MANAGEMENT CHALLENGES FACED BY NGOs IN PROVISION OF SOCIAL SERVICES TO THE HIV/AIDS I FECTED PERSONS IN NSAMBYA HOSPIT L HOME CARE A DISSERTATION PRESENTED O?THE SCHOOL OF POST GRADU TE STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS LEADING TO THE AWARD OF MASTER OF ARTS IN DEVELOPMENTADMINISTRATION AND MANAGEMENT OF KAMP LA I TERNATIONAL UNIVERSITY BY TUMUKUNDE ALOYSIUS MA-I~T-2OO4-O12 OCTOBER 2006 DECLARATION I Tumukunde Aloysius, declare that this dissertation has never been submitted for the award of a degree in this University or any other institution of higher learning. All the information in this dissertation is based on my own observation unless otherwise stated. Signed Date APPROVAL This dissertation has been submitted for examination with my approval as the supervisor. Signed ~~ Dr. OTANGA RUSOKE (3 SUPERVISOR Date ~ DEDICATION This dissertation is dedicated to my father Joseph Katafa, Mummy Bagashe Elinah, all my brothers and sisters. They have always been a source of joy and inspiration. 111 ACKNOWLEDGEMENTS This study has been made possible because of the invaluable contribution and tireless assistance of a number of people and organizations whose acknowledgement I give below; Special appreciation goes to Nsambya Hospital Home Care Managing Director Mr. SSEKIMPI KIWANA for granting me a chance to carryout research in his organization. Also special gratitude goes to all staff members and clients of Nsambya Hospital Home Care for the co-operation rendered to me while collecting data. My research supervisor Dr. OTANGA RUSOKE deserves special mention here, I do commend him for having spared so much of his time and energy to guide me in my research. The challenging influence of the Director of Post Graduate School professor PETER JOHN OPIO, Head of Social science DR. MICHAEL MAWA and all lectures who taught me deserve mention, because my endeavor would not have been possible without their challenging scholarly ideas. I cannot neglect my colleagues whom I studied with in the same class and the typists who made it possible for the final copy to appear as it does and who assisted me in computer processing of my data. Lastly, special thanks go to all my family members, for their patience and encouragement while carrying out this challenging research and studies. May God bless you all. iv L~ L’814~J ,*~ TABLE OF CONTENTS 0 DECLARATION APPROVAL ii DEDICATION iii ACKNOWLEDGEMENTS iv TABLE OF CONTENTS v LIST OF TABLES viii LIST OF FIGURES x ABSTRACT xi ACRONYMS xill C HAP~~ER ONE ~ 1 INTRODUCTION 1.0 Background of the Study 1 1.1 Statement of the problem 3 1.2 General objective of the Research 3 1.3 Specific objectives of the study 3 1.4 Hypothesis 4 1.5 Significance of the study 4 1.6 Limitations of the study 5 1.7 The scope and Delimitation of the Study 6 1.8 Summary of the thesis 6 1.9 Conceptual framework 7 1.10 Theoretical Framework 8 CHAPTER TWO aannannon,gaaanDncbnuannnnnnna GuøncaanDa~nnaubDsDucu~unnnonucønbcueua~oboaubunuuunnonannnuen 11 LITER.ATUR~~ RE~fIEW~q a~a~otac ~ 11 2.0 Introduction 11 2.1 The Review of NGO5 11 2.2 The history of HIV/AIDS in Uganda 14 2.5 Nsambya Hospital Home Care activities 24 2.6 HIV/AIDS and livelihoods 24 2.7 Stigma 25 2.8 HIV/AIDS as an emergency and its implications for relief and development. 26 V 2.9 Hostile social environment. 27 2.10 HIV/AIDS and conflict 28 2.11 Effects of HIV/AIDS 28 2.12 Institutional support 29 2.13 Management of HIV/AIDS patients 29 2.14 Clinical management (care) 30 2.15 Social support 30 2.16 Reduction of Mother to Child Transmission (MTCT) of HIV 30 2.17 Rights-Based Approach to HIV/AIDS victim 32 2.18 Voluntary counseling and testing (VCT) 33 2.18.1 Home-based HIV Counseling and Testing (HBHCT) 34 2.19 HIV Counseling and testing for special groups 35 2.19.1 HCTforchildren 35 2.20 Ongoing counseling 38 2.20.1 Referral and follow-up 39 2.21 HIV Counseling and Testing for couples 39 2.22 Confidentiality 41 2.23 Monitoring quality of services 41 2.24 Strengthening the health care systems 42 2.25 Challenges affecting HIV/AIDS related NGOs 44 2.26 HIV/AIDS and humani~rian programming 46 CHAFFER THREE ~~ 47 M E~T~HODOLOG’Vpqnapnp ~ nUPflUDCUUtflØmCfln 47 3.0 Introduction 47 3.1 Research Design 47 3.2 Area of Study 47 3.3 Study Population 48 3.4 Sample Selection Techniques 48 3.5 Data collection instruments 48 3.5.1 Questionnaire design 49 3.5.2 Interviewing 49 3.5.3 Direct observation 50 3.6 Data Collection from Nsambva Hospital Home Care 50 vi tç~ r LIDSA,~y C HAP1~ER FOUR ~ ~tn\~oo..t,buuu,,n.n,n,o.o,.n,~u~a, 52 k DATA PRESENTATION AND ANALYSIS .... .. ... ~.. .. .. ., . .. .. ~ UO*flOO~,,,, . .. s... 52 4.0 Introduction .52 4.1 Data analysis 52 4.2 The key actors in the provision of social services to the HIV/AIDS patients.. 