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The Danish Disability Fund

Application form: LARGER DEVELOPMENT PROJECT &COLLABORATIVE PROJECT INVOLVING MULTIPLE ORGANISATIONS(Up to 5 millionDKK.)

December2013

This form must be used when applying for funding for Larger Development Projects and Collabor-ative Projects involving Multiple Organisations. The form is divided into four parts:

Part 1. Cover page Basic and brief information regarding the applicant and partner as well as the project (summary, title, the amount applied, etc.).

Part 2. Application text This part contains a description of the project.Instructions (shaded grey) are provided in each section.

The application text (Part 2) must not exceed 20 normal pages. Applications exceed-ing 20 normal pages will be declined.

Part 3. Budget summary This part contains themain budget items for the project. Please note that the budget summary must be elaborated upon in detail in the annex ‘Budget format’.

Part 4. Annexes A list of the obligatory and supplementary annexes supporting the application.

Please, note: The application must be developed in collaboration between the implementing local partner organisation and the Danish organisation. Consequently, a project document must be available in a language commanded by the local partner. The application, however, can only be submitted in Danish or English.

THE DANISH DISABILITY FUND – Larger Development Project & Collaborative Project involving multiple organisations (up to 5 million DKK.)

The signed application form (including annexes) must be submitted in print to:

Danske Handicaporganisationer Afdeling for Internationalt Samarbejde Blekinge Boulevard 22630 Taastrup

In addition, the application form and Annexes must be sent electronically to: [email protected]

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mailto:[email protected]


1. Cover page

LARGER DEVELOPMENT PROJECT &COLLABORATIVE PRO-JECT INVOLVING MULTIPLE ORGANISATIONSApplied for (please tick):Larger DevelopmentProject XCollaborative Project

Project title: Building a Sustainable Mental Health UgandaApplicant Danish organisation (financial responsible)

Landsforeningen SIND

Other Danish partner(s), if any:Local partner organisation(s): Mental Health Uganda (MHU)Country (-ies):Uganda

Country’s BNI per capita: 470 USD(2011, Atlas method, World Bank)

Project commencement date:Jan 1 2015

Project completion date:Dec 31 2018

Total number of months:48

Contact person for the project:Name: Else Lillebæk NielsenEmail address: [email protected] no: 21 79 77 00Amount requested from The Danish Disability Fund:2.300.040 DKK

Annual project cost:575.010 DKK

Is this a re-submission? (i.e. a revised application, which has previously been submitted)[X] No[ ] Yes, previous date of application:Is this a:[ ] A new project?[ ] A project in extension of another project previously supported by DPOD, Danida or others?In which language should the response letter from The Danish Disability Fund be written (choose one):[ ] Danish[X] EnglishSummary of the projectMålet for SINDs udfasningsprojekt er at styrke kapaciteten i Mental Health Uganda,såden eri stand til at søge midler til sine kærne aktiviteter som fortalervirksomhed og forbedring af livskvaliteten, både social og økonomisk, for mennesker med en psykisk sygdom. Projektet vil styrke kapaciteten i 8 distrikts Associationer og dermed skabe en bæredygtig decentralisering af organisationens indsats. Projektet vil endvidere støtte, at MHU efter udfasningen skal være økonomisk uafhængig af SIND og være finansieret af en ny hoveddonor. Projektet har taget udgangspunkt i en Ekstern Evaluering af de sidste 5 års samarbejde mellem SIND og MHU og projektets mål er formuleret i forlængelse af evalueringsrapportens resultater.

1/9/2014Date Person responsible (signature)

Høje Taastrup Knud Kristensen, National ChairmanPlace Person responsible and position (block letters)


J.no. ( to be filled by DPOD)HP

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2. Application textA. THE PARTNERS(indicative length 3 pages)

A.1 The Danish Organisation Landsforeningen SIND (the Danish Association for Mental Health) was established in 1960 and has 5 districts and 43 local branches. Districts and local branches are managed by boards elected by and among the respective members. Landsforeningen SIND is managed by a national board. SIND has partnered with Mental Health Uganda (MHU) since 1999 with funding from Danish Disability Organisations (DPOD) and Civil Society in Development (CISU).

SIND advocates understanding and tolerance of people with mental problems and illnesses. SIND takes initiatives and supports initiatives to promote mental well-being, prevention and treatment.

SIND tries to influence politicians to substantially improve conditions for the mentally ill and their families and utilize channels as: government, parliament, ministries, local politicians and the media to influence Sind publishes information material to reach out information on human rights and SIND’s activities. Furthermore, SIND is consulted in connection with bills which will have an impact on people with mental problems and disorders and their families, if passed.SIND supports educational programs for the mentally ill as well as counselling services and network groups for relatives. Other SIND activities are to support groups and personal networks. SINDs activities are mainly performed by volunteers.

SIND has a Uganda Committee which includes a group of volunteers rooted in SIND. Those Committee members have broad exper -ience with the mental health sector, international and public health, cultural and anthropological as well as working experience from Uganda. They refer to and share information with members and the board about the progress in the MHU and SIND cooperation. This project is rooted in this SIND Uganda Committee.

A 3 The local organisationFrom its founding in 1997 MHU has been a user and caregiver membership organization comprising of People with mental Illnesses (PWMIs) and their care givers. MHU has grown in the last fifteen years into a national grass-root based psychiatric user and care giver organization recognized to represent local people with and affected by mental illnesses.

MHU´s vision is: “A world where People with and survivors of mental illness in society are embraced with respect and enjoy their human rights as other citizens.” To achieve this vision, MHU promotes advocacy for the rights of people with mental illness by work -ing directly with the affected individual and families in the communities.

MHU’s mission is “To create a unified voice to influence the provision of required service and opportunities in favour of people with mental illness through capacity building, networking, advocacy and partnership.”

MHU’s efforts to raise awareness on mental illness and how it can be treated, is an important part of the organisation’s mission. All their efforts are linked up to different activities like: Mobilization of psychiatric users and their families; community sensitization and awareness raising about mental health for attitude change and to fight stigmatization; advocacy work for improved public services, including networking with other potential actors in the area of mental health and development; livelihood improvement for members and their families; membership and organizational empowerment and capacity building.MHU is organized as a typical member organization, with members joining local associations that form District Associations. MHU reports that at present there are about 7,900 members in 18 District Associations. Membership registries are poorly kept, so the number is not sure. Just over half of the members are users (of mental health services), while just under half are caregivers (mainly relatives), with 1-2% being professional caregivers.

MHU has a National Secretariat of 4½ paid staffs:

Executive Director Derrick Mbuga Kizza: M.A Community Development, B:A Development Studies, P.G.Cert Research and Writing skills, Career Diploma Child Psychology. Diploma Development Studies.

Programme Officer vacant Accountant and Administrator: David Agaba, B.A of science in Accounting and Finance, Uganda Diploma in Business

Studies Project /Information, Psychosocial and advocacy Officer - Eccamayi Richard: Certificate Electrical Engineering Programme and Admin Assistant- Betty Nakato, M.A Social sciences


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Volunteers: MHU has active volunteers among its members (specifically people with mental illnesses) who participate especially in its program work at all levels local, district, national and international levels. These volunteers are instrumental in advocacy, policy and human rights, supporting of management structures, and networking. The secretariat currently has 3 volunteers and 4 students on internship. One of the members of MHU (Mr. Daniel Iga Mwesigwa) has effectively represented Psychiatry Users in Africa in the Ad hoc Committee Meetings at the UN during the drafting of the Convention on protection of the Dignity and Rights of PWDs. Former MHU staff Robina Alambuya is now the newly elected President of the Pan African Network of Users and Survivors of Psychiatry.

Networking and cooperative relations: MHU enjoys membershipwith The National Union of Disabled Person of Uganda (NUDIPU), The National Union of Women with Disabilities of Uganda (NUWODU) and Voices for Health Rights (VHR).

