Advocacy strategy on enhancing the wellbeing of veterans with Post Traumatic Stress Disorders in Uganda

Mweru Samuel ByachiUganda Veterans Assistance Board

PTSD Advocacy strategy

What is PTSD?Shell shock or battle fatique syndrome

A condition that can develop after one has experienced/witnessed traumatic event

First brought to world attention by war veterans

May begin within 3 mths but could also take years

Families of PTSD victims can develop the disease

PTSD cont. A global problem underestimated by LDCs In the US, 200,000 veterans received

disability compensation for PTSD worth $4.3bn in 2005

11-20% of US Iraq and Afghanistan war veterans were PTSD positive

About 10% of US Gulf veterans were positive Uganda estimates are about !0% of the

veterans

Military related causes of PTSD Exposure to combat Exposure to life threatening missions Shot at, seen a buddy shot, or seen

death Military sexual trauma (sexual

harassment) Other factors such as what you do in

war, politics around the war, where it is fought, and type of enemy you face add more stress to an already stressful condition

Effects of PTSD Victim’s loss of faith for safety,

predictability or meaning in the world Haunts victim and prevents normal life Difficulty in relationships Feelings of shame, guilt, despair,

helplessness, grief/loss Poor health behavior among pregnant

women Memory loss among pregnant women

PTSD effects cont. Babies born to PTSD mothers are likely

to experience a change in at least one body chemical and later taking on the condition

Failure to engage in productive life Victims risk of higher use of cigarettes,

alcohol and marijuana Likelihood of committing crime

PTSD treatment Treatment through psychotherapy (restoring

safety feelings, calming the nervous system) Educating the victims what they are feeling Stress reducing foods also recommended Recovery involves (feeling empowered,

finding meaning in life again, re-establishing a connection to oneself and feelings for other people)

Why the PTSD advocacy strategy? WHO’s health definition(veterans not

healthy) Uganda’s 1995 constitution provides for a

right to health(yet PTSD is still a terror) Problem is big but generally faced with

silence Yet it is treatable! It is worthwhile that the advocacy aimed at

favorable policy change begins with me The challenges are surmountable

Campaign narrative for advocacy strategy

Retired Captain Moses Tabora was 10 years and illiterate when he joined the armed struggle and fought till 1995 when he left the army with one leg! Retired Sergeant Mwaka Hassan joined the rebel force when he had lost all his parents and did revenge killings whenever he could till he was discharged from the army in 1997. Retired Private Baluka Harriet was a child soldier and now has ten children each with a different father. She recently returned from Somalia as part of the Amisom troops and was diagnosed with PTSD. All these were liberators who now have become a “nuisance” through no fault of theirs.

A local song composed in Uganda describes the veterans as used condoms yet they contributed a lot in ousting the dictatorship and stopped state inspired killings then. All the three have PTSD problems but government is silent. What a pity! The families of these veterans cannot afford a smile. These veterans have unexplained behavior, make noise, issue threats, utter vulgar words and cannot fend for their families. Government had put up a law to take care of the veterans but never took this problem serious. Veterans are committing crime quite often and are jailed. Nobody ever bothers to find out what the exact problem is.

Families are resorting to witchdoctors for a remedy and others are going to Pentecostal churches for miracle cure. Yet this is a medical condition that can be addressed when government has the will to take it up, and mainstream it in its programs. The time is now for our legislators to own up this matter and make all interventions necessary to make the world of PTSD sufferers’ worthwhile if they are to measure up to the global standards pushed by the World Veterans Federation. It is your duty to make this change happen.

Brief about UVAB UVAB is a statutory body mandated to

discharge the soldiers from military service and ensure that they are sustainably reintegrated in civilian life.

UVAB faces challenges of increased veterans now about one million

PTSD condition not well handled Existing law has gaps that need

amendment

Context analysis of advocacy strategy Problem affecting about 10% of the veterans Manifestations of PTSD already explained Origin of PTSD grounded in 1981-1986 war Causes of PTSD explained Limited medical interventions made Family members, community and government

most affected by problem Frequency of problem periodic or continuous PTSD impacts negatively on socio-economic and

political aspects

CAMPAIGN STRATEGIC FRAMERORKObjectives and key targets (SMART)

To push for the amendment of the UVAB Act to include the support and treatment of the Post-Traumatic Stress Disorders (PTSD) condition among ex- soldiers by 2015

To work towards a community that has favorable perceptions of PTSD sufferers and support them by 2015

Enabling easy access of PTSD services by ex-soldiers through the creation of special wings at both the regional and national psychiatric referral hospitals by 2018

Campaign strategic framework cont. Scope covers veterans countrywide and

policy makers/legislators, community leaders by 2018

Critical pathways vital for each of the three objectives as road maps

Various circles of influence at play for each objective remain almost the same because of the security nature of the vulnerable target

M&E Framework of the strategy

Objectives Desired impact

 

Success indicators Means of verification

Objective 1

To push for the amendment of the UVAB Act by 2015

A law that will take care of ex combatants with PTSD condition and improve their condition

