Church of the Province Uganda

Planning, Development and Rehabilitation Department

(CoU)

 

Malaria free Families 2020

Save lives, Invest in the Future and Impact on Families in Uganda

 

 

 

FIVE YEARS INVESTMENT CASE

 

  

 November 2014

Namirembe Hill, Willis Road, P O Box 14123, Kampala, Uganda

Phones: +256 754075699 e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

  

RESTRICTION ON DISCLOSURE AND USE OF INFORMATION

Receipt of this concept document is bound by high confidentiality clause as it contains materials, illustrations and information that may not be for public consumption. The contents herein are intended for use of the target partner to improve potential impact of malaria prevention in Uganda and shall not be duplicated, used, or disclosed – in whole or in part – for any purpose without consent of Church of Uganda. Partners funding part or whole of this concept note shall have the right to duplicate, use, or disclose the data to the extent provided in the partnerships and funding agreement. This restriction does not limit the right to use information contained in this data if it is obtained from another source without restriction.

 

Table of Contents

Abbreviations and Acronyms. iv

Foreword. v

Acknowledgements. vi

Executive summary. vii

1     BACKGROUND.. 1

1.1     Introduction. 1

1.2     Background to CoU.. 1

1.3     The CoU Malaria Control Program.. 4

2     SITUATIONAL ANALYSIS. 7

2.1     Country profile. 7

2.2     Malaria situation in Uganda. 9

2.3     The investment case for CoU malaria control. 9

2.4     The program arrangements. 12

3     STRATEGIC APPROACH.. 16

3.1     Over-arching approach. 16

3.2     Strategy 1: Strengthening integrated vector control approaches. 16

3.3     Strategy 2: Intensification of SBCC. 19

3.4     Strategy 3: Integration of malaria control into other areas. 23

3.5     Strategy 4: Documentation and dissemination. 25

3.6     Strategy 5: Synergistic Partnerships and Collaborations. 27

3.7     Strategy 6: Consolidation and guided expansion. 29

3.8     Strategy 7: Capacity building of dioceses and parishes. 31

4     PROGRAM MANAGEMENT. 33

4.1     Implementation arrangement. 33

4.2     Program risk analysis. 34

4.3     Monitoring and evaluation. 37

4.4     Sustainability and Value for money. 39

5     FINANCIAL REQUIREMENT FOR THIS INVESTMENT. 40

5.1     Approach to costing. 40

5.2     Key assumptions used. 40

5.3     Summary of costs. 40

ANNEXES. 41

ANNEX 1: MFF2020 LOGICAL FRAMEWORK. 42

ANNEX 2: NETSFORLIFE® HEALTH INTEGRATION MODEL. 47

Annex 3: List of Contributors. 49

 


Abbreviations and Acronyms

ANC

Antenatal Care

BCC

Behavioural Change Communication

CoU

Church of Uganda

CoU

Church of Uganda-Planning, Development and Rehabilitation Department

iCCM

Integrated Community Case Management

IEC

Information, Education and Communication

IRS

In-door Residual Spraying

ITN

Insecticide Treated Net

LLIN

Long Lasting Insecticide-treated Net

M&E

Monitoring and Evaluation

MFF2020

Malaria Free Families 2020

MoH

Ministry of health

NETSFORLIFE®

Netsforlife

NMCP

National Malaria Control Program

RBF

Result-Based Financing

RBM

Roll Back Malaria Partnership

SBCC

Social and Behavioural Change Communication

UMRSP

Uganda Malaria Reduction Strategic Plan

VHT

Village Health Team

WHO

World Health Organization

CMDs             Community Medicine Distributors


Foreword

The Church of Uganda (CoU) has since 1877 been an integral part of the community of Uganda through evangelism, service and promotion of improved social livelihood. Since pioneering the first health facility in Uganda in 1897, CoU has continuously made direct strides to improve the health of the community of God’s people in Uganda. Believers who are not healthy remain unable to not just maintain their spirituality but as well have great challenges to deliver to capacity. At CoU we believe in non-discriminatory delivery of health services by considering God’s people to be everyone who lives on the surface of the earth irrespective of the affiliation, beliefs, orientation and focus.

Malaria remains the single biggest threat to health and social development in Uganda and accounts for more than half of ill health reported in the country.

Families remain the central focus of every health intervention. On April 22nd 2014, I launched the Malaria Free Families 2020 initiative whose aim was to look at a need at working towards near elimination as an approach to fighting malaria. CoU is refocusing on simple solutions which include and not limited to building actual community level capabilities, Behavioural Change and Communication, facilitating community led approaches to sustainably fight malaria at household level like constant net use to prevent death to malaria.

CoU believes in a wholistic approach were religion is a unifying factor which brings all people together regardless whether they are affiliated to the religious beliefs or are non actors. Disease kills all and our health interventions go that distance in reaching all.

With the 256 health facilities founded by CoU and under the hospice of Uganda Protestant Medical Bureau (UPMB) founded in 1957; CoU is able to promote access to basic health care through curative and preventive measures for all Ugandans.  The church has in otherwords always positioned its self to reach out to God’s people through a wholistic approach in healing the lost and the sick to improve the socio-economic challenges of God’s people.

This investment case for malaria looks at the ultimate goal of having malaria eliminated by 2020. Post Millennium Development Goals’ agenda 2015 looks at the Sustainable Development Goals (SDGs) of which the Church is ready to fully contribute to their realization. The only way to get engaged is now and we have the critical mass to prove that; we have the facilities to achieve that and the God we serve will be by our side as quoted in Romans 8:31 “...what then shall we say in response to these things? If God is for us, who can be against us? Indeed God being on our side nothing is impossible. We aim at fulfilling God’s promise of abundant life in John 10:10.

God Bless you and God bless the hands that will give to this great cause. We want to see Malaria Free Families by 2020.

