Scaling up diagnostic journeys among prisoners

There are about 5000 to 8000 RDs identified globally, varying regarding their origins, risk factors, symptoms and treatments, and geographical dispersion. Despite this wide variety of specificities, they share the commonality of being rare, with patients facing similar challenges regarding diagnosis, treatment, and care. People living with RDs often struggle with social and cultural exclusion, limited political visibility and prioritization, and difficulties accessing adequate diagnosis, treatment, and care. The lack of epidemiological data that is consistent across geographies and populations and the nature of the rarity of the conditions (low prevalence) also limit the implementation of clinical trials and the gathering of real-world data. This, in turn, hinders the production of effective and innovative treatments. The management of diagnosis and treatment of RDs is also challenging. Patients, their families, and their caregivers are often affected by the heavy emotional, financial, and social burdens, and although strong disparities between countries exist, RD management remains a global concern. Even in developed economies that have more advanced RD policies, budgets, and clinical guidelines, patients struggle to navigate the healthcare system, leading to major disparities in RD quality of care and access to treatment across social classes and communities

Prisons in Uganda have no independent hospitals with exception of Murchison Bay Hospital in Luzira which works as a referral for the 274 prisons in Uganda. Prisons in Uganda have resorted to using district hospitals for their clients which is a challenge to them because transporting inmates from prisons to community hospitals without ambulances is hard, In this regard, accessing health services is completely hard among prisoners, more so inmates with rare diseases and those living with HIV/AIDS and on ART face challenges in accessing services. However, other prisons have decided to identify a prison nurse who manages minor infections and conditions among inmates but this has always been irregular and limited to malaria, fever, minor wounds acquired from the fields and or typhoid, Nevertheless, this hired special nurse can’t manage HIV/AIDS or TB or rare disease or other general conditions relating from infections or diseases  No routine investigations for Lab diagnosis and No public health Educations in prisons and host refugee communities.

Therefore, rare diseases and HIV/AIDS infection greatly increases in prison settings everyday by new inmates and lack of public health response and TB which is marked to be a silent common opportunistic condition has been shown to increase the replication of HIV, thus accelerating the progress of other AIDS diseases and rare diseases. Responding to rare diseases and HIV/AIDS in prisons settings and multi-drug resistant (MDR) requires a comprehensive strategy that must be inclusive among all people living, working, and visiting prison settings and therefore must engage active multi-sectoral participation to ensure an effective public health response.

 Therefore, TUNMAPS aims to Scale up diagnostic journeys among prisoners, refugees, ex-convicts, islands and communities in Uganda.

1.Ensuring research and development of essential evidence

• Improve national surveillance mechanisms and registries to gather sufficient information to support research, health and social services planning, and policy shaping.
• Improve monitoring and evaluation of data.
• Improve data standardization, centralizing, and sharing to develop mechanisms to support the identification of RDs.
• Engage patients in the entire product development lifecycle, including priority setting, design, execution of clinical trials, value assessing, and access decision-making.

2.Building equitable access to diagnosis, treatments, and care

• Ensure access to health services and treatment (essential medicines and advanced therapies like biotherapeutic products) are in line with the UN Sustainable Development Goals and Universal Health Coverage.
• Prioritize RD as a group in national health systems (using criteria beyond frequency) and improve reimbursement and regulatory processes to increase affordability.
• Implement, strengthen tools and mechanisms to control costs of treatment, including for RDs, ensuring high quality of care and sustainability of health systems.
• Include psychosocial services for patients and caregivers as part of the standard of care for RDs.
• Establish disease-specific and non-disease-specific centers of excellence for ultra-RDs across the country.
• Ensure comprehensive care plans and policies are in place (like adequate referral systems) to close the gap in access between rural and urban settings.

3.Building capacity and awareness of healthcare workers

• Increase capacity/knowledge of HCWs on patient experience, symptoms, and impact of RDs; types of care, treatment, and disease progression through regular training opportunities, including through employee training and development programs.
• Include education on RD as part of the healthcare education curriculum.

4.Improving the healthcare system and services for RD patients

• Ensure early access to genetic screening, and referral consultation network, including specialist care, integrated services, infrastructure, and human resources.
• Implement a people-centered model of care in partnership with the Government that is respectful of, and responsive to, the preferences, needs, and values of patients and that provides emotional support, physical comfort, information and communication, continuity, transition, care access, coordination, and involvement of patients’ families and caregivers.

