Goodbye to Projects? ¿ A livelihoods-grounded audit of the Plan for the Modernisation of Agriculture (PMA) in Uganda

Approaches to projects and development have undergone considerable change in the last decade with significant policy shifts on governance, gender, poverty eradication, and environmental issues. Most recently this has led to the adoption and promotion of the sustainable livelihood (SL) approach. The adoption of the SL approach presents challenges to development interventions including: the future of projects and programmes, and sector wide approaches (SWAPs) and direct budgetary support.This paper `A livelihoods-grounded audit of the Plan for the Modernisation of Agriculture in Uganda¿ is the fourteenth in the series of project working papers.Department for International Developmen

Goodbye to Projects? ¿ A livelihoods-grounded audit of the AIDS/STD programme in Uganda

Approaches to projects and development have undergone considerable change in the last decade with significant policy shifts on governance, gender, poverty eradication, and environmental issues. Most recently this has led to the adoption and promotion of the sustainable livelihood (SL) approach. The adoption of the SL approach presents challenges to development interventions including: the future of projects and programmes, and sector wide approaches (SWAPs) and direct budgetary support.This paper `A livelihoods-grounded audit of the AIDS/STD programme in Uganda¿ the thirteenth in the series of project working papers.Department for International Developmen

Goodbye to Projects? - Review of development interventions and livelihoods approaches in Uganda

Approaches to projects and development have undergone considerable change in the last decade with significant policy shifts on governance, gender, poverty eradication, and environmental issues. Most recently this has led to the adoption and promotion of the sustainable livelihood (SL) approach. The adoption of the SL approach presents challenges to development interventions including: the future of projects and programmes, and sector wide approaches (SWAPs) and direct budgetary support. This paper `Review of development interventions and livelihood approaches in Uganda¿ is the fourth in the series of the project working papers. This is the output of a literature review and series of interviews on development interventions in Uganda.Department for International Developmen

Goodbye to Projects? - Briefing Paper 3: The changing format of development interventions.

yesThis briefing paper reports on research exploring ten detailed case studies of livelihoods-oriented interventions operating in Tanzania, South Africa, Uganda and Lesotho. As a proxy for best practice, these interventions were analysed through an audit of sustainable livelihood `principles¿. This revealed general lessons about both the practical opportunities and challenges for employing sustainable livelihoods approaches to the design, implementation, monitoring and evaluation of development interventions and also about the changing format of development interventions.Department for International Development

Goodbye to Projects? Briefing Paper 1: An Overview: Projects and Principles.

YesThis briefing paper reports on research exploring ten detailed case studies of livelihoods-oriented interventions operating in Tanzania, Lesotho, South Africa and Uganda. Analysing these interventions through an audit of sustainable livelihood `principles¿ (as a proxy for best practice) revealed general lessons both about the practical opportunities and challenges for employing sustainable livelihoods approaches to the design, implementation, monitoring and evaluation of development interventions and also about the changing format of development interventions.Department for International Developmen

Goodbye to Projects? Briefing Paper 2: The Application of the SL Principles.

YesThis briefing paper reports on research exploring ten detailed case studies of livelihoods-oriented interventions operating in Tanzania, South Africa, Uganda and Lesotho. As a proxy for best practice, these interventions were analysed through an audit of sustainable livelihood `principles¿. This revealed general lessons about both the practical opportunities and challenges for employing sustainable livelihoods approaches to the design, implementation, monitoring and evaluation of development interventions and also about the changing format of development interventions.Department for International Development

Goodbye to Projects? - Briefing Paper 4: Lessons for the community-based planning interventions.

YesThis briefing paper compares two approaches to community-based planning in Tanzania, South Africa and Uganda. Analysing these interventions through an audit of sustainable livelihood `principles¿ (as a proxy for best practice) reveals general lessons about both the practical opportunities and challenges for employing sustainable livelihoods approaches to the design, implementation, monitoring and evaluation of development interventions and also about the changing format of development interventions.Department for International Developmen

Surgical need among the ageing population of Uganda

Background: Uganda’s ageing population (age 50 years and older) will nearly double from 2015 to 2050. HIV/AIDS, diabetes, stroke among other disease processes have been studied in the elderly population. However, the burden of disease from surgi- cally-treatable conditions is unknown. Objectives: To determine the proportion of adults above 50 years with unmet surgical need and deaths attributable to probable surgically-treatable conditions. Methods: A cluster randomized sample representing the national population of Uganda was enumerated. The previously vali- dated Surgeons Overseas assessment of surgical need instrument, a head-to-toe verbal interview, was used to determine any sur- gically-treatable conditions in two randomly-selected living household members. Deaths were detailed by heads of households. Weighted metrics are calculated taking sampling design into consideration and Taylor series linearization was used for sampling error estimation.   Results: The study enumerated 425 individuals above age 50 years. The prevalence proportion of unmet surgical need was 27.8% (95%CI, 22.1-34.3). This extrapolates to 694,722 (95%CI, 552,279-857,157) individuals living with one or more surgically treatable conditions. The North sub-region was observed to have the highest prevalence proportion. Nearly two out of five household deaths (37.9%) were attributed to probable surgically treatable causes.Conclusion: There is disproportionately high need for surgical care among the ageing population of Uganda with approximate- ly 700,000 consultations needed.Keywords: Surgical need, ageing population, Uganda

Balancing the Cost of Leaving with the Cost of Living: Drivers of Long-Term Retention of Health Workers: An Explorative Study in Three Rural Districts in Eastern Uganda

Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda. Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying. Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere. Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits

Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.

BACKGROUND: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART