Contact Persons:

Director
Network
Dr Samuel Kalibala
P.O. Box 2598 Kampala, Uganda
Tel +256 772 638 540 (Uganda)
Tel +254 722 514 371 (Kenya)
Tel 202 441 1483 (USA)
Skalibala@hotmail.com
Skalibala@popcouncil.org

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An Appeal from Namulaba Health Center in Uganda

Chairperson Namulaba CBO

Mrs. Margaret Kizito
Tel +256 751 933 462

The Namulaba Health Center is a private not for profit health facility licensed by the
Ministry of Health as a Health Center-II. It is located in an eight-room building on a
farm in Namulaba village. On your way from Kampala, the capital city of Uganda, to
Jinja town, the source of the River Nile, you turn left at a township called Namataba
which is located 35 Km from Kampala. From Namataba, you drive 8 Km on an earth
road to reach Namulaba. The journey from Kampala to Namulaba takes about 1.5
hours by car if the traffic on the highway is light.
Catchments population: The services provided by Namulaba Health Center are
targeted to a rural population in Uganda in Mukono district in Nagojje Sub-county 1.
The sub-county has a population of 17,241 men, 17,365 women (total 34,606) living
in 8,468 households with an average of 4 people per household (2014 census 2).
GAPS IN HEALTH INDICATORS
HIV Prevalence: Nagojje is in Central-2 region of Uganda where the HIV
prevalence is 9.2% while the average for Uganda is 7.3%. Unprotected sex with
multiple sex partners remains the main mode of HIV transmissionabout one
quarter (23.4%) of the men reported having multiple sexual partners in the past 12
months. HIV testing is the gateway to HIV care and prevention. Knowledge of HIV
status can enable people living with HIV to seek HIV treatment and to use condoms.
Knowledge of HIV negative status can empower people to use condoms and to seek
1 In 2014 Uganda had a total of 1382 sub-counties

2 http://www.ubos.org/onlinefiles/uploads/ubos/NPHC/NPHC
%202014%20PROVISIONAL%20RESULTS%20REPORT.pdf

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additional preventive measures such as male circumcision. However, in spite of

Uganda having a well-established HIV response in Nagojje less than half the adults
(36% of women and 47% of men) were classified as having comprehensive HIV
knowledge. And only about half (48%) of the residents have ever been tested for
HIV and received test results and the circumcision rate among men aged 15-49
years is quite low (26%) (Uganda AIDS Indicator Survey 2012). In the formative
stages of Namulaba Health Center we carried out a community survey in which we
reported that there were varying levels of abstinence depending on age and sex of respondent.
Abstinence was likely influenced by fear of HIV/STD and pregnancy but apparently not all abstinence was by
design since some said they just had not had the opportunity for sex. Not all were faithful to one partner.
Condom use at last sex was reported by a minority3.

Mother and Child Health: In Nagojje out of 1000 children 90 die before the age of
five years mostly due to malaria, HIV and other preventable communicable
diseases. Childhood immunizations provided by the expanded program of
immunization is very effective in preventing many of the common childhood killer
diseases. However, in Nagojje only three quarters (76%) of the children aged one
year were immunized against measles. The total fertility rate in Nagojje is quite high
the average number of children per woman currently aged 40-49 years is seven.
Currently, less than one third (30%) of women aged 15 to 49 years are using a
modern family planning method. However, the unmet need for family planningthe
women who want to use a modern family planning (FP) but are not accessing itis
high (30% and is the same for younger and older women. Almost all (94%) of the
women report receiving ante natal care from a skilled provider, for the last
pregnancy, but only 70% report delivering their last baby under a skilled provider.
Birth registration is quite lowonly 25% of children in Nagojje had birth certificates
(Uganda DHS 2011).
Adolescent Health: The median age at first sexual intercourse in Nagojje is 16.6
years for females aged 20 to 49yrs and 18.4 years for males aged 20-54 years thus
confirming that girls are starting sexual intercourse at an earlier age than boys. This
implies that many girls are having cross-generational sex with older men probably
in exchange for money and goods and favors. And there is a high rate of teenage
pregnancya quarter of teenagers aged 15 to 19 years (22.6%) have ever been
pregnant and many end up leaving school and never returning to school due to the
pregnancy. But as mentioned above the unmet need for FP is quite high 30% thus
giving us an easy opportunity to intervene by providing FP services to these willing
users. (Uganda DHS 2011)

The prevalence of ABC (abstinence, being faithful and condom use) and factors influencing
abstinence in a rural community: baseline survey of Namulaba church of Uganda AIDS project