5. Implement Digital health 

• Implement institutional information tools ai an App, websites and helplines to guarantee that all RD patients and HCWs have access to critical information and support.

 6. Standardizing clinical guidelines and standardize RD quality of care and treatment to ensure it is effective, efficient, and people-centered through the development and implementation of regionally and resource-relevant clinical guidelines for all types of RDs, adapted, contextualized, or updated to consider differences in available resources in different contexts

7.capacity-building

• Ensure that patients are kept informed and updated on changes in policies, regulations, and services that concern them.
• Ensure an organized network of RD to share knowledge and experience, as well as to collectively engage in advocacy

8. Building public awareness

• Implement health promotion campaigns to raise awareness and combat stigma and discrimination against RD patients and their families.
• Tackle the high economic impact of RDs by improving health services capabilities, aspects of diagnosis, integration, and coordination of care, medical and clinical practitioners’ capacity, and care and clinical pathways. 

The Uganda National Medical Alliance for Prisoners’ Support (TUNMAPS) is a registered, private and public non- profit actor, responsive for steering strategies to strengthen rapid health economic relief, research, rehabilitation and mindset Development for all incarcerated Groups (prisoners), their families, ex-convicts and refugees in Uganda, These strategies have been effected in cognitive partnership with the Government of the republic of Uganda since the inception of TUNMAPS in 2017, TUNMAPS is a pioneer service provider for health and research in closed settings in Uganda.

However, Despite the fact that prisoners and their families being the most marginalized and stigmatized in their respective communities, they are not specifically targeted for support by the available support mechanisms from the Government and other non-public actors, Prisoners are said to be Heller in most countries across the Globe,  although as professional service provider for people in detention facilities, we need to sensitize local communities, Government and donor agencies the value of supporting prisoners and their families under national development goals.

People in prisons are estimated to be with the highest rare disease and HIV/AIDS prevalence rates in Uganda with an average estimate of 15% adult male and female population incarcerated. The specific rare disease prevalence rate in Uganda prisons is unknown due to the concurrence and comorbidity of reinfections and recidivisms / decarceration. Various innovative programs for treatment, prevention, control, elimination and discrimination have been running in prisons of Greater Masaka and Mbarara and little achievements have been reported.

 A novel of strategy based on rare disease management have been identified as a cost-effective primary target tool critical in determining and managing the threat in prison settings, islands and refugee host communities.

In a high rare disease prevalence in prison settings, a desired goal for rare disease management is set to be for every inmate to know his or her health status, this is supposed to be done by strengthening diagnostic journey, adequate clinical management, access to effective treatments as they there are rare cancers, rare infectious diseases, rare poisonings, rare immune-related diseases, rare idiopathic diseases, and rare undetermined conditions thus screening  and awareness campaign in the areas of operations ai prisons, refugee host communities, islands, schools and border regions.

Under this program, TUNMAPS and partners will develop and implement a prison and community mobilization response plan for rare disease campaign in prison settings (prisons, remand homes, refugee settlements, islands and border regions).Here we aim to retain, recruit, train and motivate staff who will carry out home and prison based rare disease campaign. Ensure a referral consultation network, including specialist care, integrated services, infrastructure, and human resources in community and prison settings.

Although, erective interventions have shown other key vulnerable and marginalized in prisons, ai

• Detained pregnant women and lactating mothers
• Newborn babies and children detained with their parents
• Inmates with Disabilities and those living with HIV/AIDS
• Foreigners detained and incarcerated refugees

In Uganda, like in most countries in Africa and the rest of the world, prisoners are not popular topics politically and economically, generally prisoners have little political and economical power, however many felons are permanently disenfranchised. There is no political constituency with the clout to pressure for sufficient funding for prisoners facilities or their families for livelihood and development. More often, political rhetoric turns prison programs into a target by framing education and health care as coddling inmates who do not deserve tools for life imprisonment or even basic life sustaining care

As a result, prisoners often do not have adequate medical, mental health care, educational programs, and access to justice and equality. And as such, the conditions of most prisons in Uganda are not just a question of quality life, but also often illiteracy, a question of their life and in death. Yet, too often it is the poorest, least educated and most vulnerable people who find themselves in prisons. In Uganda and many countries across Africa, there are inmates who will never met a lawyer. They are crammed into facilities not built for their numbers, whereby some are operating at 300% capacity. In Uganda criminal justice system is a maze of complex bureaucracy whereby the accused struggle to obtain equal justice, peace and medical attention. Many prisons operate at around 300% capacity and around 80% of prisoners cannot afford the most basic access to justice. With high levels of illiteracy and little formal education, the majority of detainees are ill-prepared to defend themselves in the intimidating environment of the courts.

