Uganda is receiving substantial resources from the Global Fund against AIDS, Tuberculosis, and Malaria (GFATM), the President's Emergency Plan for AIDS Relief (PEPFAR), and the Multi-Sectoral AIDS Project (MAP) to scale up HIV/AIDS services. M&L's Uganda program focuses on improving the capacity to absorb and manage these funds, and creating effective systems to enable civil society to play effective roles in expanding HIV/AIDS services.

During this six-month reporting period, the M&L Uganda program:

• conducted a rapid assessment of the Human Resource (HR) implications of scaling up HIV/AIDS services;
  
  
• developed and launched the Inter Religious Council of Uganda's (IRCU) PEPFAR HIV/AIDS Care and Support Grants Program.

Rapid Assessment of the Human Resource Implications of Scaling Up HIV/AIDS Services

One of the greatest constraints to scaling up HIV/AIDS programs is the shortage of qualified health workers. At the request of USAID/Uganda, M&L conducted a nation-wide HR assessment in August/September 2004.

The assessment team met with key stakeholders and collaborators to gather information on HR studies/projects being undertaken and to obtain agreement with donors and the MOH Policy Advisory Committee (HPAC) on the sites and organizations to be interviewed. The team visited the selected sites and conducted interviews and focus group discussions on the root causes of identified barriers to Human Capacity Development (HCD). The HCD framework was used to further analyze barriers in the four components of the framework (Policy, HR Management, Leadership, and Partnerships). The framework helped identify actions that needed to be taken across sectors to develop an HR strategy that would result in an adequate and sustainable workforce.

The assessment report highlights specific, actionable short-term solutions and long-term recommendations to improve overall HCD, focusing on key issue areas surrounding:

1. health workforce planning;
2. supply of human resources for health and quality of existing staff;
3. distribution of the workforce;
4. motivation, supervision and staff retention;
5. HIV/AIDS and the health workforce.

While the assessment findings are not new, and certainly not applicable only to Uganda, the study brought attention to priority HR issues. It has led to the development of an HCD strategy that provides actionable solutions and shows that some of these seemingly daunting challenges can be addressed in a systematic way, with committed national leadership and continued donor support. The assessment findings were officially presented and recommendations were shared with key stakeholders and donors at a HPAC meeting in October 2004. An HR working group was tasked with developing a mechanism for wider dissemination and eventual implementation of some of the recommendations. The assessment recommendations were also used to guide Uganda's Fiscal Year 2005 PEPFAR Country Operational Plan. As a result, USAID/Uganda has set aside funds for next year for the new Capacity Project to implement some of these recommendations.

IRCU's PEPFAR HIV/AIDS Care and Support Grants Program Is Underway

IRCU was selected as a Lead Agency by GFATM to receive HIV/AIDS funds and is among the major partners of the United States Government in implementing PEPFAR. Through its network of Faith Based Organizations (FBOs), IRCU plays a critical role in expanding HIV/AIDS services by channeling resources to the community level. M&L is providing technical assistance to IRCU to strengthen their management capacity to issue grants to FBOs and to more effectively plan, coordinate, monitor, and evaluate the FBOs' response to the HIV/AIDS epidemic.

In the past six months M&L's technical assistance to IRCU focused on the development of their PEPFAR HIV/AIDS Care and Support Grants Program, an initiative of $1.7 million expected to reach 10,000 beneficiaries through 15 implementing organizations. M&L staff, together with IRCU staff, defined the kinds of activities to be supported under this program and developed an assessment tool designed to measure potential grant recipients' management and technical capacity. In September 2004, two teams of four technical staff visited 23 nominated organizations to assess their capacity to manage PEPFAR grants and carry out HIV/AIDS care and support activities. Of the 23 organizations assessed, 15 were selected. Inn October 2004, the selected organizations attended a three-day workshop where they received orientation regarding the design and expectations of the grants program and used the performance improvement methodology to develop their HIV/AIDS care and support activity plans and budgets. M&L also assisted IRCU in the design and development of a three-tiered grants program, and an M&E framework and service delivery/financial reporting tools and mechanisms to effectively monitor FBO grant activities.

In the past six months, as a result of M&L's technical assistance to IRCU, the implementing organizations have the resources in hand to expand their HIV/AIDS care and support activities. The IRCU has the necessary tools to effectively manage the grants and monitor progress. The activities supported under this grants program focus on creating a supportive environment that helps people living with HIV/AIDS live a productive life, share their sero status with their significant others, seek HIV/AIDS services, and ultimately delay progression of HIV to AIDS. Programmed grant activities began November 1, 2004, and the first quarterly report from the FBO grantees is due mid-February 2005.