USING COMMUNITY SCORE CARD APPROACH TO MONITOR THE

QUALITY HIV&AIDS SERVICES

Results of the Study conducted in Kalangala, Kitgum and Serere Districts

What is a Community Score Card• The Community Score Card (CSC) is a

participatory, community based monitoring and evaluation tool that enables citizens to assess the quality of public services such as a health centre, school, public transport, water, waste disposal systems and so on.

• It is used to inform community members about available services and their entitlements and to solicit their opinions about the accessibility and quality of these services

Assessment objectives • To empower the community (service

beneficiaries) assess the quality HIV&AIDS services in their districts

• To enable the service providers self evaluate the quality of HIV&AIDS services that they offer to the community.

• To make recommendations on HIV&AIDS service delivery to policy makers , policy implementers and other stakeholders

Study AreaThe study was undertaken in the three districts - Kitgum in Acholi Sub Region, Serere in Teso Sub

Region, Kalangala in Central Region .

The study was done in a catchment of 12 health centers across the three districts

Kitgum (5) - Kitgum General Hospital, Namokora HC IV, Kitgum Matid HC III, Orom HC III and Pajimo HCIII

Serere (5) - Serere HC VI, Apapai HC IV, Kadungulu HCIII, Kateta HC III and Pingere HC III)

Kalangala (2) - Kalangala HC IV, Bwendero HC III)

Study Population• A total of two hundred and twenty people

(110 males and 110 females ) participated in the focus group discussions

• 240 (135 females and 105 males) participated in the interface meeting.

• Key informant interviews were conducted with the in-charges of the 12 health centers.

Sampling methodology • A Simple Random Sampling (SRS) technique

was employed to select the health centers and communities for the CSC.

• A complete list of all the health centers in the three districts was collected and assigned them numbers in an excel sheet.

• An online facility RANDOM.ORG was used to obtain 12 random number of a health centers to be used for the assessment

Steps/Phases taken during the assessment

Data collection and analysis • Data was collected using qualitative methods

that involved highly participatory techniques including, among others, desk reviews, Focus Group Discussions (FGDs), Key Informant Interviews, consultative/ interface meetings and direct observation

Quality Control ; Assurance & ethical Considerations

• A team of Research Assistants with expertise in qualitative data collection were recruited, oriented in the Community Score Card Methodology and trained data collection

• All Study participants were requested for their consent to participate voluntarily in the assessment

• Permission was sought and obtained before sessions or interviews began for all study participants including permission to take photographs

• All the participants were assured of confidentiality and anonymity of their responses.

Summary of findings ( HIV Prevention)

• 59% of the participants rated eMTCT services as good (community members and service providers)

• 25% rated as a very good and 16% rated it as very poor

- Reasons for poor scoring - inadequate staff, low male involvement, low

uptake of ANC & Post-natal services, stock outs of test kits and drugs, delivery of drugs with short shelf life, Stigma and lack of privacy during counseling and testing due to inadequate space

Combined scores

Safe male circumcision score

Category Units

Very poor

Poor Fair GoodVery good

N(%) N(%) N(%) N(%) N(%)

District

Kalangala 1(50) 1(50) 0(0) 0(0) 0(0)

Kitgum 1(20) 0(0) 1(20) 3(60) 0(0)

Serere 0(0) 3(60) 2(40) 0(0) 0(0)

Level

General hospital 0(0) 0(0) 0(0) 1(100) 0(0)

Level III 2(29) 3(43) 1(14) 1(14) 0(0)

Level IV 0(0) 1(25) 2(50) 1(25) 0(0)

CSC

Men 1(8) 3(25) 3(25) 3(25) 2(17)

Women 2(17) 4(33) 4(33) 0(0) 2(17)

Service provider 2(17) 4(33) 3(25) 2(17) 1(8)

Combined score 2(17) 4(33) 3(25) 3(25) 0(0)

Safe male circumcision

• SMC service is still marred with both cultural and religious beliefs, inadequate information about SMC, lack of equipment, resources and inexperience health workers and inadequate staff numbers leading to low and poor quality service rendered as said in one of the FGDs.

• “Women in this community discourage their husbands to go for SMC; they think that SMC makes men sexually weak after 5 years”, (- a Female FGD participant at Namokora HC IV in Kitgum district)

•

•

Supply of female and male condoms

Quality of HCT• Good: 92%; however respondents

complained of lack of adequate counselling rooms, limited number of staff, lack of skilled counsellors and inadequate test kits.

Access to ART

67 % good; fair 27% and very poor 8% (constant ARV stock outs , stigma, inadequate staffing, loss to follow-up and lack of privacy)

ART for adults cont’d…

Paediatric HIV care• Good: 50%, 42% fair and 8% very poor Reasons :stock out of pediatric drugs, few health

workers, limited uptake of ANC & post-natal services, mothers not giving birth in health centers , low male involvement and stigma .

