Formative Evaluation:
Presidential Initiative on AIDS Strategy 
for Communication to Youth

Formative Evaluation: 
Presidential Initiative on AIDS Strategy 
for Communication to Youth 
Netsayi N. Mudege 
Chi-Chi Undie 
African Population and Health Research Center 
Acknowledgements 
The authors would like to thank the study participants from the Ministry of Education and Sports (MOES), 
Uganda Initiative for Teacher Development Management System and PIASCY (UNITY), Uganda Programme 
for Human and Holistic Development (UPHOLD), as well as the pupils, teachers, and school administrators 
who took their time to accommodate us and answer our questions. We would also like to thank Margaret 
Kemigisa, our consultant in Uganda, for making initial contacts with key informants, facilitating discussions, 
and assisting with field logistics. Special thanks to the field workers for a job well done. We also thank Sam 
Kalibala and Deborah Weiss of the Population Council for reading our report and providing invaluable 
comments. Special thanks also go to our APHRC colleagues, Joseph Inungu, Chimaraoke Izugbara, Akaco 
Ekirapa, Ziraba Kasiira, and Joseph Gichuru for their contributions to the project. 
This report was made possible through support provided by the United States Agency for International 
Development (USAID)/Uganda under the terms of Contract No. GHH-I-02-07-00034-00. The contents are the 
responsibility of the authors and do not necessarily reflect the views of USAID or the United States 
Government. 
APHRC conducts research in Africa focusing on health, urbanization, population studies, and education. The 
organization contributes to science through high impact research projects and publications. APHRC brings 
together African scholars to take the lead in developing priority research programs and enhancing use of 
research findings for policy formulation and program improvement in sub-Saharan Africa. www.aphrc.org 
The Population Council conducts research worldwide to improve policies, programs, and products in three 
areas: HIV and AIDS; poverty, gender, and youth; and reproductive health. www.popcouncil.org 
Published in September 2009. 
Copyright © 2009. United States Agency for International Development. 
Suggested citation: Mudege, Netsayi N. and Chi-Chi Undie. 2009. “Formative evaluation: Presidential Initiative 
on AIDS Strategy for Communication to Youth,” Final Report. New York: Population Council. 
This document may be reproduced in whole or in part without permission of the Population Council provided 
full source citation is given and the reproduction is not for commercial purposes. 
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In any correspondence on 
This subject please quote No. ADM/105/136101 'TlfE 11 REl'UIUC Of IXlANDA 
FOREWORD 
Ministry of Education & Sports 
Embassy House 
P.O. Box 7063 
Kampala, Uganda 
In 2002, the President of Uganda, Yoweri Museveni, proposed a way to improve 
communication on HIV and AIDS among young people in an effort to sustain 
declining trends in HIV prevalence rates. The President's vision was for head 
teachers to address assemblies on HIV and AIDS every two weeks, after which 
other teachers could continue the discussion in classrooms and clubs. The Uganda 
AIDS Commission responded to the President's call and brought together line 
ministries, civil society organizations, the private sector, and individuals working in 
HIV to forge a way forward, which led to the inception of the Presidential Initiative on 
AIDS Strategy for Communication to Youth (PIASCY). 
PIASCY is a national, holistic programme designed to provide all school-going 
children and teachers with information on HIV/AIDS both to cope with the disease￾for those infected and affected-and to prevent further infections. The program is 
spearheaded by the Ministry of Education and Sports (MOES) and covers all 
primary schools in the country. Targeting parents and communities reinforces 
activities delivered in the school. Most recently, PIASCY has expanded to cover post 
primary institutions under the Uganda Initiative for Teacher Development 
Management System and PIASCY. 
The formative evaluation of PIASCY, described in this report, examines the 
successes and challenges of the programme, and highlights a variety of lessons 
learned, best practices, and sustainability issues. MOES intends to use these 
findings to inform the continued roll-out and expansion of PIASCY in the years 
ahead. It is also hoped that evaluation findings will prove valuable for school-based 
HIV prevention programmes in other countries, given the unique opportunities such 
programmes afford to reach large proportions of young people. 
We thank all those who supported, conducted, and participated in this important 
evaluation. 

Table of Contents 
Acronyms i
I. Executive Summary 1
Key Findings 1
Recommendations and Conclusion 4
II. Introduction 8
Background 8
Objective and Research Questions 9
III. Methodology 10
Study Design 10
Selection and Description of the Study Sample 10
Ethical Considerations 10
Data Collection Methods 11
Data Management and Analysis 11
Limitations of the Study 12
IV. Results 13
IV.A. To what extent is PIASCY achieving its planned goals and objectives? 13
IV.B. What are the strengths and limitations of the design, organisational structure, and 
 rollout of PIASCY? 21
IV.C. What are the lessons learned and best practices for continued rollout of the 
 programme? 28
IV.D. What are the unintended consequences of the development and implementation 
 of PIASCY? 30
IV.E. What are the sustainability issues that will need to be addressed in handing over 
 the programme? 33
V. Discussion 35
VI. Recommendations and Conclusion 40
VII. References 43
VIII. Annexes 45
Annex 1: Respondent Categories and Sample Size 45
Annex 2: Study Instruments 46

i 
Acronyms 
AIDS Acquired Immune Deficiency Syndrome 
ARV Anti-retroviral 
APHRC African Population and Health Research Center 
BEPS Basic Education Policy Support 
CCT Coordinating Centre Tutor 
CIE Community Involvement in Education 
CPTC Core Primary Teachers College 
FGD Focus Group Discussion 
GOU Government of Uganda 
HIV Human Immunodeficiency Virus 
MDD Music, Dance and Drama 
MOES Ministry of Education and Sports 
NACP National AIDS Control Programme
PIASCY Presidential Initiative on AIDS Strategy for 
Communication to Youth 
PPTC Private Primary Teachers College 
PTC Primary Teachers College 
TDMS Teacher Development and Management System 
UNEB Ugandan National Examination Board 
UNITY Uganda Initiative for Teacher Development 
Management System and PIASCY 
UPE Universal Primary Education 
UPHOLD Uganda Programme for Human and Holistic 
Development 
USAID United States Agency for International Development 

PIASCY Formative Evaluation 
1
I. Executive Summary 
HIV prevention programming is increasingly taking place in school settings, which provide 
an expansive population of young people and offer immense potential for making a large and 
much-needed impact in the lives of this target group. The Presidential Initiative on AIDS 
Strategy for Communication to Youth (PIASCY) is an ambitious, school-based programme
that has sought to address the HIV/AIDS epidemic in Uganda in a holistic manner since 
2002, targeting young people, school personnel, parents, and the wider community. 
A formative evaluation was conducted by the African Population and Health Research Center 
(APHRC) in February 2009 to provide an understanding of: the extent to which PIASCY is 
achieving its planned goals and objectives (e.g., increased capacity to deliver learning 
resources and materials, increased skills and knowledge of chief actors, and promotion of 
stigma-free school environments); the strengths and limitations of the design, organisational 
structure, and rollout of PIASCY; the lessons learned and best practices for continued rollout 
of the programme; the unintended consequences of the development and implementation of 
the programme; and the sustainability issues facing the programme‘s continued 
implementation. The study findings highlight the positive elements of the programme that 
can serve as a foundation as PIASCY is rolled out to post-primary institutions, as well as 
challenges that need to be addressed in preparation for this process. 
Study Methods 
The study was carried out in the four main regions of the country (Northern, Central, Eastern, 
and Western). Its design was qualitative in nature, drawing on 250 focus group discussions 
(FGDs) with pupils, teachers, and parents/community members; 28 key informant interviews 
with relevant stakeholders and programme administrators; and rapid appraisals to record key 
PIASCY-related observations within the schools. Secondary sources—data available from 
government bodies and non-governmental organizations (NGOs)—were also used to 
supplement the interview and FGD data. 
Key Findings 
Child-centric, interactive PIASCY activities are regarded by most teachers and pupils 
as having the strongest impact. 
Respondents cited child-centric activities such as assemblies; Music, Dance, and Drama 
(MDD); and Safety Friends Networks as having the strongest impact. These activities 
imparted knowledge to pupils and their communities in a provocative and lasting way, and 
provided space for pupils to discuss, address, and/or reflect on their HIV/AIDS-related 
concerns. These activities are designed to be interactive and contain elements that inspire and 
empower young people. 
Textual PIASCY materials are regarded by most pupils and teachers as having the least 
impact. 
Despite the time and creativity invested in developing textual PIASCY materials such as 
readers, posters, and Talking Environments, overall, these were viewed as having the least 
2
impact on pupils. Respondents identified a number of barriers to using these materials. Some 
schools did not have PIASCY readers; if they did, only a few were available. To preserve 
these texts, pupils in some schools were not allowed to handle them. In other cases, teachers 
suggested that low literacy of pupils (particularly at the lower primary level) prevented them 
from reading the books. Posters were also considered difficult for pupils (particularly at the 
lower primary level) to understand, as comprehension depended on English literacy abilities, 
which were lower at the primary school level, particularly in rural areas. Finally, posters and 
Talking Environments ran the risk of being overlooked because their messages had not been 
changed over time. There was also an apparent misunderstanding of the purpose of PIASCY 
readers and handbooks. The latter were designed specifically for teachers; nonetheless, the 
use of teacher handbooks by students highlights the demand for PIASCY pupil reading 
material by both students and teachers. 
Some teachers promote condom use as a PIASCY message. 
PIASCY‘s focus is on abstinence for primary school pupils, and condom use is not an 
intended message for young people under this programme. However, several teachers in the 
Eastern and Western regions indicated that they talked about condom use under PIASCY. 
This act seemed to be an honest misunderstanding of the PIASCY objectives, rather than an 
attempt to ―rebel‖ against them. Some teachers also felt this practice was logical, given that 
some older pupils in upper primary school were sexually active. This finding is in contrast to 
that of the Northern region, where teachers were unequivocal about not teaching condom use 
under PIASCY. 
Some teachers censor PIASCY messages. 
There was evidence that some teachers who taught PIASCY at the lower primary level 
censored PIASCY information. They spoke of revising the content of their PIASCY 
messages for lower primary pupils according to their personal beliefs, noting for example that 
―the children are so young.‖ The data from many schools demonstrate that a good number of 
teachers at the lower primary level tend to emphasise topics such as personal hygiene, the 
importance of living in a clean environment, and of hand-washing after using the toilet, rather 
than placing an emphasis on life skills education, such as saying ―no‖ to sex. 
Guidance and counselling procedures under PIASCY need to be better understood and 
standardised. 
As part of the expansion of PIASCY, the current implementer of the programme [the 
Ugandan Initiative for Teacher Development and Management System and PIASCY 
(UNITY)], intends to enhance guidance and counselling activities in primary schools by 
producing materials on the subject and disseminating them nationally. UNITY also expects to 
improve the quality of guidance and counselling offered by training more teachers. However, 
guidance and counselling as currently practised in many schools is teacher-driven and takes 
the form of group instruction. Teacher-driven counselling involves teachers deciding what 
they want to talk to the pupils about depending on what the teachers define as the problem,
and not problems as defined by pupils. This is problematic as guidance and counselling issues 
are meant to derive from the pupils themselves. Female teachers are also under-represented 
among guidance counsellors in schools; yet, female pupils may feel more comfortable 
obtaining guidance and counselling on certain issues from teachers of the same sex. 
PIASCY Formative Evaluation 
3
PIASCY has successfully contributed to a stigma-free school environment, but 
inadequately addresses the needs of those who are HIV-infected. 
The PIASCY programme has achieved its intended result of creating more openness with 
regard to HIV/AIDS issues among teachers and pupils. A common perception among school 
personnel is that HIV-positive pupils are now more likely to disclose their status in school. At 
the same time, current messages under PIASCY do not take into account pupils and school 
staff that are already living with HIV, as they focus on HIV prevention. There is also 
widespread demand among school personnel for the provision of anti-retrovirals (ARVs) in 
schools for pupils and teachers. 
Structures are needed to ensure consistent implementation and longevity of the 
PIASCY programme in schools. 
The establishment of structures in schools (such as ―PIASCY teachers‘ committees‖ and 
―PIASCY clubs‖ for pupils) is necessary to ensure that periodic PIASCY activities are 
planned and actually take place. In the absence of such structures, the continuity of PIASCY 
is threatened by the transfer of PIASCY-trained teachers (who are viewed as the sole 
possessors of the institutional knowledge on PIASCY) to other schools, or the lack of 
compensation for teachers‘ perceived ―extra work‖ of engaging with PIASCY. 
The role of communities in the PIASCY design is not well understood. 
Although communities are intended to be a key component of the PIASCY programme, 
community members appear to be the least engaged of all the target groups. Unlike other 
programme actors who are directly targeted through training, such as teachers and pupils, 
community members are targeted through more indirect channels such as attendance at 
assemblies, prize-giving days, and parents‘ days, during which HIV/AIDS-related messages 
are displayed and conveyed orally. Perhaps as a result, community members, including 
parents, were the least articulate about the PIASCY programme, as well as their role in it. 
Private schools do not function seamlessly within PIASCY’s organisational structure. 
PIASCY‘s organisational structure aligns with the Teacher Development and Management 
System (TDMS), which is situated within the Ministry of Education and Sports (MOES). 
Public schools were already situated within the TDMS prior to PIASCY‘s inception. Thus, 
both the public schools that were selected as Centres of Excellence/Model Schools and the 
Core Primary Teacher Colleges (CPTCs) under PIASCY played roles that were already 
familiar to them. Under PIASCY, two or three teachers from the Centres of 
Excellence/Model Schools were trained, and in turn these teachers were meant to train other 
teachers at their school and beyond. This is referred to as the knowledge cascade approach. 
CPTCs were tasked with introducing PIASCY training modules into their curriculum to 
ensure that all teachers receiving instruction at these institutions were trained in PIASCY. For 
instance, the Model Schools supported schools within their own catchments with regard to 
PIASCY-related issues, while the CPTCs focused on pre-service and post-service training of 
teachers on PIASCY. The country‘s two Private Primary Teacher Colleges (PPTCs), 
however, are not part of the TDMS, and are therefore absent from PIASCY‘s organisational 
structure. The vast majority of key informants noted that private schools, though designated 
as satellite schools, are disconnected from the programme. 
4
Some districts and District Education Officers are not well-integrated into the PIASCY 
structure. 
Some District Education Officers (DEOs) are left out of the PIASCY structure despite the 
fact that they are vital decision-makers in the education system. The DEOs were not involved 
in the conception and implementation of PIASCY, as this followed the TDMS structure, 
which does not include the DEOs. Yet DEOs were expected to guide programme monitoring 
activities. This oversight reportedly affected the monitoring and evaluation of PIASCY 
activities, which was not carried out in some districts because the respective DEOs felt 
excluded from the TDMS structure used to roll out PIASCY. 
The monitoring of PIASCY is in need of improvement. 
The monitoring of the PIASCY programme was generally considered as poor across all 
regions except for the North. Monitoring was often noted by school personnel as either being 
non-existent or rare. The Centre Coordinating Tutors were supposed to monitor the project 
(under the guidance of the DEOs), but were often overworked and therefore ignored the 
monitoring of PIASCY in favour of monitoring ―core‖ school activities. One area in 
particular need of monitoring is PIASCY‘s knowledge cascade approach. Teachers pointed 
out that in most cases teachers trained under PIASCY were not training other teachers, either 
because they were not willing to do so, or because they faced time limitations and/or lacked 
resources to facilitate the training. 
The lack of monetary compensation is regarded by most teachers as a major weakness 
of the programme. 
The opinion that PIASCY has inordinately increased teachers‘ workload is widespread; 
therefore, teachers across all regions voiced their expectations for some form of financial 
compensation for the extra time they spend on integrating PIASCY into their regular classes 
or activities. 
There are more similarities than variances in participants’ experiences with and 
perceptions of PIASCY across the country. 
As a national programme targeting all primary schools in Uganda, one would expect some 
differences in participants‘ experiences with or perceptions of PIASCY, across the country‘s 
four regions and/or between urban and rural regions. However, narratives from the qualitative 
data collected in each region regarding the PIASCY programme were largely similar, with 
only a few markedly regional and urban-rural distinctions. For instance, compared to other 
regions, teachers in the North felt that monitoring of PIASCY programmes was strong. 
Teaching children about condoms also varied by region as indicated above. Rural schools 
were more likely to report language barriers to pupils understanding PIASCY material 
compared to urban schools. Despite the negative perceptions expressed about some aspects of 
the programme, in general, respondents where overwhelmingly in favour of the continuance 
of the PIASCY programme, underscoring that its overall benefits outweighed any limitations 
of the programme. 
Recommendations and Conclusion 
Several recommendations based on the formative evaluation are offered for the enhancement 
of the PIASCY programme. They are targeted at two levels of programme implementation: 
(1) schools and (2) MOES, UNITY, and USAID. 
PIASCY Formative Evaluation 
5
Schools 
1. Monitor the use of PIASCY readers (for schools that register them with the school 
library) to determine how often and by whom the books are being checked. This will 
help assess whether putting books in the library results in their optimum utilisation. 
2. Address the language barriers posed by PIASCY reading materials by having teachers 
read PIASCY texts aloud to pupils; creating forums for peer-to-peer reading, or for 
upper primary pupils to read to their lower primary counterparts; and by involving 
pupils more closely in the development of messages to be posted within the Talking 
Environments. Teachers can also explain and clarify some of the messages posted on 
Talking Environments to pupils during assembly. 
3. Establish a formal hand-over process for PIASCY-trained teachers that are being 
transferred. To avoid gaps in institutional knowledge, PIASCY committees can 
facilitate this process. 
