The AFFORD Health Marketing 
Initiative in Uganda: 
Mid-term Evaluation

The AFFORD Health Marketing 
Initiative in Uganda: 
Mid-term Evaluation 
Oleksandr Rohozynsky 
Christie Billingsley 
Annette Bongiovanni 
The QED Group, LLC 
ii 
Acknowledgements 
The evaluation team acknowledges the open and willing participation of the staff of AFFORD and its partners, 
as well as the Uganda Health Marketing Group. We appreciate the efforts of the Ugandan evaluation team 
members: Paul Bukuluki, Ronard Mukuye, Margaret Banga, Ddumba Nianzy, and all the interviewers who 
collected data for this study. We also greatly appreciate the guidance and oversight from Deborah Weiss and 
Sam Kalibala of The Population Council. 
Cover photo credits: (c) 2007 Jennifer Orkis (all three photos), Courtesy of Photoshare (www.photoshare.org) 
Top left and right picture: 
Children in Uganda attend a regional prize giving ceremony for The Good Life Show, an entertainment 
education quiz show that's part of a campaign under the AFFORD Health Marketing Initiative. The game show 
features different health topics each week, and shows how simple health practices and lifestyle choices can 
protect the family's health and lead to socio-economic fulfillment. 
Bottom left picture: 
A woman hands out communication materials at a regional prize giving ceremony for The Good Life Show, an 
entertainment education quiz show that's part of a campaign under the AFFORD Health Marketing Initiative. 
The game show features different health topics each week, and shows how simple health practices and lifestyle 
choices can protect the family's health and lead to socio-economic fulfillment. 
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. 
The QED Group, LLC is a full-service consulting firm that provides practical solutions to social problems 
through sound analysis, proven management techniques, and creative implementation. 
QED stands for the Latin phrase, Quod Erat Demonstrandum, meaning “proven,” or “it is proved.” Sound 
information and empirical analysis are the foundations of effective decision-making, and the QED Group is a 
proven performer in helping its clients make a difference. www.qedgroupllc.com 
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: Rohozynsky, Oleksandr, Christie Billingsley, and Annette Bongiovanni. 2009. “The 
AFFORD Health Marketing Initiative in Uganda: Mid-term evaluation,” 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. 
iii
Table of Contents 
Acronyms v
Executive Summary 1
Introduction 8
Background 8
Rationale 15
Objectives and Research Questions 15
Methodology 17
Study Design 17
Selection and Description of Sample/Study Participants 18
Ethical Considerations 20
Data Collection Methods 21
Data Management and Analysis 21
Limitations 22
Results 24
Description of the Survey Respondents 24
Overarching Achievements 25
Progress toward Meeting AFFORD Objectives 26
Discussion 37
Framework for the Discussion 37
Validating Project Results 38
Effectiveness of AFFORD Activities 41
Sustainability of UHMG 43
Conclusions and Recommendations 46
Conclusions 46
Recommendations 48
References 51
Annexes 53
Annex A : AFFORD Activities Timetable 53
Annex B : UHMG Organizational Structure 55
Annex C : Key Informant Interview Methodology 56
Annex D : Retail Store Survey Methodology 57
Annex E : Exit Survey Methodology 59
Annex F : Focus Group Methodology 63
Annex G : Interviewer Training Manual 65
Annex H : Key Informant Interview Guide 81
Annex I : Retail Store Survey Questionnaire 84
Annex J : Exit Survey Questionnaire 97
iv
Annex K : Retail Store Survey Informed Consent 103
Annex L : Exit Survey Informed Consent 104
Annex M : Short Summary of Key Informant Interviews 105
Annex N : Statistics for Retail Store Survey 118
Annex O : Statistics for Exit Survey 121
v
Acronyms 
ACT Artemesinin Combination Treatment 
AFFORD AFFORD Health Marketing Initiative 
ANC Ante-natal Clinic 
CBO Community-Based Organization 
CDFU Communication for Development Foundation Uganda 
CSW Commercial Sex Worker 
DADI District Assistant Drug Inspector 
DHE District Health Educator 
DHO District Health Officer 
DHS Demographic and Health Surveys 
FGD Focus Group Discussion 
GOU Government of Uganda 
HCT HIV Counseling and Testing 
JHU-CCP Johns Hopkins Center for Communications Programs 
LLIN Long Lasting Insecticide Net 
MARP Most At-Risk Population 
MOH Ministry of Health 
NGO Non-Governmental Organization 
NICRA Negotiated Indirect Cost Recovery Agreement 
PLHA People Living with HIV and AIDS 
POL Popular Opinion Leader 
QED The QED Group, LLC 
SSECODA Ssesse Community Development Association 
STI Sexually Transmitted Infection 
SWOT Strengths, Weaknesses, Opportunities, and Threats 
UPDF Uganda People‘s Defense Force 
UHMG Uganda Health Marketing Group 
USAID United States Agency for International Development 
VCT Voluntary Counseling and Testing 
VHT Village Health Team 
WAWI Women at Work International 

The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
1
Executive Summary 
Introduction 
AFFORD is a five-year (2005–2010) social marketing initiative financed by the United States 
Agency for International Development (USAID)/Uganda. It aims to support the Uganda 
Ministry of Health‘s (MOH) strategic plan to promote positive healthcare-seeking behavior 
and to reduce the shortage of health products and services related to HIV prevention, care, 
and treatment; family planning and reproductive health; child health; and malaria prevention 
and treatment. AFFORD is managed by the Johns Hopkins Center for Communications 
Programs (JHU-CCP) and partners: Futures Group International, Malaria Consortium, 
Communication for Development Foundation of Uganda (CDFU), Pulse Communication 
Limited, and Aclaim Africa Limited. 
AFFORD seeks to achieve the sustainable marketing of products and services that prevent the 
transmission of HIV, malaria, and diarrheal diseases; to help couples plan their families and 
to help people living with HIV enjoy improved quality of life. Target groups include families, 
young couples, caretakers of children under age five, pregnant women, and people living with 
HIV. The three objectives of AFFORD are to: 
1. Increase the accessibility and affordability of products and services; 
2. Enhance knowledge and correct use of products and services to encourage and sustain 
healthy behaviors and lifestyles within communities and families; 
3. Establish and build capacity of an indigenous health marketing organization 
and distribution systems. 
USAID/Uganda requested a mid-term evaluation to determine the initiative‘s progress, 
identify course corrections for the remaining two years of programming, and inform future 
programming. Through a subcontract from the Population Council, the QED Group, LLC 
(QED) designed and conducted the evaluation to answer the following questions: 
1. What is the effect of AFFORD activities on the volume of sales/distribution of the 
AFFORD-supported healthcare products and its substitutes? 
2. What is the effect of AFFORD activities on the health behavior of the general 
population and specific at-risk groups, such as sex workers and soldiers? 
3. Was AFFORD successful in creating a sustainable indigenous health marketing 
organization and network of distributors? 
Methodology 
The core evaluation team comprised QED staff based in Washington, DC and Ugandan 
consultants based at Makerere University in Kampala. The team used both qualitative and 
quantitative methods, including document review, key informant interviews (persons working 
in private and public sectors), a retail store check survey, client exit surveys, and focus group 
2
discussions (FGDs). A team of 23 experienced Demographic and Health Surveys (DHS) 
interviewers were trained by the evaluation team and participated in a pilot study before 
conducting field interviews. Data processing and analysis was handled by the core team. The 
Ugandan staff handled data transcription from narrative accounts and entered survey 
responses into an SPSS spreadsheet format. A Ugandan data analyst ran initial, basic 
frequencies; the QED team reviewed the results for quality and followed-up with more 
analyses. 
Results 
AFFORD is widely known in Uganda. It is managed by an effective partnership and has an 
outstanding record of relations with the Government of Uganda. Respondents, especially in 
the professional health and donor community, are aware of AFFORD and understand all or 
part of its work. Its programs and products are well-recognized by target populations and 
were visible in all regions visited by the evaluation team. The AFFORD partnership is 
cohesive. All partners play a significant role in implementation, which is fostered by the 
prime contractor‘s strong commitment to collaboration and development of a recognizable 
brand for the initiative. AFFORD has also developed strong, transparent relations with the 
Government of Uganda at both the central and district levels, and engages the government in 
ongoing dialogue to align its activities with government plans. Key informants, especially at 
the central level, attribute the good relations of AFFORD with government authorities to the 
dedication of AFFORD‘s senior management. 
AFFORD has also made impressive progress toward its three main objectives: 
1) Increase accessibility of products and services. AFFORD is distributing 12 
diverse, socially-marketed products and will begin distribution of an additional 
product in the next few months. These products are distributed through a private 
network created by AFFORD. AFFORD continued the distribution of three products 
(USAID brands) previously introduced and distributed by a predecessor social 
marketing project implemented by Population Services International: Pilplan, 
Injectaplan, and Protector. AFFORD also introduced a line of new products 
registered by the Uganda Health Marketing Group (UHMG). USAID brands are 
sold in 85 to 91 percent of private drug stores in the counties surveyed, and other 
brands are available in at least 21 percent of stores after being on the market for a 
year. Several of the products have a substantial share of the market (InjectaPlan, 
PilPlan, and Protector) and in some cases have created new markets (Moonbeads). 
In addition, AFFORD is introducing standards of services for small, private clinics, 
and uniting such clinics under the Good Life! clinic brand. In 2007 AFFORD 
selected and trained 100 private clinics that later were branded as Good Life! clinics. 
2) Enhance healthy behaviors and lifestyles. AFFORD conducted several health 
promotion campaigns during the period October 2005 to October 2008. The health 
promotion campaigns are highly visible and recognized in the areas where they are 
available, and respondents perceived that they have resulted in improved healthcare 
seeking behavior and health status. A number of these activities, such as the Good 
Life! show on television and radio, the Under the Mango Tree radio show, and 
HIV/AIDS films, are well-recognized by the target population and watched by 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
3
significantly-sized audiences. Other activities, such as PULSE community 
activation campaigns that use presentations, discussion, or HIV/AIDS films and the 
Popular Opinion Leader (POL) program that promotes community health through 
local leaders, are less recognized by the general population because of their local 
nature, but are highly known in the communities exposed to them. These activities 
are regarded as highly effective and innovative by district authorities and 
communities in the areas where they take place. Though the evaluation could not 
definitively determine the effect that any of these activities had on health behavior, 
there is indication that AFFORD activities, such as PULSE activation, the POL 
program, and long-lasting insecticide net (LLIN) distribution, are linked with 
increases in demands for the AFFORD health products and positive changes in 
health behavior, such as use of HIV testing or mosquito nets for pregnant women 
and children. 
3) Establish an indigenous health marketing organization. At the end of the first 
year of implementation, AFFORD registered and established an indigenous 
organization, UHMG, to assume its work after the initiative ends. UHMG has an 
organizational structure, dedicated staff, and has taken over much of AFFORD‘s 
day-to-day work. AFFORD has worked on capacity building with the UHMG staff 
and begun building networks of technical and financial support outside UHMG. 
Respondents were universally favorable regarding the idea of creating UHMG and 
impressed at its early establishment. However, they also identified specific areas of 
development and support needed by UHMG if it is to be truly sustainable, such as 
new business development expertise and financial planning skills. 
Discussion 
The evaluation results suggest that the AFFORD initiative made significant progress towards 
achieving all three objectives. 
The evaluation team considers AFFORD‘s Objective 1—to increase accessibility of products 
and services—near completion, but recognized that further actions may be necessary to 
support and strengthen its private distribution network over the remaining two years of the 
initiative. Two major challenges should be noted: 
1. There is competition between socially-marketed brands of health products distributed 
by different donor campaigns in Uganda. This problem was noted in previous social 
marketing studies in Uganda and was also reported by key informants in this study. 
This competition leads to inefficient use of the resources when donors spend money 
to protect their market share from other donors instead of spending these resources to 
scale up distribution, for example, or to provide other services. The competition also 
drives down the price of socially marketed brands. This is a problem for a social 
marketing project that intends to establish self-sustained marketing of these products. 
Competition drives the price of the products below cost of the product distribution 
which makes sustainability impossible. 
4
2. The original USAID brand of condoms (Protector), though technically meeting 
specifications, experienced issues with quality and consumer properties, such as size 
and smell, which have negatively affected distribution. 
Despite these challenges, the outlook for continued distribution and increases in sales volume 
of AFFORD products looks promising. The initiative created an operational distribution 
network that does not require significant financial support and therefore should function 
sustainably after AFFORD ends. Operations management for product development, 
marketing, and distribution has already been transferred to UHMG. For all brands, except the 
three USAID-supported brands, operations are conducted on a cost-recovery basis, in which 
prices set for these products equal production and distributions costs: price paid to 
manufacturer, cost of repackaging and warehousing, and margin provided for distributors and 
retailers. The cost-recovery price does not, however, include costs of social marketing 
campaigns. 
The initiative introduced and completed a variety of health promotion activities to achieve 
Objective 2—to enhance health behaviors and lifestyles. Activities supporting Objective 2 are 
considered almost completed at this point by the project. At this early point in the initiative, 
the evaluation could not determine the effect that any of these activities had on health 
behavior. The market response to the social marketing campaigns of AFFORD is reported by 
some drug shop owners who indicated an increase in the number of customers for AFFORD 
products after local or national marketing activities. However, the behavior change or stable 
market response can only be determined more than one year after campaigns end. It also 
should be noted that the high costs of the campaigns may render them unsustainable without 
external funding. As mentioned above, current cost-recovery prices for the UHMG-branded 
products do not include cost of social marketing campaigns. If such costs were included into 
the price, the products would become unaffordable to the target population, which defeats the 
goal of the initiative. 
AFFORD is also on its way to achieving Objective 3—to create a sustainable, indigenous 
social marketing organization. UHMG was created, registered, and has been functioning for 
at least two years. AFFORD is gradually transferring staff and responsibilities for social 
marketing activities to UHMG and is transitioning the international experts (who started 
AFFORD) into short-term UHMG consultants to facilitate capacity building. According to 
key informants, AFFORD has already achieved more in creating an indigenous organization 
than other international projects implemented in Africa in a similar time frame. Yet additional 
steps are needed to ensure the sustainability of UHMG. UHMG staff was trained and gained 
experience in social marketing and related activities, but not in fundraising or organizational 
management and development. As a result, currently UHMG staff, particularly upper 
management, lack knowledge and experience in these areas, all of which are fundamental to
sustainability. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
5
Conclusions and Recommendations 
The evaluation team formulated the following conclusions based on the evaluation results. 
1. AFFORD has made significant progress towards the achievement of its goals and 
objectives. 
a. It has nearly achieved Objectives 1 and 2. 
b. It has made significant progress on Objective 3, but must focus further efforts 
during the remaining years of the initiative. 
2. AFFORD implemented several innovative activities in social marketing and health 
promotion that can be considered promising practices for the implementation of 
similar campaigns, and have great potential for further support by USAID. These 
include: 
a. Working with private distributors to deliver socially marketed products with 
no distribution cost to the initiative is highly effective and sustainable. 
b. Developing social marketing methods, such as television and radio game 
shows and the POL program, that were innovative, well noticed, and 
remembered by the populations exposed to them. The POL program can be 
considered a pilot that demonstrated effectiveness in the areas where it was 
implemented and was highly regarded by local officials and the communities. 
3. The initiative undertook early, significant, steps to ensure sustainability of UHMG. 
However, UHMG requires additional capacity building and support from USAID. 
a. UHMG socially-marketed brands are distributed on a cost-recovery basis, 
which provides a foundation of sustainability. It should be mentioned, 
however, that USAID brands (Pilplan, Injectaplan, and Protector) are 
distributed at prices below cost-recovery. Therefore, continuing distribution of 
these brands by UHMG will need financial support from USAID to cover the 
cost of acquiring these products, as has been done since the creation of these 
brands. 
b. UHMG has capacity in the distribution of socially-marketed health products, 
but lacks experience in financial management and new business development. 
c. UHMG needs continuing technical support and expertise from the 
international partners of the AFFORD initiative in implementation of core 
activities and capacity building. 
Recommendations for AFFORD for the near term 
AFFORD can take some immediate steps to improve its product distribution, which 
eventually will support the UHMG distribution efforts. The evaluation team offers the 
following recommendations to address existing weaknesses: 
6
Assess the distribution network and provide training to distributors and, if possible, 
store owners, on best business practices, such as calling distributors to order products 
when current supplies are running low, confirming the needs of shops by phone 
before sending large supplies of drugs for distribution, and keeping lists of distributor 
contacts. 
Provide simple instructions and a re-order form in each bulk package of drugs that 
contains contact telephone numbers for all 12 UHMG distributors and a short 
statement-request for re-supply of the drug that can be sent by mail or by fax. 
Provide a detailed description of drugs in each bulk package with details about side 
effects and advantages of each drug to inform drug shop owners about the product. 
AFFORD can also enhance its work with local/district level authorities in promotional 
activities: 
Involve the UHMG managing director and top management in meetings with local 
authorities and make a clear statement about what should and should not be expected 
from UHMG compared to current AFFORD activities in order to avoid ambiguity. 
Extend AFFORD‘s practice of collaboration to local government structures with the 
ultimate goal of establishing district plans for health promotion activities, capacity 
building in the districts to carry out these activities, and creating an understanding 
about sources that could continue funding for these activities after AFFORD has 
ended. 
Extend the trainings and other activities conducted under the POL program to local 
community health structures already in place, such as Village Health Teams (VHT). 
Continue to identify and engage local partners, including non-governmental 
organizations, in health outreach activities, such as the PULSE activities. 
Finally, there are a number of activities that can strengthen UHMG and increase the 
probability of survival for the organization beyond the project end date: 
Strengthen UHMG‘s organizational structure through inviting periodic participation 
of the international organizations that helped to form it. For example, the UHMG 
could establish an informal network or an Advisory Board comprised of 
representatives from international organizations. 
Develop a medium-term financial plan for UHMG that considers several scenarios of 
funding availability, including a scenario in which AFFORD funding ends according 
to the initial plan. 
Continue development of UHMG capacities in the new business development through 
training and guided proposal development efforts. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
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Extend UHMG contacts with non-US international donor organizations, such as the 
World Bank and other government development programs active in Uganda to 
provide income and growth for UHMG. 
Long-term recommendations 
The following recommendations are for consideration during the design and implementation 
of new USAID social marketing programs in Uganda and elsewhere, rather than for ongoing 
AFFORD activities: 
The AFFORD name brand has high visibility and positive recognition in Uganda. 
Using the same name for an extension of the initiative or a follow-up would capitalize 
on its positive associations. USAID/Washington and USAID missions have used this 
example specifically to extend the longevity and influence of a project name; such as 
the BASICS project and the Benin PISAF project. 
The AFFORD activities on the LLIN distribution could be implemented as a part of 
an AFFORD initiative extension or as a separate project. 
Schools are major mechanisms in Uganda for reaching communities with information 
that promotes demand and use of health products. USAID should consider an 
extension of the initiative or a follow-up project that concentrates on health promotion 
through schools and engages the Ministry of Education and Sports, especially at the 
district level. For example, education about certain health products could be included 
in the PIASCY curriculum or its successor program, and implemented in cooperation 
with UHMG. 
AFFORD was successful in distributing USAID-branded products, such as Protector, 
PilPlan, and InjectaPlan. However, if USAID continues to distribute these products 
through UHMG beyond the end-date of AFFORD, it should support the broader 
UHMG product distribution network, where current volume is too low for many 
distributors to earn a profit. The availability of larger volumes of USAID-branded 
products through this network will boost distributor loyalty and ensure that USAID￾branded products continue to reach consumers without the disruption of a distributor 
change. Such a step would also ensure the products are distributed by a qualified 
indigenous partner already experienced in handling these products. 
Continued financial support to UHMG beyond the remaining two years of AFFORD 
will ensure a smooth transition to independence and avoid turnover of qualified staff. 
UHMG needs continued access to the technical experts beyond the remaining two 
years of the project in order to build capacity in new business development, financial 
planning, and intermittent health technical areas as it transitions to independence. 
8
Introduction 
Background
Social marketing ―is a process that applies marketing principles and techniques to create, 
communicate, and deliver value in order to influence target audience behaviors that benefit 
society (public health, safety, the environment, and communities) as well as the target 
audience" (Kotler et al. 2006). Social marketing is a systems approach that can increase 
access to life-saving products and services and encourage healthy behaviors and lifestyles. 
Since the late 1960s the United States Agency for International Development (USAID) has 
embraced social marketing to address communication gaps in public health education. It 
introduced this strategy in about 30 countries worldwide though flagship projects, such as the 
Social Marketing for Change program to address rapid population growth and the 
Commercial Market Strategies, which broadened this work by partnering with private and 
commercial sector entities to increase the use of quality family planning and other health 
products and services. 
Nearly every country with a USAID presence currently includes social marketing within its 
portfolio, either as a stand-alone project or as a component of projects, such as those 
addressing HIV prevention, care, and treatment. USAID is increasingly interested in applying 
social marketing strategies with direct links to public and private sector partners while 
promoting sustainability. 
Social marketing is based on the concept of applying principles and approaches of 
commercial marketing in order to achieve specific behavioral goals. One of the main 
differences between social marketing and commercial marketing is their primary goals: social 
marketing tries to influence a target population in order to achieve a social goal, while 
commercial marketing usually has a financial goal of maximizing profits. 
However, both commercial and social marketing also have common goals, such as 
maximizing sales and consumption of products by target populations. The difference between 
these two concepts is usually the target population. Social marketing arose in low-income 
countries because commercial entities enter the market with products that are affordable only 
to a small proportion of the population. However, there is a large social benefit in some 
products, especially health products for family planning, HIV prevention, and water 
purification, which are used by majority of the population. The social benefit is especially 
large when these preventive products are used by the poorest populations because they avoid 
high costs associated with unintended pregnancy and infectious disease. 
Social marketing is typically conducted through multimedia campaigns and often is 
supplemented by the distribution of the products at affordable (highly subsidized or free) 
prices. Social marketing programs usually rely on donated products that are repackaged and 
rebranded for specific markets. 
Governments in low-income countries usually have limited resources and health care 
capacity and are especially hard-pressed to provide free or subsidized products. In addition, 
the introduction of such products requires educational and motivational campaigns to 
stimulate their use—steps that in developing countries further strain the limited resources and 
knowledge required to design and execute these types of campaigns. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
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The social marketing approach tries to influence the behavior of a target population with no 
previous experience using specific health products. Therefore, contrary to commercial 
marketing, its social counterpart can achieve its goal even if the market for a specific health 
product is not growing. For example, prevention of adolescent pregnancies can be achieved 
through use of hormonal contraceptives, barrier methods, or abstinence. If a social marketing 
campaign increases abstinence, it achieved its goal, although the sales of contraceptives and 
barrier methods might decrease. 
The development of the social marketing concept under the financial constraints of 
governments and donor funding resulted in development of the total market approach to 
social marketing (see R. Pollard, 2007). This approach intends to reduce the financial burden 
of achieving a social goal by increasing targeting for free or subsidized products to the 
poorest segments of the population, while simultaneously increasing the proportion of the 
population that buys the products in commercial markets. It introduces specialized, low-cost, 
mass-produced products specifically targeted to the low-income groups that cannot afford 
products currently available on the market. At the same time, these commercially-distributed 
products are intended to be more attractive than the free or subsidized versions. Social 
marketing is used to create and increase demand for these and other commercially-available 
products. The success and sustainability of the total market approach depends on several 
factors, some of which are not necessarily under the control of social marketing projects. For 
example: 
1. There should be sufficiently large unsatisfied demand for low-priced, socially￾marketed products to allow the high-volume of the market to compensate for the low 
profit margin on these products. 
2. The existing market organizations (public and private) must have logistic and 
management capacities large enough to handle the volume and provide low-cost 
manufacturing and distribution of these products. 
The commercial market should also be willing to expand into the low-income population 
segment with low-priced products. One of the conditions to achieve this goal is that the low￾priced products do not enter the high-profit segments and do not substitute the currently 
available high-profit products. 
The AFFORD Health Marketing Initiative (AFFORD) is a five-year project funded by 
USAID/Uganda that uses social marketing techniques to increase the sustainable marketing 
of health products and services throughout the country. AFFORD was created to support the 
Uganda Ministry of Health‘s (MOH) current strategic plan, a plan that aims to promote 
positive healthcare-seeking behavior and reduce the unmet need for health products and 
services related to HIV prevention, care, and treatment as well as in other areas such as 
family planning and reproductive health, child health, and malaria prevention and treatment. 
AFFORD is intended to engage multiple partners from the private commercial sector, non￾governmental organizations, and the public sector in comprehensive efforts to increase the 
practice of healthy behaviors and generate/ fulfill demand for an affordable, accessible range 
of "public health" products and services. AFFORD is one of a new generation of social 
marketing initiatives whose primary goal is to create an indigenous, stand-alone entity that 
will outlive the project and carry on its work. 
10
AFFORD was awarded as a cooperative agreement to Johns Hopkins Center for 
Communications Programs (JHU-CCP) and partners (Futures Group International, Malaria 
Consortium, Communication for Development Foundation of Uganda [CDFU], Pulse 
Communication Limited, and Aclaim Africa Limited) in 2005. It focuses on a wide variety of 
products and services to prevent the transmission of HIV, malaria, and diarrheal diseases. It 
also helps couples plan their families and those living with HIV enjoy a healthier and 
improved quality of life. AFFORD aims to improve health among key target groups—
including families, young couples, caretakers of children under age five, pregnant women, 
and people living with HIV or AIDS—by promoting positive behavior change through 
various innovative and proven methods, and to ensure widespread access to affordable, high￾quality products and services. 
AFFORD has the following objectives: 
1. Increase the accessibility and affordability of products and services that address 
HIV/AIDS, reproductive health, child survival, and malaria; 
2. Enhance knowledge and the correct use of these products and services to encourage 
and sustain healthy behaviors and lifestyles; 
3. Strengthen and establish an indigenous organization as well as distribution systems 
for the sustainable and self-sufficient delivery of key health marketing functions, 
including management, distribution, and promotion.
To achieve these objectives, AFFORD combines targeted product development and 
distribution with media and other communication campaigns to promote knowledge of and 
correct use of products. AFFORD has introduced and supported 12 brands of health care 
products (see Table 1), which it repackages and provides to a network of 12 private 
distributors. These distributors were recruited from existing large pharmacies and trained by 
AFFORD. The project encourages the distributors to use their current retail networks to sell 
AFFORD products and refers pharmacy owners to these distributors for supplies of AFFORD 
products. It also provided bikes to local small entrepreneurs to support distribution of small 
quantities of the products to remote villages that do not have their own drug shops. Finally, 
AFFORD established the UHMG to continue distribution of the products beyond the lifespan 
of the initiative. 
Products 
AFFORD continued the distribution of three products previously introduced and distributed 
by a predecessor, the USAID-funded social marketing project implemented by Population 
Services International. These products, Pilplan, Injectaplan, and Protector are referred to as 
USAID brands in this report. AFFORD also introduced a line of new products registered by 
UHMG (UHMG brands). Both groups of products are distributed and marketed by AFFORD 
and collectively referred to as AFFORD brands. 
AFFORD also conducts different types of malaria prevention activities such as: campaign￾style long-lasting insecticide net (LLIN) distribution, Artemesinin Combination Treatment 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
11
(ACT) training with the private sector, and LLIN ante-natal clinic (ANC) distribution. Most 
of the net distribution is carried out by the Malaria Consortium. 
Table 1 USAID and UHMG brands 
Brand Name Product Strength/ Composition
USAID Brands
Protector Condoms Lubricated with SK70
PilPlan Low-dose combined oral contraceptive Duofem
Injectaplan Injectable contraceptive that prevents pregnancy 
for three months
3-month vial of Depo-Provera
UHMG Brands
RESTORS R.O. ORS Low osmolarity WHO formula
ZINKID Zinc Zinc sulphate 20mg DT
Cotramox Cotrimoxazole Cotrimoxazole tablets 960mg
"O" Condoms Ribbed/Studded /Colored
AQUASAFE Water purification 70mg NaDCC per tablet
Vitaboost Multivitamin Multivitamins with antioxidants
Newfem Combined oral contraceptive pill Levonorgestrel 0.15mg / Ethinyl Estradiol 
0.03mg + Ferrous Fumarate 75mg tablets
Soft-sure Progesterone-only oral contraceptive pill Levonorgestrel 0.03mg
Clovirex Acyclovir tablets and cream Acyclovir tablets 200mg, 400mg
Programs 
AFFORD also established several health programs (see Table 2) including outreach events, 
television shows, radio programs, and newsletters. The foundation of AFFORD‘s programs is 
the Good Life! campaign, which began as a health-focused game show broadcast in English, 
with episodes rebroadcast on both television and radio. The Good Life! name and logo 
subsequently became recognizable and were put on every AFFORD and UHMG product, as 
well as clinics operating according to the standards of AFFORD. 
12
Table 2 AFFORD Programs 
Activity Description
The Good Life! Platform
The Good Life! Show Good Life! Show is an interactive, entertainment-education game show 
broadcasted on TV in English (24 episodes) and on radio in five local 
languages, and distributed in video halls and during community road 
shows. During the show, couples are challenged to answer short 
questions, to see how much they know about their partners, and to act 
out health behaviors for their partners to guess.
The Good Life! Show Question of the 
Week
Listeners and viewers call a toll-free hotline for their chance to win 
weekly prizes and be entered to win the grand prize, a Toyota pick-up 
truck, donated by Toyota Uganda and IAA Health Care.
The Good Life! Network (Good Life!
Clinics)
UHMG identifies and trains staff of clinics that meet agreed-upon 
standards. These clinics are branded as the Good Life! clinics, part of 
The Good Life! Network, to increase their visibility to clients.
The Good Life! Teams UHMG's Good Life! teams are an extension of the Popular Opinion 
Leaders (POL) program (see below). The teams are trained and 
supported to utilize opportunities such as church gatherings, social 
celebrations, local council sessions and informal one-on-one 
interactions with neighbors, family, and friends to advocate for the 
simple things communities can do every day to keep healthy and fulfill 
their family's dreams.
The Good Life! Support Media UHMG uses a variety of supporting social and behavior change 
communication vehicles to reinforce Good Life! messages, including 
the Everyday Health Matters newsletter and Under the Mango Tree
community outreach and radio program.
The Good Life! at Work Good Life! at Work is the UHMG activity conducted together with other 
(non-AFFORD) projects that trains company employees and sensitizes 
their dependents and communities on prevention and health 
maintenance behaviors.
Other AFFORD marketing and outreach activities
Everyday Health Matters Everyday Health Matters is a free, medium literacy newsletter 
produced quarterly in English and local languages. Each issue of this 
four-page newsletter focuses on a specific health issue including 
HIV/AIDS, malaria, child health, or family planning and includes 
information about related UHMG health products. It acts as support 
material under the Good Life! Campaign, and for free net distribution 
activities with Malaria No More and the President’s Malaria Initiative, 
and at AFFORD/UHMG events.
Pulse Activations Pulse Activations are experiential marketing activities for various 
audiences through clinics, ladies clubs, Under The Mango Tree village 
meetings (see below), and men’s clubs. Activities include road shows, 
bar promotions, films, and video shows. 
Popular Opinion Leaders Network 
(POL)
Implements the idea of community health education advocacy & 
mobilization by organizing and training volunteers from local 
communities to advocate positive health behavior and provide 
information and advice on health products use to the community 
members. AFFORD works with local partners to identify, train and 
supervise popular opinion leaders in areas where AFFORD works. A 
training curriculum and information cards were developed in 
collaboration with MOH.
HIV Prevention Films Strong collaboration with MOH and UPDF, the AFFORD dubbing of 
entertainment education films (Yellow Card, Center 4, Time to Care), 
and screens the shows at the community meetings and other 
occasions.
