MATERNAL HEALTH PROJECT 2010 - 2013

Name of Organization: Sicklecell Association of Uganda (SAU) Date of Submission: 13th /December /2013

Reporting period: 1st October 2013 to 13th December 2013 District cluster: Mubende Sub county: Nalutuntu

Responsibility	Name	Title	Telephone Number	Email	Signature
Prepared by	Sentamu Edward	Program Officer	0782963611	eddiese2002@yahoo.com
Reviewed by	Ruth Nankanja Mukiibi	Executive Director	0712815978	joansempa@yahoo.com

Instructions

Report data on the meetings where the numbers of people who attended can be obtained. Also include data where individuals receive messages either in small groups or as individual entities.

Section 1

Introduction

The maternal Health Project is implemented by 9 partners in 8 districts in Uganda where Sicklecell Association of Uganda and Uganda National Health consumers Organisation are cluster implementers in Mubende district. This project focuses on a rights based approach and a cluster model in implementing its activities. All the activities for the period from October to December were successfully implemented

17th October 2013 Safe motherhood day celebrations at Caltec Academy grounds Makerere Zone II. Sicklecell Association of Uganda exhibited her materials including information on management of Sicklecell disease to the Makerere II community, other activities included; Press Statement, service delivery such as HIV/AIDS testing by Uganda Health Marketing Group, Family planning services and Cancer screening by Reproductive Health Uganda.

12th November 2013, we conducted support supervision exercise on Maternal Sexual and Reproductive Health Rights, finding out how the radio programs have impacted on Mubende communities in addressing issues related to maternal Health by convening a meeting with Radio station manager Mr. Byansi David of 102.3 Heart F.M Mubende at the radio station offices from 10.30 am to 11:30 am.

13th November 2013, a community dialogue was conducted at Kitalagerwa Trading center and the main theme was about mothers delivering from Traditional Birth Attendants and what should be done to stop them from attending Traditional Birth Attendants participants included religious leaders, Local leaders, Subcounty officials and the community.

14th – 15th November 2013, Sicklecell Association of Uganda attended and participated in a National Policy dialogue on Traditional Birth Attendants in Uganda was held at Serena Hotel including Members of Parliament, District Health Officers and other Civil Society Organisations.

18th – 20th November 2013, Sicklecell Association of Uganda and Uganda National Health Consumers Organisations conducted joint support supervision on Maternal Sexual and Reproductive Health Rights in Kiganda, Nalutuntu and Myanzi Subcounty Mubende District and also held a quarterly district stakeholders meeting.

26th November 2013, SAU attended and participated in the promise renewed campaign by Ministry of Health, UNICEF, WHO, UNFPA, UN women, World Bank, USAID and other civil society organisation

3rd December 2013, Sicklecell Association of Uganda conducted support supervision with Community Resource persons to find out the progress on matters concerning Maternal Sexual and Reproductive Health Rights in all the four parishes of Nalutuntu Subcounty.

4th December 2013 Voices for Health Rights annual Review meeting at Protea Hotel organised by the secretariat (UNHCO)

Community sensitisations were carried out by the Community Resource Persons throughout the quarter both at individual and group level.

Two Radio talk shows were conducted every 6th of the month on Heart FM 102.3 Mubende addressing Maternal Sexual and Reproductive Health Rights

180 Spot messages run on 102.3 Heart FM throughout the quarter with messages emphasising mothers to deliver from Health Centres, attending antenatal care and male involvement.

2 drama shows conducted at Kitalegerwa and Kiwumulo Trading centre with themes on HIV/AIDS, roles of Community Resource Persons, Elimination of Mother to Child Transfusion, dangers of delivering at Traditional Birth Attendants, attending antenatal visits, delivering from Health facilities, danger signs of pregnancy.

