AMREF News

To mark the first anniversary of our three-year Katine Community Partnership Project, Joshua Kyallo, country director of AMREF Uganda fielded questions from Guardian readers. You can read the transcript below or visit www.guardian.co.uk/katine for more coverage of this innovative project which is bringing good health — and hope — to one of the poorest regions of East Africa.

Please note that the order of the questions has been shuffled for the purposes of clarity. The questions and answers themselves have not been edited in any way.  

JoshuaKyallo | Nov 07 08, 10:56am: Hi everyone, thank you for joining our Katine chat today. Ill do my best to answer your questions. Looking forward to a great discussion.

Clare Thomas | Nov 06 08, 8:57am: Why Katine? Of all the places in all the world, why did you decide to work in Katine?

JoshuaKyallo | Nov 07 08, 10:59am: In response to Clare Thomas's question, this project could have been located anywhere in the developing world. The Guardian used a competitive process to select an NGO to implement this ground breaking initiative. The AMREF proposal looked at setting up the project in an urban slum community or a rural community -- Katine.

We chose Uganda, and the Katine sub-district, for several compelling reasons:

Uganda is a poor country in need of development but it does not have so many problems, like Somalia for example, where development is difficult. AMREF has also been working in Uganda since 1983, so has a strong relationship with key government ministries and local authorities. This is important because we need to generate political will to support health in the rural areas in the long-term. No funding will go to these bodies; AMREF will be providing support through the partnerships.

Soroti district is one of the poorest districts in the country and has been heavily affected by the war in the north, but not so much that development is impossible. Here, residents live on just 50p a day.

Katine is a sub-county with one of the worst health and living conditions in Uganda (Uganda population Census, 2002), where extreme poverty has been compounded by years of civil war and cattle rustling. Issues of poverty and violence are exacerbated by the fact that Katine communities are unable to access the services provided by local government.

flurry | Nov 06 08, 2:45pm: Are there any parts of the project you believe aren't working?

JoshuaKyallo | Nov 07 08, 11:05am: In response to Flurry's question, I would like to assure you that the project is doing very well overall. AMFREF is working with the District and communities to ensure that each project receives sufficient attention and is integrated with the others.

However, the livelihoods component and the community empowerment components have been relatively slower in implementation because of the extensive consultation processes that are involved. For the project to succeed and carry on with its own momentum beyond the three years, we need to make sure that the communities themselves play a leading role in the implementation of the project activities.

That means they can keep every aspect of the project running once our work is done in Katine.

AMREF has strengthened these components of the project by establishing strong community structures that in the long term will sustain the project. The establishment of the Project Management Committee at community level and the Project Steering Committee at District level has strengthened the involvement of Katine community and the Soroti District in the project planning and implementation.

This might sound a little academic, I realize – what it ultimately means is that people from the community are taking on leadership roles in the project.

Paul Cooper | Nov 07 08, 9:18am: Charles Marwa said in an article last week that there isn't a clear case for giving Katine villagers cattle, which is what they seem to want. What's the problem with giving them what they've asked for?

JoshuaKyallo | Nov 07 08, 11:16 am: In response to Paul Coopers question, without a doubt, cattle are highly valued by the Katine community. They are used a form of banking as a form of informal "banking" and they also play a big role in agricultural production. For instance, bulls/oxen are used for land opening in support of crop farming.

The reason why the project is not providing cattle to communities at this stage is because it would be far too expensive to try ton do this across the Katine sub-county.

AMREF has focused on the formation of Farmers Associations that if better organized can pool all locally resources together as we believe that this would be the most sustainable approach.

Barclays Bank, a partner in this project, is also working with CARE and UWESO (a Ugandan NGO) to develop a financial inclusion model that is aimed at ensuring increased availability of cash in the Katine economy. Increased cash in the hands of trained communities will result in more sustainable approaches.

Natasha Owen | Nov 07 08, 10:26am: What is AMREF doing about the lack of drugs available in Katine. I know there is a problem nationwide with getting hold of some drugs, but what is AMREF doing to change this? Who are you lobbying?

