ADVOCACY FOR BETTER HEALTH Cooperative Agreement No: AID -617-A-14-00004

Submitted to U.S. Agency for International Development (USAID), Uganda

Plot 1577 Ggaba Road, Nsambya. Kampala

Submitted by

Moses Dombo Chief of Party On Behalf of

USAID/PATH Advocacy for Better Health Project Tel: +256 312 393200

APRIL 29, 2017

The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government

FY 17 QUARTER ONE REPORT JANUARY– MARCH 2017

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TABLE OF CONTENTS

_________________________________________________________________________II TABLE OF CONTENTS _______________________________________________________ III LIST OF ABBREVIATIONS AND ACRONYMS

________________________________________________________________________1 EXECUTIVE SUMMARY1.0 PROGRESS BY RESULT AREA ______________________________________________________________3 1.1 Result area 1: Citizens demand improved quality services ______________________________________3 1.2 Result Area 2: CSOs effectively advocate for issues of citizen’s concern in health sectors. _____________8 1.3 Result Area 3: Institutional capacity of CSOs strengthened __________________________________ 19 2.0 PROJECT MANAGEMENT ______________________________________________________________ 25 3.0 COLLABORATING, LEARNING AND ADAPTING ______________________________________________ 25 4.0 PARTNERSHIPS ______________________________________________________________________ 26 5.0 KEY ACTIVITIES PLANNED FOR NEXT QUARTER _____________________________________________ 28 6.0 LESSONS/CHALLENGES ________________________________________________________________ 28 7.0 TECHNICAL ASSISTANCE NEEDED FROM USAID/UGANDA ____________________________________ 29

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LIST OF ABBREVIATIONS AND ACRONYMS AAG Advocacy advisory group ABH Advocacy for Better Health ACODEV Action for Community Development AMELP Activity Monitoring, Evaluation and Learning Plan ARUWE Action for Rural Women Empowerment CAOs Chief Administrative Officers CDFU Communication for Development Foundation Uganda CIDI Community Instigated Development Initiative COP Chief of Party CSO Civil Society Organization DCOP Deputy Chief of Party DHO District Health Officer DMC District Management Committee DO Development Objective GOU Government of Uganda HRH Human Resources for Health HUMCs Health Unit Management Committees I-DO Integrated Development Options IEC Information, Education and Communication IP Implementing partner IR Intermediate Result JIACOFE Jinja Area Communities Federation KACSOA Kapchorwa Civil Society Organizations Alliance KADINGO Kalangala District NGO Forum LADA Literacy Action and Development Agency M&E Monitoring and Evaluation MEEPP Monitoring and Evaluation of the Emergency Plan Progress MARPs Most-at-risk populations MOH Ministry of Health MOU Memorandum of Understanding MUCOBADI Multi-Community Based Development Initiative NAFOPHANU National Forum for People Living with HIV/AIDS in Uganda OACA Organizational and Advocacy Capacity Assessment OD Organizational Development RACOBAO Rural Community Based Organization RDC Resident District Commissioner STF Straight Talk Foundation

USAID United States Agency for International Development USG United States Government

TA Technical Assistance NAFOPHANU National Forum of People Having HIV/ AIDS Networks in Uganda NHIS National Health Insurance Scheme

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EXECUTIVE SUMMARY During the quarter, the USAID Advocacy for Better Health project accomplished the following;

• Continued empowering citizens on their rights and responsibilities using the Patients’ Charter. • Conducted advocacy forums as platforms for the citizens to engage with their duty bearers. • Worked with community groups to track the stock status of health commodities and staff availability

at health facilities through periodic health facility assessments. • Participated in the commemoration of the International Women’s Day celebrations and World TB Day

activities. These events were leveraged to champion advocacy issues related to the need for improved quality, availability and accessibility of health services.

• Partnered with FANTA to launch the Parliamentary Forum on Nutrition, and consequently held an orientation workshop for its members, which was followed by a workshop involving, MPs, district LC V Chairpersons, CAOs and District Planners in western Uganda.

• Participated in government planning processes such as District Management Committee meetings, Extended District Health Team meetings, and District Technical Planning Committee meetings, budget conferences, and Technical Working Groups, as a way of ensuring that priority advocacy issues of citizens’ concern are incorporated into the district plans and the budget framework papers of FY 17/18.

• Coordinated CSOs and Parliamentary advocacy on the 30% cut in the health sector budget, which had been stipulated in FY 2017/18 Budget Framework Paper.

• Organized a half-day meeting to orient and raise awareness of Members of Parliament on the TB epidemic and highlight the policy gaps that exist in the prevention and control of TB.

• Supported the Parliamentary Health Committee to benchmark the Rwanda Health Insurance Scheme, in preparation for legislation on Uganda’s National Health Insurance Scheme.

• Provided technical assistance and mentorship to sub awardees in advocacy, strategic planning, resource mobilization, supervision and quality improvement.

• Held a regional meeting with USAID implementing partners in Mbale, as an avenue of creating advocacy synergies, and refining the project’s advocacy evidence.

• Conducted regional Grants Management Collaborative meetings (GMCs) for sub awardees. • Trained all sub awardees in US Government rules and regulation compliance, including preparations

for the Non-US Organizations Pre-Award Survey. The above accomplishments speak to the project’s performance on key indicators, summarized in the table below: 2017 Q2 CUMMULATIVE INDICATOR PERFORMANCE, AS AT APRIL 25, 2017 INDICATOR TOTAL BY YEAR REPORT FOR YEAR(S) 2017 - 2017 [Data as at Apr 25, 2017 04:56:11PM Local Time]

IP NAME: ADVOCACY FOR BETTER HEALTH INDICATOR

NUMBER INDICATOR TITLE FY 17 Cumulative at Q2

ACTUALS FY 17 TARGET

3 ABH1.2.1 % OF SUB GRANTEE CSOS THAT DEMONSTRATE INFLUENCE ON HEALTH AND SOCIAL SERVICES AGENDA

150% [12/8]

75% [75/100]

11 ABH1.1.2.1 % OF COMMUNITY GROUPS WHOSE ACTION PLANS ADVANCE INTO IMPLEMENTATION PHASE

140% [162/116]

48% [48/100]

12 ABH1.1.2.2 NUMBER OF FUNCTIONAL ADVOCACY FORUMS AT SUB COUNTY LEVEL

196 418

13 ABH1.2.1.1 % OF CSO ADVOCACY INITIATIVES WHICH ARE SUPPORTED BY EVIDENCE

100% [14/14]

60% [60/100]

14 ABH1.2.2.1 % OF CSOS ACTIVELY INVOLVED IN PUBLIC SECTOR PLANNING PROCESSES

233% [14/6]

60% [12/20]

15 ABH1.2.3.1 NUMBER OF CSOS THAT ARE INVOLVED IN JOINT ADVOCACY INITIATIVES

7 16

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Source: USAID PRS April 25, 2017 Plans for the Next Quarter: The project plans to accomplish the following key activities during the April to June 2017 quarter:

• Disseminating the project’s revised Advocacy and Communication Strategy to sub awardees, and supporting them to domesticate it.

• Compiling the project’s e-newsletter (with content on the project’s key advocacy engagements and accomplishments) and sharing partners.

• Continue creating citizens’ awareness on their rights and responsibilities through radio talk shows and radio spot messages, advocacy forums, and community group meetings.

• Sustaining community empowerment activities through the community based organizations, to regularly track and report the availability of human resources for health (HRH) and health commodity stock status in relation to HIV/AIDS, TB, RMNCAH, and Malaria.

• Commemorating the World Malaria Day in partnership with the Ministry of Health, and the project’s focus districts. The event will also be utilized as a platform for creating the communities’ awareness on their rights and responsibilities in relation to malaria.

• Organize Stakeholder’s forums to discuss key impediments to the prevention and control of malaria in the country, especially related to ACTs and RDTs.

• Continue engaging the Parliamentary Committee on Health to advocate for the increase of the health sector budget for the FY 2017/18.

• Sustained participation in national and district level planning/budgeting processes as way of ensuring that issues affecting the delivery of quality health services are integrated in the FY 17/18 budget framework paper.

• Engaging the Parliamentary Committee on Health, MoH and other Parliamentary forums, to advocate for the expedited legislation on the National Health Insurance Scheme, as a source for alternative domestic financing for the health sector and health insurance coverage for all Ugandans.

• Meeting with the Advocacy Advisory Group (AAG), to refine the project’s advocacy agenda. • Ongoing technical assistance for sub awardees to strengthen their institutional systems. • Conducting a longitudinal case study, to inform the project’s collaboration, learning and adapting

agenda. • Recruiting and orienting fellows and interns, as a way of building skills of young professionals in

advocacy and OD. • Conducting a mid-term evaluation of the project. • Documentation of Success stories and Promising Practices in policy influencing advocacy • Orienting the three new sub awardees on the project, and supporting them to kick start

implementation.

