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Planning F&E implementation: Uganda case study

In this video, Angelia Sanders and stakeholders in Uganda's trachoma programme explain the key elements of an implementation plan to implement F&E.
[Speaker] By the end of this presentation
you should be able to: Understand the key elements of an implementation plan to implement F&E as part of the SAFE strategy to eliminate trachoma in endemic districts. And, appreciate the experiences shared by stakeholders in Uganda. Once a situation analysis has been done and partners selected, the next step in the F&E strategy is to hold a meeting to plan the implementation. The planning meeting is cross-sectoral and often done as part of the national or sub-national Trachoma Action Plan. Planning begins with understanding of what is the present situation (the ‘here’) and then plotting where we want to get to by the end of a specified time period (the ‘there’). Then each step of the journey from ‘here’ to ‘there’ is planned.
In trachoma every context is different, even in the same country. Therefore, there are different ways of achieving the same goal of face cleaning and environmental improvement.
At the F&E planning meeting, the group of F&E stakeholders: Assess the baseline data from the situation analysis to identify gaps and highlight possible ways forward to achieve F&E targets. Review activities to achieve targets. Specify which stakeholder will be responsible for carrying out each activity. Assign milestones and timeframes for all activities. Establish a schedule for review meetings. Agree on a monitoring framework and indicators by which achievement will be measured. And finally, and most importantly, the group establish a budget. This is based on the agreed deliverables and is developed using average material and staff costs in the country. The above activities and budget arrangements become the tools for the management team to use and track achievements.
During planning DO: Take local planning cycles and fiscal years for stakeholders into consideration. Factor in seasons and holidays which may limit or stop work from taking place. Create a scope of work for each partner organisation. Ensure adequate training in SAFE messages across the health and non-health partners.
DO NOT: Reinvent the wheel. Instead, build on existing process in the system.
DO NOT: Forget water - good hygiene requires water.
DO NOT: Apply a one size fits all across the districts, even in the same country. and DO NOT assume funds will be secured if they are not agreed at the beginning.
The range of activities inventory is prepared in detail for each sector - education, health, WASH and corporate: Activities that are then further elaborated for each sector
and the level at which they need to be provided: at a community level, education level and they also highlight all infrastructure required for the activity, as well as considerations for behaviour change and social marketing. Following a situation analysis, partners in Uganda were involved in integrating F&E into their work at a district level. We learn from two partners in Uganda about their experiences of, and perceptions about, implementing an F&E plan at the local level. In the first clip, partners from Water Mission an NGO that works closely with the Ministry of Water in Uganda, Moses Mandu and Fred Muwanguzi, talk about Water Mission’s work in F&E.
And then Lillian Nakato from JHU [John Hopkins University] explains how the Trust Trachoma Project Uganda contributes to F&E in Uganda. [Moses Samaali Mandu] Thank you, Water Mission has had interest in working on the trachoma elimination programme through discussions, interactions with partner organisations through which they learned about this programme to support [the elimination of] blinding trachoma and through that they expressed interest through our proposal that had to spell out strategies on how they want to contribute to this elimination task [Speaker] How is Water Mission currently partnering with the Ministry of Health for the elimination of trachoma? [Moses Samaali Mandu] The Minister of Health went through what we put down in our proposal.
We, at the moment, participating in a couple of quarterly review meetings. We share reports and right at the grass root district level we have direct engagement with the district health officers who coordinate the Ministry representative at district level and we go further down to the grassroot to engage with the district extension workers, the health inspectorate staff and the ophthalmic clinical officers who are trained as surgeons to be able to accomplish the task. [Speaker] What are the WASH sector’s strengths in partnering with the Ministry of Health and the trachoma programme?
[Fred Muwanguzi] First and foremost, elimination of trachoma is hinged on availability and use of water by individuals and for that matter WASH’s role, partners’ role, is we’ve been able to interact with the Ministry at various fora, both Ministry of Health and Ministry of Water and Environment, to try and increase access to safe water in certain areas. Secondly, alongside that we have made efforts to train community owned resource persons to be able to appreciate that prevention is the best strategy towards trachoma elimination and therefore give them knowledge, or bridge the knowledge gap, to community resource persons who then transfer this to the households through microtrainings. We therefore believe that this has been a strength in the support for trachoma elimination.
But also in addition, we have learnt, we have learnt a lot, there has been a lot of exposure from the people we are working with. Like I talked about the SAFE strategy, you know there are many terms you hear, TT, TF, TI, so you know those are health-related terms but we have come to appreciate to work with them and also to see how we can contribute not only under the Ministry of Health also under the Minister of not only under the Ministry of water but also under the Ministry of Health.
[Speaker] What was the key attraction for John Hopkins University to be involved in the trachoma programme [Lillian Nakato] I think the major attraction is the fact that trachoma prevention is about improving behaviours that put people at risk and JHU is strategically known to be, to have a lot of experience intervening in behaviour improvement programmes and for trachoma elimination the key behaviours, of like the indicators are so much what you can do to support people to see the problem, understand the risk, be able to adapt behaviours and prevent disease. So we felt like the programme is actually dealing with behaviours that can be improved. [Speaker] What is JHU currently doing in the F&E implementation process?
[Lillian Nakato] With the Ministry of Health, we are working with them at two levels. One we are working with the Ministry of Health in the department of health promotion and education unit where we are supporting partners to develop materials, communication activities. Ministry of Health, that particular department offers their endorsement, their approval, So we work with them along the way.
From the beginning, like the recent activities we’ve been doing on the adaptive flipchart for community sensitisation activities, we have worked with the Ministry of Health from the development, then on adaptations to the field pretesting of the materials so by the time we have finished the Ministry of Health has been part of the process and it was easy for them to say these are good materials, partners can continue to use them. So we have no problem of no, no procedures or sticking up because they were part and parcel of the process.
Then we are also working with the Ministry of Health, Environmental Health division in particular because they host the task for updating the national sanitation guidelines to be able to interpret in trachoma prevention communication messages so we’ve be working with them. Through the whole process of identifying issues through baseline surveys, looking at their guidelines because they already have these guidelines in place but trachoma prevention is not integrated. Working through procedures for identifying a consultant who would be able to support the process and having some many meetings on planning how the activities will take place.
Then the Ministry of Health NTD, we don’t directly work with them but they also oversee what we do in the sense that as we work with the Carter Center like when we had the partners’ BCC review meeting the Ministry of Health was represented as government and that was the NTD section of the Ministry of Health yes [Speaker] Are you working with other ministries beside the Ministry of Health [Lillian Nakato] Yes, currently we are working with the Ministry of Education and Sports and we are supporting them to be able to also update the national school sanitation guidelines which previously didn’t have a trachoma prevention component and they now realise they also need to communicate about trachoma from the early stages when children are still young and will also use them to take back the messages to their home.
So we have been working with them at a process level so involves identifying the consultant who can then do it and also relooking at the documents to be able to understand how much work the consultant has to do. We also have some activities lined up to review with other partners and also the district officials to review the content and be able to own it so that when we are disseminating, it is addressing the gaps they also felt at the district level. So we are still working with the both of them. [Speaker] What were the challenges of working with the different ministries?
[Lillian Nakato] Okay, I think the challenges of working with different ministries has been mainly that you don’t move at the same pace. Different ministries have different challenges so as you are moving on with one the other one is lagging behind. And yet the way the project is designed you are supporting different levels of the population with the same messages at the same time so the challenge is that you might find that the materials for the community sensitisation activities are already out but the sanitation guidelines which the same partners are supposed to use in the schools to be able to communicate to the children and the teachers are not yet ready because the process is at the beginning.
So that has been the major challenge, sometimes the procedures are so long, the partners to consult are many so it’s not easy to make quick decisions it requires a lot of patience, yeah. [Speaker] Do you have any advice for other countries that are trying to plan F&E? [Lillian Nakato] I think I would start by saying that the exciting part to me of this particular project is that the way it is designed you are able to target all the key populations and by bringing on board all the responsible partners at the same time.
Such interventions are not really common because many times everyone wants to go in the field and do implementation but the project is using the different partners in their area of speciality to go out and intervene and support populations to be able to adapt to the preventive behaviours. And at the same time what I like about it is that it is likely to have a strong sustainability prospect for the reason the partners are not essentially coming out to implement these activities independently but they’re integrating trachoma prevention activities, the WASH programmes, within the programmes that they have already been doing.
So they are using the same structures, they are using the same time when they go out for other activities to also communicate about WASH so to me this is a very, very big lesson for many national programmes. You will find that there are many implementers out there, they are not co-ordinated, but now you can see that even for communication they are co-ordinated. They are using the same communication messages but tailored to the different communities. They are using their own way of communicating they are not inventing new activities. The materials we supported them to develop are only helping them to do what they have been doing and also focusing on facial cleanliness and environmental hygiene.
So I think this level of coordination and synergy is very, very useful. They will continue to communicate on F&E issues even after the project is there. To me it’s a really, really a great design
In summary: The F&E planning workshop is an essential cross-sectoral activity. Cross-sectoral collaboration and communication leads to less duplication of effort and stronger planning and delivery of F&E. Targets and timeframes need to be defined for each activity and for each stakeholder. F&E activities can take place across multiple levels from grass-root to national policy formulation. Successful implementation comes from partners who are involved at a planning stage and have a sense of ownership, that they are making a difference.