75 4.3 Discussion of the results 76 4.4 Introduction 76 4.5 Dependent and independent variables 77 4.6 Social and physical problems faced by the HIV/AIDS Victims 77 4.7 How I-IIV/AIDS patients cope with social problems 79 4.8 Social services provided by the NGOs to the HIV/AIDS patients 80 4.8.1 Ways on which organizational social services helps the HIV/AIDS infected persons 81 4.9 Factors that force social service providers to be friendly to the HIV/AIDS patients 82 4.10 HIV/AIDS victims on confidentiality by NGOs officials 83 4.11 Respondents attitude towards NGOs 84 4.12 How HIV/AIDS is transmitted 85 4.13 Prevention of HIV/AIDS 86 4.14 Management challenges faced by NGO officials 87 4.15 Causes of management challenges in NGOs 89 4.16 Effects of management challenges on daily activities of an NGO 91 4.17 Appropriate ways used to reduce on the management challenges of an NGO. 92 C HAP1~ER 95 SUMMARY, CONCLUSIONS AND RECCOMENDATIONS~~,, ~ 95 5.0 Summary 95 5.1 Conclusion 96 5.3 Further Research 101 vii 102 APPENDICES ~~ ~~ 107 APPENDIX A: INTRODUCTORY LETTERS • 107 APPENDIX B 108 RESEARCH QUESTIONNAIRE FOR NGO’S OFFICIALS 108 APPENDIXC~ 113 RESEARCH QUESTIONNAIRE FOR HIV/AIDS INFECTED PERSONS 113 / \\~ / .~ viii LIST OF TABLES Tablel: Shows the basic steps adopted for VCT 33 TabIe2: The protocol undertaken while carrying out Home-based HCT 35 Table 3: Sex characteristic of the respondents 53 Table 4: Age of the respondents 53 Table 5: Religious affiliation 53 Table 6: Different districts where respondents reside/stay 54 Table 7: Sources of sensitizing information on sexual behavior 54 Table 8: Shows social and physical problems faced by the HIV/AIDS infected persons.55 Table 9: Shows some of the ways used to cope with the social and physical problems faced by the HIV/AIDS infected persons 57 Table 10: Social services offered by the NGOs to the I-IIV/AIDS infected persons 58 Table 11: Ways on how organizational social services helps the HIV/AIDS infected persons Table 12: Reasons which attracts/force social service providers to be friendly to the HIV/AIDS patients 61 Table 13: Reasons given by respondents on whether the organization should or should not disclose the information it has on HLV/AIDS infected persons 63 Table 14: Respondents’ attitude towards the NGOs 65 Table 15: ways how HIV/AIDS is transmitted 66 Table 16: Suggested ways on how HP//AIDS can be stopped from being transmitted from one person to the other 67 Table 17: Reasons given by respondents on management challenges in NGOs 68 Tablel8: Reasons given as the major causes of management challenges in NGOs 71 Table 19: Shows the effects of management chaflenges on the day to day activities of an NGO 72 Table 20: Shows the most appropriate ways which could be used to reduce on the management challenges of an NGO 74 ix LIST OF FIGURES F~gure 1: Conceptual framework 7 - ~ x ABSTRACT This study seeks to investigate the management challenges faced by NGOs in provision of social services to the HIV/AIDS infected persons. It also reveals the most key actors involved in the provision of all kinds of assistance to the HIV/AIDS patients. The study reveals the most appropriate ways used to reduce on management challenges faced by NGOs. The study also shows clearly the social services offered by NGOs to the HIV/AIDS patients as well as social problems faced by them in the due course of sickness. The study was carried out on 80 respondents from Nsambya Hospital Home Care in Kampala District. It also evaluated respondents’ responses to a questionnaire which included both open and closed ended items, The research design used was both quantitative and qualitative; it also applied across sectional survey of an NGO. Simple random sampling was also used to select the respondents from the population. Other methods used to collect data from the field include, use of direct observation and face to face interviews. The study found out that a big proportion of the respondents were in support of the NGOs for the social services given to the HIV/AIDS patients. It was realized that, the most management challenges of NGOs are caused by daily increase of the HIV/AIDS patients seeking social services. More evidence also revealed that some of the HIV/AIDS patients are abandoned by their relatives, leaving the entire burden to the NGOs care givers.