Table 1: Achievements on the targets for the quarter

Result areas/Objectives	Indicator	Actual achievement (numbers )	Deviation from plan	Reasons for deviation and remedial action
Result 1: Awareness and demand	Indicator R1.1: Number of community sensitisation meetings held to disseminate MSRHR information	294 Community Sensitisation meetings Topics included; Danger signs of Pregnancy, dangers of Gender Based Violence, Attending Antenatal care, hygiene, HIV/AIDS testing, Elimination of Mother To Child Transfusion, male involvement, Family planning, Sicklecell disease and pregnancy, patient rights	We had planned 180 sensitisation meetings	We exceeded the target because of the improved mobilisation skills by Community Resource Persons.
Indicator R1.2: Attendances at community sensitisation meetings (groups)	4971 Participants males were 1963 and Females were 3008. Topics included; Danger signs of Pregnancy, dangers of Gender Based Violence, Attending Antenatal care, hygiene, HIV/AIDS testing, Elimination of Mother To Child Transfusion, male involvement, Family planning, Sicklecell disease and pregnancy, patient rights.	Our target was 1620 participants	We exceeded the targeted number this was because of the increased numbers of men who attend these group meetings.
Indicator R1.3: Attendances for individual information and dialogue with MHP community resource persons (individuals)	3171 Participants where males were 1238 and Females were 1933 Topics covered included; Danger signs of Pregnancy, dangers of Gender Based Violence, Attending Antenatal care, hygiene, HIV/AIDS testing, Elimination of Mother To Child Transfusion, male involvement, Family planning, Sicklecell disease and pregnancy, patient rights	Our target was 1000 participants	We exceeded the targeted number because community Resource persons changed the strategy of visiting homes during morning hours to afternoon, because men are at home resting with their family members waiting to go back farming in the evening hours.
Result 2: Access and utilisation	Indicator R2.1: Number of outreaches conducted	Implemented by Uganda National Health Consumers Organisation
Indicator R2.2: Number of health facilities supported to conduct MSRH service and information outreaches	Implemented by Uganda National Health Consumers Organisation
Indicator R2.8: Maternal deaths recorded at community level	Implemented by Uganda National Health Consumers Organisation
Result 3: Accountability	Indicator R3.1: Number of health unit management committees sitting at least 4 times a year.	Implemented by Uganda National Health Consumers Organisation
Indicator R3.4: Number of health facilities (Health Centre 3 or 4) with at least one functional feedback/redress mechanism in place (i.e. Complaint desks, suggestion boxes, disciplinary committees, meetings etc).	Implemented by Uganda National Health Consumers Organisation.

Table 2: Cumulative progress to date (Total numbers since start of the project to the time of current reporting)

Result areas/Objectives	Indicator	Cumulative achievement (numbers )	Comments
Result 1: Awareness and demand	Indicator R1.1: Number of community sensitisation meetings held to disseminate MSRHR information	1724 community meetings held. Topics covered include; Danger signs of Pregnancy, dangers of Gender Based Violence, Attending Antenatal care, hygiene, HIV/AIDS testing, Elimination of Mother To Child Transfusion, male involvement, Family planning, Sicklecell disease and pregnancy, patient rights, Post Natal Care, Teenage pregnancy.	The increase in number of community sensitisation meetings was because of the support from Local leaders such as the Local Council chairpersons.
Indicator R1.2: Attendances at community sensitisation meetings (groups)	24193 participants Topics covered; Danger signs of Pregnancy, dangers of Gender Based Violence, Attending Antenatal care, hygiene, HIV/AIDS testing, Elimination of Mother To Child Transfusion, male involvement, Family planning, Sicklecell disease and pregnancy, patient rights, dangers of early pregnancy. Post Natal Care.	The increase in the number of group attendances is because men have been brought on board to participate actively towards maternal Health.
Indicator R1.3: Attendances for individual information and dialogue with MHP community resource persons (individuals)	15212 participants Topics covered include Danger signs of Pregnancy, dangers of Gender Based Violence, Attending Antenatal care, hygiene, HIV/AIDS testing, Elimination of Mother To Child Transfusion, male involvement, Family planning, Sicklecell disease and pregnancy, patient rights, dangers of early pregnancy, Post Natal Care, Teenage pregnancy	The increase in the number of Individual attendances was because of continuous home visits in the communities.
Result 2: Access and utilisation	Indicator R2.1: Number of outreaches conducted	Implemented by Uganda National Health Consumers Organisation
Indicator R2.2: Number of health facilities supported to conduct MSRH service and information outreaches	Implemented by Uganda National Health Consumers Organisation
Indicator R2.8: Maternal deaths recorded at community level	Implemented by Uganda National Health Consumers Organisation
Result 3: Accountability	Indicator R3.1: Number of health unit management committees sitting at least 4 times a year.	Implemented by Uganda National Health Consumers Organisation
Indicator R3.4: Number of health facilities (Health Centre 3 or 4) with at least one functional feedback/redress mechanism in place (i.e. Complaint desks, suggestion boxes, disciplinary committees, meetings etc).	Implemented by Uganda National Health Consumers Organisation