When you want to start a journey, the first step is to analyse the situation:

  • Where you want to go – why you need to make the journey?
  • Who is travelling and why – who are your partners?
  • What do you have to travel with – what resources and funding do you have to make the journey?

Based on this SITUATION ANALYSIS, you can make a decision on how far you can travel in the time that you have. These are your TARGETS.

Everything else that follows is about ensuring that you carry out the right activities (e.g. buying petrol for the car) at the right time (before the car runs out of fuel) and with the right budget (money for the petrol). This is your PLAN.

Uganda case study

The Uganda Trachoma Elimination Program has many SAFE partners. Currently they include: The Carter Center, Sightsavers, CBM, and RTI/ENVISION, Water Mission, Water Aid and John Hopkins University Center for Communications Programmes.

As part of the F&E strategy, the programme is currently working with three partners, though efforts are currently on-going to add additional WASH partners to provide services to other endemic districts:

  • Water Mission Uganda: 10 districts in Busoga region
  • Water Aid: 2 districts in Karamoja region
  • John Hopkins University at national level and regional level.

Following a situation analysis of F&E in Uganda, a workshop was held with representatives from the ministries of health, water and environment, education and sports and various WASH and trachoma organisations. Participants identified gaps in the national programme and came to a consensus on which F&E activities should be implemented in the country:

  • Integration of face washing and trachoma messages into existing WASH strategies and activities in Busoga and Karamoja regions
  • Revision and dissemination of school sanitation guidelines
  • Revision and dissemination of national sanitation guidelines
  • Development of a social and behaviour change communication strategy to be used as part of mass media campaigns on radio, television and video.

As you watch this video, consider why trachoma programmes need to carefully consider partners’ motivation to work together on F&E activities.

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