“People – and their children – need our projects to continue, uninterrupted, and at a high quality. Without consistent funding, that becomes precarious and lives and livelihoods are threatened”

“People – and their children – need our projects to continue, uninterrupted, and at a high quality. Without consistent funding, that becomes precarious and lives and livelihoods are threatened”

John Paul Dongo, Acting Director, The Union Uganda Office, and ‘Achiever’ profile for March

John Paul Dongo is leading an assault on an epidemic. As Acting Director for The Union’s Uganda office, he and his team are part of the frontline tackling the region’s pressing tuberculosis (TB) and HIV problems, including TB in children and adolescents – the latter being an epidemic in its own right, yet largely unacknowledged globally.

“TB, TB in children and HIV/AIDS are major public health problems in Uganda,” says John Paul. “HIV is the leading risk factor for the development of TB, and TB is the leading cause of death among people living with HIV/AIDS. The Ministry of Health (MoH) places a lot of emphasis on delivering integrated TB/HIV services to control these dual epidemics, so this is both our test and our priority.”

The challenge is not insubstantial. HIV prevalence in Uganda is estimated at 7.3 percent, and approximately 44.4 percent of TB patients are also co-infected with HIV. Additional issues concerning TB in children and adolescents, and rampant TB co-infections, not only with HIV but also diabetes, also amount to individual public health challenges. Taken together, they are a crisis.

Not easily discouraged, it was John Paul’s desire to practice public health that has led him to his current role. He joined The Union in 2011, as Project Coordinator and Trainer for The Union’s SPARK-TB (Slum Partnerships to Actively Respond to Tuberculosis in Kampala) Project, after graduating from Mbarara University of Science and Technology and a period working as Ward Manager at Kampala’s International Hospital.

“The Union gave me a platform to develop my personal interest in public health. I was impressed with how The Union understood Uganda’s health system structure at national, regional, district, facility and community levels. It also offers excellent capacity, knowledge and understanding of TB programmes and experience in the implementation of TB and TB/HIV interventions. I really wanted to work for this organisation.”

The Union Uganda Office was established in 2007 and was The Union’s first country office in Africa. In its short history, the office has delivered some of The Union’s most innovative and effective projects for combatting TB. For example, the SPARK-TB initiative, through fostering public-private partnerships, has built the capacity of private health facilities in specific districts of Uganda that has improved access to quality TB diagnosis and treatment in private health facilities for urban poor dwellers.  

More recently, in January 2016, The Union, in partnership with the MoH-Non-Communicable Disease Programme, the National TB and Leprosy Program (NTLP) and Kampala Capital City Authority, and funded by the World Diabetic Foundation, started active screening of TB patients for diabetes mellitus (DM) and linking the DM patients into chronic DM care. Capacity for DM screening and care has since been improved in TB clinics within 10 participating facilities, with automatic DM testing for 95 percent of TB patients.

And, between 2015-2016, the DETECT Child TB project has improved childhood TB case finding, treatment and prevention. In partnership with the MoH and NTLP, Baylor College of Medicine Children’s Foundation and Mildmay Health Centre, Uganda, The Union has piloted the DETECT Child TB project in two Ugandan districts through funding from ELMA Philanthropies Foundation and an anonymous donor through Vital Strategies.

As a result, TB case finding among children has more than doubled. The percentage of at-risk children receiving TB preventive therapy increased from less than 5 percent to 80 percent by the end of the project. TB treatment success for children improved from 65 percent to 82 percent. At national level, the project supported the MoH-NTLP to develop training materials, job aids, reporting and recording materials on child TB for both facility and community-based health workers. The model also mobilised and provided training to community health workers so that they can visit patients’ homes, conduct household contact tracing and provide treatment adherence support to TB patients. The DETECT Child TB model is to be scaled up to 10 new districts from 2018-2020 by the NTLP with support from the Global Fund.

These are phenomenal gains in a country where the ground and challenges keep shifting. John Paul says, “Uganda is among the top 30 high burden TB/HIV countries and the country misses approximately 40 percent of TB cases annually. The NTLP is majorly dependent on donor funding; is understaffed and has inadequate funding to fully execute its mandate. There is sub-optimal management of drug-susceptible TB, unfavourable treatment outcomes continue to persist and are a potential risk to the development and spread of multidrug-resistant TB (MDR-TB) in communities. There is an irregular supply of second line anti-TB medicines and cartridges. And with a lack of ambulances to transport MDR-TB patients, public transport is by necessity used instead. You can imagine that this just fuels the transmission of this infectious disease…this is the reality of the challenge.”

The Uganda team is under no illusions in terms of what is needed to buffer these testing conditions. John Paul says, “We need a sustained supply of funding so that we can plan and, more to the point, execute that plan - without being in fear that the rug will be pulled out from under us. People – and their children – need our projects to continue, uninterrupted, and at a high quality. Without consistent funding, that becomes precarious and lives and livelihoods threatened. I want people to understand what we do here, to take on board the scale of the challenge, and provide the funding and support we need to address it.”

With the scale of the problem in Uganda, and with TB presenting as both an economic and a health issue, it remains an on-going challenge that Uganda’s national budgets for TB management are woefully under-funded. According to the World Health Organization’s most recent Global TB Report, the budget for Uganda’s national TB programme is $54 million, of which only 29 percent is funded, leaving 71 percent requiring alternative funding. Stoking that crisis, of the 29 percent, only three percent of that is covered from domestic sources; while 26 percent is covered by external grant funding. This is the reality of a situation that impacts on the activities of The Union’s Uganda office every single day.

A large part of John Paul’s role is supervision, training and mentoring of administrative and project officers working on TB, TB-HIV and Child TB and TB-Diabetes initiatives.

“Management is a full-time job,” explains John Paul. “I work closely with the project officers in planning project activities, drafting reports, work plans and budgets, and ensuring the implementation of work plans to specific deadlines. All this has to be reported back to The Union headquarters in the form of financial reports, forecast and expenditures.”

“I am the coordinator, the lead writer for all our grant proposals and in charge of submissions for The Union Uganda office. And I spend time proactively exploring opportunities for funding, including meeting with potential donors, as well as liaising with our office, The Union headquarters and existing donors. This is not optional – it’s a vital component of our work. The majority of the work we do is fully dependent on donor funding – people in the most vulnerable positions are relying on this. The bottom line is that, despite this being life-saving work, the funding is never guaranteed and is, frankly, perilous.”

Despite this, John Paul has high hopes for the future. “I think The Union and its partners have achieved remarkable transformation in child TB indicators through the DETECT Child TB model. I envisage a future where this very innovative decentralisation of childhood TB management can be scaled up nationally and also adapted for all resource-limited settings globally. It’s a big aim but TB, and children with TB especially, need us to aim high and deliver – I don’t see any other option.”

John Paul counts himself fortunate to be surrounded by strong female role models that he finds personally inspiring. “I must acknowledge Dr Paula Fujiwara (The Union’s Scientific Director) who, as well as tirelessly providing one-on-one coaching and mentorship to the Uganda team, has had the faith in me to lead the Uganda office. And I will be forever grateful to Dr Anna Nakanwagi-Mukwaya for her continued support to the office, even after retiring from the position as Country Director.

“I want to pay tribute to my family, especially my mother and wife. My mother for raising me as a single parent after the death of our dear father. And my wife inspires me to work hard and become a better listener!” Recently married, John Paul looks forward to “a beautiful family of my own.”

While The Union takes the bulk of his attention, there is time – just – for outside interests. “I am passionate about farming and in my free time, I am involved in animal and crop husbandry. There is something calming about looking after the land, crops and livestock.”

 

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