Person-Centered Care, Uganda.

Person-centered health systems acknowledge patients as partners in their own care and support trusting patient-provider relationships. Person-centered care is organized around the comprehensive needs of people rather than individual diseases. It engages and empowers people in full partnership with health care providers in promoting and maintaining their health. Person-centered care considers a patient’s social, career, cultural, and family priorities and determinants as important facets of health. Positive patient perception of patient-provider interactions and quality of care is associated with better health experiences. However, this kind of intervention has never been practiced and/ or overlooked.

This has resulted into negative patient’s perception of the quality of care which is related to shortages of regular place of primary care, difficulties in communication with the primary care clinic, and a lack of coordination of care.  There has been inadequate education and shared knowledge; inadequate Involvement of family and friends;  inadequate Collaboration and team management;non- Sensitivity to non medical and spiritual ;dimensions of care; inadequate Respect for patient needs and preferences and  no Free flow and accessibility of information.

 Addressing these gaps requires system-wide changes in the incentive structure and organizational culture of primary care systems to promote more person-centered care. Hence Integrated people-centered health services approach is very vital. We are therefore proposing five interdependent strategies for the development of responsive people-centered health systems that deliver high-quality, safe, and acceptable services for all:

•Empowering and engaging people and communities - This strategy aims to empower individuals (including underserved and marginalized groups) with the opportunities, skills, and resources to make decisions about their own health and be empowered and engaged users of quality health services. It aims to enable communities to be actively engaged in co-producing healthy environments for individuals and be capacitated to deliver informal care that improves the health of communities (training and networks for community health workers, social participation, community delivered care).

•Strengthening governance and accountability - This strategy aims to strengthen governance using a participatory approach to policy formulation, decision-making, and performance evaluation at all levels of the health system. To reinforce good governance, a robust system for mutual accountability across stakeholders and a people-centered incentives system should be in place.

•Reorienting the model of care - This strategy calls for a people-centered approach to primary health care for the design and delivery of efficient and effective services that are holistic, comprehensive, and sensitive to social and cultural needs and preferences.

•Coordinating services within and across sectors - This strategy leverages multisectoral and intersectoral partnerships and the integration of health providers within and across settings and levels of care to promote care coordination. Coordination focuses on improving the delivery of care to better respond to the needs and demands of people.

•Creating an enabling environment - This strategy involves creating an enabling environment to bring all stakeholders together to transform all of these strategies into an operational reality. In order to effect change, this task involves a diverse set of processes in the domains of leadership and management, information systems, quality improvement methods, workforce development, legislative and policy frameworks, and health financing and incentives.

How does Person-Centered Counselling work? Counsellors, psychotherapists and psychologists using the person-centered approach work to offer clients an understanding approach that is non -judgmental and honest/friendly. The main focus of the counselling is decided by the client, who is able to discuss what might help.

We are targeting the rural poor women , children and men who are many times not considered in many development  initiatives. The situation here is very appalling with HIV prevalence peaks at 14.0% among men aged 45 to 49 and 12.9% among women aged 35 to 39. Among young adults, there is a disparity in HIV prevalence by sex. HIV prevalence is almost four times higher among females than males aged 15 to 19 and 20 to 24. HIV prevalence is nearly three times higher in men and women aged 20-24 compared to those

aged 15-19(UGANDA POPULATION-BASED HIV IMPACT ASSESSMENT UPHIA 2016–2017).With this solution, their well- being will be improved ( productivity, employment enhancement, education improvement).

We are centered in these rural  communities; we know their problems, work together with them to solves issues and the trust us.

Through our work, we always plan together with the beneficiary community for every project we do -- from the initial planning stage to the point when we implement the system -- adapting everything to the community’s needs. This brings the community on board fully to gain responsibility and ownership of the system. Then, after implementing the systems, we keep in touch with the community leadership making sure all is running well. Because of this approach, we have been able to maintain 100% performance of all our 80+ projects, creating long-lasting impact and providing basic services for many years.

