securing health through advocacy and people’s … · of health, private consultants, heps uganda,...

Submitted By

Dr. Moses Muwonge

19th September, 2016

SECURING HEALTH THROUGH ADVOCACY AND PEOPLE’S EMPOWERMENT

(SHAPE) ACTIVITY REPORT

ii

Table of Contents

1.0 Introduction ............................................................................................................................................ 1

2.0 Specific Activities implemented under the teaming agreement ............................................................ 1

3.0 Description of Activities .......................................................................................................................... 1

3.1 Review the DSW budget methodology and tools to meet the project objectives ............................. 1

3.2 Orientation of Data Collectors ............................................................................................................ 2

3.3 FP commodities tracking ..................................................................................................................... 2

3.4 Support the formation of the FP Budget Advocacy Group ................................................................. 2

3.5 Activity: Provided on-job and coaching on FP budget tracking to members of FP budget advocacy

group ......................................................................................................................................................... 3

List of Annexes

Annex 1: Training report on Orientation of Data Collectors......................................................................... 4

Annex 2: Family Planning Commodities (Contraceptive) tracking Report .................................................... 7

Annex 3: Family Planning Budget Analysis Report ...................................................................................... 14

1

1.0 Introduction

Through a teaming agreement Samasha supported DSW in implementation of the first year of

a three year project titled “Securing Health through Advocacy and Peoples Empowerment

(SHAPE) that aims to ensure increased funding from national and sub-national governments in

Uganda to address the unmet need for FP 2018; improved implementation of national and sub-

national FP funding to address the unmet need in Uganda by 2018; and improved resource

mobilization in support of FP programmes among CSOs in Uganda by 2018.

2.0 Specific Activities implemented under the teaming agreement

1. To Review the DSW budget methodology and tools to meet the project objectives but

also to capture the new emerging issues on family planning. These tools included

Reproductive Health and Family Planning Family Planning budget analysis tool, Facility

assessment analysis tool and focus group discuss guide tools.

2. To develop new tool/methodology for FP commodity tracking.

3. To support the formation of the FP budget advocacy group.

4. To provide on-job and coaching on FP budget tracking to members of FP budget

advocacy group.

3.0 Description of Activities

3.1 Review the DSW budget methodology and tools to meet the project objectives

Samasha revised the Budget analysis tools both at National and district levels on Family

Planning Financing.

Methodology:

A participatory method was used to adopt the tools to Uganda through combined effort of Civil

Society Organizations. Samasha put together all the available data collection tools from DSW,

carried out an initial desk review and made recommendations. The recommendations and the

data collection tools were validated during the Family Planning Budget Advocacy and Tracking

Experts’ Meeting held on the 19th/April/2016 at Kampala Serena Hotel.

Output:

Revised Budget analysis tools both National and district levels.

Reference:

A Detailed report on budget methodology by DSW

2

3.2 Orientation of Data Collectors

Samasha facilitated a one day data collection orientation at DSW offices in Lubowa on the

20th/April/2016 and the training was attended by 5 Participants from DSW and two facilitators

from Samasha.

Methodology:

A participatory approach was used during the training and it involved discussions plus practical

exercises. The training room was equipped with teaching tools including a projector and flip

chart.

Output:

Orientation of data collectors

Reference:

Training report submitted to DSW (See Annex 1).

3.3 FP commodities tracking

Samasha Medical Foundation (SMF) tracked and monitored every cycle of family Planning

commodities distributed by National Medical Stores (NMS) to the four project districts namely;

Mukono, Kamuli, Tororo and Mityana.

Methodology:

Samasha staff visited NMS every two months to collect data on quantities distributed to health

facilities in the four districts. NMS provided data in an excel sheet which was analysed and a

report was written.

Output:

Contraceptive distribution Report (See Annex 2)

3.4 Support the formation of the FP Budget Advocacy Group

The Uganda Family Planning Budget advocacy Group (UFPBAG) was created to challenge health

policies and budgets at national and local levels; advocate for more resources and more

efficient use of those resources; improve transparency and accountability; influence decision-

making processes; expose leakages and bottlenecks and reduce wastage in Family Planning

health expenditure.

3

Methodology:

Samasha wrote a concept note detailing the case for the need for FP Budget Advocacy Group.

