Intervention In Uganda Research Articles

What Lessons for Sustainability of Maternal Health Interventions Can Be Drawn from Rural Water And Sanitation Projects? Perspectives from Eastern Uganda

Background: Sustainability of health interventions is a global concern, as program benefits are lost as soon as programs lose donor funding. An assessment of the Uganda Rural Water and Sanitation (RUWASA) project revealed that program gains can be sustained decades later. We analysed RUWASA implementation to draw sustainability lessons for maternal and child health interventions in Uganda. Methods: Administrative data from 1997 was combined with key informant interviews and focus group discussions in Kamuli and Pallisa undertaken in 2012. Data on borehole installation, coverage of safe water and latrine construction before and after the termination of the RUWASA project was obtained. Results: Latrine coverage increased from 24% (2001 project end) to 68% (2011) in Pallisa and from 60% (2001 project end) to 83% (2011) in Kamuli districts. Access to safe water increased from 7% (2001 project end) to 68% (2011) in Pallisa and from 38% (2005 project end) to 67% (2011) in Kamuli districts during RUWASA and after it was terminated. Factors crucial to the sustainability of the project included; involvement of communities, community contributions towards installation of the boreholes and mandatory prerequisite of installation of pit latrines by all households prior to borehole installation. Conclusions: Community engagement, contributions, use of structures and ownership of RUWASA was critical for the sustainability of the intervention. These are critical lessons for sustainability of maternal and child health programs.

Disseminating new farming practices among small scale farmers: An experimental intervention in Uganda

We used a randomized control trial to measure how the free distribution of hybrid seeds and chemical fertilizers for maize production affected their adoption by small-scale farmers in the subsequent seasons. Information on their demand for the same inputs for two years after the initial trial revealed that the demand of the free-input recipients was significantly higher than that of non-recipients; that of the neighbors of the recipients fell in-between. The initial treatment assignment has a persistent influence on the farmers’ demand whereas the difference between the free-input recipients and their neighbors has been reduced over time. The reduction of their gap in the demand for fertilizers is partly driven by social learning through information networks. However, there was no clear evidence on learning effects from peers on the demand for the hybrid seeds.

Global Action to reduce HIV stigma and discrimination

Global Action to reduce HIV stigma and discrimination

Challenging International Justice: The Initial Years of the International Criminal Court’s Intervention in Uganda

This practice note describes and critiques the initial years of the International Criminal Court’s (ICC) involvement in Uganda from the perspective of local civil society actors. It argues that the substance and process of the ICC’s intervention fell chronically short of generating justice for those who had lived with the conflict for over two decades, and therefore created a disconnect between the priorities of those on the ground, and the priorities of the Court and its international minders. In order to unravel some of the dynamics that underpinned this disconnect, the paper asserts that the pivotal relationship between citizen and state provides a lens through which to assess any approach to generating justice in Uganda. It concludes that those promoting international justice need to be more cognisant of the fact that international justice mechanisms are obsolete unless they can move from theory to practice and make a genuine difference in people’s lives. In this regard, a better understanding and awareness of the political and social context in which they are operating, as well as greater self-critique and honesty, is critical.

The ICC’s Intervention in Uganda: Which Rule of Law Does it Promote?

It is often assumed that the International Criminal Court promotes the rule of law: the ICC is a court and courts enhance the rule of law. It is usually left unspecified how the ICC promotes the rule of law, and which rule of law it promotes: the rule of law at the international level, the domestic level or something in between? And what is that rule of law that it promotes? Is it the rule of law as understood in international development programmes, in which courts, acts and the adoption of international legal jargon are ‘benchmarks’ of the rule of law? Or does the ICC also promote the rule of law in its legal-philosophical meaning as a latticework of ideals? This chapter uses the ICC intervention in Uganda as a case study to focus on the relationship between the ICC and the promotion of the rule of law at the domestic level. It argues that, seen through the first lens of ‘rule of law promotion’, the evaluation of the ICC’s impact on the rule of law in Uganda can be positive: the ICC’s intervention has spurred the creation of laws and courts and has led to an increase in references to international standards. The legal-philosophical lens, however, reveals that these developments have not necessarily enhanced the aims of the rule of law. Moreover, the ICC’s intervention has unleashed other dynamics that are in synergy with some aims of the rule of law (supremacy of law and accountability) but in tension with others (equality before the law, separation of powers, fairness and legal certainty).A slightly different version of this paper has been published as:Sarah M.H. Nouwen, 'The ICC’s Intervention in Uganda: Which Rule of Law Does It Promote?', in Michael Zurn, Andre Nollkaemper and R. Peerenboom (eds), Rule of Law Dynamics (Cambridge University Press, New York, 2012) 278

