ADVOCACY FOR BETTER HEALTH Quarterly Report First Quarter – October 01, 2018 to December 31, 2018

Submission Date: January 31, 2019

Contract/Agreement Number: AID -617-A-14-00004

Activity Start Date: July 01, 2014 and End Date: March 31, 2019

COR/AOR Name: Dr. Nobert Mubiru

Submitted by: Dr. Emmanuel Mugisha, Chief of Party PATH Plot 17 Golf Course Road, Kololo Tel: +256 312 393200 Email: [email protected]

Copied to: [email protected]

This document was produced for review by the United States Agency for International Development Mission (USAID/Uganda).

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ACTIVITY OVERVIEW/ SUMMARY

Activity Name: Advocacy for Better Health

USAID Advocacy for Better Health Project:

Activity Start Date and End Date: 1st June 2014 – 31st March 2019 Name of Prime Implementing Partner: PATH [Contract/Agreement] AID -617-A-14-00004 Number: Communication for Development Foundation Uganda (CDFU), Name of International Community of Women Living with HIV in Eastern Subcontractors/Sub- Africa (ICWEA), National Forum of People Living with HIV/AIDS awardees and Dollar Networks in Uganda (NAFOPHANU), Community Integrated Amounts: Development Initiative (CIDI), NGO Forum (KADINGO), Straight Talk Foundation (STF) Major Counterpart Initiatives Inc. Organizations: Central region: Mpigi, Mityana, Sembabule, Kayunga, Luwero, Nakasongola, Kalangala, Kaliro, Kayunga, Mayuge, Iganga, Kamuli Geographic Coverage Eastern region: Mbale, Sironko, Bududa, Budaka, Pallisa, Kumi, (districts): Kapchorwa, Bukwo, Butaleja, Busia, Bugiri, Namutumba, Western region: Kabale, Kisoro, Rukungiri, Ibanda, Kanungu, Isingiro, Kamwenge, , Kasese, Kiruhura, Bushenyi, Reporting Period: October 01, 2018 – December, 31 2018

ACRONYMS AND ABBREVIATIONS

ABH Advocacy for Better Health AGYW Adolescent Girls and Young Women AMELP Activity Monitoring, Evaluation and Learning Plan AOR Agreement Officer Representative CAO Chief Administrative Officer CDFU Communication for Development Foundation Uganda CIDI Community Integrated Development Initiative COP Chief of Party CSO Civil Society Organization CSW Commercial Sex Workers DHE District Health Educator DHO District Health Officer DSDM Differentiated Service Delivery Model GFF Global Financing Facility HUMC Health Unit Management Committee ICWEA International Community of Women Living with HIV in Eastern Africa KADINGO Kalangala District NGO Forum KPP Key and Priority Populations M&E Monitoring and Evaluation MSM Men who have Sex with Men MOH Ministry of Health NAFOPHANU National Forum of People Living with HIV/AIDS in Uganda NUPAS Non-US Organizations Pre-Award Survey OACA Organizational and Advocacy Capacity Assessment PLHIV People Living with HIV RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health STF Straight Talk Foundation UAC Uganda AIDS Commission USAID United States Agency for International Development

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1. ACTIVITY DESCRIPTION

1.1 Activity Description/Introduction

The USAID Advocacy for Better Health (ABH) project is a five-year project implemented by PATH in collaboration with Initiatives Inc. It empowers citizens to demand for improved quality, availability and accessibility of health and social services. The project covers 35 districts in western, central and eastern .

The project is grounded in the belief that; IF citizens’ knowledge and awareness of their rights and responsibilities were increased (to stimulate collective consciousness); and IF the capacity of CSOs was built to effectively empower and represent communities, THEN, citizens would believe and have confidence that they can hold their leaders accountable and influence them to change health and social policies in their favor. This empowerment and confidence would motivate citizens to get organized; reach consensus on their priorities and plans of action; and demand better health and social services from their duty bearers. The persistent collective voice and actions from citizens and CSOs would compel leaders and duty bearers to respond by changing the necessary policies and taking other actions that lead to improvements in the accessibility, availability and quality of health and social services.

ABH aims at achieving three Results Areas:

1. Citizens demand improved quality of health and social services, 2. CSOs effectively advocate for issues of citizens’ concern in the health and social sectors, and 3. Institutional capacity of CSOs strengthened

The thematic areas of focus for the project are; HIV/AIDS, TB, Malaria, Nutrition, Maternal and Child Health, Family Planning and orphans and other vulnerable children. ABH works with communities and civil society organizations (CSOs) to generate evidence and advocate to the responsible duty bearers on core advocacy priorities aimed at addressing systemic impediments to service delivery. The priorities include: i) Increased Domestic Financing for health and social service delivery, ii) Human Resources for Health (availability, motivation and retention), and iii) Health Commodity Security (improvements in the supply chain).

1.2 Summary of Results to Date

Table 1(a): PMP/Project Indicator Progress - USAID Standard Indicators and Project Custom Indicators

Strategic Objective: [to enhance the capacity of citizens and Civil Society Organizations (CSOs) to carry out effective advocacy for increased investment and accountability by decision-makers so as to improve the quality and availability of essential health and social services in 35 target districts in Uganda] Quarterly Status – FY Annual Baseline data FY 2018 Comment 2019 Performan Annual ce Indicator Data Source Annual Cumulative Achieved Year Value Cumulative Q1 Q2 Q3 Q4 Planned to Date (in Actual target %) Intermediate Result (IR): R1: Citizens demand improved quality services Sub-IR: IR1.1: Increased citizens’ awareness of their rights and responsibilities Sub-IR: IR1.2: Community groups advance priorities for improved health and social services. INDICATOR 5: % of community Sub grantee CSO 2014 0.0% 64% 80% 284 74% groups whose action plans advance Progress Reports into implementation phase lIR1.3: Improved engagement between citizens and duty bearers INDICATOR 6: Number of Sub grantee CSO 2014 0 479 473 284 59% functional advocacy forums at sub Progress Reports county level. Intermediate Result (IR): R2: CSOs effectively advocate for issues of citizen’s concern in health and social sectors.

