‘I no longer worry about money for transport to the health centre’ - economic empowerment of caregivers of children living with HIV through Village Savings and Loan Associations: experiences and lessons from the 'Towards an AIDS Free Generation Program in Uganda (TAFU)’

Abstract

Background

In Uganda, social economic challenges continue to hinder attainment of HIV prevention and treatment targets for children. Aidsfonds and partners in Uganda implemented an eight-year ‘Towards an AIDS Free Generation in Uganda’ (TAFU) programme in central, western and eastern, Uganda with Village Savings and Loan Associations (VSLAs) as a key component. In this paper we document experiences of caregivers, children and health workers and lessons learnt from VSLAs as part of the TAFU programme in Uganda.

Methodology

A qualitative case study was conducted between July and August 2022 in Ntungamo, Kyenjojo Mityana, Mubende and Soroti, districts. Data were collected through 31 focus group discussions (FGDs) with VSLA members, children and adolescents living with HIV, networks of people living with HIV and Village Health Team members (VHTs). In addition, we conducted 11 interviews with children and their caregivers at TAFU supported health facilities as well as 43 interviews with health workers and district officials involved in HIV programming. Content thematic approach was used for data analysis.

Results

The VSLAs under the TAFU programme were a source of economic resources in form of loans for income generation activities and to pay for health care costs which facilitated access to HIV care for children. Members developed lasting friendships and networks of support which helped them to meet the material and psychological needs of children. The VSLA groups provided safe spaces for caregivers to share challenges and to learn more about HIV prevention and treatment from expert clients which improved the care for children living with HIV. Group training, integration of expert clients in VSLA groups, provision of VSLA kits, provision of financial top-up and linking groups to other service providers were critical success factors. However, poverty, poor leadership characterised by domination by select individuals in decision making, favoritism in giving out loans and lack of transparency in handling group activities as well as the COVID-19 were key challenges.

Conclusion

The VSLAs under TAFU were an effective strategy that enabled caregivers to respond to social, economic and psychological barriers that hinder retention of children in HIV care. Such support should be prioritised by policy makers and programme implementers in Uganda and other low income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-12303-w.