 

 

 

Most Rt. Rev, His Grace Stanley Ntagali

Archbishop of the Province of the Church of Uganda

 


Acknowledgements

The formulation of this Malaria Investment Plan (MIP) 2015-2020 would not have been possible without the leadership of the Archbishop of the Church of Uganda who has invested his life in reaching out to the people of Uganda in a wholistic manner. Church of Uganda with support from Netsforlife and Christian Aid have been at the forefront of technically and financially supporting CoU in delivering on its mandate; healing the sick; reaching out to the poor and delivering the lost.  Our local partners; Ministry of Health have been instrumental in directing our path in fighting malaria and at this moment I would like to extend my gratitude to the State Minister of Health Hon. Elioda Tumwesigye for accepting to be part of our Malaria Free Families 2020 launch on April 22nd 2014; which saw a new era in the fight against malaria under the Church of Uganda.

I would like to thank the National Malaria Control Programme under the leadership of Dr. Peter Okui for being instrumental in guiding our technical Staff in accessing some of the national platforms to discuss malaria related programmes. I would also want to thank the Executive Director of TASO Uganda for partnering with us in the 2 year Global Fund Grant which saw more that 11,000 Village Health Teams Trained and 2000 health workers trained to improve health service delivery. This kind of partnership made the church rethink its position on malaria and diversifying its approaches to see everyone free of this burden.

Church of Uganda is fully subscribing to the newly developed Uganda Malaria Reduction Strategy (UMRS 2020). It’s from this strategy that church of Uganda derives its own intervention to fight malaria. I would like want to thank the Church of Uganda Planning Development and Rehabilitation Coordinator Ms. Jessica Nalwoga Baguma for steering her team in developing this strategy; Mr. Masiko David the Programme Officer for his leadership in seeing the malaria programme thrive over the years to reach more and more people in Uganda. I also want to extend my gratitude to the Monitoring and Evaluation officer Ms. Doi Kapito Juliet for strengthening the department and other staff who have tremendously contributed to the development of the MIP. Lastly but not least, I would want to thank Mr. Morris Okumu the consultant who guided the church in developing this plan. Mr. Okumu was instrumental in bringing all church founded principles into this investment plan and we will always acknowledge your tremendous contribution to the fight against malaria.

Finally, I would like to state that the development of the MIP has been inclusive and participatory involving all malaria stakeholders from different sectors of the dioceses, government, and civil society, academia/research, and malaria development partners. I call upon all stakeholders to invest in the future of this country and to see to it that malaria is no more. I would like to encourage you with the principle verse in Acts 20:35 “...in everything I did, I showed you that by this kind of hard work we must help the weak, remembering the words the Lord Jesus said: ‘it’s more blessed to give than to receive’.”

I thank you all and God Bless you

Rev. Canon Amos Magezi

Provincial Secretary

The Province of the Church of Uganda


Executive summary

A.        Background

Malaria is the commonest yet preventable cause of ill health in Uganda with over 16 million cases and over 10,500 deaths reported at health facilities in 2013. It affects families leading to slow socio-economic development and poverty making it a disease with roots beyond the health sector. The Ministry of Health (MoH) through the National Malaria Control Program (NMCP); under the Uganda Malaria Reduction Strategic Plan (UMRSP) provides national leadership for a response aimed at attaining pre-elimination by 2019. Church of Uganda (CoU) through the Planning, Development and Rehabilitation (CoU) since 2006 has continued to implement a malaria control program as part of wholistic mission. CoU is part of the Anglican dominion of churches; faith based organization as a corporate body under Trustees Incorporation Act of Uganda since 1968. The recently launched flagship malaria control initiative “Malaria Free Families 2020” (MFF2020) is expected to scale up malaria prevention and improve lives of families in Uganda. A critical focus is on “God’s People” that means serving people without discrimination of affiliation, race or gender but as a member of the society in which CoU exists.

MFF2020 approaches: Through incremental steps, communities will subsequently aim to eliminate malaria and interrupt local transmission of the disease at household level. The planning in this case will mainly be household specific with special emphasis on Behaviour Change and Communication. MFF2020 takes into account the variation of the burden at household level with the following objectives: i) To strengthen community's participation and its sustainability in the fight against and create more awareness that; within the same community malaria can be history; and ii) To ascertain the best practices through community feedback.

This project builds on to the gains of previous projects under the malaria control program and applies the following key strategies: a) Using evidence based programming to intensify implementation of malaria project using the NETSFORLIFE® model to make it more specific to households than broad based approach; b) Use of preventive measures which will look mainly at developing diocesan advocacy strategies and creating a national advocacy forum for social accountability; c) Through BCC promote preventive measures and enhance system's strengthening, malaria reduction surveillance mechanisms, improve on health information systems through its own structures, and creation of a strong resource base to support malaria initiatives; d) Creating a sustainable financing and implementation strategy to increase on advocacy levels at grass-root level to achieve social and community mobilization for sustained delivery and use; and e) Documentation of best practices and impact so far on different interventions.

B.        Situational analysis:

Country situation: Uganda is a landlocked country located within the Great Lakes region of East and Central Africa with has a tropical climate which is favourable for both man and mosquitoes owing to its relatively high altitude. The peak of malaria transmission coincides with peak rainfall season which is also the planting and harvest seasons when demand for labour is high.  The country is mainly an agricultural economy (80%) with a large carrying out subsistence agriculture. The percentage of the population living below the poverty line declined from 56% in 1992/93 to 31% in 2005/06 and in 2013 was estimated at 23-25% with a GDP of US$ 430 per-capita. Poverty is still wide spread in the country especially in rural areas.

Demography: The population has increased from 9.5 million in 1969 to 24.2 million in 2002 and is estimated at 34.7 million in 2014. At a growth rate of 3.2% per annum (1991-2002), Uganda’s population is projected to reach 45 million by 2020, implying a relatively high number of pregnant women. More than half of Uganda’s population (52%) is female and live in rural areas. Overall literacy rate stands at 69% among persons aged 10 years and above, with more men found to be literate (76%) compared to women (63%).

