National Plan Of Action For Implementing The National Policy On HIV .
National Plan of Action forImplementing the NationalPolicy on HIV/AIDS and theWorld of WorkMinistry of GenderLabour and SocialDevelopmentOctober 2010National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work
Published by Ministry of Gender Labour andSocial Development Ministry of Gender Labour and Social DevelopmentISBN: 978 - 9970 - 205 - 02 - 8
ForewordThe HIV/AIDS pandemic is a global crisis and is one of the development challenges.HIV/AIDS knows no geographical or social boundaries. World over many workers at theirmost productive age have been affected by the AIDS scourge. HIV/AIDS has a profoundimpact on workers and their families, enterprises and national development initiatives. AIDSis known to hamper efforts to reduce poverty, and indeed often increases the number ofpeople living in extreme poverty. HIV/AIDS undermines the principles of decent work, inthat it reduces job opportunities for men and women and violates their rights as workers.The scourge also reduces the supply of labour and available skills, increases labour costs andreduces productivity.The workplace, both formal and informal, is increasingly being recognized as one of the keyentry points to prevent the further spread of the HIV/AIDS as well as to mitigate its adverseeffects at the work place. The challenge lies in dealing with issues of stigma and discrimination,changing requirements for health care benefits, training and building institutional capacities tointegrate and mainstream HIV/AIDS at the workplace, developing centres of excellence tolearn from and the craving need to prevent further HIV infection among workers.Within the framework of the national overarching policy on HIV/AIDS coordinated bythe Uganda AIDS Commission, the Ministry of Gender Labour and Social Developmentdeveloped the National HIV/AIDS and the World of Work Policy adopted in 2007. Thepolicy provides the basis for the development of workplace guidelines focusing on the specificissues related HIV /AIDS at the workplace and responses.The National Plan of Action has been developed to implement the National Policy on HIV/AIDSand the World of Work. It has been guided by the ILO Code of Practice on HIV/AIDS andthe ILO Convention on Discrimination No. 111 (1958). The Plan of Action provides a uniqueopportunity for a wide range of stakeholders, Uganda AIDS Commission, line Ministries, theprivate sector led by the Federation of Uganda Employers, the workers represented by theNational Organisation of Trade Unions and the Central Organisation of Free Trade Unions,the civil society organizations and the bilateral organizations donors, to influence coordinatedactions in scaling up the HIV/AIDS response particularly in the labour sector.Government commends the ILO for the technical guidance and the UN Joint Programme ofSupport on AIDS for the financial support as well as all the partners who participated in thedevelopment of this plan of action. I urge all partners to join the Ministry of Gender Labourand Social Development in concerted action to mitigate the impact of the HIV/AIDS in theWorld of Work.GABRIEL OPIO (M.P)MINISTER OF GENDER LABOURAND SOCIAL DEVELOPMENTNational Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Workiii
CUNAIDSUNASOUSAIDUWONETWoWivAgency for Corporation and Research on DevelopmentAIDS Information CentreAcquired Immune Deficiency SyndromeAlliance of Mayors and Municipal Leaders on HIV/AIDS in AfricaAnti-Retroviral TherapyCentral Organisation of Free Trade UnionsCollective Bargaining AgreementCommunity Development Resource NetworkCivil Society OrganizationsFaith Based OrganizationsFederation of Ugandan EmployersHIV Counselling and TestingHealth Initiatives for the Private SectorHuman Immune-Deficiency VirusHuman Rights NetworksInformation Education and CommunicationInternational Labour OrganisationInternational Non Governmental OrganizationsJoint Clinical Research CentreMinistry of Education and SportsMinistry of Energy and Mineral DevelopmentMinistry of HealthMinistry of Finance, Planning and Economic DevelopmentMinistry of Internal AffairsMinistry of Justice and Constitutional AffairsMinistry of Gender, Labour and Social DevelopmentMinistry of Public ServiceMinistry of Trade, Tourism and IndustryNational Forum for People Living with HIV/AIDS Networks in UgandaNon Governmental OrganizationsNational Organisation of Trade UnionsNational Plan of ActionNational Strategic PlanStop AIDS NowStart and Improve Your BusinessThe AIDS Support OrganisationUganda AIDS CommissionJoint United Nations Programme on AIDSUganda National AIDS Services OrganisationsUnited States Agency for International DevelopmentUganda Women Organization NetworksWorld of WorkNational Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work