The Uganda National Medical Alliance for Prisoners’ Support is Governed by a Board of Trustees lead by the chairperson whose membership is elected at the Annual General Meeting, also comprises of subscriber members. The Board is responsible for policy development, plan and strategic directions, oversight of management operations and ensure that the organization meets its statutory and donor obligations. The Team leader who supervises all other technical staff runs the day-to-day organization’s operations. TUNMAPS has a Senior Management Team of 9 Departments, which include;

• Psycho-social department/counselling,
• Medical department
• Research and advocacy department
• Community department,
• Family and child protection department
• Prisons and welfare department 
• Training and Data department
• Monitoring and evaluation department
• Finance and Administration department

TUNMAPS has registered in scaling up rare disease prevalence, in prisons settings and communities. By supporting this noble cause, the initiatives supported by development partners will strengthen TUNMAPS efforts, but also meaningfully engage TUNMAPS members in Mobilizing Officer in charge of (OC) prisons across the country to coordinate better with other implementing partners in the fight to scale up rare disease journey prevalence in prisons settings and refugee settlements.

 People living with RDs face distinct and significant challenges that arise from the infrequency of their medical conditions, such as a long diagnostic journey, inadequate clinical management, and limited access to effective treatments. The burden of RD on patients, their careers and families, healthcare systems, and society overall, merits greater visibility and recognition.

Different challenges faced

• Low human rights awareness (national, regional, & international legislations on treatment of offenders).
• Non-provision of basic necessities of life such as accommodation (e.g. prisons designed for 23 prisoners housing 265 inmates).
• There is no supply of safe water and sanitation (50% of inmates use Night Soil Bucket system, have no access to safe water supply) and the severe water crisis in some of the prisons, something that forces them to walk long distances in search for water.
• Health facilities and health supplies are in short supply (68% of clinical investigations differ from actual).
• Food supply to prisoners is inadequate (50% of prisons serve one (1) combined meal due to limited kitchen facilities).
• There is long stay of prisoners on remand (over 3 years).
• Lack of capacity building of Uganda Prison Service in observing and protecting the rights of inmates. As empowering prison staff with knowledge would help them understand human rights issues and principles of humane correctional work and respect rights and freedom of the people under their charge as well as the public.
• Lack of transport in coordinating fieldwork Bureaucracy
• Negative bias by the government and community on Prisoners, so further awareness in community is needed.
• Lack of Digital health

In a study conducted by TUNMAPS on the natural causes of death among the inmates of Luzira Prisons in Uganda as seen at Autopsy in Mulago Hospital Complex revealed:

• That a high degree of disagreement was found to exist between the clinical diagnosis and the final diagnosis established at autopsy. Out of the 35 cases of TB confirmed at autopsy, clinical diagnosis was missed in sixteen (45.7%) of the cases.
• Out of the thirty-four inmates who were found to be HIV negative by serology at autopsy, seven (20.1%) had been clinically diagnosed as AIDS cases. In eighty-four cases where diagnosis was made at autopsy, only twenty-five (24.5%) had the same diagnosis clinically.
• The study therefore noted the need to improve on the clinical diagnosis in the management of the inmates of Luzira as good clinical management could have prevented many of these deaths.

Therefore, the Prize can support;

Three Resource Centres need to be established at selected units to give prisoners an opportunity to access information. Books will be availed and could be borrowed by the inmates and returned later. This will enhance the inmates’ right to information.

Prisons clinics need to upgrade with modern laboratories to enhance clinical diagnosis in the management of disease among inmates as good clinical management is a precursor in treatment and in preventing deaths.

Support the implementation of digital health in prison settings to keep up-to-date with patient records, ease clinical diagnosis, storage and access to information.

