Draft Outline

COMMUNICATION FOR HEALTHY COMMUNITIES (CHC) YEAR SEVEN Quarter One Report October 1st, 2019 to December 31st, 2019

Submission Date: 31st January 2020

Agreement Number: AID-617-A-13-00003

Activity Start Date and End Date: June 21st, 2013 to June 20th, 2020

AOR Name: Kathleen Frank

Submitted by: Sheila Marunga Coutinho, Chief of Party Communication for Healthy Communities Plot 15 Kitante Close, Kampala, Uganda Tel: +256-312-266-406 Email: [email protected]

Submitted to: Agreement Officer’s Representative (AOR)

Copied to: [email protected]

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

ACTIVITY INFORMATION

Activity Name: Communication for Healthy Communities (CHC)

Project Communication for Healthy Communities (CHC)

Activity Start Date and End Date 21st June 2013 to 20th June 2020

Name of Prime Implementing FHI360 Partner Agreement Number: AID-617-A-13-00003

Name of Subcontractors/Sub- None awardees and Dollar Amounts: Major Counterpart Organizations: The Government of Uganda and USG Implementing Partners

Geographic Coverage National

Reporting Period: 1st October 2019 to 31st December 2019

ACRONYMS AND ABBREVIATIONS

ANC Antenatal Care BCC Behavior Change Communication CHC Communication for Healthy Communities CLA Collaboration, Learning, and Adaptation CPR Contraceptive Prevalence Rate DHE District Health Educator DHMT District Health Management Committee DHO District Health Officer DHT District Health Team DQA Data Quality Assessment DREAMS Determined Resilient Empowered AIDS-Free Mentored Safe DSDM Differentiated Service Delivery Model E Eastern Region EC East Central Region EMTCT Elimination of Mother to Child Transmission of HIV EVD Ebola Viral Demand FP Family Planning GBV Gender Based Violence GHSA Global Health Security Agenda GHSC-PSM Global Health Supply Chain – Procurement and Supply Management GIS Geographical Information System GOU Government of Uganda GP Guiding Principles HC Health Communication HIVST HIV Self Testing HMIS Health Management Information System HP&E Health Promotions and Environment HTS HIV Testing Services IDI Infectious Diseases Institute IP Implementing Partner IPC Interpersonal Communication IPTp Intermittent Preventive Therapy/Treatment IR Intermediate Result IRS Indoor Residual Spray ITN Insecticide Treated Net KM Knowledge Management KP Key Populations KPI Kampala Pharmaceutical Industries LLIN Long Lasting Insecticide Nets MAFOC Mbale Area Federation of Communities MAPD Malaria Action Program for Districts MCH Maternal and Child Health MER Monitoring, Evaluation and Research MIS Malaria Indicator Survey MNCH Maternal Nutrition and Child Health MOH Ministry of Health MUWRP Makerere University Walter Reed Program

MIYCAN Maternal, Infant, Young Child and Adolescent Nutrition NDA National Drug Authority NMCD National Malaria Control Division PMP Performance Monitoring Plan PrEP Pre-Exposure Prophylaxis PRS Performance Reporting System RCCs Risk Communication Committees RHITES Regional Health Integration to Enhance Services Projects RHSP Rakai Health Sciences Program SBC Social Behavior Change SBCC Social and Behavior Change Communication SM Social Marketing SOPs Standard Operating Procedures SW South Western Region TA Technical Assistance TASO The AIDS Support Organization TMA Total Market Approach TWG Technical Working Group UAC Uganda AIDS Commission UAIS Uganda AIDS Indicator Survey UDHS Uganda Demographic Health Survey USAID United States Agency for International Development USG United States Government VHT Village Health Teams VMMC Voluntary Medical Male Circumcision WG Working Group

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INTRODUCTION

Activity Description

The USAID/Communication for Healthy Communities (CHC) is a seven-year project whose mandate is to support the Government of Uganda (GoU) and United States Government implementing partners (USG IPs) to design and implement high-quality health communication interventions that contribute to a reduction in HIV infections, total fertility, maternal child mortality, malnutrition, malaria and tuberculosis. CHC aims to achieve this by using innovative health communication approaches, capacity strengthening, rigorous research and knowledge management for health communication. Figure 1 outlines the goal, strategic objective, and intermediate results for the project. Additional sub-areas of the CHC program include the Global Health Security Agenda (GHSA) and Social Marketing Activity.

This report highlights Year 7 Quarter 1 (October – December 2019) accomplishments under the project intermediate results that contribute to the project’s strategic objective and goal and the additional sub- areas of GHSA and Social Marketing.

Performance Analysis to Date

Table 1: CHC PMP/Project Indicator Progress - USAID Standard Indicators and Project Custom Indicators

Contribute to Reduction in HIV Infections, Unmet Need for Family Planning, Maternal and Child Mortality, Malnutrition, Malaria, and TB

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status – FY 2019- Annual Comment(s) Source 2020 Performance Year Value Q1 Q2 Q3 Q4 Achieved to Annual Annual Date (in %) Cumulative Cumulative Planned target Actual

CHC - USAID Standard Indicators High level context indicators Percent of men age 15-49 who are UAIS 2011 2015 26.4% 50% 61.8% N/A N/A N/A N/A 61.8% (291/471) Annual target is based on HSSP III. circumcised The actual is based on CHC’s 5th Listening survey June 2019. Percent of women age 15-49 who were UAIS 2011 2015 75% 100% 99.7% N/A N/A N/A N/A 99.7% (386/387) Annual target is based on HSSP III. tested for HIV and received the results The actual is based on CHC’s 5th during antenatal care Listening survey June 2019. Proportion of children exclusively UDHS 2011 2015 62% 80% 73.8% N/A N/A N/A N/A 73.8% (59/80) Annual target is based on HSSP III. breastfed for the first 6 months The actual is based on CHC’s 5th Listening survey June 2019. Percentage of children under 5yrs classified UDHS 2011 2015 Height-for- Unavailable Height-for-age <-N/A N/A N/A N/A Height-for-age Target was not set because data as malnourished. age 2SD2 = 28.9% <-2SD2 = 28.9% were unavailable. The actuals are <-2SD = 33% Weight-for-Height <- Weight-for-Height based on UDHS 2016 data. Weight-for- 2SD = 3.6% <-2SD = 3.6% Height Weight-for-age <- Weight-for-age <-2SD = 5% 2SD = 10.5% <-2SD = 10.5% Weight-for- age <-2SD = 14% Proportion of women who took 2 or more UDHS 2011 2015 25% 85% 82.3% N/A N/A N/A N/A 82.3% (195/237) Annual target based on President’s doses of IPTP Malaria Initiative (PMI). The actual is based on CHC’s 5th Listening survey June 2019. Contraceptive prevalence rate (CPR) UDHS 2011 26% 38% 35.3% N/A N/A N/A N/A 35.3% (426/1207) Annual target based on DO3. The actual is based on CHC’s 5th Listening survey June 2019.

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status – FY 2019-2020 Annual Comment(s) Source Performance Year Value Annual Annual Q1 Q2 Q3 Q4 Achieved to Cumulative Cumulative Date (in %) Planned Target Actual CHC - USAID Standard Indicators (cont.…) Strategic Objective Level Outcome indicators Percentage of individuals who used a UAIS 2015 14.8% Men 80% General Pop 41.9% - Women N/A N/A N/A N/A 41.9% - Women Target based on UAIS 2011. The condom at last higher risk sex 2011 15.8% 85% MARPS 58.9% - Men (57/136) actual is based on CHC’s 5th Women 50.5% - All 58.9% - Men Listening survey June 2019. (83/141) 50.5% - All (140/277) Percentage of mothers of children 0-11 UDHS 2015 57.4% 72% 94.9% N/A N/A N/A N/A 94.9% (225/237) Target is based on UDHS 2011. The months who delivered their last baby in 2011 actual is based on CHC’s 5th a health facility Listening survey June 2019.

Proportion of pregnant women who UDHS 2015 47% 85% 77.2% N/A N/A N/A N/A 77.2% (139/180) Target based on UAIS 2011. The slept under an ITN/LLIN last night 2011 actual is based on CHC’s 5th Listening survey June 2019. Proportion of children under five years UDHS 2015 30% 72% 94.2% N/A N/A N/A N/A 94.2% (261/277) Target based on UAIS 2011. The old with fever in the last two weeks for 2011 actual is based on CHC’s 5th Listening whom advice or treatment was sought survey June 2019.

Percent of individuals with a persistent National 2015 65% 75% 52.8% N/A N/A N/A N/A 52.8% (114/216) Target based on NTBP. The actual is cough lasting two or more weeks who TB based on CHC’s 5th Listening survey sought TB screening and testing services Program June 2019. 2014 Intermediate Result (IR): CHC Capacity Strengthening (CS) and Technical Assistance (TA) Sub-IR 1: High quality health communication interventions designed and implemented Number of collaborating partners staff HC 2015 30 IPs 30 IPs N/A 106 IPs 353% (IP) In Q1, 56 DHEs and 106 IP staff were that increased their HC competencies Capacity 50 DHEs 50 DHEs 56 112% (DHE) supported in champion-follow-up, strengthe 20 (National 20 (National level) DHEs 0% (National orientation, community activations, ning level) level) micro targeting of men to address database emerging barriers to the fight against Non- GBV and uptake of VMMC and FP cumulative services.

