Global Health Practitioners Meeting

“Health Starts at the Community”

Silver Springs

May 5th -9th 2014

ACT Health Premise

Changes within Society

(Empowerment of Individuals)

Changes within State (Inclusive and

Responsive Institutions)

Changes at State & Society

Interface(Space for

participation and collective

Voice)

Increased Accountability

and Responsiveness

Where Pilot in Bugiri District Eastern Uganda

Population : 426, 800

33 Health Facilities

5 National partners

Started January 2012

Community Voices –First phase

• 5,912 Households surveyed for development of the CRC

CRC

Citizen Report Card (CRC) Excerpt

Attendance of Health Staff at health centers

Percentage of households who said staff are always at work 43%

Percentage of households who said staff occasionally do not come to work 36%

Percentage of households who said staff are rarely at work 21%

Household rating of medical staff attendance at government health centers

Medical staff attendance at government health centers on survey day

Total number of medical staff allocated to government health centers II.

(National Standard; 3medical staff per HC II X 23= 69)

52 (75% of

what is

required)

Total number of medical staff present in the health centers on the survey days 43 (83%)

Total number of medical staff out for outreach and/or training on the survey

day

0 (0%)

Total number of medical staff out on leave on the survey day 6 (12%)

Total staff absent 3 (6%)

Community VoicesSecond Phase

• 5,912 Households surveyed for development of the CRC

CRC

•2718 engaged in action plan development

Interface Meetings /Action Plans

A sample Action PlanIssue Action (incl timeline & person

responsible)

Status of action Challenges Proposals or Changes to actions

Community unaware of the

services offered at the H/C

The HUMC to establish the sign

post not exceeding August 2013

Not achieved Inadequate and delayed release of PHC fund The in charge should prioritize the issue of

establishing a sign post and act accordingly

upon receiving PHC fund 1st April 2014

HUMC, Local leaders and VHTs

to inform community about the

services offered during static

days at the H/C

Achieved done every

Tuesday and Thursdays in

the week

None HUMC and in charge should write on manila

papers the services offered at the health facility

and pin it against the walls by the 30th of Feb

2014

Health workers to make

appropriate referrals

Achieved by health

workers explaining to the

clients why they are

referred to other Health

facilities

None No change to the proposal

H/C closed when H/Ws go for

outreaches/workshops

At least one health work should

be left at the H/C effective August

2013.

Achieved as a health

worker is always left

behind

Community members come at the health centre

during time of closure

The VHTS should always inform the Community

members to visit the H/C in the right operating

hours i.e. from 8:00am-5:pm effective

14th/02/2014

Community VoicesThird Phase

• 5,912 Households surveyed for development of the CRC

CRC

•2718 engaged in action plan development

Action Plans • 25 most significant change stories collected

Results

Why Most Significant Change (MSC) Stories

• Facilitate community involvement in monitoring and evaluation

• Track unexpected outcomes

• Support the light touch monitoring approach

• Contribute to program evaluation

MSC Collection and Analysis

• In-depth interviews with people are household level

• 1 story per month from each health facility

• Analysis categorizes stories into four domains:• Changes in service quality

• Changes in the community/service provider relationship

• Changes in health outcomes

• Other changes.

Final MSC Story Selection

MSC collected

one story per health facility

every six months

33 over six months

Categorized in Domains

for each health facility one story for each domain

132 stories

Regional Stories Chosen

1 story from each domain

Final Review of regional stories

and a final MSC is chosen every six

months

Example MSCName of storyteller: Naigaga Irene

When did the change happen? May 2013

Changes in health workers’ supervision improves service quality

“In June the in charge was demoted and a new in charge was posted to the health centre. The new in charge is always at the centre and this has resulted into improved service quality because the health workers arrive on time, very active on duty and give appropriate referrals. The high level of supervision has even led to the health workers operating on Sunday which was not the case before.This story is very significant to me because the community can now be sure to find health workers at the health centre and receive health services.”

Example MSCName of storyteller: Kagoya Rebecca When did the change happen? May 2013

Improved client care for mothers!

I raised the mother’s concerns and they were captured in the action plan. This meeting allowed us present these issues directly to the health workers who were present. The midwives have since improved the way they handle mothers and stopped asking for money. This has increased the number of mothers delivering at the health centre. This story is significant to me because the number of mothers delivering at the centre has increased .”

MoH Voices Health Facility Assessments ( 3 times)

Interface Meetings

MSC

Outcome Mapping

Quarterly Reviews with partners

ACT Health Scale Up 16 districts across Uganda

329 health facilities

7 different national partners

In conjunction with an RCT to answer the following research questions:

Does the ACT Health Program lead to greater access to services and an increase in health seeking behavior?

Does the ACT Health Program contribute to downwards accountability among duty-bearers for health services?

Scale Up: Community VoicesACT Health scale up has the potential to involve:

150,000 households in CRC

19,800 community members in action plan development and interface meetings

367 MSC stories collected every six months

Acknowledgments

Questions