Note: For indicators; R2.2, R3.1 and R3.4; the cumullative will initially increase, once the total maximum number available is reached there will be not cummulatives, instead the the number will remain the same if there are no declines.
Table 3: Mass Media

Type	Number	Topic/Theme
E.g Radio talk shows This is a joint activity implemented by both SAU and UNHCO on 102.3 Heart FM Mubende	2 radio talk shows on 102.3 Heart FM	Community voices on Health concerning Kiganda HCIV. Dangers of Teenage pregnancy in Mubende District.
Radio spot messages Were run them throughout the quarter on 102.3 Heart FM Mubende	180 spot messages on 102.3 Heart FM	Mothers attending Antenatal care, delivering from Health facilities, male involvement and danger signs.
Joint Drama shows facilitated by both UNHCO and SAU.	2 Drama shows at Kitalegerwa and Kiwumulo Trading center.	HIV/AIDS testing, Antenatal Care, role of Resource persons, dangers of delivering from Traditional Birth Attendants, PMTCT, dangers of domestic violence, effects of alcoholism.

Section 2: Narrative page

Provide a detailed description on how all activities were implemented per result area and what was achieved as a result of implementing the activities.

2.1	Result area1: Target communities aware of their rights and demand quality MSRH services

2.1.0 Safe Motherhood Day

17th October 2013 Safe motherhood day celebrations were held at Makerere West near Caltec Academy School grounds with the theme of the day “Teenage pregnancy – an obstacle to safe Motherhood: let us stop now” VHR press statement was calling the government to:

stop teenage pregnancy now by increasing investment in adolescent health. Create and Scale up universal access to accurate sexual and reproductive health information in communities and schools

Institute a range of safe and affordable contraceptive methods

Re-focus on sensitive counselling, quality obstetric and antenatal care for all pregnant women and girls in health centre IIIs and IVs

Re- enforce prevention and management of sexually transmitted infections, including HIV/AIDS

Immediately finalize a health financing strategy and increase funding for teenage health services by 4% by 2015.

Produce good quality condoms and make it more available for youth. Government should have a budget for condom procurement, distribution and quality assurance at national & district levels.

Government should scrap off post shipment testing fees from US $280 per batch to US$100.

Educate and motivate Village Health Teams in all districts to increase health education among young people.

Dramatically establish functional, well equipped and better facilitated youth health centers in public health facilities where tailored teenage friendly services and information can be offered to young people.

Government should educate midwives and nurses in handling teenage health needs and ensure that they are motivated, retained and accommodated in health facilities.

Reflect the London Summit Commitment with 12 billion shillings for reproductive health technologies in FY 2013-14, maintaining that increase for the following 5 years

There was free HIV/AIDS testing by Uganda Health Marketing Group and Family planning services rendered by Reproductive Health Uganda.

2.2 Meeting with 102.3 Heart FM Station Manager

12th November 2013, Executive Director (Ruth Nankanja Mukiibi) and Program Officer (Edward Sentamu) had a meeting with 102.3 Heart FM station Manager Mr. Byansi David, to find out how the radio programs and spot messages have impacted on Mubende communities in addressing concerns of maternal Health.

These were the resolutions from the meeting.

Sicklecell Association of Uganda and Uganda National Health Consumers Organisation with the radio coordinator to start getting grassroot people during community dialogues and later invite either a Midwife or an in charge of the facility to answer questions raised from the community.

To invite as many experts in the field of maternal Health to be hosted on radio programs and avoid bringing the same people for the same programs.

To design several spot messages with different messages on Maternal Sexual and Reproductive Health Rights.

2.3 Drama shows and Community dialogue at Kitalegerwa Trading center

13th November 2013, a community dialogue was conducted at Kitalagerwa Trading center with major theme on mothers delivering from Traditional Birth Attendants

Why mothers still deliver from Traditional Birth Attendants

Concerns from the community

Accessibility to a health facility is still a hindrance in Kitalegerwa community

Male involvement is still limited in Kitalegerwa Community

Health workers demand for the essential commodities at the facility

Health workers poor attitude towards mothers at the facility yet Traditional Birth Attedants handle us well.