Partners and donorsSIND has supported MHU since 1999. The support given has been:

1999-2001:‘To mobilize and start support groups of people with mental illness in all other parts of the country’ 2001-2003:‘User sensitization and empowerment’ 2003-2005:‘Consolidating MHU District Branches ’ 2005-2007:‘Strengthening Mental Health Uganda, the District Associations and membership for effective Mental Health

Sensitization and Advocacy. 2007-2009:”Strengthening mental health capacity and support to livelihood initiatives” 2010 Project extension of “Strengthening mental health capacity and support to livelihood initiatives” 2011 – 2013: “WE CAN” Improve the living conditions of people with mental illness. No: 10-850 SP - sep. Grant:

1,000,000 DKK. 2013: Establishing of a user rehabilitation centre in Kampala City: A learning project. No: MP 303. Grant: 199,099 DKK. 2014: Support to the 4thMHU General Assembly, recruitment of a new Executive Director and preparing for an External

Evaluation. No: HP 141 – 039. 198,654 DKK. 2014: Extern Evaluation of collaboration between SIND and MHU 2008-2013. No: HP 141 – 050. 184,857 DKK.

It is expected that large scale project funding from SIND/Disability Fund will phase out during the present project period.

MHU has from its beginning received funding from: Action on Disability and Development (ADD): 2003 – 2006 Advocacy on mental health service provision.Grant: $100,000Basic Needs: 2004-2007 Mental health and development model Grant: $54,000CORD AID: 2008 – 2010: Strengthening community psychiatric drug bank initiatives among six MHU District associations.Grant: Euro 150,000Tides Foundation and OSI: April 2008 – Both OSI and Tides Foundation jointly supported MHU to host the Global Conference and World Net Work of Users and Survivors of Psychiatry (WNUSP). Grant: $150,000Open Society Institute (OSI): Jan 2011- June 2012 Lobbying for a community based mental health intervention for Uganda.Grant: $40,000Disability Rights Fund: 2009: Promoting awareness of the convention on the rights of persons with mental disability, persons with physical disabilities and the deaf blind in six districts of Uganda. Grant: $50,000 Independent Development Fund (IDF) 2009: Promoting awareness of the rights of persons with disabilities (CRPD) in six districts of Uganda; implemented as a lead agency in partnership with The National Association of the Deaf Blind of Uganda (NADBU). Grant: $80,000Swedish International Development Agency2011-2013 Maternal Health Project; Implemented under the Umbrella net work, Voices for Health Rights (VHR) Grant: $100,000Wellspring International (USA) 2013-2014: mainstreaming disability into human rights by helping prevent torture and ill-treatment in Uganda. The project is implemented jointly with the Mental Disability Advocacy Centre- Budapest Hungary. Grant: $ 25.000

A.4 The cooperative relationship and its prospects:Is the cooperation between the Danish organisation and the local partner known by The Disability Fund and described in another/other application(s) within the past 12 months?

SIND has now worked in a partnership with and provided financial support to Mental Health Uganda (MHU) since 1999. MHU has during the years grown into a legitimate interest and democratic organisation for people living with a mental illness (PLWMI).


Yes x Please, insert the 6-digit no./HP no.: HP 141-039/HP 141-050No

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The cooperative relationship and its prospects have now changed as the DPOD in general is phasing out their support to Uganda and to MHU as well. With this in mind, SIND finds, that MHU has reached a level of organisational maturity that requires less support from their side and has therefore decided to reduce and potentially phase out its financial support to MHU during the coming four years. SIND will however like to leave MHU in the best possible condition to continue its work and has together with its donor evalu -ated the results of the partnership during the past 5 years. This was with the aim of providing recommendations for the focus areas of a potential ‘exit’ project that SIND is applying for funding for MHU to implement.

When this “phasing out project” has come to an end SIND and MHU have cooperated in about twenty years and it is SINDs intension and hopes to be able to continue supporting MHU after the funding has ended. SIND and MHU is two sister organisations with a similar mission and challenges just in two different contexts and have a lot of experience to share in the future. If possible the SIND Uganda Committee will continue to do fund raising for smaller projects in MHU.

B. PROJECT ANALYSIS (indicative length 7pages)

B.1 PreparationSIND and MHU did not have success with the approval of the last application to the Disability und DPOD in connection with applica -tion round 2013. Instead, SIND was recommended to carry out an external evaluation that looked at the last five years that MHU has been supported by SIND, with the goal of designing an exit strategy for the cooperation and funding from the Disability Fund.

The purpose of conducting the external evaluation of MHU was to paint a realistic picture of possible strategic pathways for MHU in which the cooperation between SIND and MHU could be phased out in a sustainable way. There had never been carried out an external evalua -tion of the organization's sustainability, capacity, development potential, and learning outcomes in the years the organization has been supported by SIND.A short-term consultant was employed to carry out the external evaluation and evaluation results were delivered at a debriefing meeting for MHU and SIND was held in Kampala. Recommendations from the final report (Annex No. K) have lain the ground for this application.

It is suggested in the report that a useful strategy for phasing out SIND’s support to MHU should include an upgrading of the capacity of all the relatively weaker District Associations. A certain level of expectations for a District Association could be developed (in terms of registration, organisation structure, management of the organisation, building of local networks, fundraising and key activities to be implemented), and training and mentoring programs developed to establish these. The stronger District Associations would be re-sourced to assist the weaker ones. The Secretariat will need to play a central role in organizing capacity assessments of the District Associations, to devise training and capacity development packages, and to organise exchange of assistance in between the dis -tricts.

The recommendations were that MHU must continue its core area of work; to create awareness about mental health issues and to advocate for improved service delivery for PLWMI. Efforts are required at local, national and international level and will require ef -fective networking and alliance building with likeminded CSOs and NGOs.

The evaluation recommended that SIND support to an exit project would pursue the following three objectives:

1: Improve advocacy work and collaboration with duty bearers to improve health sector service provision to PLWMI. 2: Increase access to support for livelihoods and income generation activities for MHU members.3: Increase membership, outreach, legitimacy, effectiveness of MHU

With these objectives in mind Sind has formulated a strategy for phasing tout he support to MHU with the goal: “After the phasing out project MHU as an organization is financially independent of SIND as partner and by the end of 2018, they are funded by a new main donor to continue to support their work.”(See Annex no.I)

This application has been formulated in a close cooperation between the MHU secretariat and the SIND Uganda committee with the assistance from an external consultant. MHU has had the leading role in developing the LFA, the activity plan and the budget, while SIND has been lead in giving feedback and initiating dialog to ensure that the project remain inside the framework of the SIND exit strategy, the recommendations of the evaluation and of the Disability Fund.

B.2 Context analysisIn the 2002 population census, Uganda’s population was estimated at 24.4 million but it is now projected at about 34 million. Accord -ing to the United Nations, 10% of any population has a mental illness during their lifetime, which brings the number of Ugandans estimated to have a mental health problem in their lifetime to about 3.4 million. This is made worse to a significant degree by the fact that districts in Northern Uganda are still battling the effects of the war that lasted just over 20 years, and whose impact cannot be over-emphasised.


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The general context: In1997 Uganda adopted a decentralised system of governance with the planning and budgeting of services decentralised to the lower levels. The central government mainly remained with a monitoring role. This means that while national and regional hospitals are supported by the centre, other levels are either shared between the central and the local governments or are wholly funded by the local governments. The current government has been keen to design progressive policies, some even intended to directly impact mental health, but these are yet to translate into practice. Uganda’s economy is largely based on agriculture em -ploying over 80% of the work force, making it the most important sector in the economy. Uganda has experienced an average eco -nomic growth rate of 5% for the last fifteen years with 38% of Ugandans living below the poverty line and a life expectancy of 52 years. With one of the highest population growth rates, national developmental targets are big challenges for the country. Information on the estimated number of PWMI who do not have jobs and are excluded from taking part in the economic contribution to the soci -ety is not readily available. PWMI continue to live in poverty, and general poor health status.

PWMI in Uganda: On 25th September 2008, the Government of Uganda ratified and signed the United Nations Convention on Rights and Dignity of Persons with disabilities and its optional protocol. There have also been several ongoing efforts made by the DPOs urging the government to domesticate the convention and streamline it in development programmes. However, even with such ef -forts, there are still wide spread cases of rights abuse at individual, household and community level for PWMIs. Persons living with mental illnesses continue to be locked up on poles and in houses with limited or no medical care, and other basic necessities of life including food. They are also denied access to participation in community development programmes. In the education sector, the education system has not provided for facilities that put into consideration their unique needs. There is l imited respect to user rights for instance in terms of ownership of land and property. More so, there is very limited knowledge about mental health in general. Community harassment of people living with mental illnesses and Mob justice on users is seen as a legitimate act around society, and this is often a result of what the communities do not know about mental illness and persons living with mental illnesses. Stigmat-ization is a major issue in communities, among families, and the authorized legal institutions, other authorities such as schools and educational systems and so on. Even the issue of self stigmatization among users and in families is common as well.