The need for investment: Nearly three-quarters of employers in sub-Saharan Africa just like in Uganda reported that malaria was negatively impacting their business. In Uganda, over 70% of the population (90% in rural areas) depends on agriculture for both livelihood and real employment making the significance of focus on the households more significant than ever. The challenge with access to timely health services (geographical, operational and economical) to treat common illnesses including malaria continues to always contribute to the increased death and low agricultural outputs within the informal sector and rural communities. The reduced outputs as per capita GDP expenditure continues to increase the demand for donor dependency and overall need for urgent actions to avert humanitarian crises as well as weakened resilience of the community. Significant investment into the national malaria control has been in areas of commodity procurement, strengthening curative (facility-based) care, distribution of mosquito nets and other interventions. There has been limited investment into the behavioural change and anthropological support systems to improve the knowledge, acceptability and use/adaptation of the proven malaria control approaches. Further investments are required in areas of: i) Community mobilisation for: ANC, nets use and retention and ownership; ii) Simple community-led malaria prevention approaches; iii) Community level prompt treatment of fever (iCCM); and iv) research & documentation of best evidence.

C.        Strategic Approach

In consideration of the operating environment, our strategic niche and the overall disease burden and need for intervention, CoU using a consultative manner agreed on seven strategic priorities. Our over-arching approach shall be to use the family-centred focus while ensuring full program integration and combination for malaria control intervention.

a)   Strategy 1- Strengthening integrated vector control approaches:

This will involve supporting the roll-out of integrated vector control in the country to ensure achievement of national target of reaching pre-elimination of malaria by 2019. Our approach in this project is rapidly scale up use and retention of ITNs, strengthen support to other forms of intervention and intensify the use of private sector initiatives to improve availability of ITNs. Our key strategic interventions are: Supporting routine distribution of mosquito nets, Supporting the 2016/2017 universal coverage campaign, Intensifying hang-up campaigns in target districts, Piloting and roll-out of school-based ITNs distribution, Strengthening social marketing of ITNs, and Mobilisation of communities for uptake of IRS.

b)   Strategy 2 - Intensification of Social Behavioural Change and Communication

This will leverage the current CoU strategic niche and competitive advantage to roll out highly effective SBCC activities throughout the country. Our SBCC will be driven by the understanding of changing paradigms that emphasize engagement with various participant groups and deepened empowerment of households and communities to adopt appropriate behaviour. The strategic interventions are: Intensifying the faith-based institution mobilisation activities, Leveraging of community mobilisers to increase awareness, Intensifying media campaigns, Commemoration of world malaria day, and Collaboration with youth ministries.

c)    Strategy 3 - Integration of malaria control into iCCM

Integrated approaches to implementation of disease control are considered one of the best and optimal options to improve success rates. Our approach is to integrate malaria control into existing programs running in other areas of work of CoU and other key partners including the Inter-Religious Council of Uganda (IRCU), the umbrella body for all faith-based institutions in Uganda. We shall adopt the integration model of Netsforlife. Strategic interventions are: Supporting iCCM roll-out, integrating malaria into HIV/SRH programs, and Integration of malaria control into activities of mission department.

d)   Strategy 4 - Documentation and dissemination

The need to document and share best practices and provide firm evidence for future programs of CoU. We shall improve and inculcate the culture of documentation, evidence generation and use of data to support design, implementation and advocacy. Our approach under this strategy is to improve the M&E system and develop an in-house culture of implementation research and overall documentation of best practices.

e)   Strategy 5 - Synergistic Partnerships and Collaborations

We aim to build effective partnerships and collaborations to support rapid scale-up and sustenance of the MFF2020 project activities. Our considerations shall include those relations that improve in areas of costs, time, performance, and risk. Our focus shall remain deeply rooted in our values and family. Key interventions include Exploration of mutual partnerships, Diversification of funding, and Development of clear partnership framework.

f)    Strategy 6: Consolidation and guided expansion

Cognisant of the high demand for simple and cost-effective malaria control services, we shall consolidate current CoU malaria control activities and strategically expand to new dioceses and districts to ensure high and sustained impact of the planned interventions. We shall balance this expansion to ensure sustained quality of the services delivery to cover at least 85% of the entire country by 2018 calendar year based on systematic expansion program. We have clustered the country into four priority areas for expansion of MFF2020 based on demand and already existing capabilities and programs.

g)   Strategy 7: Capacity building of Other Faith Groups and Community Partners

We shall strengthen the capacity of dioceses (the main implementers of all CoU programs and projects) to ensure stronger, resilient, results focused and sustainable implementation of all CoU programs and activities. Our consideration of capacity building is to look at areas of building strengths in planning, administration, services delivery, financial management, monitoring and evaluation as well as strengthening local ownership

D.       Program Management

The central pillar of ensuring success of this plan is to have an effective and well-coordinated implementation framework. Our implementation matrix is well focussed on use of existing grass root structures as key players and leaders of the program. The dioceses, districts and church parishes are critical front-line players for effective delivery of results as they are in touch with the beneficiaries on daily basis through their multiple activities and service delivery. To fully implement this ambitious yet highly achievable project, we have considered multiple implementing mechanisms that shall mainly rotate around the structures of CoU mainly with focus on value for money and sustainability. To ensure effective delivery of results, the different actors in this project shall be coordinated through already existing structures at provincial and diocesan levels.

Our approach to M&E is to ensure that every aspect in embedded into the program implementation cycle. While PDR has a dedicated M&E office, we shall continue to expand and integrate the M&E activities within the focus roles of each diocese as a means to improve participatory planning and management as well as use of results at point of implementation. To guide overall M&E, we shall develop a full M&E plan for the five years based on commitments and financing from 2015 period.

