Overview of TASO:
The Aids Support Organization (TASO) is an indigenous organization in Uganda that provides HIV/AIDS services to persons living with the virus. The organization was founded by Noerine Kaleeba and fifteen volunteers who had little to no experience to support persons living with HIV/AIDS in 1987. TASO expanded its operation to four regional offices and 10 service centers in most parts of Uganda. In 2004 TASO came up with the initiative by offering antiretroviral therapy (ART) to most of its clients on first come, first serve basis. Although the organization overpowered with financial support from numerous NGO‘s and other organizations, in 2006 funds started depleting as a result of mismanagement which pose significant threat to its survival. Additionally, TASO assertion of it robust development and accomplishment in Uganda continues to be one of great success reflecting on how it initially started.

The main issued identified from the case-TASO:
The main issue identified in the case is whether TASO should remain focus on delivering counselling and support services only to people living with HIV/AIDS (PLWHA).
Further elaboration is giving through the asking of the listed pertinent questions listed below to properly analyze the case: * What measures should Coutinho and his staff take to maintain their client-centered ethos while delivering services in a more cost-effective way? * TASO unarguable lacks the full capacity of human resources and financial resources to continue its humanitarian outreach for people living with HIV/AIDS in Uganda. Therefore, what are the future outlooks for TASO and its clients in Uganda? * With TASO introducing ART as a treatment to its clients, will it lose focus of its primary functions and be bombarded with too much, leading to overwhelming staff and excessive pressure on the resources of the organization both human and financial?

Question 1: What was the Ugandan government’s response to HIV/AIDS crisis prior to 1986?
Answer:
The 1980’s was considered a challenging and devastating period for the Ugandan government. In the 1980’s government did not place must emphasis and response to HIV/AID’s in Uganda at the time, continued rivalry of economic challenges, political turmoil, and war were all primary concerns of the government prior to 1986. HIV/AIDS was spreading like wild fire, villages identifying it as the “slim disease” The first case of HIV/AIDS was diagnosed in 1982;with a significantly high prevalence rate of 29% in the 1980’s to 1990’s. In 1971 Idi Amin took power, murdering a total of 300,000 Ugandans in his eight year reign. An additional 300,000 was killed during a civil war under the ruler ship of Milton Obote.
With the arrival of President Yoweri Museveni in 1986, a significant change took place, political stability. The National Resistance Movement (NRM) government brought order to Uganda’s territory; the government established relationships by creating avenues for development programs with the International Monetary Fund (IMF), World Bank and other government policies (Kleinman, Talbot, Harris, & Ellner, 2011). President Museveni made it clear by announcing to the general population that there was an HIV/AIDS crisis and immediate measures were put in place to combat this dreadful epidemic. AIDS Control Program (ACP) was set as to ascertain the extent of the disease, the method in which the disease is transferred, and to protect the national blood bank (Tumushabe, 2006). With the continued efforts from the governments and other stakeholders the reduction of HIV/AIDS prevalence was reduced significantly by 2000.
Question 2: Ugandan health system at the time of the case in light of readings in our text and the case:
Answer:
Ugandan’s health system at the time of the case during the period 1986-2006 was centered on a colonial health system. It is primarily one of a decentralized system consisting a national level and district levels. The health system was very inadequate and poor, with the government being aware of a significant need of proper health care system, yet much could not have been done. Hearths out to humanitarian aids who delivered health supplies in parts of Uganda where infrastructure and health care were wrecked due to political up rise during the 1970s and 1980s.
In 1993 a strategic health plan was established with four levels of health care, primarily working on a referral basis. Although these initiatives have been put place to extend health care to everyone, a continued decrease in the health care system was still there. Nutrition is a great concern and plays a pivotal role in the health of HIV/AIDS victims; yet for all a total of 6.75 million Ugandans were vulnerable to food. The population of Uganda was significantly affected where, in 2000 HIV/AIDS has been the highest disease held accountable for over 9.4% Ugandans being death of all ages, putting a further strain on the health care resources.
Uganda’s health system in 2005 comprised of 2,209 physicians, 16,221 nurses, and 3,104 midwives, which I considered to be rather inadequate for its extremely over-populated size of 28.72 million people. In the entire scope of Uganda, only two hundred and fifteen pharmacist were available, nine of which were rural and 215 being urban respectively.
Table 1:
Listed below in table 1, is a snapshot of some strengths and weaknesses identified from Uganda’s health system at the time of the case. I narrowed down some of the strengths and weaknesses so as one can grasp a clear idea of Uganda’s health care system. Strengths | Weaknesses | * Cost effective by partnering with donors from both bilateral and multilateral personnel. Also subsidizing medications in public government health facilities. | * The lack of adequate funding to efficiently run the health sector in Uganda. Case in point: TASO was already felling the burden, when it started offering ART to its clients. | * The health system was design to accommodate Ugandans from both rural and urban areas. | * The shortage of human resources that are fully trained to fill the hospitals and district health facilities. | * Having a decentralized system allowed communities to participate in the planning and management of the district facilities. | * The long distance for Uganda’s travelling to the nearest health care facility, according to the case is five kilometers. |
However, the HIV/AIDS epidemic among the five countries in Sub-Saharan Africa, Uganda being one of the largest of them reduced HIV/AIDS significantly between periods 2001 and 2009 (Perkins, Radelet, Lindaur, & Block, 2013).

