The community score card approach was used to assess the quality of HIV/AIDS services in 3 districts of Uganda. Key findings included poor ratings for male circumcision and adolescent HIV care due to cultural beliefs and lack of privacy. ART access received fair-good ratings but with stockouts and stigma as issues. Family planning services faced challenges of negative beliefs and domestic violence. Staffing gaps exceeded 50% at some health centers. Recommendations focused on increasing staffing, addressing stockouts, improving community sensitization and awareness of patient rights.

1. USING COMMUNITY SCORE CARD
APPROACH TO MONITOR THE
QUALITY HIV&AIDS SERVICES
Results of the Study conducted in
Kalangala, Kitgum and Serere Districts

2. What is a Community Score Card
• The Community Score Card (CSC) is a
participatory, community based monitoring and
evaluation tool that enables citizens to assess the
quality of public services such as a health centre,
school, public transport, water, waste disposal
systems and so on.
• It is used to inform community members about
available services and their entitlements and to
solicit their opinions about the accessibility and
quality of these services

3. Assessment objectives
• To empower the community (service
beneficiaries) assess the quality HIV&AIDS
services in their districts
• To enable the service providers self evaluate
the quality of HIV&AIDS services that they
offer to the community.
• To make recommendations on HIV&AIDS
service delivery to policy makers , policy
implementers and other stakeholders

4. Study Area
The study was undertaken in the three districts
- Kitgum in Acholi Sub Region, Serere in Teso Sub
Region, Kalangala in Central Region .
The study was done in a catchment of 12 health
centers across the three districts
Kitgum (5) - Kitgum General Hospital, Namokora HC IV,
Kitgum Matid HC III, Orom HC III and Pajimo HCIII
Serere (5) - Serere HC VI, Apapai HC IV, Kadungulu
HCIII, Kateta HC III and Pingere HC III)
Kalangala (2) - Kalangala HC IV, Bwendero HC III)

5. Study Population
• A total of two hundred and twenty people
(110 males and 110 females ) participated in
the focus group discussions
• 240 (135 females and 105 males) participated
in the interface meeting.
• Key informant interviews were conducted
with the in-charges of the 12 health centers.

6. Sampling methodology
• A Simple Random Sampling (SRS) technique
was employed to select the health centers and
communities for the CSC.
• A complete list of all the health centers in the
three districts was collected and assigned
them numbers in an excel sheet.
• An online facility RANDOM.ORG was used to
obtain 12 random number of a health centers
to be used for the assessment

7. Steps/Phases taken during the
assessment

8. Data collection and analysis
• Data was collected using qualitative methods
that involved highly participatory techniques
including, among others, desk reviews, Focus
Group Discussions (FGDs), Key Informant
Interviews, consultative/ interface meetings
and direct observation

9. Quality Control ; Assurance & ethical
Considerations
• A team of Research Assistants with expertise in
qualitative data collection were recruited, oriented in
the Community Score Card Methodology and trained
data collection
• All Study participants were requested for their
consent to participate voluntarily in the assessment
• Permission was sought and obtained before sessions
or interviews began for all study participants including
permission to take photographs
• All the participants were assured of confidentiality and
anonymity of their responses.

10. Summary of findings ( HIV
Prevention)
• 59% of the participants rated eMTCT services as
good (community members and service
providers)
• 25% rated as a very good and 16% rated it as
very poor
- Reasons for poor scoring
- inadequate staff, low male involvement, low
uptake of ANC & Post-natal services, stock outs
of test kits and drugs, delivery of drugs with short
shelf life, Stigma and lack of privacy during
counseling and testing due to inadequate space

11. Combined scores

12. Safe male circumcision score
Category Units
Very
poor
Poor Fair Good
Very
good
N(%) N(%) N(%) N(%) N(%)
District
Kalangala 1(50) 1(50) 0(0) 0(0) 0(0)
Kitgum 1(20) 0(0) 1(20) 3(60) 0(0)
Serere 0(0) 3(60) 2(40) 0(0) 0(0)
Level
General
hospital 0(0) 0(0) 0(0) 1(100) 0(0)
Level III 2(29) 3(43) 1(14) 1(14) 0(0)
Level IV 0(0) 1(25) 2(50) 1(25) 0(0)
CSC
Men 1(8) 3(25) 3(25) 3(25) 2(17)
Women 2(17) 4(33) 4(33) 0(0) 2(17)
Service
provider 2(17) 4(33) 3(25) 2(17) 1(8)
Combined
score 2(17) 4(33) 3(25) 3(25) 0(0)

13. Safe male circumcision
• SMC service is still marred with both cultural and
religious beliefs, inadequate information about SMC,
lack of equipment, resources and inexperience
health workers and inadequate staff numbers
leading to low and poor quality service rendered as
said in one of the FGDs.
• “Women in this community discourage their husbands to go
for SMC; they think that SMC makes men sexually weak after
5 years”, (- a Female FGD participant at Namokora HC IV in
Kitgum district)
•
•

14. Supply of female and male
condoms

15. Quality of HCT
• Good: 92%; however respondents
complained of lack of adequate counselling
rooms, limited number of staff, lack of skilled
counsellors and inadequate test kits.
Access to ART
67 % good; fair 27% and very poor 8% (constant
ARV stock outs , stigma, inadequate staffing,
loss to follow-up and lack of privacy)

16. ART for adults cont’d…

17. Paediatric HIV care
• Good: 50%, 42% fair and 8% very poor
Reasons :stock out of pediatric drugs, few health
workers, limited uptake of ANC & post-natal services,
mothers not giving birth in health centers , low male
involvement and stigma .
• Adolescent HIV care and treatment
• Fair: 58% and 17% as very poor
Gaps: Absence of youth friendly service
point/corner/space leading low privacy, low uptake
of the service and stigma coupled with the low staff
numbers

