Protecting the Human Rights of HIV Infected Children, Adolescent Girls and Young Mothers, Aids Orphans and other Critically Vulnerable Youth and Women in Uganda

Project location: Uganda
Project start date: September 2013 - Project end date: September 2015
Project number: 2013-022
Beneficiary: A-Z Children Ltd T/A Nurture Africa (NA)


90% of defiled children currently do not fully access justice in NA's areas of operation (ANAPPCAN situation Analysis Uganda, 2009).
Defilement is the most common crime committed against children standing at 57.7% for all reported child abuse cases (ANPPCAN 2009).
78% of children and their guardians do not know their own and their children's human rights as laid out in the UN Convention on the Rights of the Child (1989); the African Charter on the Rights and Welfare of Children (1990); and the Uganda Children's Act (2000). This is a big gap because without children and guardians knowing their rights they will not be able to demand for them.
On top of that police stations have inadequate child friendly facilities and have inadequate documentation and data bases to monitor and adequately follow up on child abuse cases (Nurture Africa's Situation analysis, 2010).
HIV infected children are dying needlessly in Uganda. Currently there are 150,000 HIV infected children in Uganda. 80% of these HIV infected children will die before their 5th birthday if they do not access lifesaving ART (Anti-Retroviral Therapy) (World Vision Uganda 2010). Currently there are only 3 health centers in Uganda that are providing paediatric ART to over 500 children. NA already has two health centres built and is providing both ART and primary health medication to over 300 HIV infected children. NA is striving to become the fourth health centre to provide ART to over 500 children in one centre. By the end of 2013 we will exceed 500. In Nurture Africa's areas of operation there are over 1,200 HIV infected children.
HIV infected children, AIDS orphans and other vulnerable children are denied the basic human right to adequate primary health care. A recent survey report on Local Government (LG) health centres in NA's areas of operation revealed that these health centres persistently experience drug shortages which put the lives of over 68% of children below 5 years in danger (LG Health Centre Survey report 2011).
Preventable diseases such as malaria, pneumonia, typhoid, diahorrea and measles are still causing children to die prematurely in Uganda. Children below 5 years are the major consumers of health services in these government health centres and they need to have medication available throughout the year. The same survey demonstrated that 21% of households were unable to access alternative forms of health care whenever these government health centres experienced drug stock-outs, thus a violation of their right to health. Nurture Africa wants to ensure that every HIV infected child, AIDS orphan and critically vulnerable child (as stipulated in the Ugandan Orphan and Vulnerable Child Policy 2003) have the right to access ‘best practise' primary health care and to reduce the under-5 mortality rate in its areas of operation.
Due to lack of assets and savings 95% of poverty stricken households with HIV infected children or AIDS orphans do not have the ability to access livelihoods support or income generating activities (Nurture Africa Household Survey 2010).
80% of households either do not have a will or do not know the importance or the function of a will (Nurture Africa Household Survey 2010).
70% of the households of these children only have one meal a day and 80% of women in these households are unemployed and thus have no income (Nurture Africa Household Survey 2011).
Nurture Africa intends to educate 10,000 vulnerable children and their guardians on human rights and follow up on all child abuse cases, especially defilement, sexual exploitation, gross neglect and corporal punishment.
This is in line with the Nando Peretti Foundation's goals of promoting human rights and protecting children.
Nurture Africa intends to provide all of these children with primary health services in conjunction with the local government health centers and ensure that at least 1,100 of these HIV infected children, adolescent girls and guardians gain access to ‘best practice' ART by 2015. Nurture Africa only helps the critically vulnerable child.
Nurture Africa intends to provide 20,000 AIDS orphans, HIV infected children and critically vulnerable children ‘best practice' primary health treatment by 2015.
These are in line with the Nando Peretti Foundation's goals of prioritising projects for those who live in situations of extreme economic and social hardship.
Nurture Africa intends to provide 1,000 households with livelihoods support in the form of income generation training and by providing a microfinance loan in the next 2 years. This will ensure the sustainability of the project also.
This is in line with the Nando Peretti Foundation's focus on the economic and material support for those who live in extreme hardship or poverty.

