O-Link Project

The project “Evaluating enhanced electronic-orphans and vulnerable children’s linkage model to HIV and other health and community services in Uganda (O-Link)” is implemented by Makerere University School of Public Health (MakSPH) in collaboration with Baylor Uganda, Ministry of Gender Labour and Social Development (MGLSD) and Ministry of Health with funding from Centers for Disease Control and Prevention (CDC). The project is evaluating enhanced electronic orphans and vulnerable children’s linkage model to HIV and other health and community services in Uganda.  The enhanced electronic model involves the use of weekly short messaging system (SMS) and monthly telephone calls with data collection and tracking conducted with the help of Android ODK enabled tablets with finger print and barcode unique identification numbers.

The project operates in Mpondwe Lhubiriha and Hima town councils in Kasese district, Busiriba and Mahyoro sub counties in Kamwenge district which were selected based on high prevalence of Orphans and other Vulnerable Children (OVCs). The target included all OVCs aged 0-17 years and their caregivers in households prioritised by Baylor-Uganda. Over 340 households were enrolled with about 1,020 OVCs.

The households were reassessed using MGLSD standardised tools and the OVCs found vulnerable were referred for HIV and other health and community services which formed the baseline. The referral points included the health facility that serves the study site, Community Based Organisations (CBOs) in the area and at the Town Council/ Sub-county for service offered by governments. Monthly and quarterly household follow ups were made to the enrolled household for a period of 8 months. An end line evaluation is being concluded during which all the enrolled households have been assessed based on the different core program areas.

To better understand the existing barriers and facilitators of linkage, qualitative baseline and end line data collection was conducted with the different stakeholders including; Focus group discussions with Households with female caregivers, children who are out of school, child headed, and HIV positive caregivers. Key informant interviews were also conducted with district community development officers, district probation officers, district secretary health services, district OVC focal person- Baylor-Uganda, sub county/Town council community development officers, health facility OVC referral and linkage focal persons, and a group interview with the data collection assistants.   

Data management

The data collection was done electronically using android tablets and paper based using paper forms. The electronic data was synchronised and uploaded to server at MakSPH in real time. Power BI visual platform was used to monitor data upload and flow. There were no issues with data transmission and upload apart from temporary internet outage at the server which would always be rectified.

The paper based data was converted to electronic daily, edited and also uploaded to the servers. The paper based data collection was filled and stored in lockable cabinets and all household data files with unique identification number. 

Enrollment

Findings

The project team has embarked on data processing and report writing for both quantitative and qualitative studies. However, from the verbal reports from the performance review with the data collection teams, the following have been noted.

• There is now increase awareness of OVC services availability in the different study sites resulting from the many households who were linked for services.
• There is awareness of the HIV status among study participants who didn’t know. These were referred for HIV testing and now they know their status and that of their children
• Through index testing follow up by the health facility, it was established that some participants who had adherence challenge and lost follow up were identified and these are now back in care and are adhering to the drugs.
• Through the monthly follow ups, the hope and sense of belonging for OVCs has been restored through service provision including education support, food security, psychosocial support, economic strengthening among others

Challenges and recommendations

1. Migrations and change of location; the migrations within and outside the study sites and failure to find care givers at home were one of the challenges faced during the data collection exercise.
2. Awareness of advanced referral services; there is limited awareness of advanced referral services most especially children with severe disability.
3. There was prolonged drought which adversely affected households in terms of food security. These OVC households have children who are severely malnourished and require immediate direct support which is lacking among the different service providers.
4. Death; caregivers and some of the OVCs died which led to transfer of some children to live with other relatives outside the study sites. Some of the OVCs have also died.
5. Long distances to the different service points leading to many missed opportunities amongst households 

Take note:

1. Action pictures
2. Project goals and objectives
3. Funding source
4. When did the project start and when will it end
5. Successes so far
6. Numbers