MOES, UNITY, and USAID 
1. Continue to build the capacity of teachers to seamlessly mainstream PIASCY across 
the curriculum through periodic refresher training. The widespread opinion that 
PIASCY has increased teachers‘ workload points to the need to ensure teachers have 
the skills to mainstream the curriculum in a way that does not overburden them. 
Refresher courses for PIASCY-trained teachers will also help mitigate the censorship 
of PIASCY information during teaching and the delivery of inappropriate 
information. 
2. Consider involving teachers well-versed in PIASCY in monitoring schools‘ progress 
with the programme, especially given that there are too many schools for the Centre 
Coordinating Tutors to properly handle this responsibility. Instead, monitoring can be 
conducted by school PIASCY committees. Alternatively, the Centre Coordinating 
Tutors‘ monitoring tool could also be redesigned to include the monitoring of 
PIASCY activities. 
3. Train more female guidance counsellors, as they are currently under-represented, and 
female pupils may feel more comfortable having specific issues addressed by 
guidance counsellors of the same sex. There is also a need to incorporate HIV/AIDS 
counselling for both students and teachers that are infected with or affected by the 
disease. 
4. Explore ways of directly targeting parents and community-members to maximise their 
involvement in the PIASCY programme. Trainings developed specifically for these 
target groups can be conducted with strategically-placed community leaders, for 
example, using the knowledge cascade approach. This responsibility can be given to 
school PIASCY committees. 
5. Explore ways to establish links between schools and health facilities to facilitate 
access to ARVs and counselling for pupils, school personnel, and community￾members living with HIV. Horizontal linkages with health workers and NGOs need to 
be established with schools because teachers may not have the skills to deal with 
certain issues. At the same time, NGOs have more resources, experience working 
with schools and communities, and highly trained and skilled personnel in the field of 
HIV/AIDS. There may be a need to fully adopt a multi-sectoral approach and 
advocate for a school health policy that will define ways of dealing with HIV as a 
chronic epidemic within schools. This may also serve to strengthen the 
implementation of PIASCY activities within schools. 
6
6. Diversify current HIV-prevention PIASCY messages by taking into account pupils 
and school staff living with HIV. For example, PIASCY could teach about treatment, 
emphasising the importance of drug adherence, as well as inform both teachers and 
pupils about where to get assistance if needed. 
7. There is a need to hold a meeting every two years to refocus the education sector 
strategy on HIV/AIDS. This will enable the MOES to evaluate its achievements and 
strengthen the coordination and implementation of PIASCY and other HIV/AIDS 
activities in schools. This could be turned into a regional meeting involving 
stakeholders and experts from other countries. This will help generate new ideas to 
rejuvenate and refocus PIASCY. However, it is noteworthy that this strategy will also 
have budgetary implications. 
MOES 
1. Monitor the MOES policy to put books in the hands of children. Although this policy 
is intended to ensure that children have direct access to books, there is evidence that 
some schools are not adhering to it. Monitoring of the entire PIASCY programme by 
the Education Standards Agency may be more effective. 
2. Strengthen school structures such as ―PIASCY committees,‖ as they appear to be 
instrumental in the programme‘s continuity within schools. PIASCY committees 
could be given resources to sponsor activities they identify as necessary for proper 
implementation of the programme at their schools. They can also be involved in 
monitoring and evaluation. Establishment of PIASCY committees could be 
mandatory for all schools. 
3. Develop an operational definition of ―guidance and counselling‖ for the purposes of 
PIASCY, and determine to what extent it should be student- versus teacher-driven. 
There is a need to help school administrators, teachers, and pupils reconstruct the 
notion of guidance and counselling to include pupil-driven, individual-level 
engagement that goes beyond didactic instruction. A uniform training guide should be 
developed or adopted, and the required duration of training should be specified for 
one to be certified as a guidance counsellor. 
4. Make concerted efforts to integrate private schools into the programme. Private 
schools should be brought on board as equal partners, not just as satellite schools to 
the Centres of Excellence/Model Schools. Holding deliberative meetings to explore 
ways of incorporating the PPTCs into PIASCY‘s organisational structure would also 
be useful. Integrating PIASCY into the private school curriculum could be made a 
requirement for licensing, and could be enforced through regular monitoring. 
PIASCY can also be integrated into policy through the university level. 
5. Make concerted efforts to integrate districts and DEOs into the programme by 
involving them in decision making as well as the implementation of the programme, 
rather than just at the monitoring stage. 
6. Monitor the knowledge cascade process regularly and evenly across schools and 
provide feedback to schools on how they are performing. 
7. Tailor PIASCY instructions to the needs of older students within Free Primary 
Education schools, by focusing PIASCY instructions on both the grade and the age of 
the pupil, so that older students in lower grades can be included. 
8. Include occasional studies to inform the programme implementation. 
9. Identify empirical evidence on behaviour change that is resulting from the PIASCY 
programme. This evidence could be generated by conducting school-based behaviour 
PIASCY Formative Evaluation 
7
change surveillance surveys to help PIASCY target and respond to arising issues and 
training needs. 
10. Conduct a countrywide study of adolescents that passed through the PIASCY 
programme to ascertain whether knowledge in formative years has a positive impact 
on behaviour later in life. Such a study will be valuable in designing future school￾based programmes and in improving PIASCY design, delivery, and content. 
8
II. Introduction 
Background 
The early 1990s in Uganda were characterised by a remarkable and now much-cited decline 
in national HIV prevalence, from a national average prevalence of 15 percent in 1992 (Cohen 
2006)—and as high as 30 percent in the hardest hit regions (GOU 2003)—to 6.7 percent in 
2005 (Uganda AIDS Indicator Survey 2004/2005). This success resulted from a coordinated 
effort between the Government of Uganda (GOU) and international and local non￾governmental organisations (NGOs). In 1986, high level political support led to the creation 
of the National AIDS Control Programme (NACP), which organised countrywide public 
campaigns against HIV, including HIV education programmes in schools. In 1987, the AIDS 
Support Organisation (TASO) was created to promote HIV care and to advocate against 
discrimination and stigma toward people living with HIV/AIDS. Early mobilisation of 
NGOs, including the Straight Talk Foundation and Naguru Teenage Information and Health 
Centre, led to more intensive education of youth in and out of school on HIV/AIDS and 
sexuality. 
Despite these achievements, recent evidence suggests that HIV prevalence rates have 
stagnated or even increased in some areas (GOU 2003 and 2007). According to the Uganda 
AIDS Indicator Survey, HIV prevalence rates are higher in urban areas (10.2 percent) than in 
rural areas (5.7 percent), while women have a higher prevalence rate (7.5 percent) compared 
to their male counterparts (5.0 percent). Several reasons have been put forward to explain 
these changes, including increased risky sexual behaviour, decreased intensity of HIV 
prevention programmes (UNAIDS 2006a), and ―individual and organisational complacency 
in responding to the epidemic, emanating from fatigue and false impressions that the 
epidemic was under control, following reports of declining trends‖ (GOU 2003). 
To sustain declining trends in the HIV prevalence rates among youth, President Yoweri 
Museveni launched the Presidential Initiative on AIDS Strategy for Communication to Youth 
(PIASCY) in 2002. PIASCY is a national programme designed to provide all school-going 
children and teachers with information on HIV/AIDS in order to prevent further infections, 
and to help both the HIV-infected and affected cope with the disease. Currently, about 7 
million pupils are enrolled in primary schools with a total of about 130,000 teachers (Kibenge 
2009). The broad objectives of the programme are to: 
a. Increase the capacity of a network of institutions (public and private) to continuously 
increase behaviour change; 
b. Increase the skills and knowledge of chief actors—teachers, parents, community 
leaders, and pupils—that culminate in the practice of behaviours that delay sex until 
marriage; and, 
c. Promote a stigma-free school environment in support of children infected and affected 
by HIV/AIDS (MOES 2008). 
In 2003, the United States Agency for International Development (USAID)/Uganda, through 
its Basic Education Policy Support (BEPS) programme, supported the MOES to develop two 
PIASCY handbooks and spearhead the orientation of teachers in their use. In 2005, the 
Uganda Programme for Human and Holistic Development (UPHOLD) took over support to 
roll out and implement PIASCY. By the end of 2008, UPHOLD handed over its PIASCY 
PIASCY Formative Evaluation 
9
activities to the Ugandan Initiative for Teacher Development and Management System
(TDMS) and PIASCY (UNITY), the current implementer of the PIASCY programme. 
PIASCY is a multifaceted programme that involves the use of textual material such as 
posters, readers, suggestion box notes, and HIV-prevention messages placed strategically 
around school compounds (―Talking Compounds/Environments‖). It also includes a variety 
of child-centred ―edutainment‖ activities, such as ―Music, Dance, and Drama,‖ that are often 
incorporated into school assemblies.
Objective and Research Questions 
The objective of this formative evaluation is to assess the effectiveness of PIASCY to provide 
the GOU, the MOES, USAID/Uganda, UNITY, and other stakeholders with an understanding 
of the lessons learned and recommendations for improving programme strategies and/or 
activities for continued implementation of PIASCY. The African Population and Health 
Research Center (APHRC), through a subcontract from the Population Council and with 
funding from USAID/Uganda, carried out the activity in the four regions of Uganda 
(Northern, Central, Eastern, and Western) in February 2009. 
The evaluation was guided by the following research questions: 
1. To what extent is PIASCY achieving its planned goals and objectives (e.g., increased 
capacity to deliver learning resources and materials, increased skills and knowledge of 
chief actors, and promotion of stigma-free school environments)? 
2. What are the strengths and limitations of the design, organisational structure, and rollout 
of PIASCY? 
3. What are the lessons learned and best practices for continued rollout of the programme? 
4. What are the unintended consequences of the development and implementation of 
PIASCY? 
5. What are the sustainability issues that will need to be addressed in handing over the 
programme? 
The study report first describes the evaluation methodology, data collection tools, and data 
analysis methods. It next presents the study results by research question. This is followed by 
a discussion of the study findings. Finally, a set of recommendations are offered. 
10
III. Methodology 
Study Design 
The study design was qualitative in nature, drawing on focus group discussions (FGDs) and 
key informant interviews with programme actors. Patton (2002: 10) observes that 
―Qualitative methods are often used in evaluations because they tell the program‟s story by 
capturing and communicating the participants‟ stories…. Understanding the program‘s and 
participants‘ stories is useful to the extent that they illuminate the processes and outcomes of 
the program for those who must make decisions about the program.‖ FGDs were conducted 
with pupils, teachers, and parents/community members, and key informant interviews were 
carried out with relevant stakeholders from entities such as UNITY, MOES, and UPHOLD. 
Secondary sources—data available from government bodies and NGOs—were used to 
supplement the FGD and interview data. A rapid appraisal tool was used to record key 
PIASCY-related observations within the schools. 
Selection and Description of the Study Sample 
Data collection occurred at both the school and the community levels. Using a stratified 
purposeful sampling approach, 80 primary schools were selected for participation based on 
their geographic location (North, Central, East, and West) and on their classification as either 
―public‖ versus ―private‖ schools or ―rural‖ versus ―urban.‖ Twenty schools were selected 
from each region (10 in urban areas and 10 in rural areas), resulting in a total of 80 schools 
across the four regions. The majority of the schools selected (60) were ―Model Schools‖, as 
defined by the PIASCY programme, while a few (20—i.e., one per district) were private 
schools. 
Ethical Considerations 
The research team first obtained permission from headmasters of each school to conduct the 
study within their school setting, and to have those pupils that were willing and eligible 
participate in the evaluation. The team then worked with teachers to raise awareness about 
the study, identify potential pupils for participation, and answer questions as needed. To 
ensure that the respondents represented the range of PIASCY programme experiences, the 
team worked with teachers in schools to identify pupils that represent one of two levels of 
engagement: ―engaged‖ (visibly involved in PIASCY programme activities such as 
participating in PIASCY school club activities), and ―less engaged” (less visibly involved in 
PIASCY programme activities except for class lessons). 
Prior to each FGD, participants were asked to read an informed consent statement that 
assured confidentiality and the right to refrain from answering any question posed by the 
discussion moderator. All respondents were at liberty to refuse to participate in the study with 
the understanding that there would be no punishment for such refusals. Respondents were 
assured that their responses would remain anonymous unless they indicated that they could 
be identified. Adult respondents that were willing to participate in the study signed the 
informed consent form. There were no inducements for participation in this study, nor were 
PIASCY Formative Evaluation 
11
any promises made to participants in this regard, apart from the fact that their responses could 
provide an understanding of the aspects that had worked well under PIASCY, so that these 
could be maintained, as well as to identify the negative aspects to inform recommendations 
on improvement.
Data Collection Methods 
As noted above, this formative evaluation included desk reviews, FGDs, key informant 
interviews, and naturalistic observation via rapid appraisals. The evaluation team designed 
qualitative field guides with minor variations depending on the respondent category. Within 
each of the 80 schools, one FGD was conducted with ―senior men/women‖ (a term used to 
denote teachers that had been specifically trained to deliver PIASCY instruction), along with 
two FGDs with pupils. FGDs with pupils were conducted in sex-segregated groups at either 
the upper primary or lower primary level for each school. This resulted in a total of 
approximately 40 FGDs with boys and 40 FGDs with girls at the upper primary school level, 
and approximately 40 FGDs with boys and 40 FGDs with girls at the lower primary school 
level. One FGD per school was also conducted with parents/community leaders from a sub￾sample of 10 schools that were selected from the larger sample of 80 schools, using a 
convenience sampling strategy. The rapid appraisals were also carried out within these 10 
schools, using an observation form—a checklist of observations made by the data collector to 
describe a specific school activity structure, or to note the presence or absence of PIASCY￾related materials. Finally, key informant interviews were conducted with several categories of 
stakeholders, including personnel from the MOES, UNITY, and UPHOLD. This process 
resulted in a total of 246 FGDs conducted with pupils, teachers, and parents/community 
members, and a total of 24 interviews with key informants. (See Annex 1 for a table 
summarising the data collection; see Annex 2 for study instruments.) 
Data Management and Analysis 
Interviewers took detailed, handwritten notes during the FGDs/interviews. The note-taking 
was enhanced by the use of a standardised contact summary sheet (see Annex 2 for an 
illustration), which contained focusing or summarising questions about each field contact. 
The corresponding notes and contact summary forms were labelled appropriately and typed 
in Microsoft Word format. 
The analysis of the interview and FGD data was conducted via a two-tiered process. Initially, 
first-level coding (Miles and Huberman 1994) was carried out by reading the field notes and 
contact summary sheets, and identifying key themes that emerged, or by summarising 
segments of data. Pattern coding (ibid) then followed by conducting close and repeated 
readings of the field notes and contact summary sheets to identify patterns within the 
emerging themes. The themes and patterns generated through this process were subjected to 
repeated cross-checking and comparison with other field notes in the data set, as well as with 
data from the rapid appraisal forms, to ensure their empirical grounding. Results were then 
written up thematically, organised around the five main research questions. 
Consistent with qualitative approaches to evaluation, findings are a reflection of the 
respondents‘ perspectives. Thus, the report includes several quotations that ―give voice‖ to 
12
approximately 1,400 respondents, and that signify the main themes that emerged from the 
discussions and interviews. Where multiple quotations are used to highlight a theme, an 
attempt is made to draw from different regions and interviewee categories (if applicable) to 
further demonstrate the generalisability of each theme. 
Limitations of the Study 
A limitation of the study is that teachers helped identify the pupils for participation in the 
FGDs. This process could have introduced a selection bias. Pupils that participated in this 
evaluation were certainly aware of PIASCY and able to comment on its perceived impact; 
however, teachers might have been more likely to select pupils whom they knew well and 
who may have been more satisfied with the programme. This limitation is moderated by the 
use of multiple sources of data collected from multiple categories of participants, and by the 
use of triangulation to validate findings.
PIASCY Formative Evaluation 
13
IV. Results 
IV.A. To what extent is PIASCY achieving its planned goals and 
objectives? 
In order to provide all school-going children and teachers with information on HIV/AIDS, 
prevent new infections, and to help those infected with and affected by HIV cope with the 
disease, the PIASCY programme seeks to achieve a number of goals, including increased 
capacity to deliver learning resources and materials, increased skills and knowledge of chief 
actors, and the promotion of stigma-free school environments. This section illustrates the 
extent to which the PIASCY goals and objectives outlined above are being achieved. 
A general observation that emerged during the analysis of data on the above research 
question was that some schools were more actively engaged in PIASCY activities than 
others. While the engagement of some schools was limited to the creation of Talking 
Compounds/Environments1
and the existence of suggestion boxes and/or PIASCY readers, 
other schools demonstrated stronger and more proactive participation in the PIASCY 
programme through periodic activities (e.g., assemblies; open days; parent days; and Music, 
Dance, and Drama) deliberately incorporating PIASCY activities/messages. These schools 
invariably seemed to have structures (such as ―PIASCY teachers‘ committees‖ and ―PIASCY 
clubs‖) to support the programme. PIASCY committees consisted of teachers who usually 
met to plan for periodic PIASCY activities, prepare timetables, and assign specific roles to 
teachers. Such structures were instrumental in ensuring the continuity of the programme, 
especially in the event of the transfer of a PIASCY-trained teacher, since they diffuse 
knowledge of PIASCY across several personnel. PIASCY clubs were made up of pupils who 
would meet under the guidance of a teacher to engage in PIASCY activities. These clubs 
included but were not limited to drama clubs, dance clubs, and debate clubs. 
IV.A.1. Increased capacity to deliver learning resources and materials 
Key informants consistently mentioned that all PIASCY materials designed for teachers and 
pupils were printed and delivered to the target schools as intended. This finding supports 
information from the desk review, which highlights the reach of the PIASCY programme. 
