FY 17 QUARTER ONE REPORT OCTOBER– …pdf.usaid.gov/pdf_docs/PA00MKFH.pdf · FY 17 QUARTER ONE REPORT OCTOBER– DECEMBER 2016 . Page | ii . ... 1 1.0 PROGRESS BY RESULT AREA_____

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

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

January 30, 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 OCTOBER– DECEMBER 2016

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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. _____________7 1.3 Result Area 3: Institutional capacity of CSOs strengthened __________________________________ 14 2.0 PROJECT MANAGEMENT ______________________________________________________________ 17 3.0 COLLABORATING, LEARNING AND ADAPTING ______________________________________________ 18 4.0 PARTNERSHIPS ______________________________________________________________________ 19 5.0 KEY ACTIVITIES PLANNED FOR NEXT QUARTER _____________________________________________ 19 6.0 LESSONS/CHALLENGES ________________________________________________________________ 20 7.0 TECHNICAL ASSISTANCE NEEDED FROM USAID/UGANDA ____________________________________ 20

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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

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EXECUTIVE SUMMARY The USAID Advocacy for Better Health project accomplished the following during the quarter:

• Empowered citizens on their rights and responsibilities using the Patients’ Charter for improving health.

• Conducted advocacy forums as platforms for the citizens to engage with their duty bearers. • Tracked the stock status of health commodities and staff availability at health facilities through

periodic health facility assessments by community groups. • Participated in national and international commemorative events such as the World AIDS Day, and the

International Human Rights Day to underscore concern of issues of the need for improved quality of health services.

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

• Organized a national Stakeholders’ dialogue to discuss the state of human resources for health in the country.

• Convened the Advocacy Advisory Group to elicit feedback on the project’s performance, and seek input into the project’s quarterly plan.

• Provided targeted technical assistance for CSO capacity improvement including strategic planning, and reviewing progress on the implementation of action plans developed during the organization advocacy and capacity assessments (OACA).

• Conducted the second Grants Management Collaborative for sub awardees as an avenue to share and cross fertilize lessons and experiences.

• Participated in international learning events as avenues, such as the International Conference of America Evaluators, for collaboration, learning and adapting.

• Conducted a pre-award risk assessment for three potential sub awardees. The accomplishments above inform the project’s performance on key indicators, as per the summary below: 2017 Q1 INDICATOR PERFORMANCE, AS AT JANUARY 25, 2017

INDICATOR TOTAL BY YEAR REPORT FOR YEAR(S) 2017 - 2017 [Data as at Jan 25, 2017 05:03:18PM Local Time] IP NAME: ADVOCACY FOR BETTER HEALTH

INDICATOR NUMBER

INDICATOR TITLE FY 17 Q1 ACTUALS

FY 17 ANNUAL TARGET

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

200% [8/4]

75% [75/100]

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

100% [58/58]

48% [48/100]

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

77 418

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

75% [9/12]

60% [60/100]

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

333% [10/3]

60% [12/20]

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

3 16

Source: USAID PRS 2017

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Plans for the Next Quarter: The project plans to accomplish the following key activities during the quarter January to March 2017 quarter: • Develop citizen activism and advocacy materials to be included in the Citizen Action Toolkit. • Continue compiling and disseminating to project partners the monthly e-newsletter (Advocacy Alerts),

which captures the project’s key advocacy engagements and milestones that happen on a monthly basis. • Continue creating citizens’ awareness on their rights and responsibilities through radio talk shows and

radio spot messages, advocacy forums, and community group meetings. • Continue empowering the communities through their established groups, to regularly track and report the

availability of human resources for health and health commodity stock status in relation to HIV/AIDS, RMNCAH, nutrition and malaria.

• Exerting pressure on local governments to ensure the roll out of Test and Start guidelines. • Participate in the International Women’s Day celebrations, as an avenue for raising awareness, but also

generating debate on issues affecting the delivery of RMNCAH services in the country. • Work with partners to organize a nutrition partners’ advocacy meeting. • Organize a meeting with stakeholders and parliamentarians to kick start the process of developing

guidelines for establishing the Immunization Fund— aimed at raising domestic funding for immunization activities in the country, as per stipulations in the 2016 Immunization Act.

• Continue participating 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.

• Holding a quarterly Advocacy Advisory Group (AAG) meeting • Conduct regional GMCs for sub awardees • Mentor and coach through technical assistance visits and online support, all sub awardees to finalize

development of policies and systems building on the findings of the OACA. Specifically, this will include; Supportive Supervision and Quality Improvement training for JIACOFE and LADA and finalizing the management handbook and pre-testing standards for NAFOPHANU.

• Conducting financial management, USG compliance, and NUPAS training for sub awardees • Conducting data validation visits for sub awardees.

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1.0 PROGRESS BY RESULT AREA

Below are the major accomplishments for the period October 1, to Dec 31 2016, disaggregated by result area:

1.1 Result area 1: Citizens demand improved quality services

Overview In the third year, Advocacy for Better Health (ABH) focused among others, on socializing the 90-90-90 HIV/AIDS treatment targets and reproductive, maternal, newborn and adolescent health (RMNCAH) issues especially accessibility to the 13 life-saving commodities. Through advocacy and modeling the “Patriotic Citizen” concept, which encourages identification of champions who exercise their health rights responsibilities, community empowerment was enhanced.

Key Achievements Intermediate Result 1.1: Increased citizens’ awareness of their rights and responsibilities related to health and social services Performance indicator: % of citizens who demonstrate understanding of rights and responsibilities related to health services (disaggregated by gender, youth and health thematic area). Awareness creation on citizen rights and responsibilities using the Patients’ Charter ABH continued raising citizen awareness on their rights and responsibilities using the Patient’s Charter as the major tool for community empowerment. This included utilizing media platforms and interpersonal channels especially community group meetings and advocacy forums. In such forums, community group members discussed their rights and responsibilities in relation to service standards expected at each level of health facility, before engaging in action planning for their advocacy issues. Focus has been maintained on priorities related to HIV/AIDS, TB, RMNCAH, Malaria and Nutrition. These community empowerment activities have so far yielded positive outcomes. In Kasese district, citizens expressed their dissatisfaction with the poor quality and lack of health services in their communities through peaceful demonstrations. For example, patients at Kasenyi HCIII demonstrated over lack of ARVs at their health facility (see screenshot of newspaper piece).