• Adolescent HIV care and treatment• Fair: 58% and 17% as very poor Gaps: Absence of youth friendly service

point/corner/space leading low privacy, low uptake of the service and stigma coupled with the low staff numbers

Integrated T.B services

Integrated TB services

• Limitations were cited and recommendations made which included having separate wards and areas for T.B patients, sensitization on T.B drug adherence, promoting awareness of the availability of T.B treatment among the community members, recruiting of more staff, training of available health staff on T.B/HIV co-management, provide facilitation for client follow up, avoiding stock out of T.B drugs and testing reagents

Family Planning Services

Family planning

Categories UnitsVery poor Poor Fair Good Very good

N (%) N (%) N (%) N (%) N (%)

DistrictKalangala 0(0) 0(0) 0(0) 1(50) 1(50)

Kitgum 0(0) 0(0) 2(40) 2(40) 1(20)

Serere 0(0) 1(20) 2(40) 2(40) 0(0)

LevelGeneral hospital

0(0) 0(0) 0(0) 0(0) 1(100)

Level III 0(0) 1(14) 3(43) 3(43) 0(0)

Level IV 0(0) 0(0) 1(25) 2(50) 1(25)

CSC

Men 0(0) 1(8) 3(25) 6(50) 2(17)

Women 0(0) 1(8) 3(25) 6(50) 2(17)

Service provider0(0) 1(8) 5(42) 5(42) 1(8)

Combined score 0(0) 1(8) 4(33) 4(42) 2(17)

Family planning services

• The provision and utilisation of family planning service was lowest in Serere district due to negative beliefs and domestic violence. Most health facilities lacked long term methods of family planning, trained staff and involvement of men was still low

Palliative care services

Palliative HIV Care

CategoriesUnit Very poor Poor Fair

N (%) N (%) N (%)

District

Kalangala 1(100) 0(0) 0(0)

Kitgum 1(50) 1(50) 0(0)

Serere 2(100) 0(0) 0(0)

Level General hospital 0(0) 1(100) 0(0)

Level IV 4(100) 0(0) 0(0)

CSC

Men 3(60) 2(40) 0(0)

Women 3(60) 1(20) 1(20)

Service provider 3(60) 0(0) 2(40)

Combine score 4(80) 1(20) 0(0)

Home based services

Rights awareness and support.

Staffing levels

• Most of the health centers visited had fewer staffs compared to recommended staffing norms from Ministry of health e.g Kitgum General Hospital does not have permanent Medical Officers ( 0 out of 7) and all other staff categories are not filled to capacity

Staffing levels @ HC IV

• Namokora health centre IV had a gap of 58% of the intended numbers for level IV facilities.

• Kalangala and Apapai health center IVs had a gap of 14(29%)

• Serere HCIV had the lowest gaps registered with only 6 (13%) of the total staff required total staff. I

Staffing levels @ HC III

• Bwendero HC III in Kalangala district, Kitgum Matidi, Orom and Pajimo in Kitgum district, Kateta, Kadungulu and Pingere in Serere district, registered about 68% of the total number of staff required in a level III health facility.

• 84% for Kateta HC in Serere• 79% Orom HC and 74 % for Kitgum Matidi HC

III in Kitgum district

Time management Observing working hours

Categories Units

Very poor Poor Fair Good Very good

N(%) N(%) N(%) N(%) N(%)

Level

General hospital 0(0) 0(0) 0(0) 1(100) 0(0)

Level III 0(0) 1(14) 4(57) 2(29) 0(0)

Level IV 0(0) 0(0) 4(100) 0(0) 0(0)

District

Kalangala 0(0) 0(0) 1(50) 1(50) 0(0)

Kitgum 0(0) 1(20) 3(60) 1(20) 0(0)

Serere 0(0) 0(0) 4(80) 1(20) 0(0)

CSC

Men 1(8) 3(25) 6(50) 2(17) 0(0)

Women 2(17) 3(25) 4(33) 0(0) 3(25)

Service providers 0(0) 0(0) 3(25) 6(50) 3(25)

Combined score 1(8) 3(25) 6(50) 2(17) 0(0)

Conclusion Despite the improvements in drug delivery, infrastructure,

recruitment of new staff, there are still a number of challenges that affect the delivery of HIV&AIDS services in the three districts

• Too many patients seeking medical services,• low male involvement in family planning and

reproductive health • Limited awareness of patients rights and responsibilities• Persistent drug stock outs• Poor and dilapidated infrastructure• Staff absenteeism

Recommendations • The MOH and the district service commission

should recruit more health workers to fill up the staffing gaps and reduce on the waiting time that patients take to see health workers

• NMS to ensure constant supplies of Drugs and reagents including testing kits to reduce on frequent drug stock outs.

• Community sensitisation sessions by the district local government, health facilities and VHTS on family planning benefits and maternal health services

• Sensitisation on patient’s rights and responsibilities and roll out the national patient’s charter to all health centres.

• The District Health Office should intensify monitoring and supervision of the health facilities to reduce on absenteeism and late coming.

• Sensitize the community about importance of safe male circumcision and train more surgeons at health centre III

• Provide more IEC materials, translate them into local languages and distribute them in the remotest health centres across the districts

• Ministry of health should procure ambulances for health Centre IVs and provide a budget for running it and maintenance.

• Train health workers on legal and human rights to enable them support the community more efficiently.

• Involve religious leaders and cultural leaders on issues of sexual gender based violence

• The MOH and district local governments should construct more structures and equip them with facilities to support quicker diagnostic

• Staff houses should be constructed to enable health workers reside at their work stations and report on time. This will also attract staff to hard to reach areas.

• Parliament and Ministry of Finance Planning and economic development should allocate more resources to the health sector to enable the sector implement what has been promised in the Health Sector Strategic Plan III and National HIV&AIDS strategic Plan

Thank you