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
13
Under the Mango Tree radio show Under the Mango Tree is an innovative community outreach program 
and reality radio show. Community members gather under a mango 
tree to discuss real issues they face on one of AFFORD’s supported 
topics, with a moderator and health professional. These live sessions 
are recorded and edited into entertaining 30-minute radio segments. 
Listeners provide feedback by calling a toll free hotline with questions 
and comments about the show, and frequently asked questions are 
selected and answered in 45 second radio spots.
Other AFFORD activities (non-comprehensive list)
Malaria Prevention and Nets 
distribution
Project distributes and promotes the use of long lasting insecticide 
nets (LLINs), especially by pregnant women and children under five. 
LLINs are distributed through antenatal clinics, the Good Life!
Campaign, and an NGO LLIN facility
Routine distribution of free Nets through 417 ante-natal clinics in 23 
districts in Northern Uganda.
Free distribution of nets through the NGO LLIN facility (40 NGOs in 20 
districts).
Campaign style distribution of Nets.
MARPS Network Established the MARPS Network of organizations, provides 
institutional support, technical expertise, and capacity building to the 
network.
Sub grants to WAWI,Uganda Police, UPDF, SSECODA.
Training of Peer Educators – messengers of good life.
Referral for HTC, STI and other needed services.
HIV/AIDS Program
Palliative Care 
Strengthen capacity of private clinics & drugs shops through training 
and support supervision.
Established referral mechanism from VCT to palliative care through 
POL program, MARPS network, and Good Life! Clinics.
Provide support materials and job aids to health workers.
Support PLHAs to access palliative care products.
Introduced new products for HIV-positives Cotramox, Clovirex.
Developing Distribution Network for 
Socially Marketed (Low-cost) Health 
Products
AFFORD is gradually putting in place a distribution structure which 
relies on local distributors rather than on its own distribution force. One 
key element in the distribution strategy is the incorporation of small 
scale entrepreneurs, based on the model of community distribution 
successfully used in other countries but with a special emphasis on 
financial sustainability.
Establishing Indigenous NGO for 
Sustainable Delivery of Health 
Marketing Functions – UHMG
UHMG was incorporated on 13th October 2006, began implementing 
program activities in April 2007, and was officially inaugurated by 
AFFORD on 29th May 2008.
Services 
UHMG, the independent entity that AFFORD created to continue its work after the initiative 
ends, provides a number of services listed below: 
Consultations
UHMG attracts new project funds from donors in exchange for the delivery of high 
quality programming and deliverables using its skills, efficiencies, and cost 
containment approaches. 
14
Product Facilitator
UHMG acts as a broker between frontline health organizations fighting AIDS, malaria 
and other diseases, and product and commodities suppliers. 
Sales and Marketing 
UHMG eases access to a range of quality and affordable health products. 
One-Stop-Shop Pharmacy Network.
A small network of one-stop shop pharmacies provides health solutions for the 
majority of health issues faced by Ugandans. 
Research and Market Data
UHMG's research and evaluation unit conducts health marketing and consumer 
behavior studies. 
Health Conference for Health Marketing Practitioners
UHMG holds an annual Network Conference for Health Marketing Practitioners to 
create a network of health service marketers and providers. The objective of the 
conference is to facilitate change, share success stories, improve distribution, and 
identify future opportunities for growth and investment. 
An example of the integration of AFFORD products and programs can be illustrated by their 
work in family planning. AFFORD‘s family planning program focuses on couples. The 
initiative works to market and make accessible an array of seven family planning products 
including oral contraceptives (Pilplan, NewFem, SoftSure), injectables (Injectaplan),
condoms (Protector, "O"); or a natural, rhythm-based method (MoonBeads). Complementary 
media programs, such as the Good Life! television show, Everyday Matters written materials, 
and Under the Mango Tree radio show, aim to promote these contraceptives products and 
their proper use. Simultaneously, popular opinion leaders (POLs)—AFFORD-trained 
community members who hold respect and trust and whom others may seek out for advice 
and help—work to make sure people in remote areas know about the products, where to get 
them, and how to use them. Finally, AFFORD works through the private sector to make sure 
the products are distributed to clinics and retail stores. For a summary of all AFFORD 
programs, products and services, please refer to Table 12. 
AFFORD targets specific population groups for different activities. Some socially-marketed 
products are targeted at potential consumers. For example, USAID brands are marketed to the 
poorest populations since they are subsidized and accomplish USAID mandated goals to 
focus on vulnerable populations. UHMG products such as SoftSure, NewFem, and the ―O‖
condom were introduced on a cost recovery basis (with the intention of recovering a 
percentage of costs on each sale) and target low to medium-income populations that have 
money to buy contraceptives, but cannot afford full-priced commercial brands that already 
exist on the market. Specific products such as Moonbeads were introduced for women who 
will not use hormonal or barrier methods of contraception for religious or health reasons. 
Large health promotion campaigns, such as Good Life! programming target the general 
Ugandan population with access to television and radio. Other activities have more specific 
audiences, determined either by the Government of Uganda (GOU) or USAID. For example, 
the distribution of long-lasting insecticide nets (LLINs) and related health promotion 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
15
campaigns targeted families with children under age five according to GOU policy and to 
correspond with available resources. 
A specific mandate of AFFORD is HIV prevention, a goal it hopes to accomplish by 
targeting most-at-risk-populations (MARPs), such as female and male sex workers and their 
clients (including uniformed servicemen, truckers, and fishermen). AFFORD assisted in 
establishing a MARPs network of non-governmental organizations that work with these 
population groups, such as the Women at Work International (WAWI) and the Uganda 
People‘s Defense Force (UPDF). Working with these organizations also allowed the project 
to address other health issues such as family planning, malaria control, and child health by 
reaching families of female sex workers. 
AFFORD also provided training in HIV testing and counseling (HTC) at private clinics. The 
Good Life! clinics were supplied HIV testing kits and training. Community leaders 
participating in the POL program were trained to refer community members to Good Life!
clinics for HIV counseling. The POLs were also trained to promote voluntary HIV testing 
among the population and to provide information about HIV, its prevention, and support 
services available to the HIV-positive population. 
Rationale 
AFFORD has now reached its mid-point with implementation well underway and measurable 
results realized. USAID/Uganda has requested an evaluation to determine the initiative‘s 
progress thus far and allow time for course corrections. The evaluation will provide 
USAID/Uganda with data to help make decisions regarding the continuation of the program. 
More broadly, it will inform USAID‘s worldwide investments in health marketing strategies. 
The QED Group, LLC (QED) conducted the mid-term evaluation via a subcontract from the 
Population Council. 
Objectives and Research Questions 
The purpose of the mid-term evaluation of the AFFORD initiative is to determine whether 
activities implemented during its three-year base period have achieved the desired results. 
This mid-term appraisal is a part of larger evaluation efforts undertaken by USAID/Uganda 
with objectives to: 
1. Perform process, outcome, and impact evaluations of ongoing HIV/AIDS programs in 
Uganda; 
2. Conduct formative research and assessments to inform HIV/AIDS program design 
and policy; 
3. Synthesize data, findings and other sources of information in order to make strategy, 
policy, and programming recommendations to the United States Government, and 
when requested, to the Government of Uganda; and 
4. Provide technical assistance to national and project-level monitoring and evaluation 
systems. 
16
Based on the initial assessment of the AFFORD, project, the following specific evaluation 
objectives were formulated for this mid-term evaluation: 
1. What is the effect of AFFORD activities on the volume of sales/distribution of the 
AFFORD-supported healthcare products and its substitutes? 
a. Did the market grow or are AFFORD products substitutes for other products? 
Is there a spill-over effect from retailers working with AFFORD to all 
retailers? 
2. What is the effect of AFFORD-supported activities on the health behavior of the 
general population and specific at-risk groups, such as sex workers and soldiers? 
a. Did they change their behavior over the last three years, and, if so, what was 
the reason for such changes? 
3. Was AFFORD successful in creating a sustainable indigenous health marketing 
organization and network of distributors? 
a. What tasks still have to be completed before the project ends? 
This report documents the planning, execution, analysis, and findings of the AFFORD mid￾term evaluation process. It begins with a detailed description of the methodology for the 
evaluation including the study design, data collection methods, ethical considerations, data 
analysis and quality, and limitations of the study. Next, it summarizes the evaluation results 
in terms of the three AFFORD project objectives. Results are followed by a discussion of the 
broader implications of the evaluation findings. Finally, conclusions and recommendations 
are offered for AFFORD, partners, and USAID. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
17
Methodology 
Study Design 
The evaluation team used both quantitative and qualitative methods to enable cross-validation 
of information and enhance the contextual analysis. The mixed-methods approach was 
particularly important since AFFORD implements a variety of distinct interventions and 
targets several audiences. 
The team hypothesized that there should be a large spillover effect of the social marketing 
interventions in the ―intervention‖ and ―comparison‖ groups. The team assumed that within 
the same locality (e.g., town, village, or district) retailers and other community members 
would be exposed to the same television and radio programming interventions and would 
share information. Therefore, there should be only small differences between drug stores that 
interacted with AFFORD/UHMG distributors directly and those that did not within the same 
proximity/district. In order to test this hypothesis, we included both types of stores and clinics 
in the sample. 
Data collection methods 
The evaluation team used the following five methods for data collection: 
Document review: The evaluation team reviewed AFFORD documents, such as the 
performance monitoring plan, work plans, and annual reports. The team also examined 
Ministry of Health documents to understand the epidemiological situation in the country and 
current health priorities. 
Key informant interviews: The team conducted key informant interviews to provide context 
for the achievements of AFFORD. Key informants included persons representing public and 
private sectors, namely: Ministry of Health officials, USAID, NGO representatives, MARP 
network representatives, AFFORD partners, UHMG founding partners, current members of 
AFFORD/UHMG staff and partners, all of whom had intimate knowledge of, and 
experiences with, AFFORD at different points in time and from varying perspectives. For 
example, AFFORD staff members had broad knowledge of AFFORD activities, while 
partners often brought knowledge in a specific area, such as HIV prevention. 
Retail store survey: The retail store survey was designed to assess the effect of 
AFFORD/UHMG‘s direct work with distributors and retail drug stores. The team collected 
data to assess the difference in availability of AFFORD/UHMG supported brands in drug 
stores that work with one of 12 AFFORD/UHMG distributors and, by comparison, those that 
are not direct partners of such distributors. In addition, the survey gathered data on the 
influence of AFFORD/UHMG promotion campaigns on the demand of the 
AFFORD/UHMG-supported products in these stores through retailer assessment of changes 
in sales volume and their experience with sales of particular brands of a product. 
Client exit survey: The client exit survey was designed to assess knowledge of and health 
behavior change among the targeted beneficiaries of AFFORD interventions. For example, 
questions addressed knowledge and use of mosquito nets, condoms, vitamins, and water 
18
filters or purification tablets. Respondents were also asked if they had considered HIV testing 
and if they considered being potentially exposed to HIV while engaging in sexual activities. 
They were asked about both their own behaviors and those of their family members in the 
past six months. Finally, the survey sought to gauge respondents‘ rationale for their 
individual behavior. Respondents were asked how their behavior changed over the last three 
years in the use of specific health products, visits to doctors, and HIV testing. If respondents 
indicated a change in the behavior, they also were asked to indicate the reason for the change. 
Standard reasons included information received through television, radio, recommendations 
of doctors, and personal experiences, but respondents were not limited to these choices. 
Focus group discussions (FGDs): FGDs were held with POLs and community members. 
They were designed to assess the effect of the POL program. The FGDs also included a 
discussion of AFFORD products to determine if participants recognized them and knew how 
to use them. 
Semi-structured interview guides and structured questionnaires were used to collect data. A 
team of experienced interviewers associated with Makerere University were trained over a 
one-week period, which included a pilot study. The purpose of the pilot was three-fold: 1) to 
assess the quality of interviewers‘ skills; 2) to test the implementation of the study design; 3) 
to test the survey questionnaires. 
Additional details on the methodologies, including questionnaires, informed consent forms, 
and the interviewer training manual are available in the annexes. 
Selection and Description of Sample/Study Participants 
The selection of study participants varied depending on the data collection method. Table 3 
summarizes the sampling approach and corresponding respondents for each method.
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
19
Table 3 Description of samples and study participants 
Method Sample Study Participants
Key informant 
interviews
The team used a snowball sampling approach 
starting with recommendations from 
AFFORD/UHMG and USAID/Uganda. Key 
informants were asked to recommend informants 
for further discussion of the topic, who were 
contacted and included in the key informants list 
by the evaluation team. 
Overall 76 informants were interviewed. 
AFFORD staff, AFFORD partners, and 
Uganda MOH staff at the national and 
district levels, representatives of MARPs 
network, experts from NGOs and other 
international projects, and USAID. 
Retail store 
survey
Intervention group: In each district, twelve retail 
stores were randomly selected from a list of retail 
drug stores working with AFFORD/UHMG 
distributors (Note: 12 stores were selected as a 
practical limitation of the survey in 
correspondence with the number of interviewers). 
Comparison group: The geographically closest 
retail store to the intervention store was selected 
from a list of all licensed drug stores provided by 
the District Assistant Drug Inspector (DADI). The 
study design estimated sample size of 240 
retailers.
Retail store owners and managers.
Client exit 
surveys
Clinic exits: Clients exiting health clinics. The 
Good Life! clinics were chosen as the place for 
interviews in districts targeted by AFFORD. 
Clinics recommended by AFFORD or district 
health officials were chosen in comparison 
districts. (Note: the evaluation team chose 
primarily Good Life! clinics, which are typically 
small, private clinics, but also included public 
clinics that have an informal relationship with 
AFFORD). If a district had more than six Good 
Life! clinics, facilities with the largest expected 
client volume were chosen. 
The study design estimated 1920 respondents for 
the clinic exit surveys.
Clients or accompanying persons (one 
person from a group) exiting clinics who 
were over 18 years of age and were not 
employees, were not previously interviewed,
and were not a family member of a 
previously interviewed person.
Retail store exit surveys: Clients exiting each 
store included in the retail store survey were 
interviewed for the client exit survey. The study 
design estimated 480 respondents at the retail 
store exit surveys.
Clients entering and exiting retail store 
clinics who were over 18 years of age and 
were not employees or previously 
interviewed.
FGD 8 FGDs were conducted in communities in four 
AFFORD districts with an active POL program 
and where malaria interventions were 
implemented.
Popular opinion leaders and community 
members.
Each FGD included 5–10 persons of mixed 
gender between 18–45 years of age. 
Both the retail store survey and client exit surveys had mixed-sampling strategies. In order to 
minimize cost and time, and to simplify logistics, both shared the same unified geographical 
coverage, based on a sampling of district sites selected according to the following criteria: 
20
The intervention group covered at least one district within the designated areas of 
each of the 12 AFFORD/UHMG distributors. Comparison groups were selected from 
the districts that are not primary activity areas for AFFORD/UHMG, but are 
physically adjacent to the intervention group districts. 
Districts chosen were also in areas where AFFORD/UHMG conducted different types 
of malaria prevention activities.
The availability of trained interviewers who spoke the local language was a factor in 
selection. Similarly, the main languages spoken in these districts were considered in 
order to be able to recruit an adequate number of fluent interviewers. 
For a list of districts included in the sample and actual sample sizes please refer to Table 4.
Two districts, Kampala and Kiboga, did not have formal comparison group districts because 
of their uniqueness. Kampala is the capital of the country and is the primary target for several 
AFFORD/UHMG activities that are not targeted to the rest of the country, such as the English 
language Good Life! show on television. Kiboga District is in the distribution area for 
AFFORD/UHMG. However, there were no AFFORD activities conducted in this region 
except for the distribution of AFFORD/UHMG products. 
Ethical Considerations 
The evaluation team made every effort to address ethical considerations during the planning 
and implementation of the evaluation. All evaluation team members signed QED‘s 
confidentiality statement, which confirmed their commitment to keep verbal and electronic 
information collected from respondents safe and confidential. Interviewers‘ contractual letters 
of agreement explicitly stated that they should safeguard confidentiality of completed 
questionnaires, should provide all completed questionnaires to the supervisor at the end of 
each day, and should not discuss completed questionnaires with anybody except for 
evaluation team members. 
Informed consent was given before each interview (see ANNEX K and ANNEX L for 
examples of informed consent forms). During training, interviewers were instructed on how 
to request informed consent and use the forms. Interviewers ensured that the interview was 
conducted in a confidential setting, and that it was one-on-one with a respondent so no one 
else could hear the respondent‘s answers. They also assured respondents that their 
participation was voluntary and that they could choose to stop the interview at any time. 
Only evaluation team members had access to the raw data, which were kept in a locked file at 
QED headquarters. Data were not linked to names or organizations, but rather, used unique 
identifiers. The survey procedures did not request any information that could lead to the 
identification of a respondent. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
21
Data Collection Methods 
The team sought to collect a robust body of complementary qualitative and quantitative data. 
Document review. The early document review informed the study design and the next steps 
of the evaluation process such as tool development, selection of respondents, and sample 
selection. The location of surveys gave the team a sense of the context in which AFFORD 
was working and provided a thorough, informed foundation before the field work began. 
Key informant interviews. The key informant interviews were conducted by the team 
intensively at the beginning of the evaluation in Kampala and continued at a steadier pace 
throughout the survey and focus group work at similar locations. Team members took notes 
by hand which were then typed up and readied for coding by the data analyst. 
Client exit surveys and retail store survey. The client exit survey and retail store survey 
results were gathered personally by the team of Interviewers. They were then entered into an 
SPSS data base by the data analyst, cleaned, tabulated and subjected to a series of comparison 
analysis. 
FGDs. The focus group discussions were documented with an audio recorder, transcribed, 
and translated from local Ugandan languages into English. Observers also took notes on the 
discussions and noted their non-verbal observations in writing (for example; the observer‘s 
perception of the openness of the group, the flow of conversation, the group‘s acceptance of 
the facilitator/venue, discomfort/comfort with certain topics, etc.). The notes were analyzed 
by first extracting key words and phrases and organizing them by guiding topics/questions. 
Then, the FGD findings were compared with others. The evaluation team took care to note 
both common and uncommon remarks, opinions, and feelings shared by participants. 
Data Management and Analysis 
Key informant interviews: The qualitative data analysis included summaries of the views of 
key informants by region and by project objective to determine the most typical answers. The 
answers were grouped by the questions included in the interview guide, which are also linked 
to the evaluation questions. The responses were also grouped by region to explore regional 
differences. Standardized typical responses were synthesized based on the answers of the key 
informants. The most unusual answers were also reviewed to determine if there were any 
relationships between the informant‘s observable characteristics, such as location, education 
level, or position and these answers. 
Retail store survey and client exit surveys: Data analysis included descriptive statistics, 
cross-tabulations of different variables, and a comparison of intervention and comparison 
groups. Given the diversity of AFFORD‘s target groups, it was cost prohibitive to select a 
representative sample. By interviewing a convenience sample of people visiting a clinic or 
drug shop, the sample was intentionally biased towards those more concerned with health 
problems. Therefore, it is not appropriate to make statistically significant generalizations 
extrapolated to AFFORD‘s target populations. 
22
FGDs: FGD data were reviewed to anecdotally substantiate the findings from the quantitative 
data and key informant interviews. The FGD data was grouped by questions and topics from 
the FGD guide and then compared to the results of the surveys and key informant interviews 
to verify the results from these data sources. 
Data quality 
The evaluation team took great care to ensure the integrity of the evaluation process and data 
collection. Only experienced interviewers, most of whom had previously been trained as 
DHS surveyors, where selected. They were given thorough training and guidance by QED 
staff and were supervised daily. Each survey team had a supervisor who regularly checked 
data collector performance. Every evening, the team met for about one hour to debrief on the 
day‘s events, report obstacles, and ask questions about coding. Data was also reviewed for 
inconsistencies or outliers that required further investigation. 
Limitations 
The team had a finite amount of time and funding to conduct the evaluation. Activities 
needed to be completed rapidly in order for USAID to make course corrections for the 
remaining two years of the AFFORD initiative. In spite of AFFORD‘s broad reach across 
Uganda, financial limitations precluded the team from visiting every AFFORD district. As 
noted previously, the client exit interview sample was inherently biased because respondents 
were seeking services and potentially more aware of health products and behaviors. 
The results presented might overestimate the true effectiveness of the AFFORD 
interventions. Better performing retail outlets in the AFFORD districts could be due to the 
criteria applied by AFFORD to select target districts. In order to successfully achieve a goal 
of developing sustainable distribution network, AFFORD selected districts that have larger, 
more urbanized populations more likely to have a sufficient number of individuals able to pay 
for the socially marketed products. Therefore, it is possible that even without AFFORD 
activities, the drug shops in these districts are more likely to be successful enterprises and sell 
larger quantities and offer a greater variety of health products than similar stores in other 
districts. 
As mentioned, the sample for the client exit survey is biased towards people with a greater 
propensity to care about health and health products. In addition, given that AFFORD selected 
clinics to participate in the Good Life! program based on their commitment to comply with 
standards and promote healthy behavior, these clinics may have achieved more positive 
changes in health behavior than those in comparison districts even without AFFORD 
interventions. 
Finally, it is impossible to attribute some study findings—particularly changes in behavior—
directly to the AFFORD initiative. Other groups working in Uganda have been implementing 
social marketing programs since the 1990s, supported by a variety of donors including 
bilateral donors such as the US government (USG) and multi-lateral donors. Early on, the 
PilPlan and Injectaplan were introduced by USAID-funded Population Services 
International. At the same time, international agencies have used different funding sources to 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
23
implement similar activities such as HIV testing and counseling, mosquito net distribution, 
and distribution of condoms. Many activities have nation-wide coverage, such as distribution 
of socially marketed condoms by PSI and distribution of free condoms by MOH. By 
definition, these programs cover some of the same areas where AFFORD distributed 
Protector condoms. At the local level, most activities are implemented by local community￾based organizations (CBOs). Some of these CBOs have the option to implement AFFORD 
activities one week and activities for other international organization the next week. For 
example, the Malaria Consortium could distribute AFFORD-funded mosquito nets in one 
district, and simultaneously distribute the same nets for other organization in a neighboring 
district (with all nets coming from government warehouses). The scope of this study did not 
allow for the collection of comprehensive information for each district to account for the 
direct influence of the AFFORD interventions. But even with such data, it would be difficult 
to attribute behavior change to one particular project or intervention. 
24
Results 
This section presents the main findings of the AFFORD mid-term evaluation. First, general 
characteristics of the study population are presented. This information is followed by 
evidence of AFFORD‘s overarching achievements to date. The section concludes with 
specific results for AFFORD‘s three main objectives. 
Description of the Survey Respondents 
Based on the selection criteria, the team visited 12 districts with the respective numbers of 
respondents depicted in Table 4 below. Focus groups with POLs and community members 
were conducted in the four districts distinguished in bold. 
Table 4 Sample sizes for selected districts 
AFFORD Districts Comparison Districts
District
No. Respondents
District
No. Respondents
Retail 
Store
Exit 
Survey
Retail 
Store
Exit 
Survey
Arua 12 62 Nebbi 12 41
Kabarole 12 77 Kamwenge 11 47
Mbarara 10 53 Ntungamo 13 44
Wakiso 12 59 Mpigi 12 48
Masaka 10 62 Rakai 12 69
Jinja 12 56 Iganga 12 59
Mbale 12 68 Budaka 12 76
Lira 11 74 Pader 11 57
Gulu 11 67 Oyam 12 68
Kampala 12 67 n/a n/a n/a
Kiboga 12 61 n/a n/a n/a
Total 131 706 Total 108 509
There were few differences between the retail store survey respondents in the intervention 
and comparison groups (see ANNEX D): 44 percent interviewed were the proprietors; 74 
percent indicated that they had received specialized health or health care education without 
specifying the sources and type of education; and 96 percent managed the drug shop or 
pharmacy on a regular basis. One notable difference is that the AFFORD-targeted retailers 
had been in business longer than their comparison counterparts (6.6 and 5.2 years, 
respectively, p = 0.023). 
The average respondent in the client exit interview survey was 31 years-old with an average 
household of six persons, three of whom were children. The male/female ratio was 40:60, 
most likely because women go to clinics more frequently for services for themselves or 
children. There were some differences between AFFORD and comparison samples. The 
intervention group had a more balanced urban and rural mix (53 percent of respondents were
urban and 47 percent rural) than the comparison group which was primarily a rural sample 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
25
(29 percent urban and 71 percent rural). As noted above, AFFORD purposely targets urban 
districts. Also noteworthy is that while the client exit survey comprises two populations—
those exiting retail outlets and those exiting clinics—the sample is skewed toward the latter 
by design and more people were interviewed at clinics than in stores. Seventy-seven percent 
of all respondents in the client exit survey were found at clinics (78 percent were in clinics 
for the intervention group and 75 percent in the comparison group). 
Overarching Achievements 
The AFFORD initiative and its programs and 
products were visible in all regions visited and were 
well-recognized by target population groups. Ninety￾eight percent of drug stores and pharmacies visited 
sell at least one of the AFFORD/UHMG-marketed 
products, and 68 percent display advertisements for 
AFFORD/UHMG products or events. Among the 
retailers interviewed, 79 percent indicated that they 
saw, heard, or had participated in at least one of the 
AFFORD/UHMG shows or events.1 Additionally, 63 percent of client exit survey 
respondents indicated that they had heard, seen, or participated in at least one 
AFFORD/UHMG show or activity. This figure is higher for the AFFORD districts (66 
percent) than for comparison districts (53 percent) and the difference is statistically 
significant (p = 0.004). 
Two overarching achievements were mentioned by 
most key informants as indicators of AFFORD‘s 
progress. First, the AFFORD/UHMG partnership, 
comprised a diverse group of organizations, 
including several Ugandan partners, that implements 
its activities seamlessly under the AFFORD brand. 
Contributions of partner organizations are 
recognized by local and central authorities first as 
contributions of the initiative and second as 
individual achievements. This equal partnership is a 
result of the prime contractor‘s strong commitment 
to collaboration and development of a recognizable brand for the initiative. For example, 
JHU-CCP set an example by substituting any JHU-CCP branding of activities with the 
AFFORD brand. The partners admitted that this approach contradicts the interests of 
individual organizations in brand building, but they said they recognized the important role of 
this approach for the initiative‘s development and results. The unified branding also 
contributes to the transition from the USAID project to the indigenous organization. 
However, contributing to the foundation of UHMG, this approach may diminish the 
advantages for other indigenous organizations, such as PULSE Communications or CDFU. 
 
1
 Herein the references to AFFORD/UHMG shows and events does not include viewing of HIV/AIDS films or 
LLIN distribution; since these AFFORD/UHMG activities can be easily confused with similar activities of other 
projects or the MOH. 
AFFORD brings together 
different partners with different 
expertise, and draws from the 
strength of each partner. This 
was unique from other projects. 
—AFFORD implementing 
partner
From the inception of the project, 
MOH was in close collaboration 
with the project. Ministry 
participated in the development 
of the project strategies, in the 
trainings provided by AFFORD, 
design and placement of media 
information programs, etc.
—MOH official
26
Second, the AFFORD initiative has developed a strong, transparent relationship with the 
Government of Uganda at both the central and district levels and is recognized by 
government officials for staying in contact and coordinating well with local government 
bodies. AFFORD is working with all relevant MOH divisions: HIV/AIDS, malaria 
prevention, health promotion, child health, and family planning. AFFORD is recognized by 
these divisions as an important counterpart and engages them in ongoing dialogue to align 
their activities with government plans. The project follows MOH policies and, through MOH, 
coordinates activities with other projects. These include: malaria prevention/nets distribution; 
the health materials, training guides, and message campaigns in HIV/AIDS and FP areas 
developed by AFFORD and approved by the MOH. The initiative is known by—and has 
cultivated relationships with—government officials at every district visited by the evaluation 
team. AFFORD‘s designated focal persons within district-level government, usually the 
District Health Educator (DHE), work with other district officials to involve them in major 
events and activities conducted by the initiative. Key informants, especially at the central 
level, attribute AFFORD‘s good relationship with government authorities to the strong 
leadership and excellent performance of the chief of party and his team. 
Progress toward Meeting AFFORD Objectives 
AFFORD has achieved significant progress towards all its main objectives during its first 
three years of implementation. Achievements were validated through results from the retail 
store survey and client exit survey, and supported by findings from the key informant 
interviews and FGDs. The following results are presented according to AFFORD‘s three 
project objectives. 
Objective 1: Increase the accessibility and affordability of HIV/AIDS, reproductive 
health, child health, and malaria prevention and treatment products and services 
for communities and families in Uganda through innovative private sector 
approaches. 
Availability of new products 
Currently, AFFORD is distributing 12 
socially-marketed products and will begin 
distributing an additional product (a new 
brand of multivitamins that was not 
included in this evaluation) in the next few 
months. The 12 products include three 
already distributed by USAID: the 
Protector condom and PilPlan and 
Injectaplan contraceptives. Since 
September 2006, the initiative introduced 
nine other products to the market with prior 
approval of the Government of Uganda. Based on the results of the retail store survey, 97 
percent of drug stores and pharmacies sell at least one AFFORD-marketed product; however, 
outlets in the AFFORD-targeted districts are more likely to sell these brands (see Table 5). 
No significant differences were found between AFFORD-supported and comparison outlets, 
[AFFORD] is an innovation for marketing 
healthcare to people. Previously there was 
not [any] marketing for healthcare. It is 
sending out message[s] in very 
fundamental way[s]. It is not just ―buy 
condoms‖, but more comprehensive and 
catchy. The messages were not simple 
instructions, but they explain [to] people 
how to live a good life through good health.
—MOH staff
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
27
both for Pilplan and Injectaplan which have been on the market for a long time, as well as for 
the recently introduced products, NewFem and SoftSure.
Table 5 Products sold in retail outlets by study samples in retail survey 
Type of Product
Retail Outlets 
in AFFORD 
Districts
%
Retail Outlets in 
Comparison 
Districts
%
Difference
%
p-value
(2-tailed)
95% Confidence
Protector condoms 92 78 14 0.004*
"O" condoms 24 7 17 0.000*
Pilplan 93 88 5 0.181
Injectaplan 90 86 4 0.458
Moonbeads 18 7 11 0.007*
NewFem 5 2 3 0.141
SoftSure 7 2 5 0.052
Restors 76 51 25 0.000*
Zinkid 57 32 25 0.000*
Aquasafe 47 32 15 0.017*
Cotramox 29 12 17 0.001*
Sold at least one 
AFFORD product 99 95 4 0.077
AFFORD/UHMG were able to introduce and register products in response to rapidly 
expanding markets. For example, 63 percent of drug retailers reported an increase in sales of 
anti-diarrheal drugs for children over the last year. AFFORD/UHMG is working in this fast￾growing market with recently-introduced products such as ZinKid and Restors, which are 
sold in 45 percent and 64 percent of retail stores visited, respectively. HIV/AIDS-related 
products are another fast-growing market, with 51 percent of AFFORD retailers reporting an 
increase in sales of HIV/AIDS-related products (5 percent reported a decrease and the 
remaining showed no changes). UHMG is present in this market with the Cotramox brand, 
and 21 percent of retailers reported selling this UHMG-distributed brand for the treatment of 
opportunistic infections in people living with HIV. Finally, 58 percent of retailers reported an 
increase in sales of vitamins (4 percent reported a decrease with the remainder unchanged). 
UHMG is developing a new brand for multivitamins to enter this market. 