Efforts are underway to develop a pocket version of the patients’ charter, which community members involved in advocacy can carry and use at given opportunities to educate other community members on their rights and responsibilities for health. Some implementing partners have reached out to ABH for copies and permission to reproduce the patient’s charter. These are RTI and EGPAF that are implementing the UPDF Comprehensive HIV project and RHITES SW funded by USAID, and the Department of Defence. Radio talk shows focusing on the 90-90-90 treatment targets and 13 life-saving commodities: The project conducted 30 live

ABH staff and partners being hosted on Radio One live talk show on the 90-90-90

Citizens protest the stock out of ARVs in Kasese, captured in the New Vision, November 30, 2016

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call-in radio talk shows on 151 FM radio stations, 11 at district and 4 at national level. The talk shows were all coordinated centrally by the project’s communication partner—Communication for Development Foundation Uganda (CDFU) and they involved sub awardees in their respective districts who utilized the airtime to voice out issues under their advocacy mandate. The radio talk shows were aligned to two commemorative events on the project calendar (World AIDS Day that falls on 1st December and Human Rights Day that falls on 10th December). For World AIDS day, emphasis was put on popularizing the 90-90-90 treatment targets, whereas talk shows on Human Rights Day focused on highlighting the need to increase access to the 13 life-saving commodities. All the talk shows were guided by standard talking points developed by the project technical teams. Panelists on radio talk shows included ABH Advocacy Officers, the Communications Officer, the Deputy Chief of Party, members of the Advocacy Advisory Group (AAG) and other subject matter champions. Participation in panel discussions on NTV and NBS television live talk show segments In appreciation by the media, of the project’s advocacy effort, the project was offered slots on live air shows on various TV stations to underscore these issues. On NBS television, where the Deputy Chief of Party (DCoP) and the Advocacy Officer appeared, the focus of the discussion was on availability of HIV commodities. The discussion also discussed the newly launched Consolidated Guidelines for HIV Prevention and Treatment. On NTV, the project was represented by the National Advocacy Officer, who provided insights into the Advocacy issues and ASKs that the ABH project is pursuing. The discussion also underscored the issue of inadequate human resources for health with a major focus on health worker absenteeism, a vice that must be eliminated if service delivery is to improve. Development of advocacy messages and community empowerment tools (radio spot messages, citizen action toolkits) Working with CDFU, the project developed four radio spot messages on RMNCAH, HIV&AIDS/TB, Malaria, and Nutrition. The message scripts were reviewed by the project technical teams to confirm the messages are in sync with the advocacy priorities for the project. In the next quarter, the project will produce the spot messages that will be aired on various FM stations in Kampala and upcountry. In addition, the project also initiated the process of developing additional community empowerment materials which will be packaged in a citizen action toolkit. These include the “Patriotic Citizen” chart that illustrates community empowerment pathways, an awareness poster on the 90-90-90 targets, a pocket version of the patients charter and a tracking tool (scorecard) that will be used to monitor the quality of service delivery especially availability of health workers and medicines at heath facilities. The materials will be re-produced and disseminated to the communities in quarter two.

Social media engagement Social media has become an important avenue for elevating citizen voices to duty-bearers at multiple levels. ABH worked with CDFU to increase the robustness of the social media platforms (Facebook and Twitter) that

Kampala-based stations [Radio Simba, Capital FM, CBS and Radio One FM]. District-based stations [Kanungu Broadcasting services, Rukungiri FM, Bushenyi FM, Radio West, Radio Messiah, Elgon FM, Open Gate FM, Kapchorwa Trinity Radio, NBS, Baba FM and Voice of Muhabura]

90-90-90 citizens’ poster

Excerpt from the social media platform

The DCoP, during the NBS TV talk show, on the availability of HIV commodities

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were established in the previous year. Currently, the Facebook page has 310 followers with a post reach of 180 and engagement grows daily. The followers comment on the posts shared by different CSOs and this generates discussion and clarity on issues raised. The posts have links to the source of the story where followers can access more details. The photos that are uploaded by the partners and from online give the stories and posts more credibility. So far, a video post of HRH challenges at Kisoro hospital aired on NBS television in August 2016 has attracted close to 4000 online views.

During the quarter, a post about malaria and Hepatitis B drug stock outs at National Medical Stores also generated interest and discussion from the followers. An example of such posts by a Bikingi Cyrus, gives information on drug stock out at Tororo district hospital (see screen shot above).

Two-way SMS platforms for disseminating advocacy alert messages Working with Straight Talk Foundation (a sub awardee), the project has established a two-way SMS platform that is used to share weekly Advocacy Alerts and information that is deemed necessary for sharing, with particular contact groups as they are established in the SMS platform database. The SMS platform will contribute to improved linkages among project partners and key Stakeholders at community, district and national level. The advocacy alerts sent through the SMS platform will also be used to galvanize real-time action by CSOs and citizens alike on urgent issues, such as an impending drug stock-out crisis or drastic decisions taken by government perceived as detrimental to service delivery and requiring mass action.

Media articles with reference to Advocacy for Better Health Throughout the quarter, ABH received reasonable attention in the print media, profiling stories where the project is having a lot of influence, related to both community empowerment and advocacy. For instance, in November, the Daily Monitor published a special report on Kalangala district that highlighted what a sub-awardee CSO, KADINGO, was doing to increase awareness on HIV/AIDS among the citizens and how ABH as a project had empowered the communities that are now able to demand for quality health services. Relatedly, in Kasese district, the New Vision reported in the same month of November about ABH being behind the community empowerment efforts that saw patients demonstrate over a shortage of ARVs at one of the health facilities in the district. Similar stories were also featured in the print media from Ibanda districts on health worker absenteeism crippling service delivery ( see New Vision October 31, 2016 page 15) and another one from Kasese on CSOs demonstrating over lack of ARVs in the districts’ health facilities (see the New Vision, December 19, 2016 page 22). The issues raised in the media, like stock out of ARVs in health facilities are being followed up with the relevant partner institutions to ensure they are resolved and prevented from recurring in future.