Specifically, PIASCY reports indicate that, since its inception, the programme has distributed 
113,616 copies of PIASCY materials countrywide including PIASCY Teacher‘s Handbooks, 
Guidance and Counselling Manuals and Charts, Community Involvement in Education (CIE) 
Toolkits, and Teacher‘s Guides for School Talking Environments (MOES 2008). As one 
MOES key informant notes, however, ―Delivering materials to schools is one thing and 
having people who are able to utilise the materials is another.‖ The study findings suggest 
that the efforts to distribute materials to schools are moderated by four issues of access to 
them: language barriers, insufficient supplies in light of high primary school enrolment rates, 
censorship on the part of teachers, and preservation of texts. As a result, in most of the FGDs 
with pupils, respondents spoke about the paucity of PIASCY reading materials. 
 
1
 See page 18 for additional information. 
14
Language barriers to access 
PIASCY texts (e.g., readers, posters) are written in English. However, both teachers and 
pupils pointed out that pupils were unable to read these texts independently, as they had not 
yet acquired strong English language skills. This is an issue that affected all regions in both 
urban and rural settings, but was noted most often as a problem for lower primary pupils by 
teachers in rural areas. For example, when asked ―In your opinion, which [PIASCY 
dissemination] means has had the least impact on pupils?‖ FGD respondents noted: 
Some words in English cannot be easily translated into the local language. For 
instance, the words on the posters can be hard to interpret. The language used in the 
reading material is too technical for the pupils, and it‟s even harder for us teachers to 
help them understand. (Teachers, Northern region) 
R1: Talking environments, as pupils fail to read them and more so they do not have 
explanations as they just phrase words and most of the words are new to us. 
R6: The readings [have the least impact] because they leave the burden to us to read, 
and not every child can read since the readings are in English. (Boys, Lower 
Primary, Western region) 
When asked to elaborate on such responses, pupils tended to speak in general terms about the 
particular inaccessibility of posters to their fellow pupils who struggled with reading English. 
The specific terms that some pupils may have found difficult to understand were not 
mentioned in the FGDs. 
Some school personnel, such as head teachers, explained that posters were either bought by 
the school with grants they had received from PIASCY, or delivered to them by the Centre
Coordinating Tutor (CCT), suggesting that some personnel and pupils of individual schools 
may have limited input into the kind of posters developed. However, MOES officials pointed 
out that materials had been field tested and revised before being adopted for generalised use. 
It is therefore likely that schools that pointed to limited input into the development of 
PIASCY materials had not been part of the sample of schools involved in the pilots. 
Insufficient supplies 
In some instances, the number of assigned PIASCY texts could not adequately serve the 
number of pupils, given high enrolment rates, particularly in Universal Primary Education 
(UPE) schools. A key informant from the MOES corroborated this point, which was also 
raised in several FGDs with teachers, saying, ―They also claim that because of UPE, the 
schools are overcrowded, so the books are not enough for the children. One book sometimes 
may have to be shared by between five to eight children.‖ A related issue is access to 
PIASCY materials for older pupils. As a result of UPE, some older pupils who were 
previously unable to afford primary school education are now able to attend school. Some 
UPE schools (mainly those situated in rural areas) have older/mature pupils in primary 1 and 
2 (P1 and P2) who would otherwise qualify for PIASCY education; however, PIASCY is 
targeted at pupils in P3 and upwards: ―[PIASCY] was designed like [for] P3 to P4. [Mature 
pupils] are left out of the curricular and are therefore at risk of behaving naively with regards 
to sex and HIV‖ (Teachers, Eastern region). 
PIASCY Formative Evaluation 
15
Censorship 
There was evidence of censorship with regard to PIASCY information on the part of some 
teachers who taught at the lower primary level. Some teachers spoke of revising the content 
of their PIASCY messages for lower primary pupils according to their personal beliefs, 
noting for example that ―the children are so young.‖ The data from many schools 
demonstrate that a good number of teachers at the lower primary level tend to emphasise 
topics such as personal hygiene, the importance of living in a clean environment, and of 
hand-washing after using the toilet, rather than life skills education, such as saying ―no‖ to 
sex. 
Keeping texts “new” or preserved 
The data also suggest that there is a strong perception among some school personnel that the 
PIASCY texts need to be preserved and kept looking ―new,‖ even if this means that pupils 
are prevented from reading them: 
We also have big problems with utilisation of books since the teachers want to keep 
the books new. To overcome this we have developed a policy of “books in the hands 
of children.” However, to some extent, the distribution of the materials did not go as 
we had expected. There are materials which we sent to all primary schools under 
PIASCY, but they are not being used. Instead, they are kept in cabinets by the head 
teachers… [who] claim that the children cannot borrow the books because they don‟t 
have bags, so if it rains, the books will be spoilt. (Key Informant, MOES) 
The textbooks are few. We cannot lend them out because we may lend a pupil a book 
and then they leave the school. (Teachers, Central region) 
Reading is the least effective [PIASCY-related activity] because teachers do not let us 
read the books. (Boys, Upper Primary, Eastern region) 
IV.A.2 Increased skills and knowledge of chief actors
Overview of the perceived impact of PIASCY 
In all study regions, most respondents perceived PIASCY as having a positive influence. 
Specifically, many credited the programme with changing the perception of HIV/AIDS 
among PIASCY beneficiaries. Respondents described the disease as a normalised feature of 
daily living that is integrated into other aspects of regular life (such as child protection and 
walking home from school, relating with relatives, having confidence in oneself, and 
sanitation). In essence, respondents credit the programme with constructing HIV/AIDS as 
something to live with—related holistically with other aspects of life: 
It‟s about more than just giving people information about HIV/AIDS. PIASCY is 
unique because it is about saving lives. The information and skills we get are about 
saving life. (Teachers, Central region) 
We now have children who are assertive. They can say no to sexual advances, they 
can report when faced with difficult situations, and they can get help or guidance on 
how to deal with such situations. (CCT, Eastern Region) 
16
PIASCY has encouraged parents to bring even the sick children to school. In the past, 
the children who were positive were left for dead—no one bothered to take them to 
school. (Parents, Eastern Region) 
In response to questions about what they had learned through PIASCY activities, pupils were 
fairly consistent and accurate in naming key PIASCY messages (e.g., abstinence, refusing 
gifts from strangers, taking care of the infected), which suggests the successful retention of 
knowledge gained from PIASCY activities. The following quotation represents a common 
sentiment expressed by pupils across the FGDs: ―[Before PIASCY started] I did not know 
that HIV spreads through sexual intercourse‖ (Boys, Upper Primary, Northern Region). 
Other quotes further suggest that knowledge of HIV is increasing as a result of the 
programme: 
Before, the HIV negative students feared to interact with positive ones because they 
thought it could be spread through body contact. (Boys, Upper Primary, Eastern 
Region) 
We used to refuse their [HIV positive pupils‟] food if they gave us some because we 
thought AIDS could pass through food but these days we don‟t discriminate against 
them. (Boys, Upper Primary, Western Region) 
Teachers also indicated a perceived increase in knowledge: 
I treat all children equally, whether you are positive or negative, unlike before where 
we used to see no need of HIV-positive students even studying because they will die 
soon. (Teachers, Eastern Region) 
PIASCY enriched knowledge in addition to life skills, like people being assertive. 
People comfortably go for HIV tests hence people are free unlike in the past where it 
was hard… We have a positive attitude towards AIDS. We no longer assume that 
whoever has AIDS gets it through sex. (Teachers, Central Region) 
This increase in knowledge seems to have also positively impacted the behaviour of 
programme participants. For example, a commonly expressed perception among school 
personnel was that HIV-positive children are increasingly being enrolled into school by their 
parents. HIV-positive pupils were also noted to be more open about their status, compared to 
the period before the PIASCY programme began. Other behaviour changes such as condom 
use among teachers and a reduction in cases of pupil molestation by teachers were also 
highlighted: 
It has been positive. As you all know, whatever you preach, you must practise. Thus, 
with that, our behaviour has changed, too. For example, we, too, use a condom.
(Teachers, Eastern Region) 
Teachers have reduced the behaviour of “sending pupils in the houses.” [laughter] 
(Teachers, Western Region) 
The statement ―sending pupils in the houses‖ refers to teachers engaging in sexual relations 
with their pupils in their (teachers‘) homes. This is certainly an illegal and negative behaviour 
PIASCY Formative Evaluation 
17
of teachers that should be condemned. While ―reduction of the behaviour‖ is a step in the 
right direction, the aim should be zero tolerance and complete eradication. Indeed, as shown 
below, PIASCY has empowered pupils to seek help when teachers make such advances. 
Guidance and counselling 
According to a key informant from MOES, ―Guidance and counselling is an integral part of 
HIV. There has to be counselling for vulnerable children.‖ Guidance and counselling is 
expected to play a key role in UNITY‘s future PIASCY activities. UNITY is also expected to 
introduce PIASCY to the post-primary level of education by producing PIASCY manuals and 
guidance and counselling materials, and disseminating them nationally but with a focus on 
the Northern Region. 
In addition to the distribution of guidance and counselling tool kits, more than 8,000 primary 
school teachers (two teachers per school, representing about 4,000 schools) were trained 
under PIASCY to offer psycho-social support to school children living with HIV/AIDS 
(UPHOLD 2008). At the time of fieldwork (February 2009), not all schools were covered, 
and the recent increase of registered primary schools to 17,008 complicates the issue. In 
addition, the desk review indicated that only 37 percent of teachers trained in guidance and 
counselling were women and yet, women teachers are preferred by female pupils. 
The exact duration of the guidance and counselling training is also not clear; the session is 
three weeks long, but includes several different subjects, guidance and counselling being only 
one of them. Findings suggest this training is insufficient: 
Teachers need to be trained on how to counsel students who are infected. For 
example, when conducting career guidance and counselling, students who are 
infected with HIV/AIDS may have different needs. (Key Informant, UNITY) 
There is need for more training or refresher courses. We need training on how to 
handle the infected and affected pupils in our schools. (Teachers, Central Region) 
Guidance and counselling is needed not only for the pupils, but for teachers as well. It was 
noted in FGDs with school personnel that some teachers were equally susceptible to 
emotional distress related to HIV/AIDS through caring for others, losing spouses and other 
loved ones (including their pupils), as well as through being infected. 
A previous evaluation of PIASCY activities conducted by the MOES (2008) indicated that 
although counselling of pupils existed in schools, it was mostly carried out in the form of 
group counselling activities. The current evaluation corroborated this finding. Group 
counselling is sex-segregated and focuses on issues such as body changes, menstruation, 
discipline, respect for parents, and staying away from ―sugar mummies/daddies.‖ Although 
sex-segregated counselling may encourage students to open up to discuss certain issues (e.g.,
menstruation) compared to when they are mixed, school group counselling sessions appeared 
to be more instructional in nature. This raises the issue of whether such sessions should 
instead be student-driven (i.e., focusing on issues collectively raised by pupils as representing 
their own counselling needs). There may also be a need for more individual counselling to 
address needs that may be difficult to express in a group. A disturbing observation emerged 
from one school in which pupils reported that one group counselling session was used to 
18
examine female pupils for pregnancy. This was not only inappropriate, but it violated the 
pupils‘ right to confidentiality. 
Given the acknowledged importance of guidance and counselling, there is a need to help 
school administrators, teachers, and even pupils to include individual-level guidance and 
counselling, and to ensure that group counselling goes beyond regular pedagogical-type 
instruction to become a child-centred, interactive forum based on needs identified by the 
pupils. 
Pupil participation in PIASCY activities 
The PIASCY programme uses a variety of child-centric activities/strategies, including Music, 
Dance, and Drama (MDD), Talking Environments/Compounds, suggestion boxes, and the 
Safety Friends Network/Family System. This section briefly examines the extent to which 
these activities/strategies are advancing the objectives of the programme, particularly, that of 
increasing the skills and knowledge of pupils. Overall, the evaluation indicated that 
participation in these activities gave pupils ownership of the programme while 
simultaneously enhancing their knowledge of HIV, their coping skills (for those 
infected/affected), and their agency in proactively addressing situations that could expose 
them to contracting HIV. 
Music, Dance, and Drama 
According to an UPHOLD report (2008), ―School clubs are avenues that foster peer-to-peer 
learning, because the majority of adolescents feel more comfortable discussing sexual issues 
with peers rather than with teachers.‖ In the MDD clubs, children compose their own drama 
scripts and songs with the help of their teachers to address factors that put children at risk of 
HIV. MDD thus provides an opportunity for children to discuss their issues in their own 
words. Children that participated in MDD perform before their entire school and parents. 
Some MDD club members also travel to satellite schools to perform. 
According to most respondents, this activity is not only popular among pupils, but is also 
perceived as advancing PIASCY‘s objectives. The songs and dramas were typically 
composed in the local languages and were thus easily accessible to most audiences. Key 
informants and pupils emphasised the impact of MDD via the following narratives: 
Drama clubs are more popular. At assemblies, the AIDS messages can be imparted 
through a poem, play, or skit. Imparting of information is made entertaining to make 
it more interesting. (Key Informant, UNITY) 
I think music, dance, and drama have made the strongest impact. When we participate 
in a play, we act as if it‟s real and the message people get affects them permanently. 
(Boys, Upper Primary, Eastern Region) 
Up to now, the MDD are still in demand. I think they should be replicated, promoted, 
and supported. (Key Informant, MOES) 
MDDs are [good]. Students come up with issues that affect them. The children are 
happy and sometimes cry when the events are being dramatised. (Key Informant, 
MOES) 
PIASCY Formative Evaluation 
19
When acting, pupils get emotional. If a child acts a part where s/he loses a parent, the 
pupils get emotionally caught up. (Teachers, Central Region) 
Talking compounds 
Talking compounds were initiated in Phase 1 of the PIASCY rollout process. Schools 
composed messages about HIV/AIDS and posted them in their compounds and surrounding 
environments to communicate to both pupils and communities. These messages are painted 
on highly visible target areas such as large boulders, water tanks, and school toilets (see cover 
page of this report for an example). Messages range from encouraging pupils to abstain from 
sex in order to stay safe to discouraging pupils and community members from stigmatising 
those infected or affected by HIV. While pupils and community members regarded the 
talking compounds as a useful tool, many schools noted the need to periodically alter the 
messages within the talking compounds, as there was the risk of no longer ―seeing‖ the 
messages when they had been displayed for too long. 
Suggestion boxes 
Suggestion boxes were introduced as part of the PIASCY programme in order to provide an 
opportunity for pupils to ask questions anonymously about issues that they might otherwise 
not broach. The suggestion boxes were noted by respondents as having enriched the school 
assemblies. Teachers would typically pick out an anonymous question from the suggestion 
box and answer it for the whole school. Pupils asked a range of questions via suggestion 
boxes, demonstrating the need for information not only on HIV but also on broader sexual 
and reproductive health issues. Examples include: ―Is it true that if I don‘t [have] sex, it 
means I am barren?‖ ―If you don‘t [have] sex, is it true your organ does not grow?‖ ―Is it 
normal to feel pain during menstruation?‖ ―Will my breasts not grow if I don‘t [have] sex?‖
Safety Friends Networks 
The Safety Friends Network is a system that enables children to protect themselves, defend 
their rights, and minimise or eliminate predisposing factors that put them at risk of acquiring 
HIV. Pupils choose three or four friends to accompany them to and from school, and to other 
places, such as teachers‘ houses. Each friend is supposed to watch out for the others and to 
remain aware of what is happening to them. Respondents were generally of the opinion that 
Safety Friends Networks were particularly empowering for pupils, as being in a group 
granted them a level of security they would be less likely to have if unaccompanied. A parent 
from the Eastern Region expressed the usefulness of Safety Friends Networks as follows: 
―These days, children know that they can be attacked or raped by strangers if they move 
alone or in isolation, so these days they move in groups‖. An MOES key informant gave a 
compelling example of how the Safety Friends Network had functioned successfully in a 
school in Jinja District: 
A teacher took a female student to use her at his house, but the children had known 
the teacher was using that girl. The girls moved from their dormitory, went to get the 
boys from their dormitory, and proceeded to the teacher‟s house. They demanded that 
the teacher release the girl. The children became wild, so the teacher was afraid to 
come out. The teacher on duty called the headmaster who was away at that time. The 
head teacher came back with the police. As we speak now, the teacher is in prison. 
Now, everyone knows that you cannot touch children because if you do they will take 
action and you can end up in prison. 
20
Of the four child-centric activities described above, different schools expressed a preference 
for different activities. Teachers, however, tended to point out that conveying HIV/AIDS 
information required a multi-pronged approach; therefore, ranking one method as better than 
the other was not a useful exercise. However, it was apparent in FGDs with all respondent 
categories that interactive methods such as MDD were highly valued and seen as particularly 
effective. 
IV.A.3. Promotion of stigma-free school environments 
PIASCY played a major role in reducing stigma against people living with HIV/AIDS in 
schools. The vast majority of pupils clearly articulated that they had been taught not to 
discriminate against HIV-positive individuals because the disease could not be contracted by, 
for example, playing with them. Pupils gave several examples of playing with young people 
living with the virus, and of assisting them in various ways: 
When they get sick at school, we escort them back home and we remind them to 
swallow their drugs. (Boys, Lower Primary, Eastern Region) 
R1: Some positive pupils can be sick and their parents can‟t afford treatment so 
teachers take them to hospital. 
R4: I have a friend who is positive. I remind her to take tablets whenever she forgets 
but she has not reported this term and her sister died of AIDS. 
R3: When one of the pupils who are positive is down and sick, we contribute 
vegetables and fruits as two pupils and a senior woman go to visit her/him. (Girls, 
Upper Primary, Western Region) 
Teachers voiced similar comments on pupils‘ experiences with stigma. When asked to rate 
their school in terms of being stigma-free, teachers from schools that were actively engaging 
with PIASCY made the following observations: 
R5: I rate it high because no one segregates pupils depending on whether they have 
HIV or not. 