Drug stock outs at Kiganda Health centre IV and Myanzi Health centre III

The fear to be tested for HIV/AIDS at the facility.

We stay with Traditional Birth Attendants in our villages so the distance is short unlike the long distances to the Health facility.

The Health facility has small maternity centers therefore Midwives make us sleep on the floor because of the huge numbers at the facility.

Payment for C- section at Kiganda Health Centre IV

What should be done?

We need each Local Council to get a Health facility for example we were given land by a resident to construct a Health center II in our community.

We still need to put more emphasis on monitoring and supervision of our Health facilities.

Improving on our road network to access Health facilities in Nalutuntu Subcounty.

Encourage females and Males to attend sensitisation meetings on Maternal Sexual and Reproductive Health Rights.

Mothers are encouraged to prepare well before going to the facility with all necessary requirements.

Penalise Health Workers who steal Government medicines at the facility.

To pass bylaws to penalise men who disregard their responsibilities.

Government to strictly punish Traditional Birth Attendants who are still under operation in the area.

Government to increase on the number Village Health Teams and also pay them some facilitation for the work done at community level.

SAU to talk Dr. Jude in charge Kiganda HCIV about the user fee.

Resolutions

The Subcounty pledged to improve on the Kitalegerwa road net work for proper accessibility to the health facility this Financial Year 2013/2014

Construction of a Health center II at Namasengere village this FY 2013/14 which is a nearby village at Kitalegerwa.

SAU argued that the community issues concerning the Ministry of Health such as monitoring and supervision of Health facilities, penalising Traditional Birth Attendants who are still practising and facilitating Village Health Teams, would be addressed in the National Policy dialogue on Traditional Birth Attendants which will take place at Serena Hotel on the 14th – 15 November 2013 organised by the secretariat.

2.4 National Policy Dialogue on Traditional Birth Attendants in Uganda

14th – 15th November 2013, a National Policy dialogue on Traditional Birth Attendants in Uganda was held at Serena Hotel.

Objectives;

Determine the magnitude of the presence of unskilled Maternal Sexual and Maternal Sexual and Reproduction Health providers in Uganda.

Appreciate the contextual factors in the healthcare environment which are responsible for persistent deliveries under unskilled attendance.

Propose a way forward on how the health care system can relate with the various community providers of Maternal Sexual and Reproductive Health and Child Health services, such as, Traditional Birth Attendants, other community Resource Persons.

2.4.1 Recommendations from the National policy Dialogue;

Improved access to maternity services at community level to reduce the distances currently travelled to get the services.

Improved physical infrastructures and human resources to provide adequate workspace, equipment and tools, referral systems, adequate staff and accommodation, friendly and quality services.

Peer strategy to encourage and support mothers and families to deliver in Health facilities. There is need to strengthen Family Support Groups to encourage mothers attend ANC deliver in facilities and open up to get HIV/AIDS services

Health systems strengthening for sustainable supply of medicines and medical supplies, equipment and tools.

Medical workers require regularly orientation on client care and professional code of conduct to improve on the attitude and reduction of harshness and informal charges.

2.5 Joint Support Supervision

18th – 20th November 2013, SAU and UNHCO had joint support supervision on MSRHR in Kiganda, Nalutuntu and Myanzi Subcounty Mubende District.

2.5.1 On 19th Nov 2013 Meeting with the Station Manager Mbona FM (Mr. Mike Sebalu)

It was agreed with in the meeting that, it was high time that the radio programs to go down to the grass root and get information from the community its self instead of having the same radio talk shows.

This was a new innovation reached on by both implementing partners and the radio management which started with the community dialogues at Kamusenene - Kiganda, Nkwandwa – Nalutuntu and Luswa – Myanzi.

2.5.2 Meeting with Health workers at Myanzi HC III

Issues that emerged from the meeting

The in charge did not know the use of a suggestion Box at his facility because he was new to the facility.

They have seventeen (17) Health workers approximately to the number recommended by Ministry of Health which is eighteen.

The newly constructed Out Patient Department and the Latrine have cracks on both the walls and floor indicating that it was substandard work done by the Contractor.