Promote human rights in prison settings and increase awareness on rare disease 

Communities have knowledge and expertise that are essential to developing sustainable and contextual solutions to the problems that a community faces. Solutions created by external parties such as NGOs or government developmental projects often overlook the complexities of a community and might even further contribute to the problem that it aimed to fix or create unexpected and unwanted effects therefore connecting with the community is crucial

The team lead connects with the community through;

• Through collaborating with leaders within the community ai religious, LCI, II,III,IV,V, head teachers, police, district officials to know about the organization and support the organization can give them

• Providing social work assistance to the community inform of public education, counselling to individuals, couples and families.
• Participate in planning, developing and evaluating community programs and policy
• Developing and delivering specialized programs, services and cultural activities
• Performing community needs assessment, prioritizing them and participate in planning the way forward
• Working with volunteers from the community to support, enhance project goals and gain skills
• Networking with other stakeholders including the Government to support community projects thus development
• Skilling community members including prisoners with computer skills and knowledge free of charge
• Donating to the community members ai ex-convicts, prisoners, refugees with basic needs and health services

To bring innovative therapies to people with RD, we need to evolve their capabilities into patient centred model, closely work with stakeholders across treatment continuum while embracing the power of digital analytics to identify eligible patients and tailor services to their needs

Increase awareness of rare disease among healthcare professionals to raise profile and visibility of rare conditions and embed rare conditions in training of health workers to ensure competence and quality service 

Build physician engagement model draws insights and data from several years of physician engagement and subspecialty specific clinical practice patterns

Peer to peer education sessions approach ai gathering people suffering from rare disease, forming a group to share experiences and educate them about the disease and  the treatment journey and know when and where to help from. This helps to allay patients’ anxieties, get friends and gain support.

Screening policy. It’s virtual in allowing early diagnosis of some rare diseases and initiation of early treatment to reduce complications like screening new-born babies.

Specialist care. This ensures access to proper management, right treatment, early and right diagnosis.

Developing a mobile app.  This is an effective avenue to support patients and caregivers throughout the patient journey as it helps to;

• Symptom tracking and personalized dosing recommendation
• Allow patients share their data with health care provider for an optimized treatment algorithm
• Follow up visits
• Plan lifestyle activities based on current and estimated disease makers
• Meaningfully adhere improve their therapy adherence
• Refine patients care plan.

 Ensure sustainability through

Accountability to the target group; refugees must receive updates and information on how and when to receive their assistance, and complaint, appeals and feedback mechanisms must be in place as part of broader two way communication approach with persons of concern. Call centers and outreaches are examples of effective means for such communications

Monitoring; monitoring the performance and impact enables understanding of the effectiveness of the interventions, service providers, refugee access to services, monitoring protection out comes is equally important to ensure for example social inclusion or coping mechanism.

Referral;  building on registration and assessment data, the basic needs approach facilitates referral of persons with protection needs or with other immediate needs to the appropriate service provider and this includes referral of refugees to national systems which is a priority

Registration of persons of concern; by providing a record of their status, registration helps protect people with rare disease to have access to services or assistance. It defines the total potential beneficiary population and captures data that can be used initial vulnerability modelling and targeting.

Community involvement; as it brings about their active participation, good relationship with the stakeholders thus sustainability

Quarterly stakeholder meetings to ensure effective collaboration with the stakeholders to plan and evaluate the outcomes.

Financial sustainability; as this will ensure efficient and continuous delivery of services to the target group and community at large.

Continuous visiting of the target; group for continuous assessment, monitoring and evaluation thus sustainability.

As per the goal of The Uganda National Medical Alliance for Prisoners’ Support our Strategic Implementation Plan;

We aim to continue re-engineering, while promoting and focusing on Social behavioural change and communication (SBCC) campaign to increase families, technocrats, religious leaders, Government and foreign agencies’ involvement in supporting all people with rare disease, incarcerated groups and their families in Uganda  in order to avoid isolation by the community among prisoners and ex-inmates and re-conviction.

Strengthen Community commitments, awareness and capacity development to provide post relief, SRGBV prevention and response programs on how to avoid re-crime infection, this is formally implemented through social support, care and protection.

Through formal research, TUNMAPS aim to implement Government Reporting, transparency, tracking, referral and response guidelines and partners case management, by ensuring the fidelity of all planned interventions and provide data for measuring the impact of sub-grantees tasks through research and advocacy.

General cognitive Interventions and project objectives.