Popularity of products and services 
PilPlan, Injectaplan, and Protector are among the most recognized and used AFFORD￾marketed products. Key informants indicated that demand is high in all districts visited for 
the most popular product, Injectaplan. The retail store survey indicated 89 percent of 
AFFORD drug stores and pharmacies sell Injectaplan. Since drug shops are small 
commercial enterprises with limited resources, they stock only products that can be easily 
sold. Therefore, the availability of this and other AFFORD/UHMG brands in such stores 
indicates a high level of popularity for this product. Key informants and store sales persons 
suggested that this figure could be even higher if stores were allowed to administer 
28
injections.2
 Interestingly, key informants and FGD participants claimed PilPlan is a less 
popular contraceptive than InjectaPlan since it requires discipline to take pills daily and is 
more visible to family members. Nevertheless it is the most available product—sold in almost 
91percent of the drug stores and pharmacies visited. 
Protector condoms are well known but are not the most popular brand among those socially￾marketed in Uganda. Eighty-five percent of the retail stores sampled sell this brand. 
However, key informants indicated that Trust brand condoms (not an AFFORD-marketed 
product) are the most popular condoms and are consistently named most popular by store 
owners. Trust condoms and those condoms distributed free of charge by the Government of 
Uganda at government clinics have become more popular among Ugandans, with the latter 
providing competition to commercially-distributed brands. Only 61percent of surveyed drug 
retailers reported that sales of Protector condoms increased over the last year, while 77 
percent reported an increase in sales of other brands, although not necessarily those of 
USAID. 
Issues related to the popularity of Protector demonstrate how complex consumer preferences 
can be. On one hand Protector, successfully introduced in the Ugandan market earlier than 
Trust, appears to have become synonymous with ―condom.‖ When purchasing condoms, 
people request ―a protector‖ when in fact, they want the ―blue ones‖—the Trust brand. 
Despite its strong brand recognition, however, Protector seems to be haunted by quality 
issues. Prior to implementation of AFFORD, despite meeting technical specifications, there 
were complaints of Protector’s unpleasant odor and inconsistent fit. AFFORD worked to 
ameliorate these problems and procures the Protector condoms from the one supplier who 
has the best and most consistent quality. It is hoped that this will improve its popularity. 
AFFORD also implemented activities to increase access to services. The most visible and 
recognizable has been introducing standards of services for small, private clinics, and uniting 
such clinics under the Good Life! clinic brand. In 2007, AFFORD selected and trained staff 
from 100 private clinics in providing HIV treatment and counseling as well as using 
AFFORD/UHMG products. This training also promoted positive health behavior and 
common standards of health care services. These clinics later were branded as Good Life! 
clinics. Staff of an additional 100 clinics covering ten districts were trained in 2008. These 
clinics continue to collaborate with AFFORD, distributing the AFFORD brands, participating 
in trainings and providing HIV testing and counseling to people referred by POLs. They are 
provided with a Good Life! logo and other branding products, and often supplied by 
UHMG/AFFORD-branded healthcare products for distribution. The FGDs demonstrated that 
the Good Life! clinic brand is recognized by people in the community who visit these clinics. 
The branding of these clinics allows AFFORD to achieve its goal of increased access to 
quality healthcare by the population because the brand provides additional information and 
assurance that a Good Life! clinic services are at or above the standards of other clinics. By 
contrast, local MOH authorities are not very familiar with the Good Life! clinics yet. 
AFFORD progress on Objective 1 is clearly reflected in the Performance Management Plan 
indicator annual measures compared to the baseline set at the beginning of the project. For 
 
2 Note: The MOH prohibits drug store personnel from administering injections. However, many of them are 
unofficially performing this service for their clients.
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
29
example, the indicator, estimated couple-year protection attributable to UHMG brands of 
family planning products, increased steadily from 2006–2008, exceeding its baseline target 
for 2010 of 575,000 by achieving a value of 584,578 in 2008. The percentage of prospective 
retail outlets carrying AFFORD products came close to meeting its target in 2007 (25 percent 
baseline; 23 percent actual value). Similarly, the value of the indicator, number of private 
retail outlets carrying AFFORD products, exceeded its baseline estimate of 25,000 in 2007 
with 29,931. And, finally, AFFORD exceeded the baseline of the number of targeted condom 
service outlets (PEPFAR 5.1), in 2008—baseline 31,000; actual value 47,563. 
Targeting most-at-risk-populations 
In order to reach most-at-risk-populations 
(MARPs), AFFORD supported the establishment 
of a MARP network comprising 24 Ugandan non￾governmental organizations (NGOs) that work 
with specific at-risk groups such as commercial 
sex workers (CSWs), truck drivers, fishermen, 
and uniformed forces (military and police). 
Representatives of these organizations, which 
include Women at Work International (WAWI) 
and the Uganda AIDS Commission, suggested 
that their integration into the MARP network, 
along with training provided by AFFORD, allowed them to work more effectively. They 
exchange ideas and best practices and are able to collectively lobby their interests within the 
government. Notably, MOH informants recognized that using the term ―most-at-risk‖
allowed the government to start working with CSWs, which was previously impossible 
because prostitution is illegal and not recognized at the official level. 
AFFORD support to the MARP network 
also includes distribution of condoms to at￾risk populations in bars and video salons. 
Key informants pointed out that sales of 
condoms provided by AFFORD allows some 
CSWs who sell the condoms to generate a 
significant amount of additional income, 
which enables them to quit prostitution. In 
addition, the MARP network established 
several ―referral‖ clinics, where MARPs can 
receive HIV counseling and testing 
discreetly. AFFORD provided test materials 
and training to the clinics and mobile testing 
centers operated by WAWI. This approach 
led to testing of a population that was 
previously deterred from seeking services. 
The biggest credit for AFFORD goes 
that they started working with the 
groups of population that [were] not 
covered before. This is the only 
agency that started to work with 
commercial sex workers, and this 
really opened this line of work within 
ministry, commission, etc.
—Representative of AFFORD 
partner organization
In some remote areas, sex workers are 
difficult to help. Like in Hima which had 
many people with HIV/AIDS, the sex 
workers …are not easily identified among 
population...with support from AFFORD 
we identified several sex workers one-by￾one and trained/educated them to be a 
peer-to-peer educators.... As the results, 
sex workers started using condoms. 
Thanks to AFFORD the condoms became 
affordable and sex workers are buying 
and using them.
—Representative of a MARP 
network organization
30
Objective 2: Enhance knowledge and correct use of HIV/AIDS, reproductive health, 
child survival, and malaria products and services to encourage and sustain healthy 
behavior and lifestyles within communities and families. 
Interventions to enhance awareness of products and services 
AFFORD conducted several health promotion campaigns during the period October 2005 to 
October 2008 (see ANNEX A). At the time of data collection, most of these had finished, and 
the initiative does not plan to renew these campaigns during its remaining years. These 
campaigns include: Good Life! show on television and radio and related activities such as 
prize drawings under the brand of the Good Life! show; Under the Mango Tree radio show; 
PULSE activation campaigns and HIV/AIDS films and other radio spots. AFFORD is 
continuing its POL program and Everyday’s Health Matters newspaper, but both are planning 
to phase out soon. Finally, AFFORD and UHMG are planning to start direct advertisement 
campaigns on television and radio for the products distributed by UHMG. 
The health promotion campaigns are highly visible 
and recognized in areas where they were available. 
For example, the Good Life! show on television was 
very popular in the Central Region that has high 
television coverage, and the initial broadcast in 2007 
was re-aired in 2008 with great success. About 63
percent of respondents in Kampala and Wakiso 
Districts indicated that they had seen the Good Life!
show on television. However, this show is not widely 
known outside the Central Region due to the low 
availability of television and also because the show 
was not translated into local languages. The 
proportion of client exit survey respondents in other 
districts who indicated that they watched the show varied widely from as low as 1 percent to 
as high as 38 percent. However, these districts more evenly received the radio version of the 
Good Life! show. In nine districts, over 50 percent of the survey respondents indicated that 
they heard the Good Life! show on the radio. 
Under the Mango Tree radio shows are also popular in the districts outside Kampala because 
they were aired in local languages by local radio stations. In northern districts of Uganda, 59 
to 78 percent of respondents indicated that they listened to this show. Some district officials 
suggested that if district communications specialists received training on how to produce such 
shows, they would likely continue production of similar shows on their own. 
Finally, statements by some distributors of UHMG products indicate the PULSE activation
and related promotion events greatly increase demand for health products in days following a 
show—especially UHMG brands. The retail store survey revealed that respondents noticed an 
increase in demand for AFFORD/UHMG-marketed products after the promotion campaigns. 
Among those retailers who heard or participated in meetings with community leaders to 
discuss health-related issues with AFFORD/UHMG, 73 percent said they observed increased 
demand for the products. The PULSE activation reported increased demand for the products 
from 44 percent of retailers who heard or participated in the show. However, since these 
activities had local scope, the number of stores who reported increased demand in the overall 
sample of the survey was low. 
UHMG is doing very well in 
terms of providing messages, 
and this messages should be kept 
in local languages, especially the 
health seeking behavior. They 
should make sure that this 
continues on radio and in signs 
with a reach to rural areas. This 
is an important service that they 
are providing. 
—District MOH official
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
31
Because of the intensive media 
campaign and sensitization, many 
youths are now using condoms. 
Every once in a while adverts are 
played on radios reminding people 
to mind their lives, to be 
responsible—to use condoms.
—Focus group participant
A larger effect was observed for the nation-wide campaigns. A total of 61 percent of retailers 
who heard the Good Life! show on radio and 35 percent of those who saw the show on TV 
reported increased demand for the products after the show. These stores constitute 35 percent 
and 10 percent of the overall survey sample, respectively. Please refer to ANNEX N for more 
detailed information. 
The POL program is one of the most 
successful AFFORD programs and is in 
great demand by district officials. In 2007, 
AFFORD engaged an outside organization 
to evaluate the POLs performance (Wilsken 
Agencies, Ltd 2007). The report found that 
the POLs were accepted and trusted by 
community members, who noted that their 
health behavior changed for the better as 
they increased their purchasing of healthy 
products. 
Under the current evaluation, key informants, especially district representatives, provided 
positive feedback on the POL program and expressed interest in extending it in their districts. 
The Government of Uganda has a similar structure in place already called Village Health 
Teams (VHT). The VHT program, which is currently being rolled out in every sub-county in 
every district, is designed to promote good health in the community through the actions of 
local representatives. District health officials view the two programs as complementary. 
During outreach planning, when health officials roll out the VHT structure, they take into 
account the existence of a POL program. The Government of Uganda has confidence in the 
AFFORD-trained POLs and chooses to use them for the core of the VHT program. AFFORD 
staff meet with POLs quarterly and monitor their activity forms. This simple form records the 
nature of POLs‘ interactions with groups and individuals, noting such things as topics 
discussed and questions asked and answered. The forms help AFFORD learn more about 
demand from the community and how to modify future training and job aids. 
Use of products and services and effect on health behavior 
The respondents of the retail store survey indicated 
market growth for the categories of health products 
distributed by AFFORD—although not necessarily 
for the AFFORD brands. Survey results indicate that, 
depending on the category of the product, between 
52 percent and 77 percent of stores experienced an 
increase in sales over the last year. During that same 
time period between 4 percent to16 percent of stores 
reported a decrease in sales of the same product 
categories (see ANNEX N). As discussed in the 
previous subsection, the same survey suggests that AFFORD health marketing campaigns 
increased demand for health products, at least temporarily. It should be noted that reported 
increases were subjective opinions of retailers, and the amounts of the increases (i.e., 
numbers of extra products sold) could not be quantified from the survey results. 
There are also cases when POLs helped 
community members to change negative 
cultural behaviors. For example, [a] 
person gave a birth in the village, and 
according to the culture she supposes to 
participate in a ritual in four days. 
However, she had serious complications 
from the birth, and POL insisted that she 
got to hospital [and she did]. 
—Focus group participant
32
Table 6 provides views of clients exiting clinics and retail shops regarding improvements in 
their health behavior during the past three years. The most improved behavior came in the use 
of mosquito nets, visits to health clinics, pharmacies and drug shops, and treating water. 
Among the eight products and services queried, only three were more likely to have 
improved in the AFFORD districts compared to comparison districts: mosquito nets, water 
treatment, and the use of condoms to prevent HIV. 
Table 6 Reported increased use of products and services by clients 
Question: Over the last three years, did your personal behavior change (increased use) in 
regard to the use of…
Product or Service
AFFORD 
District
%
Comparison 
District
%
Difference
%
p-value
95% 
Confidence
mosquito nets 61 55 6 0.0373*
water treatment for drinking water 
(through boiling or tablets) 52 42 10 0.0007*
vitamins and mineral supplements 20 17 3 0.2343
condoms for family planning 18 14 4 0.0987
pills, injections or other contraceptives 15 12 3 0.1432
condoms or other products to prevent 
HIV 29 21 8 0.0028*
visits to health clinics 55 53 2 0.6564
visits to pharmacies and drug shops 45 45 0 0.9603
Conversations with key informants supported the findings of the survey about increased use 
of condoms. District MOH officials suggested that people quickly started choosing free 
condoms from government clinics as soon as they were available. Previously, the same stock 
would have remained on clinic shelves for months at a time because of low demand. Now, 
despite the steady supply of condoms from the government, these supplies are gone within 
days of receipt because of high demand. Although increased demand for the free condoms 
does not necessarily imply increased usage for family planning or prevention of HIV and 
other sexually transmitted infections in conjunction with the results of exit survey, it does 
provide additional evidence for the behavior change with regard to condom use. 
Besides distribution of socially-marketed drugs, AFFORD participated in distribution of 
LLINs. More than 577,000 nets were distributed in 118 sub-counties in 2007 and more than 
453,000 were distributed in 100 sub-counties in 2008. LLIN distribution is a highly visible 
activity of AFFORD, which is recognized by district authorities. These authorities report they 
observed a corresponding reduction of malaria cases in sub-counties where nets were 
distributed and requested further net distribution to the sub-counties not covered by previous 
efforts. 
Several indicators suggest overall improvements in health status and positive health behavior 
in Uganda that coincide with the three years of AFFORD‘s implementation. While this study 
cannot definitively determine a causal relationship, evidence suggests that AFFORD 
activities may have played a part in stimulating positive changes in health behavior. Key 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
33
informants in the districts outside Kampala noted that health conditions had notably improved 
in the last three years, especially in terms of people suffering from malaria and HIV/AIDS. 
Childhood illnesses were reduced and the use of family planning increased. District health 
authorities also provided anecdotal evidence that distribution of LLINs changed health 
behavior in families with children. In a significant number of cases, nets are used to protect 
the youngest children in families. About 59 percent of the client exit survey respondents 
indicated that they increased use of the mosquito nets, and 51 percent indicated an increase of 
the mosquito net use by family members. 
Focus groups and key informant interviews provided anecdotal evidence that POLs positively 
influence health behavior. In particular, people became more aware of specific products and 
health behavior habits such as purifying water, either by boiling or with tablets, giving birth 
at health facilities, and receiving HIV counseling and testing. Yet only 8 percent of the client 
exit survey participants indicated that they participated in meetings with community leaders 
organized by AFFORD, which are most probably the meetings led by POLs. 
Key informants from the MARPs network reported that AFFORD has had a positive 
influence on its target populations. In particular, they indicated that CSWs and other at-risk 
groups have started using condoms more often, and even learned to demand condoms from 
partners or to market sex without condoms as a more expensive service. AFFORD also 
facilitated access to HIV testing that was previously unavailable because of fear of legal 
prosecution for engaging in prostitution. Since fear of prosecution is still a significant 
concern among CSWs and the doctors providing services, information about uptake of 
services was not recorded during this study. 
The surveys also provide some evidence of the impact of AFFORD activities on behavior. 
For example, 66 percent of respondents who heard or saw at least one of the AFFORD 
electronic media shows said they had increased use of mosquito nets, compared with only 33 
percent among those who did not see or hear the shows. In general, the percent of positive 
changes in behavior is significantly higher than the percent of negative change. And among 
those respondents to the client exit survey who indicated either positive or negative change in 
their health behavior, 55 to 76 percent had heard or participated in at least one of the 
AFFORD health promotion activities. However, this evidence is only suggestive. Attribution 
of impact to AFFORD would require a more complex study that can statistically exclude the 
impact of other public health campaigns that are ongoing in Uganda. 
AFFORD performance measures related to Objective 2 illustrate the initiative‘s good 
progress. For example, AFFORD met the 19 percent target in 2007 for percentage of women 
in reproductive age using pills, injectables, condoms. Over 20 percent of persons used 
condoms for family planning: in AFFORD districts, the upper bound percentage for pills or 
injectable use was 34 percent compared to 26 percent for control districts. AFFORD reached 
its 2008 target, 100, of number of service outlets providing counseling and testing according 
to national or international standards (PEPFAR 9.1). By 2008, AFFORD had reached 50 
percent of its target for number of individuals who received counseling and testing for HIV 
and received their test results, disaggregated by sex (PEPFAR 9.2): 26,706 out of 40,000 
targeted by 2010. Finally, AFFORD already exceeded its life of project target of 44 million 
litres of water made safe to drink with AquaSafe with an impressive 155 million litres. 
34
Objective 3: Strengthen and establish an indigenous organization and distribution 
systems for the sustainable and self-sufficient delivery of key health marketing 
functions, including management, distribution, and promotion. 
At the end of the first year of implementation, 
AFFORD registered and established UHMG as 
a Ugandan organization. UHMG continues to 
evolve and develop but already acts as a full￾scale partner of the AFFORD initiative. UHMG 
has gradually taken over social marketing 
activities and has introduced more products to 
the market. These products are introduced at 
prices that allow full recovery of the product, 
packaging, and distribution costs, meaning that 
the foundation for the sustainability of UHMG 
is already in place. However, this organization 
needs further development and support if it is to 
survive on its own. 
Establishment of UHMG 
AFFORD took early, critical steps to achieve its third objective. The UHMG was officially 
registered in October 2006 and has a statute, work plan, operations manuals, and other formal 
documents developed in consultation with international experts that meet national 
requirements. UHMG has an active board of directors currently comprising Ugandan 
nationals representing the directors and managers of the AFFORD partner organizations that 
established UHMG. UHMG also has a managing director, Dr. Magumba, who has worked 
with the organization for over two years, and four directors –director of finance and 
administration, director of programs and services, director of operations, and director of 
research and monitoring. The director of research and monitoring position was not filled at 
the time of the evaluation. UHMG also employs 37 staff members (see ANNEX B) that were 
transferred from AFFORD.
Transition of social marketing activities 
The current AFFORD strategy is to gradually transfer all social marketing activities to 
UHMG. The project envisions that the UHMG will assume such social marketing functions 
on the AFFORD project as product development, distribution, and promotion, as well as 
research and evaluation. 
The current project plan is to transfer all social marketing activities to UHMG or other local 
partners, and to use some of the international experts as part-time advisors to these 
organizations. AFFORD is planning to implement this transition by fall 2009. However, key 
informants admit that the current capacity of the UHMG staff is insufficient to fully replace 
support from international experts and that further training and close collaboration with 
international experts is still necessary to maintain the quality of the work. 
Key informants suggested that for an indigenous organization to be viable, it needs 
individuals in top management positions who are not only qualified to lead the organization, 
but who are also determined to stay with the organization through the early, fragile stages of 
development—even if there is a risk of a decrease in their income. The interviews with 
AFFORD’s creation of UHMG was 
exceptional. Many projects have been 
initiated and ended like AIMS and 
UPHOLD but no project had such an 
initiative…. Projects like [AIM and 
UPHOLD] started, work some time, 
and then abruptly end. The only thing 
that is left is the Land Rover they gave 
to UNESCO. [AFFORD represents] 
good practice for building indigenous 
organizational capacity.
—MOH Staff 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
35
UHMG‘s current top management suggest that 
these individuals have extensive experience 
working with international projects and had 
previously moved from project to project every 
two to three years. All of them admitted that 
what attracted them to work with UHMG was 
the possibility of a much more stable job, even 
if it offered a lower income. 
Steps toward sustainability 
UHMG has taken notable steps to secure additional sources of funding and to improve its 
financial management capabilities. The Director of UHMG is involved in the development of 
several project proposals to USAID, and UHMG is currently a local partner for two other 
USAID-funded projects. Still, most of the business development activities, including the 
participation in these two projects, were conducted under close supervision and in 
collaboration with the current international partners of the AFFORD project. 
Though most attention is devoted to the USAID projects and related financial management, 
UHMG management is also meeting with other donor organizations to explore funding 
opportunities. UHMG commissioned a strengths, 
weaknesses, opportunities, and threats (SWOT) 
broad analysis by an independent evaluator and 
currently is undergoing a process to establish a 
negotiated indirect cost recovery agreement 
(NICRA) with USAID. UHMG has also started 
developing a medium-term financial plan. 
AFFORD‘s work with the private sector to develop 
its distribution network is widely and favorably 
recognized by key informants as a unique and 
promising practice. This distribution network has 
been transferred under the UHMG management to 
provide a foundation for sustainability of the 
organization‘s distribution activities. UHMG 
provides products to 12 regional distributors, which 
are assigned districts by AFFORD, although their distribution is not limited to these districts. 
The distributors store products in the districts, and sell them to retailers at the prices 
recommended by AFFORD. In return, they receive a set margin to generate profits. Larger 
retailers also sell products to small retailers, such as drug shops and to individual customers. 
Finally, small marketing entrepreneurs—individuals who receive drugs from AFFORD 
distributors or large retailers—sell them in remote villages where the drugs are not otherwise 
distributed using AFFORD-branded bicycles. 
Although the distributors are assigned to particular regions, they are not limited to distribute 
products only in the districts of the assigned region. Distributors also work in districts not 
targeted by AFFORD as well as in the targeted districts. However, in the AFFORD-targeted 
districts the project refers retailers to the distributors as a part of other project activities. 
About 79 percent of respondents to the retail store survey in AFFORD-targeted districts and 
One of the major decisions/lesson 
learned was to begin to visualize the 
indigenous organization from the day 
one. When recruiting people, we were 
looking for people who will stay with 
the organization after the project ends.
—AFFORD senior staff
[Having the] Initiative go to 
private sector is important
because in Uganda, people try to 
seek help in the private sector 
before going to government.
—Partner staff
AFFORD is unique because it is 
targeting private sector. Other 
organizations are targeting the 
public sector, and only on a 
limited level [are they targeting] 
the private sector. 
—MOH official
36
about 54 percent of respondents in comparison districts indicated that the drug 
shop/pharmacy received supplies from an AFFORD/UHMG distributor. 
Conversations with distributors and drug shop owners also revealed several weaknesses with 
distribution. First, there is poor communication between shop owners and distributors. The 
distributors do not survey the needs of the shops before bringing drugs to a specific area. As a 
result, there are situations when a distributor cannot satisfy the needs of store owners for a 
particular product, although this product is available in the warehouse. Another problem 
resulting from this lack of coordination is that store owners may spend financial resources on 
other products before a distributor comes to the shop, although store owners may have 
preferred to wait a day and use these resources to purchase the AFFORD products. 
There is also limited awareness among shop owners about the AFFORD distribution network. 
A lot of small drug shop owners purchase their supplies from local shops and pharmacies 
instead of contacting distributors directly because they do not have contact information for 
the distributors. Finally, the store owners complained about their limited basic knowledge and 
information about AFFORD products, especially side effects and advantages of 
contraceptives such as SoftSure, NewFem, and Pilplan. They noted that information provided 
with the products is too short and too general. They requested more specific information in 
order to provide educated recommendations of these products to their customers. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
37
Discussion 
This section discusses the findings of the AFFORD mid-term evaluation to: a) validate 
results; b) identify effectiveness and further potential of activities; and c) assess the future 
sustainability of UHMG. 
Framework for the Discussion 
There are two main approaches to social marketing recognized by researchers and 
practitioners: the NGO model and manufacturers‘ model (Armand 2003). Under the NGO 
model, an organization takes on the functions of branding and distributing products provided 
by manufactures or donors, often by creating its own distribution network and retail outlets. 
This limits the organizations‘ control over the cost of the products; and often makes the 
distribution of the products unsustainable without donor funding. The manufacturers‘ model 
implies that social marketing is conducted in partnership with manufacturers of the products, 
who are often responsible for branding and distribution of the product. The advantage of this
approach is that the manufacturer has control of costs and usually sets the price of products 
above the cost to ensure sustainability. A disadvantage is that often, after completion of a 
project, manufacturers decide to increase the price of the product which negatively affects 
distribution and coverage. 
Development of social marketing concepts under financial limitations of government and 
donor funding resulted in the development of hybrid models, such as the total market 
approach to social marketing (Pollard 2007). Total marketing intends to reduce the financial 
burden of achieving a social goal by increasing targets for free or subsidized products to the 
poorest segments of the population while increasing the proportion of the population that 
buys the products on the commercial market. The approach is to introduce specialized, low￾cost, mass-produced products on the market specifically targeted to the low-income groups 
that cannot afford products currently available on the market. At the same time, these 
commercially distributed products should be more attractive than the free or subsidized 
versions. Social marketing is used to create an increased demand for these and other 
commercially available products on the market. The marketing campaigns are supplemented 
by efforts to create supply and distribution systems for the low-cost products. 
The success and sustainability of the total market approach depends on several factors, some 
of which are not necessarily under control of social marketing projects: 
1. There should be sufficiently large, unsatisfied demand for low-priced, socially￾marketed products, so the high-volume of the market can compensate for the low 
profit margin on these products. 
2. The existing market organizations (public and private) have logistic and management 
capacities, both to handle the volume and provide low-cost manufacturing and 
distribution of these products. 
3. The commercial market should be willing to expand into the low-income population 
segment with low-priced products. One of the conditions to achieve this goal would 
38
be that the low-priced products do not enter the high-profit segments and do not 
substitute the currently available high-profit products. 
Validating Project Results 
AFFORD is a social marketing initiative that includes all three major goals of social 
marketing in line with the total market approach discussed above. Objective 1 of the 
AFFORD initiative—increased availability and access to the products—corresponds to the 
goal of delivering affordable health products to low-income population. Objective 2 of 
AFFORD was designed to achieve the social goal of increased use of the health products and 
adoption of positive health behavior. Finally, Objective 3 of AFFORD aims for sustainability 
of the initiative. It was designed to sustain the social marketing achievements by coupling 
them with commercial groups in a total marketing approach. Below is a discussion of the 
current project results which demonstrate progress towards achieving its objectives. 
Maximizing product sales and delivery
AFFORD is clearly on the way to successfully achieving Objective 1 of the project, as well 
as one of the main components of the social marketing framework, which is to increase 
availability of low-cost products to the population. The pure numbers indicate that sales of 
USAID socially-marketed brands (Pilplan, Injectaplan, and Protector) are increasing (Table 
7). Protector sales started in 1993 with volume of about 1.8 million condoms sold. At year 
three of the AFFORD initiative sales reached 17.4 million. Similarly, Pilplan started in 1993 
with sales of 66,000 packs. In 2002 (during the implementation of the predecessor of 
AFFORD) sales were about 970,000; and in year three of AFFORD project, the sales volume 
is now above 1.5 million. Finally, Injectaplan was introduced in 1996 with sales volumes of 
4,000 packs. By 2002, sales volume had hit 540,000, and by the third year of AFFORD 
implementation over 1.7 million packs had been sold. These brands also are now widely 
available on the market—sold in 85 percent to 91 percent of private drug stores in the 
counties surveyed, depending on the product. This important result, however, is a success that 
can only be partly credited to AFFORD. The studies conducted by AFFORD‘s predecessor 
showed, for example, that in 2000 Protector condoms were available in 91 percent of 
pharmacies and 86 percent of drug shops (Commercial Market Strategies 2003). Only 
Injectaplan demonstrated an impressive 110 percent growth in sales between year one and 
year three of the project. 
Table 7 Comparison of USAID brands availability and sales 
Product Availability in 
Retail Stores
Before 
AFFORD
(2000)
%
At 2009 
Mid-term
Evaluation
%
Sales Volume 
Before AFFORD
Sales Volume 
After AFFORD 
(2009 Evaluation)
Pilplan n/a 91 970,000 (2002) 1.5m
Injectaplan n/a 88 540,000 (2002) 1.7m
Protector 86 85 1.8m (1993) 17.4m
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
39
One of the reasons for these results may be saturation of the market with condoms targeted at 
the lowest-income population group. The saturation of this market segment would imply that 
any further growth of the sales for Pilplan and Protector is only possible through substitution 
of other socially-marketed brands. The problem of competition between socially-marketed 
brands of health products distributed by different donor campaigns remains unresolved in 
Uganda. In their study in 2003, the Commercial Market Strategies project in Uganda found 
that the Protector and Lifeguard condoms (distributed by Marie Stopes) traded market shares. 
Since 2006, in addition to these two brands, there was a Trust brand introduced to the market. 
Provision of socially-marketed brands by a number of donors creates a large supply and great 
availability of the products. However, while one brand may command the highest market 
share, the total market (and, therefore, the total use of these products) is unlikely to change. 
Although a goal of social marketing is to increase demand for all socially important products, 
(and, therefore, for all brands of low-cost condoms) the basic marketing principles still apply. 
The necessity to achieve distribution goals for a specific brand requires more resources to 
protect the existing market share. As a result, fewer resources remain for market expansion. 
Therefore, the saturation of the market with multiple products leads to inefficient use of 
donor resources unless a concurrent effort is made to increase the size of the total market. In 
this sense, the AFFORD model is ideal because it combines behavior change communication 
alongside efforts to boost supply. It should be noted that widespread, sustained distribution of 
free condoms can destroy the commercial market for products in the same market segment. If 
that happens it may become impossible to achieve long-term sustainability of a product 
market without continuing external funding of subsidized brands. 
A significant achievement of the AFFORD initiative is the introduction of nine new brands of 
health products. These products are targeted at an income group slightly above the poorest 
population. This is an important step that allows a division of the low-income market into two 
separate parts: one that is capable of paying at least the at-cost price and another that is not. 
This differentiation is important for the introduction of the total market model because it can 
lead to commercial sustainability of at least part of the market. As mentioned earlier, the 
important element to ensure such sustainability is the size of the market segment that can pay 
at cost. 
Influencing a target population to achieve a social goal 
Objective 2 is the core of AFFORD‘s social marketing component. The initiative introduced 
and completed a variety of health promotion programs and activities in order to achieve 
increased use and adoption of healthy behavior. A number of these activities, such as the 
Good Life! show on television and radio, Under the Mango Tree radio show, and HIV/AIDS 
films, are well-recognized by the population and were listened to and watched by 
significantly-sized audiences. Other activities, such as the PULSE activation, and, especially, 
the POL program, are less well-known to the general population because of their local nature. 
However, these activities are also regarded as highly effective and innovative by district 
authorities and community members in the areas where they were implemented. At the time 
of evaluation, most of the health promotion activities connected to the initiative had been 
completed and there were plans to concentrate on product advertising for the remaining life 
of the project. Therefore, activities supporting Objective 2 can be considered almost 
completed at this point. At this early point in the initiative, the evaluation could not determine 
the impact of these activities on health behavior. The market response to the social marketing 
40
campaigns of AFFORD is reported by some drug shop owners to have increased the number 
of customers for AFFORD products. However, the behavior change or stable market response 
could only be verified and become visible more than a year after campaigns end. There is 
some indication of a relationship between the AFFORD activities and positive changes in the 
health behavior. 
It is important that—as noted above—AFFORD experienced limitations inherent to all social 
marketing projects, especially ones that are based on the NGO model. Most of the successful 
health promotion campaigns implemented by AFFORD cannot be sustained without external 
funding. As described earlier, the most highly regarded health promotion campaigns are the 
Good Life! show and POL program. These programs also are very costly. The television time 
to run the Good Life! show and the production costs are the most expensive parts of the 
promotion campaign. If these costs are distributed onto the socially-marketed products in the 
total market model, it could put the products out of reach of the target low-income group. 
There is a similar dilemma regarding the POL program. By design, the POL program has 
very limited geographical impact since each POL covers only a small catchment area. 