INDICATOR 7: % of sub Sub grantee CSO 2014 0.0% 90% 64% 0 Zero has been grantee CSOs that demonstrate Progress Reports reported for Q1 influence on health and social because of change services agenda in the operational model of the project where PATH is doing direct implementation instead of using CSOs

INDICATOR 8: % of districts District Annual 2014 0.0% 75% 77% 0 This is an annual with annual work plans that include Development indicator citizens’ concerns for improved Plans/ Project health and social services records Sub-IR: 1R2.1: Increased utilization of evidence by CSOs to inform advocacy INDICATOR 9: % of CSO Sub grantee CSO 2014 0.0% 80% 133% 0 Zero has been advocacy initiatives which are Progress Reports reported for Q1 supported by evidence because of change in the operation model of the project where PATH is now doing direct implementation instead of using CSOs

IR2.2: Effective participation of CSOs in local government planning, monitoring and accountability of health and social services INDICATOR 10: % CSOs Sub grantee CSO 2014 0.0% 80% 188% 0 Zero has been actively involved in public sector Progress Reports reported for Q1 planning processes. because of change in the operation model of the project where PATH is now doing direct implementation instead of using CSOs IR2.3: Enhanced co-ordination and collaboration among CSOs INDICATOR 11: Number of Sub grantee CSO 2014 20 4 4 0 Zero has been CSOs that are involved in joint Progress Reports reported for Q1 advocacy initiatives because of change in the operation model of the project where PATH is now doing

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direct implementation instead of using CSOs

Sub R3: Institutional capacity of CSOs strengthened INDICATOR 12: % of CSO Organizational and 2014 0.0% 80% 82% 0 This is an annual with overall improvements in Advocacy Capacity indicator organizational capacity Assessment INDICATOR 13: % of sub- Organizational and 2014 0.0% 90% 64% 0 Zero has been grantee CSOs that demonstrate Advocacy Capacity reported for Q1 improvements on the Advocacy Assessment because of change components of the Organizational in the operation and Advocacy Capacity Assessment model of the (OACA) project where PATH is now doing direct implementation instead of using CSOs

INDICATOR 14: Number of Organizational and 2014 0 8 10 0 This is an annual sub-grantee CSOs that attain Advocacy Capacity indicator adequate performance as defined Assessment in Organizational and Advocacy Capacity Assessment. INDICATOR 15: Number of Organizational and 4 3 0 This is an annual sub grantee CSOs with Advocacy Capacity indicator management systems that qualify Assessment them to receive direct donor funding in accordance with USAID’s NUPAS

2. ACTIVITY IMPLEMENTATION PROGRESS

2.1 Implementation Status

This should consist of a brief summary description of activities implemented per Intermediate Result Area, and include what was planned versus what was actually achieved. The narrative explaining the table is entered in 2.2 or in annexes.

Summary of planned Actual achieved in quarter Activities shifted activities in quarter to next quarter

Result Area 1: Sustain media engagement 90 Radio and 30 TV spot messages Citizens demand through TV, radio and print on domestic health financing were improved quality media with a focus on broadcast on 2 radio stations (Radio services advocacy messages on One and CBS FM) and 2 TV stations domestic health financing for (NTV and NBS television) Intermediate Result delivery of HIV/TB, 1.1: Increased citizens’ MCH/FP, Malaria and awareness of their Nutrition services rights and responsibilities related to health and social services

Intermediate Result Provide technical support to 465 community groups in 341 1.2: Community community groups to districts received technical support groups advance conduct health facility from project staff to conduct facility priorities for improved assessments, identify service assessments, organize meetings and health and social delivery gaps and hold develop advocacy action plans services regular meetings to develop advocacy action plans to guide their engagements with duty bearers.

Conduct reflection/review ABH held district-level reflection meetings with community meetings in 34 districts, attended by groups to share learnings, representatives of community best practices and groups from all the sub counties in consolidate advocacy issues these districts. Each group was to be advanced to district represented by two people leaders for action. (advocacy champion and group chairperson) reaching 930 participants.

1 Kyenjojo district, which has 14 community groups, was still having unresolved issues with the DHO’s office, which the project leadership was handling, so there was minimal engagement with community groups. However, project staff continued to engage the group leaders on one-on-one basis to encourage them to keep their momentum on ground. Intermediate Organize and conduct ABH conducted advocacy forums at Result 1.3: advocacy forums at district district level in 30 districts. In these Improved level for citizens to engage forums, community group leaders engagement between their duty bearers on and advocacy champions presented citizens and duty service delivery issues health delivery issues generated from their health facilities to the bearers related to the project's thematic areas leaders at district level. The forums came up with recommendations on (HIV/AIDS/TB, MCH, FP and priority issues that the groups would Nutrition). follow up with responsible duty bearers, who included sub county councilors, LCIII chairpersons and chairpersons of health unit management committees

Conduct a project-wide Documentation was done through documentation exercise to both video and written narratives in profile impact stories a sample of seven districts across through written narratives, the three regions. Consultants in videos and photos on citizen filming, photography and technical mobilization, empowerment, writing executed the exercise. The social accountability, policy stories that were collected are being advocacy and organizational packaged in form of short videos, capacity building. while the written narratives will be shared in different formats such as blogs, magazine, social media platforms and other online features.

