BASELINE EVALUATION OF THE BLOOM PROJECT IN UGANDA
Aidsfonds – Soa Aids Nederland is a Dutch non-profit organisation that works with communities as equals and conducts research in addition to ensuring that HIV, AIDS and STIs remain high on the agenda worldwide. Aidsfonds developed the Bloom project with a goal of creating a healthy life for children exposed to HIV and their young mothers living with HIV (aged 10-24 years) in Uganda. The Bloom project runs from June 2023 until May 2026 and it is implemented in 5 districts of Uganda by 3 community-based HIV partners namely; Community Health Alliance Uganda, Uganda Young Positives and Joy Initiative Uganda. The 5 districts are Mpigi, Mityana, Butambala, Mubende and Kyenjojo.
Aidsfonds sought the services of Bodmando Consulting Group to carry out a baseline evaluation of the Bloom project. The main goals of the baseline assessment were;
1. To determine key baseline indicators and benchmark data and to collect general benchmark information about young mothers living with HIV and their children, the demand for and access to PMTCT/HIV treatment and care services, and the indicators formulated for the Bloom project.
2. To provide general benchmark information on the current situation regarding existing government policy/guidelines on young mothers, uptake of (informal) health services at community and facility level, retention rates, and PMTCT/paediatric HIV care.
3. Understand the facilitators and barriers of young mothers and their children in enrolment for eMTCT, HIV care, support and treatment services in the targeted areas. This includes analyzing PMTCT demand and uptake by young mothers living with HIV and creating an understanding of this process and its barriers.
4. Understand the facilitators and barriers faced by young mothers living with HIV and their children in access, utilization and retention in paediatric HIV care in the targeted areas at family, community, and health facility levels. This includes the uptake of informal health services at community and health facility level and the availability of child-friendly services for children living with HIV, the availability of paediatric HIV interventions by government and any other Non-Government Organizations (NGOs).
The baseline evaluation adopted a comprehensive, mixed-methods approach, combining both qualitative and quantitative research methods to gain a deep understanding of the context and challenges faced by young mothers living with HIV. Key components of the approach included:
1. Participatory and Consultative Approach: Throughout the evaluation, Bodmando employed participatory and consultative techniques. We closely consulted Aidsfonds and the three local implementing partners (Community Health Alliance Uganda, Uganda Young Positives and Joy Initiatives Uganda). They provided input during the development of the evaluation framework, the implementation process and provided technical insights during report writing.
2. Feminist Evaluation Approach: Bodmando Consulting Group designed and implemented a methodology based on the feminist evaluation principles which pay attention to participatory, empowering, inclusive, and social justice agendas that seek to provide knowledge that increases social justice for women and other disadvantaged women groups. We did this by using a gender lens and ensuring that Young Mothers Living With HIV and Children Living With HIV are given maximum opportunity to voice their perspectives during the interviews and focus group discussions.
3. Social ecological model: Bodmando used the social ecological model to analyse and report the barriers and facilitators in access, utilization and retention in paediatric HIV services in the targeted areas. Findings were presented at individual, family, community, health facility and system levels considering young mothers living with HIV and their children.
4. Evaluation Design: The evaluation was cross-sectional in design. We utilised a mixed methods approach involving a review of data from the District Health Information System 2 (DHIS2) software, review of both peer reviewed and grey literature from government websites including the conducting of In-depth interviews, Key Informant Interviews, and Focus Group Discussions. The quantitative methods were based on a retrospective analysis of data for key HIV/AIDS service delivery and utilization indicators from the DHIS2 system for the period April 2023 to June 2023.
Participants included Community Health Workers, Bloom project partners, young mothers exposed to or Living with HIV, pregnant and breastfeeding young mothers living with HIV, Children Living With HIV, caregivers of young mothers living with HIV, networks of young people living with HIV, health care workers, senior woman teachers, district HIV focal persons, community support groups, local religious and community leaders and church support groups. For the young mothers living with HIV, we focussed on the 15-19- and 20-24-year age groups and the younger than 10 and 10-14-year age groups for CLWHIV
The baseline evaluation played a crucial role in addressing the client's problem by providing actionable insights that informed the design and implementation of the Bloom project. Here’s how it contributed to solving the client’s problem:
Identification of Service Delivery Gaps: The evaluation highlighted several key gaps in the delivery of HIV services, such as the lack of youth-friendly services, poor integration of HIV care with maternal and child health services, and inadequate follow-up for children born to HIV-positive mothers. By identifying these gaps, the evaluation enabled the Bloom project to focus on specific areas needing improvement, thereby enhancing the overall effectiveness of the interventions.
2. Addressing Social and Cultural Barriers: The thematic analysis of qualitative data revealed the extent to which stigma, gender inequality, and social isolation were preventing young mothers from accessing HIV services. Understanding these barriers allowed the project to develop targeted strategies, such as community-based interventions and gender-sensitive approaches, to reduce stigma and empower young mothers.
3. Informed Strategy Development: The comprehensive data collected through the evaluation informed the project’s strategic direction. For example, insights from the IDIs and FGDs guided the development of interventions that were more aligned with the needs and preferences of young mothers, such as the creation of support groups and the introduction of economic empowerment initiatives.
4. Baseline Data for Impact Measurement: By establishing baseline data, the evaluation provided a reference point against which the impact of the Bloom project could be measured. This enabled the client to monitor progress, evaluate the effectiveness of interventions, and make data-driven decisions to refine the project’s approach over time.
Empowering the Target Population: The participatory nature of the evaluation empowered young mothers by involving them in the assessment process. This not only gave them a voice but also built trust between the project team and the target population, increasing the likelihood of successful intervention implementation.
In summary, the baseline evaluation was instrumental in diagnosing the key challenges faced by young mothers living with HIV and provided the necessary insights to develop a well-informed, effective Bloom project.