The concept detailed the formation, membership and mode of engagement for all members of

the Family Planning Advocacy group.

Output:

Approved concept note for establishing the FP advocacy group

3.5 Activity: Provided on-job and coaching on FP budget tracking to members of FP

budget advocacy group

Samasha engaged in capacity building of CSO’s to impart skills and techniques of FP Budget

monitoring and tracking to CSOs at national and District levels. The orientation was attended by

30 participants from different organisations for example, UHMG, RAHU, CSBAG, SAMASHA,

PACE, Muvubuka Agunguse, UNASO, Ministry of Health.

Methodology

Participants were taken through an introduction to understanding of Budgets and the new

Budget process and cycle on day one; Day two, FP policies and alignment to Budget, FP/RH

budget process mapping exercise; budget tracking and a detailed step by step discussion of the

11 step guide. With practical sessions in which data was presented and participants had to

make sense of the data using the 11 steps for advocacy. The training took place from the 11th-

13th of July 2016 at DSW Bonita Training centre in Lubowa.

Output:

Training Report (see Annex 3)

4

Annex 1: Training report on Orientation of Data Collectors

1.0 Background

DSW Uganda has been awarded a three year project titled “Securing Health through Advocacy

and Peoples Empowerment (SHAPE) that aims to ensure increased funding from national and

sub-national governments in Uganda to address the unmet need for FP 2018; improved

implementation of national and sub-national FP funding to address the unmet need in Uganda

by 2018; and improved resource mobilization in support of FP programmes among CSOs in

Uganda by 2018. DSW is teaming up with Samasha Medical Foundation to implement the

above objective.

Samasha reviewed the tools and presented them to budget advocacy experts from the Ministry

of Health, private consultants, HEPS Uganda, Reproductive Health Uganda, National Medical

stores, Uganda Health Supply Chain, PACE, POPSEC, PPD, Parliament, Civil Society Advocacy

Group at Serena Hotel on the 19th April 2016. Based on their input and recommendations, the

tools were finalized and submitted to DSW. As a follow on, Samasha carried out an orientation

of the data collection team on the revised tools. The data collection team comprised mainly

DSW staff. This report therefore, gives a summary of the orientation.

Date and Venue

The training-workshop took place on the 20thApril, 2016 at DSW offices in Lubowa and

facilitators found the Team of data collectors ready.

2.0 Participants and Facilitators:

2.1 Training Team

The members of the training team were Dr. Moses Muwonge, Director Samasha; Ms Mariam

Namukwaya, Program Officer Samasha for the training that was held at DSW offices in Lubowa.

2.2 Participants

The orientation was attended by 5 data collectors from DSW. The list of Participants is attached

as annex 1.

3.0 The training

3.1 Objectives of the Training:

To orient the data collection team on the revised tools

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practice skills required to use the tools effectively

3.2 The Orientation centered on two data collection tools i.e. Health facility assessment tool

and The MoH /District Key Informant Questionnaire covering the following topics;

A. Health facility assessment tool covered the following Sections;

Health facility identification section described the health facility i.e. Name of the facility,

District, type of facility, management Authority (ownership), nature of facility and whether it’s

in a rural or Urban area.

Service delivery: to find out about services that is available and offered at the facility on

addition to the staffing at the facility to find the number of staff at the facility and their

qualification.

Outpatient service areas where most client services are provided, Family Planning services with

information obtained from the most knowledgeable person at the facility, Adolescent health

services and the location where they are provided.

Contraceptive Commodity stocks, indicating the current and previous stock-outs while looking

at the stock-card.

Observation of the health facility was required to find out whether there was a sign or poster

advertising the availability of Family planning services, Family Planning delivery challenges at

the facility and those identified by community members.

B. MoH/District Key Informant Questionnaire

This tool identifies FP/RH budget allocation and expenditure at National and district level,

assesses government/district policies/ordinance as regards prioritization of FP adolescent

sexual health and RH in general. Intention is to understand how Ministry of Health and District

Health Team have been prioritizing reproductive health and family planning in their plans and

budget. In addition, the tool identified partners and their support to MoH/MoF and districts on

RH and FP Budget lines (On Budget and Off Budget).