R4: Recently, during our march, pupils that have HIV comfortably participated in the 
march. 
R3: Teachers draw closer to provide help and support once they learn that one of 
their pupils has HIV. (Teachers, Central Region) 
R2: A child can come and say to you, “My father died last year and my mother died 
six months ago and I am feeling sick.” In this regard, I have to counsel the child and 
eventually take him or her for testing or treatment. 
R5: On admission, it is important to know the status of each child, whether he or she 
has both parents, a single parent, or [s/he is] an orphan. (Teachers, Northern Region) 
A recurring theme among the majority of schools was to never insult or be mean to pupils 
living with HIV/AIDS since it was not their fault that they were HIV-positive. This mentality 
was also used as a basis to guard against discrimination. 
PIASCY Formative Evaluation 
21
Despite the apparent success in addressing stigma in many schools, a few schools—notably, 
the less engaged ones—still seemed lag behind: 
We had a child whose skin was full of rashes and she was in isolation. She was 
accused of [having] AIDS, but on testing several times… she was found negative. 
Today, she is friendly with most children. (Teachers, Central Region) 
The issue of stigma seemed to place a clear demarcation between schools that were 
minimally involved in PIASCY and schools that were more involved. For example, in the 
schools that were more clearly engaged with PIASCY, the notions of love and care for people 
living with HIV were often mentioned by pupils. On the other hand, pupils from less actively 
engaged schools often indicated that their schools were not ―good places‖ for children living 
with HIV/AIDS. For instance: 
R7: It‟s not a good school for people who are suffering from HIV/AIDS because 
nobody cares [agreement from others]. (Girls, Upper Primary, Central Region) 
While concerted efforts seem to have been made to combat stigma at the level of individual 
pupils, at the school-level, there appears to be room for improvement. According to an 
MOES key informant, ―Some headmasters are taking infected teachers off the payroll or 
transferring them haphazardly to schools where they may have problems accessing ARVs.‖ It 
was also noted that some head teachers discriminate against HIV-positive teachers by 
removing them from positions of authority such as the senior teacher position. The attitudes 
of teachers and school administrators toward stigma are particularly important, as they may 
play a role in shaping pupils‘ attitudes. 
IV.B. What are the strengths and limitations of the design, 
organisational structure, and rollout of PIASCY? 
IV.B.1. PIASCY design 
Strengths of PIASCY design 
The formative evaluation suggests that the greatest strength of PIASCY‘s design is that it is a 
comprehensive, holistic programme in which all actors are simultaneously imparters and 
recipients of PIASCY knowledge, and in which HIV/AIDS is innovatively mainstreamed into 
various aspects of daily living. The PIASCY design is based on the ―Whole Schools 
Approach‖—a strategy devised by the MOES to offer continuous engagement with HIV￾related issues across schools. One key informant from the MOES elaborated: 
For example, while conducting P.E. [physical education], a teacher will be 
interacting with a number of pupils and can use that opportunity to engage them on 
issues to do with sexual and reproductive health, sexuality, and HIV/AIDS. The 
teacher can also request children to write about HIV/AIDS and describe what they 
see as part of a composition lesson. In an art lesson, the teacher can ask children to 
sit and think about a family that has been left desolate as a result of HIV and put an 
image on paper. This will teach the child creativity and at the same time allow the 
children to think and talk about HIV/AIDS. As part of comprehension skills, children 
22
can be given passages to read describing situations that border on HIV/AIDS and 
related issues and then are asked questions and can discuss these things in class. 
A second strength of the PIASCY design is its inclusion of a variety of actors who had a 
vested interest in the issue of sex education in schools. Following the development of the 
PIASCY readers, the MOES held meetings with a range of stakeholders to discuss the 
appropriateness of the content for pupils in primary school to ensure there would be no 
resistance at implementation stage. These stakeholders included UNICEF, Straight Talk 
Foundation, TASO, Uganda AIDS Commission, the Ministries of Health and Gender, the 
local government, and the National Council for Children. Given that most primary schools in 
Uganda have a religious affiliation, religious issues were also taken into account during the 
design of PIASCY. The Protestant, Catholic, and Seventh Day Adventist churches; the 
Church of Uganda; and the Uganda Moslem Education Association (UMEA) were also 
represented at the stakeholder consultation meetings. Notably, some religious stakeholders 
objected to content such as instruction on the correct use of condoms, expressing concerns 
about encouraging pupils to engage in sexual activity. A compromise was eventually reached 
between the MOES and these stakeholders, and according to an MOES key informant, ―We 
again added in a whole chapter on morals, ethics, and virginity so that our children can 
abstain. We follow the ABC model. ‗A‘ is for Abstinence, and we state that all children 
should abstain. ‗B‘ and ‗C‘ are for teachers.‖ Without close consultation with a variety of 
stakeholders, and particularly, with religious stakeholders, the very existence of the PIASCY 
programme may have been threatened. 
Limitations of PIASCY design 
The formative evaluation also revealed several limitations of the PIASCY design. First, the 
fact that PIASCY was not an examinable subject discouraged some teachers from engaging 
with it. Secondly, teachers pointed out that the design of PIASCY did not include financial 
incentives for motivating human resources. These sentiments were widespread among all 
teachers interviewed regardless of region or whether they were urban or rural. 
It also appears that the Model School approach—in particular, the disbursement of school 
incentive grants to Model Schools to facilitate their leadership roles—was not well￾understood by some schools that did not receive these grants, fostering suspicion and 
perception that Centres of Excellence/Model Schools receive ―all the praise‖ and resources, 
as well as favours from the government. Even when the grant scheme ended, suspicion and 
resentment continued: 
Some schools refused to participate [in PIASCY] because we had adopted a strategy 
of giving a small incentive to the Model Schools. Those who did not receive the 
financial incentive felt marginalised and started saying that they would not do 
anything without also getting something. Now, we have resolved to treat all schools 
as at par. (Key Informant, UNITY) 
Since we are a Model School, when we invite other schools to come, they expect 
transport, food, and an allowance, which are not provided for, so they think we ate 
the money. (Teachers, Eastern Region) 
There needs to be transparency on the funding and materials that are sent to 
particular schools and all these need to be sent directly, otherwise, that‟s the
PIASCY Formative Evaluation 
23
weakness because not all funds and materials reach the final destination—the 
schools. (Teachers, Northern Region) 
The PIASCY administration should be lowered down to the level of schools rather 
than at the districts where the PIASCY material is given selectively. (Teachers, 
Central Region) 
Another limitation of the PIASCY design noted by several respondents (primarily teachers 
and parents/community members) was that parents and communities were not engaged as 
much as they could have been during the stakeholder consultation stages. Some teachers 
attributed the resistance of some parents toward the programme to this factor: 
R2: The design is upper-centred. The people at the top designed PIASCY without 
consultation with stakeholders. 
R3: They sent us books according to classes. We are supposed to read and teach 
children, but their parents were never catered for or sensitised; thus, there is a gap 
between parents and teachers. (Teachers, Central Region) 
The programme should have been rolled out to communities before being 
implemented by ensuring that parents/communities are fully involved and trained. By 
doing all this, much more could have been realised than what has been achieved so 
far. (Parents, Central Region) 
We do not know exactly what happens in these PIASCY activities apart from the 
Talking Compound where we, too, can have an opportunity to read what is displayed.
(Parents, Eastern Region) 
It [PIASCY] has not included parents who are [key] in bringing up these pupils 
because they spend almost half of their entire lives with them. But the programme has 
not looked into that. (Teachers, Northern Region) 
Indeed, out of all the respondent categories, parents/community members were the least 
verbose about PIASCY. Most did not seem to fully understand their role as actors within the 
programme. Unlike other target groups that have clear roles outlined within the programme
(i.e., teachers and pupils), parents and community members play an indirect role as recipients 
of PIASCY knowledge (rather than as both recipients and imparters). Parents, for instance, 
receive PIASCY-related information if they attend school assemblies and through interacting 
with the Talking Environments/Compounds, but there was no deliberate effort to ensure that 
parents understood the programme and saw themselves as an integral part of it. In the rare 
instances where schools collaborated with communities for the purposes of PIASCY (e.g., by 
having key community members, such as the police or doctors, give talks at the school; or by 
having pupils visit the sick in hospitals) this collaboration was a result of efforts on the part 
of the school, rather than of the community.2
 
 
2
 Despite this general perception, there is some evidence of engagement of parents and community members 
with PIASCY. For example, one teacher noted that ―There has been appreciation by parents. Today, parents 
thank us for teaching their children things like not all relatives are good.‖ In addition, a number of schools 
indicated that community members looked to their schools for HIV counselling services, and would 
occasionally visit the schools for this purpose. 
24
Teachers also raised specific limitations of the programme. Some expressed a desire to 
provide input into the kinds of activities that should be carried out under PIASCY. Several 
teachers mentioned that there were no opportunities for them to develop their own PIASCY 
budgets and work plans to address the particular needs of their school. Rather, their 
perception was that they were expected to carry out pre-specified activities with little 
attention to the specific context of their individual schools. 
A final limitation of the PIASCY design had to do with lack of information on antiretroviral 
therapy (ART) support and care for children with HIV. The vast majority of key informants, 
as well as many teachers and pupils, expected PIASCY to incorporate linkages to services or 
actual provision of anti-retrovirals (ARVs) for HIV-positive pupils and teachers: 
We can no longer have messages on prevention alone when we are faced with huge 
numbers of children who are living with HIV/AIDS. These children should have 
access to ARVs and should be able to bring ARVs to school. We need to promote VCT 
[HIV voluntary counselling and testing] for teachers. (Key Informant, MOES) 
I think PIASCY should also include other things apart from just giving information. 
PIASCY has been very successful at disseminating information; now, there is need to 
equip the informed people with the resources and skills to practise what they know. 
For example, we may need to provide care and support for affected students and 
teachers. We need a clear plan on what to do with orphans and vulnerable children, 
and on how to link people with services. In any given community or school, we can 
find people who are affected or infected—we need to provide them with support. (Key 
Informant, UNITY) 
IV.B.2. PIASCY organisational structure and rollout 
The organisational structure and eventual rollout of PIASCY are closely interconnected. The 
two will therefore be discussed in tandem. PIASCY‘s organisational structure, which guided 
the rollout of the programme, is illustrated in Figure 1: 
PIASCY Formative Evaluation 
25
Figure 1 PIASCY organisational structure 
The Teacher Development and Management System (TDMS) is a structure that caters to 
government teacher development and training within the MOES. Within this system, 
(government-affiliated) Core Primary Teacher Colleges (CPTCs) handle teacher training 
tasks, and the Coordinating Centre Tutors (CCTs) supervise and monitor the delivery of 
school curricula. The organisational structure that UPHOLD, in collaboration with the 
MOES, adopted for the PIASCY programme was deliberately aligned with these existing 
structures. Therefore, the CPTCs were provided with a PIASCY module that was used to 
train PIASCY teachers. The CCTs were charged with supervising and monitoring the 
delivery of the PIASCY curriculum in schools. 
Between 2006 and 2008, UPHOLD encouraged the transformation of government-aided 
primary schools into Model Schools/Centres of Excellence. The Model Schools were meant 
to be foci of HIV prevention interventions that promoted practices and environments to 
enable pupils abstain from sex. They were selected based on a number of criteria, such as the 
capacity to provide leadership to other schools and presence of PIASCY-trained teachers 
(UPHOLD 2008). A total of 1,078 Model Schools/Centres of Excellence were created from 
among the 15,680 primary schools that existed at the time. Through a knowledge cascade 
approach, the Model Schools were expected to influence other schools within their area of 
influence (both public and private) by training other teachers on the implementation of 
PIASCY. 
26
Strengths of PIASCY’s organisational structure and rollout 
A major strength of PIASCY‘s organisational structure and rollout is its alignment with the 
pre-existing structures of the MOES. For example, the involvement of the various bodies 
outlined in the Figure 1 was critical for the inclusion of HIV/AIDS in the PIASCY 
curriculum. It also encouraged the Uganda National Examination Board (UNEB) to include 
HIV questions in national examinations for school children, which helped to mainstream 
HIV/AIDS within the classroom. Reliance on the TDMS also benefited the rollout process. It 
served to decentralise PIASCY activities, and, as they were already situated within the 
TDMS, the Model Schools and the CPTCs played roles that were familiar to them. 
UPHOLD was initially a regional programme working in about 20 districts to cater to the 
national PIASCY programme. The UPHOLD programme was then obligated under the 
PIASCY programme to extend its reach to other districts in which it had no prior 
relationships. Using the MOES structures for the rollout enabled UPHOLD to forge strong 
partnerships in the new districts while simultaneously relying on its regional offices where it 
had been operating prior to PIASCY‘s inception. The UPHOLD end of programme report 
notes that: ―This national rollout was accomplished in a record time of five months… It was 
probably among the most ambitious rollout efforts of its kind in Africa‖ (UPHOLD 2008:78). 
A final strength of the PIASCY organisational structure and rollout is the adaptability and 
creativity of the programme implementers, such as the MOES, BEPS, and UPHOLD, 
particularly in the face of funding limitations. For instance, as the available funding did not 
permit the provision of PIASCY training to all teachers, the project implementers devised a 
strategy through which three teachers per school would undergo training, who in turn would 
train other teachers within their schools and satellite schools. The creation of the Model 
Schools/Centres of Excellence was also partly a response to funding limitations. Under other 
circumstances, such funding limitations could have undermined programme functioning. 
Limitations of PIASCY organisational structure and rollout 
A recurrent weakness of the PIASCY structure is that the number of Centres of 
Excellence/Model Schools was insufficient to serve the number of satellite schools that 
needed their support, leading Centre of Excellence staff to feel overwhelmed. In an attempt to 
alleviate this problem, in 2007 each of the 1,078 existing centres was encouraged by the 
MOES to create one more Centre of Excellence, resulting in 2,156 Centres of Excellence by 
the end of the year. However, the total number of primary schools (both private and public) 
increased exponentially during that time, undermining the potential impact of this increase in 
Centres of Excellence. According to a key informant from the MOES, ―The schools also 
increased from to 15,000 to 17,008. The Centres of Excellence are still too few to cover all 
schools effectively.‖
Another limitation of the PIASCY organisational structure and rollout is a general lack of 
human resources: 
The structure of funding—one CPTC for the whole—is not workable, and a CCT can 
[be expected to] coordinate four sub-counties. This is a big workload… I would say 
the programme design has not been effective because for Jinja, Iganga, Kamuli, or 
maybe even for the rest of Busoga Region, we have one CPTC and in each district or 
county, one CCT. There are so many schools that a CCT has to cater for; even 
transparency about funds does not exist. We don‟t know how much we are given 
PIASCY Formative Evaluation 
27
because these CPTCs who receive the money are far. And one model school is given 
to manage and supervise other schools. In the case of [a particular district in the 
Eastern Region], there are 21 other schools. So how can we supervise 21 other 
schools? (Headmaster, Eastern Region) 
The worst part is that only few schools were chosen as Model Schools, leaving many 
schools outside [neglected], hence the multiplier-effect is still minimal. (CCT, 
Northern Region) 
As mentioned previously, the Centres of Excellence were intended to produce a critical mass 
of trained teachers who would then train other teachers in the satellite schools. This strategy 
was not entirely foolproof, however. At rollout, teachers trained under PIASCY were 
sometimes transferred to other schools, leaving a gap in institutional knowledge about 
PIASCY. In one case when a CCT who was committed to PIASCY was transferred, teachers 
pointed out that they no longer received the support they needed to implement the 
programme. Pupils and teachers described this issue as follows: 
They used to tell us about HIV/AIDS [during assemblies], but these days, they don‟t 
because the [PIASCY] teacher went away to another school. (Girls, Lower Primary, 
Northern Region) 
The programme at the beginning used to have other players like the CCT and people 
from the district who used to come and give support in implementing this programme, 
which was very good but nowadays, it is no longer done… The CCT who used to give 
us support was transferred, and for those people at the district, I don‟t know what has 
happened. (Teachers, Central Region) 
The teachers who first initiated PIASCY here were all transferred, so I don‟t 
personally know the work plan. (Teachers, Northern Region) 
Another limitation of PIASCY‘s structure and rollout is its failure to fully integrate private 
schools. While private schools were indirectly included in PIASCY‘s centrifugal approach 
through the satellite schools, their personnel were not directly trained, nor were these schools 
selected as Centres of Excellence. Private schools were described by respondents as being 
integrated at ―the end of the chain‖ (as satellite schools), rather than as potential ―centres of 
first contact.‖ Moreover, Uganda‘s two Private Primary Teacher Colleges (PPTCs) were 
omitted from the PIASCY organisational structure. These institutions have not as yet been 
integrated into the TDMS structure and do not offer training on PIASCY. In the words of an 
MOES key informant, ―We say that after training, public school teachers should go out there 
and train their private counterparts. But the impact is too little. If we train them and they go 
there and the environment is not conducive, they can‘t operate. Private schools also don‘t get 
PIASCY books.‖ In other words, the exact process through which public schools are 
expected to engage with private schools (and vice-versa) remains unclear. 
The lack of proper integration of the district authorities within the PIASCY rollout structure 
was another limitation highlighted in the respondents‘ narratives. Under the (amended) 1997 
Local Government Act, the management of primary schools is devolved to districts, which 
was the source of some struggles between Ministry-level versus district-level roles in the 
PIASCY rollout. As an MOES key informant explained: 
28
This programme has been pushed from the Ministry-level; however, districts are 
semi-autonomous government entities. Therefore, we can‟t simply direct them on what 
to do. We had a few problems with the districts. 