Result Area 2: CSOs Generate and package Through NAFOPHANU, ABH effectively advocate evidence on the systemic facilitated 13 district network for issues of citizen’s impediments to HIV & AIDS coordinators (District linkage concern in health service delivery including facilitators) to track, generate and and social sectors evidence on the roll out of package information/ evidence on the “test and treat” policy the roll out of the test and treat, Intermediate Result and the DSDM models. DSDM and performance of the 90- 2.1: Increased 90-90 target. utilization of evidence by CSOs to inform advocacy

Hold one-on-one advocacy One meeting was held with the key meetings with the Director policy makers at UAC (Director for Policy and Planning at General, Director Planning and the Uganda AIDS Policy, and Director Partnership) to Commission (UAC), and the discuss progress towards the Government Solicitor approval and operationalization of General, to finalize the draft the National anti-HIV Stigma and Anti- HIV Stigma and Discrimination Policy. The Director Discrimination Policy. Planning and Policy informed the ABH team that the policy is with the Solicitor General’s Office for alignment with the legal requirements, constitution and key priorities before it can be presented to the UAC board for approval. Create platforms for key and ABH held 12 advocacy forums in 12 priority populations (KPPs) sub counties spearheaded by such as advocacy forums at key/priority population groups in sub county and district level Bugiri and Busia districts, where to engage with decision issues affecting effective delivery of makers thereby contributing health services to these groups were to increased recognition of presented to duty bearers for KPPs rights, roles, and action. The forums were preceded responsibilities, and by consultative meetings with appropriate redress of policy district and sub county leaders in gaps related to health and Bugiri and Busia to discuss the social service delivery to Uganda US Mission Country these populations. Operational Plan 18 (COP 18) and seek their support in implementing the proposed interventions targeting key/priority population groups. Intermediate Scale up activities aimed at Through NAFOPHANU, ABH Result 2.2: Effective socialization of the organized and convened 26 district participation of CSOs Differentiated Service engagement meetings to engage key in local government Delivery Model (DSDM), duty bearers on issues identified in planning Test and Start guidelines, the sub-county PLHIV dialogue 909090 targets, and meetings on the status of monitoring their implementation of the Test and implementation in 14 Treat, the Differentiated service PEPFAR priority and ABH delivery model(DSDM) and the 90- focus districts that have 90-90 targets. HIV/AIDS as a primary thematic area of focus.

Hold national and regional One national level and three level engagement meeting regional level meetings were with Key conducted targeting 22 Populations/Priority organizations that are involved in Populations to discuss issues advocacy initiatives and health affecting them, and develop service delivery targeting KPPs. Up strategies and to 119 participants attended these recommendations that can meetings and these included; sex enhance better service workers, truck drivers, fisher folks, delivery for KPPs in the MSM, bodaboda riders, Injecting country. Drug Users, Adolescent Girls and Young Women (AGYW) and Transgender people among others. Monitor the roll-out and a) ABH, through ICWEA, implementation of the conducted monitoring visits in the Differentiated Service eight districts where the DSD model Delivery Model in Iganga, is already being implemented. The

Template Last Updated: May 18, 2018 Nakasongola, Kyenjojo, project team met with 20 members Kasese, Ntungamo, of the District Health Teams, visited Rukungiri, Kiruhura & eight health facilities and engaged 17 Kanungu Districts beneficiaries of the DSD model. Beneficiaries said the model has already brought some relief to the health care workers since the facilities are now decongested and health workers accord clients more time while handling their issues. Attend Maternal and Child ABH senior advocacy staff attended Health (MCH) Technical three MCH technical working group Working Group (TWG) meetings where the issue of meetings at Ministry of shortage of oxygen at national and Health (MOH) to present regional referral hospitals was issues around accessibility presented. The TWG recommended and availability of bringing on board in subsequent Reproductive, Maternal, meetings a representative from the Newborn, Child and infrastructure division of MOH to Adolescent Health provide updates and a way forward (RMNCAH) services in the on how this issue is going to be country addressed.

Hold follow up meetings One meeting was held and attended with RMNCAH Civil Society by more than 100 civil society Coalition to discuss organizations to review the progress of Investment case community scorecard for the GFF for Global Financing Facility investment case to include all the (GFF) implementation. RMNCAH indicators.

Convene a meeting for the One meeting was held in Jinja for Multi- Stakeholder Partners the Multi-Stakeholder Partners Nutrition Advocacy and Nutrition Advocacy and Communication platform Communication platform. Participants reviewed the national advocacy and communication strategy for nutrition. They also drew an action plan to support harmonization of the M&E framework for the strategy. Sub Result Area 3 – Conduct a mock Non-U.S. Mock NUPAS conducted with Institutional Organization Pre-award MAFOC and CIDI. A consultant Capacity Building Survey (NUPAS) for the facilitated the exercise. Two board Mbale Area Federation of members and the staff of MAFOC Communities (MAFOC) and attended the MAFOC assessment. Community Integrated Four board members and all CIDI Development Initiative staff attended the CIDI mock (CIDI). NUPAS.

Conduct finance training and Conducted finance training for continuous technical MAFOC and CIDI finance and support for MAFOC and administration staff based on the CIDI. gaps identified in the mock NUPAS. Also provided TA to MAFOC and CIDI in areas identified in the mock NUPAS by the Finance Consultant and Organizational Development (OD) team specifically to review policy and program documents.