Negotiating social change: Ugandan discourses on Westernisation and neo-colonialism as forms of social critique

ABSTRACTA common claim, in public discourses and in post-colonial theory, is that colonialism, and more recently the aid industry and the media, have created global hegemonic norms, which have been enforced on non-Western societies. While this may be true in some respects, this article takes a different stance on the debate. It scrutinises perceptions of Western-influenced social change in Uganda, and differentiates between discourses on Westernisation and discourses on neo-colonialism. Both are analysed as forms of social critique – one internally and the other externally oriented. The largely elitist discourse on neo-colonialism is explicitly critical of the West and its interventions in Uganda. But it is not representative of the more ambiguous perceptions of Westernisation among ‘ordinary’ people, who use references to the West to comment on contemporary Ugandan society. The article is based on empirical research in Northern Uganda. It focuses on discourses on gender, kinship and sexuality, and the recent debate on homosexuality.

“They arrested me for loving a schoolgirl”: Ethnography, HIV, and a feminist assessment of the age of consent law as a gender-based structural intervention in Uganda

In 1990 women’s rights activists in Uganda successfully lobbied to amend the Defilement Law, raising the age of sexual consent for adolescent females from fourteen to eighteen years old and increasing the maximum sentence to death by hanging. The amendment can be considered a macro-level intervention designed to address the social and health inequalities affecting young women and girls, particularly their disproportionately high rate of HIV as compared to their male counterparts. While the intention of the law and aggressive campaign was to prosecute “sugar daddies” and “pedophiles,” the average age of men charged with defilement was twenty-one years old and many were believe to be “boyfriends” in consensual sexual liaisons with the alleged victims. This article uses court records, case studies, and longitudinal ethnographic data gathered in east-central Uganda to examine the impact of the age of consent law at national and local levels, and specifically what the disjunctures between national intentions and local uses reveal about conflicting views about sexual privilege and rights. I argue that existing class, gender, and age hierarchies have shaped how the Defilement Law has been applied locally, such that despite the stated aim of “protecting” young women, the law reinstates patriarchal privilege (especially against men of lower social class) while simultaneously increasing the regulation of adolescent female sexuality and undermining their autonomy. This paper demonstrates how ethnography and critical gender theory—which emphasizes the intersectionality of gender, age, and class in the (re)production of inequalities—can be used to examine consequences of macro-level interventions in ways that may be undetected in conventional public health evaluation techniques but that are crucial for designing and modifying effective interventions.

The World Starts With Me: A multilevel evaluation of a comprehensive sex education programme targeting adolescents in Uganda

BackgroundThis paper evaluates the effect of the World Starts With Me (WSWM), a comprehensive sex education programme in secondary schools in Uganda. The aim of the present study was to assess the effects of WSWM on socio-cognitive determinants of safe sex behaviour (delay; condom use and non-coercive sex).MethodsA survey was conducted both before and immediately after the intervention among students in intervention (N = 853) and comparison (N = 1011) groups. A mixed model repeated measures analysis was performed to assess the effectiveness of the WSWM programme on the main socio-cognitive determinants of safe sex behaviour at post-test. A similar post-hoc comparison was made between schools based on completeness and fidelity of implementation of WSWM.ResultsSignificant positive effects of WSMW were found on beliefs regarding what could or could not prevent pregnancy, the perceived social norm towards delaying sexual intercourse, and the intention to delay sexual intercourse. Furthermore, significant positive effects of WSWM were found on attitudes, self-efficacy and intention towards condom use and on self-efficacy in dealing with sexual violence (pressure and force for unwanted sex). A reversed effect of intervention was found on knowledge scores relating to non-causes of HIV (petting, fondling and deep kissing). A follow-up comparison between intervention schools based on completeness of the programme implementation revealed that almost all significant positive effects disappeared for those schools that only implemented up to 7 out of 14 lessons. Another follow-up analysis on the basis of implementation fidelity showed that schools with a "partial" fidelity score yielded more significant positive effects than schools with a "full" fidelity of implementation score.ConclusionsThe study showed an intervention effect on a number of socio-cognitive determinants. However, the effectiveness of WSWM could be improved by giving more systematic attention to the context in which such a programme is to be implemented. Implications for the systematic development and implementation of school-based safe sex interventions in Uganda will be discussed.