• Introducing basic skills, creativity and vocational training to encourage prisoners, people with rare disease, children detained with their parents with rare diseases to use their time to prepare for release, community resettlement and employment.
• Offering psychosocial support through prisons visits, home visits and monitoring, here inmates get psycho-therapy that draws their attention from criminality and prisons stigma, trauma, re-engineering pre-bargain system and emotional torture, hence reducing mental health psychosis while adhering to emotional treatment and prepares them to re-integrate in to the community world with positive attitudinal change and become good citizens once released.
• Health services and support to inmates and prisons warders, hence uplifting enhanced medical training to prison staff so that they can deliver basic services and meet their health needs and standard of those under their care; this includes provision of nutritional support, HIV/AIDS package and psychosocial support.
• Building health infractures and training centers in every regional prison and remand homes from refurbished health clinics, here, we are committed to ensuring that local prison environments have the facilities that are conductive to good health and the resources to support patients in need.
• Vocational training: life skills and vocational program provide prisoners with the opportunity to enter employment post-release. This will help to break the cycle of poverty and crime re-infection by equipping prisoners with practical and hands on skills.
• Supporting prisoners’ families and ex-convicts to start income generating activities like micro businesses and farming practices to improve their livelihoods and afford the educational needs of their children.

This is to be achieved through, teamwork, through research and advocacy, planning, implementing, collaborating with partners and stakeholders, monitoring and evaluation, cost effectiveness and  accountability.       

How to measure track results

Results based monitoring and evaluation is an organization management tool has been always used to help policy makers and decision makers track progress and challenged. This has always been done by the TUNMAPS governing   technical team led by the leader ai, supervising the employees work, follow up the accountability, help employees use self-monitoring tools, review work in on progress on a regular basis and team field monitoring

Measure performance

Identify needs assessment and system performance deficiencies

Track finance, for operations, objectives, aims and goals

Evaluate effects of implemented project

continued staff support supervision

Communicable progress to stakeholders and identify and assess potential impacts of the management and operations staff, monitoring procedures: these are based on program goals and objectives, define key indicators, data collection tools and methodologies, time, identify monitoring and evaluation roles responsibilities    and create analysis plan repairing temporaries and dissemination of results to the donors

TUNMAPS aims to improve and expand community health and practices for underserved populations and people with rare diseases especially children detained in with their parents through collaboration, using digital health, networking and partnership manners. In this assay we aim to emphasize planning, capacity building, managing and sustaining to provide a step by step guide to the team into account when embarking on working together in professional consortium.

A network of comity based agencies including both private and public work together to coordinate deliver services to the identified beneficences in this regard we aim to envision the project team, develop innovative ideas and juveniles, coordinate partners, establish a core professional consortium of excellence and starts alone time conduct partnership

The activities

• Introducing basic skills, creativity and vocational training to encourage prisoners to use their time to prepare for release, community resettlement and employment.
• Offering psychosocial support through prisons visits, home visits and monitoring, here inmates get psycho-therapy that draws their attention from criminality and prisons stigma, trauma, re-engineering pre-bargain system and emotional torture, hence reducing mental health psychosis while adhering to emotional treatment and prepares them to re-integrate in to the community world with positive attitudinal change and become good citizens once released.
• Health services and support to inmates and prisons warders, hence uplifting enhanced medical training to prison staff so that they can deliver basic services and meet their health needs and standard of those under their care; this includes provision of nutritional support, HIV/AIDS package and psychosocial support.
• Building health infractures and training centers in every regional prison and remand homes from refurbished health clinics, here, we are committed to ensuring that local prison environments have the facilities that are conductive to good health and the resources to support patients in need.
• Vocational training: life skills and vocational program provide prisoners with the opportunity to enter employment post-release. This will help to break the cycle of poverty and crime re-infection by equipping prisoners with practical and hands on skills.
• Supporting prisoners’ families and ex-convicts to start income generating activities like micro businesses and farming practices to improve their livelihoods and afford the educational needs of their children.
• In Uganda, there is no formal structure and plan for free release of incarcerated elders above 80 years and the most ill or disabled, unlike in Europe and Asia, elderly prisoners are given free release in regard to their age and illness. Cultural and psychological disintegration is always head on their families due to un notification of in death or in between either.

