Progress made to-date Since November 2007, a great number of interventions have been undertaken that have been funded directly by the OVC program.  The OVC program funding has had a synergistic effect on other health-related programs run by the CNF and by Dr. Dieckhaus. Additional projects made possible by the identification of local needs development of a defined care delivery structure data that the OVC program were provided. Primary Programs of the OVC Project  Community Needs Survey  Beginning in July-September 2007 a community health survey for the Katarara sub-parish was performed.  The purpose of the census was to provide an accurate assessment of the population in the Clare Nsenga Health Centre catchment area including socio-demographic data, health indicators, and opportunities for public intervention.  A particular focus of the census was to locate children who were “at risk”. Results:  A total of 938 households were surveyed, including data from 2216 adults and 2901 children under the age of 18 years.  Highlights from the survey revealed the following: 234 total orphans were identified Mean age 11.5 years 87 orphaned from HIV/AIDS 16 orphaned from Malaria 97 orphaned from ‘unknown causes’ Housing and Household wealth 83% of household are “pole and mud” houses Children who had lost one or both parents had significantly less in terms of material and economic wealth in nearly all household factors measured. Livestock ownership was low in the group as a whole, but was more accentuated among orphan households: 0.41 vs 0.67 cows in household (p=.003) 1.3 vs 1.8 goats per household (p=.001) 0.06 vs 0.31 sheep per household (p=.001) No difference in chicken ownership (.21 vs .24 per household) or pig ownership (.01 vs .02 per household) Land ownership was significantly less in orphan families than non-orphan families (2.46 plots vs 3.25 plots, p<.001) Total family income in orphan families was only 54% of non-orphan families (814,000UGX/$407 vs. 446,000UGX/$223, p<.001) Health Indicators 71.6% of children did not have a mat to sleep on. This was more pronounced in orphan households (69% vs. 77%, X2=7.0, p=.008) 92.7% of children did not have access to malaria nets Ownership of insecticide treated bed nets was significantly less in Orphan households (3.4% vs 7.5%, X2=5.5 p=.02) School Attendance 16.4% (242 children in total) were identified who did not attend their last school term.  Reasons for lack of school attendance is as follows: 9.1% Refused 61.95 Dropped out to perform domestic work 39.3 Lack of appropriate funds 1.6% Peer Pressure 2.9% Other Children who had lost one or both parents were more likely to have missed their last school term (41% among orphan vs 17% of non-orphans, X2=27.6 p<.0001) Aid Assistance Specific requests for assistance included: 46.7% Water tank/water purification 67.2% School fees or supplies 16.6% Housing 30.7% Sleeping mattress 15.1% ITN Malaria nets 30.3% Clothing 2.6% Food 28.4%Livestock The effect of being an orphan on these outcomes are: More likely to request help with school fees (73% vs 66%, X2=4.54 p=.035) More likely to request assistance with clothing (49% vs 28%, X2=44.0 p<.0001) More likely to request assistance with food (10.6% vs 1.8%, X2=67.0, p<.0001) More likely to request assistance with livestock (33.3% vs 27.9%, X2=3.1, p=.082[N.S.]) Involvement of Local Stake-Holders in Planning The OVC project continues to use local resources to guide the planning and implementation of the interventions.  “OVC Project Board” to involve local stakeholders in decision-making, planning, and distribution of resources.  It is headed by Mr. Pius Bigirimana, with local community leaders, Katarara school board members and physicians.  It has been successful in organizing the community activities of the Clare Nsenga Foundation including the identification AIDS orphans in the community prior to the onset of this project, construction of the clinic, and promotion of the health outreach programs of the CNF. Continuing Community Health Education Both community health workers are intimately familiar with the community of Cyanika. Analysis of the household health census has identified numerous issues for community health education including malaria and safe water.  Perhaps more importantly, this survey placed the CHW in direct contact with >90% of households in the catchment area.  Health promotion messages for this original contact were documented including the following: Number of Households (n=938) Education Offered 279 Family 73 Sanitation 199 Water Safety 24 School/Education 77 HIV/AIDS testing /sensitization   Other health promotion messages included referrals to especially medical care (psychiatry, gynecology) and dispelling rumors associated with “gapfura” (a local perception of “severe malaria” whereby local healers perform a non-sterile oral procedure to “cure” it). This data represents only the initial contact with the population.  The two HCWs continue to make rounds in the area to provide on-going contact and advice.