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1.0 PROGRESS by Result Area

Following are details of highlight accomplishments for the period January 1, 2017 to March 31st 2017, disaggregated by result area:

1.1 Result area 1: Citizens demand improved quality services

Performance indicator: % of citizens who demonstrate understanding of rights and responsibilities related to health services (disaggregated by gender, youth and health thematic area). Empowering citizens on their rights and responsibilities using the Patients’ Charter Through the efforts of 479 community groups that the project worked with across the 35 districts, communities were sensitized on their rights and responsibilities using the patient’s charter. This happened as an integral part of the routine community empowerment activities that included community group meetings and advocacy forums. As a result of this empowerment, the project has continued to realize positive outcomes where citizens have been at the center of demanding their rights including the right to access quality health care. This level of empowerment has been demonstrated during activities such as advocacy forums, where citizens speak out boldly to their leaders on the issues affecting health care.

In Kinaaba sub county Kanungu district for example, during an advocacy forum held at Kinaaba HCII, the Deputy Chief Administrative Officer, Mr. Eliab Begumya was amazed at the confidence of the citizens, when they confidently engaged him in dialogue on controversial accountability and performance issues. “I did not expect local people to make me sit here for five hours and start asking me hard questions” remarked the CAO, as he responded to questions raised by residents of Kinaaba Sub County. The forum was preceded by a drama performance by one of the community groups

in Kanungu (pictured above) where members presented an original song composition on the patient’s charter. Live call-in Radio Talk shows The project held 15 radio talk shows in commemoration of World TB Day on 24th March 2017. The radio talk shows were conducted on 15 FM radio stations, four of which were based in Kampala but with a national/regional coverage. These included CBS FM, Capital FM, Radio One, and Simba FM. The other eleven radio stations were district-based and they included; Kanungu Broadcasting Services, Rukungiri FM, Bushenyi FM, Radio West, Radio Messiah, NBS radio, Elgon FM, Open Gate FM, Baaba FM, Kapchorwa Trinity Radio, and Voice of Muhabura. The purpose of the talk shows was to stimulate citizens’ awareness about the burden of TB and government policy on its elimination. The shows were also used as a vehicle to call upon the Government to consider increasing the budget for TB programing. The panelists on the talk shows included Members of Parliament, District health officers, CSO representatives, TB focal persons and other medical professionals proficient in TB management. The shows also featured MDR TB survivors who shared their experiences from the time they tested for TB, when they received treatment until they were declared TB free.

Development and production of radio spot messages on thematic areas

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Summary of Tweets on the project’s Twitter page

The project developed four radio spot messages on MCH, HIV&AIDS/TB, Malaria, and Nutrition. The content in the scripts focused on critical advocacy issues that include stock out of drugs and commodities that cuts across all the disease/thematic areas. The spot messages were later translated, pretested and audio-produced in 6 local languages, namely; Luganda, Lusoga, Rufumbira, Runyankole/Rukiga, Lumasaba and Lukhonzo, with English as the seventh language. The spot messages are scheduled to start running on Kampala-based and upcountry radio stations by April 20th and will go on for the remainder of the FY.

Development of community empowerment tools

The project progressed steadily on the process of developing community empowerment IEC materials that include the 90-90-90 treatment goals poster, a super-citizen poster and other community friendly materials that will include branded T-shirts, caps and stickers. These materials were being developed with support from CDFU’s graphics designer. Some of them were pretested with target audiences during the community empowerment week in the districts of Bugiri, Iganga and Busia. The suggestions from the target audiences were incorporated and bulk

production of these materials is scheduled to happen in the next quarter.

Social media engagement

During the quarter, the project continued to bolster its social media presence by focusing on increasing its online following. The project has a Facebook page, a twitter page and also operates a number of WhatsApp groups for project staff and CSO partners. Through social media, trending issues that require advocacy have been shared and these have generated responses in terms of

likes, reach and impressions. For instance by the end of the quarter, the Facebook page likes were 338 and twitter had 46 followers with 751 impressions. The social media sites can be accessed on these links; Facebook and twitter. On the left are graphs that illustrate a few of the social media analytics for both Facebook and twitter.

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SMS platform for disseminating regular advocacy alerts and awareness messages The project rolled out the SMS platform as a way of regularly sending awareness messages on the patient’s charter and other advocacy messages to citizens whose contacts are stored on the SMS database. The project also uses the platform to send out regular advocacy alerts on pertinent issues that need to be addressed by specific audiences. Under the auspices of one of the project’s sub awardees, Straight Talk Foundation, the platform so far has databases of over 500 contacts and some of these include Members of parliament, CSO partners, community group members, advocacy champions and district leaders. The project will grow the contact lists until the project is able to communicate to majority of its strategic partners and audiences on issues of mutual interest that require advocacy. In response to the messages that have so far been sent through the platform, the project received varied feedback from the platform users. Below is a sample of the feedback;

• Punctuality & irregularity of health workers is still a problem, do u have a mechanism that scrutinizes the validity of how attendance tracking exercise can be done by administration? Zimbo, Bugiri.

• My advocacy is about Namusita health center being upgraded to health center III so that it can offer a variety of health services since it is covering more than two sub counties, another issues is about Namusita lacking a weighing scale. Anonymous

• Several reports expressing congestion of Rwamwanja HC III Leading to 4 or more children to be laid on one bed, what is Government’s plan of helping us? KAMWENGE.

• How best & fast can you advocate 4 issues raised at lower levels to higher level. e. g. drug stock out is still a great outcry! Zimbo, Bugiri.

Intermediate Result 1.2: Community groups advance priorities for improved health services (based on advocacy solutions related to the health thematic areas) Performance indicator: % of community groups whose action plans advance into implementation phase (disaggregated by gender, youth and health thematic area). Tracking availability of health workers, drugs and commodities for HIV/AIDS, TB and MCH

With support from the project staff and sub awardees, 472 community groups were directly involved in tracking availability of stocks and health workers at health facilities in each of the sub counties across the 35 districts. The groups used a standard health facility assessment tool provided by the project that helped them obtain vital information about the way health facilities were functioning. The groups used this information to develop evidence-based advocacy action plans in their monthly meetings. Some of this

information from the regular monitoring and tracking exercise was synthesized and analyzed by the CSOs to generate enough empirical evidence that would be

Excerpts of messages from the project’s SMS platform

Community Group Representative Tracking Stock Availability at Health Facility

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used in advocacy at local and district levels. For instance the heath facility assessments done by community groups in the 12 western region districts revealed that 36% of the facilities assessed had either drug stock outs, non- functional Health Unit Management Committees (HUMCs) or health worker absenteeism challenges. In eastern region, health worker absenteeism rates continued to remain high with health workers taking unauthorized leave. For example in Kumi district, absenteeism rate was at 64% while in Mbale and Sironko it was at 52% and 43% respectively.

Monthly community group meetings to develop advocacy action plans

Monthly community group meetings remained critical in helping citizens discuss findings from the regular tracking of stocks and health worker availability at heath facilities and using it to develop realistic action plans. During the quarter, the 479 project-supported community groups held a total of 828 meetings that saw advocacy action plans being developed by the members. In these meetings, the community group members would also review what was agreed on in the previous meetings as a way of assessing progress on major action points in their action plans. This time round, emphasis was placed on working with networks of people living with HIV to increase vigilance in detecting stock out of HIV and TB drugs, but also in helping to popularize the 90-90-90 treatments targets.

In March, the project initiated the community empowerment week, where all the staff of the project went to the community to work with the groups and the CSOs in making sure the action planning processes conform to the standards of the project. It was also an opportunity for project staff to get immersed into and appreciate the work of community groups to advance the ABH agenda.

Intermediate Result 1.3: Improved engagement between citizens and duty bearers Core indicator: Number of functional advocacy forums at sub county level. Advocacy forums conducted at sub county level The project conducted nearly 200 advocacy forums mainly at sub county level and these were championed by the community groups supported by the sub grantee CSOs. Community groups use forums as a platform to bring together duty bearers and other citizens to discuss issues affecting the quality of health care in their localities. During the advocacy forums, citizens get a chance to reflect on the challenges affecting health services and ask those tough questions to their leaders regarding what they plan to do to address the hindrances. Forums have become a good accountability platform where health workers, health facility in-charges, local and district leaders provide information on service delivery that is often not available to the citizens for lack of a mechanism to provide this information.