4.0 Methodology

A participatory approach was used in the training. This involved discussions and practical exercises. The training room was equipped with teaching tools including a projector and flip chart.

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5.0 Outcomes for the training

Revision of tools by data collectors

Acquisition of skills by data collectors to use the tools effectively

6.0 Recommendations

Based on the training, the following recommendations were made;

Dr. Moses was to provide Brand Names and Generic names for both Combined Oral

contraceptives and progestin only pills and Injectables.

To provide FP guidelines or manual

To provide essential equipment list

To provide Adolescent Health policy

To provide SRH policies and guidelines

List of Participants :

Name Designation Organisation

1. Dr. Moses Muwonge Director Samasha

2. Ms. Mariam Namukwaya Programme Assistant Samasha

3. Ms. Diana Tibesigwa Advocacy Officer DSW

4. Ms. Esther Namirimu Communications Officer DSW

5. Mr. Jerome Olowo Project Officer DSW

6. Mr. Robert Kiwanuka Team leader Muvubuka Agunjuse DSW

7. Mr. Herbert Mugisha Monitoring and Evaluation DSW

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Annex 2: Family Planning Commodities (Contraceptive) tracking Report

1.0 Introduction

Under the SHAPE project, DSW is tracking funds allocated for procurement of RH commodities

on the NMS vote 116. It is hoped that expenditure of allocated funds combined with monitoring

of the NMS distribution schedule will lead to increased availability of contraceptives at

National, Health facility level (Hospitals, HC IV and HC III). NMS delivers essential medicines and

health supplies including contraceptives in 5 delivery zones six times in nine months1.

Samasha Medical Foundation through a teaming arrangement carried out Data collection

purposefully with NMS targeting Kamuli, Mityana, Mukono, Tororo districts. On the other hand,

DSW undertook data collection at district level in a bid to know the contraceptive stock

availability at health facilities in the project Districts.

2.0 Objectives

To Track Contraceptive availability at National level

To monitor Contraceptives distributed to health facilities

3.0 Methodology

A data collection tool was designed to collect quantities of contraceptives delivered to the

project districts. However, upon discussion with NMS it was agreed that NMS would share the

distribution data using their format. Samasha extracted distribution data from the NMS excel

sheet into the data summary collection tool. The data per health facility was aggregated to a

district summary. The data collected was from Hospitals, HC IV and HC III.

Based on the NMS distribution system, HC III’s receive a pre-packed kit (Push system) while HC

IV’s and Hospitals order for what they need (Pull systems). The table below shows commodities

that can be received in the HC III essential Medicines and Health supplies kit.

1 MoH and USAID SURE., 2011., Assessment of the Essential Medicines Kit Based Supply System in Uganda

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Table 1: Contraceptives received under EMHS Kit to HC IIIs and orders by Hospitals

Hospital HC III

Ethinylestradiol + levonorgestrel Tablet 30µg + 150µg,

Ethinylestradiol + levonorgestrel Tablet 50µg + 250µg,

Ethinylestradiol + norethisterone Tablet 50µg + 1mg,

Ethinylestradiol + norgestrel Tablet 30µg + 300µg,

Etonogestrel Implant (1 radiopaque rod) 68mg,

Levonorgestrel Tablet 750µg,

Levonorgestrel Implant (2 silicone rods) 75mg,

Medroxyprogesterone acetate Injection (aqueous suspension) 150mg/ml

Condoms Male generic bulk foiled

Levonorgetrel 750mg tab,

Norgetrel 0.075Mg tab

Ethinylestradiol 0.03+levonorgetrel 0.15Mg tab

Medroxyprogeterone w/syringe

4.0 Findings

Contraceptives should be available at the Health facilities to address the unmet need for family

Planning in Uganda by 2018 though a number of health facilities in the project districts didn’t

receive Contraceptives as shown in the table below.

Table 2: Health facilities that received and those that didn’t receive contraceptives in the

project districts.