(NB: staff can be trained more than once in a given reporting period)

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status – FY 2019-2020 Annual Comment(s) Source Performance Achieved to Date (in %) Year Value Annual Annual Q1 Q2 Q3 Q4 Cumulative Cumulative Planned Target Actual Number of collaborating partners that HC 2015 30 IPs 30 IPs N/A 16 IPs 53% (IP) During the quarter, 16 IPs and 42 DHEs adopt one or more components of the Capacity 50 DHEs 50 DHEs 42 84% (DHE) adopted CHC-IPC approaches of home integrated HC strategy strengthe 20 (National 20 (National level) DHEs 0% (National visits such as using “Manyatta elders’ & ning level) level) Manyatta VMMC task force teams” database while mobilizing clients for integrated Non- VMMC camps. They also adopted the cumulative use of standard Obulamu? materials like dialogue/referral books, stickers, health workers/ client provider charts, (NB: The Obulamu? Nutrition guides, FP same IPs may calendars in their integrated demand be targeted in generation activities for VMMC, PrEP, a quarter) FP and MCH. Intermediate Result (IR): CHC Capacity Strengthening (CS)and TA (cont…) Sub-IR 2: Improved Coordination of Health Communication (HC) Interventions Percent of HC materials disseminated HC Products 2015 100% 100% N/A 100% 100% This quarter, the refresher that have gone through the national and CHASE malaria campaign standardization process. Knowledge materials under the tag – How’s Management your family? were finalized and database approved by MoH including; posters, radio spots and TV spots/ videos, Risk assessment tool, decision making wheel on LLIN use, IRS, Case management and Malaria in pregnancy. The audio and video materials will be rolled out in Q2. Number of collaborating IPs that HC Capacity 2015 30 IPs 30 IPs N/A 11 IPs 37% (IP) In Q1, 11 IPs and 14 DHEs disseminate nationally harmonized and strengthening 50 DHEs 50 DHEs 14 DHEs 28% (DHE) reproduced soft copies of FP, standardized resources through their database 20 (National 20 (National level) 0% (National level) ANC and SRH materials including own communication activities level) FP, Whats App, ANC & EMTCT Non- for adolescents’ girls and young cumulative women as well as HC tools like Obulamu? Conversation guides, (NB: The same dialogue & referral books, IPs may be Obulamu nutrition guides that targeted in a were disseminated in health quarter) facilities and during demand creation activities.

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status – FY 2019-2020 Annual Comment(s) Source Performance Achieved to Date (in %) Year Value Annual Annual Q1 Q2 Q3 Q4 Year Cumulative Cumulative Planned Actual Target Sub-IR 3: Increased Research and Knowledge Management to Enhance Health Communication Percent of CHC HC interventions HC 2015 100% 100% N/A 100% 100% During the quarter, 100% of HC (includes HC designs, target populations Products intervention such as Ebola Risk and implementation approaches) that are and Communication activities, IPC informed by research. Knowledge activities to generate demand for Manageme VMMC, PrEP, HTS, FP, refresher nt database CHASE malaria campaign messages and nutrition met the minimum criteria that included conducting rapid assessments to understand the situation and required data to draw effective micro-plans and profile the target audience. Number of collaborating institutions that HC 2015 5 10 N/A 3 30% This quarter, 3 institutions i.e. Malaria contribute to at least one step of Capacity Action Program for Districts/MAPD, development of SBCC research through strengtheni RHITES EC, MoH-NMCD CHC TA. ng database contributed to the development of SBCC research by conducting desk reviews of existing malaria studies to provide audience insights on the barriers, risks and motivators to LLIN use, rapid assessments to understand the low uptake of FP and pretesting of SBCC tools.

Sub-IR 3: Increased Research and Knowledge Management to Enhance Health Communication (cont…) Number of knowledge events Knowledge 2015 5 * 8 regions 5 * 8 regions N/A 14 35% regional In Q1, CHC supported a total of implemented through CHC Manageme 20 national 20 national level regional 15% National 17 knowledge events including; a support/Oversight nt database level cross-border Forum meeting 3 between Uganda and DRC on 5th National Nov, 2 planning meetings in Mityana to support the mass immunization for Measles, Rubella and Polio campaign, dissemination of HC materials during World AIDs day celebrations in Kayunga and at the 8th African Population Conference (APC) held from 18th- 22nd Nov in Entebbe, organizing the National Health Promotion and Disease Prevention Conference from 6th-7th Nov in Munyonyo among others. Number of external downloads of Knowledge 2015 50 N/A N/A 337 N/A This quarter, 337 knowledge evidence-based knowledge products from Managemen products were downloaded from CHC-moderated website or cloud-based t database the CHC moderated webpage, knowledge repository platform OBULAMU. These included posters on danger signs during pregnancy (175), danger signs after delivery (52) danger signs pregnancy brochures in Acholi (41) and 49 TB factsheets. CHC SBCC Intermediate Outcome Level Indicators: Communication Effects Demonstrated Comprehensive Knowledge Across Health Areas Percent of target audience who UAIS 2011 2015 HIV – 36% 60% Women 52.0% women N/A N/A N/A N/A 87% (women) The 5th CHC Listening Survey June demonstrate comprehensive correct Women 68% Men (546/1049) 84% (men) 2019 knowledge across selected health areas 43% Men 56.8% men (270/475) 53.1% All (816/1537) CHC 2015 FP – 40% 60% 93.4% (1436/1537) N/A N/A N/A N/A 156% The 5th CHC Listening Survey June evaluative 2019 indicates that 93.4% survey demonstrated comprehensive N/A 2015 ANC – 50% 60% 95.3% (1507/1581) N/A N/A N/A N/A 159% Theknowledge 5th CHC on Listening FP. Survey June 2019 indicates that 95.3% demonstrated comprehensive knowledge on ANC.

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status FY 2019-2020 Annual Comment(s) Source Performance Year Value Annual Annual Q1 Q2 Q3 Q4 Achieved to Date Cumulative Cumulative Actual (in %) Planned target

CHC SBCC Intermediate Outcome Level Indicators: Communication Effects

Demonstrated Comprehensive Knowledge Across Health Areas Percent of target audience who not NA Malaria – 70% 89.1% (1358/1524) N/A N/A N/A N/A 127% The 5th CHC Listening Survey June demonstrate comprehensive correct available 50% 2019 indicates that 89.1% knowledge across selected health areas demonstrated comprehensive (cont.) knowledge on malaria. Not NA TB – 60% 80% 64.4% (1010/1568) N/A N/A N/A N/A 81% The 5th CHC Listening Survey June available 2019 indicates that 64.4% demonstrated comprehensive knowledge on TB. Approval of desired behaviors and/or health services across health areas HIV Testing for 60% 96.3% (1445/1500) N/A N/A N/A N/A 161% Not HIV – 40% NA available Always using The actuals are based on the 5th 60% 46.1% (666/1446) N/A N/A N/A N/A 77% Percent of individuals who approve of condoms CHC Listening Survey June 2019 health behaviors and/or health services during high across the general population. promoted in OBULAMU messages Enrollingrisk sex (esp. for 60% 99.3% (1458/1469) N/A N/A N/A N/A 166% eMTCTKey if HIVPopulations) positive – 40% Modern FP 60% 83.5% (1259/1507) N/A N/A N/A N/A 139% The 5th CHC Listening Survey June – 40% 2019 indicates that 83.5% approved of modern FP.

NOTE: The 5th CHC Listening Survey was a cross-sectional study, that sampled 1581 respondents, aged 15-49 years, in 16 districts that represented eight regions of Uganda. The data collection tool and disaggregation were tailored to CHC MEL-Plan indicators.