Mental Health services in Uganda: While making health services accessible has been highlighted on government agendas and in progressive political and administrative reforms, their effects are yet to be experienced by most citizens. There are chronic shortages of hospital supplies and personnel in all parts of the country and mental health facilities are not an exception. It is common for people requiring medical attention not to find adequate services in the clinics with either medicines missing or limited or absence of health workers to attend to the patients.The National Psychiatric Referral Hospital: There is one national psychiatric referral hospital – Butabika, and one major ward in the General National referral Hospital - Mulago. Even in the national referral Hospitals medicines are inadequately supplied coupled with inadequate personnel. There have in recent times been efforts to develop complementary mental health care services like occupa -tional therapy but the required therapists are inadequate. Many users reside in the remote areas of the country, yet the few psychiat -ric services are only available in district towns. Therefore, they are either unable to come for diagnosis or only come when they are able to get transport. This has an adverse effect on compliance to drugs. Regional Psychiatric Units: These are spread in major regions of the country and receive up to 400 patients every month in each regional hospital. The structure requires that there is a psychiatrist at this level but in many cases these have not yet been deployed. They are 100% funded directly from the Ministry of Health. Many have been redeveloped with room to accommodate more care services like occupational therapy units. But the units do not have the needed equipment to set up the occupational therapy. It is not unusual to find limited or no drugs for the patients. They are then forced to buy from the expensive open market and only a few can afford that. District mental Health Clinics: According to the new government structure each district should have a psychiatric clinical officer providing some level of mental health services at the district level. Mental health services at this level are partly supported by the ministry and partly by the local government.Constituency level /Health Centre 3: All general health providers are given training to be able to offer basic mental health care and refer the complicated cases. Again both the centre and the local government share the costs of running services at this level. In many cases PWMIs fail to get services at this and the district level and have to travel to higher levels to access treatment. Private health sector: Considering that in many instances, psychiatric drugs are usually not available in the health centres, many users and care givers are left with no option but to purchase the drugs from the private clinics. However, many are unable to afford the price of these drugs and this in turn leads to abandonment of treatment and adherence problems. The government run mental health clinics are now faced with a dilemma of human resources because most the psychiatrists have opened up private clinics whose services are not affordable for most users. Traditional Healers: As a result of the escalating levels of poverty at household and community level, many users or their care givers are unable to access quality psychiatric care including drugs. They in turn seek treatment from the traditional healers who are usually accessible, that is, based within the community. Payment for such services is either in cash or kind. It’s these advantages that lure many user households to access treatment from them. However, their treatment has been associated with poor hygiene, treatment of physical symptoms of the sufferer other than the psychiatric problem, and over reliance on myth rather than reality. Some of them


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are only exploitative and require a lot of items from the care givers including goats, hens and local brew under their guise of appeas -ing the spirits.

Beliefs and attitudes among Ugandan people In most societies in Uganda mental illness is associated with witchcraft and this determines the related health seeking behaviour commonly observed in most parts of the country. A study by The Ministry of Health found that 80% of Ugandans visiting health centres at one moment or the other consult a traditional healer either, before, during or after visiting the health centre. It is common to find that a family will neglect a member with mental illnesses thinking that the spirits are resting in this individual and should not be let loose to disturb others and let him harbour these spirits. Many people think PWMIs are violent, cannot recover etc. All these beliefs held in the community by leaders and citizens have had a negative impact on the level of care and support mobilised for PWMIs.

Gender dimensions Women comprise over 60% of MHU membership, especially among caregivers, perhaps due to the traditional social and cultural roles and health seeking patterns and behaviours between men and women. Women in most communities in Uganda are expected to take on the day to day care responsibilities. When it is the wife who has the mental illness, she and the children are at the risk of being abandoned of their husbands and fathers because they believe the sickness is inherited from the wife’s family. Women with mental illnesses are at the risk of being raped while wandering unaccompanied in their communities. Some women with mental illness are made unwanted pregnant by men that never take responsibility for their children. Both women and children of mentally ill persons are at risk of not getting preventive mental health care as well as being excluded from opportunit -ies and rights. Especially the children and young people are falling out of the educational systems.

Livelihood and livelihood activities As agriculture is the most important sector in the economy there are some development orga-nizations targeting poverty alleviation. The National Agricultural Advisory Services (NAADS) was one of the organizations PWMI´s could benefit from. NAADS was a government DANIDA supported program which targeted poor farmers for which most of MHU members, who were very poor could be benefitting from. MHU has already had some very successful cooperation with NAADS in some districts, but only very few PWMI´s have benefitted from technical support or input supplies from NAADS. NAADS has two key requirements for its beneficiaries. They have to form farmers groups and already be active farmers. Because of problems the future of NAADS is in doubt. If it is closed down, MHU expects NAADS to be replaced by another Governmental organization.

B.3 Problem analysis

Threat to sustainability of MHU activities after funding by the Danish Disability Fund ends . The main problem addressed by this project is the sustainability of MHU activities after funding by the Danish Disability Fund ends. The Evaluation of collaboration between SIND and MHU 2008-2013 found that while MHU as an organization scored well against standards such as identity, struc -ture, competences generally speaking, systems, target groups and, it faces challenges in certain areas, specifically financial sustain -ability and documentation/learning. The evaluation describes the challenges thus: “Systems for monitoring, documenting and report -ing project progress are weaker – a weakness that is presently adversely affecting MHU because the insufficient ability to report progress against SIND project objectives and indicators is delaying further funding. Financial sustainability (in the sense of self-suffi -ciency) is difficult for an organization like MHU to achieve. It will always be dependent on some level of external donor (or govern -ment) support. Fundraising skills are therefore required and need to be constantly enhanced.”“The national and local context provides many opportunities (but also challenges) for MHU to operate. The organisation has been able to take up new opportunities, but some activities are not sufficiently concluded or experiences and learnings collected and documented. This means that best practices are not used for replication in other parts of the organisation – and unsuccessful activit -ies not corrected in time.”

Ineffective economic empowerment activities Measured against standard OECD evaluation criteria, the evaluation found that MHU is doing well in relation to relevance, efficiency and impact (although attribution is not clear on this last one), while MHU faces challenges concerning effectiveness and, as already mentioned, sustainability. Concerning effectiveness, the evaluation among other things concluded that:“MHU has been relatively successful in achieving objectives relating to awareness raising, advocacy and organisational capacity building. The central objective throughout the project periods of providing direct support to improving economic livelihoods have been less successful – and benefits are not likely to reach a substantial part of the membership in the foreseeable future.” The reason MHU livelihood activities have not been effective lies in that MHU has assumed a direct service delivery approach to generating better livelihoods for its members. As the financial resources MHU can mobilize are small, and as MHU staff is not spe -cialized in business and entrepreneur skills, this approach is inherently limited in both scale and quality.MHU member consistently emphasize livelihood as one of the main issues that MHU needs to tackle. Ineffective response in this area therefore a potentially critical threat to MHU´s value to its members.


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Exclusion from poverty alleviation programs (PAP) As identified in the evaluation, the (better) alternative to MHU providing its own livelihoods programs is for PWMI to access existing mainstream poverty alleviation programs (PAP) and other opportunities delivered by governmental duty bearers, NGO´s and private sector actors. The main challenges here are that PWMI’s have been marginalised and continue to be left out in mainstream government development programmes, including NAADS. A major problem is that NAAD`s staff do not have the inquired knowledge on how to include PWMI`s in their program. This has left PWMI`s unable to access services of the different government programs due to their perceived status by the community. If they will have to enrol on a NAADs project, they must have prior experience in farming or animal rearing or have small capital to be supported to start a small business. Considering the state of most user households, many never meet these conditions. A glaring gap still exists with regards to livelihood options for the users and their households, with no concretised strategies for trans -ferring knowledge and documentation and sharing lessons learned among the districts, as well as tailoring the individual support to PLWMI for capacity strengthening and promoting sustainability. Most of the members in the associations don’t possess the required skills to write small proposals and be funded in development initiatives of their choice within the districts. This has made them unable to access saving and loan schemes, and grants offered by local governments and development partners. In order to deliver on better livelihoods for PWMI, MHU must overcome these challenges.