Undertake grants Using a grants management capacity management capacity assessment tool, ABH conducted assessment and training for assessments and a grants the four ABH FY5 grantees: management training for the four Kalangala District NGO CSOs to address gaps identified in Forum (KADINGO), the capability assessments. Topics Straight Talk Foundation included: work planning, monitoring (STF), The National Forum and reporting, finance, and PEPFAR of People Living with HIV COP 18. CSOs created action plans Networks in Uganda based on the assessment results, (NAFOPHANU), and the allowing them to begin addressing International Community of gaps immediately. Women Living with HIV Eastern Africa (ICWEA).

Prepare KADINGO to ABH drafted, presented, reviewed support and coordinate and finalized the draft Management member organizations to Handbook with KADINGO implement PEPFAR leadership and 11 member advocacy priorities, including organizations. Using the services of a introducing KADINGO consultant, ABH developed member organizations to standards to guide KADINGO the handbook and members in advocacy and associated management organizational responsibilities. The standards. members were also oriented on the handbook and performance standards.

Finalize the ABH longitudinal Initiatives Inc., finalized a longitudinal case study “Lasting case study focused on achievements Organizational Change: CSO over the duration of the project. Case Studies from the The study involved gathering Advocacy for Better Health information on successful Project.” implementation of capacity building plans and advocacy strategies. The final document “Lasting Organizational Change: CSO Case Studies from the Advocacy for Better Health Project” was written and prepared for publication by

Template Last Updated: May 18, 2018 Initiatives-Boston. M&E Develop End of project The protocol was developed and evaluation protocol and submitted to USAID for review. submit it to USAID Mission However, as the project for review experienced more budget cuts towards closure, the planned end of project evaluation was dropped in the revised year 5 work plan that was submitted to USAID in December 2018. Data validation in 35 Data validation was conducted in 34 districts using the district- districts (excluding Kyenjojo). The based community group data collected was used to update meetings model the progress on performance of core indicators under Result Area 1 that are reported on every quarter.

2.2 Progress Narrative

This brief narrative (2 pages) should respond to the following questions:

a) Is the activity on/off track as far as work plan/targets in terms of (1) overall program progress for year and (2) the current reporting period (quarter)?

b) What are the few, key challenges the activity has experienced during the quarter and how did the activity intend to address the challenges and adapt the programming?

If more space is needed to describe what has actually been achieved in the quarter or to respond to above questions, please annex the information. The quarterly report core sections aim at allowing USAID/Uganda to compile and analyze clusters of activities and adaptive project management. For activity management purposes, please agree with the Agreement Officer’s Representative or Contracting Officer’s Representative (AOR/COR) on what information and visuals need to be included.

INSERT BRIEF NARRATIVE ON PROGRESS TO DATE, LESS THAN TWO PAGES a) Is the activity on/off track as far as work plan/targets in terms of (1) overall program progress for year and (2) the current reporting period (quarter)?

The project remained on track with a major focus on ensuring it fulfils its mandate of attaining certain core indicators in its Activity Monitoring Evaluation and Learning Plan (AMELP). Being the last year of implementation with a few months to close out, program activities had been planned to last for a maximum of 3 months to allow staff and partners to write reports and be involved in final project close out. All sub-awards with CSOs were initially limited to 5 months, although later this was officially changed to 3 months (quarter 1) after year five budget was reduced further.

All the activities implemented in the quarter by five sub-awardees (CDFU, ICWEA, NAFOPHANU, STF and KADINGO) were mainly focused on contributing to PEPFAR COP 18 priorities. The activities focused on i) Supporting CSO engagement in providing independent oversight of the national HIV response to promote transparency and quality of HIV services, ii) Strengthening capacity of CSOs to advocate for PLHIV and KP/PP beneficiaries, promote human rights and community level HIV/AIDS priorities, and combat stigma and discrimination, and iii) Strengthening capacity of CSOs to mobilize PLHIV and KP/PP beneficiaries, promote human rights and community level HIV/AIDS priorities including HIV testing services.

Other activities at district and national level implemented by the project staff under the direct implementation approach that PATH adopted in year four, continued to focus on advocacy issues across the rest of the thematic areas of MCH, FP and Nutrition, especially in regard to stock out of commodities and availability of the required human resources for health.

b) What are the few, key challenges the activity has experienced during the quarter and how did the activity intend to address the challenges and adapt the programming?

First, the project experienced a serious budget cut that compelled it to make adjustments in its implementation model. This did not happen once but twice, within the same quarter. Originally, year five-planned budget was $2,316,145. The first revision was done when the mission guided that the available year five funding should not exceed $1,471,449. However, when we requested for additional obligation on December 5, 2018, we were advised by the mission that there will be no additional obligation but to scale down and use the available funds. We therefore scaled down our activities, to align with the new end of project date of 31st March 2019. PATH had to re-think its project implementation approaches to ensure we continue with core activities and make progress on the AMELP indicators. For instance, at district level, advocacy forums which initially were being implemented at sub county level were brought to a central location (district level) to ensure the issues that are being pursued by community groups can still have one audience from the district level decision makers. The forums ensured all sub counties were represented by groups, councilors, health unit management committee (HUMC) chairpersons and LCIII chairpersons. At national level, the project identified five (5) CSOs to continue implementing PEPFAR COP 18 priority activities. One of them, CDFU, supported all advocacy- related communication activities. These activities happened as planned and the outcomes were quite encouraging. This approach still helped to score well on the indicator under citizen empowerment.