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status FY 2019-2020 Annual Comment(s) Source Performan Year Annual Q1 Q2 Q3 Q4 ce Value Annual Achieved Cumula Cumulative Actual to Date (in tive %) Planned target Approval of desired behaviors and/or health services across health areas (cont…) MCHN Exclusively 60% 97.5% (78/80) N/A ExclusiveN/A N/A 163% Exclusively breastfeeding baby breastfeeding baby ly (including EIB) up to 6 months of (including EIB) up to breastfe age – 40% 6 months of age – eding Initiating and completing full Percent of individuals who approve of 40% baby course of timely vaccinations for health behaviors and/or health services (includin infants – 40% promoted in OBULAMU messages Initiating and 60% 99.5% (CHC N/A Initiating N/A N/A 166% completing full Evaluative Survey andg EIB) up If pregnant, initiating and course of timely 2017) completito 6 completing 4 ANC visits (1st - vaccinations for ngmonths full 4th) – 40% infants – 40% courseof age – Delivering child at a Health If pregnant, initiating 60% 97.3% (1445/1485) N/A Ifof40% timely N/A N/A 163% Facility – 40% and completing 4 pregnantvaccinati ANC visits (1st - ,ons for 4th) – 40% initiatinginfants – 40% Delivering child at a 60% 97.3% (1445/1485) N/A Deliverinand N/A N/A 163% Health Facility – 40% gcompleti child at ng 4 Malaria a Health FacilityANC – Malaria prevention 60% 97.9% (1484/1516) N/A Malaria N/A N/A 163% Malaria prevention and treatment 40%visits and treatment of (1stpreventi - of malaria of children) – 40% malaria of children) 4onth )and – – 40% 40%treatme Using LLIN every 60% Pregnant women: N/A Usingnt of N/A N/A 163% (women) Using LLIN every night – 40% night – 40% 97.8% (177/181) LLINmalaria 162% (children) Children <5: 96.9% everyof (535/552) nightchildren) – 40%– 40%

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status FY 2019-2020 Annual Comment(s) Source Performance Achieved to Date (in %)

Year Value Annual Annual Q1 Q2 Q3 Q4 Cumulative Cumulative Planned Actual target

Approval of desired behaviors and/or health services across health areas (cont…) Malaria (cont..) Pregnant women 60% 97.3% (1445/1485) N/A N/A N/A N/A 162% The 5th CHC Listening Survey attending ANC, and June 2019 indicates that 97.3% initiating and of individuals approved of completing full attending ANC and initiating and Percent of individuals who approve of course of IPTp (2 or completing full course of IPTp. health behaviors and/or health services more) – 40% promoted in OBULAMU messages Caregivers seeking 60% 98.2% (542/552) N/A N/A N/A N/A 164% The actuals are based on the prompt diagnosis CHC Listening Survey June 2019 and appropriate care for children upon recognizing symptoms of malaria. – 40% IRS spraying of 60% 92.4% N/A N/A N/A N/A 154% The actuals are based on the households – 40% CHC Evaluative Survey 2017 TB

If gets a persistent 60% 99.0% (1441/1455) N/A N/A N/A N/A 165% The 5th CHC Listening Survey Percent of individuals who approve of cough lasting 2 or June 2019 indicates that 99.0% health behaviors and/or health services more weeks, screen approved of screening and promoted in OBULAMU messages and test for TB – testing for TB. If40% tested positive for 60% N/A N/A N/A N/A N/A N/A TB, adhere to treatment – 40%

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status FY 2019-2020 Annual Comment(s) Source Performance Achieved to Date (in %) Year Value Annual Annual Q1 Q2 Q3 Q4 Cumulativ Cumulative e Planned Actual Intention to initiate and/or adopt desired behaviors and/or health servicestarget across health areas HIV Testing for HIV - 60% 89.6% (1355/1513 N/A N/A N/A N/A 149% The actuals are based on CHC 40% Listening Survey June 2019 Always using 60% 48.2% (587/1219) N/A N/A N/A N/A 80% across the general population. condoms during high risk sex (esp. Key Populations) - 40% Enrolling for 60% 99.4% (1440/1449) N/A N/A N/A N/A 166% eMTCT if HIV positive - 40% Obtaining SMC - 60% 34.5% (60/174) N/A N/A N/A N/A 58% 40% Modern FP – 60% 44.0% (525/1193) N/A N/A N/A N/A 73% The 5th CHC Listening Survey 40% June 2019 indicates that 44.0% intended to adopt modern FP. Percent of individuals who intend to CHC MCHN adopt health behaviors and/or health Evaluative 2015 services promoted in OBULAMU Exclusively 60% 94.1% (CHC Evaluative N/A N/A N/A N/A 157% survey messages breastfeeding Survey 2017) baby (including EIB) up to 6 months of age – 40% Initiating and 60% 98.3% (236/240) N/A N/A N/A N/A 164% completing full course of timely vaccinations for The actuals are based on the 5th infants – 40% CHC Listening Survey June 2019 If pregnant, 60% 99.0% (1446/1460) N/A N/A N/A N/A 165% initiating and completing 4 ANC visits (1st - 4th)– 40% Delivering child 60% 98.4% (1439/1462) N/A N/A N/A N/A 164% at a Health Facility – 40%

Indicator Data Baseline data FY 2019-FY 2020 Quarterly Status FY 2019-2020 Annual Comment(s) Source Performance Year Value Annual Annual Q1 Q2 Q3 Q4 Achieved to Cumulative Cumulati Date (in %) Planned ve Actual target

Intention to initiate and/or adopt desired behaviors and/or health services across health areas (cont..) Malaria Using LLIN every night 60% Children <5: N/A N/A N/A N/A 164% 3rd Listening Survey conducted – 40% 98.3% in June 2017. If pregnant, attending 60% 99.0% N/A N/A N/A N/A 165% The actuals are based on the ANC, and initiating (1446/1460) 5th CHC Listening Survey June and completing full 2019 course of IPTp (2 or more) – 40% If caregivers, seeking 60% 92.0% (484/526) N/A N/A N/A N/A 153% The actuals are based on the prompt diagnosis and 5th CHC Listening Survey June appropriate care for 2019 children upon recognizing symptoms of malaria. – 40% TB If gets a persistent 60% 86.5% N/A N/A N/A N/A 144% The actuals are based on the cough lasting 2 or (1293/1494) 5th CHC Listening Survey June more weeks, screen 2019 and test for TB – 40% If tested positive for 60% Not available N/A N/A N/A N/A Not available This data was not available. TB, adhere to treatment – 40%

Guiding Principles • Apply a holistic approach to CLA (collaboration efforts) • Ensure broad and inclusive stakeholder engagement • Apply a facilitative approach • Foster leadership as a lever for change

Contribution to CDCS Results Framework Progress Narrative

In Quarter 1 (October – December 2019) of Year 7, CHC through its SBCC technical assistance, contributed to the goals reflected in the CDCS results framework: CHC engaged in the following collaborative and integrated interventions that contributed to the CDCS framework:

Strengthening Collaborative Partnerships with stakeholders

CHC continued to work in collaborative partnerships with various stakeholders in the implementation of national and community targeted health communication and SBCC interventions, including distribution of socially marketed products. During the quarter, CHC strengthened partnerships with government line ministries, departments and authorities including MOH, MAAIF, MoWE, UWA, and UAC; USG IPs including RHITES–E, RHITES–EC, RHITES–SW, RHITES–Acholi, RHITES–Lango, RHSP, Mildmay, IDI, and MAPD; development agencies – UNICEF; districts through DHTs, champions (VHTs, health workers, religious leaders); civil society organizations, including CDFU; cultural institutions including Busoga Kingdom; Private sector organisations including KPI, Abacus Pharma, Kiboko distributors, and Dembe distributors.

Specifically, CHC

• Supported MOH, NMCD, UAC, BCC WG, and districts in the preparation of Uganda’s first National Health Promotion and Disease Prevention conference, provided radio and TV airtime to air health messages, and supported literature reviews to identify barriers to mosquito net use. These aimed at improving programming and showcasing best practices of SBCC work in Uganda. • Worked with the private sector, including Abacus Pharma and Kiboko distributors, to distribute socially marketed products using their established infrastructure networks of regional warehouses and retail outlets. • Supported partners, such as Mildmay, RHSP, the 5 RHITES and CDFU to mobilize communities for HTS, FP and VMMC services, focusing on high-risk groups and priority populations. The TA involved supporting demand creation and community mobilization activities (community shows, home visits, large and small group discussions) through twinning with CHC IPC agents. This support aimed at building the capacity of district and IP staff towards continuity and sustainability of gains. For example, as a result of the SBCC FP targeted interventions, data in Figure 2 from HMIS indicates an increasing trend in the uptake of family planning services by region.

Quarterly trends in the number of FP users by region 250000 200000 150000 100000 50000 0 East Karamoj South West Central 1 Central 2 Eastern Northern Western Central a West Nile Jan to Mar 2019 88197 98860 196751 141437 7155 111729 123962 46802 139622 Apr to Jun 2019 97355 104275 227243 151693 7147 96458 111050 53580 136906 Jul to Sep 2019 115995 109627 206261 154041 8150 94984 126143 53357 132391 Oct to Dec 2019 92529 122317 202591 157672 7465 96585 115525 58958 149169

Figure 2: Quarterly trends in the number of FP users by region

2. ACTIVITY IMPLEMENTATION PROGRESS

Summary of Implementation Status

Table 2: Summary of CHC implementation status in Year 7 Q1 (Oct-Dec 2019) Activity Summary of Actual key activities/tasks conducted during the quarter Result Areas planned activities in Year 7 work plan Intermediate Result Area 1: High-quality Health Communication Interventions Designed and Implemented Work with GoU and USG IPs to finalize, package and collate Key Health Communication Materials, Tools and Guides for OBULAMU Life Stage 1-4. OBULAMU First 90- Identifying new HIV positive case and ensuring those individuals know their HIV status Life Stage During the quarter CHC One: Implement • Continued to roll out the “What’s Your Stand on HIV Campaign” Young adults in communication plans geared towards increasing knowledge, skills among target relationships (20- and disseminate audiences to embrace different HIV prevention interventions and 30) including Key materials to support behaviors such as HTS, PreP, eMTCT, faithfulness and Abstinence. Populations on-going national A total of 2,139 radio spots were aired on HIV (Faithfulness, rollout of new HTS Adherence and SMC) under the Prevention Campaign. innovations. • Finalized U=U communication materials, these include a Brochure,

a Decision-Making Wheel and Wall Chart that will be used by IPC agent discussing VMMC with adolescents in Linkage facilitators, Peers, and Health Workers during Inter- Kanungu district

Personal Communication interventions. These materials focus on “The journey to defeating HIV which involves steps such as Getting Tested/ Knowing one’s HIV Status, Starting Treating, Adhering to Treatment and Taking a Viral Load Test.” The communication materials address the unique barriers and promote the service benefits of each.