The aim of this project, which received a grant from the Nando Peretti Foundation, is to enhance the realisation of the rights of HIV infected children and AIDS orphans and their families by developing the capacity of duty-bearers (guardians, mothers, caretakers) to meet their obligations and the HIV infected child and AIDS orphans to effectively claim their rights to enjoy a state of physical mental and emotional well- being that allows them to be productive and to achieve their full potential.
This project will ensure that the ‘duty bearers' uphold the rights of the HIV infected child and AIDS orphan and that they are protected from all forms of abuse and exploitation; and from hazards and harm. At the same time this project will increase and improve HIV infected children and AIDS orphans' access to quality comprehensive primary health care and specialized HIV care and treatment services in Nurture Africa's areas of operation.
This project will ensure these children obtain fair treatment, parental guidance and health care so as to become active Ugandan citizens.
NA has recently constructed its second paediatric HIV and Primary Health Centre. These are the only specialised paediatric health centres North of Kampala in Wakiso District. By working with the Local Government (LG), the Ministry of Health, international donors such as CDC (Centre of Disease Control) and PEPFAR (The President's Emergency Plan For AIDS Relief), NA will be able to address the high under- 5 mortality rate amongst HIV infected children, AIDS orphans and other critically vulnerable children in Wakiso and Mubende Districts.
These health centres are a hub for the communities Nurture Africa operates in and act as a protective environment for children and women. These health centres will be providing lifesaving medical treatment for critically vulnerable children and other services for women such as PMTCT (Prevention of Mother to Child Transmission) of HIV and reproductive health services.


(a) Conducting a human rights situation analysis:
This is intended to identify the claims and perceptions of rights-holders (including children) and the corresponding obligations of duty-bearers (guardians, police, local council leaders etc.) as well as the immediate, underlying and structural causes of the non-realisation of children's' and women's' rights. Thus, during project implementation, NA will ensure that the current human rights gaps identified during the situational analysis are adequately addressed by the project activities.

(b) Conducting human rights trainings:
Provision of quality HIV and primary health care and treatment services to HIV infected children and AIDS orphans, other critically vulnerable children and their families is not sufficient if they do not get a voice in the community and learn to stand up for their rights. Orphans, vulnerable children, adolescent girls and women learning about their rights and being empowered to act if these rights are violated are integral to the success of this project. Trainings will take place mainly in schools. Training of trainers' workshops with Civil Society Organisations, the police, local council leaders and child protection committees will take place at the Nurture Africa health/ community centres. Every school will get peer education workshops and child rights groups will be formed. Boys will receive the same information and talks as the girls and the consequences of defilement and sexual assault will be stressed. Human rights trainings will also be extended to women's groups and issues concerning gender equality, domestic violence and how to report child abuse or domestic violence cases will be adequately covered.

(C) ‘Systems strengthening' community child protection referral systems
NA will mobilise, train and strengthen community child protection referral systems with 30 Civil Society Organisations (CSOs). Such a system will bring together different CSOs who will provide different services to cases of child abuse and gender based violence (GBV). NA will also ensure that child protection committees are strengthened at village level. The CSO and child protection committees will collaboratively work together in the referral systems to ensure that child abuse and GBV cases within the community are identified and adequately followed up to meaningful conclusion.

(c) Provide Primary Health Care (PHC) treatment to 20,000 children
NA's pediatric health centre will provide specialist primary health services to OVC ranging from treatment of infectious diseases, especially the major causes of death to under- 5 year olds, including malaria, diahorrea, typhoid, pneumonia and opportunistic infections caused by HIV, injuries, nutritional services for any malnourished children, counseling and psychosocial support. The provision of PHC to OVC will ensure that OVC live healthier lives and will reduce on infant and under-5 mortality.