Further, the POL program is dependent upon the motivation of each volunteer and material 
support (through free drugs, raincoats, bikes) by the initiative. Although the cost of a single 
POL is relatively low, the program could have significant influence on the health behavior of 
the population and reach its social goal only if current pilot activities are scaled-up though the 
country. There is an expectation from local health officials and NGO partners that UHMG 
will continue health promotion activities after the completion of AFFORD. Unfortunately, 
due to the nature of these activities and absence of government funding, it seems unlikely that 
they can be conducted by local organizations without external financing from donor 
organizations. 
Sustainability of social marketing results
At the time of the evaluation, AFFORD also was on its way to achieving Objective 3: 
creating a sustainable, indigenous social marketing organization. UHMG was created, 
registered, and has been functioning for at least two years. AFFORD is gradually transferring 
staff and responsibilities for social marketing activities to UHMG. It has also adopted a 
model to transform the international experts (who started AFFORD) into short-term UHMG 
consultants in order to facilitate further capacity building. Key informants—including MOH 
officials, USAID, NGOs, international partners, AFFORD/UHMG partners—indicated that 
AFFORD has already achieved more in creating an indigenous organization than other, 
similar international projects have achieved at this point in their life cycle. In the opinion of 
these informants, the early establishment of UHMG and the steps taken to transfer 
responsibility for key organizational functions and activities is one of the promising practices 
introduced by AFFORD. 
The expressed willingness of senior managers to stay with UHMG despite lower salaries 
demonstrates their strong commitment to the organization. Such commitment, if fulfilled, is 
necessary but insufficient on its own to ensure sustainability. And while current UHMG staff 
was trained and obtained experience in social marketing, they lack skills in fundraising and 
organizational management and development—all essential skills for the sustainability of the 
organization. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
41
Objective 3 of the program is clearly aimed at creating a commercially-sustainable structure 
according to the total market model discussed above. As mentioned, AFFORD introduced 
nine new products that allow market segmentation into two groups, those able to pay and 
those who can‘t. Another important component for this model‘s success is the existence of a 
sales and distribution network that can handle the volume of the products necessary for 
sustainability. An operational distribution network that does not require significant financial 
support and therefore, should continue to function independently after AFFORD‘s work ends. 
Operations management for product development, marketing, and distribution has already 
been transferred to UHMG. For all brands, except USAID-supported brands, operations are 
conducted on a cost-recovery basis. Although the private distribution network has an 
incentive to support the distribution of a product if there is commercial interest, observations 
by the evaluation team showed that current distributors and store owners are not sophisticated 
in business methods and often fail to establish efficient communications with each other for 
the purpose of exchanging information about current needs for supply of particular product. 
As a result, the current profit margin of the socially-marketed products is sufficient for 
distributors as long as there is external support for cultivating new clients, promoting 
products, and ensuing consistent stock. In part, this is the expected result for a total market 
model at the early stages, when the at-cost market is just developing. As mentioned earlier, an 
important condition for the sustainability of the at-cost market segment is sufficient size of 
the market. The nine new products for this market segment were introduced by UHMG only 
one or two years ago and currently these products are present in about one-fourth of the drug 
stores surveyed. Still, this reach may not be sufficient for sustainability. 
At the moment, UHMG/AFFORD plays a significant role developing the market, in bringing 
new customers to product distributors and informing distributors about the need to bring 
products to stores. Because stores do not call distributors for new batches of products and 
distributors do not regularly survey stores for their needs, the sustainability of the distribution 
network in the absence of AFFORD is questionable. 
Key informants, and UHMG distributors in particular, indicated that there are also some 
operational problems with product distribution, such as low quality of packaging, incorrect 
invoices, and poor coordination between retailers and distributors. However, these are minor 
problems that UHMG is well-equipped to handle and the organization already is taking steps 
to resolve some of them, including changes in packaging technology and the templates for the 
receipts. 
Therefore, although the initiative achieved admirable progress towards the third objective, 
there is still significant work to be done in the next two years to ensure that UHMG has 
sufficient institutional capacity to be sustainable. 
Effectiveness of AFFORD Activities 
At this point of implementation, it is too early to expect measureable impact or observed 
results to specific AFFORD activities. Yet, there are some indications from key informants 
that AFFORD activities are effective. Here, we look at the effectiveness of AFFORD from 
two perspectives: first, the effectiveness as a USAID project and second, the effectiveness of 
specific project activities. 
42
Key informants suggested that the AFFORD team is functioning effectively and efficiently. 
One of the indicators noted by these informants was the absence of any visible conflict 
between implementation partners. Uncoordinated activities and compartmentalized project 
work in which each partner implements assigned activities as separate project are common 
problems observed in unsuccessful projects. There is no evidence that this is happening with 
AFFORD. From direct observation and interviews with project employees and partners, it 
seems that different implementation partners share information and coordinate activities well 
within the organization and with external stakeholders. 
Conversations with stakeholders suggest that the initiative‘s success could be attributed to the 
professional skills and strong leadership of AFFORD. The choice of strong and well￾qualified leadership is one of the AFFORD best practices. The leadership style was essential 
to developing and maintaining good relations with the central and local government, as 
mentioned by the key informants. Good leadership was instrumental in uniting all AFFORD 
partners around the idea of branding all initiative activities as AFFORD rather than as 
activities of individual partners. AFFORD leadership identified and involved other partners, 
such as the NGOs of the MARP network, with relevant expertise. Finally, good leadership 
was the impetus behind the early development of UHMG. 
There are also indications that AFFORD is effective at social marketing. The data collected 
during the evaluation suggests that health promotion activities reached up to 30 percent or 
more of the intended audiences (see ANNEX N), and there is evidence of a relationship 
between these activities and positive changes in health behavior of the population. If we 
assume that drug shops are small commercial enterprises that can only carry the products that 
they can sell, then the availability of the products in the shops also indicates the demand for 
AFFORD products. At least one of the AFFORD products is available in 99 percent of the 
drug shops in target districts, and 95 percent in comparison districts (see Table 4). This 
evidence suggests that the social marketing communication campaign was successful in 
creating at least temporary demand for these products. 
One of the reasons for this success may be the fact that AFFORD went beyond the ―standard‖
practices for social marketing that relies on use of multimedia campaigns. AFFORD used 
complementary communication techniques to reach different audiences: The Good Life! show 
on television had a high success rating. It engaged people and stimulated their interest in 
health questions posed on the program. It is a multimedia technique that uses an unusual 
format of a game-show to draw viewers and stand out from other programs and 
advertisements on television. Yet it is only accessible to those who are English-speaking and 
live in areas that have access to Ugandan television programs. 
The POLs program uses a completely different format to extend health messages into rural 
areas. It is highly regarded by district officials, and there is evidence it has positively 
influenced health behaviors. Unfortunately, because each POL has a very limited catchment 
area and the program was implemented in only several districts, the overall marketing effect 
of the program was small. Only 8 percent of client exit participants indicated that they 
participated in meetings with POLs. However, the POL activities as a pilot for a new 
approach to social marketing demonstrated strong potential if implemented on a larger scale. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
43
Promising and best practices 
The results of the evaluation and opinions of the key informants who are experts in social 
marketing suggest that AFFORD was successful in developing and implementing promising 
and best practices for the development of a sustainable hybrid social marketing model based 
on total market approach. These practices include: 
Reliance on private distributors and distribution network for sustainability: One of the 
successful features of AFFORD is its reliance on the private sector for distribution. Key 
informants remarked that social marketing projects in Uganda and elsewhere usually develop 
a new NGO-owned distribution network and cooperate with government health facilities. 
However, officials of the Government of Uganda underscored that reliance on private 
distributors, and especially private clinics, allows AFFORD to tap into new areas previously 
not covered by assistance programs. This approach avoids overstretching resources of 
government clinics and builds a broader base for development of the health sector. 
AFFORD products are distributed through a self-sustaining network of private distributors 
that does not require financial support from the initiative. This is an efficient low-cost method 
for distributing USAID-supported socially-marketed products. If the UHMG products expand 
the market sufficiently enough to become self-sustaining, this distribution network also 
would be an efficient, low-cost method for getting these products to market, too. 
Proactive introduction of new health products onto the market: AFFORD is often 
complimented for its proactive role in introducing new products to the market. For example, 
it assisted the government in developing MOH policies that introduced a new type of oral 
rehydration salt in lieu of an older, less-effective product. AFFORD also introduced products 
for middle-income customers not historically targeted by social marketing projects, such as 
the ―O‖ condom. These products closed an existing gap by enabling customers who have the 
capacity to pay for products, but could not afford high-end products, to purchase these
subsidized items. 
Sustainability of UHMG 
Sustainability is an important component of a hybrid social marketing concept. However, the 
AFFORD initiative also has a specific deliverable of developing an indigenous NGO oriented 
to social marketing and product delivery. By definition, this is an operational NGO, which 
has quite complex organizational structure compared to a simpler advocacy NGO. An 
operations NGO has to be able to mobilize financial and labor resources in order to 
implement program activities defined by its charter of incorporation. In the case of a social 
marketing NGO, such activities are the distribution of socially-valuable products and 
implementation of marketing campaigns both for these products and for behavioral change in 
general. Therefore, the social marketing NGO needs general capacities to prepare 
applications, to obtain grants or contracts from government or other donors, and to conduct 
budgeting, accounting, and reporting on these funds. In addition, it requires capacities 
specific to its area of expertise: market research, social marketing campaigns, and product 
acquisition and delivery. Therefore, the operational NGO has to possess a headquarters with 
qualified staff, and, in the case of a social marketing NGO, a network of local representatives 
or partners. 
44
Establishment of an NGO runs through several stages. These include: creation and 
registration; development of key personnel, developing policies and 
bureaucracy/management capacities; establishing core activities and developing capacities 
and staff to deliver the core activities; establishing fundraising and financial management 
capacities; managing on-going fundraising and project/activities implementation; and 
developing an image and maintaining relations with donors and government. 
The initiative already established an indigenous NGO, UHMG, which has already passed the 
creation and registration stages, as evidenced by the policies and management capacity it 
developed. The NGO benefitted from early establishment at the outset of AFFORD. These 
actions are in line with the best practices of international projects in other countries, and 
experience suggests that early creation of a local entity is a strong step to ensure its 
sustainability at the end of the project. Because of the early establishment, the UHMG 
inherited staff and experience in delivering core social marketing activities as well as product 
delivery network from AFFORD, and was able to conduct capacity building on the delivery 
of these core activities over substantial time period during AFFORD implementation. 
The organization also started developing fundraising and financial management capacities, 
however the development of these components could be slowed because the fundraising 
activities do not coincide with direct activities of the AFFORD project. The mid-term 
evaluation corroborated the findings of a SWOT analysis conducted by AFFORD, 
particularly in terms of weaknesses that require redress. At the moment a major challenge to 
the sustainability of UHMG is the limited experience of the management in fundraising, 
project and institutional development. AFFORD and its international partners are aware of 
this weakness and are taking steps to address it. 
It is clear from the initiative‘s performance measures that AFFORD has made steady progress 
on indicators that support the intermediate result 3.1; establishment and operationalization of 
UHMG and the increased operational capacity of UHMG by strengthening its partners. For 
example, as mentioned above, AFFORD is legally established with a certificate of 
incorporation and business plan. In addition, almost all of the key staff positions are filled. 
They have met intermediate results 3.2 targets for number of staff in partner organizations 
trained in financial management (8 in 2007), number of partners that include M&E findings 
in their periodic reports (4 in 2007; UHMG records), and have almost met number of local 
organizations provided with TA for HIV-related institutional capacity building (meeting 6 of 
8 target for 2008). 
Challenges 
There are several challenges specific to NGOs in developing countries. They are primarily a 
result of limited capability of a country‘s economy to support operational NGOs. Scarce 
financial resources mean that the salary levels for highly qualified staff at indigenous NGOs 
may be substantially lower than those offered in the commercial sector. The difference rises 
with the level of expertise, and will be especially high for the top management. Therefore, the 
motivation of top management is an important factor to compensate for lost income. Second, 
the motivation for the social marketing programs in the developing countries is often 
external, coming from people in more industrialized countries. Therefore, sustained support 
from the developed countries is important to keep an NGO‘s motivation strong. Finally, 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
45
domestic sources of funding, either from the government or private sector, are rarely 
available in developing countries. Operational NGOs in such countries must therefore rely on 
external donors for funding their activities. Because of the relatively low cost of operation for 
an indigenous NGO, a single donor or single project often can sustain such NGO activities. 
However, the funding streams coming from a single donor are highly volatile and if the NGO 
relies on a single source of funding, it risks losing most of its qualified staff and capacities in 
tough financial times when funding from this single source is put on hold. Therefore, 
diversification of the funding sources and fundraising efforts are highly desirable for an NGO 
in developing country. 
Based on the above-mentioned general hurdles for NGOs, the team identifies several 
outstanding challenges to UHMG‘s sustainability beyond the initiative: 
USAID as the single source of funding and expectations for continuation of funding: 
Because UHMG was established with the help of a USAID-funded initiative, there is a 
natural bias in the organization toward continued reliance on USAID. Most international 
experts providing capacity building to the organization, including fundraising advice, have 
vast experience with USAID-funded projects, but limited experience developing proposals 
for other donors. Key informant interviews also suggest that there is an expectation from the 
management and some advisors that USAID may provide continued support or preferential 
treatment to UHMG because it was created under its auspices. As a result, UHMG focuses 
most of its efforts on strengthening relations with USAID and competing for USAID-funded 
projects. This strategy could threaten the sustainability of UHMG if the organization fails to 
secure significant USAID funding after the end of AFFORD. 
Lack of formal linkages with the main partners that created UHMG: As mentioned 
previously, the chief of party and international partners played a significant role in the 
development of UHMG. They could be among the main motivators for the top management 
of UHMG to further proceed with the NGO when the AFFORD initiative ends. At the same 
time, current by-laws of and procedural manuals for the organization do not provide any 
official role for these partners in the future. After AFFORD ends, there is a chance that 
UHMG will lose its connection to these people as motivators as well as the technical support 
and other resources international partners can provide.
Low involvement of UHMG staff in all stages of financial planning and fundraising 
activities: Although UHMG has won two projects as a part of international consortia and 
submitted several other proposals, these were developed largely by international experts. 
While these wins are important, the proposal development process has not provided 
significant capacity building for new business development of UHMG. 
46
Conclusions and Recommendations 
Conclusions 
The conclusions are organized by the AFFORD initiative objectives. 
AFFORD has made significant progress towards achievement of its goals and 
objectives. 
AFFORD has nearly achieved Objectives 1 and 2.
The evaluation validated several results reported by the initiative, such as availability of 
socially marketed products in drug stores, short-term effects of social marketing campaigns 
on demand for the AFFORD-branded products, and ability of the distribution network to 
deliver the products around the country. For example, socially marketed products, especially 
USAID brands Pilplan, Injectaplan, and Protector are sold in over 85 percent of the drug 
stores visited by the evaluation team. In addition, other brands were successfully introduced 
and are sold on the market. AFFORD established a sustainable private distribution network 
for these products. The AFFORD health promotion campaigns are recognized by the target 
population and highly regarded by key informants. There is also evidence suggesting that 
positive changes in health behavior are linked to them. Some of the products, such as newly￾introduced UHMG brands of contraceptives, condoms, and child health products, still have a 
small sales volume and limited presence on the market. Increase in availability of these 
products and in sales remains important tasks for the remaining years of project 
implementation. Further information about these products need to be provided to both 
retailers and the population to stimulate demand for the products. 
AFFORD has made significant progress on Objective 3, but must focus further efforts 
on this objective during the remaining years of the initiative. 
AFFORD established UHMG, an indigenous social marketing organization. It provided staff, 
structure, resources, and training to ensure that the organization will continue the distribution 
of AFFORD products on a cost-recovery basis. However, UHMG requires significant 
capacity building in financial management and new business development. 
Several of AFFORD’s activities have potential for further implementation. 
Working with private distributors who deliver socially marketed products without 
charging for their services is a highly effective and sustainable method.
AFFORD created a network of private regional distributors, which in turn support regional 
networks of smaller wholesalers and retailers. The distributors and retailers participating in 
the network are commercial entities that exist without external funding by donors. Therefore, 
the network is sustainable. This system does not require the project to support any costs 
except distribution costs for the products that are provided though a normal price margin, 
similar to other (non-socially-marketed) products on the market. Currently, the network 
successfully distributes AFFORD branded products. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
47
There are outstanding gaps in the distribution network. 
Although functioning properly, the private distribution network presents some challenges that 
could be improved. These challenges include the limited knowledge of the distributor and 
retailers about the products, their uses and potential side effect. 
Health promotion activities, while popular, may not be sustainable. 
The most highly regarded efforts are the Good Life! show on television and radio, the Under 
the Mango Tree radio program, and POL program. It is clear that these program activities are 
expensive and likely cannot be sustained by a local organization without supplemental donor 
funding. The activities are implemented by local expertise via AFFORD/UHMG, but require 
supplemental funding. 
MARP activities, while valuable, may not be sustainable. 
AFFORD has made great progress in working with MARPs in Uganda—groups that are at 
high risk and often require innovative approaches to reach. However, despite the progress, 
these programs are not likely sustainable after AFFORD without additional donor funding. 
The huge demand for local level outreach efforts, such as the POL program, local radio 
shows, and capacity building for local government needs to be addressed. 
There is a huge demand from the district authorities for health promotion programs similar to 
those developed and implemented by AFFORD. Key informants spoke of a desire to extend 
these programs in their districts. In the case of local radio shows, some district authorities 
suggested that they could eventually find funds to support such programs if initial capacity 
building were funded by an international project. Therefore, an extension of the lives of these 
programs needs to be considered. 
UHMG requires additional capacity building and support. 
UHMG’s socially marketed brands are distributed on a cost-recovery basis. However, 
USAID brands (Pilplan, Injectaplan, and Protector) need ongoing support from USAID. 
Prices for the UHMG brand products are based on their cost, while prices for USAID 
products are set below their cost. As a result, continuing distribution of the latter is possible 
only if USAID covers at least the difference between the cost and price. At the same time, 
UHMG is a qualified and efficient distributor for USAID socially marketed products in 
Uganda, and there is a definite advantage in using it to distribute these brands in the future. 
UHMG lacks experience in financial management and new business development.
UHMG‘s staff has been trained in distribution and marketing of the AFFORD products but 
has significantly less experience with new business/project development. Without this 
expertise, UHMG sustainability is threatened because the market capacity for UHMG 
products alone may be insufficient to provide revenue for sustaining the organization. 
48
Recommendations 
Recommendations in the near term (AFFORD/UHMG) 
These near-term objectives are meant to be considered for the remaining time period of the 
AFFORD initiative (approximately two years). Since activities for objectives 1 and 2 are 
almost complete, the evaluation team provides some near-term recommendations that 
concentrate on strengthening UHMG to ensure its sustainability. However, some of these 
activities should also support the achievement of the other two project goals. 
Improve product distribution, which will indirectly support the UHMG distribution 
efforts. 
In particular, AFFORD should address several weaknesses, including: poor communication 
between shop owners and distributors, limited awareness of the shop owners about 
distribution networks, and limited basic knowledge and information about the products 
(especially SoftSure, NewFem, and Pilplan). 
Within the distribution network, instruct distributors on best business practices, such 
as training them to order products when current supplies are low, to survey the needs 
of shops by phone before making deliveries, and to keep an accurate list of contacts. 
Provide store owners with a simple re-order form at the bottom of each bulk package 
of drugs. The form should list contact telephone numbers for all 12 UHMG 
distributors in the area and a short request for re-supply of products, which can be sent 
by mail or facsimile (fax). 
Introduce a detailed description of medication into each bulk package of drugs so that 
trained pharmacy staff can learn about side-effects and the advantages of informing 
drug shop owners about the product. 
Transition selected promotional activities for implementation by district-level 
authorities. 
Even though these activities are costly to implement, local government and/or NGOs could 
sustain at least some of them, such as local education campaigns or local radio programs. 
Continuing them would improve visibility of the initiative in rural areas, build capacity of 
local authorities in health promotion using local resources such as radio stations and 
community meetings, and involve existing structures such as VHT and community health 
workers (especially in Lira District). 
In particular, district-level activities should seek to address the lack of understanding of the 
differences between AFFORD and UHMG. This misunderstanding hinders the establishment 
of UHMG as an independent indigenous institution. 
Encourage the involvement of UHMG senior management in meetings with local 
authorities to discuss local health issues and program solutions. Formulate and 
disseminate a clear statement of what should and should not be expected from UHMG 
compared to current AFFORD activities that the meetings identify. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
49
Extend AFFORD‘s practice of collaborating with local government entities, 
especially the district health office, through regular review meetings, sharing of 
information, and networking. Facilitate the integration of AFFORD activities into 
district-level plans and services to build capacity to carry out these activities in the 
districts. Create an understanding about sources of continued funding for these 
activities after AFFORD ends. In some cases, district health offices will have to find 
replacement funding or drop programs. 
Where possible, extend training and other activities conducted under the POL 
program to VHT and community health worker program participants. Collaborate 
with local government to provide information about UHMG products and Good Life!
clinics to the participants in these programs and encourage them to in turn educate 
their communities about these products and services. 
Continue the practice of identifying and engaging local partners, including NGOs, 
CBOs, and district structures in rural areas to promote AFFORD/UHMG products and 
services with the goal of creating a wider network that increases impact beyond the 
initially-targeted population. 
AFFORD has made great strides in supporting Uganda MARPs by linking the 
networks, promoting healthy behaviors, and encouraging correct use of health 
products. AFFORD/UHMG should continue its valuable work with MARPs as much 
as possible. However, since it is not likely to be sustainable, UHMG will need to seek 
an outside funding source to continue this work after AFFORD ends. 
Strengthen UHMG to increase the probability of its survival beyond AFFORD’s end 
date. 
AFFORD should consider formalizing the continued participation of the international 
organizations that helped to create UHMG. For example, an informal network or an 
advisory board could be established that includes the current the chief of party of 
AFFORD, representatives of USAID, and experts from other international AFFORD 
partner organizations. The goal of the network or advisory board would be to advise 
the board and the managing director of UHMG about the current state of the 
organization, opportunities for development, progress, and new best practices in 
UHMG‘s main competencies, as requested by UHMG. 
AFFORD should develop medium-term financial plans that contain several funding 
scenarios, including one that assumes AFFORD funding ends according to its initial 
time-table. The plans should include measures to trim spending and identify priority 
activities that should be supported in the face of limited funds. 
Build UHMG capacities in new business development, for example, by arranging for 
the managing director or other senior staff to visit the U.S. offices of one of the 
AFFORD implementing partners to participate in the development of a proposal from 
start to finish. 
Develop UHMG contacts with other (non-U.S.) international donor organizations, 
such as the World Bank and other groups involved in government development 
50
programs in Uganda. UHMG should be proactive and should not expect that USAID 
will make these introductions. 
Recommendations for long-term programs (USAID) 
The evaluation team offers the following long-term recommendations for USAID to consider 
after the conclusion of AFFORD. 
Support an extension of AFFORD activities, taking into consideration the following points: 
AFFORD as a brand has high visibility and positive recognition in Uganda. Therefore 
extension of the initiative or continued use of the name in a follow-on activity (for 
example, ―AFFORD-2‖ of ―AFFORD-plus‖) would capitalize on its current 
reputation. USAID/Washington and USAID missions have used this example 
specifically to extend the longevity and influence of a project name; such as the 
BASICS project and the Benin PISAF project. 
AFFORD activities supporting LLIN distribution are highly regarded in the districts, 
and authorities have indicated the need both for further net distributions and 
promotion of correct use. This activity could be implemented as a part of an AFFORD 
initiative extension or as a separate activity through another project. 
Schools are a major mechanism in Uganda for reaching communities with 
information that promotes demand and use of health products. Yet the current 
AFFORD design does not engage this resource on an adequate scale. An extension of 
or follow-up to the project could engage the Ministry of Education, especially at the 
district level, to implement health promotion through schools, such as the PIASCY 
program currently implemented in schools. 
Ensure the long term sustainability of UHMG with limited USAID support: 
AFFORD successfully transitioned the distribution of USAID branded products, such 
as Protector, PilPlan and InjectaPlan, to UHMG. USAID should continue 
distribution of these products with UHMG beyond the end-date of AFFORD, which 
will both support UHMG and prevent interruptions to product distribution. 
Provide financial support to UHMG beyond the remaining two years of AFFORD 
through a mix of competitive and noncompetitive grants and contracts to ensure a 
smooth transition to independence and help avoid the loss of qualified staff during the 
critical few years after AFFORD ends. 
Encourage UHMG‘s continued access to technical experts beyond the remaining two 
years of the AFFORD initiative. This periodic injection of technical expertise will 
help continue capacity building as the organization becomes independent and the staff 
faces new challenges. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
51
References 
AFFORD. 2005. Project Overview. Accessed at 
http://www.jhuccp.org/africa/uganda/afford.html. Baltimore, MD: Johns Hopkins Bloomberg 
School of Public Health. 
———. 2005. Original Project Proposal. Baltimore, MD: Johns Hopkins Bloomberg School 
of Public Health. 
———. 2006. AFFORD Health Marketing Initiative Annual Report, Year 1. Baltimore, MD: 
Johns Hopkins Bloomberg School of Public Health. 
———. 2007. AFFORD Health Marketing Initiative Annual Report, Year 2: October 1, 
2006 to September 30, 2007. Baltimore, MD: Johns Hopkins Bloomberg School of Public 
Health. 
———. 2008a. AFFORD Health Marketing Initiative Annual Report, Year 3: October 1, 
2007 to September 30, 2008. Baltimore, MD: Johns Hopkins Bloomberg School of Public 
Health. 
———. 2008b. Annual Work Plan Narrative: October 1, 2008 – September 30, 2009. 
Baltimore, MD: Johns Hopkins Bloomberg School of Public Health. 
———. 2008c. Baseline Survey for the AFFORD Project, Technical Proposal. Kampala, 
Uganda: Makerere University. 
———. 2008d. Program Monitoring Plan. Baltimore, MD: Johns Hopkins Bloomberg 
School of Public Health. 
———. n.d.a. Baseline Methodology Description. Baltimore, MD: Johns Hopkins 
Bloomberg School of Public Health. 
———. n.d.b. Media Report (Regional). Baltimore, MD: Johns Hopkins Bloomberg School 
of Public Health. 
AFFORD and Uganda Health Marketing Group (UHMG) presentation to the Evaluation 
Team, November 19, 2008. 
Armand, Francoise. 2003. Social Marketing Models for Product-Based Reproductive Health 
Programs: A Comparative Analysis. Washington, DC: USAID/Commercial Market 
Strategies Project. 
Commercial Market Strategies (CMS). 2003. Uganda: Country Profile. Washington, DC: 
CMS. 
Evaluation of Popular Opinion Leaders‘ Performance, Wilsken Agencies, Ltd., 2007. 
Ministry of Health (MOH) Uganda and Micro International Inc. 2007. Uganda Atlas of 
HIV/AIDS Indicators. Calverton, MD: MOH and Micro International Inc. 
Pollard, Richard. 2007. ―Social marketing: An introduction to the total market approach to 
commodities and services supply in low-income countries,‖ presentation at George 
Washington University, Washington, DC, November 6. 
52
Social Marketing Quarterly. 2006. Accessed at http://www.socialmarketingquarterly.com/. 
Washington, DC: Academy for Educational Development (AED). 
UHMG. 2008. Uganda Health Marketing Group Annual Report 2007. Kampala, Uganda: 
UHMG. 
UHMG. Uganda Health Marketing Group Annual Work Plan Narrative, October 1, 2008 – 
September 30, 2009. Kampala, Uganda: UHMG. 
UHMG. Group Organization Chart. Kampala, Uganda: UMHG 
UHMG. Management Reports. Kampala, Uganda: UHMG.
Uganda Bureau of Statistics and Macro International Inc. 2007. Uganda Demographic and 
Health Survey 2006: Key Findings. Kampala, Uganda and Calverton, MD: Uganda Bureau of 
Statistics and Macro International Inc. 
———. 2007. Uganda Demographic and Health Survey 2006. Calverton, MD: Uganda 
Bureau of Statistics and Macro International Inc. 
Uganda Ministry of Health and ORC Macro. 2006. Uganda HIV/AIDS Sero-behavioural 
Survey 2004-2005. Calverton, MD: Ministry of Health and ORC Macro. 
Uganda HIV Factsheet 2004-2005.
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
53
Annexes 
ANNEX A : AFFORD ACTIVITIES TIMETABLE 
The table bellow indicates when products or services produced or supported by AFFORD 
became available to the intended target group or became visible outside the project. This 
timeline does not include the time spent by AFFORD internally to prepare 'launch" of 
product, service or activity. 
ACTIVITY October 05 - September 06 October 06 - September 07 October 07 - September 08 October 08 - September 09
O N D J F M A M J JL A S O N D J F M A M J JL A S O N D J F M A M J JL A S O N D J F M A M J JL A S
HIV AIDS Products
Protector
"O"
Cotramox (Cotrimoxazole 960mg)
Clovirex (Aciclovir Tablets and Cream)
Vitaboost (Multivitamin Tablets)
Family Planning Products
Pilplan (COC)
Injectaplan (MPA)
MoonBeads (Natural FP Method)
NewFem (COC)
SoftSure (POP)
Child Care 
Restors (ORS)
Zinkid (Dispersible Zinc Tablets)
Aquasafe (NaDCC 70mg)
Malaria Protection
ACTs Training in the private sector
LLINs- NGO distribution
LLIN-ANC Distribution
LLIN-Global Fund
LLIN-Malaria No More
Mass Campaign PMI Disitribution
Distributors Network
Distributors Contracted
Distributors Training
SSE Contracted
SSE Training
MARPS– Interventions
Training of Peer Educators
Grants to WAWI, WAYS, Uganda Police, UPDF, SSECODA
Referral for HCT, STI and other needed services
Institutional Capacity Building
Good Life Clinics
Supply of test kits and other reagents
HCT data collection
Referral for HCT, STI and other needed services
Training in Health care waste management (with MMIS)
Linkage through referral network between private & public facilities 
Training of consulars and staff
HIV/AIDS Program Palliative Care 
Training of staff
referral mechanism from VCT to palliative care
support materials and job aids to health workers
Support PLHAs to access palliative care products
Establish data collection
ACCESS TO SERVICES
Objective I: Increase accessibility to products and services
PRODUCT DISTRIBUTION TO POPULATION
54
ACTIVITY October 05 - September 06 October 06 - September 07 October 07 - September 08 October 08 - September 09
O N D J F M A M J JL A S O N D J F M A M J JL A S O N D J F M A M J JL A S O N D J F M A M J JL A S
Community-Based Vehicles
Popular Opinion Leaders
Pulse Activations
HIV Prevention Film shows
Good Life Show
TV episodes (English)
radio episodes
press columns
radio spots 
Prize giving PR events
Other Good Life Campaign Vehicles
Under the Mango Tree
Everyday Health Matters
Other radio spots (Malaria & FP)
Establishment of UHGM
Legal registration
Established a Governance system
Organizational policies & systems 
Developed strategic and business plans
Recruit staff
UHGM Activities
Product Facility
Pharmacy
Consultancy
Market Research
COMMUNICATION
UGANDA HEALTH MARKETING GROUP
Objective II: Enhance healthy behaviors and lifestyles within communities and families
Objective III: Establish and strengthen capacity of a sustainable indigenous health marketing organization
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
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ANNEX B : UHMG ORGANIZATIONAL STRUCTURE 
56
ANNEX C : KEY INFORMANT INTERVIEW METHODOLOGY 
Key informants interviews were the most broadly used method of data collection for the 
AFFORD evaluation. Interviews were used to: deepen the team‘s understanding AFFORD 
and its expected influence; validate or refine methodologies for the retail store survey and the 
client exit survey; obtain expert opinions on the success of current AFFORD activities and 
progress towards objectives; and inform recommendations for future programming. 