Improving Clinic Attendance and Adherence to Antiretroviral Therapy Through a Treatment Supporter Intervention in Uganda: A Randomized Controlled Trial

We assessed the effectiveness of the treatment supporter initiative as an intervention in improving clinic attendance for antiretroviral (ARV) drug refills and adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in Uganda. A total of 174 adult patients on ART were randomized 1:1 to a standard adherence intervention package plus a treatment supporter intervention (TS arm) or to a standard adherence intervention package (non-TS arm) alone. Clinic attendance for refills and adherence measurements using monthly clinic-based pill counts were monitored for both arms for 28 weeks. Baseline characteristics were similar for both arms. There was a non-significant difference in mean adherence between the TS and non-TS groups at end of follow-up [99.1% (95% CI: 98.3-99.9% vs. 96.3% (95% CI: 94.2-98.3%), P > 0.05]. TS participants had more than four times the odds of achieving optimal adherence (≥95%) [Odds ratio (OR) = 4.51, 95% CI: 1.22-16.62, exact P = 0.027]. TS participants were also more likely to be on time for their clinic appointments: 91.6 vs. 90.1% for TS and non-TS, respectively (OR = 1.19, 95% CI: 0.74-1.91, P > 0.05). Use of patient-selected treatment supporters may be an effective intervention to improve ARV treatment outcomes in resource-constrained settings.

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

BackgroundGeographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.MethodsThis quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented.ResultsMotorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing.ConclusionsTransport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.

Cost of individual peer counselling for the promotion of exclusive breastfeeding in Uganda

BackgroundExclusive breastfeeding (EBF) for 6 months is the recommended form of infant feeding. Support of mothers through individual peer counselling has been proved to be effective in increasing exclusive breastfeeding prevalence. We present a costing study of an individual peer support intervention in Uganda, whose objective was to raise exclusive breastfeeding rates at 3 months of age.MethodsWe costed the peer support intervention, which was offered to 406 breastfeeding mothers in Uganda. The average number of counselling visits was about 6 per woman. Annual financial and economic costs were collected in 2005-2008. Estimates were made of total project costs, average costs per mother counselled and average costs per peer counselling visit. Alternative intervention packages were explored in the sensitivity analysis. We also estimated the resources required to fund the scale up to district level, of a breastfeeding intervention programme within a public health sector model.ResultsAnnual project costs were estimated to be US$56,308. The largest cost component was peer supporter supervision, which accounted for over 50% of total project costs. The cost per mother counselled was US$139 and the cost per visit was US$26. The cost per week of EBF was estimated to be US$15 at 12 weeks post partum. We estimated that implementing an alternative package modelled on routine public health sector programmes can potentially reduce costs by over 60%. Based on the calculated average costs and annual births, scaling up modelled costs to district level would cost the public sector an additional US$1,813,000.ConclusionExclusive breastfeeding promotion in sub-Saharan Africa is feasible and can be implemented at a sustainable cost. The results of this study can be incorporated in cost effectiveness analyses of exclusive breastfeeding promotion programmes in sub-Saharan Africa.

Comparison of the Legacy of the Special Court for Sierra Leone and the ICC Intervention in Uganda from a Practical Perspective

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Qaddaf’s Libya in World Politics by Yehudit Ronen