Work with MOH and • Provided technical support to USG IPs including: RHITES SW and Rakai Health Science Program (RHSP) IPs to roll out towards mobilization of men aged 15+ for VMMC services in Ntungamo, Kanungu, Kyotera, Masaka, aggressive but targeted Kalungu, Lwengo (see Fig. 3). CHC built the capacity of partners and community agents through twinning VMMC demand with IPC agents to enhance their competences in the dissemination and use of SBCC materials, and micro generation targeting to identify unreached audiences, such as secondary school children and men whose spouses are interventions. resisting VMMC. The community agents worked closely with religious leaders which increased acceptance and uptake of health services.

Monthly trends in number of clients circumcised by region and district

1800 1552 1600 1400 1200 1030 881 1000 742 800 582 644 416 458 498 473 451 600 394 328 346 389 305 395 400 188 200 0 Kyotera Lwengo Masaka Kalungu Ntungamo Kanungu Central South Western Oct-19 Nov-19 Dec-19

Figure 3: Number of clients circumcised in selected regions and districts • Worked with RHITES-SW and the districts of Ntungamo and Kanungu to conduct targeted condom promotion activities as part of demand creation for integrated HIV and MNCH services. CHC IPC agents were twinned with RHITES-SW community agents to communicate the benefits of condoms and build skills through condom demonstrations targeting men in garages, boda-boda stages, garages and washing bays. Female sex workers were also reached through activations in bars and lodges. A total of 1,583 people was reached with messages on condom use and 12,240 pieces of condoms were distributed. Figure 4 shows HMIS condom use data for 2 districts.

Quarterly trends in number of condom users in Ntungamo and Kanungu

2250 2000 1750 1500 1250 1000 750 500 250 0 Male Condom Female Condom Male Condom Female Condom Figure 4: NumberNtungamo of condom users in Ntungamo and Kanungu districtsKanungu Jan to Mar 2019 313 12 1087 21

Apr to Jun 2019 1088 12 1910 0

Jul to Sep 2019 1180 37 740 1

Oct to Dec 2019 1514 77 1184 0

OBULAMU Family Planning During the quarter, CHC Life Stage Mass media roll out – 6 • Continued to roll out the ‘What would pregnancy mean to you now?’ campaign that addresses low risk Two: Pregnant TV and 23 radio perception of unplanned pregnancies and contributes toward the FP Women and stations focusing on – 2020 targets of increasing the use of modern contraceptives to 50% and their Partner What would pregnancy reducing the unmet need to 10%. A total of 2,139 radio spots and 131 mean to you now? TV spots were disseminated through 23 radio stations and 6 TV stations.

• Provided technical assistance to both RHITES North Acholi and RHITES North Lango to undertake hotspot mapping, targeted mobilization, all geared towards increasing demand and uptake of FP services among AGYW (10-24), women of reproductive age (15-49) and men above 15. In Acholi subregion, the interventions were conducted in Agago, A group of men being reached with FP Nwoya, while in the Lango subregion, Oyam, Amolatar. messages in Acholi subregion

• Supported MoH to build the IPC skills of 70 Community Health workers providing community-based FP services in Lira District with a focus on young people. The training also focused on enabling them to recruit and maintain clients and to make effective referrals for family planning and related reproductive health services. DHIS2 quarterly data in Figure 5 indicates increasing trends in the uptake of family planning services among youth in Lira district.

Quarterly trends in number of youths using family planning in Lira district

6,432 20 to 24yrs 5,788 3,524 3,705

2,498 15 to 19yrs 2,153 1,525 1,957

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000

Oct to Dec 2019 Jul to Sep 2019 Apr to Jun 2019 Jan to Mar 2019

Figure 5: Number of youths using family planning services in Lira district

Malaria During the quarter, CHC Continue to provide • Finalized the refresher CHASE malaria campaign materials under the tag – How’s your family? These TA to Malaria stake included: posters, radio spots and TV spots/ videos, Risk assessment tool, decision making wheel on LLIN holders to refresh and use, IRS, Case management and Malaria in pregnancy. The audio and video materials will be rolled out on roll out the CHASE the Obulamu media platform beginning January 2020 to support the universal LLIN campaign. The campaign Malaria campaign will be officially disseminated during the month of February 2020 and thereafter the MOH and partners will scale-up activities across the country.

• Provided technical support to the Ministry of Health (NMCD) to undertake a desk review of existing Provide TA to NMCD malaria studies to identify the barriers and motivators/enablers to LLIN registration, distribution and use. and IPs during the The findings will inform the development of tailored SBCC interventions and campaign branding for the Universal LLIN 3rd Long-Lasting Insecticide-treated Nets (LLINs) Universal Coverage Campaign (UCC universal LLIN campaign where campaign). A report and PowerPoint presentation on the findings have been shared with NMCD to further appropriate inform message development. OBULAMU Maternal and Child During the quarter, CHC Life Stage Health • Continued to roll out the “What do you want your baby to become?” campaign messages focusing on Three: Mass media roll out – 6 ANC, Health facility delivery, birth preparedness and postnatal care, management of diarrhea, pneumonia, Care Takers of TV and 23 radio WASH and promoting a full course of immunization on 23 radio stations and 6 TV stations. Children Under stations of “What do five years you want your baby to • Supported Mityana District to scale up community mobilization activities during the Rubella and measles become?” campaign immunization campaign held in October 2019. The support was intended to address poor attendance at vaccination events in some sub counties. The enhanced mobilization efforts contributed to an increase in the number of children accessing immunization services from 50% to 123%. HMIS data (Figure 6) shows the increase in the number of children immunized for measles in Mityana district.

Quartely trends in the number of child immunization - measles Mityana district

6,000 Figure 6: Quarterly trends in the number of 3,820 3,654 3,835 4,114 child immunization - measles Mityana district 4,000

2,000 0 Jan to Mar 2019 Apr to Jun 2019 Jul to Sep 2019 Oct to Dec 2019

Nutrition • CHC continued to roll out Nutrition messages under the “What do you want your baby to become?” Targeted mass media campaign on 23 radio stations and 6 TV stations. The messages addressed barriers to complementary roll out of Nutrition feeding among children 6-12 months. messages on 4TV and 23 radio guided by data • Caregivers of children under 5 years and pregnant women were reached with Nutrition messages during integrated HIV and RMNCH outreaches led by USG IPs with support from CHC.

Integrated Targeted Rollout of During the quarter, CHC rollout of the Mass Media • Aired spots and DJ mentions on 23 radio stations including spots on HIV (Faithfulness, Adherence and OBULAMU Placements SMC) under the "Prevention Campaign", Family planning, Post Natal care and Nutrition adapted from the campaign "What do you want your baby to become?" campaign. Specifically, 12,844 DJ Mentions and 12,836 Spots were aired on HIV and TB (HIV Free baby DJ led discussion, HTS Fear of testing, TB Risk, Assessment, HTS Men Risk Assessment, HIV Prevention-Multiple partners). A total of 21 talk shows were hosted as indicated in Table 1. Table 1: Radio Roll-Out in Quarter 1 Of Year 7 Radio placements for October - December 2019 Properties Number of Exposures Spots 12,836 DJ Mentions 12,844 Talk show 21 Total exposures 25,701

Aired TV spots and other advertisements on 6 stations. These included spots on Child health, Nutrition and VMMC adapted from the "What’s your stand on HIV" (SMC, Abstinence, facility delivery and condom use), "What do you want your baby to become?", "How is your baby?" and "What would a pregnancy mean to you now"? campaigns. Specifically, 660 sponsor boards, 1,860 TV spots, 705 scrolls, 825 squeezebacks, 471 logos placement, 3 subtle adverts, and 300 endorsements were aired. Additionally, two Guest appearances and 6 talk shows were run to support the One Dollar HIV Run and Walk campaign on all the 6 TV stations. Uganda AIDS Commission (UAC) was supported with a talk show on Stigma on NTV following a controversy on socialite MC Kats' HIV Status disclosure. Table 2 shows the TV exposures per property. Table 2: TV Roll-Out in Quarter 1 Of Year 7 TV placements Properties Q1 (Oct-Dec 2019) Sponsor Boards (Intros/Outros) 660 Tv Spots 1860 Scrolls 705 Squeeze backs 825 Logos Placement 471 Talk Shows 7 Subtle Advert 3 Endorsements 300 Guest appearance 2 Total 4,833