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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). Orientation of community groups on the project priority issues for year three The project held a series of orientation meetings at district level to orient members of different community structures including PLHIV networks, Health Unit Management Committees (HUMCs) and other Community based organizations. The orientation covered the project’s priority areas and issues for year three including the 90-90-90 HIV/AIDS treatment targets, tools for tracking, monitoring and reporting the status of health commodities, and absenteeism of health workers.

Advocacy action planning and follow up meetings conducted by community groups. A total of 488 community groups remained active in their grassroots empowerment and advocacy activities, such as conducting health service delivery tracking, and conducting monthly meetings to discuss evidence and develop advocacy action plans. Working with the sub awardees, the project ensured that all advocacy action planning conducted by community groups on the availability of health commodities and health worker absenteeism, is based on the evidence collected by them from the health facilities.

For instance in Puti-Puti sub county, Pallisa district, the health facility monitoring exercise revealed that Puti-Puti Health center III had a maternity ward but did not have delivery beds. A community group (Mother Support and Care group) mobilized citizens around the issues and resolved to call a stakeholders’ meeting at the health facility. The meeting was attended by members of the Health Unit Management Committee, health workers, sub county staff, group members, champions and other community citizens. At the meeting, participants agreed to write a letter to the District Health Officer (DHO) highlighting citizen’s dissatisfaction with having a maternity ward without beds. In response, 6 delivery beds were allocated to Puti-Puti health center III. This is anticipated to attract more mothers to come and access maternal health services at the health center.

In addition, citizens have started appreciating the changes happening in health facilities as a result of community-led advocacy. One community group member remarked, “Bumadanda HC III has significantly transformed, all our staff quarters are now occupied by health workers. Absenteeism has reduced and we are very happy with the quality of health services that is being provided by our health workers” Safiyi Nangoli, Bubyangu Sub County, Mbale district.

In Sembabule district, a community group, Twekembe Savings and Crediting Group, advocated for health workers to have name tags for easy identification; disciplining of rude health workers—which led to the transfer with reduced responsibility, of one health worker by the DHO’s office.

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 During the quarter, the project held a total of 105 advocacy forums across the 35 districts. Advocacy forums as a community empowerment tool continue to provide avenues for citizens to interface with their duty bearers on issues of major concern. At a forum in Kitayundwa sub county, Kamuli district for example, citizens tasked the DHO to explain why drug stock-outs remained widespread in their facilities. In support of ABH’s work, the in-charge for Budadiri HCIV, in Sironko district, Dr. Chebet, commended the use of advocacy forums as

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platforms aimed at finding solutions to challenges crippling service delivery. Below is an excerpt from his remarks; “Budadiri health center was well known countrywide for having poor client-provider relationships which made the citizens hostile to the health workers and the image of the health facility had been tainted. When you were planning the first advocacy forum, all health workers were hesitant to host the citizens within the health facility premises. However after discussions with Mbale Area Federation of Communities (MAFOC) team, we eventually allowed them to have the advocacy forum. We used that opportunity to create awareness on the health rights and responsibilities, available health services at the facility, challenges faced by the health workers and also taking citizens around the health center. The advocacy forums have helped in improving client-provider relationships, staff and the clients are happy with the services we offer. We have also improved on health worker’s attendance to duty, since all the midwives are accommodated at the facility and all departments have updated duty rosters.” (Dr. Chebet) ABH will, in the subsequent quarters, leverage existing opportunities such as the Barazas championed by Office of the Prime Minister to make sure the communities have an opportunity to speak out on issues affecting health service delivery. 1.2 Result Area 2: CSOs effectively advocate for issues of citizen’s concern in health and social sectors. Result Area 2 aims at enabling CSOs to capture citizens’ concerns and to undertake evidence based advocacy by engaging duty bearers to take policy and program related decisions to address the gaps. Key Achievements Intermediate Result 2.1: Increased utilization of evidence by CSOs to inform advocacy Sub awardees continued to update, package, and utilize evidence to champion advocacy issues aimed at improving the quality, availability and accessibility of health services. At national level, the project organized a national level stakeholders’ dialogue, as the climax of its campaign on the call to improve performance of human resources for health in the country.

Eastern Region Health facility assessments were conducted to establish drug stock status, the functionality of Health Unit Management Committees (HUMCs), of the need to keep facilities open 24/7, and health worker absenteeism. The following twelve health facilities were sampled in five districts; Kapchorwa Hospital, Tegeres HC III and Kabeywa HC III in Kapchorwa district, Bukwo HC IV, Kapkoloswo HC III, Chesower HC III in Bukwo District, Nabiganda HC III and Nakwasi HC III in Butaleja, Kamonkoli HC III and Naboa HC III in Budaka and Bukigai and Bushika HC III in Bududa districts. Findings revealed that previous advocacy efforts had yielded notable results including; the display of duty rostas publicly and adherence to working hours by health center staff; convening of regular quarterly meetings in Bukwo HC IV, Kapkoloswo HC III, Tegeres HCIII, and Kapchorwa Hospital ( with evidence of minutes). Kapchorwa, Kabeywa and Tegeres Health facilities had all the essential drugs in stock. However, there are still challenges that require continuous engagement with relevant duty bearers, these include; HUMCs non functionality in Chesower HC III and Kabeywa HC III, pockets of drug stock outs of essential medicines in Bukwo HC IV, Kapkoloswo and Chesower HC III, lack of blood transfusion services in Bukwo and Kapchorwa hospitals.

Central Region Efforts included gathering additional evidence on the issues in the areas of HIV/AIDS/TB/ Malaria/ MCH/FP / Nutrition, developing and updating evidence dossiers especially making use of data collected by the

A community member voicing out his concerns during an advocacy forum in Sebei, Kapchorwa district.