Districts Hospital HC IV HC III Received Contraceptives

Didn’t Receive

Hospital HC IV HC III Hospital HC IV HC III

Kamuli 2 2 10 1 2 7 1 - 3

Mukono - 2 13 - 1 8 - 1 5

Tororo 2 3 17 1 2 2 1 1 15

Mityana 1 3 9 - - - - - -

Kamuli district: Kamuli District has Fourteen Health facilities, Two HC IV’s received Male

Condoms Generic Bulk foiled; One Hospital, Two HC IV’s and Six HC III’s received

Medroxyprogesterone Acetate 150MG/MLW/SYRINGE.

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Mukono district: Of the Fifteen Health facilities in Mukono district, Four HC III’s received two

types of Contraceptives i.e. Condoms 52MM, No Logo and Medroxyprogesterone Acetate

150MG/MLW/SYRINGE; Two HC IV’s received Condoms 52MM, No Logo and Four HC III’s

received Medroxyprogesterone Acetate 150MG/MLW/SYRINGE.

Tororo district: Out of 22 health facilities in Tororo district, One HC IV received Etonogestrel

68mg implant (implanon), 1 Hospital, Two HC IV’s and Two HC III’s received

Ethinylestradiol0.03+levonorgestrel0 .15mg 3cycles.

Table 3 below shows the different Contraceptives received by Health facilities in the project

districts.

Table 3: Contraceptives received by Health facilities

Commodity Districts

Kamuli(14 HF) Mukono( 15 HF) Tororo(22 HF)

Hosp HC IV

HC III

Hosp HC IV

HC III

Hosp HC IV

HC III

Male Condoms Generic Bulk foiled - 2 - - - - - - -

Medroxyprogesterone Acetate 150MG/MLW/SYRINGE.

1 2 6 - - 4 - - -

Condoms 52MM, No Logo - - - - 2 4 - - -

Etonogestrel 68mg implant (implanon)

- - - - - - - 1 -

Ethinylestradiol0.03+levonorgestrel 0.15mg 3cycles.

1 2 2

The following table shows the total Quantities of Family Planning Commodities distributed in

the Project Districts.

Table 4: Contraceptives Distributed to the project Districts FY2015/16

Date Quantity Product District

18th/Jan/2016 303,557 MALE CONDOMS GENERIC,BULK FOILED

Kamuli

18th/Jan/2016 140,722

MEDROXYPROGESTERONE ACETATE 150MG/ML W/SYRINGE

Kamuli

16th -17th/Sept/2015 418,269 CONDOMS 52MM, NO LOGO

Mukono

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19th-20th/Jan/2016 749,763 MEDROXYPROGESTERONE ACETATE 150MG/ML W/SYRINGE

Mukono

27th/Oct/2015 47,581

ETONOGESTREL 68MG IMPLANT (IMPLANON)

Tororo

26th-27th/Oct/2015 439,105

ETHINYLESTRADIOL 0.03+LEVONORGESTREL0 .15MG 3CYCLES

Tororo

5.0 Conclusion

Some Health districts did not receive Family Planning commodities like example

Condoms e.g. Tororo district.

Family Planning Commodities were not delivered according to the NMS delivery

schedule of 2 months to all government and accredited facilities.

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Annex 1: Contraceptives received by Health Facilities in project Districts FY2015/16

Date District Product HF Name Level Quantities

15th/Sept/2015 Mukono CONDOMS 52MM, NO LOGO

Katoogo HC III 46,546


Koome HC III 78,406


Mukono Health Centre

HC IV 197,772

17th-


Kojja HC IV 125


Kyabazaala HC III 78,406


Kyampisi HC III 17,014

19th/Sept/2015 Mukono MEDROXYPROGESTERONE ACETATE 150MG/ML W/SYRINGE

Goma HC III 89,003


Kabanga HC III 88,613


Kasawo HC III 88,998


Katoogo HC III 89,003


Koome HC III 89,003


Kyabazaala HC III 89,003


Kyampisi HC III 89,003


Mpunge HC III 85,435

18th/Jan/2016 Kamuli MALE CONDOMS GENERIC,BULK FOILED

Nabirumba HC III 19,619

18th/Jan/2016 Kamuli MALE CONDOMS Namwendwa HC III 1700

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GENERIC,BULK FOILED


Namasagali HC III 128,499


Nankandulo HC IV 153,739

18th/Jan/2016 Kamuli MEDROXYPROGESTERONE ACETATE 150MG/ML W/SYRINGE

Kamuli Hospital

Hospital

14,134


Nankandulo HC IV 60,531


Namwendwa HC IV 13,050


Balawoli HC III 2,321


Nabirumba HC III 806


Namasagali HC III 2,408


Lulyambuzi HC III 5,033


Bugulumbya HC III 8,077


Bulopa HC III 10


Kitanyunjwa HC III 96

27th/Oct/2015 Tororo ETONOGESTREL 68MG IMPLANT (IMPLANON)