Secondly, a number of senior leadership and technical staff left the project to pursue opportunities elsewhere hence creating a big gap in human resources. This challenge was managed by way of re-hiring majority of the former fellows and interns as temporary hires to fill the gap created. These had completed their fellowship/internship period in September 2018 and they had been equipped with the right technical skills to manage some of the key program activities.

Template Last Updated: May 18, 2018

Thirdly, the project also experienced a relationship challenge with the Office of the District Health Officer (DHO) in Kyenjojo district. This stemmed from the time one of the project’s sub-awardee based in Fort portal (Kabarole Research Centre) withdrew from the project in year three and was replaced with another one based in Kasese (Action for Community Development). The DHO refused to cooperate with the new partner and discredited the project as not necessary in the district, yet the heath facilities in the district were experiencing stock out of drugs, health worker absenteeism and other service delivery gaps as per reports from community groups. He never wanted his department to be portrayed as having any challenges, yet the project was there to support him in overcoming such challenges through evidence-based advocacy.

The Chief of Party for the project at that time, together with key technical staff intervened by holding a dialogue with the DHO and other top leaders in the district. The DHO was not relenting on his opinion about the project. He even went ahead to write direct to the Mission about his misgivings about the project. With continuous engagement with other district leaders to make them understand the goal and objectives of the project, the DHO was summoned and cautioned for overstepping his mandate when he sent communication directly to USAID without going through the chain of command in local government. The LCV chairperson, Mr. William Kaija, during a one- on-one meeting with project staff said; “it was bad of him to communicate to USAID without permission of government”. He emphasized that the top offices of the LCV Chairperson and the Chief Administrative officer (CAO) are the ones with the mandate to communicate to USAID. He said they condemned the actions of the DHO for disrespecting his seniors and cautioned him never to do it again.

In December 2018, the ABH program team visited Kyenjojo district to hold pre closeout meetings with key district duty bearers especially the DHO, DHE, CAO, District Planner and LCV Chairperson. The DHO attended the meetings and was very cordial happy about the project. During the same visit 3 community groups were also visited to establish progress made in their advocacy work and how they intended to continue without PATH/ABH. These meetings were fruitful and it was clear that district leadership understood the project purpose and the work that had been done through the 2 CSOs (KRC and ACODEV). Some of the actions agreed upon during these meetings included; the need for PATH to share with the district the closeout plan and status report on advocacy initiatives in the district and across the project scope. PATH was asked to share project materials that demonstrate citizen-led advocacy as a strong pillar in identifying and addressing some of the service delivery challenges.

3. ADAPTIVE MANAGEMENT APPROACH AND GUIDING PRINCIPLES

This section should provide progress updates on the Guiding Principles (GPs). Indicators that are applicable to the award are included in section 1.2. This section aims at providing additional narrative to how the activity is implementing selected GPs during the quarter. The full explanation of each Guiding Principle is found in the GP annex of CDCS 2016-2021. See also the introductory sections of the CDCS for the intended impact of the Guiding Principles and the adaptive management approach. Please note that all Guiding Principles do not need quarterly updates. Guiding Principles which require quarterly reporting, when applicable to the activity, include: GP number 1. Collaboration, Learning, and Adapting (CLA), number 3 and 4. Inclusive Development, and number 6. Partnerships. Please ensure that each section below responds to the following questions: a) How were the Guiding Principles implemented during the quarter? b) What was achieved by implementing the Guiding principles?

3.1 Collaboration and Stakeholder Engagement

The narrative (no more than 1 page) should succinctly describe progress on collaboration with USAID-supported activities in common regions of operation and engagement with stakeholders (defined collaboratively with the USAID AOR/COR) to deliver integrated services to target populations. Please provide progress updates of the quarter on the following Guiding Principles if applicable to the activity: 1. Apply a holistic approach to CLA (collaboration efforts) 2. Ensure broad and inclusive stakeholder engagement 6. Prioritize partnerships that enable Ugandan-led development 11. Apply a facilitative approach 15. Foster leadership as a lever for change

The report must include products and results of collaboration that improve implementation approaches and development practice broadly.

Template Last Updated: May 18, 2018 INSERT BRIEF NARRATIVE ON COLLABORATION AND STAKEHOLDER ENGAGEMENT, LESS THAN ONE PAGE

District and sub county-based advocacy forums remained a major platform for collaboration and stakeholder engagement bringing together citizens, community-based organizations, political and civil servants at various levels, USAID Implementing Partners, media, health workers, and members of health unit management committees to engage on issues that affect quality health delivery.

In all these forums, the citizens’ voice came out strongly on challenges that continue to impede service delivery by way of presenting evidence generated from their regular monitoring of health facilities to identify gaps. The duty bearers at these forums made commitments and promised to take action on what fell in their mandate. The advocacy forums also provided space for social accountability where leaders had an opportunity to provide information that citizens were not always privy to, such as change in policies and priorities, new budget allocations, plans in the pipeline relating to provision of health and social services, utilization of public resources for the common good, among others. In all these engagements, advocacy champions and leaders of community groups have remained at the helm of facilitating citizen-led and evidence-based advocacy after building their leadership capacity through a number of trainings.

Through its sub-awardees, NAFOPHANU, ICWEA and KADINGO, the project also held a series of engagements with members of PLHIV networks regarding socialization of the DSDM, the test and start policy and 909090 treatments targets. Other network members had an opportunity to learn about the management handbook that is streamlining operations and coordination efforts of all organizations that subscribe to the umbrella organization, NAFOPHANU.

