1. Global Health Practitioners Meeting
“Health Starts at the Community”
Silver Springs
May 5th -9th 2014

2. ACT Health Premise
Changes
within
Society
(Empowerment
of Individuals)
Changes
within State
(Inclusive and
Responsive
Institutions)
Changes at
State &
Society
Interface
(Space for
participation
and collective
Voice)
Increased
Accountability
and
Responsiveness

4. Where
 Pilot in Bugiri District Eastern Uganda
 Population : 426, 800
 33 Health Facilities
 5 National partners
 Started January 2012

5. Community Voices –
First phase
• 5,912
Households
surveyed for
development
of the CRC
CRC

6. Citizen Report Card (CRC) Excerpt
Attendance of Health Staff at health centers
Percentage of households who said staff are always at work 43%
Percentage of households who said staff occasionally do not come to work 36%
Percentage of households who said staff are rarely at work 21%
Household rating of medical staff attendance at government health centers
Medical staff attendance at government health centers on survey day
Total number of medical staff allocated to government health centers II.
(National Standard; 3medical staff per HC II X 23= 69)
52 (75% of
what is
required)
Total number of medical staff present in the health centers on the survey days 43 (83%)
Total number of medical staff out for outreach and/or training on the survey
day
0 (0%)
Total number of medical staff out on leave on the survey day 6 (12%)
Total staff absent 3 (6%)

7. Community Voices
Second Phase
• 5,912
Households
surveyed for
development
of the CRC
CRC
•2718 engaged
in action plan
development
Interface Meetings
/Action Plans

8. A sample Action Plan
Issue Action (incl timeline & person
responsible)
Status of action Challenges Proposals or Changes to actions
Community unaware of the
services offered at the H/C
The HUMC to establish the sign
post not exceeding August 2013
Not achieved Inadequate and delayed release of PHC fund The in charge should prioritize the issue of
establishing a sign post and act accordingly
upon receiving PHC fund 1st April 2014
HUMC, Local leaders and VHTs
to inform community about the
services offered during static
days at the H/C
Achieved done every
Tuesday and Thursdays in
the week
None HUMC and in charge should write on manila
papers the services offered at the health facility
and pin it against the walls by the 30th of Feb
2014
Health workers to make
appropriate referrals
Achieved by health
workers explaining to the
clients why they are
referred to other Health
facilities
None No change to the proposal
H/C closed when H/Ws go for
outreaches/workshops
At least one health work should
be left at the H/C effective August
2013.
Achieved as a health
worker is always left
behind
Community members come at the health centre
during time of closure
The VHTS should always inform the Community
members to visit the H/C in the right operating
hours i.e. from 8:00am-5:pm effective
14th/02/2014

9. Community Voices
Third Phase
• 5,912
Households
surveyed for
development
of the CRC
CRC
•2718 engaged in
action plan
development
Action Plans • 25 most
significant
change
stories
collected
Results

10. Why Most Significant Change (MSC)
Stories
• Facilitate community involvement in monitoring and
evaluation
• Track unexpected outcomes
• Support the light touch monitoring approach
• Contribute to program evaluation

11. MSC Collection and Analysis
• In-depth interviews with people are household
level
• 1 story per month from each health facility
• Analysis categorizes stories into four domains:
• Changes in service quality
• Changes in the community/service provider relationship
• Changes in health outcomes
• Other changes.

12. Final MSC Story Selection
MSC collected
one story per
health facility
every six months
33 over six months
Categorized in
Domains
for each health
facility one story
for each domain
132 stories
Regional Stories
Chosen
1 story from each
domain
Final Review of
regional stories
and a final MSC is
chosen every six
months

13. Example MSC
Name of storyteller: Naigaga Irene
When did the change happen? May 2013
Changes in health workers’ supervision improves service quality
“In June the in charge was demoted and a new in charge was
posted to the health centre. The new in charge is always at the
centre and this has resulted into improved service quality because
the health workers arrive on time, very active on duty and give
appropriate referrals. The high level of supervision has even led to
the health workers operating on Sunday which was not the case
before.
This story is very significant to me because the community can
now be sure to find health workers at the health centre and
receive health services.”

14. Example MSC
Name of storyteller: Kagoya Rebecca
When did the change happen? May 2013
Improved client care for mothers!
I raised the mother’s concerns and they were captured in the
action plan. This meeting allowed us present these issues directly
to the health workers who were present. The midwives have since
improved the way they handle mothers and stopped asking for
money. This has increased the number of mothers delivering at
the health centre.
This story is significant to me because the number of mothers
delivering at the centre has increased .”

15. MoH Voices
 Health Facility Assessments ( 3 times)
 Interface Meetings
 MSC
 Outcome Mapping
 Quarterly Reviews with partners

16. ACT Health Scale Up
 16 districts across Uganda
 329 health facilities
 7 different national partners
 In conjunction with an RCT to answer the following
research questions:
 Does the ACT Health Program lead to greater access to
services and an increase in health seeking behavior?
 Does the ACT Health Program contribute to downwards
accountability among duty-bearers for health services?

17. Scale Up: Community Voices
ACT Health scale up has the potential to involve:
 150,000 households in CRC
 19,800 community members in action plan
development and interface meetings
 367 MSC stories collected every six months

18. Acknowledgments

19. Questions