFTER INTRODUCTION OF THE CUG Source: June 2017 - October 2018 program database 75% 19,760 Program Year 2017 19% Program Year 2018 11,274 11,491 36% 9,654 8,661 28% 6,369 6,523 5,096 Reported cases Referrals made Services received Cases resolved 4 BANTWANA INITIATVE OF WORLD EDUCATION deal with statutory and more complex cases. management and service delivery pathway, PSWs work closely with multiple actors to this simple, low-cost phone technology has ensure all children receive the critical services significantly contributed to improving child they need and to provide follow up support protection and HIV outcomes for vulnerable to children until cases are concluded. Easy, children and families at scale. affordable communication across multiple actors at multiple points in the process is KEY FINDINGS central to addressing cases and getting critical, and sometimes, lifesaving services Increased response timeliness at each to children in a timely way. Without easy, critical step of the case management cycle. affordable communication between PSWs Across cadres, all respondents described and other community and district-level actors, the multiple benefits of the CUG, including cases and service referrals can take weeks to increased efficiency, effectiveness, and quality address and complete. of care through improved communication, timeliness, coordination, referrals to critical As programming increasingly focused on services, and case closure. The CUG provides supporting children living with HIV, WEI/ an effective mechanism for reaching neces- Bantwana and partners brought facility staff sary people at the right time and ensures that and community structures onto the CUG to identified cases are addressed immediately improve coordination between facility and and referrals are completed. Before the CUG, community cadres for effective mobilization of PSWs were reliant on bicycles, personal children and families for HIV testing services; airtime or monthly, in-person case conference linkages to ART; and monitoring and follow up preparation meetings for consultation or sup- of children to support retention, adherence, port with a case. After the introduction of the and viral load suppression. CUG, consultation and action were immedi- This case study examines the role of the CUG ate. in improving service delivery by examining its contributions to timely identification, response, Strengthened response as prevention and referral completion; follow up; and closure of child abuse. of cases. Before the CUG, delayed responses compromised efforts to avert or intervene By easing communication among multiple before abuse happened. PSWs and Commuity actors at multiple points across the case Development Officers (CDOs) cited several Before our connection to the CUG, health workers would need to pay a visit to the household for assessment and/or referral of those who are HIV-positive and struggling with retention or adherence issues for further management. This was very tedious and expensive, and in most cases, clients would not be visited.” - HEALTH IN-CHARGE, OI CLINIC, MAYUGE DISTRICT 5 THE CLOSED USER GROUP (CUG) CASE STUDY CUG CONTRIBUTIONS TO IMPROVED ADHERENCE & VIRAL LOAD SUPPRESSION IN CHILDREN 22% 20% 17% IMPROVED IMPROVED INCREASED ADHERENCE VIRAL LOAD TESTING VIRAL SUPPRESSION among children among children among children cases where they disrupted suspected and strengthened the community response. cases of defilement and early marriage due to minimal delays between reporting and Increased access to comprehensive response facilitated by the CUG. supports across the HIV continuum. Stronger linkages between clinics and Bolstered capacity of PSWs to address non communities has improved access to and statutory cases and improve timely access delivery of treatment and care services for to critical services. children living with HIV. With the CUG, facility With the CUG, PSWs more readily brought staff can easily communicate with PSWs in the non-statutory cases to conclusion by easy community to follow up with clients who have access to multiple supporting actors. missed clinical, medication refill, or viral load PSWs immediately contacted one another, tracking appointments and ensure that children their supervisors, or other project staff and families have access to other core services when they needed assistance with a case, to strengthen resilience and adherence. PSWs talking through problems or strategies for also use the CUG to access transport fees managing complex issues and addressing for health emergencies