JoshuaKyallo | Nov 07 08, 11:31am: In response to Natasha Owens question, this remains an ongoing challenge.

AMREF is training health workers in drug management, forecasting and budgeting in order to address the challenge of stock outs in the health units. At the community level health facilities, we have revived and trained the health unit management committees who monitor the management of drugs and supplies.

Drug shortage is indeed a nationwide problem. We're doing our best to address this on the supply chain and strategic/policy levels.

Most of the challenges associated with the unavailability of drugs can be attributed to delays and errors at the health facility level in requesting the drugs and the delayed/inadequate delivery of the drugs to the health centre. We are working with the district, health centers and central Ministry of Health to improve the timely delivery of drugs to the health units.

AMREF in Uganda addressing this on all the key national policy making bodies and NGO coordination committees in the health sector. The Health Policy Advisory Committee, is one such forum, with the mandate to operationalise the Sector Wide Approaches through negotiation and policy dialogue, agreement of plans and undertakings among stakeholders in the health sector.

During the recently concluded Joint Review Mission of the Health Sector, AMREF together with other health development organizations, made a very strong case for MoH to address this (unavailability of drugs) as a serious impediment to health service delivery, and we are confident that this is a priority for the health sector.

The Ministry of Health has now taken the issue of drug shortage as a major priority in its planning and budgetary allocation processes. AMREF will continue to use its experiences in Katine to lobby policy makers at all levels to ensure that the issue of drugs remains a key priority for the Uganda Ministry of Health and its donors.

We expect to see improvements in the drug supply issue in the next few months.

Deborah Nash | Nov 07 08, 10:27am: What are your plans for the rest of the project?

JoshuaKyallo | Nov 07 08, 12:00pm: To answer Deborah Nash's question: The high level plans for the rest of the project will focus on improving access to community health, education, clean water and sanitation, livelihoods and engaging local communities in governance.

For the second year, we plan to strengthen all the existing community structures by building their operational and professional capacity through training, apprenticeships and provision of equipment. The third and last year of the project basically focus on ensuring the structures in place will enhance sustainability of the project so that it will continue very successfully into the future — run by the community itself.

In the health component, we are looking to improve quality of health services and the community-based prevention, treatment and care for HIV/AIDS, malaria, TB and childhood illnesses. Strengthening of the rural health systems especially referrals from the community to the health facilities.

The education component will be looking to improve the teaching and learning environment, promotion of inclusive education of orphans and vulnerable children (girls, disabled, etc) and strengthening community ownership over school supervision.

For water and sanitation, we plan to increase access to safe water, improve personal hygiene and basic sanitation and empower local communities to manage water sources.

The livelihoods component will focus on improving the capacity of rural innovation groups to manage themselves for the improved and sustainable livelihoods, establish rural livelihoods stakeholders forum for the sustainable coordination of livelihoods activities; harness technology to improve food security and enhance the farmer groups business and marketing skills.

As community empowerment is one component that underpins and integrates all the other components, we plan to strengthen the local governments and enhance community planning to better meet the community needs.

In order to ensure long term sustainability, AMREF will continue to strengthen community structures and to ensure that the Project Management Committee at Katine level and the Project Steering Committee at Soroti district level continue to play a critical role in the planning and implementation cycles of the project.

Based on what we've been able to achieve so far, even with a few delays at the beginning, we're quite optimistic about the future of the project and Katine.

 aMaverick | Nov 07 08, 10:52am: Is climate change affecting, or will it in the future affect, this part of Africa and Katine? If so how are you helping the community meet its challenges?

JoshuaKyallo | Nov 07 08, 11:19am: In response to aMaverick's question, climate change is certainly an issue here and in many parts of Africa. In some places, such as northern Uganda and Kenya, we're seeing shorter drought cycles over the past few years. This makes life difficult for farmers and can cause conflicts over increasingly scarce agricultural resources, such as grazing land. The problem of cattle rustling often has to do with this. People have to move further to find land on which to graze their cattle and they come into conflict with other people.