BOOK REVIEWS / COMPTE RENDUS 397 Yehudit Ronen, Qaddaf’s Libya in World Politics. Boulder, London, Lynne Rienner Publishers. 2008.VII, 243 pp. As if to underscore Moammar Gadafi’s absolute domination of Libyan domestic and foreign affairs over the past 40 years, recent books about the country usually manage to include him in their titles. Thus it is “Gadafi’s Libya” or “Libya’s Gadafi”; it is his Islam, his revolution, his Green Book, his ideology. Yehudit Ronen’s title is no exception to this practice, hers stressing yet again how Gadafi continues to control the foreign affairs of the country he has led since 1969. Setting out her stall on page one, the author claims that her work is “based largely on Libyan and other primary Arab sources” and “offers insights into Libya’s foreign relations throughout Qaddafi’s prolonged tenure”. Here is the by-now familiar story of Libya’s foreign ventures in the first 20 years of the Gadafi revolution, up to the collapse of the Soviet Union in 198990 . This account once again reminded this reviewer of the continuing validity of what Count Oxenstierna wrote as long ago as 1648: “With how little wisdom is the world governed!” A nation that has been blessed (or perhaps cursed?) with the unearned wealth from large but finite sources of oil, natural gas, and even fossil water, has simply squandered much of that wealth on foreign ventures for which the leadership has usually failed to give any coherent or convincing explanations. It is, for instance, doubtful whether Gadafi or his advisers ever had any clear understanding of the role, importance or interests of the loyalist majority in Northern Ireland when it was decided in the 1970s to help fund what was thought to have been an Irish “anti-colonial struggle” against the British occupier. Ronen quite rightly emphasises the importance of the collapse of the Soviet Union in ushering in the so-called “New World Order” and the predominance of the United States as the sole superpower. But perhaps she attaches too much importance to the ties between Tripoli and Moscow in the 1970s and 1980s, and thus to the impact on Libya of the eventual loss of the “Soviet ally”. It was surely American success in ending the Cold War rather than Soviet failure that in the long run concentrated Gadafi’s mind on the need to put his own foreign relations in order. The USSR was never an “ally” of Libya in the strict sense of the word. The Soviets were indeed Tripoli’s main source of military training and suppliers of excessive arms stockpiles, paid for in the US Dollars Moscow needed to buy American grain; but in practice the Soviets largely (and wisely) avoided any close involvement in Gadafi’s foreign ventures. Ronen considers two episodes in Gadafi’s African policy to merit separate chapters of their own. These were the direct military intervention in Uganda in the 1970s and the much deeper and more prolonged adventures in Chad in the 1970s and 1980s. While the Chadian chapter gives a detailed account of the complex and confusing sequence of events in that unhappy country, there is 398 BOOK REVIEWS / COMPTE RENDUS little explanation of why Libya found it necessary to became so heavily involved in a poverty-stricken, deeply divided and constantly-warring state with which it also happens to have a long, almost defenceless frontier. There is little explanation of the historical, ethnic, linguistic, cultural, religious, commercial or other ties across the central Sahara that perhaps contribute to any understanding of Libya’s past and continuing concern for the course of events in this particular neighbour. The Aozou Strip issue was only one of the differences between two states on opposite sides of the central Sahara. The most valuable part of this book are the chapters covering the post-1990 period, dominated by the Lockerbie and French UTA airliner sabotages and the imposition of fairly draconian international sanctions. Then came Libya’s volte face, the turning to the west in general and to the US in particular; the renunciation of the WMD programme that may always have had more fantasy than substance; a half...

Nongovernmental Organizations in Musculoskeletal Care: Orthopaedics Overseas

Injuries are a major worldwide contributor to morbidity and mortality. The negative impact caused by such injuries is disproportionately heavy in developing countries. Such disparities are caused by a complex array of problems, including a lack of physical resources, poor infrastructure, and a shortage of trained health professionals. Overcoming such deficits in care will require the involvement of organizations that can offer broad-based solutions. These organizations must bridge the gap between private and public institutions to establish a systems-based approach to program development and institution-building. They must provide not just an adequate level of care, but a transfer of knowledge that leads to sustainable and cost-effective intervention. Orthopedics Overseas is an example of such an organization. We examine the development of Orthopedics Overseas and describe their interventions in Uganda as a case-study to show the unique position they have to affect change.

Estimates of the duration of the early and late stage of gambiense sleeping sickness

BackgroundThe durations of untreated stage 1 (early stage, haemo-lymphatic) and stage 2 (late stage, meningo-encephalitic) human African trypanosomiasis (sleeping sickness) due to Trypanosoma brucei gambiense are poorly quantified, but key to predicting the impact of screening on transmission. Here, we outline a method to estimate these parameters.MethodsWe first model the duration of stage 1 through survival analysis of untreated serological suspects detected during Médecins Sans Frontières interventions in Uganda and Sudan. We then deduce the duration of stage 2 based on the stage 1 to stage 2 ratio observed during active case detection in villages within the same sites.ResultsSurvival in stage 1 appears to decay exponentially (daily rate = 0.0019; mean stage 1 duration = 526 days [95%CI 357 to 833]), possibly explaining past reports of abnormally long duration. Assuming epidemiological equilibrium, we estimate a similar duration of stage 2 (500 days [95%CI 345 to 769]), for a total of nearly three years in the absence of treatment.ConclusionRobust estimates of these basic epidemiological parameters are essential to formulating a quantitative understanding of sleeping sickness dynamics, and will facilitate the evaluation of different possible control strategies.

Decision support for spatially targeted livestock policies: Diverse examples from Uganda and Thailand

Public policies are needed to guide livestock sector’s changes along a path that is sustainable in economic, social and environmental terms. These policies should include multiple development objectives and be adapted to location-specific contexts. Policy makers need assistance in dealing with such complex decisions. Spatial information can be integrated in decision support tools to support policy making, and is becoming increasingly available in the developing world. Spatial information, however, has seldom been used in livestock sector policy formulation because policy makers generally do not have access to resources for spatial modelling. The objective of this paper is to bridge this gap by proposing an approach to consolidating and analysing spatial information in the context of limited modelling resources. Rooted in practical experience, a method is proposed that combines two multiple criteria decision-making techniques (weighted linear combination and analytical hierarchical processes), parameterised in a participatory process and implemented in a GIS. The method is tested in two different contexts: support to single objective decision-making for targeting trypanosomiasis control interventions in Uganda, and support to multiple objective decision-making for spatial planning of livestock production development in Thailand. The results show the advantages of such an approach, in terms of stakeholder involvement and practical application to support decision-making, but also highlight two shortcomings: dependence on high quality data and uncertainty with regard to the decision rule. While the former will be addressed as digital information becomes increasingly available, the latter, embedded in any decision-making process, calls for thorough sensitivity analyses and careful scrutiny of results.