The program theory of change over the next five years is:

If CoU designs and put in place a program that is aligned with the existing national policy and guidelines, puts in place the necessary capabilities at all levels of the province; then if families use the interventions in place, there will be a near zero transmission of malaria in communities making them able to engage into economic activities that will increase household income and overall national output.

E.        Total investment required to achieve results

Church of Uganda with support from developing partners will invest up to USD 14,230.707 (Excluding LLINs and Commodities) for the 5 years i.e. 2015-2020. This will see the church achieve its ultimate goals in contributing to eliminating malaria in Uganda by 2020.

 

 


1      BACKGROUND

1.1    Introduction

The severity and scope of malaria is recognized the world over, often in the unwelcome forms of sickness and death and the close association with slow socio-economic development and poverty. Malaria is preventable yet in 2013, alone, over 16 million malaria cases and over 10,500 deaths were reported at health facilities in Uganda[1]. The determinants of the epidemiology and impact of malaria have roots beyond the health sector and the roles of other sectors need to be harnessed to prevent and control malaria in this country[2]. Uganda has adopted the multi-sectoral approach to malaria control coordinated by the Ministry of Health (MoH) through the National Malaria Control Program (NMCP); under the Uganda Malaria Reduction Strategic Plan (UMRSP). The main theme of the UMRSP is “Accelerated nationwide scale up to achieve universal coverage of cost effective malaria prevention and treatment interventions”.

Church of Uganda (CoU) in particular has since 2008 remained a central player in supporting the NMCP in various aspects of malaria control and prevention in addition to being an integral part of the community in Uganda for over a century. To complement the church ministry and evangelisation through holistic approach, CoU through the Church of Uganda-Planning, Development and Rehabilitation (CoU) continues to implement programs including malaria control that looks at the total life of the population. Over the years, CoU’s role and mandate have changed to meet the emerging trends and challenging development situations especially among the poor at grass-root levels. The malaria control program has been in place since 2006 and over the years the proposal development process has been coordinated by CoU with minimum involvement of the dioceses.

CoU recently launched its flagship malaria control initiative “Malaria Free Families 2020” (MFF2020) meant to scale up work in Uganda and to contribute to reaching pre-elimination stage as envisioned in the UMRSP. To ensure both strategic and successful implementation of this initiative, CoU requires a well laid out Strategic Business and Investment Case to inform the priorities, interventions and overall funding in the different thematic areas of comprehensive health and social well-being response to malaria in Uganda. This document describes the overall MFF2020 strategies, key milestones and the direct areas of investments.

1.2    Background to CoU

CoU is part of the Anglican dominion of churches; faith based organization as a corporate body under Trustees Incorporation Act of Uganda since 1968. Its registered name is “The Registered trustees of the Church of Uganda”. CoU is one of the oldest institutions in Uganda that dates back beyond 100years of its existence since the pre-colonial times and currently has a following of approximately 13 million people/members of congregations in Uganda. CoU has remained an integral part of Uganda’s development since starting schools and health facilities throughout the

 

  

RESTRICTION ON DISCLOSURE AND USE OF INFORMATION

Receipt of this concept document is bound by high confidentiality clause as it contains materials, illustrations and information that may not be for public consumption. The contents herein are intended for use of the target partner to improve potential impact of malaria prevention in Uganda and shall not be duplicated, used, or disclosed – in whole or in part – for any purpose without consent of Church of Uganda. Partners funding part or whole of this concept note shall have the right to duplicate, use, or disclose the data to the extent provided in the partnerships and funding agreement. This restriction does not limit the right to use information contained in this data if it is obtained from another source without restriction.

 

Table of Contents

Abbreviations and Acronyms. iv

Foreword. v

Acknowledgements. vi

Executive summary. vii

1     BACKGROUND.. 1

1.1     Introduction. 1

1.2     Background to CoU.. 1

1.3     The CoU Malaria Control Program.. 4

2     SITUATIONAL ANALYSIS. 7

2.1     Country profile. 7

2.2     Malaria situation in Uganda. 9

2.3     The investment case for CoU malaria control. 9

2.4     The program arrangements. 12

3     STRATEGIC APPROACH.. 16

3.1     Over-arching approach. 16

3.2     Strategy 1: Strengthening integrated vector control approaches. 16

3.3     Strategy 2: Intensification of SBCC. 19

3.4     Strategy 3: Integration of malaria control into other areas. 23

3.5     Strategy 4: Documentation and dissemination. 25

3.6     Strategy 5: Synergistic Partnerships and Collaborations. 27

3.7     Strategy 6: Consolidation and guided expansion. 29

3.8     Strategy 7: Capacity building of dioceses and parishes. 31

4     PROGRAM MANAGEMENT. 33

4.1     Implementation arrangement. 33

4.2     Program risk analysis. 34

4.3     Monitoring and evaluation. 37

4.4     Sustainability and Value for money. 39

5     FINANCIAL REQUIREMENT FOR THIS INVESTMENT. 40

5.1     Approach to costing. 40

5.2     Key assumptions used. 40

5.3     Summary of costs. 40

ANNEXES. 41

ANNEX 1: MFF2020 LOGICAL FRAMEWORK. 42

ANNEX 2: NETSFORLIFE® HEALTH INTEGRATION MODEL. 47

Annex 3: List of Contributors. 49

 


Abbreviations and Acronyms

ANC

Antenatal Care

BCC

Behavioural Change Communication

CoU

Church of Uganda

CoU

Church of Uganda-Planning, Development and Rehabilitation Department

iCCM

Integrated Community Case Management

IEC

Information, Education and Communication

IRS

In-door Residual Spraying

ITN

Insecticide Treated Net

LLIN

Long Lasting Insecticide-treated Net

M&E

Monitoring and Evaluation

MFF2020

Malaria Free Families 2020

MoH

Ministry of health

NETSFORLIFE®

Netsforlife

NMCP

National Malaria Control Program

RBF

Result-Based Financing

RBM

Roll Back Malaria Partnership

SBCC

Social and Behavioural Change Communication

UMRSP

Uganda Malaria Reduction Strategic Plan

VHT

Village Health Team

WHO

World Health Organization

CMDs             Community Medicine Distributors


Foreword

The Church of Uganda (CoU) has since 1877 been an integral part of the community of Uganda through evangelism, service and promotion of improved social livelihood. Since pioneering the first health facility in Uganda in 1897, CoU has continuously made direct strides to improve the health of the community of God’s people in Uganda. Believers who are not healthy remain unable to not just maintain their spirituality but as well have great challenges to deliver to capacity. At CoU we believe in non-discriminatory delivery of health services by considering God’s people to be everyone who lives on the surface of the earth irrespective of the affiliation, beliefs, orientation and focus.