 The outcomes

1.Ensuring research and development of essential evidence

2.Building equitable access to diagnosis, treatments, and care

3.Building capacity and awareness of healthcare workers

4.Improving the healthcare system and services for RD patients

5. Implement Digital health 

 6. Standardizing clinical guidelines and standardize RD quality of care and treatment to ensure it is effective, efficient, and people-centered through the development and implementation of regionally and resource-relevant clinical guidelines for all types of RDs, adapted, contextualized, or updated to consider differences in available resources in different contexts

7.capacity-building

8. Building public awareness

Outputs

• Knowledge. Health care providers gain knowledge about rare diseases and their management
• Policy formation. New policies are put in place concerning rare disease
• Quality service delivery
• Reduced long diagnostic journeys
• Improved quality of for people with rare disease
• Improved access to quality health care services
• Use of electronic medical records to capture and store patients’ information.

The Uganda National Medical Alliance for prisoners’ support uses digital health technology as per its core professional areas

• Research , advocacy and humanitarian assistance
• Disseminations, communication and linkages
• Legalizations
• Social and economic transformation in prisoners, their families and ex-detainees in Uganda
• Health support and referrals

As per TUNMAPS strategic research plan;

• Community magnification on prisoners and the scope of prisoners from the community
• Magnifications of Life in prisoners, their families and  after their sentences (ex-convicts) and refugees and children detained with their parents.
• Conduct prison’s survey and monitoring outside Uganda’s prisons, Africa, Europe and Asia for the purpose of research, advocacy and implementation of support among Ugandans incarcerated in foreign countries

 Our solution is digital technology based to improve care strategies and provide hope and relief for rare disease patients as it can improve diagnostics, boost, research and development, enable patient identification and tracking of disease progression.

In addition to the above digital health technology to improve patient outcomes though engagement of both patients and health care providers to understand the rare diseases and therapies available better with the right information, time as health care providers can greatly improve the  standard of care for their patients.

 Using Electronic Medical Records (EMR) helps to register patients with rare disease, monitor patient’s condition, and medicine, given, assess emerging health treats, guide decision-making and planning better for the patients.

Carrying out clinical research using digital technology to develop new approaches that can improve access to interventional and observational clinical studies for patients and improve their health

Disseminating results, action plan, monitoring and evaluation of the project using digital technology among the stake holders

Full time staff -10

Part time staff - 3

Contractor -  7

Volunteers - 2

The Uganda National Medical Alliance for Prisoners' Support (TUNMAPS) has been working on scaling up rare disease in prison settings for 6 years             ( prisons,  refugee host communities, islands, schools and border regions). Some of the diseases are sickling in children less than two years, Dermatological conditions among children and adults, Cardiovascular diseases, hydrocaferous diseases in children has also been diagnosed, yellow fever in children, Tuberculosis, Human papilloma virus , rubellossis and shigella etc, all these rare diseases have been diagnoses and achievements have been reported as seen above 

Over  the past six years , TUNMAPS’s professional staffing together with Government of the republic  of Uganda as core partner, community, prisons, other key stake holders have been  working jointly  to support  communities, prisons  and families in Uganda through home and prisons based  care and support (HPBCS).This has always been done through prisons and home visits and monitoring in Uganda.

We ensure Equity by

 Through community engagement programs, ai community visits and monitoring, home visits, prison visits and monitoring and refugee settlements visits to track the number of beneficiaries. In this program, The Uganda National Medical Alliance for Prisoners’ Support aims to promote care and support for special needs particularly children with disabilities, rare disease and other medical conditions.

Inclusion and gender equity by

The Uganda National Medical Alliance for Prisoners’ Support aims to design all responses to be inclusive and access to all groups of beneficiaries in the prison settings and communities, we also aim to address concerns of specific actions to target the needs of the key vulnerable beneficiaries identify their concerns for implementations and support.

We also aim to increase rare disease representatives in leadership and decision making to redistribute care and support to produce productive resources, progress towards gender equity and sustainable for implementation actions.

 Empower women and children smallholders for investment, care and protection.

MISSION

• To work with and through individuals, families, communities, Government and foreign agencies to foster fundamental care and support for prisoners, families, refugees and ex-detainees  in Uganda for relief and development enhancement

We hope to conduct research depicting situational analysis and life in families of the incarcerated groups, focusing on;

• Effects of parental imprisonment to children and child imprisonment to parents.
• Document disease burdens, epidemiology and behavioural dynamics.
• Details on demographic descriptions of inmates and their families.
• Guidelines on community ethical re-entry.
• Implication of breast feeding mothers, pregnant women and child bearing mothers while in detention facilities

The organization has been able to conduct trainings for skills development, health service delivery, nutritional support, linkage to health facilities, referrals and early child learning programs for prisoners’ children in the regions of greater Masaka, Mbarara, Gulu and Kigezi. conduct rehabilitation programs in schools, prisons, remand homes and refugee host communities, school drop outs and juveniles to enhance equity additions for gender, children and women.