Question 3: What was the biggest human resource and service/supply challenges in providing ART to clients?
Answer:
* Declining financial resources: As other organizations became competitive TASO contributions from major health organizations were dropping significantly. Reference to the case, from 2005 to 2006 contribution has declined from USD 5.54 million to USD 3.73 million respectively. * Staff felt overwhelmed: Part of TASO’s model was made up of home base visits to their clients by both center-based officers (CBO) and field officers (FO); however as the number of clients increased it became difficult to visit them all. Additionally, the managers at the centers were feeling a strain as well on their time. * Brain drain on employees: Although TASO physicians was paid twice as that of the government was offering, a number of them left as other NGO’s, research institutes were paying five times as much. * Challenges from home base clients: TASO’s clients became well overtime through the administration of ART, therefore they went back to work. Meanwhile it became difficult for their usual appointments with CBO and FO. * High cost of the ART program: ART was a very expensive program to run, especially with the continued increase in client base at TASO. Although a generic replacement of ART was created the program continued be a burden. * Decrease in proper nutrition to TASO clients: Due to a Sustainable Livelihoods Strategy project, insecurity of food threatened the health of TASO’s patients.

Question 4: How would I evaluate TASO’s performance?
Answer:
To properly evaluate TASO’s performance one would need to address all the important issues raised in the case. While at the same time I would evaluate TASO’s objectives whether they were met or not by the services and products it offered. Additionally, I would seek to explore Uganda’s government and other stakeholders’ involvement with TASO’s initiatives. Moreover, a detailed analysis would be used to give a precise examination of TASO’s overall performance. Finishing with two recommendations for the future of TASO.
TASO faced numerous issues from its time of inception. Issues such as finance, weather to focus on counselling only PLWHA, figuring ways to deliver its services in a cost-effective way, the changing demand of its client base, and how should they issue ART treatments-is it first come, first serve?. TASO’s objectives:
TASO is the first indigenous organization in Uganda offering support to PLWHA who are affected and infected by the virus. In 2004 it sort to offer ART to its clients as to increase their years of living, because the longest an average patient would live is one year. TASO’s strive to improve the lives of PLWHA through the following objectives: * Restoring hope * Promoting invention * Support to its clients both physically and emotionally * Facilitate care for both infected and affected persons
Analyzing TASO objectives:
TASO objectives without hesitation meet its obligations base on the results on the programs it offered to its clients. TASO did much more than just offering it’s counselling and support services. It is evident with the introduction of ART, despite the heavy financial cost to maintain it. TASO went as far in extending its services to rural areas outside of its main district-Kampala. Additionally, TASO develop a nutritional program to improve the health of its client. TASO had offices set up in 56 of Ugandan’s 80 districts, provided support to 186,000 PLWHA comprising of 65A5 females and 35% male (Kleinman, Talbot, Harris, & Ellner, 2011).

Recommendations: * TASO should increase its networking to international donors and financial aid programs worldwide to assist with the overall cost of running the organization. With the added financial aids received, TASO can train additional personnel such as volunteers. Having more volunteers will ultimately reduce its administrative expenses significantly and at the same time, TASO can meet its clients increasing demands. *

Bibliography:
Government of Uganda: Ministry of Health. (2010). Health Sector Strategic Plan III 2010/11-2014/15. Retrieved from www.health.go.ug/docs/HSSP_III_2010.pdf
Kleinman, S., Talbot, J. R., Harris, J., & Ellner, A. (2011). The AIDS Support Organization (TASCO) of Uganda. Cases in Global Health Delivery, 2.
Perkins, D. H., Radelet, S., Lindaur, D. L., & Block, S. A. (2013). Economics of Development 7th, edition. In D. H. Perkins, S. Radelet, D. L. Lindaur, & S. A. Block, Economics of Development 7th, edition (p. 325). London: W.W. Norton & Company Ltd.
Tumushabe, J. (2006, August). The Politics of HIV/AIDS in Uganda. Retrieved from United Nations Research Institute for Social Development: http://www.unrisd.org/80256B3C005BCCF9/(httpAuxPages)/86CB69D103FCF94EC125723000380C60/$file/tumushabe-pp.pdf

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[ 1 ]. The strengths and weaknesses listed are from a report from the government of Uganda, Ministry of Health, Health Sector Strategic Plan III 2010/11-2014/15 (Government of Uganda: Ministry of Health, 2010)