In response to the idea that some district authorities were not well-integrated into PIASCY‘s 
organisational structure, another informant explains: 
[In regard to] education, the country is divided into zones. Therefore, the Education 
Ministry operates according to zones. These zones are divided according to Core 
Primary Teacher Education Colleges. We have 23 CPTCs meaning the country is 
divided into 23 zones. However, we have 80 administrative districts in Uganda. I am 
not saying that the districts were not well-integrated, but it is possible that some 
districts may have felt that [way] because they are operating at the district level 
whilst we were operating through the education zones and the TDMS structures were 
only 23 compared to 80 districts. (Key informant, UPHOLD) 
The lack of integration for some districts caused further problems given that the districts were 
expected to monitor and evaluate PIASCY activities, but, according to an MOES key 
informant, some did not do so. Teachers in several schools underscored the comment that: 
PIASCY did not involve the District Education Officers. So it looks like we are 
running a parallel programme from our bosses. This leads to conflict, so this needs to 
be harmonised. (Teachers, Eastern Region) 
A related weakness, as reported by school personnel, was that the monitoring and follow-up 
of the PIASCY programme were inadequate. Few schools were satisfied with the monitoring 
of their activities, excluding schools in the Northern Region. Some school personnel 
mentioned that they had received one monitoring visit over the life of the programme, while 
others reported not being monitored at all: ―There has been no monitoring of the programme
since it started‖ (Coordinating Tutor, Western Region).
As with any programme, the PIASCY design, organisational structure, and rollout seem to 
have experienced a combination of both strengths and constraints. It is noteworthy that the 
limitations discussed around these areas seem to have stemmed primarily from insufficient 
resources—both human and financial. Additionally, the role of parents and community￾members in the PIASCY programme appear to have been less clearly defined than that of 
other target groups. 
IV.C. What are the lessons learned and best practices for continued 
rollout of the programme? 
The study results suggest several lessons learned and best practices for the continued rollout 
of the PIASCY programme. These have been developed with post-primary institutions in 
mind, given the intention for UNITY to introduce PIASCY within these contexts. 
PIASCY Formative Evaluation 
29
IV.C.1. Lessons learned 
1. Language barriers may prevent effective use of PIASCY material. 
2. Lack of an operational definition of ―guidance and counselling‖ has precluded some 
schools and teachers from effectively implementing this component of the PIASCY 
programme. 
3. The involvement of an extensive range of stakeholders in the design of PIASCY from 
the planning phase and during the development of readers has been critical to the 
existence of the programme. This is a practice that should be carried forward, with 
particular attention to stakeholders from religious bodies, who serve as powerful 
gatekeepers for parochial schools. 
4. Direct methods of targeting programme beneficiaries/actors (such as the methods used 
to target school personnel and pupils) make a stronger impact than indirect methods 
(the methods used for targeting parents and community members). 
5. Lack of monitoring of the knowledge cascade approach as well as lack of feedback to 
teachers and schools on their performance has led some teachers and schools to be de￾motivated and not participate in teaching other teachers and schools. Training three 
teachers in a school may also be insufficient, particularly when teachers are 
transferred to other schools. 
IV.C.2. Best practices 
1. The establishment of supportive structures within schools ensures the continued 
implementation of PIASCY (e.g., PIASCY teachers‘ committees and PIASCY school 
clubs) as these encourage ownership of the programme by a wide variety of staff 
members and pupils. Without these sorts of structures, PIASCY programmes run the 
risk of being championed by a sole teacher, which could undermine sustainability. 
2. Key PIASCY child-centric school activities (e.g., assemblies, suggestion boxes, 
Safety Friends Networks), are functioning successfully and enable pupils to gain 
valuable HIV/AIDS information as well as have their issues addressed in a non￾threatening atmosphere. School personnel and parents (who attend assemblies and 
other school functions) also gain knowledge from these activities, and some are 
inspired to change their own risky behaviour.
3. The TDMS structure helps school-based interventions to ensure that training occurs 
seamlessly. It is noteworthy, however, that this structure does not exist within the 
secondary school system (which forms an integral part of post-primary institutions). 
4. The development of school-community partnerships/collaborations (e.g., in the form 
of pupils visiting the sick in hospitals, and medical personnel or police officers giving 
talks to the pupils in school) can lead to the acceptance of PIASCY within 
communities and can also play a role in giving schools more visibility in the 
community, or in improving a school‘s image in the eyes of its community. 
30
IV.D. What are the unintended consequences of the development 
and implementation of PIASCY? 
IV.D.1.Positive unintended consequences 
The implementation of the PIASCY programme yielded a number of positive, albeit 
unintended, consequences. The programme reached populations for whom PIASCY was not 
originally designed. Although pupils in P3 to P7 were one of PIASCY‘s main target groups, 
some teachers observed that secondary school students, who had not formally gone through 
the PIASCY programme, could nonetheless gain PIASCY-related knowledge by reading the 
messages posted on school compounds. 
PIASCY has also enabled pupils to receive information beyond HIV/AIDS. Other related 
issues, such as child molestation, sexuality, and general safety were also discussed in the 
context of the programme. An UPHOLD key informant mentioned that ―because of 
sensitisation in one rural area… communities volunteered to clear up the paths and remove all 
hanging trees so that their children could be safe on the way to school.‖ The PIASCY 
programme also prompted its beneficiaries to become involved in activities outside of the 
school setting. In one school, teachers and pupils began to do outreach work, visiting the sick 
in hospitals. These efforts were noted by teachers as having improved the image of the school 
within the community. Other schools spoke of how they had developed good relationships 
with surrounding hospitals, which often sent their staff to talk to the pupils about HIV/AIDS. 
The PIASCY programme was also noted as increasing the confidence of teachers and pupils. 
For example: 
PIASCY also made teachers more confident. In the past, it was only the headmaster 
who addressed assemblies, but with PIASCY, teachers started alternating. The 
teacher on duty would be responsible for heading the PIASCY assembly. Children‟s 
confidence also increased as they were given opportunities to give testimonies and 
share with others in the assembly. In one district in Eastern, although it was not 
during the assembly, a pupil openly told the headmaster that her guardian was 
sexually abusing her and that the guardian had HIV. The guardian was reported and 
arrested and as we speak he is in jail. However, the girl was tested and she had 
already been infected. However, this also sent a message to the community that if you 
do something to the children, they will report you to the school teachers. (Key 
Informant, MOES) 
Some teachers noted that PIASCY training had improved their communication with their own 
children about sexuality issues and HIV/AIDS. The confidence-level of pupils was also said 
to have been boosted by their regular participation in plays and skits at school and through 
their involvement in addressing other pupils during assembly especially by giving 
testimonies. 
In one school, teachers suggested that enrolment in their school could have increased because 
of their outstanding performance in PIASCY: ―PIASCY has acted as an advertisement for the 
school as we have gone to PIASCY activities. Other children get to know of our school and 
PIASCY Formative Evaluation 
31
subsequently come for vacancies‖ (Teachers, Eastern Region). The teachers that participated 
in this particular discussion generally viewed this as a positive development. 
Suggestion boxes have also led to the discussion and resolution of issues that may have 
nothing to do with PIASCY at schools. In one school, the suggestion box led to the resolution 
of a particularly interesting issue: according to the headmaster, some pupils in lower primary 
dropped a note in the suggestion box complaining that boys in Primary 7 were not bathing. 
Further investigations proved this allegation to be true and it turned out that upper primary 
boys felt self-conscious bathing in the presence of the younger boys. The school authorities 
ended up putting a demarcation between the upper and lower primary bathrooms. 
Several schools in the study also noted a reduction (and, for some, the complete cessation) of 
love letters from boys to girls. Teachers were concerned that love letters between boys and 
girls could encourage pupils to experiment with sex and other risky behaviours. In one 
school, love letters ceased because girls would simply place received letters into the school‘s 
suggestion box. 
IV.D.2. Negative unintended consequences 
On the other hand, respondents noted a number of unintended, negative consequences as a 
result of programme implementation. As mentioned previously, teachers commonly cited the 
perception of a higher workload, given their new PIASCY-related responsibilities. This issue 
emerged in all FGDs with teachers. Some complained that they were not being remunerated 
for their PIASCY efforts and felt that these activities were above and beyond their call of 
duty. In one FGD, for instance, teachers remarked: ―Under PIASCY, the role of teacher has 
extended to that of counsellor and doctor, yet we had originally thought we were simply 
going to teach PIASCY.‖ Other examples include the following: 
R1: In my view, it consumes a lot of time. Training the girls takes time. Assembly time 
has expanded from 30 minutes to two hours. 
R4: It takes a lot of teachers‟ time. It is tiresome. (Teachers, Central Region) 
The programme has added more workload on the teachers, which was not the case in 
the past. (Teachers, Western Region) 
Teachers who participate should be motivated to boost their morale in supporting the 
PIASCY programme. Since in most cases it‟s an outside class activity, this would 
mean [an extra] workload for the teachers involved. (Teachers, Northern Region) 
Various other unintended, negative consequences were also mentioned by respondents. For 
example, a FGD with teachers revealed that ―some games which children used to enjoy have 
been banned [under PIASCY in their schools]; for example, ‗hide and seek,‘ because some 
students use this game to engage in sexual activities.‖ Another set of teachers remarked that 
―at some schools, PIASCY has now been limited to singing and drama and students are not 
given more information.‖ Finally, a statement by one teacher during a FGD suggests that 
some pupils may be using the gravity of PIASCY messages to their own advantage: ―since 
children know that they have to care for their sick [HIV] positive relatives, they have learnt to 
32
be absent from school, and when they come back, they give an excuse of having gone to 
Kakiso to pick medicine or to escort a sick parent.‖ 
Additionally, several school staff noted that PIASCY had been instrumental in helping them 
teach (both upper and lower primary) pupils about condom use, or that this topic fell within 
the PIASCY curriculum: 
Before training, it was difficult for us to demonstrate how to use a condom, but now, 
we do demonstrate. (Teachers, Western Region) 
As mentioned previously, abstinence is the intended focus of PIASCY for pupils, while being 
faithful and condom use are concepts reserved for teachers. The notion that condom use was 
to be taught as part of PIASCY was most prevalent in the Eastern and Western Regions, but 
was non-existent in the Northern Region. 
It is also possible that for some teachers, the process of integrating PIASCY messages with 
their regular science classes began to blur the boundary between PIASCY and other subjects: 
For upper primary, we have a topic on sexually transmitted diseases, so we take 
advantage of this topic to integrate these PIASCY messages into the standard topic… 
The community attitude is negative to the practical method that we use for teaching 
the children. For example, teaching the use of condoms to the children is resisted by 
parents. (Teachers, Eastern Region) 
There was also a perception that the motivations behind the establishment of the PIASCY 
programme were political in nature. In some cases this perception fostered a high engagement 
level of teachers; one teacher from the Western Region said, ―It is the initiative of the 
President [or else] people would have ‗dodged‘ it like they do other programmes.‖ In other 
cases, however, the association of the programme with political figures could serve as a 
deterrent to participation: 
The President‟s picture is on all the PIASCY material. If the President goes, the whole 
project may be regarded as political, and I think this is a problem for us. There may 
be a backlash against the project… We need to remove the picture of the President 
from the materials in the new revised versions so that people can see the programme
instead of seeing the whole programme as merely political. We do not want a 
backlash. (Key Informant, MOES) 
The President attributes the successes of PIASCY to his political party, which annoys 
other would-be PIASCY trainers. The programme should be made neutral to all 
people in Uganda. (Teachers, Central Region) 
In the preliminary data interpretation meeting for this formative evaluation, held at MOES, 
participants noted that as a result of PIASCY training some teachers have left the teaching 
profession and joined NGOs working on HIV and AIDS. Such departures have depleted the 
pool of PIASCY trained teachers to train other teachers in the knowledge cascade model. 
PIASCY Formative Evaluation 
33
In sum, the PIASCY programme yielded several unintended but positive outcomes, such as 
the increase in confidence for both teachers and pupils, as well as some negative outcomes, 
such as a perceived burden by teachers. 
IV.E. What are the sustainability issues that will need to be 
addressed in handing over the programme? 
Sustainability of PIASCY could be affected by funding. The integration of the PIASCY 
programme with all the departments in the Ministry of Education, as well as with other line 
Ministries (e.g., Ministry of Gender) within the rollout structure has played a key role in 
increasing the sustainability potential of the project. Nonetheless, as a key informant 
acknowledged: 
If funding ceases, projects tend to die off. However, the Ministry should identify and 
see which practices they should keep and provide supervision support to schools to 
ensure that they still practice PIASCY activities, even without funding. (Key 
Informant, UPHOLD) 
Several interviewees observed that although there was high-level political support for 
PIASCY, the government traditionally had not invested large amounts of funding in 
HIV/AIDS projects. This observation raised concerns over financial sustainability: 
The only big problem I see with PIASCY is its dependence on donor funding. PIASCY 
is PEPFAR-funded, and I do not see the Ugandan government being able to sustain it 
if USAID pulled out. We need to be integrated into the system so that the programme
becomes sustainable. The government is supposed to put in money; however, with the 
competing priorities, it may not be able to do so. For example, now we have free 
primary and secondary education, so a lot of money in the national budget has to 
cover these things. The HIV budget is also very small; therefore, projects like PIASCY 
have had to rely strongly on funders. (Key Informant, UNITY) 
The sole informant that expressed full confidence in the government‘s ability to 
independently sustain the PIASCY programme nonetheless suggested that with government 
funding alone, the delivery of the programme could still be susceptible to delays: 
With or without [donor funding], PIASCY has to go on… However, USAID funding 
helped us achieve our goals faster than if they had not funded us. Without USAID 
funding, progress would have been much slower. (Key Informant, MOES) 
Another MOES informant pointed to the risk of complacency on the part of actors, such as 
MOES, USAID, teachers, and pupils as a factor that needs to be addressed to ensure PIASCY 
sustainability. In his words: ―People say there is a lot of information fatigue and yet there is 
always a new generation of students, and we need to constantly [bombard] them with 
information‖. This issue could be mitigated by periodic PIASCY refresher courses for 
teachers, which take into account current realities and issues. It is noteworthy however that 
such an endeavour has its own financial implications. 
34
It is evident that the sustainability of PIASCY activities is threatened by the insufficient 
number of trained PIASCY teachers to take over in cases when the driver of the programme
leaves a school (e.g., transfer, career change, or death). Several respondents alluded to this 
problem: ―…You can get a very good teacher and headmaster, and they are transferred. When 
they are transferred, that school may stop performing well and the programme is 
disorganised.‖
Finally, the shortage of PIASCY texts—an issue raised repeatedly by respondents—merits 
attention. An inadequate number of books per school, coupled with some school personnel 
placing more value on preserving the texts than on allowing pupils to read them, could pose 
limitations to the sustainability of the programme. 
While the majority of key informants were unequivocal about the role of donor funding in 
sustaining the PIASCY programme, as one key informant suggested, there are actions that 
can be taken to foster sustainability, irrespective of funding. In particular, best practices that 
incur minimal costs (such as the utilisation of pre-existing structures) can be identified, 
strengthened, and maintained to guarantee the continuity of PIASCY. 
PIASCY Formative Evaluation 
35
V. Discussion 
School-based HIV/AIDS prevention programmes have been heralded as an efficient and 
effective way to combat the epidemic, given the large proportion of young people that can be 
reached (UNESCO 2005; UNAIDS 2006b). PIASCY is an ambitious programme that has 
sought to address the HIV/AIDS epidemic in a holistic manner, targeting young people, 
school personnel, parents, and the wider community. The programme was built through a 
partnership between the Government of Uganda, civil society, schools, and communities. 
This partnership is arguably responsible for many of the programme‘s achievements. 
However, the findings of this evaluation indicate that despite PIASCY‘s accomplishments, it
has not been immune to the challenges that have historically been associated with the 
implementation of school-based HIV prevention programmes. A review of the literature 
(Griffiths 2005; UNAIDS 2006) highlights a number of issues that can affect the 
implementation of such programmes, namely: problems associated with teachers, schools, 
and curricular; financial constraints; and poor political leadership. The discussion that follows 
is informed by these issues and also focuses on additional concerns arising from the study‘s 
findings. 
V.A.1. Teachers 
The lack of teacher training is a major obstacle to the success of school-based HIV 
prevention programmes. To effectively teach young people about HIV and reproductive 
health, teachers must have a good understanding of the subject, possess strong pedagogical 
skills, and be cognizant of the developmental and cultural appropriateness of teaching 
materials. In many ways, PIASCY has overcome this obstacle—the vast majority of teachers 
interviewed expressed enhanced confidence in PIASCY-related teaching because of the 
training that they had received. This is in contrast to their level of confidence prior to the 
introduction of PIASCY. Many talked about feeling uncomfortable teaching HIV issues 
before they were trained because they felt ill-equipped to do so. PIASCY has also supported 
teachers in using a variety of methods not only to instruct their pupils, but also to provide 
them with an opportunity to share in creating the learning process (e.g., through composing 
HIV-prevention messages, poems, songs, stories, writing, and acting in plays), rather than 
relying on conventional didactic methods. Although a few teachers talked about still being 
selective with their teaching to lower primary school pupils—only teaching them about things 
they personally felt were appropriate for that age group—most were comfortable delivering 
the curriculum specially designed by the PIASCY programme for both lower and upper 
primary school pupils. 