There is no provision for Electricity in the newly constructed Out Patient Department

The Midwife commended that there is some progress in the number of deliveries at the facility for example in August they had 12, September 16, October 28 unlike other months where they only got 1 delivery. This has been due to the integrated outreaches conducted by the midwife supported by Uganda National Health Consumers Organisation.

There is no Electricity in the staff quarters but the facility was connected after getting contributions from implementing partners that is UNHCO and Sicklecell Association of Uganda staff made personal contributions, Myanzi Subcounty and the District.

Delay in the Primary Health Care fund

Limited Primary Health Care at the facility where the facility receives 790,000/= a quarter.

Referrals from Traditional Birth Attendants have increased at the facility.

The In charge thanked the Maternal Health Project team for the transformation created at Myanzi Health Centre III.

2.5.3 Recommendations

More trainings and sensitization on the use of suggestion Box by both health workers and the community.

The in charge to receive the list of Village Health Teams from MHP focal person attached to the facility.

The need to change the placement of the suggestion Box.

2.5.4 Community Dialogue and Drama show on MSRHR at Kamusenene Trading Center – Kiganda Subcounty.

The drama show was conducted by Kamusenene Drama Group.

Topics covered included; HIV/AIDS, Male involvement, danger signs of pregnancy, dangers of delivering from TBAs, the role of VHTs, dangers of domestic violence and PMTCT.

This dialogue was recorded by Heart FM to get the community voices for the radio program.

Issues from the Community dialogue

When you go to most government health facilities there is no good reception why? (Simon Kareebe)

At Kiganda HCIV they always make us buy gloves yet it’s a government facility? (Musiime)

Men should learn to save for their wives while pregnant ( Rashid Kalyango)

TBAs are a threat to the health of women what should we do with them?(Nalubega)

They always charge 100,000/= for the operation in Kiganda HCIV why should we pay that money (Biira Gladys)

One mother thanked Health Workers at Kiganda HCIV for fueling the ambulance when she reached the facility because she had no money.

Elderly persons are not cared for at the facility by Health workers for example a 75 year old Mariam was made to wait for the whole day and later told that there are no drugs at the facility. What should we do as elderly persons?

A man confessed that he did not know that it was useful to accompany his wife at the facility, he pledged to be accompanying her for Antenatal. (Mohammed)

Responses from Dr. Jude Kiiza In charge Kiganda HCIV

He explained that for the last three months there was no gloves and other essentials at the facility this was because National Medical Stores has not yet supplied them.

Payments for the C- section at Kiganda Health Center IV are due to fuel for the generator, medicines used for the operated mother and sometimes to buy fuel for the ambulance in case of referrals to Mubende, Mityana or Mulago.

Nutrition supplies are about to be available at the facility free, therefore anyone will be provided when you reach at the facility.

20th November 2013

2.5.5 District meeting at the Headquarters

The District Health Team was represented by Dr. Sendikadiwa Assistant District Health Officer and Dr. Paul District Health Inspector

UNHCO and SAU team brought the following issues to the attention of the District;

The substandard work which was done at Myanzi HCIII on the newly constructed Out Patient Department

The limited supplies at Kiganda Health center IV

Responses

Dr. Sendikadiwa the Assistant District Health Educator recommended that it will be better if we discuss the above issues with the Chief Administrative Officer and District Health Officer before publicizing them.

He pledged that the district will be able to provide some essential medicines and gloves to Kiganda HCIV.

2.5.6Community Dialogue at Nkwandwa Vilage – Nalutuntu Subcounty

This dialogue was recorded by Mr. Sebalu Mike from Mbona FM

Issues from the community dialogue

They thanked Maternal Health Project for the integrated outreaches which are always conducted in our village and get services in our homesteads. However for the last three months, the Midwife has not been conducting integrated outreaches to Nkandwa village .what should we do? (Chairman Local Council I)

Male Involvement should be emphasized, the chairman was a role model in his area where he used a bicycle to take a pregnant mother to Kiganda Helth center.