(d) Provide HIV treatment to children, adolescent girls and young women
HIV treatment in children and adolescent girls is challenging. For this reason many organisations choose to treat adults. Nurture Africa's main focus is on children, adolescent girls and young mothers. HIV treatment is a lifelong regime and if taken correctly is lifesaving. NA intends to provide lifesaving ‘best practice' HIV treatment in its health centre and offers lab tests (CD4 counts, HB levels, HEP B, syphilis etc.) to monitor all clients on anti-retroviral treatment (ARV). This activity will target 500 children, 200 guardians and 200 female youth aged 15-24 in the year 2013 while in 2014 a total of 600 children, 250 guardians and 250 female youth aged 15-24 will be covered.

(e) Provision of PMTCT and reproductive health services to young mothers
It is now possible with the advances in HIV treatment for children with HIV infected mothers to be born HIV negative. The current national rate of MTCT is 28% but government is fast tracking moving from Prevention to Elimination of Mother to Child Transmission of HIV (from PMTCT to e-MTCT). This activity will ensure that less than 5% of the mothers on the PMTCT program pass HIV to their babies. Nurture Africa is targeting 100 positive women in 2013 and 500 positive women in 2014. PMTCT services will include:
A maternal and child health center in an out patients (OPD) setting incorporating antenatal care, postnatal care, immunization, linkage to the Laboratory for laboratory tests and screening and linkages to the ART clinic/pharmacy for ARVs and Septrin prophylaxis. Under special circumstances, emergency deliveries will also be provided.
A range of Reproductive Health services that will include health education to the mothers and their spouses, screening and treatment of Sexually Transmitted Infections, family planning services and distribution of condoms.
While these mothers can be linked to the PHC clinic for lab tests and drugs dispensation, some specific staff is required in this setting and notably: mid wives, receptionists and couple/PMTCT counselors.

(f) Provide SMC (Safe Male Circumcision) to boys and youth
Due to an increase in new HIV infections, the National HIV Prevention Strategy 2011/12- 2014/15 has been broadened and emphasized by government to include Safe Male Circumcision (SMC). Research has proven that getting circumcised can contribute to a 60% reduction in HIV transmission in males who are circumcised. The provision of SMC to boys, youth and children, will require the setting up of a best practice minor theatre in Nurture Africa's Health Centre.
NA will employ specific staff have to be attached to the theatre and will include a clinician/surgeon, Nurses, theatre assistants, cleaners and waste handlers. NA will target 2,500 boys and youth in 2014.

(g) Provision of PEP (Post Exposure Prophylaxis) to all rape and defilement cases
It is government policy to provide PEP to all those that have been exposed to HIV through a needle stick injury, rape or defilement. The window for this to be effective is 48 hours. Education of this fact needs to be rolled out to women and children to ensure that they seek help immediately.
Nurture Africa will be preparing for a minimum of 200 rape/ defilement cases that requires PEP. NA shall be working with the police and local councils to ensure that all defilement and rape cases should be reported immediately and handled promptly.

(h) Conducting home care visits to families of orphans and other vulnerable children.
In order to effectively monitor the health status of HIV infected children and young mothers home care visits will be conducted. This will include providing psychosocial support and to address issues of adherence, positive living, maintaining a safe environment, hygiene and nutrition. Issues regarding human rights violations including GBV and child abuse will be referred to the NA child protection team, child protection committees, the police or local council leaders and CSOs in the referral system. A team of 10 community workers, 5 child protection officers, 4 nurses and 2 counselors will conduct these visits.

(i) ‘Systems strengthen' health care referral system
NA will ensure the community health care referral system is strengthened with 3 health centres, 20 CSOs and 6 VHTs with the aim of providing OVC and young women with comprehensive health care services. The government health centres and VHTs refer OVC for HIV and PHC services. NA target is that 80% of patients in our area of operation will be successfully referred to and from the health centres. NA predicts that more CSO will start regularly referring their clients once more training on the referral system is conducted.

