evidence of social accountability_geraldine mccrossan_5.7.14
TRANSCRIPT
Global Health Practitioners Meeting
“Health Starts at the Community”
Silver Springs
May 5th -9th 2014
ACT Health Premise
Changes within Society
(Empowerment of Individuals)
Changes within State (Inclusive and
Responsive Institutions)
Changes at State & Society
Interface(Space for
participation and collective
Voice)
Increased Accountability
and Responsiveness
Where Pilot in Bugiri District Eastern Uganda
Population : 426, 800
33 Health Facilities
5 National partners
Started January 2012
Community Voices –First phase
• 5,912 Households surveyed for development of the CRC
CRC
Citizen Report Card (CRC) Excerpt
Attendance of Health Staff at health centers
Percentage of households who said staff are always at work 43%
Percentage of households who said staff occasionally do not come to work 36%
Percentage of households who said staff are rarely at work 21%
Household rating of medical staff attendance at government health centers
Medical staff attendance at government health centers on survey day
Total number of medical staff allocated to government health centers II.
(National Standard; 3medical staff per HC II X 23= 69)
52 (75% of
what is
required)
Total number of medical staff present in the health centers on the survey days 43 (83%)
Total number of medical staff out for outreach and/or training on the survey
day
0 (0%)
Total number of medical staff out on leave on the survey day 6 (12%)
Total staff absent 3 (6%)
Community VoicesSecond Phase
• 5,912 Households surveyed for development of the CRC
CRC
•2718 engaged in action plan development
Interface Meetings /Action Plans
A sample Action PlanIssue Action (incl timeline & person
responsible)
Status of action Challenges Proposals or Changes to actions
Community unaware of the
services offered at the H/C
The HUMC to establish the sign
post not exceeding August 2013
Not achieved Inadequate and delayed release of PHC fund The in charge should prioritize the issue of
establishing a sign post and act accordingly
upon receiving PHC fund 1st April 2014
HUMC, Local leaders and VHTs
to inform community about the
services offered during static
days at the H/C
Achieved done every
Tuesday and Thursdays in
the week
None HUMC and in charge should write on manila
papers the services offered at the health facility
and pin it against the walls by the 30th of Feb
2014
Health workers to make
appropriate referrals
Achieved by health
workers explaining to the
clients why they are
referred to other Health
facilities
None No change to the proposal
H/C closed when H/Ws go for
outreaches/workshops
At least one health work should
be left at the H/C effective August
2013.
Achieved as a health
worker is always left
behind
Community members come at the health centre
during time of closure
The VHTS should always inform the Community
members to visit the H/C in the right operating
hours i.e. from 8:00am-5:pm effective
14th/02/2014
Community VoicesThird Phase
• 5,912 Households surveyed for development of the CRC
CRC
•2718 engaged in action plan development
Action Plans • 25 most significant change stories collected
Results
Why Most Significant Change (MSC) Stories
• Facilitate community involvement in monitoring and evaluation
• Track unexpected outcomes
• Support the light touch monitoring approach
• Contribute to program evaluation
MSC Collection and Analysis
• In-depth interviews with people are household level
• 1 story per month from each health facility
• Analysis categorizes stories into four domains:• Changes in service quality
• Changes in the community/service provider relationship
• Changes in health outcomes
• Other changes.
Final MSC Story Selection
MSC collected
one story per health facility
every six months
33 over six months
Categorized in Domains
for each health facility one story for each domain
132 stories
Regional Stories Chosen
1 story from each domain
Final Review of regional stories
and a final MSC is chosen every six
months
Example MSCName of storyteller: Naigaga Irene
When did the change happen? May 2013
Changes in health workers’ supervision improves service quality
“In June the in charge was demoted and a new in charge was posted to the health centre. The new in charge is always at the centre and this has resulted into improved service quality because the health workers arrive on time, very active on duty and give appropriate referrals. The high level of supervision has even led to the health workers operating on Sunday which was not the case before.This story is very significant to me because the community can now be sure to find health workers at the health centre and receive health services.”
Example MSCName of storyteller: Kagoya Rebecca When did the change happen? May 2013
Improved client care for mothers!
I raised the mother’s concerns and they were captured in the action plan. This meeting allowed us present these issues directly to the health workers who were present. The midwives have since improved the way they handle mothers and stopped asking for money. This has increased the number of mothers delivering at the health centre. This story is significant to me because the number of mothers delivering at the centre has increased .”
MoH Voices Health Facility Assessments ( 3 times)
Interface Meetings
MSC
Outcome Mapping
Quarterly Reviews with partners
ACT Health Scale Up 16 districts across Uganda
329 health facilities
7 different national partners
In conjunction with an RCT to answer the following research questions:
Does the ACT Health Program lead to greater access to services and an increase in health seeking behavior?
Does the ACT Health Program contribute to downwards accountability among duty-bearers for health services?
Scale Up: Community VoicesACT Health scale up has the potential to involve:
150,000 households in CRC
19,800 community members in action plan development and interface meetings
367 MSC stories collected every six months
Acknowledgments
Questions