Building on strengths To overcome the above mentioned challenges related to financial sustainability and livelihood interventions and achieve organizational sustainability, the evaluation recommends that MHU build on the strengths of the organization, first and foremost its work on user rights in the health sector, its community awareness work and its empowerment of members through peer counselling and organization. However, there is still room for improvement in all these areas. The related issues are:

PWMI User Rights not respected Due to limited knowledge of human rights, in many cases the users or even care givers do not easily notice that their rights are being violated. In the rare cases where they are able to know, they lack the awareness on where to seek redress, or are neglected in case they report such cases to the concerned parties. There is a big need to influence authorized system, the legal institutions, educational systems, the mental health system. The need of sensitizing and educating the different groups of staffs is essential for attitude behavioural changes. A systematic documentation and reporting on cases is absent. There are very limited reports and other materials on cases and life stories on users being abused on their legal rights and violation by authorities, in their communities and even in their families. This is due to limited knowledge and awareness on user rights and mental health issues by judicial system, health workers, police and security agencies and the community in general.In common instances, rights violations at family level are usually not reported to the authorities and in cases where they are reported the local councils only listen to the family ignoring the views of the person suffering from mental illnesses. The families also usually connive with the police and considering that the person being violated suffers from mental illness, little or no audience is given to him/her. The authorities are not dressed to take care of their interests and rights. The need for documentation on cases is a major issue for Mental Health Uganda to influence the authorized legal system and change of attitudes among staff working with human rights and mental health issues.

Limited community awareness of PWMI issues People with mental illness as disabled category still face a variety of health and development challenges at individual, family and community level. These are due to a range of socio-economic factors such as: poverty, stigma, limited income generating activities, limited access to and often expensive mental health care, limited capacity to demand for their services and rights and limited access to different livelihood opportunities. Exclusion is a major problem that faces PWMI and their families. This is further coupled by the limited capacity by PWMIs to effectively influence policy at all levels. They also do not have access to equal opportunities, rights, mental health programs and service, a quality education system that puts into consideration their unique needs, and employment that would enable them to have a decent standard of living. PWMI are one of the disabled groups in Uganda that are most excluded from taking part in Government programs for disabled persons due to the stigma of mental illness and the traditional believes that occurs within the communities as well as among other disabled persons/ groups.

Struggle for a supportive living environment and rehabilitation for people with mental illness Generally, most user households have limited knowledge on mental illness and health, how to live and handle persons living with mental illness and comprehensive support and rehabilitation towards the user. The result has been that the users abandon medica-tion, excluded from family, friends and community relationships. If nothing is done to address these challenges, the situation is likely to escalate into discrimination, stigma and exclusion, loneliness and isolation, low self-esteem and high risks of suicide. Knowledge on best practices of a supportive living environment and rehabilitation for PLWIM has not been compiled and docu -mented. Looking at the experiences in MHU and the districts, there has been little sharing of knowledge on best practices on psycho social rehabilitation. There is a need to strengthen the lessons learned and networking across districts and among users in MHU. Many users do not have the means of transportation and have long distances that prevent them from benefiting from the needed counselling and occupational therapy offered at some of the few hospitals. There is only few trained occupational therapist in the districts. That makes it impossible to reach out to the users who need such services. There is a need for MHU to establish service where the users are, so that they don’t have to reach service at long distances. Home based occupational therapy is a way to reach


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the user in his/ her own environment, so that rehabilitation takes place in the right context for the users. The experience in MHU and the country as such is rare and MHU needs to engage with local Mental Health Services so that these can benefit from, and support, the peer counselling done by MHU members.There is also limited reference material for MHU secretariat and the associations on how peer counselling is done in communities and homes. A standardised training manual for users and care givers in peer counselling is not in place to support this initiative. There is also need for gathering and developing of educational material on good practice on peer counselling and psycho-social education. Community based therapy needs to be discussed with a occupational therapist and paramedical schools so that the best psycho social practices could be documented and packaged in a resource booklet.

Unequally empowered District Associations As most government services are budgeted and delivered at the District level, a District level organizational presence is key to engaging with these services. MHU has made strides in empowering District Associ -ations to serve as organizational spaces for peer counselling and mutual self activities as well as community awareness work and advocacy for user rights. However, not all Districts are equally strong and most need to build capacity in one or several aspects of leadership and association management. District Associations have capacity for neither fund raising nor know how to identify and take advantage of opportunities provided by Poverty Alleviations Programs that are present in the District.

B. 4 Stakeholder analysisMHU has prepared the following analysis of the stakeholders involved in these issues:

Stakeholder Level Role played in area of project interest

What behavior change will we work for with this actor?

Strategy/activity towards this group to obtain the wanted change.

Rights holders (MHU)MHU Membership (PWMI and care givers)

District They are the primary Rights Holders and drivers of change in their own lives. They define the interests that MHU seeks to advance, and give legiti-macy to its work.

Will be active members of MHU, will actively seek and use to Mental Health Services and will participate in Income Generation Activities.

Members will be individually empow-ered through Peer Counselling and Livelihood Skills training. Their opin-ions and decisions will be sought and respected by MHU Board, Staff and District Executives.

MHU District Execu-tives

District Prime drivers of change for PWMI in the Districts.

Improved capacity for leader-ship, association manage-ment, advocacy and fund raising.

MHU will provide District Executives with training, spaces for learning, and with ongoing support from District Coordinator and National Secretariat.

MHU Board Na-tional

Define policies of MHU, guide staff and lead advocacy and fund raising at national level.

Improved capacity for organi-zational leadership, manage-ment and fund raising.

Project will support MHU Board with training and support for staff, monitor-ing activities and meetings.

MHU National Secre-tariat

Na-tional

Implements MHU policies and projects, support Board in national level advocacy and fund raising.

Improve capacity for project management, organizational learning and fund raising.

The project will support with training and salaries.

Potential advocates for rights holders (need to be targeted as having a duty to include MH issues and rights in their advocacy)Media Na-

tionalThe media brings the plight of PWMIs to the attention of policy makers and imple-menters to the limelight hence drawing attention to redress-ing their needs.

There will be increased inter-est in reporting about issues related to mental illness, health and rights.

CSOs in Uganda working in the area of health are battling on how to en-gage media to increase reporting on health related issues including mental health. A national meeting with media houses could be important. This has helped a lot with increased reporting on maternal health, malaria & HIV/AIDs.

District Disability Union, PWD District Councilors

District They lobby and advocate for the inclusion of PWDs in community development programmes.

Change perception on the needs and concerns of PWMIs as a unique disability within the broader movement.

Awareness raising workshop on issues related to mental illness, health and rights.Push for representation on the district unions and councils.Radio talk shows, music dance and drama, and community sports are very help-ful.

NUDIPU, NUWODU Na-tional

These are umbrella organiza-tions for DPOsThey have structures from national level- district- Sub County- and parish level

Now that PWMIs are repre-sented on the NUDIPU board, this must well be reflect at the district unions and sub county disability committees.

District based awareness raising workshop on issues related to mental illness and health.MHU secretariat organizes engage-ment meetings with these institutions.


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Health Sector Duty BearersMinistry of Health, National Drug Author-ity, National Medical Stores (NMS), and Joint Medical Stores (JMS). MPs

Na-tional

Ministry of health provides support supervision to re-gional and district hospitals. They also take lead in the process of formulation, imple-mentation and review of policies and Acts like it has been with the Mental Health Act.

Increased national health ministry budget investment in community mental health services rather than just psychiatric drugs

Regular engagements between secre-tariat and MOH, Parliament and NMS.Important that annually at the end of year we have a general meeting, starting at the end of in the second year; gather stakeholders from the districts and MH, MPs, NMS, Kampala City Council to share progress, lessons learnt and existing chal-lenges.

Health workers and officers, psychiatric clinical officers and administrators at re-gional referral hospi-tals and Butabika National Referral Hospital in Kampala

Re-gional/Na-tional

Most of the psychiatric health services are available at these health facilities.

Increased priority for invest-ment in psychiatric drugs.Increased human resource in psychiatric wards.

Invite them for district feedback, advocacy and lobby meetings on issues related to PWMIs.These will also play an important role in designing the guiding manual for psycho-social groups and supporting the work of these groups.