(j) Creation and strengthening of 2 District Human Rights Commissions
NA will facilitate the creation of a District Human Rights Commission in Mubende district and use this Commission and the Commission it is already a member of in Wakiso District as a platform to promote human rights and also ensure that CSOs mainstream gender, human rights and HIV/AIDS.

(k) Assist with the follow up on child rights violations in the project area
NA will ensure that all reported cases are adequately followed up. Without cases being brought to justice the community will not gain confidence in the child protection system and in turn they will not report cases of human rights violations. Police stations in NA's areas of operation have limited facilities such as vehicles or even motorcycles to follow up reported cases of child abuse. NA will provide assistance to follow up such cases. NA will also provide support to victims during the prosecution process by way of legal and psycho-social support and also cover some costs.

To ensure effective documentation of child rights violations, NA will build the capacity of 5 police stations and 20 local council leaders to keep adequate records and also sufficiently follow up cases in the community. NA, through the 2 formed District Human Rights Commissions will also ensure that there is a formal mechanism where all duty bearers can come together and address human rights violations.

(l) Provide income generation management training and a microfinance loan to critically vulnerable families.
The capacity of vulnerable households will be built to ensure that they can sustainably meet the basic needs of vulnerable children under their care. This is vital to ensure these critically vulnerable families lead independent lives. It is also vital to the sustainability of the project.

Operational Procedures

A) Partnerships and networks
NA will strengthen its formal partnerships and referral system to ensure that the rights and needs of HIV infected children, AIDS orphans, adolescent HIV infected girls, HIV infected young mothers and critically vulnerable children and their families are comprehensively addressed. Currently, NA has signed Memoranda of Understandings with 30 NGOs to work together in a health care referral network. NA intends to increase its network to 50 schools, 50 CSOs, 5 police stations, 20 village child protection committees and 20 local councils in year one of the project cycle.
NA also has formal partnerships with many small grass roots CBOs in Wakiso and Mubende districts and provides capacity building to them. This will ensure the sustainability of its projects. Thus, to effectively implement this project, NA will create more effective partnerships with the police, legal aid agencies, government institutions and other relevant organisations with similar objectives of promoting children's rights.

B) Ensuring effective participation
NA acknowledges that every woman and child has the right to be able to give their opinion and actively contributes to society as a citizen. By exercising their rights to information, expression and association, women and children are able to demand their rights. In this project the views of HIV infected children, AIDS orphans, other critically vulnerable children, adolescent HIV infected girls, young HIV infected mothers and their families will be adequately listened to and considered in the planning, implementation and evaluation of the project.
Participation in the planning, implementation and evaluation of the project will not be limited to only children, women and their families but will include duty-bearers at village, sub county and district levels including probation and social welfare officers, religious leaders, clan leaders, representatives from NGOs, health centre managers, school administrators, sub county chiefs, Town council officials, local council chairpersons, local council secretaries on children's affairs, health and school inspectors, lawyers, police, and parliamentarians in the project locations. This will be done through holding workshops, sharing of work-plans, developing an adequate referral system and adequate documentation. Through workshops duty-bearers will share views and work-plans on how best to implement and evaluate an effective child protection system within NA's areas of operation and the entire District.
To promote children's participation, the project will conduct workshops to raise awareness and developing skills in children's participation. The project will also initiate and enhance community forums in which leaders will be accounting to the community members on a quarterly basis.

C) Capacity building of rights-holders and duty-bearers
Capacity is the sum of all factors that enable individuals, communities, institutions and government to adequately perform their respective roles and responsibilities. In order for HIV infected children, AIDS orphans, other critically vulnerable children and their families to claim their rights, they need to know what their rights are and how they are being addressed, how decisions are being made and by whom and what mechanisms exist to seek redress in cases of violations. This can be achieved through providing human rights education workshops and also by providing live examples of cases being followed up thoroughly, which will in turn motivate the community to report violations as they know justice can be served.