Malaria remains the single biggest threat to health and social development in Uganda and accounts for more than half of ill health reported in the country.

Families remain the central focus of every health intervention. On April 22nd 2014, I launched the Malaria Free Families 2020 initiative whose aim was to look at a need at working towards near elimination as an approach to fighting malaria. CoU is refocusing on simple solutions which include and not limited to building actual community level capabilities, Behavioural Change and Communication, facilitating community led approaches to sustainably fight malaria at household level like constant net use to prevent death to malaria.

CoU believes in a wholistic approach were religion is a unifying factor which brings all people together regardless whether they are affiliated to the religious beliefs or are non actors. Disease kills all and our health interventions go that distance in reaching all.

With the 256 health facilities founded by CoU and under the hospice of Uganda Protestant Medical Bureau (UPMB) founded in 1957; CoU is able to promote access to basic health care through curative and preventive measures for all Ugandans.  The church has in otherwords always positioned its self to reach out to God’s people through a wholistic approach in healing the lost and the sick to improve the socio-economic challenges of God’s people.

This investment case for malaria looks at the ultimate goal of having malaria eliminated by 2020. Post Millennium Development Goals’ agenda 2015 looks at the Sustainable Development Goals (SDGs) of which the Church is ready to fully contribute to their realization. The only way to get engaged is now and we have the critical mass to prove that; we have the facilities to achieve that and the God we serve will be by our side as quoted in Romans 8:31 “...what then shall we say in response to these things? If God is for us, who can be against us? Indeed God being on our side nothing is impossible. We aim at fulfilling God’s promise of abundant life in John 10:10.

God Bless you and God bless the hands that will give to this great cause. We want to see Malaria Free Families by 2020.

 

 

 

Most Rt. Rev, His Grace Stanley Ntagali

Archbishop of the Province of the Church of Uganda

 


Acknowledgements

The formulation of this Malaria Investment Plan (MIP) 2015-2020 would not have been possible without the leadership of the Archbishop of the Church of Uganda who has invested his life in reaching out to the people of Uganda in a wholistic manner. Church of Uganda with support from Netsforlife and Christian Aid have been at the forefront of technically and financially supporting CoU in delivering on its mandate; healing the sick; reaching out to the poor and delivering the lost.  Our local partners; Ministry of Health have been instrumental in directing our path in fighting malaria and at this moment I would like to extend my gratitude to the State Minister of Health Hon. Elioda Tumwesigye for accepting to be part of our Malaria Free Families 2020 launch on April 22nd 2014; which saw a new era in the fight against malaria under the Church of Uganda.

I would like to thank the National Malaria Control Programme under the leadership of Dr. Peter Okui for being instrumental in guiding our technical Staff in accessing some of the national platforms to discuss malaria related programmes. I would also want to thank the Executive Director of TASO Uganda for partnering with us in the 2 year Global Fund Grant which saw more that 11,000 Village Health Teams Trained and 2000 health workers trained to improve health service delivery. This kind of partnership made the church rethink its position on malaria and diversifying its approaches to see everyone free of this burden.

Church of Uganda is fully subscribing to the newly developed Uganda Malaria Reduction Strategy (UMRS 2020). It’s from this strategy that church of Uganda derives its own intervention to fight malaria. I would like want to thank the Church of Uganda Planning Development and Rehabilitation Coordinator Ms. Jessica Nalwoga Baguma for steering her team in developing this strategy; Mr. Masiko David the Programme Officer for his leadership in seeing the malaria programme thrive over the years to reach more and more people in Uganda. I also want to extend my gratitude to the Monitoring and Evaluation officer Ms. Doi Kapito Juliet for strengthening the department and other staff who have tremendously contributed to the development of the MIP. Lastly but not least, I would want to thank Mr. Morris Okumu the consultant who guided the church in developing this plan. Mr. Okumu was instrumental in bringing all church founded principles into this investment plan and we will always acknowledge your tremendous contribution to the fight against malaria.

Finally, I would like to state that the development of the MIP has been inclusive and participatory involving all malaria stakeholders from different sectors of the dioceses, government, and civil society, academia/research, and malaria development partners. I call upon all stakeholders to invest in the future of this country and to see to it that malaria is no more. I would like to encourage you with the principle verse in Acts 20:35 “...in everything I did, I showed you that by this kind of hard work we must help the weak, remembering the words the Lord Jesus said: ‘it’s more blessed to give than to receive’.”

I thank you all and God Bless you

Rev. Canon Amos Magezi

Provincial Secretary

The Province of the Church of Uganda


Executive summary

A.        Background

Malaria is the commonest yet preventable cause of ill health in Uganda with over 16 million cases and over 10,500 deaths reported at health facilities in 2013. It affects families leading to slow socio-economic development and poverty making it a disease with roots beyond the health sector. The Ministry of Health (MoH) through the National Malaria Control Program (NMCP); under the Uganda Malaria Reduction Strategic Plan (UMRSP) provides national leadership for a response aimed at attaining pre-elimination by 2019. Church of Uganda (CoU) through the Planning, Development and Rehabilitation (CoU) since 2006 has continued to implement a malaria control program as part of wholistic mission. CoU is part of the Anglican dominion of churches; faith based organization as a corporate body under Trustees Incorporation Act of Uganda since 1968. The recently launched flagship malaria control initiative “Malaria Free Families 2020” (MFF2020) is expected to scale up malaria prevention and improve lives of families in Uganda. A critical focus is on “God’s People” that means serving people without discrimination of affiliation, race or gender but as a member of the society in which CoU exists.