D. Sebyayi Muwanga, S. Kalibala: https://www.aids2014.org/Default.aspx?

pageId=12&abstractId=2190968

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Other Social Health Gaps: Prior to the commencement of the Namulaba project a
needs assessment survey was carried out and the findings were discussed in focus
group discussion (FGD) with key stakeholders in the community. The key findings
from the needs assessment and the FGDs were reported in the first project proposal
that was submitted to Avert UK in January 2007 4 and funded in February 2007. The
following paragraph summarizes the community concerns:
While it was apparent that these community leaders, young and old, believed that
sex was inevitable the youth leaders mentioned some conditions for youth to have
sex These included age, consent and knowledge of HIV status. Its also important
to have sexual relations after consent and at a right age. In Uganda the acceptable
age is 18 years for boys and girls. However, before you engage in sexual relations
you are supposed to go for a blood test and always remain faithful to each other.
Community leaders also said that there were factors such as alcohol, pornographic
videos, provocative clothes, deteriorated morals and peer pressure that prevent
people from abstaining from sex. It was also mentioned that many engage in sex to
get money and gifts and as such cannot abstain. But it was also felt that overall
lack of awareness or concern about the epidemic might be a factor in preventing
abstinence. The liberal nature of todays society was blamed as the main cause of
early sex among teenagers. There was also mention of a form of dilemma which
some parents face in terms of instilling discipline and moral values in their children
versus the need to observe childrens rights. Some parents are very relaxed
towards their childrens behaviour because they claim that the childs rights law
overshadows them.
NAMULABA HEALTH CENTER ESTABLISHED IN 2007 TO ADDRESS HEALTH
GAPS
Mode of service delivery
The project started providing medical services in June 2007. The main clinic
operates on the last Saturday of every month. The staff includes two clinical
officers, two laboratory technicians, two HIV counselors and three nurses. The
services provided include primary health care and HIV counseling and testing. On
the first three Saturdays of the month a nurse operates a community pharmacy
which enables community members to purchase medicines for simple illnesses. The
pharmacy

is

managed

by

the

Namulaba

Network

of

Community

Based

Organizations (CBOs). The money for buying the first stock of medicines was
obtained from a local fundraising event that was organized by the CBO Network and
4
https://www.scribd.com/doc/273170393/Namulaba-Proposal-to-Avert-9-Jan-2007

attended by the area member of parliament. The medicines are sold at almost cost
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price and this enables the pharmacy to re-stock its supply. The salary of the nurse is
paid by our project. The nurse also examines and treats patients who come seeking
care. On these Saturdays the clinic is also used as an outreach post for the ministry
of health to provide family planning and child immunization services. In December
2011 we added maternity services to the services we provide. For more details
about the number of people we serve and the services we deliver please click these
links which will direct you to our annual reports 5,6,7, 8, 9.
Funding received and services delivered
The project was started by the Director (Dr Samuel Kalibala 10) on his farm land in
February 2005. He was prompted by the number of patients who would come to him
for help whenever he visited the farm. The rationale for starting a health center on
the farm is presented in Namulabas first newsletter 11 dated February 2008 from
which the following paragraph was excerpted:
5
Annual Report 2009/2010: https://www.scribd.com/doc/273252885/NamulabaAnnual-Report-1-August-2009-to-31-July-2010
6
Annual Report 2010/2011: https://www.scribd.com/doc/273253296/NamulabaAnnual-Report-August-2010-to-July-2011-FINAL-Draft-8-Sept-2011
7
Annual Report 2011/2012: https://www.scribd.com/doc/273253475/NamulabaAnnual-Report-August-2011-to-July-2012-Draft-12-May-2013
8
Annual Report 2012/2013: https://www.scribd.com/doc/273257741/NamulabaAnnual-Report-August-2012-to-July-2013-FINAL-31st-March-2014
9
Annual Report 2013/2014: https://www.scribd.com/doc/273253671/NamulabaAnnual-Report-August-2013-to-July-2014-FINAL

Imagine you are a health worker who works on HIV and AIDS but you have bought land in a

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remote location, where you think people do not know you, to develop a retirement farm. What
would you do if when you reach your farm, you find a sick looking woman with a 2 year old
daughter who has a high fever and she asks you for help? She says she has been told that you
are a doctor and that she lost her husband and her 2 year old daughter has malaria and she
herself is sickly and she has no money. Do you immediately put her and her child into your four
wheel drive truck, which you came with because the roads were so bad you could not use a
simpler car, and take her to the nearest hospital one hours drive away? And what do you think
you would find there? I bet you would find an outpatient department that is operated by unmotivated under-paid staff. You would find that they are short of basic supplies and medicines,
that their labs do not have the necessary reagents and that the facility is over crowded with
patients and they do not have a constant supply of electricity and water.

In February 2007 the project got its first external funding of UK 9,414 from
AVERT12, a UK based charity. This funding helped with the purchase of equipment
and the clinic became operative from June 2007. Using this funding the project
provided services for eight months until January 2008. During this period each
patient was contributing about 10% of the cost of a medical visit. Young people,
pregnant women, VCT clients and people living with HIV were paying no cost-share
fee for the service.
During that 8 month period we provided the following services.