Amendment tabled and discussed

Amendment passed

Bill assented to by H.E the President

Parliamentary sessions monitored

Hansard Reports

 

Objective 2

To work towards a community that has favorable perceptions of PTSD sufferers and support them by 2015

A civil community that fully understands the PTSD problem and be in position to sustainably address those challenges

80% of community leaders having a favorable attitude

80% of PTSD veterans receiving support from the community

Press reports

Community meetings

Radio feedback

No of veterans assisted

Objective 3

To enable easy PTSD access services through special PTSD wings in regional and national psychiatric hospitals by 2018

Hospitals with PTSD wings that make it easy for the ex-combatants to get quick attention regarding their conditions

80% PTSD wings established

80% Special wings operational

80% of PTSD cases reporting for treatment registered

Reduced violence in PTSD homes

Hospital Reports

Minutes of ministerial meetings

 

Campaign elements Creative brief with emphasis to background

to the problem hyping need for intervention Campaign objectives seek favorable

attitude change and actualizing the change Messaging to policy makers and other

targets focuses on need to rise to the challenge

Emotions elicited seek policy change by comparison between past and present with liberators turned into rejects

Campaign elements cont.Lobbying Importance of lobbying is critical in the policy

process from agenda setting, option formulation and implementation

My case falls at agenda setting given my targets and desired policy change

Alternatives later considered Implementation would be the dream as soon as

OPM communicates accordingly Policy brief document prepared aimed at giving

the bigger sieved picture giving solutions and recommendations and call to action

Campaign elements cont.Popular mobilization Grounds for passion for MPs done

(scratch where it itches) Go for what works not strategy per se Threats of demonstration, petition to

parliament and request to meet H.E the President

Continuous engagement of friendly forces (via dialogue, sports, media, reminders, workshops) to keep fire burning

Campaign elements cont.Media analysis Media analysis key in any campaign Done with view to getting to my objectives with cost

effectiveness, efficiency, mass audiences in a timely manner

Media channels identified and prioritized Relevant press releases issued with call to action Media relations should take mutually beneficial,

loudspeaker, agenda setter, cordial and supportive relationships

Media is supportive because of its alleged non biased nature as a fourth estate (informative, educative and entertaining roles)

Alliance building(UVAB SWOT analysis)Strengths

Skilled manpower Long serving staff at headquarters Financing availed by the donor

community for demobilization Created a favorable history of good

performance Weekly veterans radio programs (that

help in sensitization)

Opportunities

Decentralization local government policy adopted in 1997

Favorable community H.E the President is a veteran Many cabinet ministers are ex-soldiers Rt. Hon. Prime Minister is the Minister

for veterans affairs Liberalization policy Vibrant civil society

Weaknesses

Space limitations at Head Office Location on 7th Floor that is bad for

Veterans with Disabilities Current limited funding Regular staff turnover in districts

affecting district veterans office performance

Threats

Fight for control over veterans Limited legal mandate Instability in the region A non-supportive opposition in

parliament Confusion of who a veteran is Political definition of a veteran

Alliance Building cont.SWOT analysis SWOT analysis vital in the strategy to locate

our standing as an organization Opportunities and risks identified help in way

forward leading to a number of allies to fill gaps and enhance capacity

Alliances to build in this strategy include NRM Veterans League (Ruling party organ) Uganda Local Government Association (ULGA) Uganda NGOs Forum (vibrant civil society) Uganda Medical Association

Action Plan For One yearObjective Target Year 1

Desired Outcome

Activity Timeline Resources

1. Amendment of the UVAB Act

Board of directors UVAB

Board of Directors approve a board paper highlighting the need for amendment

1.1 Drafting of researched board paper 1.2 Distribution of agenda 1.5 Two (2) Board meetings called and sat

April –November 2013

Funds (facilitation) Technical staff

The Prime Minister

Board minute on amendment considered by the Rt. Hon. Prime Minister

1.1 Premier tables the need for action in the top management meeting for adoption 1.2 Need for amendment tabled in cabinet 1.3 Cabinet memo done

February 2014

Technical staff

Members of Parliament

Members of Parliament get to appreciate the dangers associated with PTSD among veterans

1.1 Conduct district veterans advisory committee meetings countrywide 1.2 Conduct workshops targeting the parliamentary defence committee and other members of parliament

January 2014

Technical staff/Facilitators Funds

2 Have a community that has favorable perceptions of PTSD sufferers.

Board of directors UVAB

Board approves expenditure on mobilization of various stakeholders

2.1 Regional officers asked to present budgets for mobilization 2.2 Budget preparation for national mobilization after receipt of

April-June 2014

Funds Technical staff

THE LAST REMARKS I AM AN IMPROVED HUMAN RESOURCE

NOWWITH ADVOCACY SKILLS TO RALLY MY TARGETS FOR CHANGE VETERANS IN UGANDA HAVE CAUSE TO

BE HOPEFUL I SAY THANK YOU TO THE COURSE

SPONSORS, COURSE ORGANIZERS, FELLOW PARTICIPANTS, VALERIE AND CO.