Community Based Organisations Set in Remote and Peripheral Communities Away from The Amenities of Central Governments Contribute to Critical Options Catalysing Demand for Services Leading to Better Life Outcomes: Translating Global Fund and PEPFAR Aspirations by Greater Masaka Based TB, HIV and Malaria Prevention Service Organisations in Uganda

Peripheral based organisations contribute to establishing differentiated service delivery models. They bring to peripheral communities, novel approaches such as antimicrobial stewardship; embed the One Health approach at community level where animal-human interactions are a daily experience to foster better health outcomes; and other interventions that improve the Quality of Life (QoL) of people. This sets in place the cultures necessary for people-centered services whose elements include affinity, access, appropriateness, affordability, acceptability and demand for those services which improve longevity and quality of life of the people, health of the planet and increase productivity in such communities.

Good health and wellbeing are aspirations through which it is possible to mobilise communities so that people effectively engage in practices that prevent diseases, prolong life and promote health. Through health promotion and education in the communities peripheral-based service providers contribute to practices that avert risk and vulnerability to, for instance, malnutrition which affects body mass changes, healing, is linked to severe weight loss, failure of organs, stress and emotional Instability.

Good health and wellbeing are a means to achieve physical, social and mental health through interventions, risk-mitigation, linking those who are eligible to care, testing, screening, care, housing stability, food security, livelihood enhancement and eco-conservation. These improve life outcomes. Yet too often, talk about good health and wellbeing is clouded in language that is judgemental, fear-laced and taboo-related. It is important that as services are rolling out to peripheral communities the harbinger narratives are community and user-friendly so that they address the dilemma of issues these communities face on a regular basis.

When it comes to promoting good health and wellbeing, evidence shows that strategies and theme such as gender and nutrition justice which are informed by salutogenesis rather than fear and disease (pathogenesis)– are a more effective motivator to engage in health seeking practices. Research shows that good health and wellbeing programmes should address such issues like inequality gaps, ensure cultural-shift, economic wellbeing and translate the principles of salutogenesis into lived experiences leading to healthy decision-making like increased participation in health seeking practices by all people across all age groups mindful of the diversity in humanity.

Peripheral based service providers interface with a diversity of population groups. As TB Prevention, Anti-malarial activities and ART coverage expand diverse population groups differing in age and ability are able to access testing services and initiate the treatment increasingly at early stages of the diseases. This has quality of life benefits in African countries, where the vast majority of all TB, Malaria and HIV-infected people live, are likely to live well past the age of 50.

In Africa Global Fund and PEPFAR have contributed to the good health and wellbeing of large populations. More people now access knowledge, skills and attitudes to demand and translate TB, HIV and Malaria-related prevention information, education and communication into health seeking practices contributing to prevention-consciousness, prevention literacy, life expectancy (longevity) and reductions in deaths occurring among infants. This contributes to improved quality of life in Africa. As people age, they migrate to quieter and more laid-back rural communities so the peripheral-based organisations have to position themselves to embrace gender, physical status and age-related nuances. Gender Justice and inclusion principles call for human freedom and opportunities for individuals to flourish.

Our experience in promoting a TB, HIV and Malaria prevention continuum at the peripheral communities in Greater Masaka Region and providing Public Health-related consultancy services has shown us that there are struggles in maintaining the golden standards of prevention, treatment and care without funding and other non-monetary resources.

It is a struggle to advance fair and equitable access to services. So, this in turn affects the quality of life for all people at all age groups. Yet, this is robust, catalytic and aspirational. Advancing fairness and equitableness strengthens the agency of all people who are actors in their own lives. It enables communities to examine and challenge the underlying structures and norms that perpetuate inequalities. It inspires people to create their own vision of positive change in their lives. It empowers members to express themselves as rational beings, capable of making an informed choice and asserting their bodily integrity. Advancing fair and equitable services  makes TB, HIV and Malaria interventions less fear-based and more life outcome-driven; less of stigma-reinforcing and more of inclusion-leaning; from a single-issue HIV-centric approach to a multiple-issue UHC, Climate-smart, Housing stability, Food security, livelihood enhancing, TB, Malaria and HIV-centric; bio-social-medicalized and far-future focused that allow differentiated models to ensure that clinic-based models are integrated with Public health-centred approaches.