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community groups and ABH staff. A case in point is in Kaliro district where linkage facilitators tracked ARV and anti TB drug stocks in Bumanya HC IV. A number of drugs were found out of stock. The findings were shared with the District HIV&AIDS Committee in the presence of the District Health Officer (DHO) and Chief Administrative Officer (CAO). As a short term measure, the DHO solicited drugs from neighboring Namutumba district, and pledged to pursue the issue with National Medical Stores (NMS) to ensure that the district doesn’t experience stock outs of ARVs and anti TB drugs again.

Sub awardees namely Action for Rural Women Empowerment (ARUWE), Community Integrated Development Initiative (CIDI), and Rural Action Community Based Organization (RACOBAO) conducted health facility assessments as part of evidence gathering. Evidence in the areas of reproductive, maternal, new born and adolescent health (RMCAH), and HIV/AIDS was generated. ABH is currently supporting sub awardees to package this evidence, which will be disseminate to different duty bearers with the aim of attaining improved quality, accessibility and availability of health services in their respective districts.

Western Region

Sub awardees in the region continued to work with citizens through community groups to collect, package and disseminate evidence to support advocacy efforts on the project thematic/disease areas i.e. HIV/AIDS, TB, RMNCAH and with a focus on Human resources for health, commodity security, as well as domestic health financing. This evidence was collected using a template provided by the Project to all CSOs (see copy of the tool). It was packaged using different modes including; letters, factsheets or power point presentations, and disseminated during district meetings, CSO coalition meetings, one on one engagements, and community advocacy forums. Publications were also made in national newspapers.

Sample tool used for Health Facility Assessments

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Another sub awardee Action for Community Development (ACODEV) working in Kasese district presented community concerns related to inadequate HIV/AIDS services in fishing communities. This compelled the district leadership to engage the Ministry of Health (MoH) to accredit health center IIs in the fishing communities to offer HIV/AIDS services. The District wrote to the Director General MoH, expressing this need (see a copy of the letter below).ACODEV will work with a national level sub awardee— National Forum for People Living with HIV/AIDS Networks in Uganda (NAFOPHANU), to follow up progress with MoH. Further engagements with the district leadership will also be done, to seek feedback on this issue, in order to update citizens on progress.

Commemoration of International days The project through its sub awardees, participated in the commemoration of the International Safe Motherhood day, Anti-Corruption day, and the World AIDS Day. These events were used as advocacy opportunities to present citizens’ concerns to duty bearers who officiated at the commemoration events. These concerns included impediments to the attainment of the 90-90-90 targets for HIV prevention and control, such as inadequate supply of HIV commodities. Additional evidence on shortages related to the 13 Life-saving commodities was also disseminated during these events through letters and or factsheets. Western Region

Copy of Letter from the CAO Kasese to Director General MoH

Literacy Action Development Agency-LADA participating in the safe motherhood day and World AIDS day respectively.

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Central Region In Mayuge district, the Jinja Area Community Federation (JIACOFE sensitized citizens on 90-90-90 targets, and also presented the issue of lack of HIV/TB services on Jaguzi Island, Bwondha and Lwanika landing sites. JIACOFE’s ASK was directed at the Local Council (LC) V Chairperson who was also the guest of honor. In his speech, the LCV Chairperson made a commitment to pursue his council on the need to offer HIV/TB outreach services to the Islanders. JIACOFE is following up this commitment.

National Dialogue on Human Resources for Health As a climax to its nation-wide campaign that included consultative meetings with stakeholders and a media tour to profile the status of HRH and how it is impacting the delivery of health services, ABH organized a stakeholders’ dialogue, to share concerns on HRH and to agree on a common agenda for advocacy. This meeting attracted, representatives from MoH, Parliament, USAID, CDC, WHO, implementing partners such as: IntraHealth, Marie Stopes, and Strengthening Decentralization for

Sustainability, CSOs and the Media. Notable was also Dr. Diana Atwine— the Director of the Health Monitoring Unit in the President’s Office. The Chiefs of Party of IntraHealth and ABH set the platform for dialogue, by presenting evidence on the current staffing levels, and key advocacy issues (including low staffing, poor remuneration, absenteeism and inadequate housing/accommodation) that require fixing respectively. In his response, the Chief Guest (Prof. Anthony Mbonye—who was representing the Hon Minister of Health), pointed out that H.E the President is prioritizing improving health services, driven by the public outcry for the need for improved health services, which was profiled by ABH and other Stakeholders during the recently concluded elections. This would be attained by implementing the 23 guidelines that he issued under his slogan dubbed, “Kisanja Hakuna Mchezo”. The key areas of focus for health under these guidelines are:- improving infrastructure, addressing drug shortages, tackling absenteeism of health workers (especially due to dual employment), addressing lack of accommodation/houses for health workers, improving supervision especially within the Ministry of Local Government, and laying emphasis on disease prevention (given that 70% of diseases are preventable). Prof. Mbonye also informed the participants that MoH had designed a strategy for implementing these issues, on which they had consensus with the president.

Copies of factsheets on 90-90-90 targets and safe motherhood Disseminated in Western Uganda by LADA

The Chief Guest-Prof Mbonye making his remarks

Dr. Atwine-(Then) Director Health Monitoring Unit and now PS Health, makes her submission

Mr. Moses Dombo- ABH Chief of Party presenting

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The following were the major recommendations made during the dialogue: the need for a wider forum that brings together the Ministry of Public Service, Ministry of Local Government, Ministry of Finance, Planning and Economic Development, District Service Commissions to deliberate on the state of human resources for health and priority areas for improvement; MoH should focus on implementing the six key issues from H.E the President’s guidelines; MoH and MoLG should implement performance based rewards, as a way of ensuring improved performance of health workers and the need to keep the pressure on through advocacy. The project is pursuing these outcomes.

Kalangala District NGO Forum (KADINGO) actively participated in pre WAD activities in Kalangala district that led to development of comprehensive documents presented to H.E the President, during the national commemorations held in Kalangala district. These activities included meeting with the Parliamentary HIV/AIDS Committee, the District AIDS Committee, and one-on-one meetings. During these engagements, the following key issues were agreed upon as key talking points for the statement presented to H.E the President of Uganda—who was the Chief Guest: the need to conduct door to door HIV testing and counselling, with possibility of contact indexing; offering health outreach services; increasing health financing through the establishment of the HIV/AIDS Trust Fund; Upgrading the HC IV in Kalangala district to a hospital status; organizing moonlight activities for sex workers and youths, and assessing the quality of services of seven (7) ART accredited health facilities, by conducting a community scorecard.

