Skip to 0 minutes and 12 seconds[Speaker] By the end of this presentation

Skip to 0 minutes and 14 secondsyou should be able to: - Consider the planning steps that need to be taken at a local level for successful F&E - Appreciate this in action through the Uganda case study. The national Trachoma Action Plan includes a clear and decisive strategy for F&E at the district level.

Skip to 0 minutes and 33 secondsThe key F&E activities at district level include: - Identifying partners in the district and their motivation for engagement. - Organising a meeting to identify shared objectives for implementing WASH activities - Doing a situation analysis for F&E - Undertaking formative research to identify and inform behaviour change. On a practical level all relevant stakeholders in the district are listed - from the health, neglected tropical diseases, education, WASH and corporate sectors. Key partners are selected from the list and invited to a meeting - which can be a formal or informal occasion - to discuss how to proceed on collaboration.

Skip to 1 minute and 19 secondsSelection of partners is based on: - their track record to deliver and their motivation to integrate trachoma specific messaging and activities - whether they can contribute human, technical and financial resources - and, whether they can deliver key components of water and sanitation and health education.

Skip to 1 minute and 40 secondsDO NOT ASSUME: - All partners will collaborate, as there maybe conflicting priorities - That F&E is already being delivered by other WASH programmes. For example, they may have hand washing with soap but no face washing - That infrastructure funding can be diverted from other sectors. In Uganda, within the affected districts, how were key partners selected? [Ruth Tushemereirwe] First of all we asked the WASH umbrella organisation, which was WASHNET to give us the list of WASH partners that were already existing in those districts and we invited them for a F&E workshop and those ones who attended were actually invited to write a proposal and then come on board.

Skip to 2 minutes and 38 secondsAnd the proposals were written and a few were selected [Speaker] Which government agencies did you reach out to, to get the information you needed for the situation analysis? [Ruth Tushemereirwe] We visited the Minister of Health, Minister of Water and Environment, Minister of Education and Sports and the WASHNET, which actually give us the names of organisations which is the Busoga Trust, Water Mission, John Hopkins University and Water Aid. [Speaker] How did you determine which potential partners to invite to the first F&E workshop? [Stella Kanyesigye] The WASH partners, the organisations were considered and those organisations that had wide experience in doing WASH activities. We also considered organisations that were part of the national sanitation group.

Skip to 3 minutes and 41 secondsWe also looked at those organisations that had collaboration with ministries of government. And their history in managing donor funds was also considered. And those who had a very good history of managing donor funds were considered. [Speaker] Once the partners are selected, the next step is to carry out a situation analysis of F&E at district level. In some settings this could work in reverse, as in Uganda where they did a situation analysis followed by selection of partners. This will help to provide a detailed insight into the environment we want to influence. A situation analysis requires both quantitative and qualitative data to be collected.

Skip to 4 minutes and 30 secondsQuantitative data is collected on: - Disease and demographics - Sanitation and water access points, gaps and investment plans. - Key policy and planning documents for NTDs, health education and WASH activities - Existing health extension programmes in the area. For example, school health clubs.

Skip to 4 minutes and 52 secondsQualitative data is collected on: - The social context and community behaviours in WASH - Practical views and use of toilets and water points - And, community knowledge about environmental improvements such as fly prevention.

Skip to 5 minutes and 9 secondsIN A SITUATION ANALYSIS: - Don't expect data to be always available - Don't go to just one place for data - collect from different ministries, partners and reports - Don't assume toilet availability means that toilets are being used - Don't assume access to WASH is uniformly distributed - and don't assume all planning is based on needs. For example it may be linked with political patronage or easy access by road. The insights provided by the situation analysis are considered at a detailed workshop with selected stakeholders.