Table of ContentsForeword.vAcronyms.viExecutive Summary .viiBackground .1Goals and Objectives for the Policy and National ActionPlan for HIV/AIDS at the World of Work.12Strategic Focus for the National Plan of Action for the Implementationof the National Policy and the World of Work .14Institutional Arrangements for the Implementation of the NationalPlan of on HIV/AIDS and the World of Work .48Monitoring and Evaluation Arrangements for theNational Plan of Action .52Annex .53References .57National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Workv
viNational Plan of Action for Implementing the NationalPolicy of HIV/AIDS and the World of Work
Executive SummaryThe National Plan of Action (NPA) has been developed to implement the National Policyon HIV/AIDS and the World of Work. The prevalence of HIV among workers acrossdifferent sectors of the economy is highest among the public administration which is at16.3%, while for the hotel and restaurant sector it is at 10.3%, for sales it is 9.8%, while8.6%, 7.4%, 7.1%, 7.0% and 6.9% for real estate, manufacturing, fishing, transport andcommunication and domestic employment respectively. For health and social workers theprevalence is 7.9% while education stands at 6.3%. Vulnerability causes a high risk ofHIV infection among workers. Other risk factors include: Long hours at work, mobility and work postings that separate spousesDisposable income among workers, driving them into risky social and sexual behaviour.Poor health seeking behaviour for HIV/AIDS prevention and treatment servicesPerception that workers particularly the civil service and NGO sector are well informedabout HIV/AIDS issues.Limited efforts and coverage of HIV/AIDS work place interventionsSexual exploitation, abuse, rape, and favours for promotion, training opportunities,avoidance of transfers or for better work positions / stations and job security.Dis-empowered junior level female workers who are submissive to sexual demands oftheir superiors to secure their employment status/ positionsLow level of risk perception that HIV/AIDS is a serious problem at home andworkplaces.The profit driven and not people centred private sector, giving low priority to thewelfare of workersPoor and exploitative working conditions especially among plantations and large firmsLow level of empowerment of workers who are unable to demand for their rights.It is therefore important that workplaces join efforts for the national HIV/AIDS response.The NPA has been developed within the framework of the national policy for HIV/AIDSand the World of Work, and has the following objectives:1. To implement measures for reducing vulnerability and risk of HIV infection at thework place2. To develop and implement responses that will mitigate the social economic impact ofHIV/AIDS at the work place3. To institute work place measures for provision of treatment, care and support toworkers infected and affected by HIV/AIDS4. To strengthen institutional capacity of organizations to respond to HIV/AIDS at thework placeThe NPA has four sectoral areas of focus, which are: The public, private, NGO sectorand the Workers’ Union sectors. The focus of the NPA under each sectoral area is asfollows:National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Workvii
Public SectorThe public sector led by the Ministry of Public Service. The support to the public sectorwill be to strengthen their institutional capacity to deliver the following: To implement comprehensive HIV prevention services to public servants their familymembers especially those that address their vulnerability and risk factors, in eachministry department and Government Agency. To implement comprehensive treatment, care and support measures for public sectorstaff who happen to be HIV infected To address measures for mitigating the social – economic effects of HIV/AIDSamong public sector staff affected by HIV/AIDS in each ministry department andgovernment agency To support measures that will ensure that the public sector institutions are able tomanage the HIV/AIDS response at the work place To increase advocacy for resource mobilization and allocation for HIV/AIDS workplaceinterventions.Private SectorThe private sector led by the Federation of Uganda Employers (FUE). The support toFUE will be to strengthen their institutional capacity to deliver the following: To ensure a functional and sustainable HIV/AIDS work place for the private sector,both formal and informal economy To foster a collaborative arrangement between the Employers’ and Workers’organizations for a common harmonised approach to HIV/AIDS management andresponse at the work place To ensure that member organizations institute measures in accordance to the minimumstandards for managing the HIV/AIDS response at the workplace To undertake a comprehensive assessment on the nature and magnitude of impact ofthe HIV/AIDS epidemic in the informal sector and recommend appropriate mitigationresponses. To support measures for rights-based approaches and legal empowerment of workers To increase advocacy for resource mobilization and allocation for HIV/AIDS workplaceinterventionsWorkers’ OrganizationsThe two labour union centres NOTU and COFTU will lead the Workers’ Organizations.The support to Workers’ Organizations will be to strengthen their institutional capacity todeliver the following:viiiNational Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work
