Uganda is home to some 37.1 million people and has been experiencing rapid population growth at a rate of 3.4 percent, largely due to a combination of high fertility rate, short birth intervals, and high levels of teenage pregnancy. This has resulted in high maternal and infant mortality rates.
The country’s healthcare system is decentralized and burdened by a severe shortage of trained health workers and very high risk of infectious diseases. Physician density is low at 0.12 per 1,000 people. Front line mid-level care providers such as nurses and midwives area also stretched too thin.
According to UNAIDS, Uganda’s HIV epidemic has not changed pattern over the past 30 years and remains generalized, though HIV prevalence has consistently been higher among women than men. During the 1990s, the country achieved impressive success controlling the spread of the virus, reducing the adult prevalence rate from a national average of 18.5 percent in 1992 to just 6.4 percent in 2005. This success was compromised during the 2000s when the country’s response shifted direction and HIV prevalence rates ticked up. Uganda’s current HIV prevalence rate is 7.44 percent, the country is home to some 1.6 million PLHIV, and roughly 800,000 children under the age of 17 have been orphaned or made otherwise vulnerable by HIV/AIDS.
African Palliative Care Association / American International Health Alliance
2005 – 2009
AIHA provided targeted technical assistance to bolster APCA’s capacity as a regional member association by focusing on building organizational management, networking, training, and advocacy skills of APCA staff.
The African Palliative Care Association (APCA) was established in 2004 in Kampala, Uganda. With funding from PEPFAR, AIHA provided technical assistance to APCA from 2005 to 2009, largely in the form of organizational development and staffing support to empower the nascent association as a leading pan-African association capable of helping scale up local and national palliative care associations and programs across the continent.
AIHA supported APCA’s efforts to gather African stakeholders and health providers from 10 countries in April 2005 to develop a strategy that would build donor relations and develop key palliative care policies across Africa. The workshop emphasized priorities set forth by the World Health Organization to advance palliative care, including expanded palliative care drug access, policy development, and training and education.
With this support, African stakeholders and providers were able to more effectively leverage other support and address key policy gaps in their countries. This includes appropriate symptom management for PLHIV who are on ART and pain management for PLHIV during the end-of-life stage of the disease.
Through our HRSA-supported HIV/AIDS Twinning Center Program, AIHA established and managed several south-south partnerships involving APCA:
- Botswana Institute of Health Sciences (2007 – Present)
This south-south partnership is strengthening the Institute’s capacity to provide pre- and in-service training on palliative care and helping integrate palliative care concepts into existing pharmacy technology, health education, and dental therapy programs.
- Hope Worldwide (2007 – 2011)
This south-south partnership advocated for increased availability to appropriate palliative care medicines and working to improve the overall provision of palliative care services available in Cote d’Ivoire.
- Mozambican National Nursing Association (2006 – 2008)
This south-south partnership focused on building the institutional capacity of ANEMO, strengthening its capacity as a member organization to help improve HIV-related nursing care throughout Mozambique.
- Palliative Care Alliance of Zambia (2005 – 2010)
This south-south partnership worked to develop institutional and human resource capacity at PCAZ and position the organization as a leading advocate for national palliative care policies and standards throughout Zambia. Based on the success of this twinning partnership, AIHA was able to graduate APCA and provide direct support to PCAZ from 2010 to 2014.
In addition to the partnerships listed above, AIHA provided direct funding to APCA to support three other palliative care associations in Kenya, Tanzania, and Uganda.
The early work of APCA was highlighted in February 2006 as a PEPFAR success story.