Abstract
In 2005, Hospice Africa Uganda (HAU) signed a cooperative agreement with USAID Uganda. The program was entitled "Expanding the access to and scope of Palliative Care for People Living with HIV/AIDS (PLHIV) and their families". The overall objective of the program was to increase access to and utilization of quality palliative care service by PLHIV's and their immediate families. Aims of the Palliative Care Program were: (1) improving access to holistic Palliative Care for PLHA's and their immediate families; (2) strengthening specialist palliative care competencies within the public, private, faith based and civil society HIV/AIDS service providers; and (3) influencing national policy to reposition pain, symptoms management and end of life care within the overall health and HIV/AIDS care delivery. The purpose of the evaluation was to present an independent opinion on the impact of expanding coverage and access of Palliative Care services (PC) through the Hospice Africa Uganda program over the last 5 years. The evaluation was also intended to document lessons learned and best practices developed from the implemented program. The key evaluation questions included: (1) HAU has training care providers as one of its major approaches--were the trainings delivered effectively and efficiently; (2) how well has HAU design and structure addressed factors facilitating or hindering palliative care giving [and] what was the value-addition of HAU sub-partners; (3) analyze the relevance of palliative care in the era of expanding access to Anti Retroviral Therapy (ART); (4) how effective has HAU been in influencing national policy and practice on palliative care; (5) what is the likelihood that this program will be successful [and] given the rate of achievement of results and current approaches and activities, assess the prospect that this project will achieve all its intended results; (6) how sustainable are HAU activities and results[and] suggest modifications to increase sustainability; and (7) what are the lessons Learned and best practices? The evaluation team concludes the following: (1) the HAU program is most likely to be successful; however, certain elements of holistic PC services like psycho-social and spiritual care delivery need to be strengthened; (2) HAU trainings effectively and efficiently transferred specialized PC skills [and] Implementing Partners (IPs) now must take this forward, integrating PC in AIDS care and treatment, and rolling out trainings through Continuous Medical Education (CMEs); (3) the 2009-2013 program design and structure satisfactorily addressed the hindrances identified at end-phase 1 evaluation, and leveraged the facilitating factors [and] emerging hindrances were identified mostly at facility/district level; (4) PC remains relevant even with expanding ART [and] PLHIV on ART suffer pains, psychosocial and spiritual needs, yet for Uganda, less than 10% of PLHIV in need have accessed PC; (5) although the policy influence targets were satisfactorily achieved, the short term outcomes are not yet translated into budget allocations for PC activities and they remain unknown at district and facility levels; and (6) the HAU PC program has established several structures for sustainability, though considered to be at infancy. (Excerpt, modified)