Integrated Targeted Inter- During the quarter, CHC in collaboration with partners reached a total number of 15,552 people through IPC, rollout of the personal and 32,032 people with EVD messages as shown in table 3. Some people were reached through group events OBULAMU communication (IPC) including community activations, community shows, and community dialogues, and others were reached through campaign activities for demand small group activations such as small groups, one-on-one, and home visits. creation/ community mobilization to Table 3: IPC activities conducted in Quarter 1 Of Year 7 increase uptake of services Group events Total IPC Total EVD Community activation 1424 1131 Community shows 1 25 Community Dialogue 109 Sub-total 1425 1265 Small group activations Small Group 1534 22926 One-on-one 1338 361 Home visit 1455 101 Sub-total 4327 23388 No of people reached Male 9029 15063 Female 6523 16969 Total 15552 32032

Figure 7 shows the number of people referred for health services through IPC activities conducted in quarter 1 (October – December 2019).

Number of people referred to health services through IPC activities

Other 197 PNC F 96 ANC F 601 VLM Female 57 VLM Male 96 Nutritional Assessment Girls 131 Nutritional Assessment Boys 120 FP Women 2347 FP Men 637 Malaria Test Female 616 Malaria Test Male 489 SMC Men 1897 TB Female 370 TB Men 208 Condom Men 2607 Condom Female 735 HTS Women 1867 HTS Men 3515 0 500 1000 1500 2000 2500 3000 3500 4000

Figure 7: Number of people referred to health services through IPC activities OBULAMU Provide TA to MOH During the quarter, CHC Life Stage and USG IPs to • Supported RHSP in demand creation for VMMC for men aged 15-49 years in the 5 health facilities that Four: integrate the Bukulu HCIV, Kyazanga HCIV, Kyanumakaka HCIV, Kiwangala HCIV & Kasala HC II. As a result, 141 boys Adolescent adolescents’ campaign aged 10-14 years were motivated to get circumcised. Girls and Boys (Life Stage 4 materials) (15–19) in their interventions. Intermediate Result Area 2: Improved Coordination of Health Communication Interventions Global Health Strengthen parish, CHC strengthened the capacity of risk communication structures to detect, prevent and mitigate disease outbreaks Security subcounty and district in the hot spot districts of Ntoroko, Bundibugyo, Bunyangabu Kasese, Kabarole, Kisoro and Kanungu. The Agenda risk communication committee members engaged included: Parish Headquarters chiefs, VHT coordinators, Business communities’ (GHSA) committees in 7 representatives, Women and Youth representations, LC II chairperson, PISO, Elder/opinion leader, Representation districts of the Youth Groups, Community Animal Health Workers, In-charge of HC II, Representative of Religious Leaders, Cultural leaders and Opinion leaders. A total of 234 parishes were covered.

Support the risk CHC formed risk communication structures in 19 parishes and oriented them on their roles and IPC skills in Kisoro communication sub- and Kanungu districts. The structures comprised of 61 people (13 committees at all female and 48 male) who: alert suspected outbreaks to the district levels committees, supervise risk communication activities at village level, report feedback from the community to the sub-county committee and conduct community sensitization.

A VHT coordinator sensitizing school pupils about Ebola in Kanungu district.

Coordination Capacity During the quarter, CHC of HC efforts strengthening for • Provided TA to RHITES-E to reproduce seed copies of the Obulamu? nutrition guide (How’s Your Baby?), at Regional GoU, districts, and champions dialogue and referral books which they have integrated into their SBCC programming and into level USG IPs their work plan with CDFU.

• Provided TA to RHITES EC to conduct rapid audience assessment to understand the reasons married women age 15 – 49 years were not accessing and using any family planning methods despite the identified need. The rapid assessment was also used to assess the capacity of health facilities to provide services. A total of 59 health workers were engaged in 10 facilities and 89 clients participated in the assessment. The assessment focused on 4 key result areas of Adolescents and youth, Social and Behavioral Change Communication, Linkages and Referrals and Gender Based Violence (GBV). A client exit interview was administered to random clients after receiving care to establish their satisfaction with the services received. As a result, materials and strategies to improve service delivery were developed.

• Strengthened the capacity of and oriented 13 VHTs with IPC skills on mobilizing the communities in Kanungu and Ntungamo for services. CHC worked with the DHEs to disseminate 15 viral load flip charts, 10 Nutrition guides, 34 HTS ABS boards, and distribute 2,640 pieces of male condoms.

• Mentored and strengthened the capacity of 183 VHTs (73 females and 110 males) with interpersonal communication skills in Kanungu and Kisoro during EVD risk communication activities and demand generation activities. These VHTs were twinned with CHC IPC agents during community activations.

• Provided technical assistance to Mildmay by building capacity of their community champions in IPC skills and micro targeting of audiences to increase the yields for HIV self- testing and HTS services targeting men in Mityana, Mubende, Kassanda, Nakaseke and Luweero districts.

• Twinned with the volunteers and peers from RHSP to enhance their capacity in using SBCC materials and micro targeting using the IPC skills. Most importantly, the volunteers and peer smarts were empowered on effective communication skills especially working with the religious leaders as a platform of targeting 20

men and young boys who have not been circumcised. A total of 3,118 people (2,711 males and 407 females) were engaged during health education one on ones, and small group discussions on HIV preventative messages, HTS and VMMC benefits.

Support USG IPs and During the quarter, CHC; districts to plan and • Provided talk show airtime to IDI and UAC on Bukedde TV in preparation for World AIDS Day and coordinate HC celebrating the 16 days of activism addressing gender-based violence with emphasis on the role of parents interventions during in reducing GBV. special events such as World AIDS Day, • Supported Kisoro and Kanungu districts with mobilization for the HTS services in Nyamirama sub county World Malaria Day and Kisoro Mayors Gardens during commemoration of World AIDs Day. A total of 950 people were among others. reached with HTS messages and 701 people were tested for HIV in both districts. During this time, 9,600 pieces of male condoms were distributed to people in Kisoro district.

• Provided communication support in the form of radio and TV talk shows, facilitated journalists and disseminated several Obulamu new-born care and child health SBC materials to commemorate World Prematurity Day held on 19th November 2019 in Busia district. The theme for the event was: “Born Too Soon: Providing the right care, at the right time, in the right place” geared towards scaling up efforts to reduce preventable new born mortality in line with the global commitment to end all preventable new born and child deaths by 2030. The event was presided over by the State Minister of Health for Primary Health Care, Dr. Joyce Kaducu.

Work with MOH, IPs During the quarter, CHC and the districts to • Supported Mityana DHT during the mass immunization campaigns on 16th to 20th October 2019 through conduct targeted SBC demand creation using megaphones. This contributed to the activities through IPC increase in the number of children accessing immunization and mass media services by 60%. “The number of people seeking immunization services has really increased much more than we expected. CHC’s support has done a great job because community turn up was low but has now increased by almost 60%”. (DHE, Mityana district). • Supported Busoga Kingdom to conduct IPC sessions during the Ekigangu kya Busoga health camp targeting adolescents and youth aged 9 – 25 years. A total of 347 participants (249 females and 98 Small group discussion with women on FP in males) were reached in IPC sessions held during the health camp. Nwoya

• Supported RHITES North Acholi in two demand generation activities for FP in the districts of Nwoya and Agago and conducted orientations of IP champions on audience profiling and targeting, dissemination of FP materials and HIV/TB materials. Consequently, CHC twinned with the IP champions and conducted targeted mobilization where 5,478 people (1,906 male and 3,572 female) were reached, and of those, 659 were referred to FP services. 21

• Supported RHITES-SW, Ntungamo and Kanungu district with demand generation for VMMC, FP, HTS services, MCH and PrEP. A total of 6,065 men and 1,571 women were reached directly by the IPC agents and VHTs with messages on safe male circumcision, HTS services, PrEP, Family planning and Maternal child Health. Of those reached, 521 men were circumcised in the facilities of Rubaare HCIV, Rwashamaire HCIV, Kambuga Hospital, Rugyeyo HCIII and Kihihi HCIV.

Intermediate Result Area 3: Increased Research and Knowledge Management to Enhance Health Communication Design and Conduct specialized During the quarter, CHC Implement assessment as part of Customized routine learning and • Provided TA to RHITES EC on SBC research for unmet FP demand creation and materials development. A Research adaption. participatory assessment was conducted among married women, men, young people, and health care providers Methodologies to understand why married women had unmet FP need. The preliminary findings indicated that men were a major barrier to service uptake, and they needed to be targeted as key decision makers in the family. Service providers also needed to be targeted as well to address the issue of health worker attitude. Data analysis is still ongoing, and the results will be shared with partners in Quarter 2 to inform their programming.