District Health Team (District Health Offi-cer, District Health Inspector, District Health Educator)

District Provides support supervision to all health staff in all health facilities in the district. They mentor health staff, investi-gate conduct of health staff and make recommendations to the personnel committee of the district.DHO is responsible for requisition of drugs from National Medical Stores (NMS). They are also respon-sible for the redistribution of drugs.

There are only 22 psychia-trists in Uganda. There are only 4 regional referral hospi-tals with psychiatrists includ-ing Arua, Kabale, Gulu & Mbarara. All the others are run by psychiatric clinical officers who are general practitioners with some spe-cial training in psychiatry.

Get MH issues on the indicators that are tracked in health service supervi-sion.

HIV/AIDS clinic District Serious gaps in treatment of people with HIV/AIDS and with MH issues.How do you build collabora-tion between psych service providers and HIV/AIDS clinic?

Increased knowledge on life of people living with mental illness.Increased referral of patients between the two clinics in the hospitals.

Important to have a forum where psych health worker are brought together with HIV clinic to create general awareness on both health conditions and therefore build a strong referral system between the two wards at the health facility.

Health workers District They provide the treatment. There are many rights abuses at health facilities. Seclusion is a serious issue.Health workers would also help to support the work of peer counseling groups.

Positive perception and attitude towards PWMIs. Provide more time to listen to user concerns rather than just prescription of drugs. Provide more follow up of patients in their communities.

Participate in engagement meetings with the district health team;Increased awareness training on the patients’ charter to provide rights based health care.Participate in district based engage-ment meetings with traditional healers.

Traditional healers Com-munity

Is in many cases the primary health responder. Most users do not come to health centers but seek treatment with these people. But they only treat physical symptoms.

Provide early referral for PWMIs to health facilities that provide psychiatric services.

First step is to engage them, seek an audience with them.Second step to get them to refer people to mental health services.

Poverty alleviation Duty BearersNUDIPU Trust Fund Program,

Na-tional

Has previously supported our members in Northern Uganda.

Give more consideration to households of people with mental illnesses.

Organizing lobby meetings with themTargeting them during district feed-back meetings

ABILIS foundation under NUDIPU (Fin-land)

Na-tional

They channel their funds through NUDIPU.They have interest in funding marginal-ized groups including people with psycho-social disabilities.

Give more consideration to households of people with mental illnesses

Engagement meetings with their office at NUDIPU.

NAADS District Have previously supported a few members in Mbale district.Have district based offices

Considering groups/ house-holds of PWMIs as special category groups or streamlin-

Engagement meeting with them to streamline PWMIs in the district running programmes


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running these programmes ing PLWMIs in the district running programmes.

District Disability Grant

District These are funds meant for all categories of people with disabilities in the district.They have supported the MHU user association in Mbale.


Awareness raising workshop on rights.Target meetings after mapping exer-cise.

Other mainstream programs (VSLA programs, etc)

District Have running programmes in some of the districts.

Pick more interest in support-ing groups/ individual house-holds of people with mental illnesses

The secretariat will have engagement meetings with the district based offices.

NUSAF North & East-ern Dis-tricts

They have district based offices including Gulu, Soroti & Mbale.


Engagement meetings with their district offices and showcase to them some of the users/ user households that have excelled in livelihood.Target them during district feedback meet-ings

Potential donorsDisability Rights Fund from US.

Na-tional

Has a country office.The country representative is a Ugandan with physical disability

Continuously support the capacity of other user associ-ations who might not be project target areas

The secretariat will support some user associations to apply for support from DRF

NUDIPU Trust Fund Na-tional

Based at NUDPU National offices

Build from the experience where some of our associa-tions in Soroti, Gulu and Mpigi have been supported before so that others can also be supported

The secretariat will continuously engage NUDIPU. MHU will also continue to mentor the district associ-ations so that they are well equipped to be eligible for such funding.

Abilis Foundation Na-tional

They have their office at the NUDIPU Secretariat

Start supporting our district associations

They have held previous meetings with the MHU secretariat and have high interest in supporting groups of people with psycho- social disability.

Open Society Foun-dation of East Africa

Na-tional

They have a country office.The country representative is a Ugandan and is blind.

Support MHU work especially in the area of human rights promotion and protection.

Have had previous interaction and collaboration with MHU. They have a lot of interest in supporting work of people with mental illness and their rights. MHU will continuously engage them.

C. PROJECT DESCRIPTION (indicative length 7pages)

C.1 Target group and participantsThe primary project target group are men, women, and young people living with mental health illness their caregivers, as well as their District and National organizations. The project intends to target about 2900 members from 8 MHU district associations, about 80 members of their elected District Executives, 9 members of the MHU National Board and 5 staff members in the national secret -ariat. The last mentioned 100 or so MHU leaders are the key implementers as well as target group of the project.

Many MHU members are caregivers. Caregivers are the primary contact of a person living with mental illness and often play a very important role to ensure that the user seeks the required medical treatment, adheres to treatment and receives other basic require -ments of life. The role of the care giver in Uganda is usually in the hands of the women. Women in Ugandan communities have the role of caring for the sick in the family. Women constitute most caregivers in MHU membership providing care and company to pa-tients whenever going to mental clinics. Some men would prefer to start another family if a wife should break down with mental ill -ness while most women will stay to care for a husband who has broken down with mental illness.Men once they break down with mental illnesses will lose jobs. This disrupts sources of livelihood and will lose respect in their homes.

The project will work with the following MHU 8 district associations.Due to the policy of subdividing Districts, Several District Associa-tions cover several Districts. Mental Health users in a total of 13 Districts will be affected by the project.District # General impres- Reason to include in project.


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Association Mem-bers

sion of organiz-ation

Mbale 489 Works well It is a cross regional user association that can reach out to several members in the neigh-bouring districts.

Soroti 258 Has potential to do better

It has potential to mobilize membership from the neighbouring districts of Ngora, Kumi, Amuria, Bukedea, and Katakwi.The chairperson of the BOD sits in the district council as a PWD representative and is the deputy speaker of the council.

Arua 109 Working poorly There are available opportunities to improve. Membership has reduced over the years due to weak leadership.

Gulu 769 Works well The association has received lots of livelihood support from the NUDIPU Trust Fund over the years.Even when the number of registered users is high, there are many patients that have not been reached by the association.As a result of the long armed conflict, psycho-social support is still very important in keeping the association together and the recovery of most members.

Mpigi 291 Works well They have a membership which covers neighbouring districts of Butambala, and Gomba.Their superiority in loan and savings could facilitate shared learning with other district associ-ations.

Rukungiri 696 Has potential to do better

The district hospital does not provide consistent mental health services. Most of the patients purchase their drugs from private drug shops.

Kabale 121 Disorganized The user association has a representative at the district disability union but her views are usually not respected by other members.

Tororo 216 Works poorly The number of registered members is rising steadily.

The secondary target groups will include: Some 30 Media representatives and 240 members ofnational OPWDs, District Disability Unions and Councilors, as potential

advocates for MH rights. Some 240 members of District Health Teams, traditional healers and Regional and National duty bearers involved in deliver -

ing health services to MH users. District, Regional and National duty bearers to be engaged in including MH users and caregivers in Poverty Alleviation Pro-

grams and services (these are yet to be identified in each district).. Potential donors to MHU National and District organizations. The general public in 8 Districts who will be targeted by awareness activities such as radio programs, sports galas and

theatre.

C.2 Objectives and indicators1

Development objective: To strengthen the capacity in Mental Health Uganda to enable the organization to get funds for its further work in performing advocacy and improving livelihoods for People With Mental Illness.

Immediate objective 1: By the end of December 2018 Mental Health Uganda`s Secretariat and district Associations` capacity has been built in management, resource mobilization, networking and sustainability to enable them to have funding from a primary donor to cover the basic operating costs and core activities until 2020.

Succes criteria: By the end of 2015 MHU formulated strategies for Financial Independence/fund raising and resource mobilization at na -

tional and local level (MOV: Strategy document as approved by Board). By the end of June 2016, MHU has built relevant organizational and management capacity of the secretariat, board and

district associations (MOV: activity reports by secretariat to MHU listing subject and content of training and names/position of participants).