To strengthen the delivery of workers’ rights and empowerment of labour unionmembers to realise their rights including those related to HIV/AIDS To ensure compliance of employers to occupational safety and health measures,particularly those that reduce occupational hazards in relation to HIV/AIDS. To ensure negotiation of comprehensive provision for HIV prevention, care andtreatment and protection of workers’ rights in the Collective Bargaining Agreements(CBA) To ensure implementation and evaluation of CBAs To raise HIV/AIDS awareness and education, including HIV/AIDS services amonglabour union members and other workers To ensure meaningful participation of labour union members and other workers inimplementation of HIV/AIDS workplace programmes To increase advocacy for resource mobilization and allocation for HIV/AIDS workplaceinterventionsNon Governmental Organization SectorThe NGO sector will be led by the NGO networks / forum arrangements at nationallevel. The support to the NGO sector will be to strengthen their institutional capacity todeliver the following: To ensure provision of HIV/AIDS prevention, treatment, care and support servicesamong workers within NGO organizations, including workers in the communities theyserve To integrate issues of gender based violence and all forms of sexual abuse in therespective HIV/AIDS workplace programmes To enhance public-private partnerships to ensure effective delivery and access toHIV/AIDS prevention, treatment, care and support services among workers To increase advocacy for resources mobilization and allocation for HIV/AIDSworkplace interventionsOverall, the Ministry of Gender, Labour and Social Development will lead theimplementation of the NPA. The Ministry will coordinate the planning, lead the resourcemobilization process as well as monitoring and evaluation and will be accountable for theplan implementation.National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Workix
xNational Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work
1Background1.1 IntroductionHIV/AIDS is a major work place issue and every effort is required to mobilise employersto take the fight for HIV/AIDS epidemic to all workers and at every work place. With theincrease in new infection, the epidemic is outpacing actions to contain it. It is thereforeimportant that every part of the society is mobilised to join efforts to counter the spreadand impact of the epidemic. The World of Work (WoW) is well placed to greatly contributeto the efforts for containing the epidemic.The HIV/AIDS epidemic is a threat to the effective and efficient delivery of servicesin the private and public sectors. It undermines the ability of private and public sectorinstitutions to attain the goals of national development. It is therefore important that eachindividual takes responsibility to play an important role for the prevention, managementand elimination of HIV-related stigma and discrimination from their respective workplaces.HIV/AIDS is a reality and communities are vulnerable to the disease. The workplace hasa vital role to play to limit the spread and effects of the epidemic. The working populationspends at least eight productive hours of the day at the work place. It is therefore importantthat the workplace provides an environment that facilitates the prevention, treatment,care and mitigation of the impact of HIV/AIDS among the workers and their familymembers. In addition, it is also important to ensure that the work places have the requiredcapacity to effectively respond to the HIV/AIDS challenges.Uganda developed the National Policy on HIV/AIDS and the World of Work. Thepolicy provides the principles and a framework for mounting an optimum response toHIV/AIDS in the entire Ugandan world of work. It forms the basis for the developmentof workplace policy guidelines, which addresses the more specific issues related tothe workplace HIV/AIDS response. The policy applies to all current and prospectiveemployers and workers, including applicants for work, within the public and privatesectors. It also applies to all aspects of work, both formal and informal.The Ministry of Gender Labour and Social Development