High teacher attrition rates are another limitation of school-based HIV-prevention 
programmes. While the literature often focuses on the loss of teachers to HIV/AIDS (see, for 
example, World Bank 2002; Gallant and Maticka-Tyndale 2004), teacher attrition in the 
PIASCY programme is reported to have stemmed largely from the small number of teachers 
who were initially trained in each model school. These teachers were trained with the hope 
that a knowledge cascade approach would eventually result in a much larger group of 
PIASCY-trained teachers across the country. Where teachers did proceed to train other 
teachers at their schools, however, they were sometimes still regarded as the repositories of 
PIASCY knowledge and the drivers of the school-based programme. This meant that 
whenever they were transferred, the programme often came to a standstill. 
36
V.A.2. Community engagement 
Another challenge of the programme has to do with engaging with local communities under 
PIASCY. Although communities are a key target of the programme, the formative evaluation 
found that parents and community members were the least engaged out of all programme
actors. This seems to be linked to the fact that, unlike other actors such as teachers and pupils, 
parents and community members were targeted in more indirect ways. Teachers were trained 
and then passed on teachings to pupils, who were then expected to relay information to their 
parents. There is evidence that this occurred, but not in a systematic way. Parents also 
attended parent days, sports days, and assemblies at which PIASCY information was 
disseminated. Nonetheless, these activities were held infrequently and were not compulsory 
for parents. Many teachers wondered why parents were not directly trained in the manner that 
teachers were, feeling that this would have been beneficial. Indeed, the International 
Academy of Education strongly advises close collaboration between Ministry of Education‘s 
work and the target groups of children, local communities, and school administrators in the 
course of the ―development, planning and implementation, evaluation, and redesigning of the 
programmes‖ (IAE 2005). As a result of these factors, of all respondent categories, parents 
were the least articulate about what PIASCY involved, and expressed a lack of clarity over 
their role in the programme. 
There was also no systematic way for teachers and schools to engage their broader 
communities; therefore, while a few schools spoke of involving community members as 
resource people (e.g., to give talks to the pupils), the role of the community in PIASCY was 
not clear in most schools. Because of this lack of systematic engagement of parents and 
community members, teachers were in some instances blamed when communities or 
community members disapproved of the dissemination of HIV information to children. At 
least one teacher in the present study narrated experiences of physical assault from 
community members for his engagement with PIASCY. 
V.A.3. A conducive school environment 
Schools are entrusted with ensuring that young people have a safe place to learn. This role 
becomes particularly important when implementing HIV prevention programmes or carrying 
out HIV/AIDS education. Schools across the continent have often not lived up to this 
expectation, however. The literature notes that schools are often highly sexualised sites in 
which school personnel take advantage of pupils (Humphreys, Undie, and Dunne 2008), 
increasing risks of HIV/AIDS and undermining the effectiveness of school-based HIV 
prevention programmes. However, the PIASCY evaluation provides evidence that creating 
safe school environments for primary school pupils was one of the achievements of the 
programme. Interviewees from all respondent categories spoke of how involvement with the 
PIASCY programme had empowered young people to resist advances from both school 
personnel and their peers. PIASCY provided mechanisms for addressing this behaviour, 
including talking with teachers, using the suggestion boxes, and joining a Safety Friends 
Network. Teachers themselves spoke of a deliberate change in their own behaviour as a result 
of exposure to PIASCY information. 
PIASCY Formative Evaluation 
37
V.A.4. Structures and incentives within the schools 
The study shows that some schools were more actively engaged in PIASCY activities than 
others. Teasing out the exact reasons for this variation is complex, but a number of 
commonalities emerged from schools that were more engaged. These schools invariably had 
set up structures (such as ―PIASCY committees,‖ ―committees of teachers,‖ and ―PIASCY 
clubs‖) whose role was to plan for periodic PIASCY activities, prepare timetables, and assign 
specific roles to teachers. Such structures were instrumental in ensuring the continuity of the 
programme, even in the event of the transfer of a PIASCY-trained teacher, since they diffuse 
knowledge of PIASCY across several personnel. 
Schools that had structures for ensuring the continuity of PIASCY had the advantage of 
creating incentives or benefits, which in turn served as motivating factors for teachers. For 
instance, such schools talked about how they had gained popularity in their communities as a 
result of their PIASCY activities. These activities (e.g., assemblies and national 
performances) helped to enhance the visibility and image of some schools in their 
communities, fostering pride amongst teachers that compelled them to continue their 
engagement with the programme. Such positive perceptions of the programme may explain 
why, although all schools talked about the dwindling funding for PIASCY or the complete 
lack thereof, some were purchasing their own PIASCY materials. It is also true that some 
schools were simply better resourced than others, and therefore may have been in a better 
position to purchase such materials. 
V.A.5. The role of monitoring and evaluation 
The role of monitoring and evaluation (M&E) with regard to school-based HIV-prevention 
programmes cannot be over-emphasised, as M&E not only helps ensure that programme
targets are being met, but also can help programme implementers make strategic decisions 
about improving the programme. In the case of PIASCY, study findings indicate that there is 
need to actively monitor and manage the knowledge cascade process. Apart from the 
Northern Region, in which school personnel were satisfied with the monitoring of their 
PIASCY activities, there was widespread concern across the regions (especially in the East 
and West) that there was no M&E of schools‘ PIASCY activities, with some respondents 
indicating that no follow-up of the programme had occurred in their schools since the 
programme‘s inception. Regular and consistent monitoring can ensure that diffusion of 
PIASCY training and knowledge among teachers occurs evenly across schools.
V.A.6. Funding issues 
Funding was a recurrent theme of the evaluation. Teachers across all regions voiced their 
expectations for some form of financial compensation for the extra time they spent 
integrating PIASCY into their regular classes or activities. At the same time, many 
respondents showed a lack of understanding with regard to funding of the programme. The 
first set of Model Schools under PIASCY received (school incentive) grants for the 
implementation of the programme. However, this practice was not continued as the number 
of Model Schools increased. A number of schools erroneously suspected that they were being 
short changed, thinking that some schools were still receiving grants while they were 
38
overlooked. This led to resentment and disenchantment among some teachers. In addition, 
several private schools stopped attending PIASCY training sessions when they were neither 
given transport refunds nor materials, unlike the public schools. This differential treatment 
between public and private schools was also noted in interviews with many public schools. 
Financial constraints can also hinder the effective implementation of school-based HIV￾prevention programmes, despite the best intentions of many African governments. In similar 
school-based programmes in the region, the necessary teaching materials are often not 
available (Gachuhi 1999). Likewise, the PIASCY programme experienced a shortage of 
PIASCY reading materials for pupils. Some teachers circumvented this issue, for instance, by 
reading the PIASCY materials aloud to the class, or registering them with the library so that 
each pupil would have an opportunity to check them out. It was not clear whether pupils were 
actually doing so, however. In other schools, there was a clear objective to preserve the 
PIASCY readers, as it was feared that pupils would either ruin or lose them. In these schools, 
the readers were therefore kept away from pupils in places such as locked cabinets or the 
headmaster‘s office. 
V.A.7. Integration within the school curriculum 
A major challenge for Ministries of Education that attempt to implement school-based HIV 
prevention programmes is the integration of such information into an already overloaded 
curriculum. There are arguments in the literature that teaching separate HIV/AIDS courses or 
lessons in schools has a better chance of impacting students than integrating HIV/AIDS 
information into pre-existing courses (Gachuhi 1999). However, the training that teachers 
received under PIASCY has clearly helped them with this task of integration, as they 
described many innovative ways in which they successfully incorporated PIASCY messages 
into both their curricula and other school activities/structures, such as assemblies and 
suggestion boxes. The fact that the majority of pupils were able to speak knowledgeably 
about HIV/AIDS is proof that this integration is working well. 
Nonetheless, a good number of teachers expressed the view that PIASCY ought to be an 
examinable subject in order to guarantee its long-term sustainability. There is also a need to 
ensure that all schools are aware of the approved and standardised PIASCY messages to be 
relayed to pupils. While condom use is not a focus of the PIASCY curriculum, FGDs with 
school personnel in the Eastern and Western Regions indicate that some teachers and 
administrative staff consider this topic as part of the PIASCY curriculum for upper primary 
school pupils, and sometimes for lower primary school pupils who were older and already 
sexually experienced. This finding is in contrast to the Northern Region, where teachers were 
consistent in saying that condom use by young people was strongly discouraged and therefore 
not taught at all. 
V.A.8. Political will
Political will is a final ingredient necessary for the effective implementation of school-based 
HIV prevention programmes. Uganda is well-known for its committed efforts toward 
combating the spread of HIV/AIDS, and PIASCY is one of several Presidential initiatives. 
The study findings suggest, however, that political will can be a double-edged sword. A few 
PIASCY Formative Evaluation 
39
teachers attributed PIASCY‘s achievements to its connection with Uganda‘s President, which 
was perceived as a motivator for some teachers to participate. Conversely, this connection 
was seen by others as a deterrent for would-be participants who were not proponents of the 
ruling political party. There were also fears that the close association of PIASCY with the 
President could actually be detrimental to the programme in the long-run, as it might be 
viewed as a purely political endeavour, regardless of the gains made. 
School-based HIV-prevention programmes are not a new phenomenon. In comparing the 
PIASCY programme to those discussed in the literature, it is evident that in some ways, 
PIASCY has experienced parallel challenges. On the other hand, PIASCY has in many ways 
overcome challenges enumerated in the literature — a testament to its strengths. PIASCY‘s 
teacher training component is particularly strong and has had a spill-over effect to teacher 
behaviour and the general school environment. 
40
VI. Recommendations and Conclusion 
Based on the results of this study, the evaluation team offers two sets of recommendations to 
enhance PIASCY programme delivery: for (1) schools and for (2) MOES, UNITY, and 
USAID. This division is made for organisational purposes; clearly it represents an artificial 
boundary, given that these entities are closely interconnected within the PIASCY programme. 
V1.A.1. Schools 
Recommendations at the school level include: 
1. Monitor the use of PIASCY readers (for schools that register them with the library) to 
determine how often and by whom the books are being checked. This will help assess 
whether putting books in the library results in maximum utilisation. 
2. Address the language barrier posed by PIASCY reading materials by having teachers 
read PIASCY texts aloud to pupils; creating forums for peer-to-peer reading, or for 
upper primary pupils to read to their lower primary counterparts; and by involving 
pupils more closely in the development of messages to be posted within the Talking 
Environments. Teachers can also explain and clarify some of the messages posted on 
Talking Environments to students during assembly. 
3. Establish a formal hand-over process for PIASCY-trained teachers who are being 
transferred to avoid gaps in institutional knowledge; the PIASCY committees can 
facilitate this process. 
VI.A.2. MOES, UNITY, and USAID
1. Continue to build the capacity of teachers to seamlessly mainstream PIASCY across 
the curriculum through periodic refresher training. The widespread opinion that 
PIASCY has increased teachers‘ workload points to the need to ensure teachers have 
the skills mainstream the curriculum in a way that does not overburden them. Periodic 
refresher courses for PIASCY-trained teachers will also help mitigate the censorship 
of PIASCY information during teaching and the delivery of inappropriate 
information. Alternatively, the Centre Coordinating Tutors‘ monitoring tool could 
also be redesigned to include the monitoring of PIASCY activities. 
2. Consider involving teachers well-versed in PIASCY in monitoring schools‘ progress 
with the programme, especially given that there are too many schools for the Centre 
Coordinating Tutors to properly handle this responsibility. Instead, monitoring can be 
conducted by school PIASCY committees. Alternatively, the Centre Coordinating 
Tutors‘ monitoring tool could also be redesigned to include the monitoring of 
PIASCY activities. 
3. Train more female guidance counsellors, as they are currently under-represented, and 
female pupils may feel more comfortable having specific issues addressed by 
guidance counsellors of the same sex. There is also need to incorporate HIV/AIDS 
counselling for both students and teachers that are infected with or affected by the 
disease. 
PIASCY Formative Evaluation 
41
4. Explore ways of directly targeting parents and community-members to maximise their 
involvement in the PIASCY programme. Trainings developed specifically for these 
target groups can be conducted with strategically-placed community leaders, for 
example, using the knowledge cascade approach. This responsibility can be given to 
school PIASCY committees. 
5. Explore ways to establish links between schools and health facilities to facilitate 
access to ARVs and counselling for pupils, school personnel, and community￾members living with HIV. Horizontal linkages with health workers and NGOs need to 
be established with schools because teachers may not have the skills to deal with 
certain issues. At the same time, NGOs have more resources, experience working 
with schools and communities, and have highly trained and skilled personnel in the 
field of HIV/AIDS. There may be a need to fully adopt a multi-sectoral approach and 
advocate for a school health policy that will define ways of dealing with HIV as a 
chronic epidemic within schools. This may also serve to strengthen the 
implementation of PIASCY within schools. 
6. Diversify current HIV-prevention PIASCY messages by taking into account pupils 
and school staff living with HIV. For example, PIASCY could teach about treatment, 
emphasising the importance of drug adherence as well as inform both teachers and 
pupils about where to get help and assistance if needed. 
7. There is a need to hold a meeting every two years to refocus the education sector 
strategy on HIV/AIDS. This will enable the Ministry of Education and Sports to 
evaluate its achievements and strengthen the coordination and implementation of 
PIASCY and other HIV/AIDS activities in schools. This could be turned into a 
regional meeting involving stakeholders and experts from other countries. This will 
help in generating new ideas to rejuvenate and refocus PIASCY. However, it is 
noteworthy that this strategy will also have budgetary implications. 
Given the structure of the PIASCY programme, the MOES has a particularly prominent role 
to play in building and monitoring the capacity of teachers, and in ensuring that key 
stakeholders, such as private schools and district authorities, are properly integrated into the 
programme. Thus, the activities that are recommended specifically for the MOES are as 
follows: 
1. Monitor the MOES policy to put books in the hands of children. Although this policy 
is intended to ensure that children have direct access to books, there is evidence that 
some schools are not adhering to it. Monitoring of the entire PIASCY programme by 
the Education Standards Agency may be most effective. 
2. Strengthen school structures such as ―PIASCY committees,‖ as they appear to be 
instrumental in the programme‘s continuity within schools. PIASCY committees 
could be given resources to sponsor activities they identify as necessary for proper 
implementation of PIASCY at their schools. They can also be involved in M&E of 
school-based programmes. Establishment of PIASCY committees could be mandatory 
for all schools. 
3. Develop an operational definition of ―guidance and counselling‖ for the purposes of 
PIASCY, and determine to what extent it should be student- versus teacher-driven. 
There is a need to help school administrators, teachers, and even pupils re-construct 
the notion of guidance and counselling to include pupil-driven, individual-level 
engagement that goes beyond mere didactic instruction. A uniform training guide 
should be developed or adopted, and the required duration of training should be 
specified for one to be certified as a guidance counsellor. 
42
4. Make concerted efforts to integrate private schools into the programme. Private 
schools should be brought on board as equal partners, not just as satellite schools to 
the Centres of Excellence/Model Schools. Holding deliberative meetings to explore 
ways of incorporating the Private Primary Teachers Colleges into PIASCY‘s 
organisational structure would also be useful. Integrating PIASCY into the private 
school curriculum could be made a requirement for licensing, and could be enforced 
through regular monitoring. PIASCY can also be integrated into policy through to 
university level. 
5. Make concerted efforts to integrate districts and DEOs into the programme by 
involving them in decision making as well as the implementation of the programme
and not just at the monitoring stage. 
6. Monitor the knowledge cascade process regularly and evenly across schools and 
provide feedback to schools on how they are performing. 
7. Tailor PIASCY instructions to the needs of older students within Free Primary 
Education schools, by focusing PIASCY instructions on both the grade and age of the 
pupil, so that older students in lower grades can be included. 
8. Include occasional studies to inform the programme implementation. 
9. Identify empirical evidence on behaviour change that is resulting from the PIASCY 
programme. This evidence could be generated by conducting school based behaviour 
change surveillance surveys to help PIASCY target and respond to arising issues and 
training needs. 
10. Conduct a countrywide study of adolescents that passed through the PIASCY 
programme to ascertain whether knowledge in formative years has a positive impact 
on behaviour later in life. Such a study will be valuable in designing future school￾based programmes and in improving PIASCY design, delivery, and content. 
In conclusion, this formative evaluation has highlighted both PIASCY‘s innovative 
approaches that should be continued during the expansion of the initiative, as well as the 
areas in need of improvement. In subsequent phases of PIASCY, it is important to keep in 
mind that even the best of school-based programme designs can only flourish with strong 
mechanisms for monitoring, evaluation, and feedback, followed by specific actions to address 
arising issues. Large-scale, multi-faceted programmes such as PIASCY are not without their 
challenges, yet education and HIV-prevention programmes continue to be the best options in 
the absence of a cure for HIV. 
PIASCY Formative Evaluation 
43
VII. References 
Cohen, J. 2008. ―A tale of two Presidential Initiatives,‖ Human Rights Watch. 
Retrieved December 29, 2008, (http:www.hrw.org).
_______. 2006. ―The less they know, the better: Abstinence-only education programs in 
Uganda,‖ Reproductive Health Matters 14(28): 174–178.
Gachuhi, D. 1999. ―The impact of HIV/AIDS on education systems in the Eastern and 
Southern Africa Region, and the response of education systems to HIV/AIDS: Life Skills 
Programmes,‖ prepared for UNICEF ESARO. Retrieved March 18, 2009 
(http://www.unicef.org/lifeskills/files/gachuhi.pdf).
Gallant, M. and E. Maticka-Tyndale. 2004. ―School-based HIV prevention programs for 
African youth,‖ Social Science & Medicine 58(7): 1337–1351. 
Government of Uganda. 2008. ―UNGASS country progress report, Uganda, January 2006–
December 2007.‖ Kampala: Government of Uganda. 
———. 2007. ―End of term PIASCY review meeting report.‖ Kampala: Government of 
Uganda. 