• Conducted a literature review in preparation for the third Long-Lasting Insecticide-treated Nets (LLINs) Universal Coverage Campaign (UCC). The review focused on Social and Behavior Change (SBC) intended to contribute to adoption of positive Malaria behaviors. The objectives were: a) To outline of the risks related to LLINs use in the country by region or vulnerability or minority settings b) To create a summary of key barriers and enablers for mosquito net registration, Distribution and Usage and c) To generate categorical issues by region, Vulnerability or Minority settings. A desk review report titled Current Barriers, Motivators, Norms, Skills on LLINs Registration, Distribution and Use and a set of PowerPoint slides were shared with MoH to guide the design and implementation of the campaign. The main findings indicate that issues of perceived risk, religious cults, and timing of the national net distribution drives are still major barriers to mosquito net use.

Barriers to mosquito net use • Perceived risks of net use: “…they do say that the net has poison that can cause itching of the body that is why they do not use the net.” Female IDI, Amuru district, In-depth Assessment of malaria prevention and control practices, Makerere School of Public Health 2019

• Religious cults that downplay the use of nets: “…There are those people whose religions do not allow sleeping under mosquito nets…. It is called ntinkalu (dry wood).” Male IDI, Namutumba district- CHC CHASE Malaria Campaign Audience Assessment Report, 2018

• Timing of net distribution doesn’t favor those who work away from home “I do not sleep under a net because I missed getting one the last time they were being distributed. I was not around that is why I do not sleep under a net” (FGD HH Heads, Ogwete Sub County, Otuke District) – Baseline Survey DFID/SURMA 2018

Implement Monitor intervention During the quarter, CHC project roll-out for fidelity, • Participated in the Feed the Future and Economic Growth Partners' meetings held on 16th Oct 2019 at the Monitoring, quality, and coverage Learning Hub to clarify FY19 reporting requirements. During the meeting, guidance on submission of data Evaluation through quantitative in the FTFMS and Performance Reporting System due at the end of October 2019 was provided to support and Learning and qualitative analysis accurate and timely reporting. CHC also attended a meeting on 13th Dec 2019 to discuss Producer (MEL) Plan of progress against Organizations Activity (POA) achievements, challenges and lessons learnt on local level advocacy. objectives, targets, and timelines. • Conducted media monitoring of OBULAMU messages on 19 radio stations. These aired spots on HIV (Faithfulness, Adherence and SMC) from the "Prevention Campaign", Family planning, Post Natal care and Nutrition adapted from the "What do you want your baby to become?" campaign. All the Mentions were on HIV and TB (HIV Free baby DJ led discussion, HTS Fear of testing, TB Risk, Assessment, HTS Men Risk Assessment, HIV Prevention-Multiple partners) as per the agreed upon schedule. Monitoring During the quarter, CHC standardized data flow • Continued to enforce implementation of data management Standard Operating Procedures (SOPs) at all procedures, check stages of data collection to ensure data quality. All data is reviewed and validated at various stages by consistency and regional teams before capture into the CHC Management Information System. This data has been used for

completeness of data reporting (narrative report, USAID reporting systems), monitoring of activity implementation, and decision- through internal Data making to improve program implementation. Quality Assessments- DQA Analyze data and During the quarter, CHC collate output for • Continued to analyze data on a monthly and ad-hoc basis to inform decision making, activity planning and timely periodic implementation. Routine analysis of HMIS and UDHS was also conducted and this data was used for monthly reporting and quarterly progress reports to key stakeholders. requirements (PRS, quarterly/annual reports) Implement the Document and During the quarter, CHC knowledge disseminate a variety • Participated in the Cross-Border Forum meeting between Uganda and Democratic Republic of Congo on management of OBULAMU health 5th Nov 2019 with an objective of “Engaging communities and plan communication empowering leaders to fight Ebola in Democratic Republic of materials, how-to Congo (DRC) and Uganda.” The participants shared EVD risk guides, success stories communication experiences, developed action plans and for different user signed a commitment banner to fight against EVD. categories. • Participated in two planning meetings with Mityana District Health Team and IPs in support of the mass immunization for Measles, Rubella and Polio campaign in the 12 sub counties of th th Mityana on 13 and 20 September 2019. During the Participants signing the commitment to fight EVD

meetings, CHC identified one key area for mass mobilization as the use of megaphones to reach more people.

• Participated in the one stakeholder’s meeting for FP during the DHMT Meeting held in Mizigo on 30th November 2019. CHC used this platform to present the new HIV prevention materials. The IPs and DHTs expressed interest in accessing the materials for scale-up.

• Participated in the final planning meeting for the World AIDs Day during which key issues were identified such as polygamy increasing the risk of new HIV infections and adolescents needing privacy while accessing ARVs.

• Celebrated World AIDS Day in Kayunga District on 1st Dec 2019. CHC participated in a dialogue with a theme titled ‘Engaging young people to champion the end of HIV new infections’ and exhibited an assortment of SBCC Materials.

• Disseminated several HC materials to national stakeholders’ meetings. The disseminated materials included posters, child spacing guides, Nutrition brochures, talking points and MCH messages during World Prematurity Day held on 20th November 2019 in Busia district.

• Participated and exhibited HC materials in the 8th African Population Conference (APC) held on November 18-22, 2019 in Entebbe, Uganda. The conference was organized under the theme “Harnessing Africa’s Population Dynamics for Sustainable Development: 25 Years After Cairo And Beyond.” The conference brought together various stakeholders to discuss issues relevant to African population, including (but not limited to) national, regional and continental investments to address rapid urbanization, population growth, sexual and reproductive health, technology, youth, the demographic dividend and capacity building. CHC disseminated soft and hard copies of SBCC materials on FP and MNCH to 312 conference participants.

• Partnered with MoH to organize Uganda’s first Annual National Health Promotion and Disease Prevention Conference held on 6th-7th Nov 2019 at Speke resort Munyonyo. The aim was to provide a platform for government, health professionals, partners and the academia to share best practices and lessons learned, provide networking opportunities, and raise awareness on the importance of health promotion for disease prevention in improving primary health care outcomes. CHC co-chaired the conference preparatory meetings, supported the conference branding logistics and media coverage, and led the SBCC: From theory to practice track of the conference. CHC also made a presentation about the project’s SBCC work, exhibited and disseminated an assortment of OBULAMU HC materials.

The minister of Health and main speakers at the opening of the conference. CHC staff exhibiting Obulamu? SBCC materials to the Minister of Intermediate Result Area 4: Improved utilization of USAID socially marketed health products andHealth services and the Permanent among Secretary, target MOH populations in urban and rural areas and enhance capacities to prevent, detect, and rapidly respond to infectious disease threats and achieve measurable targets Increase access Engage the approved During the quarter, CHC to affordable licensed • Signed a repackaging agreement and production plan with KPI covering the duration of the agreement. 54% and high-quality pharmaceutical of Injectaplan products were repackaged while Protector condom repackaging was delayed due the lack of health products manufacturer partner spare parts, which are scheduled to be delivered by the end of January 2020. Unbranded Pilplan Plus and services to Repackage remains out of stock and will be delivered by the end of February 2020. through social unbranded Injectaplan marketing product. • Held monthly meetings with KPI to review product stock status against production targets and agreed to increase repackaging volumes for the month of January 2020 to produce at least 500,000 vials of Injectaplan to meet monthly sales targets.

• Conducted quality assurance supervision visits to KPI twice a month to ensure compliance with the repackaging process. It was noted that all repackaging activities for Injectaplan were as per required guidelines.