with the technical guidance ofthe ILO and with support from the Italian Government, embarked on the developmentof a National Plan of Action (NPA) on the implementation of the National PolicyFramework on HIV/AIDS and the World of Work (WoW). The NPA describes strategiesand specific activities to be undertaken by the key sectors and social partners in an effortto prevent and mitigate the socio-economic impact of HIV/AIDS on the labour force.The NPA will act as a potential tool for resources mobilization and will inform the nationalmonitoring and evaluation framework (as aligned to the National Strategic Frameworkon HIV/AIDS). It also outlines the key indicators for measuring the performance andprogress of implementing work place interventions.National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work1
1.2 Current Status of the HIV/AIDS Epidemic in Uganda andthe World of WorkUganda has a mature and generalized HIV epidemic affecting different segments of thepopulation. Overall the national HIV prevalence rate is estimated to be 6.4% among themost sexually active age group of 15 – 49 years1. Close to a million people in Uganda areliving with HIV/AIDS. New infections are estimated to be on the increase. In 2007, itwas estimated that a total of 135,300 people were newly infected with HIV2, while 77,000people are estimated to have died of HIV/AIDS related illness. This trend and situationimplies that, the prevention efforts are not achieving the desired results, and the burden ofHIV continues to grow with new infections outstripping number of deaths. Table 1 belowgives the summary of the HIV/AIDS situation in the country.Table 1: Keys HIV/AIDS Situation IndicatorsIndicatorNumber of People Living with HIV/AIDSPeople newly infected with HIVAIDS DeathsUganda’s n 15 yearsTotalAdultsWomenChildren 15 yearsTotalTotalDecember 6819,50077,0028,000,000Estimates derived from Spectrum (UNAIDS, 2008; MOH, 2008)Data available from the national sero - survey, shows that there is a shift from youngerto older age groups. The highest prevalence for men is 9.3% among 35 – 39 years; whilethat for women is 12.1% among 30 – 34 years. The greatest numbers of HIV/AIDSinfected people are therefore people of the working age group. In addition, the macroeconomic assessment study revealed that HIV prevalence among the private, business andpublic sectors workers as being high above the national average. Prevalence of HIV acrosssectors of the economy is highest among the public administration, being at 16.3% almostthree times the national average. For health and social workers the HIV prevalence is 7.9%while the education sector stands at 6.3%. The HIV prevalence among commercial sectorsin Uganda is as follows3:1Ministry of Health; Uganda HIV/AIDS Sero - Behavioural Survey 2004/05, Kampala2Uganda AIDS Commission 2008; National HIV/AIDS Strategic Plan for Uganda 2007/08 to 2011/12, Kampala3Ministry of Finance Planning and Economic Development –Jefferis, Nanyonjo et al (August, 2008) assessing the Macroeconomic impact of HIV/AIDS inUganda, Phase II Report: Selected Studies, August 2008.2National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work
Table 2: HIV Prevalence among the commercial sectorsSectorPublic AdministrationHotel and RestaurantsSalesReal Estate and Renting BusinessManufacturingFishingTransport & communicationsDomestic 6.9%The same study also revealed that there is a higher HIV prevalence among femaleemployers more than their male counter parts; except in a few male dominated sectors likeconstruction and transport. The prevalence of HIV among female workers is estimatedto be 7.3% while among male workers; it is estimated to be at 5.2%. Overall, of the HIVpositive workers, 59 % were found to be female as compared to the 41% who were males.This shows the gender dimension of HIV/AIDS and vulnerable nature of women attheir workplaces, which puts female workers at a higher risk of HIV infection. The macroeconomic assessment study also revealed that Uganda spends 1.7% of the total wage billto educate and train workers to replace those who die due to HIV/AIDS.It is estimated that by 2025, Uganda’s labour force would have grown to 23.7m withoutthe problem of the HIV/AIDS epidemic. However, because of HIV/AIDS, the labourforce would be 21.6m with ART intervention and 21.4 with out ART intervention.In the public sector, a study conducted by the Ministry of Public Service (MPS) revealedthat death due to HIV/AIDS was on average at the age of 40.3 years as compared to 46.6years for the non AIDS related deaths4. The death of such workers therefore happenedduring the prime peak of the careers of public sector workers leading to loss of criticalskills and experience. Another study conducted in 2000 by MPS, also revealed that 14.2%of workers in the