One ABH Sub-awardee, NAFOPHANU also participated at the national WAD commemoration in Kalangala district. A representative of persons living with HIV (PLWHIV) read their statement highlighting key issues highlighted above, underscoring the need to prioritize HIV funding (especially the National AIDS Trust Fund) that would contribute to averting drug stock outs that risk increasing drug resistance, and switching from lower to upper regimens that are costly. H.E the President made a number of observations and commitments, which included: expediting the upgrading of Kalangala HC IV to a hospital status, availing speed boats to connect health centers, and a ferry to connect to Kyamuswa

Island, all aimed at easing accessibility of treatment by the islanders. H.E the President also pronounced that the

government wouldn’t phase out HC IIs on the Islands, since these were instrumental in bringing health services closer to the communities. KADINGO will pursue the accreditation of these HC IIs as facilities that will be able to provide comprehensive health services to the citizens.

Eastern Region Mbale Area Federation of Communities (MAFOC), Kapchorwa Civil Society Organizations Alliance (KACSOA) and Straight talk Foundation (STF) participated in the commemoration of WAD in Mbale, Kalangala,

Mayuge district LCV Chairperson Omar Bongo, making a commitment during WAD commemoration at Wabulungu Primary school.

Article Published by STF in the New Vision, as part of WAD 2016

H. E President Museveni inspecting NAFOPHANU exhibitions stall in Kalangala District on World AIDS Day

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Bugiri and Kapchorwa districts respectively, under the theme, “Joining hands to scale up HIV prevention”. They presented issues to the duty bearers, which included among others; long distances to ART sites, stock out of HIV commodities, inadequate HIV counselling services, and stigma. One of the community groups was able to deliver a petition to the district leadership, demanding for establishment of Viral Load testing centers in Mbale Regional Referral Hospital so as to minimize the costs of transport and wastage. STF packaged and published evidence in the New Vision and Daily Monitor newspapers with a call to leaders to prioritize addressing stock out of HIV/AIDS drugs; and the need for continuous support supervision including spot checks of health facilities as a way of dealing with health worker’s absenteeism.

Intermediate Result 2.2: Effective participation of CSOs in Government planning and budgeting processes In order to ensure that advocacy issues of citizens concern are incorporated in plans and budgets, a number of planning and budgeting meetings were attended by sub awardees with the support of ABH staff. Below is a table of meetings attended per district and issues presented therein:

Table 1: Summary of meetings attended by sub awardees and issues discussed

Type of meeting attended

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

District Management Council (DMC) meeting

Bugiri, Ibanda, Isingiro

-Non-functionality of Health Unit Management Committee across Bugiri.

-Limited youth friendly services across the lower level health centers in Bugiri district

-Stock out of RDTs, Absenteeism of health workers -Inadequate human resources to provide HIV/AIDS and

Nutrition services at the health facilities

Extended TPC Ibanda Stock out of RDTs, Absenteeism of health workers District HIV

committee Kasese, Kiruhura

-Limited HIV/AIDS services access in the fishing communities

-Discrimination/stigmatisation of HIV/AIDS patients

District Health Management Team (DHMT)

Bukwo, Kapchorwa, Kabale

-Low performance of MCH & EPI Indicators in Kapkoloswo HC III

-Drug stock outs (Insufficient Live saving commodities in Health facilities due to the push system)

-Understaffing in Kapkoloswo HC III - Use of Lower cadres in facilities to prescribe

medicines -Upgrading of yard health centre II to a health centre III -Inadequate skills by some health workers on the new

and long term family planning methods

-In Eastern Uganda, district leadership pledged to continue working with the ABH project to improve on maternal health services in focus districts

Budget conferences

Sironko, Kyenjojo, Ibanda, Kiruhura, Kamwenge,Rukungiri

Kanungu, Kisoro, Sembabule, Kayunga, Luwero, Nakasongola, Iganga, Kaliro,

-Inadequate funds for Primary Health Care. -Construction of sanitary facilities for girls in UPE

schools -Lack of maternity ward at Butunduzi H/C -Stock out of RDTs, Absenteeism of health workers -Lack of HCIIIs for some sub counties, -Malaria and HIV/AIDS Test, Treat and Start policies -MCH and Family Planning -Recruitment of midwives for Health Centre IIIs -Stock out of ART Paediatric drugs Deliveries at the TBAs -Failure to go for Counselling and testing for HIV -Elevation of HCII to HCIII -Introduction of long lasting Family Planning methods

- In Sironko district for example, HUMCs were reconstituted in all sub counties while the budget framework paper integrated their orientation on roles and responsibilities for FY 2017/2018 under unfunded priorities

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Mayuge, Kamuli

District Technical Planning Meeting

Mpigi -Inadequacy of health workers. -Lack of ambulances in HC III’s. -Inadequacy of supplies and equipment.

In Muduuma Health Centre III, evidence from the health facility assessments reveal that health workers are attending their work more regularly,

Sub awardees will continue engaging the district sector heads to advocate for inclusion of community priority issues into the district plans and budgets.

Participation in National government Planning, Monitoring and accountability of Health and social services In order to influence planning and budgeting at national level, the project represented by a national sub awardee Centre for Health, Human Rights and Development (CEHURD) participated in the MoH Maternal and Child Health Technical Working Group (TWG) meetings. CEHURD advocated for the availability of the Life-Saving Commodities and urged MoH and partners to ensure availability of cold chain facilities in public health facilities for the proper and efficient storage of oxytocin; ensure availability of other commodities that control bleeding in expectant women such as misoprostol; prioritize training of health service providers on use of misoprostol; and maintenance of the life-saving devices such as new-born resuscitation devices.