Teenage Pregnancy is rampant in our area of residence. What should we do? (Elifazi)

Distance to the nearby Health facility is 1 mile which is a private mission facility,	Kakungube Health center II sponsored by Uganda Muslim Council. What can we do to get a nearby government Health facility?(Mate Lazaro)

I thank MHP for the work done in our Health Workers, when I went to Kalamba HCIII my wife delivered well after receiving a positive attitude from the midwife.(Samuel)

We have got a problem of Diarhorea and Vomiting among our children. What can we do to prevent this? (Kigoma Gideon)

We thank government facilities which provide for us the mosquito nets and this encourages our wives to go for Antenatal Care (Baluku Partrick)

Why should do we go with our husbands for HIV/AIDS Blood testing? (Nakazi)

Why they charge us 100,000/= an operation in Kiganda HCIV yet it is a government facility?

Responses from the Health Assistant- Nalutuntu Subcounty and MHP implementing partners

Mrs. Nabukeera Solomy emphasized the issues of hygiene in the community homesteads. There must be construction of Latrines and drinking boiled water so as to prevent the rampant diarrhea in the area.

She thanked SAU and UNHCO for supporting the Subcounty in addressing maternal health issues in the community by facilitating the resource persons and a focal person to conduct sensitization meetings among communities.

Recommended that male involvement is paramount in addressing maternal health, she gave an example of her husband who supports her during and after pregnancy in terms of finance, moral and physical support.

Parents were advised to be stakeholders in addressing the issue of teenage pregnancy in the area. Educate and sensitize their children about the dangers of early sex.

Testing HIV/AIDS with your husband helps both couple to know their status and plan for the future if positive start taking Anti viral drugs and if negative to stay faithful.

Charging patients 100,000/= for the C- section at Kiganda is due to inadequate funding from the Primary Health Care to buy fuel for the generator, ambulance and essential medicine for the operated mother.

2.5.7 Community dialogue at Luswa – Kitawuluzi Myanzi Subcounty Mubende District.

This dialogue was recorded by Mr. Sebalu Mike from Mbona FM

We started with a drama and music show on MSRHR by Kamusenene drama group.

Issues from the community

Nalubwama prossy wanted to know whether Myanzi HCIII is a government or private facility this was because when she delivered a baby two months back she was asked to pay 40,000/=.

Health workers at Myanzi HCIII collect our books and prescribe for us drugs and tell us to buy them from private clinics what should then be the essence of having a non functional facility?

Absenteeism of health workers at Myazi HCIII is paramount yet on paper they are seventeen but practically seven. There are no health workers on weekends and at night

One of the Health Unit Management Committee member Mr. Joshua Ssalongo was asked by the health workers to pay 40,000/= after his wife delivered from this facility

Late coming of Health workers at the facility has been witnessed

Responses from Dr. Damascus Kiyoola – Health Worker Myanzi HCIII

He explained that Myanzi is a Health center III which cannot do its own purchase but only wait for the district to supply them, for the last four months they had a stock out of most of the essential drugs, gloves, mama kit and others. That’s why at times ask the patients to buy for themselves and get the services

About the payment of 40,000/= he said he will follow it up.

The dialogue resolved that most of these issues need to be answered by the In charge Myanzi Health Centre III and a Midwife at Mbona FM radio on 9th December 2013 in a radio program supported by SAU and UNHCO.

2.6 Support Supervision

3rd December 2013, we conducted support supervision on Community Resource persons in addressing Maternal Sexual and Reproductive Health Rights

Community sensitisations were carried out by the Community Resource Persons throughout the quarterly both at individual and group level. The communities were sensitised on the following topics; danger signs of pregnancy, attending antenatal care, delivering in Health centres, Family planning, HIV/AIDS testing, Elimination of Mother to Child Transmission, dangers of Gender Based Violence, Male involvement, Sicklecell disease testing and care for pregnant mothers, hygiene and dangers of delivering from Traditional Birth Attendants.

Three Radio talk shows conducted every 6th of the month on Heart FM 102.3 Mubende with topics on dangers of delivering from Traditional attendants and community concerns regarding maternal health from Kiganda Health Center IV.

180 Spot messages run on 102.3 Heart FM throughout the quarter with the messages on maternal Health such as encouraging male involvement, mothers to attend Antenatal care and delivering from skilled midwives.

2 drama shows conducted at Kitalegerwa and Kiwumulo Trading centre with maternal Health themes such as HIV/AIDS testing, dangers signs of pregnancy, dangers of Gender Based Violence, attending Antenatal care, roles of Village Health Teams.

2.7	Result 2: Good access to and high utilization of MSRH services in target communities

Result area 2 is being implemented by Uganda National Health Consumers Organisation.