public service left due to HIV/AIDS, second to those are ones who leftfor greener pastures (32.6%). This greatly affected the capacity of the Public Service todeliver the required services, at the time when reforms for right sizing the public sectorhad been implemented.The labour force is an important factor of production and economic development. Thereis no doubt, that the HIV/AIDS epidemic in Uganda has undermined the livelihoodsof many workers and their dependants. The loss of skills and experience, threatens theproductivity, competitiveness and survival of many enterprises. The informal sector, whichemploys the greatest number of workers in Uganda, is particularly vulnerable, because ofits reliance on individuals and not systems. The death today and the failure to preventHIV infection among workers of tomorrow, impoverishes the stock of human capital andcapacity of the Ugandan economy to cope with the AIDS epidemic.4Government of Uganda, Ministry of Public Services, Implications of HIV/AIDS on the Public Capacity and Performance, 2003, KampalaNational Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work3
1.3 Context of the National Plan of Action for theImplementation of the National Policy on HIV/AIDS andthe World of WorkThe National Plan of Action has been developed within the framework of the NationalPolicy on HIV/AIDS and the World of Work, which is one of the national responses tothe challenge of HIV/AIDS epidemic. The objectives of the plan have been guided bythe planned out puts of the national policy on HIV/AIDS and the world of work. TheNPA was developed within the framework of the national overarching policy on HIV/AIDS,coordinated by the Uganda AIDS Commission (UAC). The ILO Code of Practice hasalso guided the NPA on HIV/AIDS and the World of Work and the ILO Convention onDiscrimination N0.111. One of the indicators for the performance measurement of thenational strategic plan is about workplaces that are implementing HIV/AIDS work placeinterventions. The development of the NPA has therefore also been developed with in theframework of the National Strategic Plan on the HIV/AIDS (NSP). The NPA will aim atensuring that the performance measurements of the NSP on HIV/AIDS and the workplace are achieved.The NPA has also been developed bearing in mind the roles and mandates of the differentsectors and line ministries. The proposed interventions in the NPA will be carried out underthe policy framework and direction of the sectoral policies, and ensure that harmonizationand collaboration are fostered to avoid duplications.1.4 Process for the Development of the National Plan ofAction for the Implementation of the National Policy onHIV/AIDS and the World of WorkThe process of the development of the NPA was participatory and involved the followingapproaches:I)Consultative meetings / workshops:Workshops were held with the following stakeholders: workers organisations; private sector,NGO sector, and the public / government sector. During these workshops, participantsdiscussed and presented risk /vulnerability factors; drivers of the epidemic and proposedactions among the different sectors. Draft work plans were then developed and formedthe basis for further consultations.ii)Key Informant Interviews with stakeholdersKey informant interviews were also held with key stakeholders that included leadershipof: Labour Union Centres and Affiliates, Federation of Uganda Employers, Governmentsector that included Ministry of Public Service, Ministry of Health, Ministry of Educationand Sports, and the Ministry of Gender Labour and Social Development, and UgandaAIDS Commission. Other stakeholders included NGOs, UNAIDS and Programmesimplementing Work Place Inventions.4National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work
iii)Document ReviewThe following documents were reviewed and informed the development of the nationalaction plan (See Appendix: References).iv)Validation WorkshopA national level validation workshop was organized to discuss, validate and gain consensuson the plan.Table 3: Current Efforts for HIV/AIDS Prevention, Care and Management at theWork PlaceFundingSourceDurationILOEnded in 2006MOGLSDBudgetOn goingImplementation ofwork place programUSAID /Spear ProjectProgram for 5 years, started in2008 and will end in 2013Ministry of LocalGovernment (MLG)Implementation ofwork place programUSAID /Spear ProjectProgram for 5 years, started in2008 and will end in 2013Ministry of InternalAffairs (HQ, Policeand Prisons)Implementation ofwork place programUSAID /Spear ProjectProgram for 5 years, started in2008 and will end in 2013Ministry of Energyand MineralDevelopmentImplementation ofwork place programGTZOn going, integrated in GTZsupport to the energy sectorMinistry of PublicService (MPS)Public Service HIV/AIDS PolicyMinistry ofFinance Planningand EconomicDevelopmentTreatmentGOUOngoing and part of theMOFPED budgetBank of UgandaComprehensiveMedical SchemeBank ofUgandaOngoing and part of the BOUbudgetVarious CorporateorganizationsComprehensiveMedical an AuthoritiesHIV/AIDS workplaceprogrammingAMICALL /UNDPOn-goingHealth Initiatives forthe Private SectorWork place programsfor the private f DutchNGO andCivil SocietyFund (CSF)Started in 2005 to 2010Ministry / InstitutionInterventionsMGLSDMGLSDNational Policy onHIV/AIDS and WoWInternal work placeprogrammeMinistry of Educationand Sports (MES)ACORD under theSTOP AIDS NOWProjectPolicy implementation is yet tobe rolled outNational Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work5