CEHURD also highlighted the need to prioritize the operationalization of the Immunization Fund (Provided for in the Immunization Act, 2016) in the FY 2017/2018. It is also important to note that during the December meeting, a representative from MoH indicated that immunization was included as a priority in the Ministerial Policy Statement for the FY 2017/2018. CEHURD, as a member of the Civil Society Budget Advocacy Group (CSBAG) has ensured that maternal, new born, family planning issues are integrated in the national budget framework paper. ABH Advocacy Officers, participated in the review of the budget framework paper of the MoH, and emphasized the need to allocate resources to RMNCAH, including the recruitment, motivation and retention of critical health workers specifically midwives.

Intermediate Result 2.3: Enhanced co-ordination and collaboration among CSOs During the quarter, the project continued to strengthen and enhance coalition and network building both at national and district level. In Kasese, for example, ACODEV mobilized other CSOs to follow up citizens’ concern of shortage of ARVs in the health facilities in the district. They agreed to petition the Hon Speaker of Parliament if the situation is not improved. ACODEV will continue monitoring stock status of HIV commodities in the district. Proceedings and outcomes of this meeting were reported in the New Vision dated December

19, 2016, see excerpt below In Central region, JIACOFE organized two Coalition meetings (1 in Mayuge, 1 in Kamuli) to discuss HIV/TB and Family planning issues in both districts. In both districts, the key action was to invite the district heads of department for a discussion on issues identified including; the need to ensure that HIV/TB

services/activities are integrated across departments, coupled with ensuring the implementation of the HIV workplace policy.

Article written in the New Vision about the status of HIV Commodities in Kasese district

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In Kalangala district and as part of the pre WAD commemoration (highlighted above), KADINGO organized a coalition meeting for partners in the district aimed at championing issues affecting the quality of HIV services in the district. These included; inadequate funding for Primary Health Care; the push system of health commodities from NMS, lack of transport for emergency health conditions; unreliable power supply, and the need to accredit health center IIs to be able to provide comprehensive health services (including ART services). At national level, CEHURD convened a coalition meeting whose objective was to harmonize advocacy initiatives on maternal and child health undertaken by different members of the coalition. In this meeting, coalition members shared their advocacy efforts and these included; advocacy on newborn resuscitation services, particularly on streamlining the procurement process; assessment of the availability and affordability of the 13 life-saving commodities; and strategies for making the female condoms acceptable by society. Coalition members proposed to follow up actions arising from the emerging issues and these included; advocacy for budget allocation and maintenance of newborn resuscitation devices; advocacy for the purchase of the cold chain facilities for the storage of oxytocin; follow up the quality of oxytocin with the National Drug Authority (NDA), and following the participation/attendance of NDA and NMS in MCH cluster meetings up with the Reproductive Division of MoH of Health. Working together with coalition members, CEHURD will review progress on the identified actions in the next coalition meeting.

Advocacy Advisory Group (AAG) Meeting During the quarter, the project held a meeting with its AAG. Key issues underscored include the need to: engage and advocate more on the systemic challenges affecting the quality of health services in the country; conduct more research on the irrational use of medicines by citizens who are perpetuating this vice to improve the quality of food products; educate citizens on the implications of Uganda graduating to middle income status—for instance, GAVI has put a window of five years of supporting immunization activities in countries to prevent gaps that arise when donors pull out as countries graduate to middle income status; organize a bigger platform that will involve stakeholders from districts, NMS, MoH and CSOs to discuss the chronic challenges related to the supply chain that seem to be contributing to the poor delivery of health services; and involve the AAG more in project field activities, as a way of giving them hands-on experiences and evidence for their national level engagements.

1.3 Result Area 3: Institutional capacity of CSOs strengthened During the quarter July –September 2016, the project finalized the 2nd organizational and advocacy capacity assessments (OACA), with the results analyzed in the quarter ending December 31st, followed by development of a TA plan based on the requests from the sub awardees. The quarter also provided an opportunity to review action plans and identify priorities for support and continue support to sub awardees to address problems using the Plan, Do, Study and Act PDSA approach. Eighteen (18) sub awardees had an opportunity to share their achievements and problems and worked with other CSOs to identify possible solutions which they individually included in their PDSA. One of the sub awardees, Family Live Education Program (FLEP) was also supported to develop its strategic plan.

Key Achievements

Developing a Technical Assistance plan for CSOs Following the completion of the OACA, the organizational development (OD) team analyzed the OACA action plans and identified key areas where the sub awardees requested technical assistance. These were compiled into a Technical Assistance (TA) plan for the project. The plan identifies the key OACA section, issues and type of TA requested and CSOs that require support and the timelines. The plan will guide TA provided to the CSOs. Based on this plan, the team has developed tools for the CSOs and continues to review policy documents. Below is an extract from the TA plan:

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Summary of the TA Plan

The project team will continue to provide support aimed at addressing the priority issues of the CSOs in the coming quarter.

Organizational Section TA requested UDN STF NAFOPHANU LADA ACODEV HEPS ARUWE KADINGO RHU URCS RACOBAO CIDI CEHURD

Governance

Review organizational structure and or develop narrative Dec-16 Aug-16 Dec-16

Governance

Templates for Board TORS /Review constitutions and other boad policies Dec-16 Jun-17

Governance

Conduct board orientation and performance evaluation Oct-16

Advocacy

Review of draft Advocacy strategy documents/ training Jul-16 Jun-17 Mar-17 Mar-17 Aug-16

Advocacy

Develop tools for collecting data that measures the effectiveness and progress towards advocacy goals and objectives Dec-16

Advocacy

Training, review and share guidelines on Policy and budget development and analysis processes Mar-17 Dec-16 Dec-16 Mar-17 Dec-16 Jan-17 Mar-17 Mar-17

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Conducting the Grants Management Collaborative A Grants Management Collaborative (GMC) is an organizational development approach that bring sub awardees together to share their achievements and challenges, identify possible solutions to the problems and use the PDSA on how to address the problem. In December 2016, the project organized the second GMC that brought together 17 sub awardees to share their experience and learn from each other on ways to address challenges affecting the attainment of Advocacy and community engagement goals in their projects. An introduction to the GMC was given as some participants were attending the GMC for the first time. Sub awardees shared their successes and challenges in implementing their first PDSA. NAFOPHANU used the PDSA

to improve communication and reporting by the community linkage facilitators on the stock outs of HIV and TB drugs. This provided timely evidence that was used to engage with MoH and NMS on the status of these commodities. This resulted in NMS delivering buffer stocks to some of the districts. In groups, sub awardees were guided to identify problems in the implementation of their advocacy and community empowerment strategies. The key problems included; inadequate documentation of success stories, collecting

and packaging of evidence for advocacy, strengthening community group initiatives to develop action plans, and improving and increasing duty bearers’ responsiveness. The ABH team developed a PDSA on improving the milestone certification process. Sub awardees facing similar challenges were organized in teams, and will continue communicating among themselves, as a way of sharing strategies and progress on their PDSAs. Each team selected a leader, and formed

WhatsApp platforms to support communication. A technical team member from ABH was assigned to provide ongoing guidance for each team. Below is the list of challenges that each CSO is trying to address through the PDSA.