2.8	Result 3: Key duty bearers held accountable for delivery of MSRH services in target areas

Result area 3 is being implemented by Uganda National Health Consumers Organisation

2.9. Advocacy progress: report on the indicators below using the questions;

Is there evidence and signs of enhanced advocacy effectiveness and opportunity?

Communities have been empowered to demand for improved services and this included the grading of Nkandwa to Kakungube main road for accessibility to Kakungube Health Center II

What change has there been and how did it come about?

It was through the community dialogues we have been supporting in Nalutuntu that the communities have been demanding the Subcounty officials to grade their road network from Nkandwa to Kakungube main road. The Subcounty chief informed the community that in 2013/2014 they allocated 7,000,000/= in grading of that road for accessibility to their health facility.

What was the role of the MH project in securing this outcome?

Facilitating community dialogues in empowering the community to held their leaders accountable for example in a dialogue held at Nkandwa village, the community were demanding from Subcounty officials the grading of their road network to access Kankungube Health center II.

What change has there been in the focal institutions (at community, district or national level) for the MH project and how did it come about?

At Community level

In some places accessibility to health facilities has improved this is evidenced from Kyakatebe main road to Kyakatebe Health center 11 the grading of the road network.

Accessibility from Nkandwa to Kakungube main road near Kakungube Health Center II has improved due to the grading of the road network.

District level

The district has recruited enough health workers for example at Myanzi Health Center 111 there are 17 Health workers yet the recommended number is 18. Kiganda HCIV they recruited more 4 midwives adding to the existing 3 totalling to 7. Mothers from Nalutuntu deliver from either Kiganda HCIV or Myanzi Health center III.

National Level

14th – 15th SAU participated in a Policy National dialogue on Traditional Birth Attendants which was supported by World Health Organisation and Swedish International Development Agency organized by Uganda National Health Consumers organisation with all the stakeholders such District Health Officers in Implementing Districts, Ministry of Health, National Medical Stores and other Civil society organizations. Recommendations were drawn such as;

Improved access to maternity services at community level to reduce the distances currently travelled to get the services.

Improved physical infrastructures and human resources to provide adequate workspace, equipment and tools, referral systems, adequate staff and accommodation, friendly and quality services.

Peer strategy to encourage and support mothers and families to deliver in Health facilities. There is need to strengthen Family Support Groups to encourage mothers attend antenatal care, deliver in facilities and open up to get HIV/AIDS services

Health systems strengthening for sustainable supply of medicines and medical supplies, equipment and tools.

Medical workers require regularly orientation on client care and professional code of conduct to improve on the attitude and reduction of harshness and informal charges

What was the role of MHP in securing this outcome?

Voices for Health Rights secretariat UNHCO organized the policy dialogue on Traditional Birth Attendants to draft recommendations which would be used in Health policy formulation by Ministry of Health and World Health Organisation.

3.0 Signs of positive change in key audiences' at national and district levels in support of actions geared towards improving maternal health.

National Level

Through breakfast meetings held with Members of Parliament, Ministry of Health and other civil societies involved in Maternal Newborn and Child Health we have a common agenda to push government to increase the Budget in the Health sector for FY 2014/15.

The phasing out strategy of Traditional Birth Attendants in the Health system through recommendations by District Health Officers, Ministry of Health and World Health Organisation in a policy dialogue organised by UNHCO at Hotel Serena on 14th to 15th November.

District level

The District has recruited enough health workers for example at Myanzi Health Center 111 there are 17 Health workers yet the recommended number is 18. Kiganda HCIV they recruited more 4 midwives adding to the existing 3 totalling to 7. Mothers from Nalutuntu deliver from either Kiganda HCIV or Myanzi Health center III.

Partnership with other implementing partners in the District fighting the same cause of ending maternal mortality has been evidenced such as UNFPA, Uganda Community Based Child welfare (UCOBAC), Action aid, Mild may, Women Won’t Wait and Kasanda Cornerstone Foundation.

3.0.1 Signs of positive change at district level with actions that respond to maternal health needs of communities

The District has recruited enough health workers for example at Myanzi Health Center 111 there are 17 Health workers yet the recommended number is 18. Kiganda HCIV they recruited more 4 midwives adding to the existing 3 totalling to 7. Mothers from Nalutuntu deliver from either Kiganda HCIV or Myanzi Health center III.