MFF2020 approaches: Through incremental steps, communities will subsequently aim to eliminate malaria and interrupt local transmission of the disease at household level. The planning in this case will mainly be household specific with special emphasis on Behaviour Change and Communication. MFF2020 takes into account the variation of the burden at household level with the following objectives: i) To strengthen community's participation and its sustainability in the fight against and create more awareness that; within the same community malaria can be history; and ii) To ascertain the best practices through community feedback.

This project builds on to the gains of previous projects under the malaria control program and applies the following key strategies: a) Using evidence based programming to intensify implementation of malaria project using the NETSFORLIFE® model to make it more specific to households than broad based approach; b) Use of preventive measures which will look mainly at developing diocesan advocacy strategies and creating a national advocacy forum for social accountability; c) Through BCC promote preventive measures and enhance system's strengthening, malaria reduction surveillance mechanisms, improve on health information systems through its own structures, and creation of a strong resource base to support malaria initiatives; d) Creating a sustainable financing and implementation strategy to increase on advocacy levels at grass-root level to achieve social and community mobilization for sustained delivery and use; and e) Documentation of best practices and impact so far on different interventions.

B.        Situational analysis:

Country situation: Uganda is a landlocked country located within the Great Lakes region of East and Central Africa with has a tropical climate which is favourable for both man and mosquitoes owing to its relatively high altitude. The peak of malaria transmission coincides with peak rainfall season which is also the planting and harvest seasons when demand for labour is high.  The country is mainly an agricultural economy (80%) with a large carrying out subsistence agriculture. The percentage of the population living below the poverty line declined from 56% in 1992/93 to 31% in 2005/06 and in 2013 was estimated at 23-25% with a GDP of US$ 430 per-capita. Poverty is still wide spread in the country especially in rural areas.

Demography: The population has increased from 9.5 million in 1969 to 24.2 million in 2002 and is estimated at 34.7 million in 2014. At a growth rate of 3.2% per annum (1991-2002), Uganda’s population is projected to reach 45 million by 2020, implying a relatively high number of pregnant women. More than half of Uganda’s population (52%) is female and live in rural areas. Overall literacy rate stands at 69% among persons aged 10 years and above, with more men found to be literate (76%) compared to women (63%).

The need for investment: Nearly three-quarters of employers in sub-Saharan Africa just like in Uganda reported that malaria was negatively impacting their business. In Uganda, over 70% of the population (90% in rural areas) depends on agriculture for both livelihood and real employment making the significance of focus on the households more significant than ever. The challenge with access to timely health services (geographical, operational and economical) to treat common illnesses including malaria continues to always contribute to the increased death and low agricultural outputs within the informal sector and rural communities. The reduced outputs as per capita GDP expenditure continues to increase the demand for donor dependency and overall need for urgent actions to avert humanitarian crises as well as weakened resilience of the community. Significant investment into the national malaria control has been in areas of commodity procurement, strengthening curative (facility-based) care, distribution of mosquito nets and other interventions. There has been limited investment into the behavioural change and anthropological support systems to improve the knowledge, acceptability and use/adaptation of the proven malaria control approaches. Further investments are required in areas of: i) Community mobilisation for: ANC, nets use and retention and ownership; ii) Simple community-led malaria prevention approaches; iii) Community level prompt treatment of fever (iCCM); and iv) research & documentation of best evidence.

C.        Strategic Approach

In consideration of the operating environment, our strategic niche and the overall disease burden and need for intervention, CoU using a consultative manner agreed on seven strategic priorities. Our over-arching approach shall be to use the family-centred focus while ensuring full program integration and combination for malaria control intervention.

a)   Strategy 1- Strengthening integrated vector control approaches:

This will involve supporting the roll-out of integrated vector control in the country to ensure achievement of national target of reaching pre-elimination of malaria by 2019. Our approach in this project is rapidly scale up use and retention of ITNs, strengthen support to other forms of intervention and intensify the use of private sector initiatives to improve availability of ITNs. Our key strategic interventions are: Supporting routine distribution of mosquito nets, Supporting the 2016/2017 universal coverage campaign, Intensifying hang-up campaigns in target districts, Piloting and roll-out of school-based ITNs distribution, Strengthening social marketing of ITNs, and Mobilisation of communities for uptake of IRS.

b)   Strategy 2 - Intensification of Social Behavioural Change and Communication

This will leverage the current CoU strategic niche and competitive advantage to roll out highly effective SBCC activities throughout the country. Our SBCC will be driven by the understanding of changing paradigms that emphasize engagement with various participant groups and deepened empowerment of households and communities to adopt appropriate behaviour. The strategic interventions are: Intensifying the faith-based institution mobilisation activities, Leveraging of community mobilisers to increase awareness, Intensifying media campaigns, Commemoration of world malaria day, and Collaboration with youth ministries.

c)    Strategy 3 - Integration of malaria control into iCCM

Integrated approaches to implementation of disease control are considered one of the best and optimal options to improve success rates. Our approach is to integrate malaria control into existing programs running in other areas of work of CoU and other key partners including the Inter-Religious Council of Uganda (IRCU), the umbrella body for all faith-based institutions in Uganda. We shall adopt the integration model of Netsforlife. Strategic interventions are: Supporting iCCM roll-out, integrating malaria into HIV/SRH programs, and Integration of malaria control into activities of mission department.