Primary health care to a cumulative total of 1,026 clients

HIV testing to a cumulative total of 279 clients (referring those testing
positive for ARV treatment)

Between February 2008 and July 2009 we had no external funding and we depended
on resources from the farm. In addition each patient was contributing about 20% of
the cost of a medical visit. This included young people, VCT clients and people living
10
http://www.google.com/webhp?
nord=1#safe=active&nord=1&q=Dr+Samuel+Kalibala+CV
11
https://www.scribd.com/doc/273094538/Namulaba-Update-Newsletter
12
http://www.avert.org/

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with HIV. Only pregnant women are exempted from the cost-share fee for the
service. As a result the number receiving services decreased and this decrease
disproportionately affected the most vulnerable including women, children, the
elderly and the unemployed.
During that 17 month period we delivered the following services:
Primary health care to a cumulative total of 1,433 clients
HIV testing to a cumulative total of 449 clients (referring those testing
positive for ARV treatment)
Malaria testing to a cumulative total of 395 clients (treating all those testing
positive using the highly effective drugsArtemesimin combined therapy
(ACT))
The project was funded by a kind Swedish couple for five years from July 2009 at a
rate of US$ 12,500 per year. During this period each patient was contributing about
10% of the cost of a medical visit. Young people, pregnant women, VCT clients and
people living with HIV were paying no cost-share fee for the service.
In the five years of this gift we delivered the following services:
Primary health care to a cumulative total of 7,592 clients in the main clinic
and 988 in the community pharmacy (nurses clinic).
HIV testing to a cumulative total of 1,508 clients (referring those testing
positive for ARV treatment)
Malaria testing to a cumulative total of 2,145 clients (treating all those
testing positive using the highly effective drugsArtemesimin combined
therapy (ACT))
Family Planning to a cumulative total of 485 women
Immunization to a cumulative total of 1,383 children
272 ante natal care (ANC) consultations (over a period of 32 months since
maternity opened in Dec 2011)
Delivered 72 babies (over a period of 29 months since first delivery in March
2012)
Since August 2014, the project has had no consistent external funding and is
depending on resources from the farm. In addition each patient is now contributing
about 20% of the cost of a medical visit. This includes young people, VCT clients
and people living with HIV. Only pregnant women are exempted from the cost-share
fee for the service. As a result the number receiving services has decreased and this
decrease disproportionately affects the most vulnerable including women, children,
the elderly and the unemployed.
In the past 12 monthsAug 2014 to July 2015 we have managed to provide the
following services:

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Primary health care to a cumulative total of 676 clients

HIV testing to a cumulative total of 249 clients (referring those testing
positive for ARV treatment)
Malaria testing to a cumulative total of 335 clients (treating all those testing
positive using the highly effective drugsArtemesimin combined therapy
(ACT))
211 ante natal care (ANC) consultations
Delivered 21 babies
A cumulative total of 24 youths have attended the youth club since its
inception in March 2015.
Currently we are providing these minimal services using funding from the farm-$560 per month comprising of personnel ($282); transport ($108); general
expenses ($60) and drugs ($110). Please see details of this survival budget at this
link13.

So, how can you help us?

As per our story above over the eight years of existence of this health center, since
June 2007, we have been fortunate to have got external funding for 8 months from
Avert and for 5 years from the Swedish couple. From August to December 2014 the
Swedish couple provided us with an additional $5,000 as bridging funds as we tried
to establish a community based health insurance (CBHI). The effort to establish the
CBHI is currently on hold because it requires a substantial amount of funding to set
up the system.
Here are our asks to you:

The fully operational monthly budget of Namulaba Health center is $1,659.

This includes personnel salaries ($830); transport ($253); general expenses
($106); community activities ($50); and drugs ($420). Please see the budget
details at this link14. We are seeking this amount per month in order to be
able to provide the services we provided during the five years of the gift from

13
https://www.scribd.com/doc/273186607/Namulaba-Survivalbudget-Jul31-2015
14
https://www.scribd.com/doc/273186393/Namulaba-Fully-Operationalbudget-Jul312015

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the Swedish couple plus the following community activities which we have
ever delivered before but stopped due to lack of funds:
o Health education events targeting in-school youths (essay
competitions, seminars about adolescent sexuality)
o Church seminars providing health education
o Competitions in football for boys and netball for girls during school
holidays targeting in-school and out of schools youths with health
education messages
o Music dance and drama competitions targeting adults and youths with
health education messages
o Mobile HIV voluntary counseling and testing (VCT) provided at trading
centers in the community
If you provide us with $1,000 per month we will be able to provide the
services we provided during the five years of the gift from the Swedish
couple.
If you provide us with any amount you are able and willing to provide it will
help reduce the current burden of $400 per month on the farm.
We have a vision for a community based health insurance, if you have
interest in joining us in this learning experience please do come. We need to
learn how to provide sustainable health care to low income families using a
kind of insurance system appropriate for low income earners.