By end of December 2017 MHU has received funds from a primary donor to cover 75% of the basic operating costs at national and district level until end of 2018. (MOV: Signed MOUs with funding partners. Information tracked: Name, dura-tion, total grant, budget assigned to MHU Board and Secretariat, District Offices & Coordinators)

1In the design of this project we have generally tried to formulate output and indicators in the form of progress markers, tracking advances in several steps on the way to the end of the project in 2018, instead of only as final indicators/outputs. We believe this will help implementers maintain focus and keep on track. Therefore there are more indicators and output for each objective then perhaps customary.


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By the end of 2018, MHU has attracted funding sufficient to cover basic operating costs of Board and Office at least until 2020. (MOV: Signed MOUs with funding partners. Information tracked: Name, duration, total grant, budget assigned to MHU Board and Secretariat, District Offices & Coordinators)

By the end of 2018, MHU at Regional and Association level has attracted funding to maintain at least 3 of the 6 District Coordinators and Offices until 2020.(MOV: Signed MOUs with funding partners. Information tracked: Name, duration, total grant, budget assigned to MHU Board and Secretariat, District Offices & Coordinators)

Immediate objective 2: By the end of December 2018, there will be increase in the level of awareness among national and district policy makers and implementers in the project districts about Stigma and rights of PWMIs By the end of June 2016 MHU has en-gaged the Ministry of Health and Parliamentarians on the health service sector to prioritize the needs of people with mental illness. Success Criteria:

By the end of December 2017, local communities and target stakeholders in 8 MHU districts are giving priority to the needs of MH users and their households. (MOV: Statements made by Users, District Executives and District Coordinators are solicited and tracked over time using an “Opinion of Services” monitoring tool developed by National Secretariat, supported my meeting minutes and MOUs from advocacy meetings (Information tracked: Date of MOU/Meeting, Location, Duty Bearer involved, MHU rep involved, Obligation assumed by Duty Bearer, Comment, Archive location of MOU or Meeting Minute)

By the end of December 2018, 6 out of 8 District Executives have reported improvements in mental health services to their members. (MOV: as above)

By the end of December 2018, there is active representation of people with psycho-social disabilities in district Disability Unions and district councils (MOV: Reports by District Coordinators. Information collected:Name, Position and relationship to MHU.)

Immediate objective 3: By the end of December 2018 1000 users and caregivers in the District Associations have access to com-munity development programs to improve their livelihood.Success Criteria:

By the end of December 2015 the district associations have listed all the potential local organizations and programs from where to get training and support for livelihood improvement. (MOV: Lists copied to National Secretariat by District Coordi-nators)

By end of June 2016 at least 400 PWMI`s have received general skills training in the district associations. (MOV: Activity reports and attendance sheets)

By end of December 2017 at least 800 users and caregivers in 8 district associations have access to a poverty alleviation program (Information collected and recorded in Membership Registry by District Executive, supported by District Coordina-tor).

C.3 Outputs and activitiesOutput for Immediate Objective 1 Activities for Immediate Objective 11.1 By the end of December 2015, MHU has developed a fundraising strategy, calculated basic operating costs, and has identified po-tential national and international donors

1.1.1 Recruit a program officer with knowledge, skill and experience in fundraising and advocacy and an accounts assistant with relevant skills

1.1.2 MHU to work with consultant to develop a fundraising strategy/ strategic plan for the next five years

1.2 By the end of June 2016 the staff in the secretariat has been upgraded in organiza-tional manage-ment, fund raising, book keep-ing and secretarial skills.

1.2.1 A plan of courses for staff at the secretariat, district coordinators and BOD members is developed by the secretariat

1.2.2 Courses for staff in Monitoring and evaluation, multi project manage-ment, fundraising, organizational development and documentation

1.2.3 Train the accounts officer and install Quick books as the general ac-counts system

1.2.4 Support to review of Human Resource and Financial Manual and job descriptions for staff at the secretariat

1.3 By the end of 2015 80 members of 8 dis-trict executives have been trained in leader-ship, membership mobilization and fundrais-ing,

1.3.1 Training in leadership, networking, fundraising, association financial management and conflict resolution

1.3.2 Support district associations to develop a group constitution, open up bank accounts, and registration with the district.


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1.3.3 Support 8 District Associations to update their membership registries using a tool that captures relevant information.

1.3.4 Making linkages with existing programmes in the district

1.3.5 Use existing district associations to mobilize for new associations in neighboring districts

1.4 By the end of 2016, 160 members in 8 districts have been identified and trained as peer support councilors for psycho-social support.

1.4.1 Training peer support counselors in psycho-social support

1.5 By the end of 2017, MHU has set up a performance monitoring system for peer coun-selors, and 160 Peer Counselors have re-ceived follow up support to function efficiently.

1.5.1 Develop a manual for peer support counseling

1.6 By June 2017, MHU has engaged with and submitted applications that include basic operating costs to at least two major potential donors. By June 2018 has engaged with at least 2 more donors.

1.6.1 Continuously document MHU work and support for publication

1.6.2 Review, re-design and update the MHU website so as to make it acces-sible and user friendly

1.6.3 Quarterly BOD meetings and monitoring1.7 By the end of 2017, at least 6 district asso-ciations have been able to fundraise for projects from local government or private institutions, including funding for District Coor-dinators.

1.7.1 Recruit regional coordinators to support the district associations in fundraising

1.7.2 Drawing a one- year activity plan1.7.3 Develop group constitution, open bank account and registration with

district1.7.4 Lobby for and constitute an office1.7.5 Monitoring and continuous mentoring and support from regional coordi-

nators and secretariat

Output for Immediate Objective 2 Activities for Immediate Objective 22.1 By June 2016, MHU has engaged the Ministry of Health, National Medical Stores and parliamentarians, on MHU issues.

2.1.1 Organize a national workshop with media houses and orient them nature of people with mental illness and their challenges so as to increase media reporting

2.2 By the end of December 2016, 8 MHU District Associations, supported by MHU sec-retariat have engaged local communities and target stakeholders on awareness of MH issues.

2.2.1 Support to music dance and drama in two district associations.

2.2.2 Hold a sports gala in one of the MHU districts to engage policy makers and the community on the underlying issues faced with people with mental illness.

2.2.3 Hold district based radio talk shows.2.2.4 Support to production of IEC materials including brochures/ leaflets,

annual review series and t-shirts.

2.3 By the end of December 2017, 8 MHU District Associations have engaged target stakeholders on giving priority to the needs of MH users and their households.

2.3.1 District based meetings with the District Health team and traditional healers to support early referral for patients to health centers

2.3.2 Quarterly district based advocacy, lobby and feedback meetings with district health teams and policy and implementation teams

2.4 By the end of 2018, 8 District Associations have engaged with District Disability Unions and Counselors to ensure active representa-tion of people with psycho-social disabilities in district Disability Unions and district councils.

2.4.1 Hold one district based sensitization and awareness workshop on mental illness and rights targeting members of the district union and council.

2.4.2 Hold bi-annual meetings with district disability unions and council mem-bers on follow up issues.

2.4.3 Build partnerships within the disability movement and other CSOs to push for positive towards PLWMIs


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2.4.4 Participate in International Disability Days- International Day for the Disabled and World Mental Health day to demonstrate capability or share information on the plight of people with mental illness.

2.4.5 MHU conducts bi-annual engagement meetings with the NUDIPU Secre-tariat and the BOD.

2.4.6 Empower user associations’ members to stand for elective positions on the district union and councils.

Output for Immediate Objective 3 Activities for Immediate Objective 33.1 By the end 2015 80 leaders from 8 MHU Districts have identified existing poverty allevi-ation programs in their area and have received training in the public budget process and in structures and procedures of poverty allevia-tion programs.

3.1.1 Work with regional coordinators to identify potential partners in income generation

3.1.2 Conduct annual national meeting to share results on lessons learnt success stories and existing challenges.

3.2 By the end of 2016 400 users/care-givers in 8 districts have been trained in loan and savings, book keeping, networking, and busi-ness sustainability.

3.2.1 Training in loan and saving, book keeping, and business sustainability

3.2.2 Each regional coordinator holding at least 3 quarterly meetings with identified partners to plan for inclusion of PLWMIs in income generating activities.