Left to right: Community group action planning in progress in Bugiri and Rukungiri districts respectively

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The project has realized a number of positive outcomes as a result of having regular advocacy forums. As an example, Kabwangasi Health Centre III in Pallisa district, has been connected to Butebo- Kabwangasi water supply booster after spending three years without running water. This was done after the citizens presented this and many more issues to their duty bearers at an advocacy forum that was attended by the sub county Chief, In-charge, midwives, HUMC chairperson, CDO, and sub county councilors.

In Bugitimwa Sub-county Sironko District, a full time enrolled midwife has been posted and the maternity ward has been equipped with 10 delivery beds after a community group in the area held a series of advocacy forums fronting the issue of health worker absenteeism and lack of adequate staff to provide services to the people. At one of the most recent forums held, the chairperson of the HUMC had this to say, “Thanks to the Advocacy for Better Health team for the tremendous work you have done in improving the status of our H/C III. The project has empowered me to exercise my roles as a chairperson and improved the

health seeking behavior of the community. The health centre is stocked with drugs and citizens are sure of being attended to by a skilled Health worker”-HUMC chairman, Bugitimwa health centre III. In Kapchorwa district, several commitments made by decision makers during forums have been honored including posting of two additional midwives to Chebonet HC III in Munarya Sub County. In Busia, a rude nurse from Majanji health center II was transferred and a new one recruited, while an additional midwife was recruited and the center started conducting HIV testing and treatment outreach services once a week.

In Kisoro district, south western Uganda, the health facility in Nyakabande Sub County now opens early and one health worker was posted there after the community group raised these issues during an advocacy forum. Similarly, in Busanza Sub County, same district, the district has included a budget line in the next financial year (2017/2018) to facilitate construction of a placenta pit, after the community group raised this issue to the district leaders at an advocacy forum.

An advocacy champion presenting issues from her sub county to district leaders at an advocacy forum in Mpigi district.

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CSOs tour NMS's stores

CSOs presenting to NMS

1.2 Result Area 2: CSOs effectively advocate for issues of citizen’s concern in health and social sectors. This result area is largely aimed at empowering CSOs to capture citizens’ concerns related to health and social services, gather evidence around these issues, and engage duty bearers to take actions in the form of; policy change, policy formulation or policy implementation, allocation of budgets and putting programs in place to address citizens’ concerns. The section below highlights the key accomplishments during the quarter; Key Achievements Intermediate Result 2.1: Increased utilization of evidence by CSOs to inform advocacy

National Level Meeting with the National Medical Stores During the quarter, the Centre for Health, Human Rights and Development (CEHURD) in collaboration with other civil society organizations (CSOs) held a meeting with the management of the National Medical Stores (NMS) to establish challenges and discuss strategies for efficient stocking of the essential lifesaving commodities. The discussion focused mainly on maternal health medicines (underscoring UN Life Saving Commodities (UNLSCs), malaria and HIV / TB medicines. The partners that attended the meeting included; PATH, National Forum of People Living with HIV/AIDS Networks in Uganda (NAPOPHANU), Coalition for Health Promotion (HEPS), Uganda National AIDS Service Organizations (UNASO), Support on AIDS And Life Through Telephone Helpline (SALT) and The Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda. CEHURD raised a concern of over stocking of oxytocin in health center IIs and under stocking of the same in Health Center IIIs. This gap was highlighted in Ministry of Health quarterly reports for 2016 on stock status and these were echoed in CEHURD's report on stock status of Life Saving Commodities which was developed in 2016 with support from the ABH project. The NMS General Manager justified the overstocking of the commodity basing on the position that NMS only delivers what facilities request for and in practice a number of Health centre IIs in the country handle maternal deliveries. He however noted that, the Ministry of Health has not revised the clinical guidelines to reflect the changing circumstances. In the next quarter, CEHURD will follow up with the Ministry of

Health to establish whether personnel in Health Center IIs have capacity to administer maternal health commodities, and whether they are well equipped to handle. Documentation of the availability of cold chain facilities for the storage of oxytocin in selected health facilities.

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In partnership with MOH and HEPS (a sub awardee), the project focused its efforts on generating evidence to inform advocacy for the implementation of the 2012 WHO malaria Test, Track and Treat policy and the Uganda

Malaria Strategic plan 2014-2020.

Through key informant interviews with various stakeholders, the project identified the problem surrounding affordability and quality of malaria Rapid Test Diagnostic (mRDT) kits. It was discovered that mRDTs only attract a tax of 2% if they are cleared as medical supplies-which is supposed to be the standard practice through National Drug Authority (NDA), however importers tend to opt to clear them as ordinary merchandise, attracting a tax of 18%. This not only raises

concern on the quality of the mRDTs being imported, but also makes the kits expensive, since an extra cost is passed on to the consumers. Having generated this evidence, HEPS, shared it with other CSOs in advance of a planned engagement with relevant duty bearers such as the Uganda Revenue Authority, and the Ministry of Health.

Working with Trac FM (a communication agency that transforms citizens from passive listeners to active participants, by facilitating informed and real-time debate on topical issues and in collaboration with broadcasters such as TV and radio) and in order to enrich its evidence with anecdotal information, HEPS also conducted a citizens’ opinion poll, to establish whether citizens believe in the outcome of malaria test results. Below is a summary of the outcomes from the opinion poll:

Eastern Region Partners in the region through the community groups/community base organizations (CBOs) collected, utilized and packaged evidence from routine monthly tracking to inform their engagements with duty bearers. Findings from tracking revealed low staffing levels, persistent absenteeism of Health workers, non-functionality of Health Unit Management committees and drug stock outs. For example; Kabwangasi Health centre III in Pallisa, Buwalasi H/C III, Buwasa H/C III in Sironko had run out of some lifesaving commodities like misoprostol, mama kits and magnesium sulphate. With both evidence from CBOs and likeminded partners, sub awardees were able to package the evidence in form of fact sheets, advocacy briefs or power point presentations that were used at decision maker engagements. The generation of evidence by the project sub awardee has won them confidence from the leadership of districts like Mbale and Bugiri, where they have been incorporated into the district joint supportive supervision teams. This has facilitated their triangulation of evidence, which has been used for advocacy to decision makers in the respective districts.

Central Region During the reporting period, sub awardees conducted health facility assessments in the districts as part of identifying health service delivery gaps in the areas of HIV/AIDS, MCH, Malaria, Family Planning, OVC, TB and Nutrition. These assessments focused on stock status of HIV/TB drugs and supplies, and the availability of

Sample findings by HEPS

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District Leaders from Mayuge and Kamuli, pose for a photo with the delegation from PATH

relevant health works at the facilities, including the functionality of HUMCs. Evidence generated through these assessments were packaged into reports, evidence dossier, positon papers and factsheets. Platforms such as district/ sub county meetings, CSO meetings, one on one meetings with duty bearer, community meetings, health facilities and newspapers where used as avenues for disseminating these findings. Key findings from these assessments revealed the following:

• In Kayunga district, 4 out of the 7 health facilities assessed had experienced stock outs of ARVs for at least one month. The major stocked out drug was nevirapine syrup for children which occurred for at least 2 months. Fluconazole had also run out for 3 months in all facilities.

• Staffing levels stood at 54 % in Bbaale HC IV in Kayunga district against the established government staffing norms.

One of the sub awardees—Jinja Area Communities Federation (JIACOFE) utilized evidence during the inter-district duty bearers experience sharing meeting, which included duty bearers of Kamuli and Mayuge districts at source of the Nile hotel in Jinja. The meeting brought together over 30 key service providers in the two districts of Mayuge and Kamuli. The key stakeholder included among others the Resident District Commissioners (RDCs), Chief Administrative Officers

(CAOs), District Chairpersons, District Health Officers (DHOs), District Education Officers (DHEs), District HIV/TB Focal Persons, media and implementing partners from Mayuge and Kamuli districts. The meeting was also attended by PATH International and National teams led by the Chief of Party. Guests from PATH headquarters who were visiting the project at the time and attended the CSO led activity were; the Vice President Advocacy and Public Policy Ms. Carolyn Renolds, the Vice President Public Health Dr. David Fleming, the Director Business Development, Mr. Derrick Reynolds and the Senior Communications officer, Ms. Carla Sandine. Ms. Cathy Cahill, Vice President of International programs did not go to the field.

The major issues discussed during this meeting included among others the rampant stock outs of drugs for HIV/TB in the health facilities and for Mayuge district, the total lack of HIV/TB services in 7 sub counties which have only HCII. As a result, the District Health Officers (DHOs) for Mayuge and Kamuli districts made commitments to speed up the process of accrediting and upgrading HCII to HCIII; and to orient the health facility in charges on proper forecasting, quantification and requisitioning of HIV/TB drugs to ensure the sustained stock of health commodities.