As a result of implementing some of the applicable guiding principles, the project has seen greater commitment and appreciation of the mechanism and its community mobilization and empowerment model. A number of district leaders such as DHOs and CAOs have praised it and promised more support to ensure the groups continue identifying and reporting to them issues that impede service delivery. Some leaders promised to officially recognize the groups by giving them mandate letters so that the lower level cadres in service delivery can cooperate with them and always provide them with information whenever they are carrying out health facility assessments.

3.2 Learning and Adaptation

The narrative (no more than one page) should provide progress updates of the quarter on the following Guiding Principles: 1. Apply a holistic approach to CLA (learning and adaptation efforts) 5. Seek to do business differently 9. Maintain a problem-driven focus 12. Emphasize operational considerations

Please highlight a few examples of implementation findings, successes or failures, that have generated adaptations in the program during the quarter. Please also highlight any implementation findings that will have a larger impact on the performance of other activities in the project. The narrative should specifically report on a) increased ability of USAID implementing partner to respond to the needs of target groups by using learning, b) instances of learning applied to influence decision making, resource allocation, and contextual shifts, and c) increased efficiency in intervention implementation. INSERT BRIEF NARRATIVE ON LEARNING AND ADAPTATION, LESS THAN ONE PAGE Based on the government sanctioned district performance league table of 2017/18, it was found that was one of the poorly performing districts in critical health and social service indicators. After attending People’s Parliament in Butaleja that discussed high teenage pregnancy rates in the district, district leaders requested ABH to support them in a visit to any of the well performing districts to learn some of the strategies used and best practices in addressing teenage pregnancy. The same problem was affecting the neighboring districts of Namutumba and Pallisa. ABH then organized a combined exchange visit for the district leaders of Butaleja, Namutumba and Pallisa to Bushenyi, Ntungamo and Kabale. The choice for the three districts to be visited was based on the same district league table that put Bushenyi and Kabale in the top ten districts and Ntungamo under the most improved districts. In addition, Bushenyi had greatly built community resilience hence poverty reduction among citizens.

The purpose of the visit was three-fold; i) facilitate experience sharing among the district leaders of the visiting and host districts, ii) develop new strategies of addressing poverty, teenage pregnancy and school dropout and iii) document best practices in teenage pregnancy prevention and management in the host districts for replication in the visiting districts. The leaders were fired up and have created their own action platforms to pursue recommendations from the visit. For instance, in Butaleja district the leaders have already initiated the process of developing a district ordinance to eliminate child marriages and teenage pregnancy.

In adapting to a resized budget for year five, the project also adopted the approach of conducting district-based advocacy forums instead of sub-county based ones. This approach was found to be very effective and efficient because it reduced on the frequency and cost of holding these forums at sub county level but focused on the effectiveness and efficiency. Each group had an opportunity to package their issues and present them to district decision makers, who were always difficult to bring down to sub counties. Besides, most of the issues identified by the groups at health facilities needed resources to be addressed and the district level leadership had a higher mandate in determining how and when these resources could be allocated. Majority of the district leaders appreciated the approach and have committed to continue supporting and giving a listening ear to the groups whenever they present to them service delivery-related issues from the lower health facilities.

3.3 Inclusive Development

Please provide a progress update (no more than 500 words) on the following Guiding Principles: 3. Harness youth-appropriate approaches 4. Infuse and prioritize inclusive development (includes but is not limited to empowering women, youth, indigenous peoples, LGBTI and People with Disabilities.)

The narrative should specifically report on a) what interventions were implemented during the quarter to achieve the Guiding Principles and b) how did those interventions lead to a more inclusive development?

INSERT BRIEF NARRATIVE ON INCLUSIVE DEVELOPMENT, LESS THAN ONE PAGE

ABH, through one of its sub-awardees (Straight Talk Foundation) conducted an orientation of representatives of Key and Priority Populations (KPPs) from twenty sub counties in Bugiri and on the PEPFAR priorities spelt out in the COP 18. Groups included those for People Living with HIV (PLHIV) and other key priority populations (KPPs) like Commercial Sex Workers (CSW), bodaboda riders, and truck drivers, Men who have Sex with Men (MSM) and fisher folks. Participants were educated on tracking and documenting evidence on commodity stocks and health worker availability at health facilities and empowered them to be in position to amplify their voices as active agents of change for better health services in their respective communities.

Other strategies that these groups were oriented on included the regular monitoring of health services, monthly action planning meetings and advocacy forums to engage leaders on issues affecting health in the localities. Central to these efforts was to also increase knowledge and awareness on citizen health rights and responsibilities, government policies, guidelines and standards for access and utilization of HIV/AIDS services especially the Test and Treat, adolescent health services and enhancing their ability to identify, articulate and take advocacy actions relative to community needs.

At national and regional level through ICWEA, ABH worked hand in hand with the national level organizations of Key/Priority Populations to organize national and regional level meetings with a specific objective to collate issues that affect key/priority populations’ access to HIV services. This information would be used in engaging duty bearers and service providers on the need to provide non-stigmatizing and discriminative services, policies and laws for key/priority populations. More than 100 representatives of key/priority populations from national to regional level networks participated in these meetings.

4. LEADERSHIP DEVELOPMENT

Leadership development is an Intermediate Result and a Guiding Principle in CDCS 2016-2021. If applicable to the specific award, please provide a progress update of the quarter. If not applicable, leave blank. If leadership development of partners is reported in section 1. and 2., the narrative here can solely focus on leadership development of staff. If not, all leadership activities should be described here. Please provide updates on a) activities that have been implemented, b) planned outcomes of those activities and c) indications of results.

Leadership Planned outcome in Indications/examples of development activity quarter outcomes

Participation by MAFOC Increased awareness of board Improved organizational and financial and CIDI staff and board members on roles and systems and policies in line with members in the mock responsibility. Development of NUPAS assessment and action plans. NUPAS procedures and policies to improve CSO management and implementation.