———. 2003. ―Implementing the Presidential Initiative on the AIDS Strategy for 
Communication to Youth: Enhancing HIV awareness and dialogue among youth leadership 
in Uganda. Summary of the proposal.‖ Kampala: Government of Uganda. 
Griffiths, J. 2005. ―HIV/AIDS intervention programs for youth in Africa: The role of 
grassroot soccer,‖ unpublished M.A. thesis. Department of International Comparative 
Education, School of Education. Stanford University. Retrieved March 5, 2009, 
(http://www.grassrootsoccer.org/docs/griffith_standford.pdf).
Humphreys, S., C. Undie, and M. Dunne. 2008. ―Gender, sexuality and development: Key 
issues in education and society in sub-Saharan Africa,‖ in Mairead Dunne (ed). Gender, 
Sexuality and Development: Education and Society in Sub-Saharan Africa, 7–38. Rotterdam: 
Sense Publishers. 
Ibale, A.M. 2007. Do „Talking Environments‟ talk? Experience from Uganda‟s primary
schools. Unpublished UPHOLD manuscript. 
Ibale, A.M. and M. Nakibirige. 2004. ―End of tour report.‖ USAID-UPHOLD. 
Kibenge, A. 2009. ―Overview of PIASCY,‖ presented at Commonwealth Conference of 
Education Ministers, Kuala Lumpur Malaysia, June.
Miles, M.B. and A. M. Huberman. 1994. Qualitative Data Analysis: An Expanded 
Sourcebook. Sage: Thousand Oaks, CA. 
Ministry of Education and Sports. 2008. PIASCY Primary UPHOLD Supported Activities: 
Status and Achievements. Kampala: Government of Uganda. 
44
Office of the President. 2004. ―President‘s Program for Enhancing HIV/AIDS Dialogue 
among Youth Leadership,‖ Summary Progress Report. Kampala: Government of Uganda. 
__________________. 2003. ―Implementing the Presidential Initiative on the AIDS Strategy 
for Communication to Youth: Enhancing HIV/AIDS awareness and dialogue among youth 
leadership in Uganda—Summary of the Proposal.” Kampala: Government of Uganda. 
Patton, M. Q. 2002. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: 
Sage. 
UNAIDS. 2006a. ―AIDS epidemic update.‖ Retrieved December 30, 2008, 
(http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2006/defa
ult.asp). 
———. 2006b. ―Linking EDUCAIDS with other ongoing initiatives: An overview of 
opportunities, an assessment of challenges.‖ Retrieved May 4, 2009, 
(http://unesdoc.unesco.org/images/0014/001479/147916E.pdf).
UNESCO. 2005. ―UNESCO‘s response to HIV and AIDS.‖ Retrieved May 4, 2009, 
(http://unesdoc.unesco.org/images/0014/001414/141417e.pdf). 
UPHOLD. 2006. ―Quarterly report, April to June 2006.‖ Kampala: Government of Uganda. 
World Bank. 2002. Education & HIV/AIDS: A Window of Hope. Washington, D.C.: World 
Bank.
PIASCY Formative Evaluation 
45
VIII. Annexes 
Annex 1: Respondent Categories and Sample Size 
Respondent Category No. of FGDs per site Total No. of 
FGDs
No. of 
respondents per 
FGD
Sample 
size
Pupils 2 FGDs x 80 schools 160 FGDs 160 FGDs x 6 
pupils
960 
pupils
Teachers 1 FGD x 80 schools 80 FGDs 80 FGDs x 4 
teachers
320 
teachers
Parents 1 FGD x 10
communities
10 FGDs 10 FGDs x 8 
parents
80 
parents
250 FGDs in 
total
Total no. of FGD 
respondents = 1,360
Key Informant Category No. of Key Informants
Headmasters 8
Core Primary Teachers College representative 6
Coordinating Centre Tutors 6
Ministry of Education representative 3
UNITY representative 1
Total number of Key Informants = 24
46
Annex 2: Study Instruments 
Guide for Focus Group Discussions with Pupils 
PIASCY Project 
African Population and Health Research Center 
Introduction
Thank you so much for your willingness to take part in this group discussion. My name is 
[Name] and I work with [Institution]. We would like to have a group discussion with you 
based on the PIASCY program that is being implemented in your school. 
We‘re interested in learning about what goes on in the PIASCY program and how the 
PIASCY program activities have affected things at your school. Many times, people from 
outside think they know what students are experiencing when they really don‘t. To us, you
are the real experts, and there‘s a lot we can learn from you. So today I‘d like to ask you a 
few questions about your experiences with PIASCY as students of this school. This is very 
informal; you can talk about anything you think is important for us to know. We hope this 
discussion will help us better understand what you‘ve experienced and how the program has 
functioned so that the great things about the program can continue, and so that any other 
aspects of the program can be improved in the future, if necessary. 
Please note that this is a general discussion which should not involve the sharing of personal, 
private information. I also want to remind you that everything we talk about today is 
confidential. We will be taking down notes as we discuss, but no one will see our notes 
except for people working on the project. Whenever we write a report, we will use numbers 
rather than names in the report so no one can identify you. If there are any questions you‘d 
rather not answer, just let me know—that‘s fine. 
 Explain the role of note-takers 
 Give a few minutes for answering any questions regarding the interview
 Provide ground rules for the discussion
Finally, I would like to point out that your frank responses and discussion will be most 
helpful to us as we try to really understand the PIASCY program. Remember, your answers 
to our questions will not be considered ―right‖ or ―wrong.‖ They are merely information you 
will provide based on your experiences, observations, or feelings. 
Before we begin, let‘s go round the room and introduce ourselves. You could just tell 
everyone your name and how long you‘ve been at this school. 
PIASCY Formative Evaluation 
47
Perceptions of PIASCY’s Impact
1. Let‘s start by hearing from you what the PIASCY program is all about. Kindly 
describe to me what the PIASCY involves. 
What are some of the key things you have learnt through the PIASCY 
program? 
What did you not know about HIV/AIDS until the PIASCY program started? 
2. Let‘s imagine that today I‘ll be sitting in during one of your PIASCY activities (it 
could be a class, club meeting, assembly, etc). Tell me what I would observe during 
the PIASCY activity. [Let respondents choose two PIASCY activities to talk about 
in this section]
How would you describe the way in which students and teachers typically 
relate to one another during the PIASCY activity? Kindly elaborate. 
How free would you say students feel to ask questions or contribute their 
views during these activities [do you feel they ask any question you want, or 
do you feel they limit themselves to certain kinds of questions]? 
What is the typical content of the HIV-related messages that are disseminated 
during activities such as school assemblies? 
Do students discuss things they learned during PIASCY activities with 
teachers or parents outside the PIASCY context? If so, how often would you 
say this occurs, and what kinds of things are discussed? If not, why not? 
3. HIV info is disseminated in different ways in your school (e.g., assemblies, posters, 
clubs, readings, talking environments, etc.). In your opinion, which means has made 
the strongest impact on students? Kindly elaborate. 
Which means has made the least impact on students? Kindly elaborate. 
4. What would you say students at your school have gotten out of participating in 
PIASCY? 
What changes do you see in your fellow students as a result of the PIASCY 
program? 
What are some of the things students have learned through the PIASCY 
program that have carried over to their lives (i.e., influenced your lives)? 
Kindly elaborate. 
What plans have students made, if any, to change anything or do anything 
differently as a result of the PIASCY program? 
How have your fellow students‘ thoughts/behaviour in regard to abstinence 
changed, if at all, since the PIASCY program started? 
What about your fellow students‘ thoughts on having unprotected sex—how 
have they changed, if at all, since PIASCY? 
5. As a result of the PIASCY program, how have the feelings of students in this school 
about HIV changed, if at all? Kindly give an example of what you mean. 
48
How have students in this school come to understand HIV differently, if at all? 
How have students in this school come to understand sexual behaviour 
differently, if at all? 
6. As a result of the PIASCY program, how have the feelings of students in this school 
changed in regard to people living with HIV, if at all? Kindly give an example of 
what you mean. 
To what extent would you say your school is a nice place to be for people that 
are HIV positive? 
What role do students play in the lives of those in your school that are HIV+? 
What role do students play in the lives of others in your community that are 
HIV+? 
How is this role different from the role students played before PIASCY was 
introduced at your school, if at all? 
Reasons behind PIASCY’s Impact
7. So far, you‘ve provided a lot of useful information about how PIASCY has impacted 
the students in this school, and your school at large. Now, what is it about PIASCY 
that makes it have the effect it has? 
What happens within the PIASCY program that makes a difference? 
What do students see as the important parts of PIASCY that make the program 
what it is? 
What has been the high point of the program for most students? Kindly 
elaborate. 
What has the low point been? Kindly elaborate. 
Likes & Dislikes about PIASCY
8. Let us turn now to people‘s general likes and dislikes about the program. What are 
some of the things that students really like about the program? 
What are some of the things people don‘t like so much about the program? 
How can these things be improved upon—what would you like to see happen 
instead? 
Recommendations
9. Okay, you‘ve given us a lot of information about your experiences in the program, 
and some of the things you‘ve liked and haven‘t liked so much. Now I‘d like to ask 
you about your recommendations for the program. If you had the power to change 
things about the program, what would you change or do differently? What would you 
focus on first? 
PIASCY Formative Evaluation 
49
10. Suppose you were asked by a government agency for your honest opinion on whether 
or not they should sponsor a program like PIASCY. What would you say? 
What arguments would you give to support your opinion? 
Closing
That covers the things I wanted to ask. Is there anything you care to add? 
Thank you so much for you time. I‘ve really learned a lot from you today and I really 
appreciate your insights. 
50
Guide for Focus Group Discussions with Teachers 
PIASCY Project 
African Population and Health Research Center 
Introduction
Thank you so much for your willingness to take part in this group discussion. My name is 
[Name] and I work with [Institution]. We would like to have a group discussion with you 
based on the PIASCY program that is being implemented in your school. 
We‘re interested in learning about what goes on in the PIASCY program and how PIASCY 
program activities have affected things at your school. Today I‘d like to ask you a few 
questions about your experiences with PIASCY as teachers at this school. This is very 
informal; you can talk about anything you think is important for us to know. We hope this 
discussion will help us better understand what you‘ve experienced and how the program has 
functioned so that the great things about the program can continue, and so that any other 
aspects of the program can be improved in the future, if necessary. 
I also want to remind you that everything we talk about today is confidential. We will be 
taking down notes as we discuss, but no one will see our notes except for people working on 
the project. Whenever we write a report, we will use numbers rather than names in the report 
so no one can identify you. If there are any questions you‘d rather not answer, just let me 
know—that‘s fine. 
 Explain the role of note-takers 
 Give a few minutes for answering any questions regarding the interview
 Provide ground rules for the discussion
Finally, I would like to point out that your frank responses and discussion will be most 
helpful to us as we try to really understand the PIASCY program. Remember, your answers 
to our questions will not be considered ―right‖ or ―wrong.‖ They are merely information you 
will provide based on your experiences, observations, or feelings. 
Before we begin, let‘s go round the room and introduce ourselves. You could just tell 
everyone your name, how long you‘ve been at this school, and what your role in the PIASCY 
program at this school has been so far. 
Perceptions of PIASCY’s Impact
1. Let‘s start by hearing from you what PIASCY is all about. What is the PIASCY 
program about, and how does it feature in your lives as teachers and in the lives of 
students at your school? 
2. Now, I would like to ask you to kindly walk me through the way the PIASCY 
program works, step-by-step. When you receive the PIASCY materials, for instance, 
what happens next? 
PIASCY Formative Evaluation 
51
To what extent are the materials being translated and adapted into action? 
What are the barriers to this happening, if any? 
What happens next (i.e., after materials are received)—how exactly does the 
program work at your school? 
3. To what extent has the PIASCY program been what you expected it to be? 
In what ways has it met your expectations so far? 
In what ways has it been different from what you expected? 
To what extent did the things you were concerned about before the PIASCY 
program come true? 
o Which things came true? 
o Which didn‘t come true? 
4. How would you describe your skills and knowledge in relation to HIV/AIDS before
you got involved with the PIASCY program? Kindly elaborate. 
How would you describe your skills and knowledge in relation to HIV/AIDS 
after your PIASCY orientation and beyond? Kindly elaborate. 
5. Let‘s imagine that today I‘ll be sitting in during one of your PIASCY activities (it 
could be a class, club meeting, assembly, etc). Tell me what I would observe during 
the PIASCY activity. [Let respondents choose two PIASCY activities to talk about 
in this section]
How would you describe the way in which the students and teachers typically 
relate to one another during the PIASCY activity? Kindly elaborate. 
How free would you say students feel to ask questions or contribute their 
views during these activities [do you feel they ask any question they want, or 
do you feel they limit themselves to certain kinds of questions]? 
What is the typical content of the HIV-related messages that are disseminated 
during activities such as school assemblies? 
Do you discuss things you taught during PIASCY activities with students 
outside the PIASCY context? If so, how often would you say this occurs, and 
what kinds of things are discussed? 
6. Which particular topics, if any, do the students feel less comfortable discussing/being 
taught during PIASCY activities, and why do you think this is the case? What about 
you as teachers—which topics, if any, do teachers typically feel uncomfortable 
teaching/discussing, and why do you think this is the case? 
How are these topics dealt with, given the discomfort you mention on the part 
of students/teachers? 
What do you think could have been done in advance to help ensure students 
and teachers feel comfortable addressing these kinds of topics? 
52
7. HIV info is disseminated in different ways in the school (e.g., assemblies, posters, 
clubs, readings, talking environments, etc.). In your opinion, which means has made 
the strongest impact on students and staff? Kindly elaborate. 
Which means has made the least impact on you? Kindly elaborate. 
8. What would you say you, as teachers, have gotten out of participating in PIASCY? 
What changes do you see in yourselves/others at this school as a result of the 
PIASCY program? 
What are some of the things you have learned through PIASCY that have 
carried over to your lives (i.e., influenced your lives)? Kindly elaborate. 
What plans have you made, if any, to change anything or do anything 
differently as a result of the PIASCY program? 
What are some of the things students have learned through PIASCY that they 
have carried over to their lives? Kindly elaborate. 
How have students‘ thoughts/behaviour in regard to abstinence changed, if at 
all, since the PIASCY program began? 
What about students‘ thoughts on having unprotected sex—how have they 
changed, if at all, since PIASCY? 
9. As a result of your experience with the PIASCY program, how have your feelings 
about HIV changed, if at all? Kindly give an example of what you mean. 
How have you/other staff at this school come to understand HIV differently, if 
at all? 
How have you/other staff at this school come to understand sexual behaviour 
differently, if at all? 
10. As a result of your experience with the PIASCY program, how have your feelings/the 
feelings of students in this school changed in regard to people living with HIV? 
Kindly give an example of what you mean. 
To what extent would you say your school is a stigma-free environment when 
it comes to HIV? 
What role do you/other students play in the lives of students in your school 
that are HIV+? 
What role do you/other students play in the lives of others in your community 
that are HIV+? 
How is this role different from the role you/other students played before 
PIASCY was introduced at your school? 
Reasons behind PIASCY’s Impact
11. So far, you‘ve provided a lot of useful information about how PIASCY has impacted 
teachers, students, and your school at large. Now, what is it about PIASCY that makes 
it have the effect it has? 
What happens within the program that makes a difference? 
PIASCY Formative Evaluation 
53
What do you see as the important parts of PIASCY that make the program 
what it is? 
What has been the high point/best part of the program for you as teachers? 
Kindly elaborate. 
What has the low point/worst part been? Kindly elaborate. 
Unintended Consequences of PIASCY
12. I‘d like to ask you to think over the PIASCY program and any implications that 
running it at your school has had for the ways things usually operate here. Has 
running the PIASCY program brought up any issues at your school that you didn‘t 
expect? If yes, kindly tell me more about that. 
Let‘s start with any issues it may have brought up. What are the positive 
issues, if any? 
How have they affected the way you used to do things at the school? 
What are the negative issues, if any? 
How have they affected the way you used to do things at the school? 
PIASCY Design, Organizational Structure, & Roll-out
13. I would now like you to reflect on how the PIASCY program is designed. 
How well or effectively would you say the program design has worked so far? 
Kindly elaborate. 
What would you say are the strengths of the program? 
What would you say are the weaknesses of the program, and how can they be 
modified/improved? 
What would you say are the strengths of the program‘s organizational 
structure? 
What would you say are the weaknesses of the program‘s organizational 
structure, and how can they be modified/improved? 
14. I would like to ask you to reflect on the design of the roll-out of the PIASCY program 
in Uganda. How well or effectively would you say the design is working? Kindly 
elaborate. 
How were the private schools integrated into the roll-out? To what extent was 
this process effective? 
What would you say are the strengths of the roll-out design? 
What would you say are the weaknesses of the roll-out design and how can 
they be modified/improved? 
54
Recommendations
15. Okay, you‘ve given us a lot of information about your experiences in the program, 
and your impressions of how things are running. Now I‘d like to ask you about your 
recommendations for the program. If you had the power to change things about the 
program, what would you change or do differently? What would you focus on first? 
16. Suppose you were asked by a government agency for your honest opinion on whether 
or not they should sponsor a program like PIASCY. What would you say? 
What arguments would you give to support your opinion? 
Closing
That covers the things I wanted to ask. Is there anything you care to add? 
Thank you so much for you time. I‘ve really learned a lot from you today and I really 
appreciate your insights. 
PIASCY Formative Evaluation 
55
Guide for Focus Group Discussions with Parents/Community Members 
PIASCY Project 
African Population and Health Research Center 
Introduction
Thank you so much for your willingness to take part in this group discussion. My name is 
[Name] and I work with [Institution]. We would like to have a group discussion with you 
based on the PIASCY program that is being implemented in your child‘s school/the school 
you are involved in. 