Public Sector Programmei)Current SituationFor the public sector, Ministry of Public Service (MPS) is mandated to develop policy,guidelines, rules and regulations on HIV/AIDS work place for the government publicservice and ensure implementation. The line ministries and other government agenciesmobilize and implement work place HIV/AIDS policy tailored to the workers specificneeds. In addition, the Ministry of Gender, Labour & Social Development (MGLSD) ismandated to develop, national policy on HIV/AIDS at the workplace and occupationalsafety and health standards, and ensure implementation. The national policy on HIV/AIDSat the work place was developed and to date seven Government ministries and agencieshave HIV/AIDS work place interventions.In Uganda, public sector HIV/AIDS work place interventions have mainly focused onsensitizations and condom supplies. Ministries that have accessed external support havedeveloped work plans, including a budget for HIV/AIDS, which are being implemented.These include: MEMD, MES, MIA and MLG, which are being supported as, indicated inthe table 3 above. Overall in the public sector, the work place initiatives are still very limitedin coverage and reach. The public sector HIV/AIDS work place policy was developedand distributed to ministries. However there was no implementation plan developed andresources to support follow on to operationalise the policy. As a result, HIV/AIDS workplace activities in the public sector are adhoc, one-time interventions, with limited reachto the staff. At the same time, even the adhoc activities are general and not focused onissues of vulnerability that are pertaining to the staff in a given ministry/sector. The IECmaterials used in the public sector are obtained from MOH and are the same materials,which are used to raise awareness in the general population. Apart from MEMD, MES,MIA and MLG, no other ministry has an organized work place programme with a workplan that is being implemented. Even for the four ministries, implementation has hadlimited coverage, with only 42% of the workers in MES being aware of the educationsector for HIV/AIDS work place policy. Overall for the MES, MIA and MLG, only38% of the workers are aware about the existence of the HIV/AIDS work place policyguidelines. This situation is even worse with districts and field level staff. The work placeHIV/AIDS policy for example in MES is not widely disseminated and not known in theschools where the problem of the epidemic is greatest.ii)Vulnerability/ Risk Factors in the Public SectorThe documentary review and key informant interview analyzed and revealed the vulnerabilityand HIV infection risk factors in the public service to be as follows: Long hours at work, mobility and work postings that separate spouses Disposable income among workers, driving them into risk behaviours such asalcohol consumption and extra marital and casual sexual relationships. Poor health seeking behaviour for HIV/AIDS prevention and treatment services.In the MES, MIA, and MLG, 50% of males and 58% of females have tested for6National Plan of Action for Implementing the NationalPolicy on HIV/AIDS and the World of Work
HIV in the last 12 months5, though this is more than twice the national average.More public sector workers should have tested for HIV/AIDS g
integrate and mainstream HIV/AIDS at the workplace, developing centres of excellence to learn from and the craving need to prevent further HIV infection among workers. Within the framework of the national overarching policy on HIV/AIDS coordinated by the Uganda AIDS Commission, the Ministry of Gender Labour and Social Development
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5.1 Process for Developing the National Action Plan 5.2 Vision, Mission, Objectives and Guiding Principles of the National Action Plan 5.3 Matrix of the National Action Plan on Women, Peace and Security 5.4. Matrix for the National Action Plan on Women Peace and Security: 2020-2025 6. Means of Implementation 6.1 National Coordination Mechanisms
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