Widespread implementation of person-centered care requires a restructuring of the incentive structure and vision at the system level to increase to capacity of facilities to achieve person-centered high-quality primary health care. It is a new solution that needs to be promoted/ advertised. All  these arrangements require money and technical banking. It cannot be done single handily hence the need for partnership building.MR

It is a person - centered solution focused on pointing out new ways of measuring primary  health care performance improvement in low-middle in-come countries. Other structures have been in place but this one we are proposing  will avail users with Key attributes of person-centered care as: 

• Education and shared knowledge
• Involvement of family and friends
• Collaboration and team management
• Sensitivity to non medical and spiritual dimensions of care
• Respect for patient needs and preferences
• Free flow and accessibility of information

Availability, Accessibility, and Affordability of Interventions that Promote Rights of PLHIV and Other People Affected By, or at Risk of HIV ;stigma and discrimination reduction; training of health workers in providing group-specific friendly services (e.g., PLHIV-friendly, KP-friendly, youth friendly, PWD-friendly services/practices); engagement with duty-holders or duty bearers; providing legal literacy; proving legal aid services; reducing discrimination of women in the context of HIV; and advocacy for legal reform, strategic litigation, and legal reform monitoring.

Primary Health Care Performance  core Indicators ( PHCPI) will be used:

• PHC spending per capita ($USD)
• % of government health spending allocated to PHC.
• Government PHC spending as % of current PHC spending.
• Out-of-pocket PHC spending as % of current PHC spending

When people are empowered, they can  develop their communities by making rightful decisions hence prevent occurrences of many diseases that affect their lives.

Therapists who practice OUR  person centered therapy should exhibit three essential qualities: genuineness, unconditional positive regard, and empathetic understanding. This is accompanied by mind- set change.

Our team is  a group of everyday people living everyday lives, with a shared desire to make a difference in the world.

We have 6 men and 4 women in our team. These are all determined and motivated staff to make the solution succeed. Among the team are 3  persons Living  with HIV/ AIDS and 1 person with disability.

Our business model is people centered. We will raise awareness on sustainability of HIV programmes. People need information. We will empower and engage people and communities  in project implementation- This strategy aims to empower individuals (including underserved and marginalized groups) with the opportunities, skills, and resources to make decisions about their own health and be empowered and engaged users of quality health services. It aims to enable communities to be actively engaged in co-producing healthy environments for individuals and be capacitated to deliver informal care that improves the health of communities (training and networks for community health workers, social participation, community delivered care). Governance and accountability will be strengthened using a participatory approach to policy formulation, decision making. Capacity building will be carried out. and  We will also Create an enabling environment - This strategy involves creating an enabling environment to bring all stakeholders together to transform all of these strategies into an operational reality. In order to effect change, this task involves a diverse set of processes in the domains of leadership and management, information systems, quality improvement methods, workforce development, legislative and policy frameworks, and health financing and incentives.

We will seek additional  grants from other donors , local government, and also  Angel Investors. We will use  our voluntary efforts too.

Past Funders:

S/N

Name of funder

1

Mission St. Paulus-Holland -1998(3students supported to secondary level of education; all have finished University and are giving back to their communities).

2

Sister Servite Charitable Trust – UK- 1999 (25 poor women from Mukongoro sub- county benefited from the goat project supported and were able to provide for their families).

3

ABILIS Foundation- Finland -2002 (25 deaf women in Ogosoi, akadot, Komolo and Agaria villages benefited with one heifer each).

4

Feed the minds – UK -2009 (25 rural women were trained to read and write under the” breaking the cycle of illiteracy in the Teso women” project.

5

One percent fund for development, Geneva -Switzerland-2015,2017, 2019(Four projects funded: On- farm improvement of indigenous chickens; Beekeeping for 15 rural poor farmers; training 25 poor rural women in sewing; Dairy cows for rural poor women.

6

Association of Independent Tour Operators (AITO) in collaboration with Just a Drop – UK- 2014 (3 communities in Mukongoro sub- county, south of Kumi District had deep boreholes drilled for them to improve access to water and hygiene).

7

Redd Burnet – 2000 (Youth for youth reproductive health and rights project. 30 youth benefited).

Current donor

8

Kitchen Table Charities Trust – UK- 2020/2021(Aojamorok / Kabukol nutritious vegetable growing project. 35 rural women are benefiting.