We‘re interested in learning about what goes on in the PIASCY program and how the 
PIASCY program activities have affected things at the school. Today I‘d like to ask you a 
few questions about your experiences with PIASCY as parents/community members involved 
in this school. This is very informal; you can talk about anything you think is important for us 
to know. We hope this discussion will help us better understand what you‘ve experienced and 
how the program has functioned so that the great things about the program can continue, and 
so that any other aspects of the program can be improved in the future, if necessary. 
I also want to remind you that everything we talk about today is confidential. We will be 
taking down notes as we discuss, but no one will see our notes except for people working on 
the project. Whenever we write a report, we will use numbers rather than names in the report 
so no one can identify you. If there are any questions you‘d rather not answer, just let me 
know—that‘s fine. 
 Explain the role of note-takers 
 Give a few minutes for answering any questions regarding the interview
 Provide ground rules for the discussion
Finally, I would like to point out that your frank responses and discussion will be most 
helpful to us as we try to really understand the PIASCY program. Remember, your answers 
to our questions will not be considered ―right‖ or ―wrong.‖ They are merely information you 
will provide based on your experiences, observations, or feelings. 
Before we begin, let‘s go round the room and introduce ourselves. You could just tell 
everyone your name and how long you‘ve been involved with this school. 
Perceptions of PIASCY’s Impact
1. Let‘s start by hearing from you what the PIASCY program is all about. Kindly 
describe to me what the PIASCY involves. 
What are some of the key things you have learnt through the PIASCY 
program? 
What did you not know about HIV/AIDS until the PIASCY program started? 
56
2. Let‘s imagine that today I‘ll be sitting in during one of your PIASCY activities (it 
could be a school assembly, school open days, talking environments etc). Tell me 
what I would observe during the PIASCY activity. [Let respondents choose two 
PIASCY activities to talk about in this section]
How would you describe the way in which students and teachers typically 
relate to one another during the PIASCY activity? Kindly elaborate. 
How would you describe the way in which you and students typically relate to 
one another during the PIASCY activity? Kindly elaborate. 
How free would you say students feel to ask questions or contribute their 
views during these activities [do you feel they ask any question they want, or 
do you feel they limit themselves to certain kinds of questions]? 
What is the typical content of the HIV-related messages that are disseminated 
during activities such as school assemblies? 
Do students discuss things they learned during PIASCY activities with you 
outside the PIASCY context? If so, how often would you say this occurs, and 
what kinds of things are discussed? 
3. HIV info is disseminated in different ways in the school you‘re involved with (e.g., 
assemblies, posters, clubs, readings, talking environments, etc.). In your opinion, 
which means has made the strongest impact on students? Kindly elaborate. 
Which means has made the least impact on students? Kindly elaborate. 
4. What would you say students at the school have gotten out of participating in 
PIASCY? 
What changes, if any, have you observed in the community as a result of the 
PIASCY program? What about changes in yourselves? 
What are some of the things students have learned through the PIASCY 
program that have carried over to their lives (i.e., influenced your lives)? 
Kindly elaborate. What about yourselves? 
What plans have you made, if any, to change anything or do anything 
differently as a result of the PIASCY program? 
5. As a result of the PIASCY program, how have the feelings of community members 
about HIV changed, if at all? Kindly give an example of what you mean. 
How have community-members come to understand HIV differently, if at all? 
How have community-members come to understand sexual behaviour 
differently, if at all? 
6. As a result of the PIASCY program, how have the feelings of people in this 
community changed in regard to people living with HIV, if at all? Kindly give an 
example of what you mean. 
To what extent would you say this school is a nice place to be for people that 
are HIV positive? What about this community? 
PIASCY Formative Evaluation 
57
What role do students play in the lives of others in your community that are 
HIV+? 
How is this role different from the role students played before PIASCY was 
introduced in this school, if at all? 
Reasons behind PIASCY’s Impact
7. So far, you‘ve provided a lot of useful information about how PIASCY has impacted 
the school and the community. Now, what is it about PIASCY that makes it have the 
effect it has? 
What happens within the PIASCY program that makes a difference? 
What do you see as the important parts of PIASCY that make the program 
what it is? 
What has been the high point of the program for you? Kindly elaborate. 
What has the low point been? Kindly elaborate. 
Likes & Dislikes about PIASCY
8. Let us turn now to your general likes and dislikes about the program. What are some 
of the things that you, as parents/community members, really like about the program? 
What are some of the things that you don‘t like so much about the program? 
How can these things be improved upon—what would you like to see happen 
instead? 
Recommendations
9. Okay, you‘ve given us a lot of information about your experiences in the program, 
and some of the things you‘ve liked and haven‘t liked so much. Now I‘d like to ask 
you about your recommendations for the program. If you had the power to change 
things about the program, what would you change or do differently? What would you 
focus on first? 
10. Suppose you were asked by a government agency for your honest opinion on whether 
or not they should sponsor a program like PIASCY. What would you say? 
What arguments would you give to support your opinion? 
Closing
That covers the things I wanted to ask. Is there anything you care to add? 
Thank you so much for you time. I‘ve really learned a lot from you today and I really 
appreciate your insights. 
58
Guide for In-depth Interviews with Ministry of Education and Sports (MOES), Uganda 
PIASCY Project 
African Population and Health Research Center 
Introduction
Thank you so much for meeting with me today. My name is [Name] and I work with [Name 
of Institution]. We would like to conduct an interview with you based on the PIASCY 
program that is being implemented in primary schools in Uganda by the Ministry of 
Education and Sports in partnership with other organizations. 
We‘ve requested an interview with you because we believe that in your position as a 
[Position/Job Title] in [Name of Institution], we can learn a lot from you about the 
PIASCY program, how your institution/office has engaged with it, and the kinds of issues 
your institution/office and the other organizations involved may be dealing with. We hope 
this interview will help us better understand what your institution has experienced and how 
the program has functioned so that the great things about the program can continue, and so 
that any other aspects of the program can be improved in the future, if necessary. 
Is there anything you‘d like to ask me at this point? [Answer any questions regarding the 
interview]. 
Overview of PIASCY & MOES’s Involvement 
1. Perhaps we can start by getting an idea of your understanding of the PIASCY 
program. What is your understanding of the PIASCY program and what it was 
designed to achieve? 
What is your assessment of how well the PIASCY program is achieving its 
objectives? 
What are some of the factors that have helped the program achieve its 
objectives? 
What have the barriers been to the program achieving its objectives, in your 
opinion? 
How can these barriers be addressed? 
2. Some of the things that the PIASCY program hoped to do were to: 1) increase the 
capacity of key providers (BEPS and UPHOLD) to deliver learning resources and 
materials to train teachers and students, 2) increase the number of trained (PIASCY) 
teachers, and 3) increase the number of schools involved in the PIASCY program in 
all the regions. To what extent would you say this has been achieved? [Let‘s begin 
with the first one] 
What are some of the factors that have helped the program achieve this 
objective? 
What have the barriers been to achieving this objective? 
How can these barriers be addressed? 
[Repeat questions for all 3 objectives above] 
PIASCY Formative Evaluation 
59
3. What has been the nature of MOES‘s engagement with PIASCY schools over the 
years? 
Whom within the schools does the MOES engage with, how, and how often? 
In addition to the orientation provided to school teachers by the MOES, are 
there ways in which the MOES has followed-up with teachers/schools to see 
the PIASCY program is working? Kindly elaborate. 
What, in your opinion, have been the commendable things about the MOES‘s 
engagement with schools? 
What areas in the MOES‘s engagement with schools could have been 
improved, and how? 
Based on the MOES‘s engagement with schools, what do you see as the areas 
of strength that the schools bring to the PIASCY program? 
What are the areas of weakness that schools need to improve upon in regard to 
the PIASCY program? 
Reasons behind PIASCY’s Impact
4. What would you say that school teachers have gotten out of participating in the 
PIASCY program? 
What changes have you been able to observe in teachers as a result of the 
PIASCY program? 
What are some of the things school teachers have learned through the PIASCY 
program that have carried over to their lives (i.e., influenced your lives)? 
Kindly elaborate. 
What plans, if any, have you observed school teachers make to change 
anything or do anything differently as a result of the PIASCY program? 
What is it about the PIASCY program that makes it have the effect it has? 
What do school teachers see as the important parts of PIASCY that make the 
program what it is? 
Unintended Consequences of PIASCY
5. I‘d like to ask you to think over the PIASCY program and any implications that 
implementing it has had for the ways things usually operate here at the MOES. Has 
implementing the PIASCY program in the country brought up any issues at the 
MOES that you didn‘t expect? If yes, kindly tell me more about that. 
Let‘s start with any positive issues it may have brought up. What are the 
positive issues, if any? 
How have they affected things at your institution? 
What are the negative issues, if any? 
How have they affected things at your institution? 
PIASCY Design, Organizational Structure, & Roll-out
6. I would now like you to reflect on how the PIASCY program is designed. 
60
How well or effectively would you say the program design has worked so far? 
Kindly elaborate. 
What would you say are the strengths of the program? 
What would you say are the weaknesses of the program? 
What would you say are the strengths of the program‘s organizational 
structure? 
What would you say are the weaknesses of the program‘s organizational 
structure, and how can they be modified/improved? 
7. I would like to ask you to reflect on the design of the roll-out of the PIASCY program 
in Uganda. How well or effectively would you say the design has worked? Kindly 
elaborate. 
How were the private schools integrated into the roll-out? To what extent was 
this process effective? 
What would you say are the strengths of the roll-out design? 
What would you say are the weaknesses of the roll-out design and how can 
they be modified/improved? 
Recommendations
8. Okay, you‘ve given us a lot of valuable information about the program from your 
perspective as someone within the MOES. Now I‘d like to ask you about your 
recommendations for the program. If you had the power to change things about the 
program, what would you change or do differently? What would you focus on first? 
9. Suppose you were asked by a donor for your honest opinion on whether or not they 
should sponsor a program like PIASCY. What would you say? 
What arguments would you give to support your opinion? 
10. Finally, as you are aware, the Uganda Program for Human and Holistic Development 
(UPHOLD) took over support to roll out and implement PIASCY, and now, 
UPHOLD will be handing over its PIASCY activities to the Ugandan Initiative for 
TDMS and PIASCY (UNITY). Given the MOES‘s experience as the first 
implementer of PIASCY, what are some of the sustainability issues that will need to 
be addressed in handing over the program from one establishment to another? 
Closing
That covers the things I wanted to ask. Is there anything you care to add? 
Thank you so much for you time. I‘ve really learned a lot from you today and I really 
appreciate your insights. 
PIASCY Formative Evaluation 
61
Guide for In-depth Interviews with Funders 
PIASCY Project 
African Population and Health Research Center 
Introduction
Thank you so much for meeting with me today. My name is [Name] and I work with [Name 
of Institution]. We would like to conduct an interview with you based on the PIASCY 
program that is being implemented in primary schools in Uganda by the Ministry of 
Education and Sports in partnership with other organizations. 
We‘ve requested an interview with you because we believe that, given your affiliation with a 
donor institution that has helped to fund PIASCY, we can learn a lot from you about the 
initiative, how your institution has engaged with it, and the kinds of issues your institution 
and the other organizations involved may be dealing with. We hope this interview will help 
us better understand your institution‘s impressions of how the program has functioned so that 
the great things about the program can continue, and so that any other aspects of the program 
can be improved in the future, if necessary. 
Is there anything you‘d like to ask me at this point? [Answer any questions regarding the 
interview]. 
Overview of PIASCY & Funder’s Involvement 
1. Perhaps we can start by getting an idea of your understanding of the PIASCY 
program. What is your understanding of the PIASCY program and what it was 
designed to achieve? 
2. What has been the nature of your institution‘s engagement with the PIASCY program 
over the years? 
Whom within has your institution engaged with, and how? 
In addition to what you‘ve described, are there ways in which your institution 
has followed-up with those implementing the program to see PIASCY is 
working? Kindly elaborate. 
Based on the MOES‘s engagement with schools, what do you see as the areas 
of strength that the schools bring to the PIASCY program? 
What are the areas of weakness that schools need to improve upon in regard to 
the PIASCY program? 
3. To what extent has the PIASCY program so far been what you expected it to be? 
In what ways has it met your expectations so far? 
In what ways has it been different from what you expected? 
62
To what extent did the things you were concerned about before the PIASCY 
program come true? 
o Which things came true? 
o Which didn‘t come true? 
4. Some of the things that the PIASCY program hoped to do were to: 1) increase the 
capacity of key providers (BEPS and UPHOLD) to deliver learning resources and 
materials to train teachers and students, 2) increase the number of trained (PIASCY) 
teachers, and 3) increase the number of schools involved in the PIASCY program in 
all the regions. To what extent would you say this has been achieved? [Let‘s begin 
with the first one] 
What do you feel are some of the factors that have helped the program achieve 
this objective? 
What do you feel the barriers have been to achieving this objective? 
How can these barriers be addressed? 
[Repeat questions for all 3 objectives above] 
Reasons behind PIASCY’s Impact
5. What would you say that PIASCY beneficiaries (teachers, pupils, parents, 
community-members, etc.) have gotten out of participating in the PIASCY program? 
In your opinion, what is it about the PIASCY program that makes it have the 
effect it has? Kindly elaborate. 
PIASCY Design, Organizational Structure, & Roll-out
6. I would now like you to reflect on how the PIASCY program is designed. 
How well or effectively would you say the program design has worked so far? 
Kindly elaborate. 
What would you say are the strengths of the program? 
What would you say are the weaknesses of the program? 
What would you say are the strengths of the program‘s organizational 
structure? 
What would you say are the weaknesses of the program‘s organizational 
structure, and how can they be modified/improved? 
7. I would like to ask you to reflect on the design of the roll-out of the PIASCY program 
in Uganda. How well or effectively would you say the design has worked? Kindly 
elaborate. 
What would you say are the strengths of the roll-out design? 
What would you say are the weaknesses of the roll-out design and how can 
they be modified/improved? 
PIASCY Formative Evaluation 
63
Recommendations
8. Okay, you‘ve given us a lot of valuable information about the program from your 
perspective as a funder. Now I‘d like to ask you about your recommendations for the 
program. If you had the power to change things about the program, what would you 
change or do differently? What would you focus on first? 
9. Suppose you were asked by another donor for your honest opinion on whether or not 
they should chip in and help sponsor a program like PIASCY. What would you say? 
What arguments would you give to support your opinion? 
10. Finally, as you are aware, the Uganda Program for Human and Holistic Development 
(UPHOLD) took over support to roll out and implement PIASCY, and now, 
UPHOLD will be handing over its PIASCY activities to the Ugandan Initiative for 
TDMS and PIASCY (UNITY). Given the your experience as a funder of PIASCY, 
what are some of the sustainability issues that will need to be addressed in handing 
over the program from one establishment to another? 
Closing
That covers the things I wanted to ask. Is there anything you care to add? 
Thank you so much for you time. I‘ve really learned a lot from you today and I really 
appreciate your insights. 
64
Contact Summary Form: Illustration
CONTACT SUMMARY
SITE: Boma Primary School (rural)
WRITTEN BY: MM
TODAY‘s DATE: 1/20/09
Type of contact: FGD with Teachers Library 1/20/09
 Who, what group place contact date
Instructions: Pick out the most salient points in the contact. Number in order on this sheet. Attach relevant study 
question or theme to each point in CAPITALS. Invent themes where no existing ones apply and asterisk these. 
Comment may also be included in double parentheses.
SALIENT POINTS STUDY QUESTIONS/THEMES
1. Students not able to comprehend many PIASCY MEETING ITS OBJECTIVES [‗increased
 technical terms in the English PIASCY capacity to deliver learning resources‘]. (Maybe
 manual, so teachers have developed a this is also an ‗unintended consequence‘??)
 manual in the local language to
 complement the official manual.
2. Teachers are generally enthusiastic about *RESISTANCE
 teaching upper primary classes, but vary
 in their willingness to introduce PIASCY 
 concepts to lower primary students
 lower primary school students.
3. One teacher says, ‗Now that we have to UNINTENDED CONSEQUENCES
 meet our PIASCY obligations, we have
 done away with the P.E. program at school.
 There‘s no time for it.‘ (All others agreed.)
4. PIASCY orientation was fondly remem- STRENGTHS OF PIASCY PROGRAM
 bered; gave teachers lots of confidence,
 which has positively affected how they
 teach their other subjects.
5. Would really like to have refresher trainings RECOMMENDATIONS
 and to have new teachers with potential to 
 undergo PIASCY orientation, as teachers 
 get transferred often.
PIASCY Formative Evaluation 
65
Rapid Appraisal Tool
_____Talking Environments
Notes: What messages are posted and the location of messages (e.g. toilet block, water tank, gate etc is it a place that students can 
easily access)
_____Assembly and what happens during the Assembly
Notes: (if there is an assembly at the time of visit please observe and note down what happens)
_____Material/Readers
Notes: (which ones do they have and who is using them. Have they been issued to student or are locked up if locked up give 
reason why. Are they enough for students and teachers)
_____Guidance and Counseling
Notes: (Do they have the files. How are they used. Please check for content of files to determine what guidance and counseling 
occurs, e.g. group counseling/individual counseling. Do they have a counseling room, how often is it used)
_____Suggestion Box files, issues and how they are handled
Notes: (Do they have the suggestion box files. Get a sample of messages and write down their content. How are issues handled 
and recorded)
_____Clubs
Notes: (Names of Clubs, Activities, Who is involved, play titles, debates topics etc. Have they participated in the Music Dance 
and Drama festival)
_____Safety Friends and Networks
Note: (Do they have safety friends and networks at the school. Are all the children in the SFN or particular children)
USAID 
FROM THE AMERICAN PEOPLE