Supporting FLEP to develop a strategic plan As part of their year three work-plan, FLEP prioritized developing a new strategic plan since their strategic plan was expiring in December 2016. The four-day session was attended by staff, management and board members. The process helped FLEP to reflect on their identity and purpose through participatory exercises on the history, vision and mission review, external environment scan and SWOT analysis. Through creative dreaming exercises, FLEP identified key priorities that will form their strategic plan for the next five years. The team was supported to start working on various approaches to guide the implementation of the plan. This process also helped FLEP to address other areas in their OACA action plan, including; commencing the development of the stakeholder mapping and engagement plan, human resource and staffing plan, costing, and organizational monitoring and evaluation framework, and a one year operational plan. The OD team will provide further support in the next quarter to complete the implementation of action plans.

Quarterly OACA action plan reviews and focused institutional development meetings In year two, the project had a challenge ensuring that sub awardees focus on their OACA action plans, and continuously review progress. This affected the level of implementation of the actions that had been identified. In year three, all sub awardees included a review of OACA action plans in their work-plans. During this quarter, over 80% of the sub awardees held quarterly meetings to review progress on addressing their

CSOs discuss how to improve evidence collection & packaging and use in advocacy

GMC participants, pose for a group photo

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OACA actions. The review focused on seven (7) organizational development areas that included; Governance, Administration, Human Resource Management, Program Management, Advocacy, Financial Management and Performance Management. These reviews are very significant because they help the organization to collectively keep track on the implementation of OACA action plans. For example, one of MAFOC’s actions was orienting staff on the organization’s communication strategy, to help them deepen their understanding of organizational internal and external communications.

During this activity, staff also reviewed their communication strategy in smaller groups and made recommendations that informed the development of the final communication strategy. LADA addressed HR issues related to exit interviews, HIV/AIDS workplace policy and developing a supervision plan. FLEP addressed actions related to governance, especially reviewing their vision and mission statements, stakeholder mapping and analysis. Other sub awardees reviewed and updated their advocacy strategies. The ABH team also held meetings with Management, Finance and Human Resource sub committees and the overall board to discuss organizational development issues including; reviewing OACA action plans, approval and signing of year three sub awards, organizational progress and support to their management teams. The project will continue following up sub awardees and reviewing progress on the implementation of action plans, all aimed at strengthening organizational systems. Planning for NAFOPHANU management handbook and standards One of the key issues identified during the second OACA, was the need to strengthen NAFOPHANU’s coordination and capacity building role with its member networks at national, district and sub-county level. The project plans to support NAFOPHANU in year three, to develop a management handbook and standards to guide their work with district and sub county networks. These standards should help NAFOPHANU strengthen its coordination function and provide clear guidelines for their engagement with the district chapters, which should lead to improved communication, collection and use of evidence on HIV and attainment of the 90-90-90 targets. In November, Initiatives staff and a consultant started planning for this activity, including reviewing of existing documentation from NAFOPHANU, and coming up with a roadmap for the entire process. An outline for the management handbook still under review by NAFOPHANU, has been developed. From the roadmap, the standards will be completed in June 2017, and piloted between July and September. The rollout to other districts will be done in year four.

2.0 PROJECT MANAGEMENT

Pre-award risk assessments of potential sub awardees: Building on conversations with various teams from USAID/PEPFAR, the need to bring on board additional mandates became apparent. Particularly, with the launching of the 90-90-90 goals, the differentiated services delivery model and the Consolidated Guidelines for HIV Prevention and Treatment, as well as the need to enhance the coordination aspects of the program as spelt out in the Strategic Optimization Budget (SBOR), it became necessary to identify sub awardees that will contribute to the consolidation of the national level gains from year 2 of the project, while being the catalysts for accomplishing Advocacy for Better Health’s paradigm shift of galvanizing advocacy efforts at the national level. Similarly, there is need to ensure that effective inroads are built by networks already engaged on specific issues including systemic advocacy related to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH). Consequently, PATH used its strategic involvement in some of these networks to identify three CSOs who will fit the gap, given their national scope, niche, experience, influence and evidence of work. Uganda Network of AIDS Service Organizations (UNASO), the International Community of Women Living with HIV— Eastern Africa (ICWEA), and White Ribbon Alliance Uganda (WRA-U) were identified and pre-award risk assessments conducted. Findings from this assessment have been submitted to the Agreement Officer for vetting.

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3.0 COLLABORATING, LEARNING AND ADAPTING

Conducting the Grants Management Collaborative As earlier highlighted in the report, the project organized the second GMC in December 2016, which brought together 17 sub awardees to share their experience and learn from each other on ways to address challenges they face in implementing their projects. Working in groups, sub awardees identified challenges in implementation of their advocacy and empowerment strategies, analyzed the root causes of these challenges, and identified possible solutions and available opportunities. Sub awardees facing similar challenges formed groups that will continue cross fertilizing and sharing progress on their PDSAs.

Production of a bi-monthly “Advocacy Alerts!” newsletter During the quarter, the project produced and disseminated two editions of the Advocacy Alerts! Newsletter. The purpose of the newsletter is to document and share with staff, partners and donors, simplified information about major events, meetings and other advocacy milestones that the project has been able to accomplish, without waiting for periodic reports which usually carry a lot of detail. The previous editions can be accessed online.

