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Skip to 0 minutes and 13 seconds [Speaker] By the end of this presentation

Skip to 0 minutes and 14 seconds you 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 seconds The 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 seconds Selection 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 seconds Do 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?

Skip to 2 minutes and 9 seconds [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. And 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.

Skip to 3 minutes and 15 seconds [Speaker] How did you determine which potential partners to invite to the first F&E workshop? [Stella Kanyesigye] The WASH 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. We 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.

Skip to 4 minutes and 18 seconds 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 seconds Quantitative 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 53 seconds Qualitative 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 8 seconds In 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. - 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 seconds Participants work together to: - Brainstorm to determine which activities should be conducted and prioritised by the programme. - Review implementation mechanisms, roles, indicators and 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 seconds So a number of them submitted the proposals, 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. [Speaker] What have been the benefits for the Ministry of Health in working with other WASH organisations? [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.

Skip to 7 minutes and 42 seconds 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. First take an inventory of the existing WASH partners, even if they are not dealing with health issues, have a discussion with them and discuss with them how they can incorporate the trachoma activities into their existing ones.

Skip to 8 minutes and 41 seconds Then thereafter you come up with a trachoma strategy and then engage them to take them 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. Much 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 that 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 even more than we are already engaging.

Skip to 9 minutes and 43 seconds 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. [Speaker] In summary: - F&E success depends on partnerships and collaboration. - 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 years.

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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