3.2.3 Each district coordinator reporting quarterly to the national secretariat on performance, monitoring and lessons learned

3.2.4 Each district coordinator to mobilize members and participate in national Budget consultative meetings at sub country and district levels

C.4 StrategyThe Theory of Change behind this project can very shortly be formulated as: Sustainability in MHU lies in ensuring the capacity for delivering membership value as well as fund raising of 100 key MHU leaders at District and National Level.Capacity must in turn be sustained through social practice. This can be doneby nesting it in mutually supportive and strongly committed, motivated, invested or engaged (as the case may be) relationships among the key stakeholder networks these 100 or so leaders are engaged with. This includes various groups of duty bearers, donors, and, most critically, the membership of the MHU District Associations. The project activities consist in large part of building these relationships.

The project has been designed according the Change Triangle as promoted by CISU and the Disability Fund, where change is con-ceived as an interplay between Strategic Service Delivery, Capacity Building and Advocacy.

- The outputs designed to support Immediate Objective 1– Building Financial Sustainability –are mostly Capacity Build-ing and Fund Raising.

- The outputs designed to support Objectives 2 (Gaining access to Mental Health Services) and 3 (Gaining access to Poverty Alleviation Programs) are mostly Advocacy.

- Outputs for Strategic Services Deliveries to MHU members have been included to build membership capacity for social and organizational participation (under Obj. 1) and for participation in poverty alleviation programs (under Obj 3).

The three objectives are mutually supporting in order to bring about the organizational sustainability described in the development goal:

- The organizational capacity built through Obj 1 adds strength to the advocacy work of Objectives 2 and 3. - Obj. 2 and 3are mutually supporting in that the District Executive mobilizes and reinforces the same basic leadership

skills, community awareness and organizational image to influence District stakeholders for both objectives.- Obj 2 and 3 also create added value for members and added visibility and attractiveness among donors, thus in turn

supporting Objective 1.

MHU has described the theory of change behind the project in a diagram attached as appendix H.

Cross cutting strategies


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Organizational development: The project provides support for capacity building among District Executives, National Board and Sec-retariat with a focus on fundraising:

- The project will support National Board, Staff and District Executives in building fund raising capacity and implement-ing fund raising activities(Obj 1). An initial fund raising plan will be developed in 2015 which gradually will be reined into a strategy as experience is gained. The goal will be to win the commitment of at least one new major donor (cov-ering the operating cost of National Board and Secretariat) as well as funds for at least 3 of the 5 District Offices.

- National Board and Staff will also be helped to build broad management skills and tools that increase credibility of the organization towards donors and membership.

- District Executives will also build capacity in basic organizational management (obj 1) as a prelude to building fund raising and advocacy capacity. This will support member ownership and build credibility for fund raising (obj 1) and advocacy work (Obj 2 and 3) alike

- District Coordinators as key capacity builders: Based on lessons learned from the previous project, local elected leaders will be supported by District based coordinators (who also serve neighboring districts, becoming de facto Regional Coordinators). They will serve as key resource persons for District Based fund raising. Being locally based, these resource persons will be well placed to help build capacity in District Executives, and will in many functions be cheaper and more sustainable than direct support from National Secretariat.

- The project also helps the Secretariat to support the work of District Executives under all three objectives. SIND sup-port to core functions (Staff salaries, administrative costs, Board costs) will be withdrawn gradually during the project period, as alternative financing hopefully comes on board, starting with a financing level of 80% the first two years, then dropping to 40% and 20% during the last two.

Advocacy: Advocacy activities are directed toward achieving user access to health services and to poverty alleviation programs, focused on the district and regional level. Success in these endeavors will directly benefit the involved MH users, building added value for membership and also among potential donors, supporting Objective 1.

- The advocacy themes of health and poverty alleviation have been chosen because they are of paramount interest to the members and the organization must reflect this to maximize membership value.

- Health advocacy will focus on building a mutually supportive relationship with regional referral hospitals, awareness raising and coordination among primary level healers and health workers, and work with District Health Teams as well as National Health Offices to bring the right medicines onto pharmacy and clinic shelves and to support primary health workers in giving adequate service.

- Poverty Alleviation Advocacy will focus on gaining access for MH users to both mainstream and disability targeted poverty alleviation programs. This involves District Development Offices as well as identification of specific program offices in each District. It also involves awareness raising among the disability fraternity on MH issues.

- Advocacy work will be supported by broader community awareness efforts targeted at creating a “MH aware” mental-ity among community leaders, politicians, official and other stakeholders.

Strategic Service Delivery: The project provides Strategic Service Delivery to members in two areas:- Training of peer counselors for psycho social support. This enables members to participate in basic social activities,

including organizational activities. It also adds value to membership, helping to build motivation and member owner-ship. And it provides a focus for engaging psycho social clinics in mutually beneficial support for continuing peer counseling. Increasing membership capacity for social action initially supports the District Capacity Building part of Immediate Objective 1, but later on also directly supports Objective 2 (Health advocacy) and 3 (Advocacy for inclusion in PAPs).

- Training of members in business skills to enable them to participate in Poverty Alleviation Programs and follow up training to those who gain access to ensure good results (Obj 3). This helps identify and build confidence among members seeking access to PAPs, and also makes MH users more attractive to PAP managers. Follow up helps achieve a good initial track record to on which to build future inclusion in mainstream programs.

- In both cases the number of members to be trained has been selected with an eye to building a “critical mass” among membership that permits replication of best practices by word of mouth and example.

Synergy among key participants in the project: The key actors of the project are about80 elected leaders of the 8 District Executives, on whom much hopes are laid. As explained, this leadership level is a key for building organizational sustainability, as it is here value for membership meets capacity for action.To build sustainable capacity at this level it is necessary to embed this group in a network of mutually reinforcing relationships with other groups “above”, “below” and “outside”:

National Board and Secretariat, accompanying and advising DEs, and receiving their support in return. Members becoming capable of participating, valuing the results achieved by the DEs, and demanding transparency and

quality of their leadership. Among them Peer Counselors serving as future leaders and liaison to membership. District Coordinatorscapable of supporting DEs with management and fund raising skills.


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Members of District Health Units, District Disability Unions, donor agencies, Poverty Alleviation Programs and other stake-holders who have invested in MHU as an important local actor enabling them to better reach their target groups and com-ply with objectives, and supporting MHU in return.

Communities aware and respecting of MHU.

MHU has written a strategy paper for district intervention (appended) covering several of the above mentioned elements.

C.5 SustainabilityAt the end of the project the MHU National Office and the district associations will have improved their capacity and gained compe-tences in managing the office, more specifically fundraising, project monitoring and evaluation, partnership building and strengthen-ing. The organization will have been strengthened with improved capacity of the Board of directors, Secretariat and district associa-tions throughout the future. MHU will be visible among disabled people’s organizations and be networking with other disabled and other civil society organizations. The district associations will be less dependent on the secretariat for resource mobilization, financial management; effective group mobilization and leadership.

At the individual level, the project expects to leave behind the following permanent changes created by individual participation in project activities:

- About 100 leaders and staff of MHU capable of functioning better as leaders of their organization.- About 3000 members that have been personally empowered by peer counselling, participation in MHU activities and

access to mental health services, and thereby contributing more to the lives of themselves and their families.- About 800 individual members with improved livelihoods.- About 500 members of external stakeholder organizations with increased awareness and practical experience work-

ing with PWMI, and with inclusive policies and practices in place in their organizations.

At the organizational level, the project hopes to leave behind sustainable and replicable practices for advocacy, fund raising and organizational life that has attracted funding in the form of at least one new major and 3 minor donors, sufficient to permit

- the national secretariat and board to continue functioning at least at 75% of present level, - enable at least 3 of the 6 District Offices to keep functioning.

The main strategies to achieve organizational sustainability are:- Improving the capacity of District Executives to deliver membership value to their members in two important areas of

their life, thus building commitment to the organization. It is more than one to make the leadership practices both adaptable and replicable, and to better chances of delivering at least one important value to members.

- Improving members´ capacity to be members (peer counseling)and successful users of services (skills training).- Nest organizational sustainability and practices at different levels (District and National) and in as broad a variety of

reinforcing stakeholder networks as possible (internal and external).- Spread capacity throughout the organization, especially fund raising capacity.- Develop organizational capacity for learning through documentation and exchanges of experiences.- Give National Staff and District Coordinators time to develop fund raising activities as a major part of their work load.