Management Capacity Management capacity of CSOs The assessment identified the existing Assessment and Training strengthened. policies and procedures of the CSOs. for CSOs CSOs developed action plans to address identified capacity gaps and training was carried out to build the CSO capacity.

Exchange learning visit to District leaders developing Action plans by each of the districts western districts specific action plans detailing represented in the learning exchange involving top leaders in how they intend to replicate visit. the eastern districts of the best practices in leadership Namutumba, Butaleja and they had found useful during Commitments by the leaders to do Pallisa. the visit to improve their own things differently to achieve better development indicators outcomes in their district programs aimed at addressing poverty, teenage pregnancy and school dropouts.

5. MANAGEMENT AND ADMINISTRATIVE ISSUES

Describe briefly any key management issues such as activity staff changes, software and procurement issues, etc. Please also list all upcoming procurement actions that require A/COR approval/notification.

INSERT BRIEF NARRATIVE ON MANAGEMENT ISSUES, LESS THAN HALF PAGE

During the quarter, ABH experienced top-level project management staff changes with the Chief of Party and Deputy Chief of Party leaving the project. Other people who left the project include the Acting Regional Coordinator Western and IT Officer. As the team became leaner on ground yet the project was ending, a decision was taken not to advertise their positions but to reallocate their duties to the remaining staff.

For instance, USAID approved PATH Country Director to be the Chief of Party while the roles of the Deputy Chief of Party were distributed amongst three other technical staff whose competence to manage these roles was deemed satisfactory. The project also rehired former Fellows and Interns to work as Temporary Hires to fill the gap that was created by the absence of sub-grantee CSOs in the districts to conduct community empowerment and advocacy activities at district and sub county levels.

As the project winds up, majority of the technical staff and temporary hires have been given notice of termination of their employment contracts as part of the normal and anticipated project closure processes. Nearly 90 percent of these staff will leave the project at the end of January 2019. A few program and finance staff that will remain will be responsible for managing the close out process including overseeing the disposal of assets, financial reporting, closeout of all active sub-awards with CSO partners and compiling a number of reports (quarterly, annual and end of project).

6. PLANNED ACTIVITIES FOR NEXT QUARTER INCLUDING UPCOMING EVENTS

Indicate opportunity/need for media and/or USAID/Uganda or other US Government involvement, particularly for USAID project monitoring site visits.

INSERT BRIEF NARRATIVE ON PLANNED ACTIVITIES, LESS THAN HALF PAGE

In the second quarter (January to March 2019), which will be the last one before the project completely closes out by March 31st, 2019, ABH plans to implement the following activities;

 Closeout engagements with district leaders in all the 35 districts and 479 community groups. This will be in form of disseminating and distributing official close-out letters, district project close status reports and certificates of recognition to the groups, their advocacy champions and chairpersons.  Final project dissemination planned at USAID. Since the project could not have a budget to hold a national level close out event, a request was sent to USAID through the project’s AOR to allocate time on the Mission calendar when the project senior team can present/disseminate end of project documents and communication products.  Complete production of short videos and story narratives profiling ABH project and its impact/successes. The raw materials/footage were gathered from ABH districts with the support of consultant filming and documentation experts.  Compilation and submission of end of year 5 annual report to USAID. ABH will profile its activities for the two quarters that made up its fifth and final year into an annual report using a standard USAID template.  Compilation and submission of end of project report to USAID. This will be a comprehensive report that looks at all the five years of the project. Its structure will be based on guidance from USAID.  Disposal of assets based on the USAID approved disposition plan. All the assets including vehicles, motorcycles, laptops and other computers, furniture, among others will be disposed of by PATH based on the approved deposition plan and the guidance that has been provided by PATH headquarter in Seattle Washington.  Dissemination of Longitudinal Case Study Findings. Initiatives Inc. undertook this study entitled: “Lasting Organizational Change: CSO Case Studies from the Advocacy for Better Health Project”. Dissemination of the final report will be done electronically with key stakeholders including USAID.  Close out active awards with sub-grantee CSOs. ABH will ensure all the active awards with the local partners it has been working with are completely closed out before March 31, 2019.

Template Last Updated: May 18, 2018

How IMPLEMENTING PARTNER has addressed A/COR comments from the last quarterly OR Semi-annual report.

If issues were raised in the last report(s), please describe how the activity addressed them specifically.

INSERT BRIEF NARRATIVE ON ADDRESSED COMMENTS, LESS THAN HALF PAGE

Not applicable this quarter.

7. SUMMARY FINANCIAL MANAGEMENT REPORT

Monitoring financial conditions is one of the most important, yet often neglected areas of management reporting. The information contained in this section is utilized to make management decisions, particularly as it is related to future work on and funding for the project. It provides a valuable and timely snapshot of financial conditions, and complements (but does not replace) the SF-425.2 Activity Financial Analysis

Award Details: a. Total Estimated Cost $19,980,735 b. Start/End Date June 1, 2014 March 31, 2019 c. Total Obligated Amount $16,381,848 d. Total estimated cost share (if applicable) NA e. Total estimated leverage (if applicable) NA f. Total Expenditure billed to USAID/Uganda $15,244,966.99 g. Expenditure incurred but not yet billed $663,392.00

f. Total Accrued Expenditure (both billed and not $15,908,358.99 yet billed); sum of lines f and g

Actual spend for four quarters

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Quarterly expenditure rate by funding source $663,392.00 $473,456 Discuss issues such as: unexpected expenditures, material changes in costs due to considerations outside of the control of the project, cost savings and cost savings plans.