Mukuju HC IV 47,581

27th/Oct/2015 Tororo ETHINYLESTRADIOL0.03+LEVONORGESTREL0 .15MG 3CYCLES

Mulanda HC IV 206,662


Poyameri HC III 3,930

27th/Oct/2015 Tororo ETHINYLESTRADIOL0.03+LEV Tororo Hospi 114,403

13

ONORGESTREL0 .15MG 3CYCLES

Hospital tal


Malaba HC III 2,411


Mukuju HC IV 111,739

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Annex 3: Family Planning Budget Analysis Report

FAMILY PANNING BUDGET ANALYSIS,

MONITORING AND TRACKING TRAINING

WORKSHOP REPORT

July 2016

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1.0 Background

DSW Uganda was awarded a three year project titled “Securing Health through Advocacy and

Peoples Empowerment (SHAPE) that aims to ensure increased funding from national and sub-

national governments in Uganda to address the unmet need for FP 2018; improved

implementation of national and sub-national FP funding to address the unmet need in Uganda

by 2018; and improved resource mobilization in support of FP programmes among CSOs in

Uganda by 2018. DSW teamed up with Samasha Medical Foundation to implement the above

objective.

This report gives an overview of the 3 days capacity building training of CSO’s to engage in

Budget monitoring and tracking.

2.0 Date and Venue

The training-workshop was for three days i.e. took place from the 11th-13th July 2016 at DSW

Bonita Training Centre Lubowa Hill.

3.0 Goal of the training

The Ultimate goal of the training was to impart skills and techniques of FP budget monitoring

and tracking to CSO’s at the national and district levels.

4.0 Participants and Facilitators:

4.1 Training Team

The members of the training team were Dr. Moses Muwonge, Director Samasha; Mr. Daniel

Lukwago, Consultant; Ms. Mariam Namukwaya Program Assistant Samasha, for the training

that was held at DSW offices in Lubowa.

4.2 Participants

The orientation was attended by 30 participants from different organisations for example,

UHMG, RAHU, CSBAG, SAMASHA, PACE, Muvubuka Agunguse, UNASO, Ministry of Health

among others as per the attached participant’s list annex 1.

5.0 The training

5.1 Objectives of the training were;

1) To increase awareness about the importance of FP budgeting

2) To analyze the national and district budgets from an FP perspective

3) To design a FP budget advocacy plan

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5.2 The Training on Family Planning Budget analysis, Monitoring and Tracking workshop.

The workshop covered topics on Budgets and these were covered on different days of the

training as outlined below;

Day 1;

Understanding of Budgets (budget basics, budget terminologies)

Understanding the new budget process and cycle- key entry points both at local and

national level

Practical analysis of government budgets and the related interpretations

FP issue Identification

FP budget analysis of the health sector using the DSW analysis excel tool

Day 2;

FP policies and alignment to Budget

FP/RH Budget process mapping

Budget tracking practicum

FP/RH Budget tracking including commodities

Advocacy and accountability i.e. global perspective

Day 3;

Advocacy and accountability i.e. Local perspective

Budget Advocacy concepts, definitions and indicators

Available FP/RH budget advocacy tools and resources.

6.0 Methodology

A participatory approach was used during the training this involved discussions and practical exercises. The training room was equipped with teaching tools that included a projector and flip chart. 7.0 Outcomes for the training include the following

Participants equipped with FP budget monitoring and tracking skills

Analysis of National and District budgets from an FP perspective

17

8.0 Recommendations

Participants were encouraged always apply what they had learned during the training in

practice as it would be the only way budget monitoring and tracking can be improved.

Partners and stakeholders encouraged to work together and engage in tracking of

resources in order to identify the loopholes and find ways of improving them.

Annex 1: Attendance Lists;

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