Out Patient Services are essential for the community. Government staff hospitals but clinics are NGO run
Hope Clinic's out-patients department works with partners to reduce the barriers that the community could face. The bad STICK is replaced through a strong referrals network using hosted referrals so that the service comes to Lukuli, not with the patient told to go elsewhere. The whole system is client focussed, comprehensive and caring.

Stigma is replaced by Support - the working together of partners means we can serve the community with the services they need, and seek, and do so in a low stigma, non-judgmental setting. We partner with the Kampala City clinic which provides immunisation vaccines so that we can ensure good coverage for under-5s. Through partnerships with Right to Play we have youth information games and Straight Talk work with the teenagers.

Time to travel is reduced with hosted referrals. Through Training our staff think not only about one service but integrate child immunisation with growth development advice, with family planning choices, nutrition recommendations and counselling information for HIV. Very few organisations have experienced local capacity development to offer general health services integrated to a comprehensive HIV and AIDS service. We have over five years of community systems strengthening with government, CBO, women's groups and individuals working together. Our partnerships include UNITAID, the Global Fund, CHAI and PEPFAR through their commodities we stock.

Inertia can halt any action by the client. Our Infrastructure of partners is a key strength that the OPD and the other clinic services have developed and maintain. The NGO Facility allows access to centrally procured commodities and as affiliates to the UPMB we are a Health Centre III and access malaria ACTs and Essential Drugs from Joint Medical Stores. We partner with the UNFPA to access family planning products. We are a Good Life Clinic in the UHMG network through whom we access client service materials (including signage) and HIV test kits. We provide reports to each of our partners ensuring 'information for decision making' is identified, recorded and used.

Cost remains the biggest barrier to accessing health. Whether travel costs, opportunity cost of being away from work or the fees and unpublished 'access charges' to see the medic or receive the tests at some for-profit sites. Government sites are over-run and cannot serve the clients in terms of equipment, space or time per patient. A key part of the hosted referrals model are Community Catalysts. These are clinic staff who manage outreaches to deliver services or mobilise clients, but also volunteers, other health service providers, religious leaders and our expanding customer base who motivate the community to learn their human rights for health and to access the services. With TextToChange we used mHealth to support our Catalysts in their work.

Knowledge is not as Lacking as it was. Not knowing that services exist, not realising diet affects strength affects resistance to illness and affects growth means the demand for health services was low. Hope Clinic Lukuli works with partners to offer the services, through Catalysts we mobilise the community and through Affordable Medical Treatment From Good and Friendly Staff we reduce the other barriers.

The good STICK: Support Training Infrastructure Catalysts Knowledge was developed by Hope Clinic Lukuli and through the PEPFAR New Partners Initiative was taken to other NGO in other countries. In Lukuli, the referrals network is maintained by the active engagement with partners by the 'network manager' and that means we balance the clients' needs and the need for our continued ability to serve their needs.

Sustainability for a local indigenous organisation is about using the existing technical skills of the staff and community to build partnerships and through those local capacity is developed to keep serving. It is not simply financial self-sufficiency as each country - whether Canada, USA, UK, South Africa or Uganda - has a population who don't have the incomes to buy the health services they need. In some countries the necessary safety net is called a National Health Service, in the developing world the reliance is on support from development partners. For Lukuli, Hope Clinic's partnerships with government and development partner programmes means we are the safety net. The nearest government staffed facilities is 3 miles (5km) away, the nearest (private) hospital is 2 miles in the opposite direction. Makindye Division Health Department recognise our partnership role to meet local health needs.

Not for Profit - For the Community	Our range of services meet clients' needs	Hosted Referrals - client at the core

Hope Clinic Lukuli's Hosted Referrals concept was expanded to detail the bad stick, good stick, and the wheel for mapping client service needs by the Director and co-founder of Hope Clinic whilst he was Project Director of a technical assistance team. This and production of these graphics was funded by the US Centers for Disease Control and Prevention (CDC). Project site The concept has now been adopted with other NGO in East and Southern Africa.