Make a free call to get health solutions

She had been raped and infected with HIV/Aids by a family friend but had never told anyone about it. About to sit for A-level exams, the 19-year-old was on the verge of committing suicide because she felt her life was meaningless.

“I feel I should end my life,” the devastated teenager told a counsellor over the phone. “I should go out and infect men in revenge. I feel I should not tell anybody. I don’t want to even seek treatment,” she told a counsellor over the toll-free National Health Hotline, 0800200600.

Counsellors provided her with continuous telephone counselling that restored her hope and she was able to sit her UACE exams.

This is one of the success stories that have resulted from the toll-free telephone line through which Ugandans all over the country can access reliable, anonymous and non-judgmental health information on HIV/Aids, family planning, malaria, reproductive health, gender-based violence as well as alcohol abuse. The hotline which started operating in 2009 also promotes health-seeking behaviour by referring its clients to places where they can receive hands-on-service in these areas.

Richard Mashero, the hotline’s Counsellor Supervisor says his team of eight counsellors and four part-time volunteers attends to approximately 300 calls per day from all over Uganda adding that, “people can freely express themselves since it is anonymous, without worrying about the stigma associated with some of the topics that are handled. It gives them the confidentiality they need because they are able to make the calls without us judging them.”

Men prefer the information forum
For all sorts of reasons, men tend to be shy about seeking health services. But records, since the hotline’s inception in 2009, show that the majority of callers (70 per cent) have actually been men.

“Men generally have poor health-seeking behaviour,” Mashero explains. “However they are comfortable using the hotline because they are anonymous.”

This hotline has thereby filled a key information gap among men who would want to have the information but yet fear using the designated channels to access it.

Another challenge (as observed by the counsellors) that the men worry about concerning HIV/Aids is how they can introduce the subject of going together for couple counselling and testing to their partners, Mashero says.

On family planning, Cecilia Namakula, one of the 12 hotline counsellors observes that most men would want to have small manageable families yet they worry about all the misconceptions regarding family planning.

“They ask questions like, ‘Is it true that when a woman uses family planning she can have deformed children or become barren?’ We help to clear their misconceptions,” she says.

Hotline counsellors like Namakula speak at least three languages, and languages from across the country are all catered for. The counsellors are also thoroughly trained to handle the varied questions raised by callers. They also offer individual, couple and group counselling. All a caller has to do is dial 0800200600 on any network countrywide from 8am to 5pm, Monday to Friday.

More resources needed
The hotline began work in October, 2009 as collaboration between Health Communication Partnership (HCP) and a local NGO, Communication for Development Foundation Uganda (CDFU), with funding from Usaid. Ministry of Health actually endorsed it as a National Health Hotline.

According to Dr Paul Kaggwa, an Assistant Commissioner in the MoH, the hotline objectives of communication, counselling and guidance are areas the MoH is interested in, the reason it was endorsed.

HCP was however making a 70 per cent contribution to the hotline’s annual budget of $320,000- approximately Shs800m. Other partners include STRIDES, an NGO specialising in family health, Uganda Health Marketing Group and the Adolescent Sexual and Reproductive Health project.

In June this year however, HCP’s funding came to an end and CDFU got stranded yet there is still need to meet the growing demand for health counselling and referral services, and they would like to continue operating this hotline beyond the Usaid funding.

“HCP has been supporting that area but we are trying to lobby other partners to come on board and we believe when we work together, we shall continue supporting the hot line. I must say it’s a very good source of information and guidance,” Dr Kaggwa says.

But even with this funding, the hotline will not satisfactorily fulfill the needs of the callers so CDFU needs much more than what HCP was covering to achieve its objectives.

For example, while recording the calls coming in during a particular month, Anne Gamurorwa, the Executive Director of CDFU says, “In only one month, we had 46,000 calls coming in and but were only able to attend to 6,000. So you can see the great need we have. Actually, when there are several health campaigns going on in the country, the hotline receives more calls than average. We get overwhelmed.”

Mashero gives an example: “There is a time someone called from an island telling us that the men were experiencing many side effects from a circumcision camp that had taken place. We informed the organisation which carried out the campaign and they went back and managed the side effects. They found out that people were using contaminated lake water for cleaning which was leading to infections.”

High demand, no funds
The mismatch between the overwhelming demand for the hotline services and inability of CDFU to satisfy it is due to the limited number of counsellors and the limited hours of operation.

The hotline uses an infrastructure that can accommodate 80 counsellors but it has only eight full time and four volunteer counsellors working eight hours only on week days. Records however show that the system receives a high number of calls that go unanswered during weekends, public holidays, and at night when the hotline call centre is closed.

“We believe there are many working class people who are freer to make calls during these times but cannot access our services. Maybe a spouse has been abused by a partner in the night and needs help. We want to be able to work 24 hours in shifts to meet this need but that requires manpower.”

Mashero adds that the hotline receives calls from all over the country and beyond, like from the border towns of Southern Sudan, Kenya and Tanzania.

Why the focus on HIV/Aids and malaria
The HIV prevalence rates recently shot up to 7.3 per cent from 6.4 per cent in 2005 according to the 2011 Uganda Aids Indicator Survey. And Uganda has the third highest number of deaths due to malaria with the disease accounting for approximately 30-50 per cent of outpatient care, 15-20 per cent of admissions and 9-14 per cent of in-patient deaths according to the malariaconsortium.org web site.

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