Partnership with other implementing partners in the District fighting the same cause of ending maternal mortality has been evidenced such as UNFPA, Uganda Community Based Child welfare (UCOBAC), Action aid, Mild may, Women Won’t Wait and Kasanda Cornerstone Foundation.

3.0. 2 Signs of positive changes at national level (MOH, Parliament and general political leadership) in response to maternal health improvements proposed by the MHP partners.

Through Voices for Health Rights continued advocacy Ministry of Health and other four plus stakeholders (UNICEF, WHO, UNFPA, UN Women, World Bank and USAID) launched the “A promise Renewed (APR) campaign which was under the leadership of the Government of Uganda with Civil society, private sector and other development partners to renew their collective commitment to end preventable maternal, newborn and child deaths. The campaign was launched by His Excellency, Vice President Edward Ssekandi on 26th November 2013 at Serena Hotel.

Through breakfast meetings held with Members of Parliament, Ministry of Health and other civil societies involved in Maternal Newborn and Child Health we have a common agenda to push government to increase the Budget in the Health sector for FY 2014/15.

The phasing out strategy of Traditional Birth Attendants in the Health system through recommendations by District Health Officers, Ministry of Health and World Health Organisation in a policy dialogue organised by UNHCO at Hotel Serena on 14th to 15th November 2013.

Tabel 4: Progress on the work plan (show in brief the status of implementation of each planned activitiy for the period under review)

Result areas/Objectives	Planned activities	Actual	Variance and Mitigation measures
Result 1: Awareness and demand	One community Dialogue	One was successfully implemented	Improved mobilisation skills by both the Focal person and community resource persons made it successful.
2 Drama shows	Two drama shows were successfully implemented	Drama shows attract more people and especially men whom we also target in our sensitisation meetings.
2 Support Supervision visits with CORPS on MSRHR	Two visits were successfully implemented	We were joined by Uganda National Health Consumers Organisation to conduct a joint supervision exercise in all the three sub counties that is Nalutuntu, Myanzi and Kiganda.
3 Radio talk shows	Three radio talk shows were successfully implemented	These are jointly implemented on 102.3 Heart FM Mubende by UNHCO and SAU. Currently our radio programs have been drawn to the grass root level. Where the community participate and recorded.
180 spot messages	180 spot messages were successfully implemented	These are run daily by the station
180 Sensitisation meetings	294 sensitisation meetings were conducted.	Community Resource persons and focal person mobilisation skills have improved and getting support from the local chairpersons.
Result 2: Access and utilisation	Implemented by UNHCO
Result 3: Accountability	Implemented by UNHCO

Section 3:

3.1	Lessons learnt

Drama shows on MSRHR attract men who tend to refuse participating in group sensitisation meetings.

Community dialogues empower communities to demand improved services from their leaders.

Bringing radio programs down to the grassroots and record the peoples voices creates a lot of impact to the community who are demanding improved health services.

3.2	Challenges

What are the main challenges and their implication on the achievement of the project results?

Absentia of health workers from the facilities can hinder our progress

Drug stock outs in Health facilities especially those used after C- sections at Kiganda Health Center IV and scarcity of gloves at Myanzi Health Center III

Lack of Fuel in the generator and ambulance at Kiganda HCIV leading to charge the patients a fee of 50,000/= to 100,000/= for the C- section.

3.4	Recommendations

Which action should be taken to address the challenges? (They must be feasible and in the means of the project, they should also answer the challenges)

About drug stock outs National Medical Stores has intervened and demanded the Incharge Dr Jude of Kiganda to send them a procurement plan.

Increase the Primary Health care fund to support the Health facility to purchase fuel for both the generator and ambulance.

The District Health Officer has been informed about the absentia of health workers at the facility and a duty roaster has been given to the In charges of these facilities.

3.5	Conclusions

Close relationship with all stakeholders both at National, District and Community level has enabled the progress of Maternal Health Project in Mubende District. This includes Members of Parliament, Ministry of Health, National Medical Stores, District Health Team, Subcounty officials and partners in Mubende such as Mild May, UNFPA, Action Aid, UCOBAC and Kasanda Cornerstone Foundation.

Annexes

Work plan and budget for the next period

Cash request for the next period

Success story (optional)

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