Engage established During the quarter, CHC commercial sector • Engaged Abacus Pharma (A) and Kiboko distributors to distribute SM products using their established pharmaceutical and infrastructure networks of regional warehouses and retail outlets. Monthly sales and distribution volumes fast-moving consumer were agreed on in distribution agreements. goods, distributor. • Held supervision meetings with the distribution partner, Abacus Pharma (A), every first Thursday of the month to review sales and distribution quantities and the distribution channel sales analysis, as well as trade/sales volume forecasts as summarized in the table 4 below;

Table 4: SM products sales distribution quantities and volume forecasts

Product Injectaplan Protector Pilplanplus 1. Monthly Targets 160,000 Pcs 1,600,000 Pcs 155,000 Pcs 2. November 2019 Supplies 98,080 Pcs 0 pcs 0 pcs 2. December 2019 Supplies 160,000 Pcs 0 pcs 0 pcs 3. Target number of Outlets served 10,070 outlets 10,238 outlets 10,135 outlets • 4. Actual number of Outlets served 3,000 outlets 0 Outlets 0 Outlets Coordinate with During the quarter, CHC USAID, Global Health • Coordinated with USAID, Global Health Supply Chain (GHSC-PSM) in the procurement of replenishing Supply Chain – supplies of the USAID SM emergency commodities. Procurement and Supply Management • Participated in the GHSC-PSM stakeholders pipeline stock forecasting and status exercise. Due to delays (GHSC-PSM), and the in replenishing Pilplan Plus stocks, it was proposed that when those commodities arrive they should be GOU to distribute supplied to JMS’s alternative distribution channel. unbranded soon-to- expire stock. Improve Support the GOU to During the quarter, CHC strategic implement the TMA • Held meetings with key TMA stakeholders and commercial distributors of condom commodities (i.e. PSI, partnerships for strategies for both PACE, MSI, FHI360, Dembe distributors, DKT, and SAMATIA) to discuss market segments for the growing the male condoms and distribution of respective (commercial, subsidized and free) condom products. Key recommendations were private sector family planning to fast track the review and update of the national TMA policy. and products. coordination of social marketing efforts in the country

Increase Develop marketing During the quarter, CHC; demand among plans and roll-out • Developed marketing plans to guide the relaunch of Protector, Pilplan Plus, and Injectaplan and recruited target promotional activities consultants to develop the creative and graphic designs, as well as services to produce materials for the populations for for Protector, Pilplan relaunch of promotional campaigns. Radio airtime and TV Spots were booked to promote Protector and USAID socially Plus, and Injectaplan Injectaplan in targeted regions. marketed products and services

Progress Narrative

During the quarter, CHC continued to build capacity of USG IPs as a way of preparing them to fully take over and scale up SBCC interventions after CHC project closure in June 2020. Specifically, CHC provided technical assistance to:

• USG IPs including RHITES SW and Rakai Health Science Program (RHSP) towards mobilization of men aged 15+ for VMMC services. CHC built capacity of partner staff and community agents through twinning them with IPC agents to enhance their competences in the dissemination and use of SBCC materials, and micro targeting to identify unreached audiences.

• RHITES North Acholi and RHITES North Lango to undertake hotspot mapping, targeted mobilization, all geared towards increasing demand and uptake of FP services among AGYW (10-24), women of reproductive age (15-49) and men above 15.

• The Ministry of Health to undertake a desk review of existing malaria studies to provide audience insights on the barriers and motivators/enablers to LLIN registration, distribution and use, whose findings will inform the development of tailored SBCC interventions for the 3rd universal LLIN campaign.

• Risk communication structures to detect, prevent and mitigate disease outbreaks in the hot spots of the Ebola virus disease risk prone districts. Specifically, CHC oriented them on their roles and IPC skills.

• RHITES-E to reproduce seed copies of Obulamu? nutrition guide (How’s Your Baby?), champions dialogue and referral books which they have integrated in their SBCC programming and work plans.

• The Ministry of Health to organize Uganda’s first Annual National Health Promotion and Disease Prevention conference held under the theme, “Investing in Health Promotion and Disease Preventions to Achieve Universal Health Coverage”. CHC supported the conference branding logistics and media coverage and led the SBCC: From theory to practice track of the conference. The lessons drawn from this conference will guide future preparations of the next conference anticipated to take place in the next two years.

Partnership, Collaboration, and Stakeholder Engagement

During the quarter, CHC worked with Government entities, USG implementing partners, and communities in the design and implementation of health communication interventions to strengthen partnerships, collaboration, and stakeholder engagement for ownership and continuation of gains. CHC’s progress towards the guiding principles included:

Apply a holistic approach to CLA (collaboration efforts): CHC worked with MOH and partners to develop, review and approve all the posters, radio spots and TV spots/ videos, Risk assessment tool, decision making wheel on LLIN use, IRS, Case management and Malaria in pregnancy. The audio and video materials will be rolled out on the OBULAMU media platform beginning January 2020 to pave way for the universal LLIN campaign.

Ensure broad and inclusive stakeholder engagement: CHC worked with stakeholders including MOH, district leadership (DHO, DHE) and community members (VHTs, local leaders, religious leaders) to conduct community demand creation activities targeting priority populations, like men, and strengthening the skills of demand creation mobilizers. The stakeholders were twinned with CHC IPC agents to conduct joint planning meetings for the interventions, conduct pre-test exercises, and community one-on-one and small group engagements. This aimed at providing on-job mentoring and skills development.

Prioritize partnerships that enable Ugandan-led development: CHC provided technical assistance to MOH and partners in the development of the HTS materials, and in conducting targeted demand creation activities for FP, HTS, and VMMC to increase demand for services and to support partners to reach their targets.

Apply a facilitative approach: This guiding principle is not applicable to this reporting period.

Foster leadership as a lever for change: CHC supported MOH to strengthen leadership in coordinating Uganda’s first National Health Promotion and Disease Prevention Conference held on for 6th - 7th November 2019 in Munyonyo. The aim of the conference was to provide a platform for government, health professionals, partners and the academia to share best practices and lessons learned, provide networking opportunities, and raise awareness on the importance of health promotion for disease prevention in improving primary health care outcomes.

Learning and Adaptation

Apply a holistic approach to CLA (learning and adaptation efforts): CHC worked with MOH and partners to develop, review and approve all the print, audio and visual materials on the refresher malaria campaign, tagged “How is your family?”, and finalize U=U communication materials, which include a Brochure, a Decision-Making Wheel and Wall Chart to be used by Linkage facilitators, Peers and Health Workers during Inter Personal Communication interventions. This aimed at strengthening the skills of the partners in the processes of reviewing and approving communication materials.

Seek to do business differently: CHC emphasized the use of data for decision making in implementing targeted demand creation interventions. HMIS and program data was used to plan for IPC interventions including: setting targets for activities such as home visits, large and small group discussions, and one-on-one discussions.

Maintain a problem-driven focus: The approach of using data to target interventions helped CHC to go where there was need to address a problem. This use of evidence in programming and decision making helped CHC to maintain a problem-driven approach.

Emphasize operational considerations: This is not applicable to this reporting period.

Inclusive Development

Harness youth-appropriate approaches: As part of the OBULAMU campaign, Life Stage 1 and 4 are dedicated to addressing the unique health needs of adolescents and young adults. During the quarter, CHC provided technical assistance to USG IPs through capacity building of volunteers and champions on how to mobilize youth to increase uptake of FP, HTS and VMMC services. This helped partners to boost their reach to the youth population.

Infuse and prioritize inclusive development (includes but is not limited to empowering women, youth, indigenous peoples, LGBTI and People with Disabilities.): CHC’s OBULAMU? campaign is premised on life stage approaches and focuses on four life stages; adolescent boys and girls (10-19 years), care givers of children under 5 years, young adults in relationships (18-30 years) and pregnant couples (15-49 years). The crosscutting target audience in all life stages are key populations, including female sex workers and their clients and men who have sex with men. During the quarter, CHC provided technical assistance to USG IPs to mobilize communities focusing on at-risk groups and priority populations for HTS service uptake.

Gender analysis during program activity implementation: From the data, persistent gender and social norms were identified as barriers to the uptake of FP services. Among the barriers found was that men were a major barrier to FP service uptake, and they needed to be targeted as key decision makers in the family. CHC’s IPC sessions focused on dispelling such gender and social norms as well as targeted mobilization, especially for men, to increase awareness and service uptake.

Science, Technology and Innovation Impacts

This section is not applicable to CHC. However, CHC has embraced the use of GIS including provision of TA to implementing partners that work on health communication interventions.

Activity Result Area Science, Tech, Innovation Planned outcome Achievements activity/task description N/A N/A N/A N/A

Transparency and Accountability

This section is not applicable to CHC’s mandate.

3. LEADERSHIP DEVELOPMENT

This section is not applicable to CHC.

Leadership development activity/task Planned outcome for the reporting Indications/examples results year

N/A N/A N/A

4. ENVIRONMENTAL COMPLIANCE

This section is not applicable to CHC’s mandate.

5. AWARD-SPECIFIC REPORTING REQUIREMENTS

During the quarter, CHC used GIS tools to innovatively document the locations of SBCC interventions, such as IPC and mass media activities, within the districts of program operation. This mapping highlights the targeting of the following activities: • HTS demand creation: Provided TA to Mildmay Uganda to build their competencies in behavioral change communication and social mobilization for males aged 25 plus to scale up HTS and integrated services. These efforts were geared towards promoting HIV preventive actions such as correct and consistent use of condoms, PrEP and PEP, mobilization and provide information on the benefits of HTS and obtaining results, HIV treatment and care and linkage among others. • Targeted mobilization for FP: Provided TA to USAID RHITES Acholi and Lango respectively in mobilization and demand generation activities to increase demand for FP services among targeted audiences in; Oyam, Amolatar, Agago and Pader districts. • Improving MCH and FP indicators: Supported Kasese DHT to conduct community engagements aimed at improving uptake of integrated FP and MCH services in communities within the catchment of Maliba HCIII, Hiima dispensary HCIII. Integrated family planning messages were tailored and disseminated among men and women of reproductive age in communities of Maliba and Hiima. • FP mobilization to increase access: Supported RHITES-E health facility staff and community health structures (VHTs & Community Facility Champions) to improve IPC and effective community mobilization skills of VHTS for family planning in Kibuku, Budaka and Bududa District. • Formation of EVD RCCs: Worked with partners like the Uganda Red Cross, UNICEF, and the different government structures to strengthen Ebola Viral Demand (EVD) Risk Communication in high risk districts of Kisoro and Kanungu districts. Risk communication committees were established at the district, sub counties and parishes. CHC will continue to work with Implementing Partners and districts together with VHTs, Animal health workers/youths on the EVD Risk communication. The geographical coverage of the above activities is presented in the Map of Uganda below.