d)   Strategy 4 - Documentation and dissemination

The need to document and share best practices and provide firm evidence for future programs of CoU. We shall improve and inculcate the culture of documentation, evidence generation and use of data to support design, implementation and advocacy. Our approach under this strategy is to improve the M&E system and develop an in-house culture of implementation research and overall documentation of best practices.

e)   Strategy 5 - Synergistic Partnerships and Collaborations

We aim to build effective partnerships and collaborations to support rapid scale-up and sustenance of the MFF2020 project activities. Our considerations shall include those relations that improve in areas of costs, time, performance, and risk. Our focus shall remain deeply rooted in our values and family. Key interventions include Exploration of mutual partnerships, Diversification of funding, and Development of clear partnership framework.

f)    Strategy 6: Consolidation and guided expansion

Cognisant of the high demand for simple and cost-effective malaria control services, we shall consolidate current CoU malaria control activities and strategically expand to new dioceses and districts to ensure high and sustained impact of the planned interventions. We shall balance this expansion to ensure sustained quality of the services delivery to cover at least 85% of the entire country by 2018 calendar year based on systematic expansion program. We have clustered the country into four priority areas for expansion of MFF2020 based on demand and already existing capabilities and programs.

g)   Strategy 7: Capacity building of Other Faith Groups and Community Partners

We shall strengthen the capacity of dioceses (the main implementers of all CoU programs and projects) to ensure stronger, resilient, results focused and sustainable implementation of all CoU programs and activities. Our consideration of capacity building is to look at areas of building strengths in planning, administration, services delivery, financial management, monitoring and evaluation as well as strengthening local ownership

D.       Program Management

The central pillar of ensuring success of this plan is to have an effective and well-coordinated implementation framework. Our implementation matrix is well focussed on use of existing grass root structures as key players and leaders of the program. The dioceses, districts and church parishes are critical front-line players for effective delivery of results as they are in touch with the beneficiaries on daily basis through their multiple activities and service delivery. To fully implement this ambitious yet highly achievable project, we have considered multiple implementing mechanisms that shall mainly rotate around the structures of CoU mainly with focus on value for money and sustainability. To ensure effective delivery of results, the different actors in this project shall be coordinated through already existing structures at provincial and diocesan levels.

Our approach to M&E is to ensure that every aspect in embedded into the program implementation cycle. While PDR has a dedicated M&E office, we shall continue to expand and integrate the M&E activities within the focus roles of each diocese as a means to improve participatory planning and management as well as use of results at point of implementation. To guide overall M&E, we shall develop a full M&E plan for the five years based on commitments and financing from 2015 period.

The program theory of change over the next five years is:

If CoU designs and put in place a program that is aligned with the existing national policy and guidelines, puts in place the necessary capabilities at all levels of the province; then if families use the interventions in place, there will be a near zero transmission of malaria in communities making them able to engage into economic activities that will increase household income and overall national output.

E.        Total investment required to achieve results

Church of Uganda with support from developing partners will invest up to USD 14,230.707 (Excluding LLINs and Commodities) for the 5 years i.e. 2015-2020. This will see the church achieve its ultimate goals in contributing to eliminating malaria in Uganda by 2020.

 

 


1      BACKGROUND

1.1    Introduction

The severity and scope of malaria is recognized the world over, often in the unwelcome forms of sickness and death and the close association with slow socio-economic development and poverty. Malaria is preventable yet in 2013, alone, over 16 million malaria cases and over 10,500 deaths were reported at health facilities in Uganda[1]. The determinants of the epidemiology and impact of malaria have roots beyond the health sector and the roles of other sectors need to be harnessed to prevent and control malaria in this country[2]. Uganda has adopted the multi-sectoral approach to malaria control coordinated by the Ministry of Health (MoH) through the National Malaria Control Program (NMCP); under the Uganda Malaria Reduction Strategic Plan (UMRSP). The main theme of the UMRSP is “Accelerated nationwide scale up to achieve universal coverage of cost effective malaria prevention and treatment interventions”.

Church of Uganda (CoU) in particular has since 2008 remained a central player in supporting the NMCP in various aspects of malaria control and prevention in addition to being an integral part of the community in Uganda for over a century. To complement the church ministry and evangelisation through holistic approach, CoU through the Church of Uganda-Planning, Development and Rehabilitation (CoU) continues to implement programs including malaria control that looks at the total life of the population. Over the years, CoU’s role and mandate have changed to meet the emerging trends and challenging development situations especially among the poor at grass-root levels. The malaria control program has been in place since 2006 and over the years the proposal development process has been coordinated by CoU with minimum involvement of the dioceses.

CoU recently launched its flagship malaria control initiative “Malaria Free Families 2020” (MFF2020) meant to scale up work in Uganda and to contribute to reaching pre-elimination stage as envisioned in the UMRSP. To ensure both strategic and successful implementation of this initiative, CoU requires a well laid out Strategic Business and Investment Case to inform the priorities, interventions and overall funding in the different thematic areas of comprehensive health and social well-being response to malaria in Uganda. This document describes the overall MFF2020 strategies, key milestones and the direct areas of investments.

1.2    Background to CoU

CoU is part of the Anglican dominion of churches; faith based organization as a corporate body under Trustees Incorporation Act of Uganda since 1968. Its registered name is “The Registered trustees of the Church of Uganda”. CoU is one of the oldest institutions in Uganda that dates back beyond 100years of its existence since the pre-colonial times and currently has a following of approximately 13 million people/members of congregations in Uganda. CoU has remained an integral part of Uganda’s development since starting schools and health facilities throughout the entire country as part of wholistic evangelisation.

Church of Uganda is headed by an Archbishop who oversees all ministry work in the province. A province is comprised of 35 dioceses spread out in the entire country. CoU delivers all its socio-economic development work through the department of Planning, Development and Rehabilitation (PDR). PDR was first established in 1974 as an advisory office to the Archbishop in the area of social-economic development. Over the years, the office has grown with expansion of its mandate to include planning, development work and rehabilitation and this is the work that the department is engaged in to date. Currently, the department is implementing a 6 year strategic plan 2012-2017 with known six core values that determines the ethos an overall approach to services delivery.