In Mpigi district, another sub awardee—Action for Rural Women Empowerment (ARUWE) also gathered, analyzed, packed and utilized evidence for its advocacy on the major impediments to maternal and child health (MCH) services in the district. The major issues identified as affecting MCH in Nkozi sub county included the following; health worker absenteeism, unhygienic maternity wards, financial exploitation of patients by the health workers, lack of supplies for the maternity ward, and lack of adequate drugs. In Muduuma Midwife at Muduuma HC III responds to MCH issues

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sub county; inadequacy of drugs, lack of equipment like blood pressure machines and other supplies in maternity ward and ART clinic, lack of an ambulance, and inadequate numbers of health workers were also reported as affecting service delivery. The evidence generated by ARUWE was presented to the district leadership at a district level forum attended by Members of Parliament, the RDC, the Speaker of the Council, LCV Chairperson, the CAO, and the DHO among others. The DHO acknowledged the concerns presented and declared that some of the issues like purchase of equipment, including their maintenance and servicing were beyond the capacity of the district budget. She noted that Mpigi health center (HC) IV receives Uganda shillings 3 million as primary health care funds per quarter, which is not sufficient to cater for utility bills (electricity and water), and purchase of equipment among others. She lamented that each HC III receives Uganda shillings 1.7 million, and HC II receives approximately Uganda shillings 800,000 respectively, per quarter. All these funds are insufficient to meet all the needs of the health facilities.

The district officials resolved to document the systemic impediments that are beyond the ability of the district local government, to seek attention from central government.

ARUWE staff giving feedback to district officials during the meeting.

The DHO gives feedback on some of the issues highlighted as affecting MCH and HIV/AIDS

Western Region In Kabale district, one sub awardee—Reproductive Health Uganda (RHU) held a meeting in the region to refine evidence on the issues affecting the delivery of MCH and Family Planning services, also as an avenue to inform their national level advocacy. Among the major issues that were underscored were: the need to accredit Health Facilities for provision of ART services, the need for increased domestic health financing for family planning services. These issues were packaged in evidence dossiers and used for advocacy to the respective duty bearers including the DHO, the CAO and the LCV Chairpersons. Intermediate Result 2.2: Effective participation of CSOs in Government planning and budgeting processes Participation and involvement in government planning and budgeting processes in paramount in ensuring that advocacy issues of citizens’ concern are incorporated in plans and budgets. During the quarter the project through its sub awardees and supported by ABH staff, participated in a number of government planning and budgeting meetings, both at district and national level. Below is a table of meetings attended by in the respective districts, the issues presented, and the progresses/responses received from the duty bearers:

Kabale district duty bearers meeting to discuss issues affecting health services

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Table 1: Summary of meetings attended by the project at district level

Type of meeting attended

District(s) Issues presented/discussed Examples of registered progress/response by duty bearers

District Council meeting

Bududa, Kisoro -Absenteeism and late coming among health workers -Non functionality of Health Unit Management Committees (HUMCs) -Lack of accommodation for health workers -Prevalence of quack Doctors and practitioners

-The district supervisory team to intensify supervision to all health facilities

District Management Committee (DMC) meeting

Kanungu, Kamwenge

-Prioritization of MCH and Family Planning in the district plans and budgets -Malaria and HIV/AIDS Test, Treat and Start policies, -Drug stock outs, -Rude health workers, -Late reporting and early closure of health facilities, & closure during public holidays and weekends.

District AIDS Committee (DAC) meeting

Butaleja

District Health Team (DHT) meeting

Mpigi, Luwero, Kabale

-Inadequacy of drugs, supplies, equipment and of health workers. Some transferred staff also not reporting to new duty stations (e.g. Luwero district)

-Inadequate skills by some health workers on the new and long term family planning methods -Inadequate supplies in FP

-Pledge for more efficient supervision to reduce cases of absenteeism, health worker misconduct among others by the district health team of Mpigi. -Resolution for the Chief Administrative Officer to write to health workers that had not assumed duty. Luwero district posting 3 midwives to Kasana health centre IV

Budget conferences Kumi, Mbale,

Namutumba, Budaka, Mityana

-Stock out of ART Paediatric drugs -Prioritization of MCH and family planning in the district budget Lack of maternity ward and staff house at Jeewa HC III—Mbale district

-1% of the domestic revenue allocation to family planning services in Mityana district for FY 17/18 -The sub-county to budget for construction of a Maternity ward and staff houses at Jeewa Health centre III for FY17/18

District Technical Planning Committee (DTPC) Meeting

Kapchorwa, Sironko, Mbale, Pallisa, Rukungiri, Ibanda, Kiruhura

-The need to kick start implementation of the test and start policy to achieve 90:90:90 targets - Under staffing in health sector -Nonprofessional cadres treating patients -Prioritization of MCH and family planning in the district budget

-District health supervisory team to intensify supervision to health facilities

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-Non-compliance with government on Test and Start policy, Absenteeism of health workers, closure of health facilities during working hours -The need to accredit Health Centre III’s to offer ART services in Kiruhura district

Sub county Technical Planning meeting

Bugiri

-Drug stock outs -Non-functionality of HUMCs -Lack of privacy at the facility.

-Sub county Chief to write to DHO requesting for HUMC, while the Chairperson LCIII to reconstitute the HUMC

Sub county AIDS Committee meeting

Kalangala -Stock out of ART drugs -Non functionality of HUMCs

-Need for the DHO to document the drugs requested for by the health facilities, but not delivered by the NMS.

-The Sub County Chief to write to the DHO, detailing the status of HUMCs, as an entry point to ensuring their functionality

The sub awardees will continue engaging the district sector heads to advocate for inclusion of community priority issues into the district plans and budgets. National Level Participation at Technical Working Group Meetings During the quarter, the project through its sub awardees also participated at TWGs. These platforms were leveraged to champion advocacy issues affecting the delivery of quality health services. The following is a summary of the meetings the project participated in: Straight Talk Foundation (STF) participated in the Adolescent Health Technical Working Group Meeting and presented the need to popularize the HIV Counselling and Testing (HCT) policy. Going forward, STF will meet the Ministry of Health AIDS Control Program to present the plan to have the policy popularized among young people and adolescents. STF will follow up with the secretary of the technical working group to include this action on the agenda for the next meeting. CEHURD participated in Maternal and Child Health (MCH) Technical Working Group (TWG) meetings in the Ministry of Health. CEHURD concentrated on advocacy for availability of cold chains for storage of oxytocin. In these engagements, the Reproductive Health division adopted the issue and committed to present it to the Ministry of Health’s Senior Management Team for discussion. In collaboration with its sub awardee (HEPs), the project will continue pursuing this with MoH. In order to enrich its evidence, the project also plans to conduct a rapid assessment of the availability of storage facilities for oxytocin in selected districts. This evidence will be a key guide in advocacy.

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Intermediate Result 2.3: Enhanced co-ordination and collaboration among CSOs During the quarter, sub awardees sustained their collaboration with other CSOs, to amplify issues of citizen concern related to health and other social services. A number of functional coalitions and networks were leveraged to champion advocacy issues that the project is pursuing both at district, and at national level. Eastern Region Twelve (12) joint CSO coalitions and advocacy initiatives were held to discuss HIV/AIDS/TB, FP and MCH service delivery gaps in each district. Partners shared their key project thematic areas of HIV and AIDS/TB, highlighting the 90:90:90 global strategy, and MCH— underscoring district MCH indicators and the 13 UN lifesaving commodities that most of the CSO representatives were not aware of. In Budaka district for example, the coalition collaborated with community groups to petition the woman MP on the issue of shoddy work that was done by the contractor while constructing Sapiri H/C III maternity ward. To date, over 200 individuals have signed the petition demanding for her intervention for the reconstruction of the maternity ward. USAID Implementing partners meeting in Mbale: The project organized and coordinated a regional meeting of USAID implementing partners (IPs) meeting in

Mbale. The purpose of the meeting was to inform the partners about Advocacy for Better Health project as a platform into which they should tap to enhance their advocacy concerns. The

meeting laid strategies for regular updates on health

and social service gaps/issues and identified areas of collaboration. The meeting was attended by several partners that included; Bantwana World Education’s/ Better Outcomes for OVC project, Communication for Healthy Communities, Child Fund, The AIDS Support Organization (TASO), AIDS Information Centre (AIC), Production for Improved Nutrition (PIN), STAR-E, SUSTAIN/Mbale referral hospital, Program for Accessible Health, Communication and Education (PACE), Uganda Health Marketing Group and World Vision. Partners presented a detailed analysis of what they thought are the systemic challenges hampering quality health service delivery, suggested mitigation measures and possible timelines for implementation. They proposed turning this meeting into a regular platform for sharing information, collaboration, networking and learning. The meeting will be rotational. Partners also expressed the need to participate in district level planning processes to be able to influence district outcomes and the ABH Regional Coordinator was assigned responsibility to share information on available opportunities to enable them participate. The team resolved to meet quarterly (on a rotational basis), with ABH coordinating these meetings. The next meeting was tentatively fixed for June 28th, 2017, with UHMG as the host.