AFFORD provided the initial list of key informants. The evaluation team expanded and 
refined the list based on suggestions of key informants and recommendations from USAID. 
Key informant interviews started by phone before the field work began. However, the 
majority of the interviews were conducted in Kampala during the first two weeks of field 
work. The key informant interviews in Kampala were conducted by the International 
Evaluator and the Senior Evaluator. Key informant interviews in districts outside Kampala 
were conducted during the planned visits by two data collection/survey teams: 1) the 
International Evaluator and Research Assistant as one team and 2) the International Evaluator 
and Lead In-country Evaluator as another team. Key informants were contacted to schedule 
interviews in advance. If they were not able to meet during the proposed time, the scheduler 
asked for a suggested colleague who was equally familiar with the topic. All key informants 
interviews were conducted in English. 
The evaluation team developed a semi-structured instrument with open-ended questions, 
which was refined after the first week of interviewing. The instrument was also used as the 
basis for the summary prepared in electronic format after each interview. Key informants 
were provided information about the study and asked for informed consent before each 
interview. 
The key informant interviews in electronic and paper form were reviewed, summarized, and 
encoded into a Microsoft Excel table by the Data Analyst. Responses to each question were 
organized by district. The data was further reviewed and aggregated in a table to link 
individual responses to the main questions for the evaluation. The team used a summary of 
the key informant interview findings to write the report, also presented as ANNEX K. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
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ANNEX D : RETAIL STORE SURVEY METHODOLOGY 
The retail store survey‘s purpose is to evaluate the AFFORD initiative specifically and not to 
collect information about the impact of specific activities, policies or measures of the whole 
population of Uganda. The retail store survey was designed to assess the effect of 
AFFORD/UHMG‘s direct work with distributors and retail drug stores. The QED team 
collected data to assess the difference in availability of AFFORD/UHMG supported brands in 
drug stores that work with one of twelve AFFORD/UHMG distributors and, by comparison, 
in the stores that are not direct partners of such distributors. In addition, the survey also 
collected data on the impact of AFFORD/UHMG promotional campaigns on the demand of 
the AFFORD/UHMG-supported products in these stores. 
Both the client exit surveys and retail store survey have mixed sampling strategies, unified 
geographical coverage based on convenience sampling. District sites criteria are: 
1. The treatment group should cover at least one district within the designated areas of 
each of the twelve AFFORD/UHMG distributors. Comparison group districts should 
be adjacent to the treatment group districts and should not be included in primary 
activity areas for AFFORD/UHMG. 
2. Districts should be a part of the areas where AFFORD/UHMG conducted different 
types of malaria prevention activities: campaign-style LLIN distribution, ACT 
training in the private sector, LLIN ANC distribution, and malaria prevention 
activities. 
3. The number of main languages spoken in these districts should be minimal in order to 
recruit an adequate number of fluent interviewers 
Based on these criteria, the following districts were selected: 
Treatment Group Districts Comparison Group Districts
Arua Nebbi
Kabarole Kamwewge
Mbarara Ntunaamo
Wakiso Mpigi
Masaka Rakai
Jinja Iganga
Mbale Budaka
Lira Pader
Gulu Oyam
Kampala NA
Kiboga NA
Two districts, Kampala and Kiboga, did not have formal comparison group districts identified 
due to their uniqueness. Kampala was the capital of the country and the primary location for 
AFFORD/UHMG activities not targeted to the rest of the country, such as the English 
language ―Good Life! show‖ on television. Kiboga District was in the distribution area for 
AFFORD/UHMG. However, there were no AFFORD activities conducted in this region 
except for the distribution of AFFORD/UHMG products. 
The retail stores in each district were randomly selected from two sources: 
1. List of all licensed drug retail stores provided by a District Assistant Drug Inspector 
(DADI). 
58
2. List of retail drug stores working with AFFORD/UHMG distributor that was 
responsible for the distribution in this district. 
Selection criteria: Based on the two sources above, in each district six main and six 
alternative locations (retail stores) were randomly selected from the list of retail drug stores 
working with AFFORD/UHMG distributor. These stores were in the treatment group sample. 
From the lists of all licensed drug stores in a district provided by a DADI, all stores that are 
not on the list provided by the AFFORD/UHMG distributor were selected for the comparison 
group list. From this list, the store geographically closest to each in the treatment group 
sample was selected. These stores formed the comparison group sample. 
Recruitment procedures and selection requirements: Interviewers received a list of two 
retail drug stores from the treatment group and the corresponding names of two stores for the 
comparison group. Each interviewer was instructed to proceed as follows: 
In a main store from the treatment group, identify a person who was either a store 
owner or main store manager on duty. Directly ask for such a person and probe with 
such criteria: a person who was responsible for purchasing products/supplies for the 
store, control of the stock, and dealing with distributors. 
If such a person was identified, the interviewer conducted an interview. However, if 
such a person was not present in the store, the interviewer could either wait (if arrival 
of such person was expected) or move to an alternative location/store from the 
treatment group. 
After completing a survey with the retail store owner or main manager, the 
interviewer remained near the store for an hour and conducted the exit survey 
interviews. The interviewer then moved to the location identified as a corresponding 
location in the comparison group and repeated the procedure. 
Sample size: The retail store survey sample size was limited by geographic dispersion, time 
constraints for the survey, and the number of Interviewers in each district. For each district, 
an interviewer was expected to conduct two Retail Stores Checks: one treatment group store, 
and a control group store. Therefore, the expected number of retail store survey interviews for 
the treatment sites was 132 (6 interviewers x 2 stores x 11 districts). For the comparison sites, 
the team estimated 108 interviews (6 interviewers x 2 stores x 9 districts). 
Inducements for participation: Interviewers were instructed to provide a clear explanation of 
the survey‘s purpose and provide convincing evidence for potential respondents to participate 
in the retail store survey. However, no special inducements for participation, such as 
monetary or non-monetary rewards or compensation, were given to the survey participants. 
Interviewers were instructed to receive informed consent from the respondents and provide 
reassurance that their relations with AFFORD/UHMG would not be affected by the 
respondent‘s decision to participate. The store management was also provided with a copy of 
an introduction letter written by UHMG/AFFORD to support the study. The letter clearly 
stated that there is no direct benefit for participation in the study or punishment for 
nonparticipation. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
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ANNEX E : EXIT SURVEY METHODOLOGY 
The purpose of the client exit survey is to evaluate the AFFORD initiative‘s progress 
specifically; but not to collect information about the impact of activities, policies or measures 
on the whole population of Uganda. The client exit survey sought to assess specific health 
behaviors targeted by AFFORD; such as malaria prevention by using nets properly, HIV 
prevention by wearing condoms during sex, family planning through use of contraception, 
and child health through use of clean water, vitamins, and oral rehydration solution treatment 
during diarrhea. The survey also focused on a population assumed to be the most health 
conscious as suggested by their patronage of Good Life! clinics and retail stores (such as 
pharmacies and dukas). Specifically, the survey recruited respondents exiting AFFORD￾supported clinics and retailers/clients. This sub-population ostensibly is expected to show a 
higher than average positive response to the AFFORD products and activities. The results 
provide an upper bound estimate of AFFORD‘s ability to enhance healthy behaviors and 
lifestyles within communities and families. However, if the estimate of the upper bound is 
lower than AFFORD‘s self-assessment results from their internal mid-term evaluation, it 
indicates potential problems with the initiative‘s monitoring systems and/or with 
implementation. 
Both the client exit survey and retail store survey have mixed sampling strategies, unified 
geographical coverage based on convenience sampling. District sites criteria are: 
1. The treatment group should cover at least one district within the designated areas of 
each of the twelve AFFORD/UHMG distributors. Comparison group districts should 
be geographically adjacent to the treatment group districts and should not be included 
in primary activity areas for AFFORD/UHMG. 
2. Districts should be a part of the areas where AFFORD/UHMG conducted different 
types of malaria prevention activities: campaign-style LLIN distribution, ACT 
training in the private sector, LLIN ANC distribution, and malaria prevention 
activities. 
3. The number of main languages spoken in these districts should be minimal in order to 
recruit an adequate number of fluent interviewers. 
Based on these criteria, the following districts were selected: 
Treatment Group Districts Comparison Group Districts
Arua Nebbi
Kabarole Kamwewge
Mbarara Ntunaamo
Wakiso Mpigi
Masaka Rakai
Jinja Iganga
Mbale Budaka
Lira Pader
Gulu Oyam
Kampala NA
Kiboga NA
Two districts, Kampala and Kiboga, did not have formal comparison group districts identified 
due to their uniqueness. Kampala, the capital of the country, was the primary location for 
60
several AFFORD/UHMG activities which are not targeted to the rest of the country, such as 
the English language Good Life! show on television. Kiboga District was in the distribution 
area for AFFORD/UHMG. However, there were no AFFORD activities conducted in this 
region except for the distribution of AFFORD/UHMG products. 
Selection criteria: Clinics in treatment districts are selected from the list of Good Life! clinics 
supported by AFFORD/UHMG. If a district has more than six Good Life! clinics, the team 
selected those clinics with the largest expected number of patient visits per day based on 
UHMG information. In comparison districts, six clinics were selected in the sample based on 
recommendations provided by the DHO. (Note: retail stores for the client exit survey are the 
same as retail stores for the retail store survey). 
Recruitment procedures and selection requirements: Interviewers were instructed to 
approach each person exiting a clinic, with three exceptions: 
1. Do not approach a person that appears to be a family member of a person that was 
already interviewed. 
2. Do not approach a person that appears to be a medical or health worker of the clinic 
(such as persons wearing white coat or seen working at the reception in the clinic). 
3. Do not interview persons under 18 years of age. 
Sample size: The client exit survey sample size was not identified a priori because it was 
expected to be limited by the following factors: 
1. The number of people visiting a clinic or retail store on a given day was a factor. 
Since most Good Life! clinics are small in size; the team expected an average of about 
five people per day. 
2. The number of interviewers and number of people interviewers could process in an 
hour was a factor. Only six interviewers were working in each district, and only one 
Interviewer deployed at each clinic. The expected completion time of a single client 
exit survey interview in a local language was 20–25 minutes, therefore an interviewer 
was able to interview only up to two people an hour. The total number of hours that 
an interviewer spent in a particular location was limited to eight hours. 
3. The availability of trained interviewers with particular language skills was a factor. 
Consequently, the total expected maximum number of interviews conducted at clinics in 
AFFORD districts exits was 1,056 (6 clinics x 11 districts x 8 hours x 2 respondents). Among 
the comparison clinics, the team expected 864 interviews (6 clinics x 9 districts x 8 hours x 2 
respondents). In addition, 264 Retail Store Exit Interviews conducted in AFFORD districts 
and 216 in comparison districts. The actual number of Client Exits Surveys (combined clinics 
and retail stores) completed in AFFORD districts is 706 and in comparison districts is 509. 
Inducements for participation: Interviewers were instructed to provide a clear explanation of 
the survey‘s purpose and provide convincing evidence for potential respondents to participate 
in the client exit survey. However, no special inducements for participation, such as monetary 
or non-monetary rewards or compensation were provided to the survey participants. 
Interviewers were directed to receive informed consent from the respondents and provide 
reassurance that future services received at the clinic would not be affected by the 
respondent‘s decision to participate. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
61
Clinic and retail store management were contacted in advance to receive permission for 
conducting the survey near their premises. They were provided full information about the 
survey, but did not receive any form of compensation. The establishment‘s management was 
also provided with a copy of an introduction letter written by UHMG/AFFORD in support of 
the study. The letter clearly stated that there was no direct benefit for participation in the 
study or punishment for nonparticipation. 
Ethical Considerations 
Both the client exit survey and retail store survey procedures did not request any information 
that could lead to the identification of a respondent. Neither type of surveys asked for a 
respondent‘s name or information that can be used to identify the person or his/her family; 
such as, address, phone number, etc. The surveys did not collect sensitive personal or 
business information, such as health status, income level, business profits or revenues. 
Additionally, there were several extra precautions taken to ensure the protection of 
respondents‘ rights and to take into consideration ethical issues:
During training, each interviewer was instructed to begin a survey after the receipt of 
informed consent from the respondent. Interviewers were instructed on how to request 
informed consent, and were provided with informed consent forms. There was one 
form per every questionnaire which has a code number that links it to a particular 
questionnaire. The form requires signature of interviewer (but not the respondent) 
before the start of the interview. 
Also during the training, each interviewer was instructed how to ensure that the 
interview was conducted in a confidential setting, one-on-one with a respondent so no 
one else could hear the respondent‘s answers. 
Interviewers‘ contractual letters of agreement explicitly stated that he/she should 
safeguard confidentiality of completed questionnaires, provide all completed 
questionnaires to the Evaluation Supervisor at the end of each day, and should not 
discuss completed questionnaires with anybody except a designated data entry person, 
the Lead In-country Evaluator or the International Evaluator. The following is an 
excerpt from the Interviewer agreement: 
...Interviewer is responsible for safeguarding completed questionnaires and other personal 
and confidential data in strict accordance to the study protocol regarding 
sensitive/confidential data. He/she should not provide completed questionnaires to anybody 
except Lead In-Country Evaluator unless otherwise specified in the study protocol. 
Interviewer should not discuss answers to questionnaires or other confidential data with 
anybody including other interviewers and survey participants, except with the Lead In￾Country Evaluator, Senior Evaluator or Team Leader, unless otherwise required by survey 
protocols and methodology provided to the interviewer in advance…. 
Since no personal information, such as a name, address or telephone number were 
collected, such information is not present in the survey database. Each record in the 
survey database is identified only by a questionnaire code number in the following 
format: ―2-digit district number—2-digit interviewer number—3-digit interviewee 
number within the district.‖
62
All evaluation team members signed QED‘s Confidentiality Statement which 
confirms their commitment to keep information collected from respondents safe and 
confidential. This applies to both verbal conversations and electronic information. The 
data analysts had secure computers that were password protected. Discussions on the 
data collected remained internal to the evaluation. Reporting of data was on an 
aggregate level, protecting the identification of the respondents. 
The Lead In-Country Evaluator, Evaluation Assistant and Research Assistants were in control 
of their written notes at all times. When the notes were not in their personal possession, they 
remained in a locked cabinet in the Lead-In Country Evaluator‘s office. After the interviews 
and discussions were completed, the team merged their notes into one Microsoft Word 
document per interview which was transmitted by email to the Team Leader and protected by 
QED‘s network firewall. In the rare event the data are transmitted to a wrong address, all 
QED emails have a confidentiality statement included as an email footer. Since no personal 
information, such as a name, address or telephone number were collected, such information 
could not be present in the written questionnaires or electronic database. Each record in the 
database is identified only by a unique identifier code as noted earlier. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
63
ANNEX F : FOCUS GROUP METHODOLOGY
The QED evaluation team conducted focus groups with local communities specifically to 
assess the effect of the POL program, LLIN distribution, and other anti-malaria activities 
implemented by AFFORD and UHMG. 
FGDs were conducted in the same districts included in the client exit surveys and the retail 
store survey. Four districts with a variety of anti-malaria activities were selected for the focus 
groups: Lira in Northern Uganda where UHMG conducted a distribution of the LLIN through 
ANC services; Fort Portal (Kabalore) in Western Uganda where no mosquito net distributions 
were conducted; and Mbale in Eastern Uganda, where mosquito nets were conducted through 
campaign and civil society organization distributions; and Wakiso, as a unique region close to 
Kampala. 
Selection criteria: The evaluation team intended to conduct two FGDs per district; one with 
POLs, and another with participants living in areas covered by the AFFORD/UHMG‘s POL 
and anti-malaria activities. POLs were contacted based on information provided 
AFFORD/UHMG. In two districts (Kabalore and Lira) the schedule allowed the team to 
conduct two groups with POLs and one with community members. Community FGD 
participants were selected from one of the villages in the district that has a POL, and helped
recruit group participants. Participants averaged approximately 5-10 persons per focus group. 
The evaluation team chose groups representing persons of mixed gender and age between the 
ages of 18 and 60 years of age. 
Recruitment procedures and selection requirements: AFFORD/UHMG and its partners in 
districts assisted the evaluation team in identifying FGD participants from areas included in 
Lira, Fort Portal, Mbale and Wakiso Districts programs and anti-malaria activities. 
Inducements for participation: None of the focus group participants received any form of 
inducement or incentive to participate in the study. Persons who had questions or showed
interest about AFFORD/UHMG-supported products or services received referral information. 
The evaluation team members conducting the FGDs reiterated their external role. They 
explained that participation in the focus group was strictly voluntary; and questioning begun 
only after informed consent has been secured. FGD participants received light snacks and 
beverages after the end of each FGD as is customary for such a gathering. 
The FGDs generated qualitative data about health behaviors, community education and 
effectiveness of the POL approach implemented by AFFORD/ UHMG. They shed light on 
AFFORD/UHMG‘s ability to influence knowledge and health behaviors at the parish level. 
64
Uganda AFFORD Mid-term Evaluation 
Popular Opinion Leader Focus Group Guiding Questions 
1. WHAT IS YOUR ROLE AS A POPULAR OPINION LEADER? WHAT DO YOU 
DO ON A DAILY BASIS? IS THERE ANYTHING ELSE YOU DO ON A 
MONTHLY OR QUARTERLY BASIS? (PROBE FOR MEETINGS WITH 
UHMG/CDFU REPRESENTATIVES, FOLLOW UP TRAINING, ETC)? 
2. WHAT ARE THE BIGGEST HEALTHCARE PROBLEMS IN YOUR 
VILLAGE/COMMUNITY? 
3. WHAT DO YOU KNOW ABOUT THE AFFORD PROJECT? HOW ABOUT 
UGANDA HEALTH MARKETING GROUP (UHMG)? 
4. DO YOU KNOW THE DIFFERENCE BETWEEN AFFORD AND UHMG? 
PLEASE EXPLAIN. 
5. HAVE YOU EVER ATTENDED ANY AFFORD/ UHMG TRAINING SESSIONS 
OR MEETINGS? WHAT TRAINING DID YOU RECEIVE? WHAT ARE YOUR 
IMPRESSIONS ABOUT THE AFFORD/UHMG TRAINING THAT YOU 
RECEIVED? 
6. DO YOU THINK ANYTHING WOULD BE DIFFERENT IN YOUR 
COMMUNITY IF YOU HAD NOT RECEIVED TRAINING AS A POL? PLEASE 
EXPLAIN.WHAT ARE PEOPLE‘S REACTIONS WHEN YOU TELL THEM 
ABOUT THE FOLLOWING: 
A. HIV TESTING 
B. USE OF FAMILY PLANNING METHODS 
c. CONDOMS 
D. MALARIA PREVENTION PRODUCTS SUCH AS MALARIA NETS 
e. CHILD HEALTH PRODUCTS SUCH AS RESTORS AND ZINKIDS 
7. DESCRIBE IF THERE HAVE BEEN ANY SIGNIFICANT CHANGES IN 
HEALTH BEHAVIORS, IN YOUR PARISH/VILLAGE OVER THE LAST 3 
YEARS? (PROBE FOR CHANGES IN BEHAVIOR REGARDING USE OF 
MALARIA NETS, HIV/AIDS, CHILD HEALTH AND USE OF SAFE WATER) 
8. IN THE LAST 3 YEARS, HAVE THERE BEEN ANY OBSERVABLE CHANGES 
IN RESPECT TO THE AVAILABILITY OF HEALTHCARE PRODUCTS 
(DRUGS, MALARIA PREVENTION PRODUCTS E.G. MALARIA NETS, 
VITAMINS, ETC.?) EXPLAIN. (PROBE: WHAT PRODUCTS/CATEGORIES OF 
PRODUCTS? WHAT DO YOU THINK BROUGHT ABOUT THIS CHANGE?) 
9. WHERE THERE ANY CHALLENGES OR BARRIERS TO PARTICIPATING IN 
THE AFFORD EVENTS? IF SO, WHAT WERE THEY? 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
65
ANNEX G : INTERVIEWER TRAINING MANUAL 
AFFORD Mid-term Evaluation 
USAID/Uganda HIV/AIDS Evaluation, Assessment, and 
Formative Research 
INTERVIEWER TRAINING MANUAL 
The QED Group, LLC 
Project SEARCH 
February 5, 2009 
Contract No. GHH-I-02-07-00034-00
66
TABLE OF CONTENTS 
I. Background and the Purpose of the Study 67
II. Administrative Matters 68
II.A. Schedule of the Survey Work, Composition of the Team and How to Address 
Your Questions 75
II.B. How to Prepare for Interviews 69
II.C. Materials You Will Need on this Study 70
II.D. What Is Expected of You 70
II.E. Asking for Help 70
II.F. Your Most Important Jobs 70
III. General Point of Interviewing 71
III.A. Introducing Yourself 71
III.B. How to Answer General Questions and Complaints 72
III.C. How to Maintain Confidentiality 72
IV. Basic Techniques for Interviewing 73
IV.A. How to Read Questions 73
IV.B. How to Get Adequate Answers 73
IV.C. How to Record Answers 75
V. How To Administer the Questionnaires 76
V.A. Exit Survey Questionnaire 76
V.B. Retail Store Check Survey Questionnaire 78
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
67
I. BACKGROUND AND THE PURPOSE OF THE STUDY
The purpose of this research is to gather information for the mid-term evaluation of the 
AFFORD project, funded by the United States Agency for International Development 
(USAID). The rationale of the mid-term evaluation is to determine whether the 
implementation of AFFORD activities during its three-year base period have achieved the 
desired results. The evaluation will determine the effectiveness of the marketing and 
awareness creation components. It will also assess the extent to which the products and 
services promoted by AFFORD are made available by local institutions in a sustainable 
manner. 
AFFORD is a five-year project funded by USAID that was designed to increase the 
sustainable marketing of products and services for HIV prevention and treatment, 
reproductive health, child health, and malaria. AFFORD also intends to enhance the 
knowledge and correct use of these products and services. The core of the AFFORD 
interventions has been to facilitate the development and implementation of innovative social 
marketing and communication strategies to ensure that Ugandans obtain access to affordable 
and high quality health products and services. One of the key goals (and an expected major 
result) of AFFORD is the creation of an indigenous organization that will continue in the 
footsteps of AFFORD after the end of the project. The Uganda Health Marketing Group 
(UHMG) is a new entity that was created by AFFORD and is being developed and nurtured 
to assume AFFORD‘s role. 
The two surveys that will be conducted during this study will collect information to help 
evaluate two main objectives of the AFFORD project and answer the following questions: 
1. What is the effect of AFFORD activities on the volume of sales/distribution of the 
AFFORD-supported healthcare products and substitutes? 
2. What is the effect of AFFORD-supported activities on the health behavior of the 
general population? 
In order to collect this information, we will conduct two surveys. First, we will carry out a 
population survey conducted at the exits of Good Life! clinics and Retail Stores called the 
‗Exit Survey‘. Second, we will perform a survey of owners or managers of stores that sell 
drugs and medical products, conducted at their premises called the ―Retail Store Check‖. 
68
II. ADMINISTRATIVE MATTERS 
II.A. Schedule of the Survey Work, Composition of the Team and How to 
Address Your Questions 
1. The surveys will be conducted throughout the districts of Uganda, during a period of 
4 days in each district or surrounding area(s). The work schedule in each district will 
be as follows: 
a. Day 1. Exit Survey at the exit/entrance to a Good Life! clinic or other clinics in 
a district. Each interviewer works in separate clinic. 
b. Day 2. Exit Survey at the exit/entrance to a Good Life! clinic or other clinics in 
neighboring district. Each interviewer works in separate clinic. 
c. Day 3. Retail Store Check Survey and Exit Survey at the exit/entrance to a 
retail store. Each interviewer will visit 2 retail stores in the districts, and 
conduct the Retail Store Check survey at a store and then interview visitors at 
the same store. 
d. Day 4. Retail Store Check Survey and Exit Survey at the exit/entrance to a 
retail store. Each interviewer will visit 2 retail stores in this or neighboring 
district, and conduct the Retail Store Check survey at a store and then 
interview visitors to the same store. 
2. Tentatively, the survey work will start on February 15, 2009, and will end at the end 
of March 2009. 
3. The interviewers will be assigned to cohorts/teams according to the language they 
speak. Each cohort will work in districts that speak their language. Each cohort will 
have an individual schedule (start and end dates for their work). Individual schedules 
for each cohort will be communicated separately by you project contract. 
4. Each team will be accompanied by a project staff member, who will conduct 
supervision, quality checks, and will also conduct key informant interviews in the 
districts. 
5. Each team will also have a supervisor selected from among the interviewers based on 
the demonstrated results of the training. 
6. The work of each individual interviewer will be conducted in three stages: 
a. First, all interviewer candidates will receive a two-day theoretical training on 
the survey instruments. 
b. Second, all interviewer candidates will participate in the pre-test of the survey 
instruments, a third day of training, and a test of their survey skills. Four 
interviewer candidates selected to be supervisors will receive another day of 
training after the pre-test. 
c. Third, interviewer candidates who successfully pass the training will be 
invited to participate on a team and conduct interviews. Each interviewer is 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
69
expected to spend at least 6 days and no more than 42 days in the districts 
including travel days. Sunday are non-work days, and will be used either for 
rest or travel between districts. 
7. Each individual interviewer will be paid in at least three installments: 
a. All interview candidates who participated in the training will receive payment 
for the days of training 
b. For the individuals selected as interviewers: interviewers will receive Uganda 
government level per-diems which include lodging and meals allowances prior 
to travel. If transportation is not provided by the project, a transportation 
allowance for travel to or from a district to or from Kampala will be provided. 
c. At the end of the work conducted by a language cohort, each interviewer will 
be evaluated individually. Interviewers who completed their work according to 
the survey design discussed in this manual and who submitted completed 
questionnaires to the project staff will receive payment for the amount of days 
worked. Please note that Sundays are not counted as work days, however per￾diems will be provided for interviewers who are staying in the districts or 
traveling on Sundays. 
8. Documentation of interviewer contractual obligations will be done in the following 
way: 
9. Each interviewer candidates will sign a Letter of Agreement with The QED Group, 
LLC, which will serve as a contract between you and the company. 
10. At the time of payment, each interviewer will sign a receipt for payment which will 
also be signed by a witness. 
11. Per-diems are not required to be supported by receipts. 
12. Travel allowances will be provided based on the receipt for a bus and/or bus ticket. 
II.B. How to Prepare for Interviews 
1. Read all the Training Manual material, familiarize yourself with all the forms and 
their use, and prepare the introduction you plan to use in beginning the interview. 
2. Interview yourself, answering as if you were the respondent, and record your answers 
just as if someone else were conducting the interview. Take your time and make sure 
you get a feeling for the skip directions 
3. Conduct a practice interview with a friend. The purpose of the practice interview is so 
you can become accustomed to asking the interview questions, to help you recognize 
inadequate responses, to indicate which parts of the instructions need your review, to 
identify problems which these instructions do not cover adequately, and to reveal 
problems we need to cover in future instructions to interviewers. 
4. Jot down notes of anything that is unclear or any questions that you wish to ask, or 
sections that benefit from further instruction. Since the questionnaires are provided in 
70
English, select a master copy of each questionnaire and mark difficult places with 
translation in the local language for your quick reference. 
II.C. Materials You Will Need on this Study 
The following is a list of materials designed for this study and a brief description of how to 
use them. Detailed instructions on how to use all forms appear later in this manual. 
1. Interviewer Training Manual. Read this manual carefully and consult it whenever 
you have a question about administrative matters, filling out forms, or the interview 
itself.
2. Exit Survey Questionnaire. You will use this form to interview respondents for the 
Exit Survey at exit/entrances to clinics and retail stores. 
3. Retail Store Check Survey Questionnaire. You will use this form to interview owners 
or managers of retail stores/drug stores. 
4. List of assigned clinics and retail stores assigned to you individually. 
II.D. What Is Expected of You 
1. Interview locations will be assigned to you individually on a daily basis. You will get 
to the interview location and conduct interviews one at a time. It is your responsibility 
to make contact with the management of clinics or retail stores to explain the purpose 
of the survey and receive their authorization to work near their establishment. If 
problems occur, it is your responsibility to notify your supervisor immediately to get 
reassigned to a different location. 
2. Conduct interviews according to the rules and general concepts outlined in this 
manual. Supervisors will conduct random checks of each individual interviewer at 
their location during the day. 
3. You expected to be at your first location for the day at 9AM and continue the 
interview process until 6PM unless you are given your supervisor‘s permission to 
shorten the interview process. 
4. Organize your materials at the end of the day. Bring in all questionnaires and have 
them arranged in ID # order. Your supervisor will review your completed work and 
go over those cases you have not yet completed. 
II.E. Asking for Help 
1. Ask for help before major problems develop. Almost every interviewer will need 
individual help with some aspects of the study. If there is anything you don‘t 
understand about the study or the interview procedure, please don‘t hesitate to ask 
questions. We want to help you do the very best job you can when interviewing the 
respondents. 
II.F. Your Most Important Jobs 
1. Persuade people to cooperate in the study by giving them the necessary time to 
answer our questions honestly. 
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2. Get a clear, complete, and unambiguous statement of a person‘s responses. To do this 
you should (a) help the respondent feel relaxed enough to answer all the questions, 
regardless of the popularity of the answer, and (b) allow the respondent to answer the 
question without suggesting answers, even subtly. Therefore, do not appear shocked, 
pleased, or upset by anything respondents say. Do not contaminate the interview with 
your own opinions. Instructions will be given later in this manual about how to use 
neutral probes in interviewing. 
3. Record the respondent‘s ideas accurately on the form which will give someone else 
(such as the Evaluator and Data Manager) a clear picture of what happened in the 
interview. The best interview in the world is worthless if what happened is a secret 
between the interviewer and the respondent. 
III. GENERAL POINT OF INTERVIEWING 
III.A. Introducing Yourself 
1. Some General Rules 
a. Know roughly what you will say before the interview. Try not to sound 
anxious or hesitant when you talk to the respondent. Know in advance what 
you want to say, but don‘t use a ―canned‖ speech that will sound phony. Say it 
in an easy, relaxed manner. 
b. Don‘t say more than necessary. Your introduction should be done in the 
shortest way possible. You should not spend much time giving explanations 
that the respondent did not ask for because this may cause the respondent to 
not want to be interviewed. 
c. Be business-like, yet friendly. 
2. Suggested Introduction: 
a. Each questionnaire has an individual consent form that also provides an 
introduction for the interview. Please learn the introduction before the 
interview and follow it closely when introducing yourself to an interviewee. 
The survey methodology requires you to receive consent for the interview 
before proceeding. 
b. When conducting the Exit Survey at an entrance to a clinic, introduce yourself 
to the management or clinic staff before conducting the interview and obtain 
their permission to interview people near their establishment. You will be 
provided with a short introduction statement, and you can also show the 
questionnaire to the personnel, if requested. 
72
III.B. How to Answer General Questions and Complaints 
Try to answer all questions simply and don‘t go out of your way to offer long detailed 
explanations that are not needed. Any complaints by respondents should be noted in writing, 
given to your team supervisor when you turn in your questionnaires, and the respondent 
should be told that s/he can call in any complaint to the supervisor if s/he would like.
Below are some questions you may be asked and our suggested answers; but you should try 
to put the answers in your own words. Be familiar with the answers so that you can respond 
in a smooth and comfortable manner if you are asked any of these questions. However, don‘t 
try to say too much because you may lose your respondent or find yourself answering many 
more questions and wasting valuable time. 
1. “What is this all about?” 
―We are conducting an evaluation of a USAID-funded project. Your answers will help to 
determine if the project achieved its desired effect.‖
2. “Do you know my name?” 