Key secretariat staff will dedicate about 20% of their time the first 2 years to stakeholder relationships and fund rais-ing. Because these activities carry few costs aside from the time dedicated to them, the relationship between the budgets for activities and staff+administration in this project is therefore a rather low 50:50.

- Phasing out of SIND support in a gradual, measured, transparent and planned manner during the 4 year exit period, with planned facing out of support to salaries and administrative costs, so that SIND can help MHU react to both challenges and opportunities while scaling up alternative channels of financing.

The project will continuously document best practices, lessons learnt, case studies and sustainability mechanisms that will be yard-sticks for future MHU programming and fundraising. Documentation will also help to support efforts for the domestication of the UNCRPD, policy formulation and legislation.

- Project documentation will include a fund raising strategy, a psycho social support manual, and training manuals/guides for fund raising, advocacy and leadership.

- Project monitoring will systematically collect information on advocacy results, duty beare responses and actions, fund raising, and user and livelihoods information from membership. This will lay the ground for further fact based advo-cacy work and for demonstrating value to donors and stakeholders.

C.6Assumptions and risksThe critical assumptions that the project is based on are:


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- PWMI will continue to actively support their organization, thus giving legitimacy to MHU in the eyes of stakeholders and donors.Risk evaluation: Low.

- That duty bearers in Health and Poverty Alleviation sectors are approachable and willing to include PWMI in their programs. Especially critical here is bridging the gap between the requirement of Poverty Alleviation Programs and the limited life experiences of some PWMI. Risk Evaluation:In general, government and NGO officials in Uganda have shown themselves amenable to awareness raising on PWD issues. However, the risk may be relatively higherin some Districts and some Programs. Steps taken: Risk is spread among several Districts and Areasof work, thus ensuring that valuable success stories will be generated in most, in not all user groups.

- One major and three donors can be identified and successfully engaged during the project period.Risk: Medium. Steps taken: District based decentralization of MHU capacity, engagement of volunteers as capacity bearers in MHU, wide focus of fund raising, and a felt growing awareness among government duty bearers for the need to support CSOs as partners to government (which is to be tested by engaging District Psych Officers on peer counselling) all serve to build resilience of MHU to donor ups and downs.

External risks:- That the project may to be usurped by district stakeholders as a stepping stone to solicit for political capital; now that

we are tending towards 2016 General Elections. - That the project risks being accorded little time by the district stakeholders as they will be preparing their political

ground for 2016 as much more attention is normally put attention on infrastructure improvement like roads. - The project however intends to use other unique methods of engaging policy makers and other stakeholders. These

include radio, music dance and drama, and community sports.

D. PROJECT ORGANISATION AND FOLLOW UP (indicative length 1 ½ pages)

D.1 Division of roles in project implementationSIND will ensure the following in this cooperation: Take responsibility for communicating to MHU any relevant information from DPOD. Support overall project monitoring through at least one yearly project visit to implement planned monitoring activities in the

secretariat as well in the District Associations. The monitoring will be guided by the projects success criteria. Overall responsibility for this project is in the SIND secretariat and board – the daily responsibility in contact and monitoring of

the project is placed in the SIND Uganda Committee, who is referring to the secretariat and board. SIND secretariat is responsible for the timely disbursement of funds to MHU and the accountancy with funds in collaboration

with the SIND Uganda Committee. Responsibility for timely reporting to DPOD is placed in the committee.

On the other hand MHU will ensure the following: MHU will prepare timely implementation plans and follow this plan in implementation of the projects activities in accordance with

the objectives and success criteria. MHU will ensure sound financial management practices as stipulated in the Contract signed and guided by the SIND Account -

ant and Auditors. MHU will ensure timely field narrative and financial reports to SIND as scheduled in the contract with DPOD and the SIND/MHU

contract.

D.2 Monitoring and evaluationQualitative and quantitative approaches will be used to examine progress and effectiveness of the intervention as well as providing numeral information about the impact and coverage. Monitoring will therefore be continuous and participatory (implementers, benefi -ciaries).To this end, simple monitoring tools that track District Association organizational development, advocacy work and fund raising will be developed. This project will be subjected to periodic review meetings (every six months). The project will share quarterly reports, midterm and end of project reports (this will include narrative and financial) with the SIND Uganda Committee and yearly reports with DPOD. The narrative will indicate progress, key achievements, lessons learnt and good practices worth replicating. It will also highlight chal-lenges and key recommendations for both the donor and implementing agency.SIND will visit the project at least once a year. At these project visits it will be decided if there should be made any necessary adjust -ments if the assumptions fail to materialize and how these adjustments should be made to keep the project in line with the objectives and success criteria’s. Over a four year period other conditions could be changed and through the monitoring changes will be taken in consideration and adjustments made to handle them.


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A midterm evaluation and review will be held to evaluate progress the first two years and, if necessary, adapt the project design to the challenges and opportunities encountered, especially as to those provided by alternative fund raising. Success will be measured through midterm and end of project participatory assessment/ approaches of investigation using both qualitative and quantitative methods. The success criteria’s will be used as guidelinesin the monitoring programme implemented yearly of the SIND Uganda Committee.

E. INFORMATION WORK (indicative length 1½ pages)

E.1 Project related information work in DenmarkSIND Uganda Committee has not yet planed any information work in detail, but the following issues have been discussed:An article in the trade journal “Sygeplejersken” about mental health in Uganda and the traditional healer’s role in treatment of users. The article will be written by volunteers in the Committee and it will target the health system to inform of the conditions for PWMIs in Uganda and about MHU work to improve the conditions for users in the health system.Articles will be put in the “SIND Bladet” to inform the members about the progress in Uganda. An article in the “Kristelig Dagblad “ about MHU and how they work and the results reach have been planed. The Committee will write the article and this will target a broader group of people. Lectures in various associations could be arranged – Rotary and Lions Club could be interested in hearing about conditions for PWMIs in Uganda. Other organisations will be addressed as well.As there is a Health Educator in the committee some colleges will be addressed to inform about mental health conditions in Uganda and to inform of the possibility of Internship stay at one of the hospitals who have wards for mentally patients and MHU has an Asso -ciation. The committee will take part in arrangements coming up through the 4 year project period. The overall goal for the information work will be to raise the awareness of the high quality of organisational work done in Uganda for people with a mental illness and other disabilities; to change the attitude towards the African countries from looking at them as just so poor to see their human resources and potential for development.


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3. Budget summaryBudget summary Currency

Indicate the total cost (i.e. including contributions from the Dis-ability Fund as well as others)

2.300.040 DKK

Of this, the Disability Fund is to contribute 2.300.040 DKK

Of this, indicate the amount to be contributed by other sources, including self-funding by the Danish organisation or its local partner, if any 0 DKK

Indicate total cost in local currency 1.012.017.556 UGX

Indicate exchange rate applied 440 UGX/DKK

Main budget items:Financing plan

Full amount Of this, from the Disability Fund

Of this, from other sources

1. Activities 840.573 840.5732. Investments 52.273 52.2733. Expatriate staff 0 04. Local staff 684.891 684.8915. Local administration 159.827 159.8276. Project monitoring (by the Danish organisation) 158.000 158.0007. Evaluation 39.500 39.5008. Information in Denmark (a maximum of 2% of

budget line 1 - 7)10.000 10.000

9. Disability compensation10. Budget margin (a minimum of 6% and a max-

imum of 10% of budget line 1 - 9)194.506 194.506

11. Project expenses in total (budget line 1 - 10) 2.139.570 2.139.57012. Auditing in Denmark 10.000 10.00013. Subtotal (budget line 11 - 12) 2.149.570 2.149.57014. Administration in Denmark (a maximum 7% of

the subtotal 13.)150.470 150.470

15. Total 2.300.040 2.300.040


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4. AnnexesOBLIGATORY ANNEXES

A. Organisational fact sheet for the local partner(s). B. Budget formatC. The organisation’s statutesD. The latest annual reportE. The latest audited annual accounts

SUPPLEMENTARY ANNEXES: for example reports and analysis that directly support the project's objectives and rationale (max 30 pages)

Annex no. Annex titleF LogframeG Stakeholder analysisH Theory of ChangeI SIND udfasningsstrategiJ MHI District Intervention StrategyK Evaluation report MHU/SIND 2008-13


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