USAID Implementing Partners meeting that took place at Mbale Resort Hotel

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Central Region ARUWE conducted a meeting for representatives of the Mpigi CSO network to discuss issues affecting MCH and HIV/AIDS service provision, and draw a joint advocacy action plan (with prioritized advocacy ASKs) for duty bearer engagement. Among the issues presented as affecting MCH and HIV/AIDS service provision include: the lack of ambulances in the district which greatly affects referrals especially for mothers that require emergency obstetric care. Other issues highlighted were; drug stock out especially for maternal and child

health, inadequacy of health workers in a health facilities, inadequate supplies and equipment in all the 7

health facilities ARUWE works with, lack friendly facilities for mothers with disabilities, poor state of structures that needs renovation, lack of budgets to repairs and servicing health facility equipment, poor enrolment on ART and adherence to ART, community complaints about under the table financial charges being levied in health facilities, and limited number of counsellors for HIV/AIDS clients. In Mityana district one of the sub awardees— Rural Action Community Based Organization (RACOBAO) coalesced with organizations including; Forum for Women in Development, DSW, Mityana Diocese, the International Community of Women Living with HIV/AIDS in Eastern Africa-ICWEA (Uganda Chapter) ICWEA, Reproductive Health Uganda and (RHU), to successfully advocate for a 1% budget allocation to family planning services from the local revenue, for the district budget for FY 2017/18. Another sub awardee— Jinja Area Communities’ Federation (JIACOFE) held a coalition meeting in Mayuge district, where a position paper that was presented during the commemoration of World TB day, was developed. The two critical issues affecting TB service delivery in Mayuge district were that were raised include; lack of TB services in seven (7) sub counties— including Island communities of Mayuge district, and stock out of drugs for TB in Mayuge district. Western Region

In Kabale, RHU together with White Ribbon Alliance Uganda (WRA-U), held a meeting with the District to present issues affecting family planning and MCH services at the health facility. They presented a report to the district leaders which was discussed and actions agreed. In Rukungiri and Kanungu districts a sub awardee— Literacy Action Development Agency (LADA) hosted the Southwestern Advocacy Network (SWANET) meeting with the aim of developing a joint advocacy action plan for the network. This coalition meeting resolved that members of SWANET should carry out impromptu visits to at least 6 health facilities in the region, to document the quality of health service delivery, as a way of refining their advocacy evidence –in advance of their meeting with district leadership. The major areas of focus that the meeting agreed upon as critical for follow up during the visit

include; absenteeism of midwives, inadequate MCH commodities in health facilities, and drug stock out of essential drugs.

The coordinator Mpigi NGO Forum suggests strategies for advocacy for issues affecting MCH and HIV/AIDS.

LADA SWANET committee meeting to develop a joint advocacy plan

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Members of Parliament during the TB Forum orientation meeting held at Grand Imperial, Hotel

Minister of State for Health tours ABH stall during the TB commemorations in Tororo

Ms. Salome from NAFOPHANU/ABH reads a statement during the TB commemorations in Tororo

National level

As part of efforts to build a critical mass of people who can play a pivotal role in shaping policy and allocation of budget, ABH organized a half-day meeting to orient and raise awareness of Members of Parliament (MPs)/caucus on the TB epidemic and highlight the policy gaps that exist in addressing TB. The meeting also aimed to strengthen partnership and collaboration with other TB key players. The meeting was attended by 14 MPs, USAID TRACK TB project, Uganda Cares, Ministry of Health (National TB and Leprosy Program), AIC, Uganda Stop TB Partnership (USTP), and Welfare Development Network (WEDNET) Africa. The project will continue working with this caucus to discuss policy issues regarding TB management, including funding for TB

services. The National Forum for People Living with HIV/AIDS Networks in Uganda (NAFOPHANU) also met with the HIV Parliamentary Committee, to discuss the stock status for ARVs in the country, including the need for additional funding for the procurement of HIV commodities i.e. from Uganda shillings 100 billion to at least Uganda shillings 150 billion for the FY 2017/2018. World TB Day in Tororo offers a platform for advocacy

As part of the commemorations of the World TB Day, ABH leveraged this opportunity to champion messages, targeting both duty bearers and citizens to stimulate interest in playing a role in ending TB. Information on patient rights and responsibilities was ably passed on through explaining the patient charter to whoever visited the ABH stall. This resonated well with the day’s theme of “Finding the missing TB patients” who do not come out to seek medical care, especially the men, hence neglecting their responsibilities. ABH also used the platform to demand for more to be done by district leaders and government agencies (MoH and MoFPED) to increase domestic funding for TB to enable recruitment and strengthening the national TB response. Working with its sub awardees, the project will continue pursuing these ASKs with the respective duty bearers.

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Engagements with NMS are key in sustained supply of medicines

One of the key advocacy ASKs for the ABH project is for government through NMS and related departments to ensure uninterrupted supply of HIV medicines and other related supplies in the health facilities. ABH and partners engaged NMS with a view to presenting the issues that have been noted in the supply chain from the community level and health facility assessments. Key among these was that NMS making deliveries that do not purportedly correspond to health facility orders and that last mile deliveries were not being efficiently handled hence causing delays. The meeting yielded fruitful deliberations and promises for enhanced collaboration/partnership to ensure sustained medicine availability. As an outcome, NMS has now included some ABH members on the online tracking and SMS alert system that enables real time

monitoring of medicines at facilities. This is expected to enhance drug usage monitoring, and curb thefts that happen downstream at the health facility. The information shared by NMS enabled the team to understand more of their operations. NMS was asked by the team to develop an infographic that shows how they operate at each stage to enable the population and health workers to clearly understand the stages involved in medicines delivery. This will go a long way in addressing knowledge gaps that often posture NMS to be operating in an environment shrouded in mystery and suspicion.

Commemoration of International Women’s Day

CEHURD in collaboration with other CSOs, held a press conference to join the rest of the world in commemorating the International Women's Day. The press conference focused on maternal health under the theme, “Improving maternal health is key to empowering women in changing world of work”. This was adopted from the international theme: “Women in the changing world of work planet 50-50 by 2030”. The major issues discussed were largely on the preventable causes of maternal deaths such as; recruitment of midwives, improving access to emergency obstetric care, access to quality antenatal services and access to lifesaving commodities. CSOs called upon government to prioritize the following;

• Ensure the availability, accessibility and good quality of the 13 lifesaving commodities (four of which are critical for the improvement of the maternal health outcomes)

• Scaling up efforts in training of midwives on the 13 lifesaving commodities including curriculum review where necessary

• Recruiting, retaining and remunerating midwives in Uganda • Investing in resourcing the underlying determinants of health such as water, electricity sanitation and

a concerted political will.

CSOs engagement with NMS in Entebbe

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The ABH Deputy Chief of Party giving remarks at the meeting with the Parliamentary Health Committee

See links to media coverage below;

http://www.newvision.co.ug/new_vision/news/1448246/women-appeal-government-invest-funds-maternal-health http://www.monitor.co.ug/News/National/Women-to-boycott-celebrations-of-their-day-over-service-delivery/688334-3840650-gsrhwi/index.html

Women’s Day “Banquet”:

The project supported and participated at an Annual Women’s Day event, organized by Business Day Communication—the annual convener of this advocacy forum. At this forum that was attended by a multitude of stakeholders including representatives from government Ministries, Departments and Agencies, civil society, international NGOs and the donor community, both the Chief of Party and the Country Director of PATH in Uganda, reiterated the need for improving the quality, availability and accessibility of maternal health services in the country. The Chief Guest was Hon. Betty Kamya, the Minister of Kampala.

Budget Advocacy for the FY 17/18 In order to enrich engagements with the Parliamentary Health Committee, and as part of the budgeting cycle for the FY 2017/18 and in response to the Budget Framework Paper issued by the Ministry of Finance, Planning and Economic Development (MoFPED), the project coordinated a meeting for CSOs to refine a position paper that had earlier been developed in partnership with the Civil Society Budget Advocacy Group (CSBAG). The main element of concern was the projected reduction of the Health Sector budget by Uganda shillings 541.5 billion i.e. from Uganda shillings 1,828.07 billion to 1,285.76 billion (a 30% budget reduction).