The organization has been able to promote respect for others, National identity, promote care for other key vulnerable and marginalized children like children detained with their parents, people with rare diseases perseverance, and commitment, and diligence, empathy in order to promote law abiding and reformed children in Uganda. However, TUNMAPS has been able to improve on mental health status and psychosocial support to people with rare diseases and caregivers as well as training for health care providers and caregivers in rare disease management, psycho education scaled up.

Promote equitable access to safe, quality health care delivery to people living with rare disease in prison settings, refugee hosting areas and distribution of support inclusive education focusing on children with disabilities and disabled. This includes home visits to facilitate the identification and assessment of children and people with rare diseases in need of support as well as the provision of assistive devices.

Value for money in TUNMAPS’s docket is based not only on the minimum purchase, expenditure and or income limitations but also on the maximum efficiency and effectiveness of the expenses and purchases. Value for money is important in project implementations in order to avoid over spending and narrowing budgetary allocations and planning. This is also based on balancing the income and expenditure of the project.

 In order to promote efficiency and formal value for money we shall have to minimize expectation gaps of stakeholders e.g. district local governments, government ministries and other local stake holders by narrowing their expectations from the organization

Through resource mobilization, collaborating with stakeholders and partners to acquire funds. Through donors for smooth running of the project. 

Organizational approach to financial management

In respect with our technical accounting officers and the accounting systems in place, we aim to adhere to an evaluation plan for alternative utilization of funds, capital budgeting, planning, and ascertainment of financial standards for the project and organization success.

We also aim to determine the cost of capital investments, funds and management of incoming funds, our technical management of finance is based on traditional and modern approaches basing on income approaches, quality statistics generated from the field and employing both internal and external auditors for financial management

Fraud prevention and response

TUNMAPS being a committed member and partnership agency with financial intelligence authority, we aim re engineer receipts for all cash expenses, using cash books, conduct cash counts both weekly and monthly, evaluate budgetary monitoring, gearing daily cash receipt books, mail tabulations with effective auditors both internal and external auditors.

We also aim to scale up fraud prevention by employing internal and external quality control measures, SOPs, systems for fraud detection, monitor and review fraud responses, monitoring and evaluation to investigate timely investigations and corrective action measures.

Available policies

TUNMAPS has the configurations of restrictions put in place to guide the ongoing activities e.g. employment code of conduct policies, dressing code, attendance policies, equal opportunity policies, financial policies and human resource policy. These policies have helped the organization to move on in a formative manner.

The Uganda National Medical Alliance for Prisoners' Support is a private and public actor responsive for steering strategies to strengthen research and sustainable development and health for people in closed settings and their families in Uganda, It is an implementing partner with the Government of the republic of Uganda to scale up care and support for prisoners and their families in Uganda, 

Examples of Plans to achieve financial sustainability for success 

we aim to continue strengthening networking, corporations, collaborations and scaling up  partnership with other key stake holders not limited to Government of the republic of Uganda, local district governments, local village teams, religious institutions and international corporates

The Uganda National Medical Alliance for Prisoners' Support (TUNMAPS) has an independent computer laboratory donated by Government through Uganda communication Commission (UCC), Ministry of ICT and National Guidance and this lab has been used to train local people and school children, Teachers and police officers in ICT , this has helped the organisation to sustain its income and revenue

some of our key partners are

Uganda network of Aids service Organisations (UNASO), Uganda aids commission (UAC), Ministry of information, communication and technology (ICT), Ministry of health, office of the prime minister Refugee department and Uganda Human rights commission, these have helped to strengthen sustainable development and income for the organisation

In vision of the above, The Uganda National Medical Alliance for Prisoners' Support is an accredited organisation in Uganda with all relevant documentations and permissions to intervene relevant places including prisons and refugee settlements in Uganda

The organisation is on the ground in all district local Governments, hospitals, health centres and we work with all categories of people not limited to village health teams (VHTs) and we posses an audited engagement reports to ensure sustainable accountability, revenue , assets and income and expenditure for the organisation.