The Social and Political Potential of Cash Transfers by Maxine Molyneux

Author:Maxine Molyneux [Molyneux, Maxine]
Language: eng
Format: epub
ISBN: 9780367142537
Barnesnoble:
Publisher: Taylor & Francis
Published: 2018-12-19T00:00:00+00:00

Towards a New Social Contract in Rural Uganda? The Mini TASO Project

TASO is an indigenous NGO, established in 1987 to ‘contribute to a process of preventing HIV, restoring hope and improving the quality of life of persons, families and communities affected by HIV infection and disease’ in Uganda (Grebe & Nattrass, 2009). In 2003, TASO crafted the MTP as a capacity-building programme that involved various training programmes for government health workers, financial support to district hospitals, and supporting citizens to demand their rights and engage in coproduction activities with service providers. The name suggested the intention to transform government hospitals into ‘TASO-like’ agencies which recognised PLHIV as full citizens and ensured that they received the required treatment in an effective and accountable manner (TASO, 2005). Between 2003 and 2010, TASO annually initiated partnerships with two to four district local governments to transform the HIV/AIDS departments in their main hospitals into Mini TASOs. According to TASO documents (TASO, 2005, 2007) and interviewees, MTPs were established through a three-phase programme that involved site mobilisation, capacity building, and service delivery. The MTP thus constitutes both a protective and a transformative form of social protection (Devereux & Sabates-Wheeler, 2004, p. 10), in that it seeks to both increase the provision of the drugs required to ameliorate the effects of HIV/AIDS and to challenge disempowering and discriminatory tendencies that have reduced PLHIV to the status of second-class citizens.

Prior to TASO’s intervention in 2006, both Kamuli and Masafu hospitals had introduced antiretroviral therapy (ART) programmes in 2005. Government guidelines stated that before a health facility was accredited to provide ART services, it ought to have capabilities in various areas, including: the presence of basic physical infrastructure for the treatment of PLHIV (for example space for counselling and testing, drug storage facilities); qualified personnel with experience in HIV/AIDS management, and the ability to ensure the provision of follow-up care and support for families and communities with PLHIV (Okero, Aceng, Madraa, Namagala, & Serutoke, 2003).

However, TASO’s own evaluation of its intervention sites deemed them to have ‘inadequate levels of capacity, resources, community mobilization and community involvement’ (TASO, 2007, p. 18). The capacity assessment found that these units had neither the social nor the physical infrastructure for providing ART. Our own research confirmed this: in Masafu, one respondent recalled that health workers started providing HIV/AIDS services ‘with hardly any basic understanding of the processes involved in this specialised service area’ (Male health worker, Masafu, 14 April 2011). Health workers in Kamuli hospital also claimed that, prior to 2006, they lacked the skills in psychosocial work required to educate and provide counselling services to PLHIV. These observations were further confirmed by the findings of a 2008 Uganda Ministry of Health survey, which reported that ‘only one third of facilities prescribing ART and/or medical follow up services have a provider trained in ART prescription or medical services and in counselling for adherence to antiretroviral (ARV) drug therapy’ (Ministry of Health and Macro International Inc., 2008, p. 187).

Health workers noted that their

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