This position paper was ultimately presented to the Parliamentary Health Committee, at a meeting attended by the Ministry of Health and Civil Society Organizations (CSOs). The meeting made a number of resolutions, which included; the need to retain the health budget at the existing FY 2016/17 allocation, ensuring adequate budgetary allocation for the maintenance of medical equipment, allocating Uganda shillings 5 billion—as start up funds for the National Health Insurance Scheme, increasing the allocation of the primary heath care non-wage budget to

disctricts, ensuring the mandatory monitroing of the performance of government loans on a qaurterly basis by Parliament, and ensuring the

recruitment of critical cadre of health workers including; anaesthetists, midwives, pharmacy staff, and laboratory personnel.The project organized a press conference, to amplify the position of CSOs in relation to the Budget Framework Paper, coupled with generating public debate. The Chief of Party read this press statement on behalf of all CSOs. The project will continue pursuing the issues with the Parliamentary Health Committee.

Meeting with MoFPED over inadequate FY 2017/18 health sector Budget allocations

Partnering with its sub awardee Uganda Debt Network (UDN) the project mobilized other CSOs to participate in inter-ministerial consultations on the FY 2017/18 budget coordinated by MoFPED. The same ASKs articulated above, were presented.

Partners during the press conference

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The demands of CSOs were in sync with those presented by MoH led by the Permanent Secretary (PS) Dr. Diana Atwiine, and those of other Health departments and agencies like KCCA, National Drug Authority Mulago Hospital, Makerere University College of Health Sciences and Uganda Cancer Institute.

The PS/ Secretary to the Treasury MoFPED responded that some of the health sector gaps were occasioned by halting of the commitments made by the Global Fund to Fight AIDS, TB and Malaria. He stated that the reinstatement of funding from this source would relatively scale up the health sector budget. He also pledged to address some of the urgent issue raised in the meeting, and asked MoH to formally follow up on those for possible redress. The project will commitments will be followed upon in the next quarter.

1.3 Result Area 3: Institutional capacity of CSOs strengthened

During the quarter, the team focused on providing support to the sub awardees to implement actions from their Organizational and Advocacy Capacity Assessment (OACA) action plans, review implementation strategies and finalize the “Plan Do Study Act” (PDSA) process, as well as to participate in other project management activities including the community empowerment week. The organizational development (OD) team, with technical assistance from Initiatives Boston, facilitated the quarterly Grants Management Collaborative (GMC) and supported sub awardees to strengthen their change strategies. The GMC guides sub awardees to follow the PDSA process when defining change strategies and measuring and reporting results. This quarterly GMC provided an opportunity for sub awardees to report on the implementation of improvement strategies/activities and progress achieved so far in their advocacy and community empowerment work. Key accomplishments for the quarter:

A. KEY ACHIEVEMENTS OF THE QUARTER

Strengthening capacity to develop and implement strategic plans

Strategic planning is one of the key areas supported under the ABH project; it helps organizations review their history to identify key lessons and trends that inform their future, review their vision and mission statements, identify their core competencies and decide on the direction for the future of their organizations. Strategic planning also provides a framework for operational planning which was an area found to be weak in the OACAs. This quarter, the project supported LADA to develop a strategic plan through a facilitated appreciative inquiry methodology. The process was an opportunity for board members and staff to reflect together on the past strategic plan and agree on the direction for the next five years.

LADA identified Advocacy as one of the key pillars of their strategic plan that they would like to continue focusing on. As part of this process, LADA was supported to address other issues in their OACA action plans related to strategic planning, for example stakeholder mapping and engagement plan, costing, human resource and staffing plan, organizational Monitoring and Evaluation framework and one-year operational plan. Support was also provided to Family Life Education (FLEP) to develop a draft plan, although due to internal staffing challenges, the strategic plan document is yet to be finalized. It will be concluded in the coming quarter. Other sub awardees such as, Community Integrated Development Initiative (CIDI), JIACOFE, ARUWE and RACOBAO were supported to develop their strategic plans in year 2. They have continuously used their strategic plans to determine resource mobilization needs and drives, and to refine their structures. For example, CIDI, ARUWE and JIACOFE have re-organized their staffing based on the new strategic plans. The support to finalize the strategic planning documentation is ongoing for both LADA and FLEP.

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Lada: Stakeholder Analysis

Strengthening capacity for resource mobilization

During the quarter, the team facilitated a training for JIACOFE staff and board members in Resource Mobilization. This increased understanding of their relationship with organizational development, strategic planning and resource mobilization. They also identified board roles in fundraising and key challenges they face in fulfilling this role, researching and communicating with donors, and developing concept notes and proposals. The training was practical, and used examples from JIACOFE’s experience and a proposal they were working on to get their management team and board members to review and share feedback based on the guidance provided by facilitators. Both the staff and board members participated in developing the capacity statement and practiced elevator speeches. This being the first training for JIACOFE board members in resource mobilization, attendees greatly appreciated the knowledge gained.

Since the training, JIACOFE has responded to two Requests for Application, and awaits the results. The same support was provided to ARUWE while responding to a call by STARS FOUNDATION on behalf of the ‘WITH AND FOR GIRLS Award 2017”, an initiative of the Girls Collective. Other organizations such as FLEP and KADINGO were also provided offsite support to review and guide their draft proposals, while responding to various calls for applications and resource mobilization initiatives. Support for strengthening resource mobilization capacity will continue in the next quarter. Most CSOs involved in ABH have reported improved resource mobilization since receiving training and capacity building support from ABH.

Strengthening supervision systems that ensure quality programs

During the second OACA, most partners scored low on supervision and quality improvement and many requested for support to improve that dynamic. The team supported sub awardees to develop field oversight procedures that ensure effective management and implementation of programs in their field offices. These are being reviewed by the ABH team before final approval. Support was also provided in individual sub awardee trainings for three partners namely: IDO, JIACOFE and CEHURD. The trainings were tailored to meet the needs of each CSO. In JIACOFE the focus was on supervision and quality improvement, IDO on supervision, and

CEHURD on strengthening the internal performance management system.

In JIACOFE, the training introduced supportive supervision, discussion of internal structures and supervision mechanisms and tools, and used a case study to help them appreciate the scope of field supervision. The participants were supported to develop supervision checklists and tools including a plan for supervision. On quality improvement, they appreciated the need to deliver quality programs and identified expected outcomes from each of their program areas, reviewed the different dimensions of quality they need to focus on and

Group Discussion: Stakeholder Engagement Plan

JIACOFE staff conducting a role play on Performance Appraisal

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reviewed and developed standards for program activities. Due to the training, JIACOFE now has tools for supervision, which will be disseminated to all staff in April, and later rolled out.

For IDO, the focus was on strengthening internal and field supervision, and a review of their performance management system, field supervision practices and tools. This helped clarify the role of supervisors and commitment to ensure planned supervision and tools.

CEHURD’s one-day session focused on streamlining its internal supervision and performance management systems to ensure clarity of supervisors and their role in planning, monitoring and evaluating performance. Consideration and commitment were made to review their structure and processes to promote stronger relationships and communication between supervisors and supervisees. In addition, the need to ensure that proper planning remains available for individual staff, and that staff are delivering their expected outputs and are rewarded for them. Based on these principles, CEHURD has had to adjust its annual contracts to re-define performance objectives and targets and roles of supervisors.

Training sub grantees in Financial Management, USG compliance and NUPAS

The project conducted 2 four-day training sessions in the Eastern and Western regions on financial management. The purpose of the training was to equip participants with guidance on the relevant USAID rules and regulations, particularly the new 2CRF200, ADS 303 guidelines and Fixed Amount Awards (FAA) regulations. It also provided best practices in organizational set up/ legal structure, financial management and internal control, procurement and human resource systems, project performance management, organizational sustainability and orientation on the NUPAS process and tools. The training was facilitated by external consultants supported by the

finance and OD team. The training was attended by all 23 sub awardees. Participants appreciated the training, for addressing specific concerns related to USG compliance and clarifying agreement provisions. The OD team provided the tools and materials on NUPAS and augmented the consultants during the sessions. In addition to the training, the finance team has continuously provided support to the sub awardees to address their OACA action needs. Support was provided to Kapchorwa Alliance of Civil Society Organizations (KACSOA), MAFOC, Multi-Community Based Development Initiative (MUCOBADI), and STF to refine procurement, travel, cost share guidelines and templates for Audit trackers.

Conducting the Grants Management Collaborative

With support from the technical advisor from Initiatives Boston, ABH conducted the quarterly grants management collaborative in each of the regions. The purpose of the quarterly GMC was to review progress on the implementation of the change strategies developed in the December 2016 GMC learning session. All sub awardees participated in the GMC in their respective regions. National level sub awardees joined the central region GMC. Each of the sub awardees shared their progress on the implementation of their PDSAs, including the challenges encountered. It was clear from the sub awardee presentations that progress on key issues is being addressed including; strengthening community engagement and advocacy through motivating community groups and ensuring effective use of evidence in advocacy. In the central region for example, CIDI reported improved responsiveness from decision makers to issues of citizen concerns, while JIACOFE observed timely reporting from advocacy champions after they were trained and shared templates on their change strategy. In the eastern region, MUCOBADI also noted improved and fast response from duty bearers after improving packaging of evidence. In the western region, Integrated Development Option (IDO) has seen community groups integrating advocacy into their work, and taking on activities without direct involvement of IDO.