―No, I don‘t know your name or any other information such as your address or telephone 
number, and no interviewers will ever know this information. Each questionnaire is coded 
with an individual ID, which is not linked to your name. However, we do ask for the name of 
your town/village in order to record the town/village each of the respondents who participate 
in this Survey.‖
3. “Can I refuse to answer any question in this interview?” 
―Yes, the interview is totally voluntary. But I would appreciate any help you can give us. I 
might add that if you would rather not answer certain questions, all you have to do is say so, 
and I will skip them.‖
4. “I don’t want to be a part of your data bank.” 
―Since we do not ask for your name or contact information, you will not be a part of any data 
bank.‖
5. “How long will the interview take?” 
For the Exit Survey: ―That‘s hard to say because it varies depending on how many answers 
you tell us, but it usually takes about 20 minutes.‖
For the Retail Store Check Survey: ―That‘s hard to say because it varies depending on how 
many answers you have, but it usually takes about 1 hour. If during this time you need to 
attend to your business, for example, talk to a client, we can interrupt the survey and continue 
after you finish with the client‖
6. “Who’s funding and conducting this study?” 
―The study is funded by USAID and conducted by The QED Group, LLC, a consulting 
company based in Washington, DC.‖
III.C. How to Maintain Confidentiality 
You are bound by strict ethical procedures which prevent you from ever revealing what any 
respondent has said. While the respondents will be answering many questions about their 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
73
private lives, they will confide in you because you can promise them strict confidentiality—
by this we mean the luxury of being totally open and honest without fear of being censured or 
quoted personally. This is very important if respondents have questions about confidentiality. 
Explain to them that their names will never be connected with what they tell you. When you 
get an interview assignment, the respondents‘ name will not be divulged to you so that even 
you are blinded to who the respondent is and to his/her responses on the questionnaire after 
the interview. 
IV. BASIC TECHNIQUES FOR INTERVIEWING 
IV.A. How to Read Questions 
1. All questions should be read in a natural conversational rhythm in a normal tone of 
voice. We tried to write the questions in the everyday language that people use in 
conversation. You must learn to read them exactly as written but should as though 
you are talking rather than reading. Do not read a question too fast. A respondent may 
not feel free to ask you to repeat it and may guess at what the question was intended 
to be. If the respondent does not understand a question, repeat it exactly as written. No 
unusual emphasis should be used unless (a) it is clear that the respondent did not 
understand certain words, in which case you may want to emphasize the words that 
were missed, or (b) the words are underlined in the question, indicating that they 
should be emphasized. 
2. Be aware of your tone of voice and facial expressions. How you ask a question or 
probe can be just as important as the wording of the question. Be careful that a tone of 
censure of criticism does not creep into your voice. Also your face may give you 
away. The best way to avoid such problems is to remember that your job is not to get 
people to agree with you, but to try to understand how people feel and think and what 
they do. 
3. Reading Verbatim. Ask the questions exactly as they are worded and in the same 
order as in questionnaire. Even minor changes in the questionnaire wording can 
completely change the meaning of a question. So every interviewer must ask the 
questions just as worded or the responses are meaningless. Also you must follow the 
order of the questions and never ask questions out of order UNLESS there are special 
instructions to do so, such as in Question X of the Retail Store Check Questionnaire. 
In this case, follow the skip instructions just as printed. 
IV.B. How to Get Adequate Answers 
1. General Guidelines 
a. Learn the purpose of each question. In order to do a good job of interviewing, 
you must understand the kind of information we are trying to get by asking a 
question. Unless you understand its purpose, you will not be able to judge 
when a response is adequate and you must probe for clarity or for more 
information. 
b. Don‘t try to explain the question. Be neutral. As mentioned before, if a 
respondent does not understand a question, repeat the question slowly and 
clearly. Give the respondent time to think about the question. Unless you have 
74
other information about handling specific questions, the only acceptable 
answer for a respondent who wants to know what a question means is 
―Whatever it means to you.‖ Never explain the meaning or purpose of a 
question unless the interviewer instructions tell you to do so. 
c. Don‘t define terms used in questions. Some respondents may ask you what we 
mean by a word used in a question. Leave the definition to the respondent, 
except where the written instructions give you a definition or alternate 
wording. Instead of giving your own definition, just say “Whatever________ 
means to you” or “However you use the term ___________.” The only 
exception to this rule is that for certain factual questions you will be given 
specific instructions on how to probe for accurate information, such as 
Question X. 
d. Don‘t leave a question until you have an adequate answer or find that a 
respondent can‘t give a clearer answer. 
e. Don‘t accept a ―don‘t know‖ without probing at least once. When you ask a 
question, people often say ―I don‘t know‖ just to give him/her time to collect 
their thoughts. If anyone says ―don‘t know,‖ then probe by saying “Well, 
what do you think?” or “I just want your opinion” (if the question asks for 
opinions rather than facts). Or, if the question asks for facts, we prefer if you 
probe further by saying “What’s your best guess?” or “Approximately?” to 
indicate that 100% accuracy is not required. 
f. Be sure that the respondent understands the time frame of the question being 
asked. Both surveys have only two time frames for the recall periods: one 
month and one year. Please be careful and remind individuals of specific time 
frame with each question. You can facilitate the respondent‘s recall by asking 
them to think back 1 month or a year, to a specific date, season or event to 
‘anchor‘ their recall. Then ask, for example, "Since (date, season or event), 
how often have you ________?".
g. Respondents may have difficulty with questions having multiple response 
options. Please note that there are four types of multiple response option 
questions and that all of these questions have four response categories. For 
these questions, you will be provided with set of responses. You can ask 
individuals to provide answers from each category in their own words, and 
then code the answers according to the set of responses provided in 
questionnaires. 
2. Probing
In most interviews, you will have to ask additional questions in order to clarify the 
respondent‘s response. This is called probing. There are several issues to keep in 
mind when probing for clarification: 
a. Use neutral probes that do not suggest answers. Probes are needed to get more 
complete and detailed answers. All probes must not be ―leading‖—that is, 
your probe must not suggest any particular answer to the respondent. Probes 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
75
should be used whenever the respondent is hesitant to answer a question; when 
s/he seems to have trouble expressing her/himself; when s/he seems to shy to 
speak; whenever there is any reason for the interviewer to think that the 
respondent has not given a complete report of her/his thinking; and, finally, 
when reassuring is needed because a respondent seems to lack confidence. 
b. Many interviewers forget to use two of the most effective neutral probes: (1) 
silence and (2) repeating the original question. The interviewer who can 
wait patiently and quietly will soon find that 15 seconds of silence is more 
than most respondents can take, and the respondent will often expand or 
clarify a previously inadequate answer if you simply wait. And repeating the 
question is another neutral way of probing. Be sure to repeat only the question 
as it is written in the questionnaire. 
c. Avoid ―depends‖ or ―qualified‖ answers. Never accept a ―depends‖ or 
―qualified‖ answer the first time it is given as a response to a question. 
Respondents often use phrases such as ―Well, that depends.‖ When the 
respondent gives a qualified answer, we advise one of the following probes: 
Repeat the question (unless this response will sound like you are not listening). Preface the 
question with a phrase like “Well, in general” or “On the whole.” Remind the respondent 
that we want to know which code comes closest to her/his views; use an introductory phrase 
such as “Well, if you had to choose” or “Even though you are somewhere in the middle, 
which way do you lean?” and repeat the question. If the respondent insists upon answering 
in qualified terms after probed enough, simply record verbatim her/his entire response, alone 
with your probes. 
IV.C. How to Record Answers 
1. General Guidelines 
a. Be ready to write. Have your pen or pencil ready as you ask your question. 
b. Learn to look up at your respondent and to look interested while you are 
interviewing. 
c. Never erase. If you make a mistake, cross out the wrong part instead of 
erasing. It‘s faster and often easier to read. 
2. How to Handle Precoded Questions 
Nearly all the questions in the questionnaire are precoded. For most questions, you 
will simply circle a number or fill in a box with a number the respondent gives you. 
Keep the following in mind when asking precoded questions. 
a. Show corrections if you need to change a code. If you give the wrong 
precoded response by mistake, or the respondent changes her/his mind about 
an answer, cross it out and make the correction. 
b. Be sure to record any comments the respondent volunteers in answering a 
precoded question whenever you have any doubt about whether you entered 
the right code. 
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3. How to Record Verbatim Responses 
When asking the few open-ended questions, you must record exactly what the 
respondent tells you. Use the following guidelines when recording responses word for 
word. 
a. Don‘t hesitate to ask the respondent to ―Please slow down.‖ Many times 
respondents will talk much more quickly than you can write. So asking them 
to talk slower is understandable in order for you to take their comments down 
correctly. 
b. Always use a person‘s own language. Quote your respondent directly. Don‘t 
polish what the respondent says even if s/he uses slang language or profane 
language. 
c. If there‘s not enough space for the respondent‘s answer, use the margins (top, 
side, or bottom) but be sure to label the continuation of your notes clearly. 
V. HOW TO ADMINISTER THE QUESTIONNAIRES 
V.A. Exit Survey Questionnaire 
1. Survey Code Number Q.N is an important part of questionnaire. When you preparing 
for the next interview, you have to enter the Survey Code Number in the following 
format: 
Two digit district code-two digit interviewer number –three digit interview number 
For example: 01-01-001 
A unique district code is assigned to each district. Please locate your current district 
code in the following table: 
District 
Code
District Name District Code District Name
01 Arua 21 Nebbi
02 Kabarole 22 Kamwewge
03 Mbarara 23 Ntunaamo
04 Wakiso 24 Mpigi
05 Masaka 25 Rakai
06 Jinja 26 Iganga
07 Mbale 27 Budaka
08 Lira 28 Pader
09 Gulu 29 Oyam
10 Kampala
11 Kiboga
A unique two-digit interviewer number will be assigned to each interviewer before 
going to the field. This number will be constant throughout the field work. 
You are responsible of keeping track of the number of Exit Surveys you conducted in 
particular district. First questionnaire that you complete in a new district has three￾digit interview number 001. When moving from location to location within the same 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
77
district, you have to continue increasing this number each time you complete a 
questionnaire. 
2. Most other questions of the questionnaire are self-explanatory. You have to follow the 
general guidelines to conducting survey described above. If you have any questions, 
please do not hesitate to ask your supervisor. Exceptions from this rule are discussed 
bellow. 
3. Questions Q.1, Q.2.1 – Q.2.3: According to your assignment, your location is either 
Clinic or Retail Store. Record this location type in Q.1. On each questionnaire that 
you complete at particular location (either clinic or retail store exit), complete 
questions Q.2.1 – Q.2.3 with the address of the establishment as it is written on your 
list of designated locations. If you know a name of the owner/manager of this location 
and his/her contact number, please also record it in these questions. 
4. Q.4.1 Please ask interview what village or town he/she permanently leaves for the last 
year. Record this number. For this address please ask respondent if it is a town or a 
village. Answer code 1 for this question is only applicable to Kampala 
5. Q.4.4 and Q.4.5: If respondent is confused about definition of the family, please 
provide an explanation that by family we mean all relatives leaving in the same house 
as the respondent. Question Q.4.5 records how many children are among these 
individuals. If an individual leaves alone, both Q.4.4 and Q.4.5 should be coded as 0. 
6. Q.4.6 If occupation of a respondent cannot be coded as one of the choices provided 
for the question, please mark choice Other-7, and record respondents‘ occupation in 
the space for variable Q.4.6_O 
7. Ask question Q.5 only if answer to question Q.1 is 1 (Clinic Exit Survey) Otherwise, 
leave the question blank 
8. Ask question Q.6 only if answer to question Q.1 is 2 (Retail Store Exit Survey) 
Otherwise, leave the question blank 
9. Questions Q.7 and Q.8. Read each choice for the question as individual question, 
repeating the top (common) portion of the question. Please make sure that 
respondents understand that the duration of recall period is one month. 
10. Q.8: Please explain to respondent that he/she should use the same definition of family 
as used for answering question Q.4.4 
11. Q.9 and Q.10: Please read the top part of the question to the respondent, and then ask 
he/she to identify if there was behavioral change with each specific area. Present each 
choice separately. If respondent indicates that there is a behavioral change (increase 
or decrease in use of some products, coded 1 or 3 for the question), please follow this 
question with question Q.9_R or Q.10_R, asking individual to identify possible 
sources of this change. Based on the respondents‘ response, please code it with 
choices presented at the bottom of the page, but do not read these choices to the 
responded prior to the answer. If respondent gives more than three reasons, please ask 
him/her to identify three most important. Number of completed choices does not 
necessarily have to be 3, it can be smaller. Three main reasons are not required to be 
coded in order of priority. 
78
V.B. Retail Store Check Survey Questionnaire 
1. Retail Store Check Survey Questionnaire is designed to survey owners or primary 
managers of retail stores that sell drugs (such as drugs stores and pharmacies) that 
work with AFFORD/UHMG distributors or are similar to these stores. Therefore, it is 
important when coming to the store to identify such person. Start with talking to a 
person behind the counter. Since most stores are small, this will probably be the 
person that you are looking for. If it is not the owner or primary manager, please 
enquire if such person is around for an interview, or will return to the store soon. If 
the person is unavailable at the moment, but can be available later, please consider 
going to the next store on your list and then returning to this store for the interview 
later. Finally, if a store owner or primary manager is not available, go to the next 
location on your list and include in your daily schedule nearest store from your 
reserve locations list. If you have any questions or foresee problems, please do not 
hesitate calling your supervisor. 
2. Most questions of the questionnaire are self-explanatory. You have to follow the 
general guidelines to conducting survey described above. If you have any questions, 
please do not hesitate to ask your supervisor. Exceptions from this rule are discussed 
bellow. 
3. You can pre-complete first page of the questionnaire with the information about the 
location available from your list of locations (such as store address) before coming to 
the field. However, you expected to record exact time (not a guess) of the interview 
start and end, and sign the first page of the questionnaire only after asked respondent 
for this informed consent using provided form. 
4. Survey Code Number Q.N is an important part of questionnaire. When you preparing 
for the next interview, you have to enter the Survey Code Number in the following 
format: 
Two digit district code-two digit interviewer number –three digit interview number 
For example: 01-01-001 
A unique district code is assigned to each district. Please locate your current district 
code in the following table: 
District
Code
District Name District Code District Name
01 Arua 21 Nebbi
02 Kabarole 22 Kamwewge
03 Mbarara 23 Ntunaamo
04 Wakiso 24 Mpigi
05 Masaka 25 Rakai
06 Jinja 26 Iganga
07 Mbale 27 Budaka
08 Lira 28 Pader
09 Gulu 29 Oyam
10 Kampala
11 Kiboga
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
79
A unique two-digit interviewer number will be assigned to each interviewer before 
going to the field. This number will be constant throughout the field work. 
You are responsible of keeping track of the number of Retail Store Check Surveys 
you conducted in particular district. First questionnaire that you complete in a new 
district has three-digit interview number 001. When moving from location to location 
within the same district, you have to continue increasing this number each time you 
complete a questionnaire. 
5. SECTION 1 is related to information about the store. Please make sure that 
respondent understands that recall period for this ONE YEAR. Read each question 
individually, listen to the respondents answer, and code it based on provided set of 
responses. Some questions lead to a skip pattern. This means that certain answer to a 
question (either yeas or no) will prompt you to skip several following questions and 
start your questioning from the question to which point instructions to this question. 
6. SECTION 2 is related to information about products sold in this store. It contains 
general section and subsections specific to each type of products marketed by 
UHMG/AFFORD. First, ask question Q.2 to determine which types of products are 
not sold in the store. If particular type of products is not sold in the store, you should 
skip corresponding sub-section of questionnaire. 
7. SUBSECTION 2.A has nonstandard for this questionnaire pattern. First two columns 
of the section ask about the bands marketed by UHMG/AFFORD. Third column asks 
about all other bands of condoms. If store sells other brands of condoms, please find 
out how many other bands NOT including UHMG/AFFORD are sold in the store 
currently. Ask respondent which of this brands is sold the best. When asked about 
volume of sale, please ask total amount of packs sold by ALL other brands. All other 
questions in column three should be asked about the brand that respondent identified 
as BEST BRAND among bands that are not marketed by UHMG. 
8. SUBSECTIONS 2.B – 2.D in the last column asks respondent identify up to five other 
best selling products in this category. Other questions in this subsection should NOT 
BE APPLIED to these brands. 
9. If a store does not sell a product identified at the head of column in SUBSECTIONS 
2.A - 2.D, please skip all questions and go to the last question in this column. If a 
store sells the product, please skip the last question for this product. 
10. SECTION 3 asks about typical consumer coming in the store for particular type of 
products. If particular type of products is not sold in the store, please code all 
questions in a raw with code for N/A. Explain to the store owner that we are looking 
for his personal opinion about the typical costumers, not a scientifically confirmed 
answer. If respondent asks, offer him/her to recall typical costumers for a period of 
LAST MONTH. Please listen to respondent‘s answer, and then code it with a choice 
provided in the list of choices. Do not read choices to the respondent with the 
question. 
11. SECTION 4 asks about store sources of drugs and medical products and their 
experience with suppliers. Read each question and choice of answers to the 
respondent. For the questions Q.4.2 – Q.4.4, ask respondent to select only one 
80
response that is the most applicable to the situation in the store. If respondent asks, 
provide him a recall period of ONE YEAR. 
12. SECTION 5 asks about experience with AFFORD. Question Q.5.1 relates to the store 
experience with UHMG/AFFORD distributor if they can clearly identify such person. 
All other questions in this section refer to the respondents personal experience with 
AFFORD or UHMG activities. 
13. After SECTION 5 your interaction with a respondent should be completed. Please 
thank the respondent for taking part in our research. 
14. SECTION 6 of the questionnaire is based on interviewer‘s observations. Take a quick 
look around the store. For each item on the list in the section, please identify if this 
item is present and visible in the store. However, please DO NOT ASK store owner, 
manager or sales person to point to a product or other material mentioned in this 
section. 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
81
ANNEX H : KEY INFORMANT INTERVIEW GUIDE 
KEY INFORMANT INTERVIEW
Date/Location Jan. 27, 2009 9:00am AFFORD OFFICE
Introduction:
Hello. My name is _________________ and I‘m part of The QED Group, LLC (QED) 
team which is leading the mid-term evaluation of the USAID-financed AFFORD project. 
QED is a full-service international development company located in Washington, DC 
which specializes in project monitoring and evaluation.
The purpose of this evaluation is to determine if the AFFORD project activities have 
achieved the desired results during the first 3 years of operations. The objectives of the 
evaluation are to: a) validate the project results; b) identify the effectiveness and further 
potential of project activities; and c) assess the future sustainability of the Uganda Health 
Marketing Group (UHMG).
Your views will help to provide a better understanding of the changes in the health sector in 
Uganda and the effect of current AFFORD programs. Information collected from key 
informant interviews will be used to highlight best practices and make recommendations 
for improvements to AFFORD‘s current and future mixture of activities. Your responses 
will also be used to test the initial assumptions that led to the development of AFFORD, to 
inform USAID/Uganda‘s decisions on the continuation of the program, and to United 
States Government‘s investments in marketing strategies for the health sector in Uganda.
Participation in this interview is voluntary. We ask to interview you alone in order to 
facilitate your honest responses. If you choose, the information you provide can be kept 
strictly confidential and not be shown to AFFORD or UHMG representatives. However, 
summary results based on key informant interviews will be shared with AFFORD and 
USAID/Uganda officials
During the interview, if we come to any question you don't want to answer, just let me 
know and I will go on to the next question; or you can stop the interview at any time.
However, we hope that you will participate in this interview since your views are 
important.
At this time, do you want to ask me anything about the survey? 
May I begin the interview now?
Signature of Interviewer: ______________________ Date: ________________________
82
A-1. PLEASE TELL AS BRIEFLY WHAT DOES YOUR ORGANIZATION OR DEPARTMENT DO, 
AND WHAT ARE YOU ROLE AND RESPONSIBILITIES?
A-2. DO YOU KNOW ABOUT THE AFFORD PROJECT? DO YOU HAVE ANY AFFILIATION 
WITH AFFORD?
WHAT ABOUT UHMG? DO YOU KNOW ABOUT OR HAVE ANY INVOLVEMENT WITH 
UHMG?
A-3. DO YOU KNOW ABOUT SIGNIFICANT CHANGES IN HEALTH IN UGANDA OVER THE 
LAST 3 YEARS? IN YOUR OPINION, WHAT WAS THE SOURCE OR CAUSE OF THESE 
CHANGES?
A-4. IN YOUR OPINION, WERE THERE CHANGES IN THE HEALTH BEHAVIOR OF THE 
GENERAL POPULATION AND SPECIFIC AT-RISK GROUPS IN THE COUNTRY OVER THE 
LAST 3 YEARS? WHAT WAS THE SOURCE OR CAUSE OF THESE CHANGES?
A-5. IN YOUR OPINION WAS THERE A CHANGE IN AVAILABILITY OF HEALTHCARE 
PRODUCTS (DRUGS, ETC.) TO THE POPULATION IN THE LAST 3 YEARS? WHAT 
PRODUCTS/CATEGORIES OF PRODUCTS, AND WHAT IS THE SOURCE OR CAUSE OF THIS 
CHANGE?
A-6. HAVE YOU EVER PARTICIPATED IN ANY AFFORD ACTIVITIE(S)? PLEASE DESCRIBE 
THE ACTIVITIE(S), AND YOUR PARTICULAR ROLE.
A-7. WHAT IS YOUR EXPERINECE WORKING/COOPERATING/COMMUNICATING WITH 
AFFORD? WHAT WERE THE ADVANTAGES? WHAT WERE THE LESSONS LEARNED FROM 
THIS EXPERIENCE? 
WHERE THERE ANY CHALLENGES OR BARRIERS? IF SO, WERE THERE ANY STEPS TAKEN 
TO RESOLVE THEM AND MOVE FORWARD SUCCESSFULLY?
A-8. IN YOUR EXPERT OPINION, WHAT IS THE EFFECT OF AFFORD IN THE FOLLOWING 
AREAS OF WORK: 
A) PRODUCT AVAILABILITY, 
B) POPULATION HEALTH BEHAVIOR, 
C) NON-PROFIT AND FOR-PROFIT HEALTHCARE SECTORS, 
D) OR OTHER AREAS OF LIFE IN UGANDA? 
A-9. IN YOUR EXPERT OPINION, WHAT ARE THE MAIN AFFORD SUCCESSES OR BEST 
PRACTICES?
A-10. IN YOUR EXPERT OPINION, WHAT ARE AFFORD‘S MAIN CHALLENGES OR 
BARRIERS?
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
83
A-11. HAVE YOU HEARD ABOUT UHMG? 
 A. DO YOU KNOW WHAT UHMG DOES? 
 B. IF YES, CAN YOU COMMENT ON THE PERFORMANCE OF UHMG 
 C. WHAT ARE THE SUCCESSES OF UHMG?
 D. WHAT ARE THE CHALLENGES OF UHMG?
 E. WHAT SHOULD BE DONE TO MAKE UHMG A SUCCESSFUL NONGOVERNMENTAL 
ORGANIZATION (NGO) IN UGANDA? 
A-12. IN YOUR EXPERT OPINION, WHAT PROBLEMS IN THE HEALTHCARE SECTOR MOST 
NEED UHMG ATTENTION AND SUPPORT IN THE NEXT 5 YEARS?
A-13. INTERVIEWER, PLEASE SELECT APPROPRIATE QUESTION RELATED TO THE AREA 
OF EXPERTISE OF RESPONDENT AND RECORD ANSWERS?
1. In your opinion, has there been a change in marketing or volume of sales/distribution of the healthcare 
products in Uganda over the past two years? If so, what products, and what is the source or cause of this 
change? Has AFFORD or UHMG played any role in this change?
2. In your opinion, has there change in availability and/or use of malaria prevention products over the 
past two years? If so what products in particular? What is the source or cause of this change? Were there 
also changes in malaria prevention behaviors? What is the source or cause of these changes? Has 
AFFORD or UHMG played any role in this change?
3. In your opinion, has there been change in HIV/AIDS understanding and related behaviors? What is the 
source or cause of this change? Was there change in availability and/or use of HIV/AIDS 
protection/prevention products and/or services? What is the source or cause of this change? Has 
AFFORD or UHMG played any role in this change?
4. In your opinion, has been there any change in the NGO/civil society organization environment in 
healthcare sector in Uganda? What is the source or cause of this change? Has AFFORD or UHMG played 
any role in this change?
5. In your opinion, what progress has UHMG achieved at the moment? What should be done to ensure 
long-term sustainability of UHMG? 
A-14. DO YOU HAVE ANY OTHER SUGGESTIONS OR RECOMMENDATIONS RELATED TO 
THE TOPIC OF TODAYS INTERVIEW?
A-15. CAN YOU RECOMMEND ANY OTHER EXPERTS WHO‘S OPINION MAY BE USEFUL 
FOR THIS EVALUATION?
84
ANNEX I : RETAIL STORE SURVEY QUESTIONNAIRE 
Retail Store Study 
Survey Questionnaire 
Date………………………. 
District : Town/Village: 
Starting time of interview
Ending time of interview
Type of Outlet RETAILER/PHARMACY
Name of Outlet 
Address 
Telephone # 
Supervisor’s name and signature 
Interviewer’s name 
Interviewer’s signature 
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
85
SECTION A: Interviewer/Pharmacy Background 
Q.A.1
Are you the proprietor or main manager or main 
sales person for this establishment (drug store, 
pharmacy, retail store)?
Yes .. 1 No.. 2
(If no, stop interview)
Q.A.2 Are you the proprietor of the establishment? Yes .. 1
go to Q.A.4 No.. 2
Q.A.3
Who is proprietor of this establishment (drug store, 
pharmacy, retail store)?
1. Respondent’s family
2. Respondent’s friend or neighbor
3. Unrelated businessperson
4. Government of Uganda
5. Uganda nongovernmental organization
6. National company/business
7. International company or individual
8. International project/donor organization
9. DNK (Do not know)
_______
Q.A.4 Do you usually work in the establishment (drug 
store, pharmacy, retail store) most of the time?
Yes .. 1
go to Q A. 6 No.. 2
Q.A.5
Who is the main person who usually works in this 
establishment (drug store, pharmacy, retail store)?
1. Owner
2. Member of respondent’s family who is not the 
owner
3. Friend/neighbor of the respondent who is not the 
owner
4. Other unrelated employee who is not the owner
9. DNK (Do not know)
_______
Q.A.6 How long has this establishment existed here 
(Number of years)? _______
Q.A.7 How long have you worked in this establishment 
(Number of years)? _______
Q.A.8
What is your (respondent) level of education?:
1. No Education 
2. Incomplete Primary School (less than 7 years) 
3. Complete Primary School ( 7 years) 
4. Incomplete O-level (less than 11 years.) 
5. Complete O-level (11 years
6. Incomplete A-level (less than 13 years) 
7. Complete A-Level (13 years)
8. University or training institution
 99. DNA (Did not answer)
_______
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
86
SECTION 1: Interviewer and pharmacy store information 
Q.1 FOR THE LAST ONE YEAR, UNLESS OTHER TIME FRAME SPECIFIED, PLEASE ANSWER THE FOLLOWING?:
Q.1.1 Did you have any health or healthcare education? Yes .. 1 No.. 2
Q.1.2 Do you know if the establishment/store received supplies from 
AFFORD/United Health Marketing Group (UHMG) distributors? Yes .. 1 No.. 2
Q.1.3 Do you know if the establishment sold/still sells products 
marketed by AFFORD or UHMG? Yes .. 1 No.. 2
Q.1.4
Do you know if the establishment sold/still sells products 
marketed by international projects or donor organizations such 
as the USAID or the World Bank?
Yes .. 1 No.. 2
SECTION 2: Product information 
Q.2 DO YOU SELL THE FOLLOWING PRODUCTS?:
Q.2.1 Male condoms (if no, skip subsection 2.A) Yes .. 1 No.. 2
Q.2.2 Other contraceptives/family planning products (if no, skip subsection 
2.B) Yes .. 1 No.. 2
Q.2.3 Vitamins Yes .. 1 No.. 2
Q.2.4 Child health related drugs/supplements (if not, skip subsection 2.C) Yes .. 1 No.. 2
Q.2.5 HIV/AIDS and other sexually-transmitted infections (STI) treatments (if 
no, skip subsection 2.D) Yes .. 1 No.. 2
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
87
SUBSECTION 2.A: Condoms (Note: The brands indicated here are AFFORD/UHMG Products. Show the pictures of these 
brands to the respondent) 
FOR THE FOLLOWING BRANDS: Protector “O” Other Brands
2.A.1 Do you sell this brand of male condoms?
Q.2.A.1_1
1. Yes
2. No (go to Q.2.A.10_1)
Q.2.A.1_2
1. Yes
2. No (go to Q.2.A.10_2)
Q.2.A.1_3
1.Yes (#of other brands) ____
2. No (go to Q.2.A.10_3)
2.A.2 How many packs of this brand do you usually sell a month? Q.2.A.2_1 Q.2.A.2_2 Q.2.A.2_3 (Total for other brands)
2.A.3 How many condoms are in a pack (if several sizes are available, the best 
selling pack size)?
Q.2.A.3_1 Q.2.A.3_2 Q.2.A.3_3 (Best selling brand)
2.A.4 What is the current price per pack (if several sizes are available, the best 
selling pack size)?
Q.2.A.4_1 Q.2.A.4_2 Q.2.A.4_3 (Best selling brand)
2.A.5 How often do you run out of supply for this brand?
1. More than once a month
2. Once a month 3. Once a quarter
4. twice a year 5. Once a year 6. Never 99. DNA
Q.2.A.5_1 Q.2.A.5_2 Q.2.A.5_3 (Best selling brand)
2.A.6 What do you do when you run out of supply for this brand?
1. Call/place an order with the supplier
2. Wait for the supplier to visit
3. Buy from another source
4. Never run out of supply
5. Other 99. DNA
Q.2.A.6_1 Q.2.A.6_2 Q.2.A.6_3 (Best selling brand)
2.A.7 How would you rate sales of this brand among all other brands available 
at your store? 
1. Best 2. Average
3. Worst 99. DNA 
Q.2.A.7_1 Q.2.A.7_2 Q.2.A.7_3 (Best selling brand)
2.A.8 How often do customers ask for this specific brand? 
1. More than once a day 2. Once a day
3. At least once a week 4. Less than once a week
99. DNA
Q.2.A.8_1 Q.2.A.8_2 Q.2.A.8_3 (Best selling brand)
2.A.9 How do you usually get this brand?
1. Sales person visits me
2. Buy it from wholesaler
3. Buy from another retailer
4. Other 99. DNA
Q.2.A.9_1 Q.2.A.9_2 Q.2.A.9_3 (Best selling brand)
2.A.10 What is the reason you do not sell this brand?
1. No distributor
2. Not available
3. No credit/cash to buy
4. Not interested
5. Other (specify) ……………………. 6. DNK 99.DNA
Q.2.A.10_1 Q.2.A.10_2 Q.2.A.10_3 (Best selling brand)
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
88
SUBSECTION 2.B: Other contraceptives/family planning products (Interviewer show these brands to respondent) 
FOR THE FOLLOWING BRANDS: Pilplan Injectaplan® MoonBeads NewFem SoftSure Other 
Products
2.B.1 Do you sell following brands of 
contraceptives or family planning products?
Q.2.B.1_1
1. Yes
2. No (go to 
Q.2.B.9_1)
Q.2.B.1_2
1. Yes
2. No (go to 
Q.2.B.9_2)
Q.2.B.1_3
1. Yes
2. No (go to 
Q.2.B.9_3)
Q.2.B.1_4
1. Yes
2. No (go to 
Q.2.B.9_4)
Q.2.B.1_5
1. Yes
2. No (go to 
Q.2.B.9_5)
Please list up 
to 5 other best￾selling 
products
2.B.2 How many packs of this brand do you 
usually sell a month?