The Vision and Mission of PDR clearly focuses on the use of firm foundation of the church to advance community socio-economic development. A critical focus is on “God’s People” that means serving people without discrimination of affiliation, race or gender but as a member of the society in which CoU exists.

This departmental vision is in line with the overall vision of the Province of the church of Uganda which is; “A Christ Centred Church equipped for transforming Mission among people”.

1.2.1     Management Structure:

The Provincial Secretary of CoU is equivalent of a Chief Executive Officer; he/she reports to the Archbishop. PDR is headed by a Coordinator who reports to the Provincial Secretary. Other functioning offices like the Internal Audit, Human Resource and all the other departmental Heads of Department (Health, Finance, Education and Mission) all report to the Provincial Secretary. 

The Church of Uganda has a governing body called the Provincial Assembly which convenes once every 2 years. The Provincial Standing Committee is an auxiliary body that operates yearly on behalf of the Provincial Assembly to handle policy operations of the church. Each of the departments have boards; in this case PDR board is the Planning Development Board which meets quarterly and has 9 members representing all the 34 dioceses.

1.2.2     Policy Framework:

Church of Uganda operates within a defined policy framework. The Provincial Assembly is responsible for passing all policies tabled through the Provincial Assembly Standing Committee. All policy formulation processes start from the grass-root church and are researched upon. Currently the church works within the following policy environment;

1.2.3     PDR Mandate:

PDR is mandated to implement socio-economic development work on behalf of the Church of Uganda. It’s a facilitator of change among God’s people. Church of Uganda works with communities for development and holistic transformation. It does not discriminate on basis of religious affiliation, colour or race; but works with one goal of making life more worthwhile.

1.2.4     CoU Programming Capacity:

CoU has immense experience in managing programs that are complex with extended funding, geographical and technical scope. Currently, CoU is implementing over thirteen projects supported through various agencies. These agencies include UNFPA, UNICEF, Tear Fund, Christian Aid, Netsforlife, TASO/Global Fund, Diakonia-Sweden, Church of Sweden, among others. The current programs span from health through environment to overall social livelihood programs. Since 1974 PDR has implemented programmes ranging from relief aid response to people affected from the war, to rehabilitation of families after the war, dealing with after effect of war like famine, disease and orphans to currently facilitating development through rigorous capacity building and equipping grass-root people for a more sustainable approach to development. The programme and services below reflect the kind of engagement and experience CoU has on international scene.

Our specific health portfolio includes Health Promotion and Prevention Services and the Curative Health Programme. The Health promotion and prevention services currently have the following programs/projects: Malaria Reduction Programme, HIV Project, Life Water, Adolescent Sexual Reproductive Health, Family Planning, Early Child Development, and Lake Victoria Rights Programme.

1.2.5     Differential Competence:

CoU is one of the oldest institutions of Uganda; it commands outmost respect and trust among different bodies and agencies including the Government of Uganda. Since arrival of the Church Missionary Society in Uganda in 1877, the church has become an integral part of the history of the country; shaping economic, health, social welfare and education sectors of the country including being the most trusted advocacy institution in the country with a clear unrivalled acceptability and coverage.

The unique feature of the church is that it commands a following of approximately 13million people in Uganda. Structurally, the institution has clear line of administration reaching up to the village level making it easy to mobilise both human resources and the population for immediate reach of the project. With the combination of excellent countrywide network of structures, time-tested policies and community-based capacity, CoU as an institution has an immense capacity to delivery every project.

Its vast structure reaches down to the grass-root with the last church structure being the sub-parish often headed by a lay-reader. The church through its structure has the ability to:

  • Mobilise communities effectively and with minimum costs
  • Communicate effectively to all structure with minimum cost
  • Disseminate all forms of information through the elaborate structure
  • Advocate freely for services through the governance structure

More to the above, the church leadership is able to meet all the 13 million Christians every week (Sunday) which makes it possible for easy dialogue and information sharing. The church has good will in that people will always believe in what the church leaders say and pass on as information.

1.3    The CoU Malaria Control Program

1.3.1     Program description

Since 2006, Church of Uganda through its Planning Development and Rehabilitation department has been implementing a Malaria Reduction Programme. This has been implemented in 17 dioceses and 33 districts [3]of Uganda with an aim of reducing malaria incidence at household level through various malaria prevention strategies. CoU uses the NetsforLife® Model of Implementation that involves:

i)        Identifying communities with high vulnerable rating

ii)      Identifying community leaders

iii)    Training and equipping community focal persons e.g. VHTs

iv)    Reaching out to households (Distribution, sensitization and Registration)

v)      Behavioural Change and Communication

vi)    Effective and embedded M&E

This model has been effective in the different areas of implementation and has been instrumental in improving outcomes.

CoU recently launched the Malaria Free Families 2020 project meant to scale up work in Uganda and to contribute to reaching pre-elimination stage as envisioned by MoH through its Uganda Malaria Reduction Strategy. The malaria programme has been implemented through an integrated approach that looks at every other communicable disease at household level as contributing to malaria prevalence and equally prevalent.

Through incremental steps, communities will subsequently aim to eliminate malaria and interrupt local transmission of the disease at household level. The planning in this case will mainly be household specific with special emphasis on Behaviour Change and Communication. MFF2020 takes into account the variation of the burden at household level.

Figure 1: The Health State Minister Elioda Tumwesigye (2nd Left) launching Malaria Free Families 2020 campaign on 22nd April 2014: (Right) is Bishop Nathan Kyamanywaof Bunyoro Kitara Diocese representing the Archbishop of the Church of Uganda-Picture by Ruth Bwana Atuhairwe-Communication Assistant