The American Evaluation Association Conference (AEA), 2016 in Atlanta GA, USA. The Advocacy for Better Health M&E Specialist attended and presented at the conference. He shared on the Designing indicators for policy advocacy in a developing world: Experiences from Uganda. The AEA Conference brings together evaluators, evaluation scholars, and evaluation users from across sectors to share and learn from the successes (and failures!) of the international discipline and practice of evaluation. The conference offers a forum for the professional exchange of knowledge and skills related to evaluation. The M & E Specialist had the opportunity to share with and learn from 20 speakers of the over 1000

speakers, majorly through presentations; including participation in workshops, panels, and oral/paper sessions.

The Pan African Social Accountability Learning Lab

The DCoP participated as a panelist at the Pan African Social Accountability (PASA) held in Manzini Swaziland from October 16-21, 2016 themed, “Unlocking Africa’s Potential for Participatory Governance”. The session at which he shared lessons from ABH was entitled, “The East African context and social accountability: experiences, what is and isn’t doable and opportunities for innovation in Uganda, Tanzania & Kenya”. PASA Learning Lab is an annual event that is coordinated by World Vision and affiliate partners implementing social accountability work, as a platform for learning and sharing best practices in social accountability work. This third Lab attracted a total of 103 participants from 13 countries located in Africa, Australia and Canada.

The purpose of the event was to interrogate methodologies on how contextual factors foster and or inhibit social accountability programming and the impact thereof.

The DCoP making remarks on behalf of the delegates at the closing ceremony

The M & E Specialist during his poster presentation

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The Health Systems Research conference in Vancouver In November, two initiatives staff participated in the Health Systems Research conference in Vancouver. The conference provided an opportunity for the project to learn from different experiences in other countries on key issues related to the project. Key to this was community engagement approaches tried in other countries related to developing and reviewing action plans and human resources for health. Experiences were also shared on country ownership of donor funded programs but also on the work of community health workers that can be tapped into to improve performance of the ABH project.

4.0 PARTNERSHIPS The ABH technical team participated in a number of partnership meetings. Noteworthy are the several meetings held with Nutrition implementing partners i.e. FANTA III and SPRING. Key issues discussed during these meetings was the need to harmonize advocacy efforts on issues affecting the quality of nutrition programming in the country, and in sync with the Uganda Nutrition Advocacy and Communication Strategy. One of the major resolutions, was the need to come up with a coordination platform for nutrition advocacy, coupled with advocating for the establishment of a parliamentarian forum to champion issues nutrition advocacy issues for policy change. In collaboration with the Parliament of Uganda and partners such as the Uganda Stop TB Partnership, the Chief of Party (CoP) together with an Advocacy Officer, participated at the launch of the Parliamentary Caucus on TB. At this launch, the CoP called upon policy makers to address systemic challenges that were impeding the prevention and control of TB in the country. These include inadequate financing (underscoring domestic financing), stock out of TB commodities, inadequate community mobilization and limited political support.

Partnering with the CDC funded Local Capacity Initiative being implemented by THETA, ABH co-funded a meeting held between representatives of key populations (KPs) and implementing partners, to improve KP programming in line with attaining 90-90-90 targets for HIV prevention and control. This meeting built on the recommendations made during the inception meeting held in September 2016. Key discussions included the greater need for the coordination of all KP organizations 5.0 KEY ACTIVITIES PLANNED FOR NEXT QUARTER The project plans to accomplish the following key activities during the January to March 2017 quarter:

• Developing citizen activism and advocacy materials to be included in the Citizen Action Toolkit. • Finalizing the project’s Advocacy Communication Strategy. • Continue compiling and disseminating to project partners a monthly e-newsletter that captures the

project’s key advocacy engagements and milestones that happen on a monthly basis. • Continue creating citizens’ awareness on their rights and responsibilities through radio talk shows and

radio spot messages, advocacy forums, and community group meetings. • Continue empowering the communities through their established groups, to regularly track and report

the availability of human resources for health (HRH) and health commodity stock status in relation to HIV/AIDS, RMNCAH, and Malaria.

• Participating in the International Women’s Day celebrations, as an avenue for raising awareness, but also generating debate on issues affecting the delivery of RMNCAH services in the country.

• Work with partners to organize the nutrition partners’ advocacy dialogue. • Organizing a meeting with stakeholders and parliamentarians to kick start the process of developing

guidelines for establishing the Immunization Fund aimed at raising domestic funding for immunization activities in the country, as per stipulations in the 2016 Immunization Act.

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• Continue participating 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.

• Holding the quarterly Advocacy Advisory Group (AAG) meeting. • Conducting regional GMCs for sub awardees • Mentoring and coaching through technical assistance visits and online support for all sub awardees to

finalize development of policies and systems building on the findings of the OACA o Including; Supportive Supervision and Quality Improvement training for JIACOFE, Strategic

Planning session for LADA, Resource Mobilization training for JIACOFE management and Board members and finalizing the management handbook and pre-testing standards for NAFOPHANU.

• Conducting financial management, USG compliance, and NUPAS training for sub awardees • Finalizing the different advocacy strategies for sub awardees. • Conducting data validation visits for sub awardees.

6.0 LESSONS/CHALLENGES

The following were the key learnings for the project during the quarter;

• The festive break, affected the execution of a number of community empowerment and national level advocacy activities, since most institutions had closed by mid-December.

• The provision of uninterrupted technical assistance, is imperative to ensuring the appreciation and ownership of the project’s thematic focus on HIV/AIDS, TB, malaria, nutrition and RMNCAH by sub awardees.

• It is important for the project through its sub awardees to keep track of, and participate at almost all stages of the government planning and budgeting cycle, for the effective integration of issues of citizens concern that are affecting the delivery of quality health services.

7.0 TECHNICAL ASSISTANCE NEEDED FROM USAID/UGANDA

• Continue working with the Agreement Officer Representative (AoR) and other technical staff at the

Mission, to review progress and seek guidance on project implementation, premised on the project’s emphasis of national level and thematic advocacy.

• Seeking the ratification of new sub awardees from the Agreement Officer.