Q.2.B.2_1 Q.2.B.2_2 Q.2.B.2_3 Q.2.B.2_4 Q.2.B.2_5
2.B.3 What is the current price per pack? Q.2.B.3_1 Q.2.B.3_2 Q.2.B.3_3 Q.2.B.3_4 Q.2.B.3_5
2.B.4 How often do you run out of supply for 
this brand?
1. More than once a month
2. Once a month 3. Once a quarter
4. twice a year 5. Once a year 6. 
Never 99. DNA
Q.2.B.4_1 Q.2.B.4_2 Q.2.B.4_3 Q.2.B.4_4 Q.2.B.4_5
2.B.5 What do you do when you run out of 
supply for this brand?
1. Call/place an order with the supplier
2. Wait for the supplier to visit
3. Buy from another source
4. Never run out of supply
5. Other 99. DNA
Q.2.B.5_1 Q.2.B.5_2 Q.2.B.5_3 Q.2.B.5_4 Q.2.B.5_5
2.B.6 How would you rate sales of this brand 
among all other brands available at your 
store? 
1. Best 2. Average
3. Worst 99. DNA 
Q.2.B.6_1 Q.2.B.6_2 Q.2.B.6_3 Q.2.B.6_4 Q.2.B.6_5
2.B.7 How often do customers ask for this 
specific brand? 
1. More than once a day 2. Once a day
3. At least once a week 
4. Less than once a week
99. DNA
Q.2.B.7_1 Q.2.B.7_2 Q.2.B.7_3 Q.2.B.7_4 Q.2.B.7_5
2.B.8 How do you usually get this brand?
1. Sales person visits me
2. Buy it from wholesaler
3. Buy from another retailer
4. Other
99. DNA
Q.2.B.8_1 Q.2.B.8_2 Q.2.B.8_3 Q.2.B.8_4 Q.2.B.8_5
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
89
FOR THE FOLLOWING BRANDS: Pilplan Injectaplan® MoonBeads NewFem SoftSure Other 
Products
2.B.9 What is the reason you do not sell this 
brand?
1. No distributor
2. Not available
3. No credit/cash to buy
4. Not interested
5. Other(specify)……………………
6. DNK 99.DNA
Q.2.B.9_1 Q.2.B.9_2 Q.2.B.9_3 Q.2.B.9_4 Q.2.B.9_5
SUBSECTION 2.C: Child health related drugs/supplements (Interviewer show the pictures of these brands to respondent) 
FOR THE FOLLOWING BRANDS: Restors 
(ORS)
Zinkid 
(Zinc Tablets)
Aquasafe 
(NaDCC 70mg)
Other 
Products
2.C.1 Do you sell following brands of child health 
related drugs/supplements?
Q.2.C.1_1
1. Yes
2. No (go to Q.2.C.9_1)
Q.2.C.1_2
1. Yes
2. No (go to Q.2.C.9_2)
Q.2.C.1_3
1. Yes
2. No (go to Q.2.C.9_3)
Please list up 
to 5 other 
best-selling 
2.C.2 How many packs of this brand do you usually sell products
a month?
Q.2.C.2_1 Q.2.C.2_2 Q.2.C.2_3
2.C.3 What is the current price per pack? Q.2.C.3_1 Q.2.C.3_2 Q.2.C.3_3
2.C.4 How often do you run out of supply for this brand?
1. More than once a month
2. Once a month 3. Once a quarter
4. twice a year 5. Once a year 6. Never 99. 
DNA
Q.2.C.4_1 Q.2.C.4_2 Q.2.C.4_3
2.C.5 What do you do when you run out of supply for 
this brand?
1. Call/place an order with the supplier
2. Wait for the supplier to visit
3. Buy from another source
4. Never run out of supply
5. Other 99. DNA
Q.2.C.5_1 Q.2.C.5_2 Q.2.C.5_3
2.C.6 How would you rate sales of this brand among all 
other brands available at your store? 
1. Best 2. Average
3. Worst 99. DNA 
Q.2.C.6_1 Q.2.C.6_2 Q.2.C.6_3
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
90
FOR THE FOLLOWING BRANDS: Restors 
(ORS)
Zinkid 
(Zinc Tablets)
Aquasafe 
(NaDCC 70mg)
Other 
Products
2.C.7 How often do customers ask for this specific 
brand? 
1. More than once a day 2. Once a day
3. At least once a week 
4. Less than once a week
99. DNA
Q.2.C.7_1 Q.2.C.7_2 Q.2.C.7_3
2.C.8 How do you usually get this brand?
1. Sales person visits me
2. Buy it from wholesaler
3. Buy from another retailer
4. Other
99. DNA
Q.2.C.8_1 Q.2.C.8_2 Q.2.C.8_3
2.C.9 What is the reason you do not sell this brand?
1. No distributor
2. Not available
3. No credit/cash to buy
4. Not interested
5. Other (specify) …………….. 6. DNK 
99.DNA
Q.2.C.9_1 Q.2.C.9_2 Q.2.C.9_3
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
91
SUBSECTION 2.D: HIV/AIDS and other sexually-transmitted infections (STI) treatments (Interviewer, show the picture of 
this product to respondent) 
FOR THE FOLLOWING BRANDS: Cotramox (Cotrimoxazole 960mg) Other 
Products
2.D.1 Do you sell following brands of HIV/AIDS and other STI treatments? Q.2.D.1_1
1. Yes
2. No (go to Q.2.D.9_1)
Please list up 
to 5 other best￾selling 
2.D.2 How many packs of this brand do you usually sell a month? Q.2.D.2_1 products:
2.D.3 What is the current price per pack? Q.2.D.3_1
2.D.4 How often do you run out of supply for this brand?
1. More than once a month
2. Once a month 3. Once a quarter
4. twice a year 5. Once a year 6. Never 99. DNA
Q.2.D.4_1
2.D.5 What do you do when you run out of supply for this brand?
1. Call/place an order with the supplier
2. Wait for the supplier to visit
3. Buy from another source
4. Never run out of supply
5. Other 99. DNA
Q.2.D.5_1
2.D.6 How would you rate sales of this brand among all other brands available at your 
store? 
1. Best 2. Average
3. Worst 99. DNA 
Q.2.D.6_1
2.D.7 How often do customers ask for this specific brand? 
1. More than once a day 2. Once a day
3. At least once a week 
4. Less than once a week 99. DNA
Q.2.D.7_1
2.D.8 How do you usually get this brand?
1. Sales person visits me
2. Buy it from wholesaler
3. Buy from another retailer
4. Other 99. DNA
Q.2.D.8_1
2.D.9 What is the reason you do not sell this brand?
1. No distributor
2. Not available
3. No credit/cash to buy
4. Not interested
5. Other (specify)………………………………………. 
6. DNK 99.DNA
Q.2.D.9_1
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
92
SECTION 3: Customer information 
FOR EACH TYPE OF THE PRODUCTS, PLEASE INDICATE THE FOLLOWING: 
Q.3.1 Who is the main 
customer for this category 
of products?
Q.3.2 How do the 
customers select a 
specific brand?
Q.3.3 Do your customers often? Q.3.4 What do you think 
influences most 
customers to choose a 
specific brand?: 
Select from following 
choices:
1. Male
2. Female
3. Both
4. DNK (Do not know)
98.N/A (if do not sell these 
products)
99. DNA (Did not answer)
1. Ask for specific brand
2. Ask for your advice
3. Buy the least expensive
4. Buy the most expensive
5. Other (specify)
98. N/A
99. DNA
1. Ask for brand/product advertised on TV
2. Ask for brand/product advertised on radio
3. Ask for brand/product advertised in newspaper
4. Ask for brand/product advertised in your store
5. Ask for brand product advertised
6. Ask for brand/product suggested by doctor
7. others (Specify)…………………….
98. N/A 99. DNA
1. Price
2. Quality
3. Brand recognition
4. Recommendation
5. Simplicity of use
6. 
others(Specify)………………
7. DNK
98. N/A
99. DNA 
Male condoms Q.3.1_1
________
Q.3.2_1
________
Q.3.3_1
________
Q.3.4_1
________
Other 
contraceptives/family 
planning products
Q.3.1_2
________
Q.3.2_2
________
Q.3.3_2
________
Q.3.4_2
________
Vitamins Q.3.1_3
________
Q.3.2_3
________
Q.3.3_3
________
Q.3.4_3
________
Child health related 
drugs/supplements
Q.3.1_4
________
Q.3.2_4
________
Q.3.3_4
________
Q.3.4_4
________
HIV/AIDS and other 
sexually-transmitted 
infections (STI) 
treatments
Q.3.1_5
________
Q.3.2_5
________
Q.3.3_5
________
Q.3.4_5
________
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
93
SECTION 4: Product distribution network 
Q.4.1 FOR THE LAST YEAR, WHICH OF THE FOLLOWING DID YOU USE TO GET MEDICAL PRODUCTS/DRUGS 
THAT YOU SELL?:
Q.4.1_1 Other stores like yours Yes .. 1 No.. 2
Q.4.1_2 Larger store or pharmacy Yes .. 1 No.. 2
 Q.4.1_3 Wholesale distributor Yes .. 1 No.. 2
Q.4.1_4 Company that produces this drug Yes .. 1 No.. 2
Q.4.1_5 Government (for free distribution) Yes .. 1 No.. 2
Q.4.1_6 Government (for sale) Yes .. 1 No.. 2
Q.4.1_7 NGOs or International Projects Yes .. 1 No.. 2
Q.4.2 DURING THE LAST YEAR, WHAT WAS THE MAIN SOURCE THAT YOU USED TO GET MEDICAL 
PRODUCTS/DRUGS THAT YOU SELL?:
Please select only one source, mark box with X
1 Other stores like yours □
2 Larger store or pharmacy □
 3 Wholesale distributor □
4 Company that produces this drug □
5 Government (for free distribution) □
6 Government (for sale) □
7 NGOs or International Projects □
Q.4.3 DURING THE LAST YEAR, WHAT IS THE FURTHEST PLACE THAT YOU TRAVELLED TO GET THE 
MEDICAL PRODUCTS/DRUGS THAT YOU SELL?:
Please select only one choice, mark box with X
1 Did not travel/All products were delivered to me by suppliers □
2 Nearest trading center (other than current location, if located in trading center) □
 3 Capital of my district (other than current location, if located in capital of the district) □
4 Neighboring district □
5 Kampala (only if it does not qualify as choice 1,2 or 3) □
6 Districts far from my district □
7 Another country □
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
94
Q.4.4 DURING THE LAST YEAR, HOW DID YOU USUALLY GET NEW BRANDS/MEDICAL PRODUCTS TO 
SELL AT YOUR STORE?:
Please select only one source, mark box with X
1 Look for distributors of new products that I want to sell by myself □
2 Buy new products that available in neighboring stores □
 3 I am contacted by distributor who offers new products □
4 Other □
Q.4.4_O Specify _______________________________
99 DNA □
SECTION 5: Experience with AFFORD 
Q.5.1 FOR THE LAST ONE YEAR, PLEASE RECALL THE FOLLOWING?:
Q.5.1_1 Did you work with a distributor who clearly identified that he is working 
with UHMG or AFFORD project? Yes .. 1 No.. 2 (Go to 
Q5.2)
Q.5.1_2 Is this distributor the main source of medical products/drugs that you sell 
in the store Yes .. 1 No.. 2
Q.5.1_3 Is this the only source of medical products/drugs that you sell in the store Yes .. 1 (Got to 
Q5.2) No.. 2
Q.5.1_4
What is your experience working with this distributor compared to other 
distributors?
Better than the other…….1
Same as the other……….2
Worse than the other…....3
N/A………………………98 
_______
Q.5.1_5
What is most attractive to you in this distributor?
Brands of the products offered…………..1
Prices……………………………………….2
Distributor delivers to my store…………..3
Distributor responds to requests quickly..4
Distributor always has supplies………….5
Other (specify)……………………………..6
N/A…………………………………………98
_______
Q.5.2 DID YOU EVER HEAR/SEE THE FOLLOWING?: 
Q.5.2_1 Good Life Show on TV Yes .. 1 No.. 2
Q.5.2_2 Good Life Show on radio Yes .. 1 No.. 2
Q.5.2_3 Good Life Show column in newspapers Yes .. 1 No.. 2
Q.5.2_4 Under the Mango Tree on radio Yes .. 1 No.. 2
Q.5.2_5 Everyday Health Matters newspaper Yes .. 1 No.. 2
Q.5.2_6 HIV prevention films Yes .. 1 No.. 2
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
95
Q.5.3 DID YOU EVER PARTICIPATE IN THE FOLLOWING?: 
Q.5.3_1 Good Life Show prize drawings Yes .. 1 No.. 2
Q.5.3_2 Pulse Activation theatre/show Yes .. 1 No.. 2
Q.5.3_3
Meeting with community leaders to discuss health related issues organized 
by the AFFORD Project (AFFORD) or the Uganda Health Marketing Group 
(UHMG)
Yes .. 1 No.. 2
Q.5.3_4 Training on healthcare issues or other events organized by AFFORD or 
UHMG Yes .. 1 No.. 2
Q.5.3_5 Malaria net distribution from AFFORD, USAID, or UHMG Yes .. 1 No.. 2
Q.5.4 DID YOU NOTICE MORE CUSTOMERS COMING TO YOUR STORE AFTER THE FOLLOWING?: (You can 
only record 98 for these questions if the answers to the corresponding questions in Q. 5.2 are no (2))
Q.5.2_1 Good Life Show on TV N/A .98 Yes .. 1 No.. 2
Q.5.2_2 Good Life Show on radio N/A . 98 Yes .. 1 No.. 2
Q.5.2_3 Good Life Show column in newspapers N/A . 98 Yes .. 1 No.. 2
Q.5.2_4 Under the Mango Tree on radio N/A . 98 Yes .. 1 No.. 2
Q.5.2_6 HIV prevention films N/A . 98 Yes .. 1 No.. 2
Q.5.2_6 Pulse Activation theatre/show in your town/village N/A . 98 Yes .. 1 No.. 2
Q.5.2_6
Meeting with community leaders to discuss health related 
issues organized by the AFFORD Project (AFFORD) or the 
Uganda Health Marketing Group (UHMG) in your 
town/village
N/A . 98 Yes .. 1 No.. 2
THIS IS THE END OF THE INTERVIEW. 
THANK YOU FOR PROVIDING VALUABLE INFORMATION FOR OUR EVALUATION!
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
96
SECTION 6: Concluding observations 
(to be completed based on interviewer observations) 
Q.6 INTERVIEWER, PLEASE LOOK AROUND THE STORE AND MARK IF YOU SEE THE FOLLOWING 
UHMG/AFFORD SUPPORTED PRODUCTS AND ADVERTISEMENT. DO NOT ASK STORE PERSONAL TO HELP 
YOU FIND THESE PRODUCTS. ALL UHMG/AFFORD PRODUCTS/MATERIALS SHOULD BE DISTINCTLY 
MARKED WITH UHMG/AFFORD LOGOs:
Q.6.1 Cotramox (Cotrimoxazole 960mg) Yes .. 1 No.. 2
Q.6.4 Restors (ORS) Yes .. 1 No.. 2
Q.6.5 Zinkid (Dispersible Zinc Tablets) Yes .. 1 No.. 2
Q.6.6 Aquasafe (NaDCC 70mg) Yes .. 1 No.. 2
Q.6.8 Pilplan Yes .. 1 No.. 2
Q.6.9 Injectaplan® Yes .. 1 No.. 2
Q.6.10 MoonBeads Yes .. 1 No.. 2
Q.6.11 NewFem Yes .. 1 No.. 2
Q.6.12 SoftSure Yes .. 1 No.. 2
Q.6.13 Protector Yes .. 1 No.. 2
Q.6.14 “O” Yes .. 1 No.. 2
Q.6.15 Signs or advertisements for at least one of the above products Yes .. 1 No.. 2
Q.6.16 Advertisements for Good Life Clinic Yes .. 1 No.. 2
Q.6.17 Advertisements for UHMG/AFFORD events/shows Yes .. 1 No.. 2
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
97
ANNEX J : EXIT SURVEY QUESTIONNAIRE 
Exit Survey Questionnaire 
Q.0.A INTERVIEWER’S Number ……………………... Q.0.B INTERVIEWER’S NAME…………………………... 
Q.3 Date: …………………………………..(MM/DD/YY)
Q.4 Respondent’s Background
Q.4.1 Respondent Address (Zone, Village, Division, District)
…………………………………………………………………
Q.4.2 Type of area 
Capital…………………………..……1
District Capital/Town………………..2
Village/Rural…………………..……..3
Q.4.3 Gender : Male ……………..…………….1
 Female………………………...2
Q.4.4 Marital status : Single ……………..………..…..1
 Married/living together ………..2
 divorced/separated…………….3
Widowed ………………….……4 
DNA……………………. ……….99
Q.4.5 Age (approximately if not known): ……….
Q.4.6 Number of people in your household: …. ……
Q.4.7 Number of children in your household: … ..….
Q.4.8 Occupation of respondent
 Health worker .……..………….………..1
 Industrial Worker.……………………...…2
 Service Industry....……………………......3
 Science/Professional/Management ...…4
 Farmer……………..………………………5
 Household & Domestic...…………….…..6
 Other(specify)….……….…………………7
 DNA…………………….………………….99
Q.4.9 Education level of respondent: 
 No Education ………………………………………….……...1
 Incomplete Primary School (less than 7 years) …………..2 
 Complete Primary School ( 7 years) ……………..………..3
 Incomplete O-level (less than 11 years.) ……….…..……..4
 Complete O-level (11 years)………………...…………..…5
 Incomplete A-level (less than 13 years) ……………...….. 6
 Complete A-Level (13 years) …………..….....…………… 7
 University or training institution……………………….…… 8
 DNA……………………………………………………….….99
Q.1 Exit Survey Type: 
Clinic Exit Survey ……..……1
Retail Store Exit Survey……2
Q.2.1 LOCATION ADDRESS:
(address of clinic or retail store)
Q.2.2 Contact authority/owner Name: 
(at clinic or retail store)
Q.2.3 Tel. Number : 
(of contact authority)
If Exit Survey Type 1 (Clinic)
Q.5. Purpose of visit to clinic:
 Get services ……………………………1
 Accompany someone..…………..……2
 Did not come to the clinic ……………3
 Other (specify) ………….………..……4
 DNA …………………………………...99
If Exit Survey Type 2 (Retail Store)
Q6. Purpose of visit to the store:
 Buy drugs/health related items………………..1
 Buy items not health related………………….2
 Accompany someone..……………………..…..3
 Did not come to the store.……..….…………....4
 Other (specify) ………….……………………...5
 DNA ……………………………………………..99
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
98
Q.7 DURING THE LAST SIX MONTH, DID YOU?
Q.7.1 Use Mosquito nets Yes .. 1 No.. 2
Q.7.2 Treat water by boiling, using filters or purification tablets before drinking Yes .. 1 No.. 2
 Q.7.3 Take vitamin tablets Yes .. 1 No.. 2
Q.7.4 Use condoms for family planning Yes .. 1 No.. 2
Q.7.5 Use pills, injections, bids or other birth spacing/family planning products 
(for females only) Yes .. 1 No.. 2 98.. N/A
Q.7.6 Consider the possibility of being exposed to a sexually-transmitted 
infection (STI) like HIV/AIDS before engaging in sexual activities Yes .. 1 No.. 2
Q.7.7 Use condoms for protection against HIV/AIDS and other STI’s Yes .. 1 No.. 2
Q.7.8 Consider taking HIV test Yes .. 1 No.. 2
Q.7.9
Consider the possibility of being exposed to an infectious disease like 
HIV/AIDS when health provider, other person or yourself is using 
needles to inject you with drugs or medication
Yes .. 1 No.. 2
Q.8 HAS AT LEAST ONE PERSON IN YOUR HOUSEHOLD (excluding you) DURING THE LAST SIX MONTHS (Skip this 
question or recode 98 if the respondent stays alone )
Q.8.1 Used mosquito nets Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.2 All children under 5 years of age in your family slept 
under mosquito nets Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.3 Treated water by boiling, using filters or purification 
tablets before drinking Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.4 Taken vitamin tablets Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.5 Provided vitamins and mineral supplements for all 
children under 5 years of age in your family Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.6 Used condoms for family planning Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.7 Used pills, injections, bids or other birth 
spacing/family planning products Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.8
Discussed the possibility of exposure to an infectious 
disease like HIV/AIDS before engaging in sexual 
activates or using needles for injections
Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.9 Used condoms for protection against HIV/AIDS and 
other STI’s Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.8.10 Considered taking or took HIV test Yes .. 1 No.. 2 DNK.. 3 98..N/A
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
99
Reasons for behavioural change 
1 Information on TV 7 Experience/information from family members 13 No drugs/medicine available
2 Information on radio 8 Opinion of colleagues 14 No doctor/clinic available close by
3 Information in newspapers 9 Opinion of respected community leaders 15 Do not think it is effective
4
Information distributed by community leaders or 
at meetings 10 Recommendation by a doctor 16 Religious reasons
5 Greater availability of health products 11 Personal experience with being sick 17 Others (specify)……………………….
6 Greater availability of health services 12 Not getting sick any more 99 Did not answer (DNA)
Q.9 OVER THE LAST 3 YEARS, DID YOUR PERSONAL BEHAVIOUR CHANGE REGARDING THE 
FOLLOWING?: ( If there was a change, probe to find out if the change was an increase or decrease. 
If question Q.9.1 – Q.9.8 is answered 1 or 3, please ask for the reasons for behavioural change 
(Q.9_r), and code the response with the choices given at the bottom of this page)
Q.9.1 Use of mosquito nets Increased
1
No changes
2
Decreased
3
DN/A
99
Q.9.2 Use of water treatment for drinking 
water (through boiling or tablets)
Increased
1
No changes
2
Decreased
3
DN/A
99
Q.9.3 Use of vitamins and mineral 
supplements
Increased
1
No changes
2
Decreased
3
DN/A
99
Q.9.4 Use of condoms for family planning Increased
1
No changes
2
Decreased
3
DN/A
99
Q.9.5
Use pills, injections, bids or other 
birth spacing/family planning 
products (for females only)
Increased
1
No changes
2
Decreased
3
DN/A
99
Q.9.6 Use of condoms or other products to 
prevent HIV/AIDS
Increased
1
No changes
2
Decreased
3
DN/A
99
Q.9.7 Visits to health clinics Increased
1
No changes
2
Decreased
3
DN/A
99
Q.9.8 Visits to pharmacies/Drug shops
Increased
1
No changes
2
Decreased
3
DN/A
99
Reason 1 Reason 2 Reason 3
Q.9.1_r1
______
Q.9.1_r2
______
Q.9.1_r3
______
Q.9.2_r1
______
Q.9.2_r2
______
Q.9.2_r3
______
Q.9.3_r1
______
Q.9.3_r2
______
Q.9.3_r3
______
Q.9.4_r1
______
Q.9.4_r2
______
Q.9.4_r3
______
Q.9.5_r1
______
Q.9.5_r2
______
Q.9.5_r3
______
Q.9.6_r1
______
Q.9.6_r2
______
Q.9.6_r3
______
Q.9.7_r1
______
Q.9.7_r2
______
Q.9.7_r3
______
Q.9.8_r1
______
Q.9.8_r2
______
Q.9.8_r3
______
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
100 
THIS PAGE IS FOR RECORDING REASONS FOR BEHAVIOUR CHANGE IN QUESTIONS Q.9 AND Q.10, IF ANSWER 
CAN NOT BE CODED USING CODES FOR REASONS PROVIDED AT QUESTION PAGES 
Q.9: Question starts at the PREVIOUS PAGE. If reason can not be coded with codes provided on previous page, 
please use code 17 and record the reason here.
Q.9.1_rO Use of mosquito nets
Q.9.2_rO Use of water treatment for drinking water 
(through boiling or tablets)
Q.9.3_rO Use of vitamins and mineral supplements
Q.9.4_rO Use of condoms for family planning
Q.9.5_rO
Use pills, injections, bids or other birth 
spacing/family planning products (for females 
only)
Q.9.6_rO Use of condoms or other products to prevent 
HIV/AIDS
Q.9.7_rO Visits to health clinics
Q.9.8_rO Visits to pharmacies/Drug shops
Q.10: Question starts at the NEXT PAGE. If reason can not be coded with codes provided on the next page, 
please use code 17 and record the reason here.
Q.10.1_rO Use of mosquito nets
Q.10.2_rO Use of water treatment for drinking water 
(through boiling or tables)
Q.10.3_rO Use of vitamins and mineral supplements
Q.10.4_rO Attention to the health care of children under 
5 in the family
Q.10.5_rO Use of condoms for family planning
Q.10.6_rO
Use pills, injections, bids or other birth 
spacing/family planning products (for 
females only)
Q.10.7_rO Potential risks to infectious diseases
Q.10.8_rO Use of condoms or other products to prevent 
HIV/AIDS
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
101
Reason 1 Reason 2 Reason 3
Q.10.1_r1
______
Q.10.1_r2
______
Q.10.1_r3
______
Q.10.2_r1
______
Q.10.2_r2
______
Q.9.2_r3
______
Q.10.3_r1
______
Q.10.3_r2
______
Q.9.3_r3
______
Q.10.4_r1
______
Q.10.4_r2
______
Q.9.4_r3
______
Q.10.5_r1
______
Q.10.5_r2
______
Q.9.5_r3
______
Q.10.6_r1
______
Q.10.6_r2
______
Q.9.6_r3
______
Q.10.7_r1
______
Q.10.7_r2
______
Q.9.7_r3
______
Q.10.8_r1
______
Q.10.8_r2
______
Q.9.8_r3
______
Reasons for behavioural change 
1 Information on TV 7 Experience/information from family members 13 No drugs/medicine available
2 Information on radio 8 Opinion of colleagues 14 No doctor/clinic available close by
3 Information in newspapers 9 Opinion of respected community leaders 15 Do not think it is effective
4
Information distributed by community leaders or 
at meetings 10 Recommendation by a doctor 16 Religious reasons
5 Greater availability of health products 11 Personal experience with being sick 17 Others (specify)……………………….
6 Greater availability of health services 12 Not getting sick any more 99 Did not answer (DNA)
Q.10 OVER THE LAST 3 YEARS DID YOUR FAMILY MEMBERS’ BEHAVIOUR CHANGE RELATED TO THE 
FOLLOWING? (Skip this question or recode 98 if respondent lives alone) (If there was a change, probe to find 
out whether the change was an increase or decrease. If questions Q.10.1 – Q.10.8 is answered 1 or 3 please 
ask for the reasons for behavioural change (Q.10_r) and code the responses with the choices given at the 
bottom of the page)
Q.10.1 Use of mosquito nets Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.10.2 Use of water treatment for drinking 
water (through boiling or tables)
Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.10.3 Use of vitamins and mineral 
supplements
Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.10.4 Attention to the health care of 
children under 5 in the family
Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.10.5 Use of condoms for family planning Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.10.6
Use pills, injections, bids or other 
birth spacing/family planning 
products (for females only)
Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.10.7 Potential risks to infectious 
diseases
Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.10.8 Use of condoms or other products 
to prevent HIV/AIDS
Increased
1
No changes
2
Decreased
3
DNK
4
N/A
98
Q.N Questionnaire Code Number ( ) /format: dist_code - interviewer_n - quest_n/
102
Q.11 DID YOU EVER HEAR/SEE THE FOLLOWING?:
Q.11.1 Good Life Show on TV Yes .. 1 No.. 2
Q.11.2 Good Life Show on radio Yes .. 1 No.. 2
Q.11.3 Good Life Show column in newspapers Yes .. 1 No.. 2
Q.11.4 Under the Mango Tree on radio Yes .. 1 No.. 2
Q.11.5 Everyday Health Matters newspaper Yes .. 1 No.. 2
Q.11.6 HIV prevention films Yes .. 1 No.. 2
Q.12 DID YOU EVER PARTICIPATE IN THE FOLLOWING?:
Q.12.1 Good Life Show prize drawings Yes .. 1 No.. 2
Q.12.2 Pulse Activation theatre/show Yes .. 1 No.. 2
Q.12.3
Meeting with community leaders to discuss health related issues organized 
by the AFFORD Project (AFFORD) or the Uganda Health Marketing Group 
(UHMG)
Yes .. 1 No.. 2
Q.12.4 Training on healthcare issues or other events organized by AFFORD or 
UHMG Yes .. 1 No.. 2
Q.12.5 Mosquito net distribution from AFFORD, USAID, or UHMG Yes .. 1 No.. 2
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
103
ANNEX K : RETAIL STORE SURVEY INFORMED CONSENT 
AFFORD Mid-term Evaluation 
Retail Store Survey Informed Consent (English) 
February 9, 2009 
Using structured, signed informed consent forms, all survey respondents will be informed 
about the study objectives, procedures, benefits and risks. They will be assured that should 
they agree to participate in the study, they have the right to withdraw at any point in time and 
that they can refuse to answer any or all of the questions, even after consenting to participate 
in the study. 
After being fully informed about the study objectives, procedures, benefits and risks, the 
respondents will be asked to give oral consent if they wish to participate in the study. The 
interviewers will then sign and date the informed consent form, attesting to the fact that they 
received the respondent‘s oral consent. 
The informed consent to be used for each respondent follows: 
INFORMED CONSENT
Hello. My name is ____________ and I am working with the QED Group evaluation team to evaluate 
AFFORD project. We are conducting a research study that asks retail store owners about their experience 
with drugs supported by AFFORD project and UHMG, as well as similar products. We would very much 
appreciate your participation in this survey. This information will help in the planning of health services and 
the AFFORD project activities. The survey usually takes about 1 hour to complete. However, we understand 
that you need to attend your business, and we can interrupt the survey at any minute so you attend your 
costumers. We would appreciate if you continue the survey after that. 
Your views will help in providing better health services to the greater community. The information collected in this 
survey will be utilized to improve programming related to increase access to and use of selected quality basic 
health products and services in the private sector, by women and men of reproductive age, as well as health 
products and services for children under 5 years of age. 
Participation in this survey is voluntary. We ask to interview you alone, to facilitate your honest responses. 
Whatever information you provide will be kept strictly confidential and will not be shown to other persons 
outside the research team. Please also note that participation or not participation in this survey would not in 
any way effect any current or future relations with AFFORD Project or UHMG. 
If we should come to any question you don't want to answer, just let me know and I will go on to the next
question; or you can stop the interview at any time. However, we hope that you will participate in this survey 
since your views are important.
At this time, do you want to ask me anything about the survey? 
Do you agree to participate in the survey and may I begin the interview now? 
 YES RESPONDENT AGREES TO BE INTERVIEWED: [START INTERVIEW] 
NO RESPONDENT DOES NOT AGREE TO BE INTERVIEWED: [END] 
Signature of Interviewer: ___________________________________ Date: ________________________ 
104
ANNEX L : EXIT SURVEY INFORMED CONSENT 
AFFORD Mid-term Evaluation 
Exit Survey Informed Consent (English) 
February 5, 2009 
Using structured, signed informed consent forms, all survey respondents will be informed 
about the study objectives, procedures, benefits and risks. They will be assured that should 
they agree to participate in the study, they have the right to withdraw at any point in time and 
that they can refuse to answer any or all of the questions, even after consenting to participate 
in the study. 
After being fully informed about the study objectives, procedures, benefits and risks, the 
respondents will be asked to give oral consent if they wish to participate in the study. The 
interviewers will then sign and date the informed consent form, attesting to the fact that they 
received the respondent‘s oral consent. The informed consent forms have been translated into 
Luganda language. 
The informed consent to be used for each respondent follows: 
INFORMED CONSENT
Hello. My name is ____________ and I am working with The QED Group, LLC evaluation team to evaluate 
AFFORD project. We are conducting a research study that asks men and women about various health issues.