2 Note: the financial data provided in this section is an estimate of the financial condition, and does not constitute the contractually required financial reporting as defined in the Award Notice.

Template Last Updated: May 18, 2018

ANNEX B: SUCCESS STORY TEMPLATE

Partners are requested to submit at least one (1) success story (with a picture) per quarter; however, partners are welcome to submit more than one story each quarter.

Success Stories/Lessons Learned Template One Story Per Template

Instructions: Provide the information requested below. Remember to complete the Operating Unit Standardized Program Structure selections in order that your program element selections are pre-populated in the FACTS drop-down menu. “ * ” indicates required fields.

* Program Element: Health_ HIV/AIDS, TB, MCH, FP, Malaria, Nutrition, OVC)

* Key Issues: Human Resources for Health, Health Commodity Security, Domestic Financing, and organizational capacity development of sub awardees

Title: USAID Advocacy for Better Health Project

Operating Unit: ____USAID/Uganda Advocacy for Better Health ______

Please provide the following data:

* Headline (Maximum 300 characters): A good headline or title is simple, jargon free, and has impact; it summarizes the story in a nutshell; include action verbs that bring the story to life.

* Body Copy (maximum 5,000 characters): The first paragraphs should showcase the challenge encountered and the context of the foreign assistance program. Presenting a conflict or sharing a first-person account are two good ways to grab the reader’s attention. Continue by describing what actions were taken and finally describing the result. What changed for the person or community? What was learned? How did this make a difference in the

INSERT BRIEF SUCCESS STORY WITH HEADLINE AND BODY LESS THAN 5000 CHARACTERS

Fruits of Advocacy! The Changed “Face and Heart” of Hamukungu HCII -

What was the problem? Hamukungu HCII is located at Hamukungu landing site on Lake George within Queen Elizabeth National Park in Kasese district. The facility serves a population of more than 5000 people, most of them people who derive a living from fishing activities. This fishing village has more than 300 people living with HIV (PLHIV) who are on antiretroviral treatment (ART), but because the health centre is not accredited to offer HIV services, PLHIV have to travel over 40 kilometers to Kagando Hospital to receive regular HIV services including drug refills. It has always been the desire of PLHIV staying in Hamukungu fishing village to have their facility upgraded to a health centre III or at least accredited as an outreach or static site that offers HIV services including ART. This would reduce the cost of travelling to Kagando Hospital, and also avoid the risk of crossing the national park that is inhabited with animals such as lions. One of the residents who is the new chairperson of the health unit management committee, Mr. Paul Ndyanabo says there are lions that are always waiting for people walking about in the park. “We don’t feel safe. There are lions that roam around the fishing village. They have eaten our cows and goats. We fear for our lives. It is worse for people who have to always move through the park as they go to access their HIV/AIDS treatment at Kagando Hospital. Imagine you run the risk of dying from HIV/AIDS because you can’t easily access treatment or risk being eaten by a lion as you cross the park. The district should be serious and address our challenges as a fishing community” Paul Ndyanabo narrates

What was the engagement? Early 2017, ABH mobilized journalists from NBS Television to travel in some of the districts and document gaps in service delivery, and use the stories to advocate to the concerned decision makers. Hamukungu HCII was in a very bad state. It had no facilities, no drugs and no health workers. In short, it was just an empty ramshakled building. When the journalists interracted with the residents and a nursing officer who was on duty but with no clients, they all expressed their frustration. ABH carefully worked with the TV journalists to run a story that could highlight the plight of residents of Hamukungu. The story run. The district leaders saw it. They got concerned. They felt they had been stripped naked. They decided to so something about it. Wanting to believe what they had seen on TV, the DHO together with the CAO and LCV Chairperson, among other leaders, had to first visit the facility to confirm the rotting state of the health facility they had seen on NBS Television news. They saw it with their own eyes and immediately developed a plan to reach out to partners [MSF, Baylor, and others] to come to the rescue of this facility.

Results/Progress Today as a result of continous advocacy efforts and the pressure that PLHIV networks in the area continued exerting on the district leaders, the facility shines both in and out. It has a functional outpatient department with drugs. The residents have bought mattresses for the maternity beds that were delivered by partners. The Ministry of Health also sent its officials to assess the need. They passed a recommendaion to accredit Hamukungu HCII to offer static HIV services and in the long run it will be upgraded to a HCIII.

Way forward ABH will continue advocating, to ensure that a theatre is constructed, and that the facility is expanded. community or to the country overall? If this story is relating to a "best practice", what were the innovations in planning, implementation, or partnering that made it different? If this story is about an evaluation, what program adjustments were made?

* Pullout Quote (1,000 characters): Please provide a quote that represents and summarizes the story.

INSERT PULL OUT QUOTE

“We don’t feel safe. There are lions that roam around the fishing village. They have eaten our cows and goats. We fear for our lives. It is worse for people who have to always move through the park as they go to access their HIV/AIDS treatment at Kagando Hospital. Imagine you run the risk of dying from HIV/AIDS because you cannot easily access treatment or risk being eaten by a lion as you cross the park. The district should be serious and address our challenges as a fishing community” Paul Ndyanabo, Chaiperson, Hamukungu HCII, Kasese district.

* Contact Information (300 characters): Please list the name of the person submitting along with their contact information (email and phone number).

INSERT CONTACT INFORMATION

Submitted by: Dr. Emmanuel Mugisha, Chief of Party

Plot 17 Golf Course Road, Kololo

Tel: +256 312 393200

Email: [email protected]