According to Negin (2012) with political commitment, substantial economic support, and concerted community and medical efforts, global epidemics can be slowed and, perhaps one day, halted. In the peripheral communities extending health and development services averts catastrophic costs. However, stigma, non-targeted planning, and patriarchy promote instances of inequalities affecting indigent households, child parents, persons with TB, People who have lived long with HIV, Persons affected by malnutrition, Persons with Disabilities, Persons with chronic diseases and Persons with HIV. Peripheral communities are now dealing with indigent households, child parents, persons with TB, People who have lived long with HIV, Persons affected by malnutrition, Persons with Disabilities and Persons with chronic diseases during the TB, Malaria and HIV epidemic in the present post-COVID-19 times exacerbated by climate-change. These are trends that need to be funded because most peripheral based intervention organisations are lacking the resources to provide a full range of services addressing the emerging needs.

There is a relationship between climate-change, housing instability, food insecurity, lack of livelihoods, TB Malaria, HIV and NCDs. Gender and aging of the TB, Malaria and HIV epidemic due to medications such TB-Prevention drugs and ART have several important implications for the health of different affected and infected populations (Simon, 2008; Gebo, 2008; Marin, 2008; Cotton, 2011; and Mills, 2011). As people age they experience steeper declines in CD4 progression and slower immune system reconstitution impacting good health and wellness of people (Negin, 2012).

There is a need to be more aggressive when implementing interventions as we look toward ending HIV, TB and Malaria. There are factors we need to factor into the interventions which range from psycho-social support, addressing Drug, Alcohol, Substance, Tobacco Abuse (DASTA), Climate-smart approaches, ensuring housing stability, food security and livelihood enhancement.

Peripheral based service provider must shape demand for services because trends change as in the case of TB, HIV and Malaria prevention and care. According to different studies by Valcour (2005), Lederberger (2007), Carr (2008), France (2009), Justice (2010), Nigen (2012) and Mills (2012), drugs included in the standard ART regimens increase the risk for NCDs; second, individuals on ART increasingly live into ages when NCDs burdens increase due to aging and life style; and, third, people on ART live longer with HIV, and the virus is an independent risk factor for NCDs. These conditions affect TB and Malaria immunology. There is need to extend services beyond TB, Malaria and HIV Prevention and Care.

In order to align and plug local experiences into global narratives, we came up with the Public Health Steering Team-Uganda (PHSTU) whose Fiscal Agency is the MOD Public Health Foundation-Uganda/Public Health Consultants-Uganda to advance an agenda of interventions mainstreaming the broader Public Health contexts that impact general wellbeing, TB, Malaria and HIV prevention, care and treatment. We are aware that peripheral based organisations may be overwhelmed, for instance, by the changing landscape of TB, HIV and Malaria Prevention and it translates into neglect which increases the disease burdens and un-met healthcare needs.

Slowly and surely, we are building a large network of peripheral-based CBOs to leverage contribution to the critical efforts to end TB, HIV and Malaria through ensuring a re-imagination and rationalisation of demand and delivery of services. There is need for well-wishers to support our work that continues to enable people to engage in health seeking practices, demand and advance TB, Malaria and HIV prevention, treatment and eradication through ensuring availability, acceptability and access to medicines, laboratory services, psycho-social support, information, and care.

We call upon the different African governments, line ministries, development partners e.g., PEPFAR and the Global Fund, CSOs, NGOs, FBOs and CBOs to strategically position themselves to create the critical mass of services contributing to the end to TB, HIV and Malaria. This will contribute to the saturation of services fostering optimisation and maximisation of health promoting a range of resources from family planning; countering malnutrition; ensuring housing stability; food security; sexual reproductive health; mental health; TB, Malaria and HIV Prevention; Persons With Disabilities (PWD), Persons With Chronic Infections/Diseases, Mother, Child, Adolescent, Youth, Adult and Seniors’ health; Climate-smart action; Livelihood projects; and considering future pandemics.