We would very much appreciate your participation in this survey. This information will help in the planning of 
health services and the AFFORD project activities. The survey usually takes between 10 and 15 minutes to 
complete.
Your views will help in providing better health services to the greater community. The information collected in this 
survey will be utilized to improve programming related to increase access to and use of selected quality basic 
health products and services in the private sector, by women and men of reproductive age, as well as health 
products and services for children under 5 years of age. 
Participation in this survey is voluntary. We ask to interview you alone, to facilitate your honest responses. 
Whatever information you provide will be kept strictly confidential and will not be shown to other persons. 
If we should come to any question you don't want to answer, just let me know and I will go on to the next
question; or you can stop the interview at any time. However, we hope that you will participate in this survey 
since your views are important.
At this time, do you want to ask me anything about the survey? 
Do you agree to participate in the survey and may I begin the interview now? 
 YES RESPONDENT AGREES TO BE INTERVIEWED: [START INTERVIEW] 
NO RESPONDENT DOES NOT AGREE TO BE INTERVIEWED: [END] 
Signature of Interviewer: ___________________________________ 
Signature of Interviewer: ___________________________________ Date: ____________ 
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
105
ANNEX M : SHORT SUMMARY OF KEY INFORMANT INTERVIEWS 
The AFFORD initiative was widely recognized by almost all key informants at the national 
and district levels. However, the relationship and difference between UHMG and AFFORD 
was less clear. The majority of the key informants underscored the role of AFFORD 
distributor and promoter of certain health products and programs—such as LLINs and 
training of private health practitioners (basic palliative care; HIV counseling and testing)—
who incidentally are often not targeted by government training and capacity building 
programs. 
―AFFORD has been working with us since 2007; and it started with identifying and training 
of health [private] providers—clinics and drug shop. I think these were trained in basic 
palliative care. AFFORD later identified clinics with potential [for instance established 
infrastructure, qualified personnel] to provide HIV counseling and testing. They trained two 
staff from each of the identified health facility in HIV counseling and testing. AFFORD also 
distributed some mosquito nets in selected sub-counties [not sure how many], particularly to 
children under-five and pregnant mothers. They [AFFORD] also carried out promotional 
activities aimed at promoting use of mosquito nets and other AFFORD products such as 
Aqua safe.‖ (KEY Informant, Iganga District) 
AFFORD was lauded for its unique approach of working with the private drug distribution 
network—to increase the availability of health products. The volume of health products 
available in the different districts, covered during the study, was reported to have 
substantially increased over the last three years, due in part, to an increase in the number of 
private drug outlets (including clinics). These entities were reported to be playing a vital role 
in filling gaps left by the public health care system. However, monitoring use and dispensing 
of health products by private drug outlets remains a daunting challenge. Yet, as one moves 
away from urban centers to remote villages, most drug outlets are manned by ill-trained 
personnel which ultimately affects the quality of care. 
Key informants, at the district and national levels, observed several changes in health in 
Uganda, which were attributed to a confluence of factors, including specific interventions by 
civil society organizations, and targeted government health programs such as mass 
immunization, HIV campaigns, and others. The changes range from decreased incidence of 
malaria and diarrheal diseases to significant improvements in health care seeking behavior 
and the number of people seeking HIV counseling and testing services—albeit with 
variations between districts. While condom use was reported to have significantly improved; 
encouraging condom use among couples remains an up-hill task. 
Key informants were nonetheless concerned with increasing discordance rates, HIV 
prevalence, and the rising infections among married couples. According to The Modes of 
Transmission Study, 43 percent of new infections in Uganda occur among married couples 
(UNAIDS/UAC 2008). This increase was reported to be due to non-disclosure of HIV status 
between couples and an unwillingness of couples to be counseled and tested as couples. 
Therefore, key informants urged: renewing focus on identifying and promoting prevention 
messages; offering a more comprehensive and robust HIV counseling and testing service that 
enables ―couples to test as couples‖; and providing strategies that transcend the current client￾initiated HIV counseling and testing for couples. 
106
Discussions also revealed that the contraceptive prevalence rates are generally low in most 
districts, despite slight improvements in the last three years. The fear of side effects coupled 
with refusal by male partners bar a significant number of women from using contraceptives. 
Key informants generally noted that men are very reticent and reluctant when it comes to 
discussing reproductive health issues, including family planning and HIV testing with their 
spouses. 
The initiative of training and using POLs to promote the utilization of health products 
socially-marketed by AFFORD and to encourage certain desirable health behaviors was 
praised as an innovative way to engage communities in the promotion of better health 
outcomes. POLs were reported to be playing a vital health promotion role including: 
counseling and referring community members with different health problems; dialoguing 
with community members on different health issues; and promoting use health products such 
as aqua-safe, LLINs, and contraceptives. However, key informants noted that POL activities 
are limited to a few sub-counties within different districts. Thus, their reach and effectiveness 
is limited. Nonetheless, a significant number of key informants in the districts expressed 
willingness to constitute and, where necessary, incorporate the trained POLs into VHTs, a 
much broader government community health initiative. 
Other key informant comments: 
Some AFFORD products such as moonbeads and mosquito nets, despite being 
subsidized, are still less affordable and limit demand. 
There is need to monitor the use of health products such as mosquito nets which will 
help inform the district strategies to improve utilization of health products. 
Staff turnover in private health clinics is significantly high. Some clinics lose staff 
trained which collaborate directly with AFFORD which affects continuation of 
programs. Consequently, there is a need for continuous and/or refresher training for 
staff in private health clinics. 
107
Kampala WEST NORTH WEST NILE CENTER AND EAST
GENERAL CONTEXT AND COMMENTS
ACTIVITIES 
PERFORMED BY 
RESPONDENTS 
ON AFFORD 
PROJECT
Trainer and supervisor in 
AFFORD projects;
investigation of 
outbreaks; training and 
HIV testing; management 
of HIV test results;
training and 
monitoring/follow up to 
the trainees; training.
Distributor of 
AFFORD/UHMS 
products; focal 
person for AFFORD 
in district; trained by 
AFFORD and then 
offered training;
supply of nets, and 
promotion of other 
health products;
AFFORD focal 
person in district;
training; training;
distribution of 
AFFORD products;
recruiting clients in 
districts for AFFORD 
products.
Health educator/trainer;
training of drug store 
owners; monitoring and 
evaluation of health 
activities; health 
promotion and education;
mobilization and 
sensitization of 
communities on VHT;
supply of long-lasting 
mosquito nets, and 
training in the use of 
these nets.
Coordination and 
supervision of 
health-related 
activities; planning 
for health sector;
training of health 
workers on new 
policy on malaria;
supply of treated 
nets; training of 
drug store owners 
in their products;
training on 
sanitation and 
HIV/AIDS and 
palliative care; 
distribution of 
mosquito nets.
Training health workers;
distribution of mosquito 
nets; worked with private
sector and NGOs;
training of private health 
practitioners; training of 
POLs; training of private 
healthcare services 
outlets and event 
promotional activities.
108
Kampala WEST NORTH WEST NILE CENTER AND EAST
CHANGES IN 
HEALTH SECTOR 
IN UGANDA
More private sector 
involvement in the health 
sector even in rural 
areas; people’s health 
seeking behavior 
improved; more demand 
for health care services;
HIV care has greatly 
improved with more 
availability and affordable 
drugs.
Reduction in malaria;
increased use of 
contraceptives 
including condoms;
prevalence of child 
diseases and 
epidemic diseases 
are under control; no 
major outbreaks;
increase in deliveries 
in clinics; decrease in 
oral diseases among 
children; safe water 
coverage was 
improved leading to 
reduction of water 
related diseases; 
increased awareness 
leading to increase in 
VHCT; malaria cases 
have significantly 
decreased.
Health seeking behavior 
has increased; attitude of 
health workers has been 
improving; male 
participation in family 
planning is still very low;
malaria is on the 
increase; many people 
now embrace family 
planning; health seeking 
behavior is still negative;
use of condoms has 
steadily increased;
increase in use of treated 
mosquito nets; a change 
from preventive to 
curative measures;
funding of the health 
sector has remained very 
low.
There has been 
some improvement 
in health services;
welfare of health 
workers has also 
improved; mosquito 
nets have greatly 
improved mothers’ 
health and reduced 
infant mortality;
resources in health 
sector have been 
decreasing as 
compared to the 
health sector 
demands;
motivation of health 
workers is quite 
low.
There has been an 
overall reduction in the 
incidence and occurrence 
of diarrheal diseases;
cases of malaria are still 
high although on a 
downward trend; HIV 
infection rates are rising 
among couples as is the 
discordance rate;
HIV/AIDS prevalence has 
stagnated; non-disclosure 
between couple and 
unwillingness of couples 
to be counseled and 
tested together; general 
reduction in the 
incidences and severity of 
epidemics.
CAUSES FOR 
CHANGES IN 
HEALTH SECTOR
Increased community
awareness by POLs 
at grassroots level;
private sector 
involvement;
distribution of the 
nets by AFFORD;
reduction in 
stigmatization for 
using products; 
introduction of 
Aquasafe.
Changed courses in 
counseling provided by: 
AIMS, UNICEF, NUMAT 
and AIDS Information 
Centre; flooding creates 
breeding ground for 
mosquitoes.
Private and NGO 
involvement in the 
health sector e.g. 
malaria consortium.
109
Kampala WEST NORTH WEST NILE CENTER AND EAST
EXPERIENCE 
WORKING WITH 
AFFORD 
PROJECT AS A 
PARTNER
Training is well organized 
under AFFORD; good 
materials; support from 
office staff is good; good 
working relationships.
AFFORD has very 
broad range of areas 
but networks with 
other organizations;
no big difference from 
other partners the 
distributor works with;
it’s fulfilling its 
objectives; work well 
with the district.
AFFORD staff is good to 
work with; interaction and 
communication is good;
AFFORD does not plan 
with the district; AFFORD 
is not clear about its 
activities; people to use 
VHT and Zinkid were not 
trained; AFFORD 
products are expensive; 
some products are not 
well promoted.
AFFORD staff are 
cooperative; they 
follow the 
procedures and 
provide supervision 
and support for 
their activities.
District is only involved at 
implementation stage, not
at planning stage.
CHALLENGES 
WORKING WITH 
AFFORD AS 
PARTNER
Selection/identification of 
people to train was 
difficult initially.
Out of stock of products;
AFFORD funding is sent 
to district but indicative 
figures are not shown in 
the budget.
110
Kampala WEST NORTH WEST NILE CENTER AND EAST
AFFORD BEST 
PRACTICIES
Using the media to 
educate the public about 
their products; working 
closely with private sector 
(including testing); giving 
support to trainees after 
training; beating cultural 
misconception about
HIV/AIDS through 
communication programs 
(e.g., Goodlife show); 
MARPs network; 
bringing organizations to 
work together; capacity 
building for organizations.
Use of POLS; good 
working relationship 
with MOH and DHO;
working within district 
policies and MOH
policies; work closely 
with National Drug 
Authority; motivation 
of POLS; production 
of UHMG; translation 
of health booklets 
into local languages;
working closely with 
private sector and 
government training 
to CBOs and POLs in 
health issues.
Funding of trainings; use 
of the media radio talk 
shows; working with MOH 
and private sector; timely 
supply of AFFORD 
products; distribution of 
mosquito nets; 
introduction of purifiers;
training health 
practitioners on palliative 
care; contribution to 
prevention of malaria; 
good advertisements; 
good communication with 
distributors; always 
enough stock.
Follow set 
procedures; they 
do supervision and 
support for their 
activities;
communication;
distribution of nets 
attracted pregnant 
women for 
antenatal services;
involvement of the 
district in its 
activities.
Training of private health 
providers; working with 
private sector and NGOs; 
regular supervision and 
follow-up visits; capacity 
building of private health 
providers/POLS; working 
closely with private 
sector; provision of 
regular supervision and 
observance of strict 
timelines.
CHALENGES IN 
HEALTH SECTOR 
THAT WILL NEED 
ATTENTION 
DURING THE 
NEXT 5 YEARS
Coverage is still low, and 
covering everywhere is 
still a challenge.
Male involvement in 
child health and 
prenatal care; UHMG 
should penetrate into 
villages; micro -
element deficiency 
and nutrition;
immunization against 
the 8 diseases;
encourage/sensitize 
mothers to deliver at
clinics.
Sensitization of 
community on health 
issues; complement 
government efforts to 
have clinics at parish 
level.
HIV counseling and 
testing; improving access 
to HIV prevention;
treatment and support 
services; capacity 
building for health 
workers; nutrition for 
people living with 
HIV/AIDS; improving 
maternal and child health;
increased access to vital 
drugs.
111
Kampala WEST NORTH WEST NILE CENTER AND EAST
AFFORD OBJECTIVE I: Increasing access and affordability of health products and services through 
innovative marketing and distribution approaches
CHANGE IN 
AVAILABILITY OF 
HEALTHCARE 
PRODUCTS 
(DRUGS, ETC.) TO 
THE POPULATION 
IN THE LAST 3 
YEARS
Basic drugs became 
more available even in 
rural areas; people are 
now more interested in 
socially marketed 
products because of 
quality; establishment of 
GoodLife clinics.
Condoms, HIV 
products and FP 
products have 
increased; Restors 
and Zinkind; services 
brought closer by 
opening new drug 
shops through the 
work of 
AFFORD/UHMG;
increase in number of 
pharmacies.
Increase in availability 
health products e.g.,
condoms and Aquasafe, 
mosquito nets, ZinKid 
and other family planning 
products; mosquito nets, 
Aquasafe have 
increased; people have 
been sensitized on use of 
Aquasafe to prevent 
cholera.
Increase in 
availability of health 
products e.g.,
condoms and 
Aquasafe, 
mosquito nets, 
ZinKid and other 
family planning 
products;
moonbeads are 
less demanded;
private involvement 
in health sector 
e.g., UHMG.
Health products are 
increasingly available but 
expensive; volume of 
health products available 
in both private and public 
health facilities and on 
the market has increased; 
family planning products 
and condoms and water 
purifiers usage is limited 
by price; increase in the 
number of outlets;
promotional activities and 
advertising campaigns 
have generated demand 
for certain health 
products.
CHANGES THAT 
CAN BE 
ATRIBUTED TO 
AFFORD 
ACTIVITIES
Increased sales and 
availability of AFFORD 
supported products;
improved product 
availably since it is 
privately driven (due to 
work with AFFORD).
Improvement in 
health behavior 
where POLS operate; 
increased availability
of mosquito nets & 
moonbeads.
Increase in supply of 
Protector condoms, 
Pilplan and Injectaplan, 
Aquasafe.
Increased availably 
of health products 
in communities 
(due to POLs).
112
Kampala WEST NORTH WEST NILE CENTER AND EAST
CHALLENGES
There is a gap in linking 
clinics to distributors; 
logistical support is weak;
no job security in private 
sector; turnover is high;
competition between 
condoms for sale and 
condoms that are free;
AFFORD policy does not 
allow advertising of 
condoms; free distribution 
of condoms by MOH;
competition from other 
marketing groups e.g.,
MSI and PSI; no 
motivation to make 
trained staff stay in the 
clinic for long.
Not involving males 
in PMTCT; AFFORD 
never leaves reports 
at the district; pilplan 
has no margin: cost 
price and selling price 
is the same.
Men take the nets 
supplied to pregnant 
women; promotion of 
moonbeads and O 
condoms is low; they do 
not involve district 
authorities and VHTs;
running out of stock of 
supplies especially nets; 
competition from 
LifeGuard; competition 
from other suppliers e.g.,
PSI; usage of nets being 
ignored; private clinics 
may not take training 
seriously; free condoms 
find their way into the 
market and are sold 
cheaply; mosquito nets 
were not enough; some 
NGOs buy in bulk and 
supply products for free;
some pharmacies buy 
direct from Kampala and 
sell cheaply.
There was demand 
for the products but 
products could run 
out of stock;
procurement of 
stock is a length 
process; people’s 
past experience 
with other USAID 
projects e.g., AIMS 
and UPHOLD 
which wind up 
before impact is 
felt; irregularity of
review meetings 
with the district 
officials; small 
margin on all 
products; 
packaging of 
protector is not 
attractive to 
customers.
Competition from other 
condom producers; high 
prices for the products; 
people want free 
condoms; AFFORD 
activities are not 
incorporated in district 
plans; AFFORD’s pricing 
structure leaves room for 
customers to be 
overcharged; drug shops 
and clinics are not 
authorized to administer 
injectable contraceptives; 
new AFFORD products 
have not been promoted; 
staff turnover in private 
health clinics is 
significantly high; 
confinement to few 
subcounties; it doesn’t 
work closely with the 
district; AFFORD 
products are expensive.
113
Kampala WEST NORTH WEST NILE CENTER AND EAST
AFFORD OBJECTIVE II: Enhancing knowledge, self efficacy and correct use of products and services to encourage health lifestyles.
CHANGES IN 
HEALTH 
BEHAVIOUR OF 
POPULATION
Health seeking behavior 
has improved.
People's health service 
seeking behavior has 
improved including HIV 
testing; people look for 
health information (radios 
and talk shows); VCT has 
increased; seeking 
treatment from witch
doctors has decreased;
mobilization and 
sensitization undertaken 
by the district and the 
efforts of NGOs.
People’s 
awareness on
health issues has 
increased; valuing 
highly the socially 
marketed health 
products; condom 
use has increase;
increased 
awareness on 
basic health issues.
Contraceptive prevalence 
rate has been stagnant;
improvement in mosquito 
net utilization in 
communities; condom 
use is slightly higher 
among the youth 
compared to adults; 
people feel comfortable 
paying for condoms; 
condom use among 
PLHIV and discordant 
couples is still poor; use 
of mosquito nets has 
slightly increased; 
increase in awareness;
contraceptive use has 
also improved;
improvements in latrine 
use; increasing 
normalization of 
HIV/AIDS and the risky 
behaviors spurred by 
availability of ARVs. 
114
Kampala WEST NORTH WEST NILE CENTER AND EAST
CHANGES THAT 
CAN BE 
ATRIBUTED TO 
AFFORD 
ACTIVITIES
Significant 
improvement in 
health behavior 
where POLS operate.
CHALLENGES
There is a gap in linking 
clinics to distributors;
logistical support is weak;
no job security in private 
sector; turnover is high;
competition between 
condoms for sale and 
condoms that are free;
AFFORD policy does not 
allow advertising of 
condoms; free distribution 
of condoms by MOH;
competition from other 
marketing groups e.g., 
MSI and PSI; no 
motivation to make 
trained staff stay in the 
clinic for long.
Not involving males 
in the PMTCT;
AFFORD never 
leaves reports at the 
district.
Men take the nets 
supplied to pregnant 
women; promotion of 
moonbeads and O
condoms; they do not 
involve district authorities
and VHT; AFFORD does 
not work with district 
health team.
There was demand 
for the products but 
products could run 
out of stock;
procurement of 
stock is a lengthy
process; people’s 
past experience 
with other USAID 
projects e.g., AIMS 
and UPHOLD 
which wind up 
before impact is 
felt; irregularity 
review meetings 
with the district 
officials; small 
margin on all 
products;
packaging of 
protector is not 
attractive to 
customers.
People want free 
condoms; monitoring use 
and dispensing of health 
products by private drug 
outlets; new AFFORD 
products have not been 
promoted and so demand 
is low; confinement to few 
subcounties.
115
Kampala WEST NORTH WEST NILE CENTER AND EAST
AFFORD OBJECTIVE III: Strengthening/establishing indigenous organization and distribution systems for sustainable delivery of health 
marketing functions
KNOWLEDGE 
ABOUT UHMG 
AND AWARENESS
ABOUT ITS 
ACTIVITIES
No visible difference 
between AFFORD and 
UHMG; AFFORD 
activities are actually 
implemented by UHMG;
still a confusion between 
UHMG and AFFORD.
There is no difference 
between UHMG and 
AFFORD.
Find it a problem 
differentiating AFFORD 
from UHMG; UHMG has 
wide and varied services;
UHMG is part of 
AFFORD.
Find it a problem 
differentiating 
AFFORD from 
UHMG; knows 
AFFORD but not 
UHMG.
UHMG is to take over 
from AFFORD.
116
Kampala WEST NORTH WEST NILE CENTER AND EAST
RECOMMENDA￾TIONS FOR 
AFFORD AND
USAID
AFFORD should 
collaborate with other 
service providers/
projects; AFFORD should 
support whole range of 
services related to HIV 
e.g., testing and 
counseling; repackage 
protector condoms.
AFFORD should 
work with UHMG for 
5 years before its left 
on its own; AFFORD 
to involve districts in 
their plans; POLS 
should be spread to 
grass roots; 
Packaging of rectors 
is not good; Drug 
shops shouldn’t sell 
Injectaplan® since it 
has to be 
administered by a 
doctor; price for O 
condoms is too high, 
needs to be reduced. 
AFFORD should 
decentralize its services;
motivate VHTs in form of 
T-shirts and caps; work 
directly with districts;
regularly hold review 
meetings with the 
stakeholders; 
communicate before 
visiting distributors; revive 
radio talk shows; 
emphasis on utilization of 
mosquito nets instead of 
distribution of nets;
increase marketing and 
making products known;
have a desk office in 
each district e.g., through 
the district health officer; 
impact assessment of the 
AFFORD products on 
community; more training 
is needed; continue 
funding field activities;
involve districts in 
planning, not just 
implementation; design a 
clear reporting and data 
storage system that 
works from the health 
facility level upwards.
AFFORD project 
should be extended 
for additional years 
so as to have 
significant impact 
on the community 
or to be replicated 
in other areas;
AFFORD should be 
flexible and open to 
collaboration in 
handling 
emergencies that 
are outside their 
program activities 
e.g., meningitis;
AFFORD should 
facilitate 
districts/person 
implementing the 
project at the 
district with things 
like computers; 
AFFORD should 
not restrict 
distributors to 
regions; AFFORD 
officials should 
communicate 
before visiting 
distributors.
Promotional materials 
e.g., t-shirts are needed;
AFFORD needs to 
monitor proper utilization 
of the health care 
products e.g., mosquito 
nets; packaging of 
protector needs to be 
revisited; AFFORD needs 
to work closely with the 
districts.
117
Kampala WEST NORTH WEST NILE CENTER AND EAST
SUSTAINABILITY 
OF UHMG
AFFORD should not pull 
out resources after it 
closes, should leave 
everything for UHMG.
UHMG should look 
for funding for its 
activities; UHMG 
should establish 
branches at districts.
UHMG should increase 
publicity of the products;
reduce the gap between 
providers and 
beneficiaries; UHMG 
should ensure that 
distributors especially in 
Kampala adhere to 
recommended prices;
UHMG should reach out 
to rural areas.
UHMG should 
source for funding 
from the 
government and 
other donor 
organizations.
118
ANNEX N : STATISTICS FOR RETAIL STORE SURVEY 
Main characteristics of the drug shops/pharmacies and respondents in the sample 
AFFORD or comparison 
district
Primary 
AFFORD 
target
Comparison
Are you the proprietor or main manager or main sales person 
of the establishment
100.0% 100.0%
Are you the proprietor of the establishment? 42.0% 45.4%
Do you usually work in the establishment most of the time 96.2% 96.3%
Did you ever have any health or health care education? 73.3% 75.9%
Do you know if the establishment received supplies from 
AFFORD/UHMG distributors
79.4% 57.4%
Do you know if the establishment sold/still sells products 
marketed by AFFORD/UHMG?
89.3% 76.9%
Do you know if the establishment sold/still sells products 
marketed by International projects or donor organizations e.f 
USAID?
39.7% 35.2%
How long has the establishment existed (in years) 6.62 5.19
How long have you worked in this establishment (in years) 4.43 3.76
Did respondent ever heard, saw or participated in any of the AFFORD/UHMG events? 
AFFORD or Comparison district Total
Comparison %
%
Primary AFFORD target
%
Yes 79 80 79
No 21 20 21
Total 100 100 100
Is there a visible advertisement for AFFORD/UHMG events in a store? 
AFFORD or Comparison district Total
Comparison %
%
Primary AFFORD target
%
Yes 59 76 68
No 41 24 32
Total 100 100 100
Does a store sell at least one of the AFFORD/UHMG marketed brands? 
AFFORD or Comparison district Total
Comparison %
%
Primary AFFORD target
%
Yes 96 99 97
No 4 1 3
Total 100 100 100
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
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Sales of the AFFORD/UHMG marketed brands by retailers in the sample: 
Yes
%
No
%
Not applicable
%
Not answered
%
Do you sell Injectaplan? 87.9 6.7 5.4
Do you sell Pilplan? 90.8 3.8 5.4
Do you sell Protector condoms? 85.4 10.0 4.6
Do you sell Cotramox? 21.3 47.3 31.4
Do you sell Aquasafe? 39.7 51.0 9.2
Do you sell Zinkid? 45.2 45.6 9.2
Do you sell Restors? 64.4 26.4 9.2
Do you sell SoftSure? 4.6 89.5 5.4 0.4
Do you sell "O" condoms? 15.9 79.5 4.6
Do you sell NewFem? 3.8 90.8 5.4
Do you sell moonbeads? 12.6 82.0 5.4
Noticed that more customers coming to a store after AFFORD events/shows (overall sample)? 
Yes
%
No
%
Not 
applicable
%
Not 
answered
%
after Good Life shows on TV 10.5 18.8 70.7
after Good Life shows on Radio 33.9 20.5 45.2 0.4
after Good Life show column in newspapers 18.0 18.0 64.0
after under the mango tree on radio 16.3 14.2 69.0 0.4
after HIV prevention films 22.6 48.1 29.3
after Pulse activation theatre/show in your town/village 6.3 24.7 69.0
after meeting with community leaders to discuss health 
related issues with AFFORD/UHMG
14.6 29.7 55.2 0.4
120
Did respondent noticed more costumers coming to the store given that there was this type of show in 
the store location (respondent‘s participation/knowledge of the show as proxy for the availability of 
the show/even in the location). 
Did you ever hear/see/ 
participate in the show/event
%
Total
%
Type of show/event: Noticed increase in 
customers
Yes No Not 
answered
Good Life shows on TV Yes 35 0 0 10
No 61 0 100 19
Not applicable 4 100 0 71
Good Life shows on Radio Yes 61 0 100 34
No 37 0 0 21
Not applicable 1 100 0 45
Not answered 1 0 0 0
Good Life show column in 
newspapers
Yes 48 0 18 0
No 48 0 18 0
Not applicable 4 100 64 0
Under the Mango Tree on radio Yes 48 0 16 0
No 42 0 14 0
Not applicable 9 100 69 0
Not answered 1 0 0 0
HIV prevention films Yes 33 2 23 0
No 61 24 48 0
Not applicable 6 73 29 0
PULSE activation theatre/show in 
your town/village
Yes 44 4 0 6
No 25 25 0 25
Not applicable 31 72 100 69
Meeting with community leaders to 
discuss health related issues with 
AFFORD/UHMG
Yes 73 3 15 0
No 23 31 30 0
Not applicable 5 65 55 0
Not answered 0 1 0 0
Over the last year, how did the total sales of this product category changed: 
Increased
%
Not 
changed
%
Decreased
%
Not 
applicable
%
Not answered
%
Male condoms 61.1 18.0 16.3 4.6
Other contraceptives 77.0 11.7 6.3 4.6 0.4
Vitamins 57.7 29.3 3.8 8.8 0.4
Child health-related drugs 63.2 20.5 6.7 9.2 0.4
HIV/AIDS and other STI 
treatments
51.9 10.9 5.0 31.4 0.8
The AFFORD Health Marketing Initiative in Uganda: Mid-term Evaluation
121
ANNEX O : STATISTICS FOR EXIT SURVEY 
AFFORD Comparison Total
Number of observations 706 509 1,215
including
Clinic exit survey 553 380 933
Retail exit survey 153 129 282
Type of area where respondents live
Capital 48 48
District capital/town 326 146 472
village/rural 328 363 691
did not answer 4 4
Gender
Male 41% 39% 40%
Female 59% 61% 60%
Marital status
Single 25% 20% 23%
Married/living together 65% 69% 67%
Divorced/Separated 6% 6% 6%
Widowed 4% 4% 4%
Did not answer 1% 1% 1%
Age of respondent (average) 31 32 31
Household size (average) 6 6 6
Number of children in your household (average) 3 3 3
Did respondents even heard, saw, or participated in AFFORD/UHMG show or event 
Primary AFFORD district
%
Comparison district
%
Total
%
Yes 66 58 63
No 34 42 37
Respondents knowledge about specific AFFORD promotion activities 
Yes
%
No
%
Did not answer
%
Did you ever hear/see Good Life show on TV 21 78 1
Did you ever hear/see Good Life show on radio 48 51 0
Did you ever see good life show column in newspapers 16 84 0
Did you ever hear under the mango tree on radio 28 72 0
Did you ever see everyday health matters newspaper 11 89 0
Did you ever see HIV Prevention films 53 47 0
Did you ever participate in Good Life show prize drawings 3 97 0
Did you ever participate in pulse activation theatres/show 5 95 0
Did you ever participate in meeting with community leaders to 
discuss health related issues organized by AFFORD or UHMG
 8 92 0
Did you ever participate in training on healthcare issues or other 
events organized by AFFORD or UHMG
 4 95 0
Did you ever participate in mosquito net distribution from 
AFFORD, USAID or UHMG
 8 92 0
122
Over the last 3 year, how did respondents personal health behavior changed 
Increased
%
No 
changes
%
Decreased
%
Non 
applicable
%
Did not 
answer
%
use mosquito nets? 59 34 7 0
use of water treatment for drinking 
water (though boiling or tablets)?
48 49 3 0
use of vitamins and mineral 
supplements?
19 79 2 1
use of condoms for family planning? 16 80 3 1
use of pills, injections or other birth 
FP products?
14 41 5 40 0
use of condoms or other products to 
prevent HIV/AIDS?
26 70 3 1
visits to health clinics? 54 31 15 0
visits to pharmacies and drugshops? 45 40 14 1
Over the last 3 year, how did respondents family health behavior changed 
Increased
%
No 
changes
%
Decreased
%
Did not 
know
%
Not 
applicable
%
Did not 
answer
%
use mosquito nets? 51 30 5 1 12 1
use of water treatment for drinking 
water (though boiling or tablets)?
40 42 2 2 12 2
use of vitamins and mineral 
supplements?
28 47 2 8 12 3
attention to the health care of 
children under 5 in the family?
46 20 3 3 27 1
use of condoms for family 
planning?
 9 51 1 24 12 4
use of pills, injections or other 
birth FP products?
 6 41 0 10 40 3
considering potential risks to 
infectious diseases?
22 35 7 23 12 2
use of condoms or other products 
to prevent HIV/AIDS?
 9 40 1 36 12 4
Knowledge and participation in AFFORD shows among those who had positive and negative change 
in specific health behavior: 
Increased 
(positive behavior change)
Decreased 
(negative behavior change)
Health behavior Heard/saw/participated in 
AFFORD shows
Heard/saw/participated in 
AFFORD shows
No
%
Yes
%
No
%
Yes
%
use mosquito nets? 33.70 66.30 43.00 57.00
use of water treatment for drinking water (though 
boiling or tablets)?
36.20 63.80 36.40 63.60
use of vitamins and mineral supplements? 24.00 76.00 34.80 65.20
use of condoms for family planning? 28.10 71.90 32.40 67.60
use of pills, injections or other birth FP products? 45.00 55.00 32.70 67.30
use of condoms or other products to prevent 
HIV/AIDS?
24.30 75.70 24.30 75.70
visits to health clinics? 29.40 70.60 29.20 70.80
visits to pharmacies and drug shops? 30.80 69.20 26.70 73.30