6. ACTIVITY MEL PLAN UPDATE

In Year 6, CHC initiated the process of updating the MEL Plan to include indicators for GHSA, SM, and new indicators on nutrition and FP as well as the PRS update. However, in Y7 Q1, more emphasis was placed on close out of the project including final documentation and handover processes to MOH and USG IPs for purposes of sustainability.

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-425.1

Activity Financial Analysis Award Details: a. Total Estimated Cost $ 58,309,557 b. Start/End Date 21-06-2013/ 20-06-2020 c. Total Obligated Amount $ 50,636,302 d. Total estimated cost share $ 2,915,478 e. Total estimated leverage (if applicable) f. Total Expenditure billed to USAID/Uganda $ 48,456,160 g. Expenditure incurred but not yet billed h. Total Accrued Expenditure (sum of lines f and g) $ 48,456,160

Actual Spend for Four Quarters Q 1 Q 2 Q 3 Q 4 Actual Actual Actual Estimate Quarterly expenditure rate by funding source $ 1,432,184 $1,520,497 $ 712,040 $ 0 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. ▪ The cumulative cost share for CHC project is $ 2,816,764.

Key Management Issues

During the quarter, CHC addressed the following management and administrative issues:

• CHC finalized the revised Year 7 budget and workplan for the remaining 6 months of activity implementation (Oct 2019-March 2020) and shared it with USAID for approval. • CHC had a few staff positions that fell vacant as a result of staff moving on to other organizations due to the near end date of the project. Among the affected portfolios were the Regional Technical Manager-SW, Communication Associate, and Senior Adviser, MER.

Resolved Management Issues

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

Given the limited time to close out, it was resolved that the roles and responsibilities of staff who have separated will be distributed among the identified staff best suited to handle the tasks.

1 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.

8. PLANNED ACTIVITIES FOR NEXT QUARTER INCLUDING UPCOMING EVENTS

As part of the transitioning phase and in preparation for project closure, CHC plans to implement the following activities in quarter 2 (January – March 2020). • Conduct regional closeout meetings for CHC program targeting MOH, USG IPs, and districts. • Provide TA to MoH and USG IPs to support scale up of the HIVST and APN/ index testing and rolling out the completed client and provider materials. • Support roll out of various campaigns i.e. parents’ campaign, every hour counts GBV campaign, “I wonder” and ‘What’s my Choice’ campaign. • Review and finalize materials and tools on HIV care and treatment (viral load suppression/U=U, TLD transition, cotrimoxazole, TB/HIV integration). • Participating in MOH quarterly FP/RH TWG meetings to disseminate FP data, provide TA and orient IPs on the continued use of the FP tools and handover SBC tools and resources to MoH ahead of program closure. • Attend and present abstracts during KM platforms, such as International SBCC conference. • Mass media roll out on 6 TV and 24 radio stations of “What do you want your baby to become?” campaign, and Nutrition messages. • Attend MOH BCC TWG, Maternal and Child Health TWG meetings and providing tailored TA to address emerging SBC needs. • Hold a dissemination workshop for the CHASE Malaria to Zero campaign among MoH, IPs stakeholders and provide guidance for scale-up. • Participate in BCC TWG, Malaria BCC Thematic WG platform, IP activities, and render tailored TA to partners use data and implement targeted interventions • Strengthen parish, subcounty and district risk communication committees in 7 Districts. • Monitor standardized data flow procedures, check consistency and completeness of data through internal Data Quality Assessments. • Analyze data and collate output for timely periodic reporting requirements (PRS, quarterly/annual reports, DATIM narratives, TRAINET, FTFMS). • Coordinate and finalize inputs from appropriate technical and program teams to develop key dissemination products (abstracts, technical briefs and success stories). • Organize monthly meetings with distributors to review sales data and troubleshoot, where needed. • Conduct quality assurance visits to KPI repackaging process and to confirm reported stock volumes. • Develop, print and disseminate provider behavioral change tools and SBCC materials. • Conduct consultations with key commercial sector entities to identify opportunities to transition Protector, Pilplan Plus, and Injectaplan to the commercial sector.

9. ANNEXES

Success Story Program Element: Social and Behavior Change Communication Key Issues: Nutrition Title: Nutrition demonstrations boost youth bashes in Mityana district Operating Unit: USAID/ Communication for Healthy Communities (CHC) program, Uganda

* Pullout Quote (1,000 characters): Please provide a quote that represents and summarizes the story. “My children are not growing well. I prepare watery porridge for my three children. Worst of all, these children have suffered from diarrhea many times” Mama Sheila, Mityana.

“Mama Sheila’s baby is 6 months. She needs a variety of foods to develop well. Therefore, mothers should prepare the porridge thick enough to eat and not to drink. This is because thick porridge stays longer in the stomach and its nutrient dense unlike watery porridge that many mothers prepare for their children”, Senior enrolled nurse at Mityana Referral hospital.

* Background Information (3,000 characters): Please provide whether this story is about a presidential initiative, key issue(s), where it occurred (city or region of country) and under what item(s) (Objectives, Program Areas, Program Elements) in the foreign assistance Standardized Program Structure. Include as many as appropriate. See Annex VIII of the Performance Plan and Report Guidance for a listing of Key Issues. See the list and definitions for the Standardized Program Structure. http://f.state.sbu/PPMDocs/SPSD_4.8.2010_full.pdf.

This story is about nutrition and preparing nutritious food for children under five years. It shows how a mother of three children under five benefited from the knowledge she got from nutrition experts during nutrition demonstrations conducted in a youth bash at Mityana district. The mother explains how she learnt to prepare nutritious foods for her children including preparing thick porridge.

Nutrition demonstrations boost youth bashes in Mityana district

The Development partners have always extended financial and capacity building assistance to the government including line ministries and districts to participate and implement development interventions. Through FHI 360’s Obulamu project, the Interpersonal Communication Activities provided a platform for continuous sharing of nutritional messages and engagement of parents, guardians and care givers of children. Mildmay-Uganda also committed one hundred fifty shillings for buying nutrition demonstration items. These were used for demonstration during this year’s International Breastfeeding Day celebrations. The items included groundnut paste, maize flour, cooking oil, water and other types of foods at the youth bash which coincided with the district celebrations for the world breasting day. In addition, the nutritionist (volunteer) from Mityana hospital explained further that nutrition is not just fish, food but rather food of all types including protein, carbohydrates and vitamins. “As the baby grows, feeding a six months’ baby is equally important for every mother or caretaker to begin complementary feeding. This means breastfeeding the baby as well as introducing soft foods for the baby,” Nutritionist (volunteer) from Mityana hospital. It is at this moment that Mama Sheila a 20-year-old mother acknowledged that coming for youth bash organized by FHI 360 CHC project has helped her appreciate the knowledge she has acquired on preventing diarrhea and cooking nutritious porridge for her children aged 5, 2 years and 6 months. “My children are not growing well. I prepare watery A Nutritionist from Mityana Hospital explaining to the mothers the nutrition practices during World breastfeeding porridge for my three children. Worst of all, these day in Mityana district. children have suffered from diarrhea many times” Mama Sheila, Mityana. A senior enrolled nurse at Mityana Referral hospital said that Mama Sheila is among the many mothers who are keen on learning how to prepare thick porridge for her 6 months old baby. “Mama Sheila’s baby is 6 months. She needs a variety of foods to develop well. Therefore, mothers should prepare the porridge thick enough to eat and not to drink. This is because thick porridge stays longer in the stomach and its nutrient dense unlike watery porridge that many mothers prepare for their children”, Senior enrolled nurse at Mityana Referral hospital. Every mother who attended the youth bash, benefited from the knowledge sharing of mixing different foods (“kitoobeero”) and cooking nutritious porridge. It is also important to note with the continued messages from FHI 360, mothers and Mityana district have holistically embraced the Obulamu project to the extent that mothers have put up individual initiatives in their communities to teach young mothers the benefits of breastfeeding and cleaning children. This initiative is very good for sustainability because it has not been there in Maanyi sub county, Mityana district. Today, FHI 360 can be proud that it has greatly contributed to the development of children in the district to the extent that the district itself has started allocating funds for nutrition related events.

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

Sheila Marunga Coutinho, Chief of Party Communication for Healthy Communities, FHI360 Plot 15 Kitante Close, Kampala, Uganda Tel: +256-312-266-406 Email: [email protected]