Skip to 5 minutes and 48 secondsPARTICIPANTS WORK TOGETHER TO: - Brainstorm to determine which activities should be conducted and prioritised by the programme - Review implementation mechanisms, roles, indicators, schedules - Create deliverables and timelines - Determine responsibilities for each activity - Determine what can be accomplished based on a realistic budget and funding source - And agree on the monitoring and evaluation plan. [Speaker] How did you identify which WASH partners to work with? [Muheki Edridah] Immediately after the workshop, the WASH partners were requested to write proposals and submit them to the trust for us to be able to identify the potential partners to work with.

Skip to 6 minutes and 38 secondsSo a number of them submitted the proposals and then the Ministry of Health constituted a panel that reviewed these proposals and this panel included members from the division of environmental health, the Ministry of Health, the NTD programme members, the Carter Center. We all sat together, reviewed the proposals and we did find three potential WASH partners to work with according to their specialities. and these included John Hopkins university Specialised in (Inaudible) PCC and also water missions and water aid. who were already working in some of the trachoma endemc districts [Speaker] What have been the benefits for the Ministry of Health in working with other WASH organisations?

Skip to 7 minutes and 33 seconds[Muheki Edridah] The benefit is that most of these organisations already have structures in place in these districts. So working with them, we build onto those structures. And also, because the work is too much, it takes a concerted effort and a wide approach. So the benefit is that they have a role that they are already playing in the district and when we engage them they are willing to integrate the trachoma activities into their existing activities so the benefit is great because we can reach out more than engaging just one partner and new in an area and starting from square one. [Speaker] What has been learnt from this experience? [Muheki Edridah] The best thing to do is to do a situation analysis.

Skip to 8 minutes and 37 secondsFirst take an inventory of the existing WASH partners, even if they are not dealing with health issues, have a discussion with them and discuss how they can incorporate the trachoma activities into their existing ones. Then thereafter come up with a trachoma strategy and then engage them to take it up. The experience is that it is possible to eliminate trachoma by engaging many partners and the main challenge is environmental, sanitation and facial cleanliness.

Skip to 9 minutes and 24 secondsMuch as mass drug administration has taken place and some districts, in the example of Uganda, have already stopped mass drug administration but with no sanitation in place there is a high risk of recrudescence so the lesson learnt is that the existing structures and partners out there whom we can utilise even for future sustainability of the programme. Another lesson learnt is that ministries of health cannot work alone on programmes. We need to engage much more than we are already engaging. We need to engage the communities, local governments, Ministries of Education because they already have some sanitation programmes running in schools. So it is a big lesson learnt by engaging the WASH partners.

Skip to 10 minutes and 20 seconds[Speaker] In summary: - F&E success depends on partnerships and collaborations - At district level, it is essential to select the right stakeholders across a wide range of sectors - WASH, education, health and corporate - Do a detailed situation analysis for the district - Plan in partnership with stakeholders - Recognise that each partner comes with their own experiences, expectations and motives.

Situation analysis for F&E: Uganda case study

Interventions for face washing and environmental improvements often require expertise beyond the reach of health programmes. A wide range of stakeholders and partnerships are needed to implement sustainable solutions. In this step we look at how Uganda has been working towards establishing F&E in their trachoma endemic districts.

Uganda is a landlocked country located in Eastern Africa. It has 114 districts and a population of approximately 36 million people. The country has targeted trachoma to be eliminated by 2020. The national trachoma elimination program started in 2007 as part of an integrated programme to eliminate neglected tropical diseases. Trachoma mapping of all the districts was completed by 2013. As of July 2016, there are 20 districts with a prevalence of active trachoma (TF) of more than 5% in children aged 1-9.

17 districts in the Busoga and Karamoja regions of Uganda have received funding for F&E activities. A situational analysis was carried out in early 2014 to understand the Water, Sanitation and Hygiene (WASH) situation in the regions.

As you watch this video, consider the potential of including local and multinational businesses as F&E partners (for example, soap makers). What role could they play in F&E for trachoma elimination? And what would be the key argument with which to approach these groups?

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Eliminating Trachoma

London School of Hygiene & Tropical Medicine

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