In addition, capacity building will enhance the abilities of duty-bearers including probation and social welfare officers, religious leaders, clan leaders, representatives from NGOs, health centre managers, school administrators, Sub county chiefs, Town council officials, local council chairpersons, local council secretaries on children's affairs, health and school inspectors, lawyers, police, parliamentarians to fulfill their obligations towards HIV infected children, HIV infected adolescent girls, HIV infected young mothers, AIDS orphans, other critically vulnerable children and their families.

D) Advocacy
Community based efforts to raise awareness about the connections between health care and child rights will be adopted. These will include; use of brochures printed in local languages for broader outreach, banners, posters, music and drama and community workshops. These community based advocacy strategies will be complimented by the use of radio presentations.

NA uses the ‘rights based approach' to improve the quality of life of HIV infected children, HIV infected adolescent girls, HIV infected young mothers, AIDS orphans and other critically vulnerable children and their families by focusing on their needs, problems and potential. NA integrates child rights and gender equality at all levels of its programmes including analysing immediate causes of rights violations, setting up strategies to empower the most vulnerable children as well as reinforcing the capacity of duty-bearers and also evaluating and monitoring programmes with participatory processes. Building the capacity of children, adolescent girls, and their families will empower them to claim for their rights.
Nurture Africa also believes in ‘community participation'. Community participation is central if HIV infected children, HIV infected adolescent girls, HIV infected young mothers, AIDS orphans and critically vulnerable children and their families are to effectively claim their rights. Participation ensures that primary health care and HIV/AIDS prevention and treatment services are locally acceptable and sustainable in the community. This is simply because it is every one's right to be involved in decisions and actions that impact on their lives.
To ensure that these children and their families realise their rights, this project will ensure that collective action is maintained. The project will work in partnership with government departments at the District and Town Council level, the police, judiciary and other civil society organisations in the local area and at all levels to provide advice and share ideas on organisational annual work-plans. The creation of partnerships and networks for this project will lead to efficiency in project implementation and eliminate duplication of activities.

This project aims at the following goals:
• Over 1,100 HIV infected children and female adolescents and young mothers will gain access to lifesaving anti-retroviral medication
• The under- 5 mortality rate will reduce by 75% to up to 20,000 HIV infected children, AIDS orphans and other critically vulnerable children gaining access to free ‘best practice' primary health care per year (15,000 in yr. 1, 20,000 in yr. 2).
• Over 2,500 males will be at a 60% less risk of HIV due to receiving Safe Male Circumcision
• Over 600 HIV infected mothers will receive Prevention of Mother to Child Transmission and Reproductive Health Services significantly reducing their chances of transmitting HIV to their child (100 in yr. 1, 500 in yr. 2).
• 10,000 children and their guardians will understand their human rights and learn how to act should child abuse occur.
• A child protection network and referral system will be strengthened to ensure that all reported cases are followed up to a satisfactory conclusion, i.e. successful prosecution in defilement cases etc.
• A health network referral system strengthened resulting in fewer drug stock outs and all children receiving appropriate high quality health care throughout the year
• 20 Village child protection committees will be strengthened
• 2 District Human Rights Commissions will be formed and active
• 1,000 guardians of HIV infected children, AIDS orphans and critically vulnerable children will be trained in income generation and be given a microfinance loan resulting in them being able to lead sustainable, independent lives

Multiplier effects
Case studies of HIV infected children leading healthy happy lives are prompting more people in these communities to go for HIV testing knowing that they too can access anti-retroviral treatment if they are HIV infected (Last year Nurture Africa tested over 6,000 children and adults for HIV).
Sensitising children and the community is insufficient unless you can demonstrate to them that cases are actually taken seriously and followed up to a successful conclusion. Successful prosecution of defilement cases are prompting more members of the community to seek justice.
60,000 family members will indirectly benefit from the human rights trainings as guardians will roll out information learnt to their families.
6,000 family members will indirectly benefit from the guardian's income generating activities after receiving a microfinance loan.
Partner CSOs who are also involved in trainings will use this to target more of the population in child rights, health care and sustainable livelihoods.
Strengthened child protection and health community systems will be strengthened meaning that thousands of women, men and children will benefit

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