National ownership in the implementation of global climate policy in Uganda

This article explores the history, from a developing country perspective, of how external interventions to implement global policies on the Climate Convention and the Clean Development Mechanism (CDM) have been integrated into national development policy frameworks in the period 1990–2005. The main question asked is to what extent external interventions have formed part of a country-driven approach in Uganda. The conflicting national and global priorities concerning the need for adaptation to the impacts of climate change versus the need for global mitigation of greenhouse gases (GHGs) are explored first. Against this background, Uganda's policy response to climate change is reviewed. National climate policies are found not to exist, and the implementation of global policies is not integrated into national policy frameworks, partly due to conflicting national and global priorities. Given limited national awareness and the fact that climate policy is marginal compared to other national interests in Uganda, the experiences with donor support for the implementation of global climate policy nationally are analysed. This article demonstrates that neither national policies nor national management of donor support have secured a country-driven approach to external interventions in Uganda.

Uganda is learning from its Global Fund grant suspension

When in Kampala Victor Bampoe East Africa portfolio manager for the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM) works in an office with panoramic views of the downtown area of Ugandas capital city. In mid- November this area was thronged with riot police and dotted with cars torched by crowds protesting at Ugandan President Yoweri Kaguta Musevenis decision to jail his principal political opponent. Yet when Bampoe was recently asked how he was coping with the ongoing unrest he was momentarily confused about whether the question referred to the political protests or the Global Fund. Indeed the decision by the Geneva-based GFATM secretariat to suspend Ugandas five grants--totalling US$367 million--sent shock waves through a country whose robust response to AIDS is a point of national pride. At a meeting during the 11-week suspension one finance ministry staffer said: "This almost brought the country down." While this is more than a slight hyperbole the suspension did tarnish Ugandas reputation for AIDS programmes in sub-Saharan Africa. So the lifting of the suspension on Nov 10 was welcomed as an opportunity for the country to restore its reputation. (excerpt)

Saving Strangers: Humanitarian Intervention in International Society

Introduction Humanitarian Intervention and International Society India as Rescuer? Order versus Justice in the Bangladesh War of 1971 Vietnam's Intervention in Cambodia: The triumph of realism over common humanity? Good or bad precedent? Tanzania's Intervention in Uganda A Solidarist Movement in International Society? The case of Safe Havens and 'No-Fly' Zones in Iraq From Famine Relief to 'Humanitarian War' the US and UN Intervention in Somalia Global Bystanders to Genocide: International Society and the Rwandan Genocide of 1994 The Limit of Humanitarian Intervention from the Air: the cases of Bosnia and Kosovo A New Solidarity? Humanitarian Intervention and the Future of International Society

Advocacy for gender equity: the case of bridewealth in Uganda.

This article presents The UN Population Fund s (UNFPA s) advocacy intervention in Uganda; it is directed at the traditional institution of bridewealth and is intended to reinforce gender equity and equality in keeping with the UNFPA s statement on Gender Population and Development. Cultural practices in Uganda related to marriage and bridewealth put women in a difficult position. They are burdened by social economic and cultural conditions. Bridewealth involves payment in cash and/or kind from the groom to the brides family and results in a lack of equality within the marriage. To address this issue the UNFPA has organized several IEC and advocacy campaigns. These activities culminated in a 2-day Round Table organized in November 1996. The Round Table meeting addressed six priority themes: conceptualizing the issue of bridewealth the prevalence and significance of the practice its impact and legal significance changing roles in relation to the practice implications of the institution for the status of women and the family and youth perspectives. Other issues concerning bridewealth s negative impact on women were also addressed. Workshops on Reproductive Health Advocacy were conducted and a Task Force was established. The high point of these advocacy activities was the publication of recommendations to reform the law and the regulations related to marriage (including bridewealth) by the Law Reform Commission. This publication was referred to as the Domestic Relations Bill; it dealt with property rights sexual rights (marital rape) age of marriage (defilement) and inheritance practices (property female children and widows).