JoshuaKyallo | Nov 07 08, 11:25am: AMREF is currently addressing the issue of climate change and its impact, particularly on health. We are looking at the relationship between climate change and malaria and water sanitation. We're documenting experiences in central Uganda which will benefit our work in Katine. We're also involving ourselves more in the climate change debate on the international level and hoping the evidence we're gathering will bring to bear on that. 

Ariege | Nov 07 08, 11:07am: I'd like to ask whether any aspects of permaculture design have been taken into account in designing agricultural and livelihood strategies for Katine. I know that permaculture has been influential in other African projects and my experience working in the discipline leads me to think that it would have a great deal to offer.

JoshuaKyallo | Nov 07 08, 11:47am: In response to Arlege's question about permaculture, it is a question best answered by our partners at FARM-Africa, who are serving as technical advisors on the livelihoods/agricultural aspects of the project. Our colleagues at FARM are not available for this chat, but this is something we can discuss in greater depth in future ones.

JoshuaKyallo | Nov 07 08, 12:06pm: Going back to Ariege's question, we can provide a little more context on permaculture.

For the general readers, this word is derived from PERMAnent agriCUTURE - the framing approach that aims at sustainability stressing harmonious relationships between the people, animal, and the environment in general.

In the Katine project, AMREF is working with FARM to ensure that we put in place strategies aimed at attaining sustainable food security and diversified income sources for the Katine population without compromising the environment.

In an attempt to improve crop productivity, we are training farmers in soil, water and environmental conservation practices (establishing community managed multipurpose tree nursery beds), organic manure making (composting). In this way, the fodder trees from the nursery beds serve in restoring soil conservation, they also serve as feed for the livestock and the manure from the livestock recycle back the nutrients.

Our FARM-Africa will provide further information on this in the future, here on the Katine website.

KatineEditor | Nov 07 08, 11:29am: A teacher from Katine writes: My name is Eyedu Jean, a teacher in one of the schools in Katine and currently writing a blog on education in Katine. Here are a few questions to the country director of AMREF which I gathered from some colleagues in Katine:

The costs of most of the constructions/renovations of some of the schools in Katine are truly exaggerated.

Secondly, if this project is meant to benefit the people of Katine, then why not look for some of the people from either Soroti or Katine in particular to be part of the implementors of some of the activities being implemented in the area? This would even minimise some of the exaggerations being made in costing of some the activities being carried on and would even make the community develop a feeling that they are part of what is going on in their area like delegating some responsibility to the community.

JoshuaKyallo | Nov 07 08, 11:53am: In response to Jean Eyedu, AMREF recently reviewed the construction work that is being undertaken in Katine and compared it with similar construction works that AMREF undertakes in many other districts across Uganda. We found the costs in Katine to be reasonable. AMREF does a thorough analysis of all project costs on case by case basis in order to ensure quality and value for money. We are also working very closely with the district education team to ensure that all our activities are in line with the frameworks set by the key line Ministries of Uganda.

For all construction work, AMREF uses a transparent system where all prospective contractors (including those in Katine/Soroti) are welcome to bid through a competitive process. There is an independent selection that ensures that the contractors that we use can guarantee quality at a reasonable price. Katine communities are indeed involved in all the activities of the project. School Construction committees have been set up in Amoriokot and Kadinya schools that were recently constructed.

These committees selected local masons who were instrumental in the implementation of the construction work. The committees also monitor all construction activities as part of AMREFS strategy of promoting community ownership and involvement in all project activities. AMREF has recently used construction firms based in Soroti such as Nebo enterprises and OKH who have undertaken construction works in Oimai and Katine primary school, respectively.

In cases, AMREF contracts stipulate that the contractor must draw at least 60% of skilled and manual labor from the local communities and must use locally available construction materials, where possible. This remains true for Katine. 

Photo: Dan Chung/The Guardian