Group picture of participants at the Finance and Grants training held in Western Region

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Using the December 2016 learning session and technical assistance support enabled sub awardees to identify their steps/activities and targets to implement their change strategies. The M&E section of the PDSA was also refined to ensure clear definition of indicators and data to be collected. This GMC session also introduced the importance of tracking data. The sub awardees were empowered to track their steps and data on indicators which they used to develop charts. Using the guidance from this GMC, each of the sub awardees refined its change strategies, and was supported during implementation to ensure they were following key steps, and collecting data to demonstrate progress.

Some CSOs brought data and used it to develop charts to display progress in addressing the challenges identified at the learning session. For example, LADA created a graph to identify how many advocacy issues used evidence to engage duty bearers, and how many duty bearers acted on citizen’s needs.

Using LADA's graph to support advocacy

The GMC also provided an opportunity to review overall progress on ABH implementation since October 2016. Sub awardees shared their achievements, challenges and key lessons, including: disbursements, centralization of radio programs, funding for community engagement activities/community groups, and slow responses from duty bearers. The team also used this opportunity to communicate about the need to continue improving on the quality of work and milestone verification processes.

Technical assistance to address OACA actions (Telephone, Email and Visits)

In addition to group and individual sub awardee trainings, the project team provided technical assistance to the sub awardees through email, telephone and visits. The email support was mainly to share templates on field oversight procedures, succession planning and reviewing draft documents that included supervision tools and checklists, human resources manuals, finance and procurement guidelines and other related documents. MAFOC for example, reviewed its advocacy strategy, human resource policy, finance and procurement policies and strategic plan which re-phrased the organization’s Vision and Mission, re-aligned the organizations’ structure with clear reporting channels, and revised salary ranges and grades. MAFOC also developed volunteer and intern performance management guidelines which were integrated into policy documents. MAFOC also reviewed its finance and procurement policy to integrate compliance requirements on travel and procurement. MUCOBADI revised and aligned a wide range of strategic documents including a strategic plan,

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volunteer policy, advocacy strategy, gender policy, and per-diem and travel policy, and time-keeping policy. Having these policies in place contributed to a good assessment and eventual funding from the BANTWANA World Education Better Outcomes OVC Project. JIACOFE was also supported to review its human resources policies to align with its new strategic plan.

Technical Assistance visits were provided to a number of organizations to address specific issues in their OACA action plans and other emerging issues:

STF: A technical assistance visit to STF focused on reviewing progress on the PDSA, orientation on the NUPAS tools, and review of their year three work plan. The advocacy team provided guidance on the additional work plan for STF while OD shared and oriented the STF team on NUPAS. STF has expressed interest to be among the NUPAS candidates. The project will prepare and support at least four sub awardees, to meet NUPAS criteria.

MAFOC: Technical Assistance to MAFOC was provided by an OD team, an Advocacy Officer, and the Regional Coordinator to support issues in the OACA action plans. This support focused on the review of MAFOC’s advocacy strategy, to ensure alignment with the new thematic areas and the right decision makers, influencers, and tactics were identified. The visit also focused on key OACA actions including; the development of the staffing plan, review of the draft strategic plan, and development of a change management as well as a succession plan. The OD team used the opportunity to orient the MAFOC team on the NUPAS process, requirements and tools. The PDSA was discussed and given the changes in the structure of MAFOC, the team agreed to change the PDSA testing area from Sironko to Kumi district. The MAFOC ABH advocacy team was oriented on the GMC approach and PDSA, so as to ensure continuity of implementation as staff who had been taking the lead on this had left the organization.

Action for Community Development (ACODEV): Technical assistance visits to ACODEV were mainly focused on progress in implementing the OACA action plan and the change strategies. The visit was conducted by the OD team and included the Senior Technical Advisor from Initiatives Boston and the responsible Regional Coordinator. The ACODEV team shared their achievements and challenges in all result areas. There was good progress noted on the implementation of all the result areas, and lessons that can be used across the project. These include the; distribution of community forums to different parishes, so as to reach citizens, and the use of active community champions to support other sub counties. ACODEV management embraced the GMC and PDSA approach and through orientation its management team demonstrated commitment to ensure effective implementation of the change strategy. The team was guided on how to strengthen their change strategy and other key OACA actions. Support will continue in the next quarter to review draft documents submitted for review.

HEPS. A technical support visit was made to HEPS by the OD and M&E Officers, to review progress made on the OACA Action Plan. Discussions were attended by HEPS management and staff and the pending actions were re-prioritized and fresh technical assistance needs identified. The team also took the staff through several templates and tools. HEPS was also taken through the PDSA implementation process and was oriented on NUPAS. Based on the needs identified, HEPS requested technical support in supportive supervision and developing a monitoring and evaluation plan; these have been planned for the third quarter.

CIDI: CIDI organized a meeting of management and staff to review progress on the OACA action plan. The Organizational Capacity Officer and the Advocacy and Empowerment Officer provided CIDI the required support. The team provided guidance on key OACA actions and what CIDI was expected to do. Support was provided to review the advocacy strategy and align it with the new thematic areas. The OD team also reviewed progress on the PDSA and provided orientation on NUPAS process and tools.

ABH Advocacy Officer supporting STF

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Uganda Red Cross Society (URCS): A technical visit was organized to the URCS head office to meet the new Program Director overseeing the ABH project. In the meeting, commitments made in the OACA Action Plan were reviewed. The Program Director was also oriented on the ABH project objectives and work plan. A meeting was scheduled for the ABH team, to meet with URCS management to share the project progress and next steps. The meeting with PATH and ABH leadership was conducted and URCS management committed to support the ABH staff and project to ensure targets are achieved.

Project meetings to support project implementation:

CSOs have continued to hold meetings aimed at reviewing progress and challenges and use that to determine the direction for the following period. As part of strengthening governance systems, the project has encouraged CSOs to comply with their board terms of reference, conduct board meetings to allow board members to appreciate organizational progress organization and review of documents as part of the OACA implementation. Overall eight CSOs (MUCOBADI, MAFOC, JIACOFE, FLEP, CIDI, ACODEV, HEPS, ARUWE) held quarterly board meetings to discuss board operations which also provided an opportunity to carry out their oversight role and review project progress and OACA implementation. For example, ACODEV and HEPS used board meetings to discuss revised policies. During the board meeting, HEPS, for example, had the board review the Whistle Blower Policy, Travel Policy, Staff Retention Policy, and Change Management Policy. The documents were submitted to the board and reviewed. The board also made recommendations for improvements on the documents before they were approved.

MUCOBADI and MAFOC also conducted monthly project review meetings for management and staff to discuss progress and challenges. The CSOs have also continued to conduct quarterly reviews of the OACA action plans to check on progress and remind teams to work on pending actions. This will continue to be encouraged in the coming quarter.

Supporting NAFOPHANU to develop a management handbook and standards for coordinating and supporting district forums:

ABH is supporting NAFOPHANU to develop a management handbook and standards that will help strengthen coordination and support for its 106 district forums. It is anticipated that with the handbook and standards in place, NAFOPHANU will be able to assist district forums to fully understand their roles and operational responsibilities. In this way, they can more effectively coordinate, collect and report evidence for advocacy issues, create awareness on key program areas including the 90-90-90 and effectively engage with district level duty bearers. A meeting was held with the NAFOPHANU team to plan for the series of activities that will culminate in the development of the District Management Handbook and Standards. In the meeting, different activities and timelines were discussed, and a core team was appointed to lead the process at NAFOPHANU. The meeting also reviewed the draft table of contents for the management handbook and provided feedback to the facilitators/consultants. The development of the Management Handbook is in its final stages and the Initiatives Advisor will work with NAFOPHANU next quarter, to pretest the draft handbook and meet with the task force to refine the draft.

2.0 PROJECT MANAGEMENT

Ratification of new sub awardees: The project received concurrence from USAID’s Agreement Officer and the AOR, to work with three new sub awardees, as per the summary below:

# Sub Grantee DUNS Number Total Estimated Amount in USD

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1 International Community of Women Living with HIV East Africa (ICWEA)

850554815 $70,047

2 White Ribbon Alliance –Uganda (WRA-U)

561221077 $50,039

3 Uganda Network of AIDS services Organization (UNASO)

366489060 $99,442

The new partners will go a long way in catalyzing and galvanizing the project’s national level advocacy efforts towards; the attainment of the 90-90-90 goals, the implementation of the differentiated services delivery model and the Consolidated Guidelines for HIV Prevention and Treatment, as well as ensuring the building of effective inroads by networks for advocacy on systemic impediments to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH).

3.0 COLLABORATING, LEARNING AND ADAPTING

Conducting the Grants Management Collaborative As a follow up to the GMC held in December 2016 and as earlier highlighted in the report, the project organized regional GMCs, which brought together all the sub awardees. The sub awardees shared their progress on the implementation of their PDSAs, including the challenges encountered. From the presentations made, there evidence of progress in addressing key issues such as; strengthening community engagement and advocacy, and ensuring effective use of evidence in advocacy. The GMCs certainly continue providing a platform for sub awardees to learn from each other. Production of a bi-monthly “Advocacy Alerts!” newsletter During the quarter, the project produced and disseminated one edition of the bimonthly Advocacy Alerts! Newsletter. The edition was issued at the end of February and it highlighted major project events and accomplishments that happened in the period leading up to the end of February. It was circulated, among others, to PATH staff, CSOs, USAID and to members of the Advocacy Advisory Group. The newsletter is a conduit for quick information sharing to partners on what the project has been able to accomplish in a span of two months. The February newsletter can be accessed online on the following link February 216 Advocacy Alerts.

4.0 PARTNERSHIPS Nutrition

Formation and orientation of the Parliamentary Forum on Nutrition (PFN)

Given the absence of concrete nutrition advocacy agenda involving Members of Parliament (MPs) in Uganda, ABH in partnership with FANTA, held a breakfast meeting with Members of Parliament (MPs) of the 10th Parliament in Uganda as a starting point to the formation of the Parliamentary Forum on Nutrition (PFN). The MPs expressed willingness to work on the nutrition agenda in Parliament. A roadmap outlining planned Parliamentary Nutrition Advocacy activities was developed. PFN was approved by the Right Honorable Speaker of the Parliament of the Republic of Uganda. Succeeding this approval, was an orientation of the PFN that was supported by the project and FANTA, in collaboration with the Office of the Prime Minister.

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Hon. Kamusiime Innocent-Chair of PFN, presenting

Copy of a letter of commitment from Kisoro district

Regional Advocacy Event

In partnership with the Office of the Prime Minister, USAID-FANTA project, USAID-SCORE project and World Vision organized a Regional Advocacy and experience sharing meeting on nutrition for the Western Region. The purpose of the meeting was to bring to the attention of district leaders the problem of malnutrition in the region, share experiences on interventions each district is implementing to improve nutrition and together with members of parliament ask district leaders to include nutrition interventions in the ongoing district planning and budgeting process. The formation and revitalization of District Nutrition Coordinating Committees was emphasized.

The workshop was attended by 12 Members of parliament, four of whom are members of the parliamentary nutrition forum, 11 district planners, 10 District Chief Administrative Officers, 10 District council chairpersons, representatives from Office of the Prime Minister, representative from Ministry of Local Government, UNICEF, FHI360 (FANTA and CHC projects), AVSI (SCORE) project, RHIGHTS- South West and World Vision. All the 12 districts where ABH operates in the Western Region, were represented at the workshop. In this meeting, the project presented the following ASKs:

• Government should a National Nutrition Action Plan. • MoFPED working with the Office of the Prime Minister to include nutrition as a performance indicator

for district local Governments in the Output Budgeting Tool. • Government should increase funding and staffing for nutrition at district and sub county levels. • Districts should include nutrition activities in District Development plans, annual work plans and

budgets. • District should develop and implement District Nutrition Action Plans. • Districts should establish and functionalize District Nutrition Coordination Committees.

ABH Regional Coordinator for Western Uganda, making a presentation

District representatives pose for a group photograph with their letters of commitment

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In their submissions, the MPs and officials from the Office of the Prime Minister urged the district leaders to include nutrition interventions in the ongoing planning and budgeting process including; development of district and sub county nutrition action plans, formation and functionalization of district and sub county coordination committees, recruitment of nutritionists and allocation of funds in the district budgets to implement nutrition activities in the district. As an outcome of the orientation, all participating districts signed letters of commitment, to prioritize nutrition in their respective plans and budgets

Group photo of workshop participants with district leaders holding copies of their respective commitments made during the workshop.

National Health Insurance Scheme Benchmarking Trip to Rwanda:

The project supported the Parliamentary Health Committee to conduct a pre-legislative benchmarking trip to Rwanda, as a way of building the capacity of its members to make a positive contribution, while legislating the highly anticipated National Health Insurance (NHIS) Bill, 2017.

Joined by the Deputy Chief of Party ABH, Mr. William Kidega, the Committee engaged in the following activities; listened to presentations on the Rwanda Health System and the Rwanda Health Insurance System, visited the Rwanda Social Security Board and held a meeting with the Director General, Ms. Solange Hakiba, visited a district hospital and a lower health center, and paid a courtesy call to the Ministry of Health,

where they held a meeting with the Minister of State for Health, Hon. Patrick Ndimubanzi. The project will continue working with the Parliamentary Committee and the Ministry of Health, to advocate for the expedited legislation on the NHIS, as an alternative source for domestic health financing.

5.0 KEY ACTIVITIES PLANNED FOR NEXT QUARTER The project plans to accomplish the following key activities during the April to June 2017 quarter:

• Disseminating the project’s Advocacy and Communication Strategy to sub awardees, and supporting them to domesticate it.

• Compiling the project’s e-newsletter (with content on the project’s key advocacy engagements and accomplishments) and sharing partners.

• Continue creating citizens’ awareness on their rights and responsibilities through radio talk shows and radio spot messages, advocacy forums, and community group meetings.

• Sustaining community empowerment activities through established community groups, to regularly track and report the availability of human resources for health (HRH) and health commodity stock status in relation to HIV/AIDS, TB, RMNCAH, and Malaria.

• Commemorating the World Malaria Day in partnership with the Ministry of Health, and the project’s focus districts. The event will also be utilized as a platform for creating the communities’ awareness on their rights and responsibilities in relation to malaria, but also generating discussions on key impediments affecting the prevention and control of malaria in the country.

• Continue engaging the Parliamentary Committee on Health to advocate for the increase of the health sector budget for the FY 2017/18, from the proposed 30% reduction.

Courtesy call at the Ministry of Health. In the middle is Hon. Dr. Patrick Ndimubanzi— Minister of State for Health in Rwanda and the Director General in charge of Planning is to his right.

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• Sustaining the participation in national and district level planning/budgeting processes as way of ensuring that issues affecting the delivery of quality health services are integrated in the FY 17/18 budget framework paper.

• Engaging the Parliamentary Committee on Health and MoH, to advocate for the expedited legislation on the National Health Insurance Scheme, as a source for alternative domestic financing for the health sector.

• Meeting with the Advocacy Advisory Group (AAG), to refine the project’s advocacy agenda. • Conducting regional GMCs for sub awardees. • Ongoing technical assistance for sub awardees to strengthen their institutional systems, including;

o Supportive Supervision and Quality Improvement training for HEPS, NAFOPHANU and STF o Strategic planning session for KADINGO o Finalization of the management handbook, and support for introduction of the NAFOPANU

Management Handbook to district forum representatives, and development and pre-testing of management standards for the NAFOPHANU district forums.

o Providing technical assistance to conduct the NUPAS o Implementing change strategies o Mentoring and coaching through technical assistance visits and online support for all CSOs to

address actions in their OACA action plans • Conducting a longitudinal case study, to inform the project’s collaboration, learning and adapting

agenda. • Recruiting and orienting fellows and interns, as a way of building skills of young professionals in

advocacy and OD. • Recruitment of a new OD staff member to bolster support the increasing need for technical assistance

to sub awardees • Conducting a mid-term evaluation of the project. • Orienting the three new sub awardees on the project, and supporting them to kick start

implementation.

6.0 LESSONS/CHALLENGES

The following were the major lessons drawn by the project during the quarter; • It is important to consistently work with the Parliamentary Committee on Health and other

Parliamentary forums, as a way of equipping them with well packaged evidence that informs their legislation.

• Partnership with implementing partners and other CSOs not only leverages comparative advantages, but also ensures that the project triangulates and refines its advocacy evidence.

• Advocacy forums at Sub-county and District level are critical platforms for duty bearers to hear from the citizens and for them, to provide critical information to the citizens, which greatly enhances social accountability

• The sustained provision of technical assistance to sub awardees, largely through hands-on mentoring and coaching, is critical in ensuring the quality of project implementation.

7.0 TECHNICAL ASSISTANCE NEEDED FROM USAID/UGANDA

The project will continue seeking guidance from the Agreement Officer Representative and other technical staff at the Mission, as a way of ensuring the attainment of results. Key during the quarter, will be seeking support for conducting the mid-term evaluation; documentation of best practices and interpretation of the New Mexico policy.