18. Integrated T.B services

19. Integrated TB services
• Limitations were cited and recommendations made
which included having separate wards and areas for
T.B patients, sensitization on T.B drug adherence,
promoting awareness of the availability of T.B
treatment among the community members,
recruiting of more staff, training of available health
staff on T.B/HIV co-management, provide facilitation
for client follow up, avoiding stock out of T.B drugs
and testing reagents

20. Family Planning Services
Family planning
Categories Units
Very poor Poor Fair Good Very good
N (%) N (%) N (%) N (%) N (%)
District
Kalangala 0(0) 0(0) 0(0) 1(50) 1(50)
Kitgum 0(0) 0(0) 2(40) 2(40) 1(20)
Serere 0(0) 1(20) 2(40) 2(40) 0(0)
Level
General hospital
0(0) 0(0) 0(0) 0(0) 1(100)
Level III 0(0) 1(14) 3(43) 3(43) 0(0)
Level IV 0(0) 0(0) 1(25) 2(50) 1(25)
CSC
Men 0(0) 1(8) 3(25) 6(50) 2(17)
Women 0(0) 1(8) 3(25) 6(50) 2(17)
Service provider
0(0) 1(8) 5(42) 5(42) 1(8)
Combined score 0(0) 1(8) 4(33) 4(42) 2(17)

21. Family planning services
• The provision and utilisation of family
planning service was lowest in Serere district
due to negative beliefs and domestic violence.
Most health facilities lacked long term
methods of family planning, trained staff and
involvement of men was still low

22. Palliative care services
Palliative HIV Care
Categories
Unit
Very poor Poor Fair
N (%) N (%) N (%)
District
Kalangala
1(100) 0(0) 0(0)
Kitgum
1(50) 1(50) 0(0)
Serere
2(100) 0(0) 0(0)
Level
General hospital
0(0) 1(100) 0(0)
Level IV
4(100) 0(0) 0(0)
CSC
Men
3(60) 2(40) 0(0)
Women
3(60) 1(20) 1(20)
Service provider
3(60) 0(0) 2(40)
Combine score
4(80) 1(20) 0(0)

23. Home based services

24. Rights awareness and support.

25. Staffing levels
• Most of the health centers visited had fewer
staffs compared to recommended staffing
norms from Ministry of health e.g Kitgum
General Hospital does not have permanent
Medical Officers ( 0 out of 7) and all other
staff categories are not filled to capacity

26. Staffing levels @ HC IV
• Namokora health centre IV had a gap of 58%
of the intended numbers for level IV facilities.
• Kalangala and Apapai health center IVs had a
gap of 14(29%)
• Serere HCIV had the lowest gaps registered
with only 6 (13%) of the total staff required
total staff. I

27. Staffing levels @ HC III
• Bwendero HC III in Kalangala district, Kitgum
Matidi, Orom and Pajimo in Kitgum district,
Kateta, Kadungulu and Pingere in Serere
district, registered about 68% of the total
number of staff required in a level III health
facility.
• 84% for Kateta HC in Serere
• 79% Orom HC and 74 % for Kitgum Matidi HC
III in Kitgum district

28. Time management
Observing working hours
Categories Units
Very poor Poor Fair Good Very good
N(%) N(%) N(%) N(%) N(%)
Level
General hospital 0(0) 0(0) 0(0) 1(100) 0(0)
Level III 0(0) 1(14) 4(57) 2(29) 0(0)
Level IV 0(0) 0(0) 4(100) 0(0) 0(0)
District
Kalangala 0(0) 0(0) 1(50) 1(50) 0(0)
Kitgum 0(0) 1(20) 3(60) 1(20) 0(0)
Serere 0(0) 0(0) 4(80) 1(20) 0(0)
CSC
Men 1(8) 3(25) 6(50) 2(17) 0(0)
Women 2(17) 3(25) 4(33) 0(0) 3(25)
Service providers 0(0) 0(0) 3(25) 6(50) 3(25)
Combined score 1(8) 3(25) 6(50) 2(17) 0(0)

29. Conclusion
Despite the improvements in drug delivery, infrastructure,
recruitment of new staff, there are still a number of
challenges that affect the delivery of HIV&AIDS services
in the three districts
• Too many patients seeking medical services,
• low male involvement in family planning and
reproductive health
• Limited awareness of patients rights and responsibilities
• Persistent drug stock outs
• Poor and dilapidated infrastructure
• Staff absenteeism

30. Recommendations
• The MOH and the district service commission
should recruit more health workers to fill up the
staffing gaps and reduce on the waiting time that
patients take to see health workers
• NMS to ensure constant supplies of Drugs and
reagents including testing kits to reduce on
frequent drug stock outs.
• Community sensitisation sessions by the district
local government, health facilities and VHTS on
family planning benefits and maternal health
services

31. • Sensitisation on patient’s rights and responsibilities
and roll out the national patient’s charter to all
health centres.
• The District Health Office should intensify monitoring
and supervision of the health facilities to reduce on
absenteeism and late coming.
• Sensitize the community about importance of safe
male circumcision and train more surgeons at health
centre III
• Provide more IEC materials, translate them into local
languages and distribute them in the remotest
health centres across the districts

32. • Ministry of health should procure ambulances for
health Centre IVs and provide a budget for running it
and maintenance.
• Train health workers on legal and human rights to
enable them support the community more
efficiently.
• Involve religious leaders and cultural leaders on
issues of sexual gender based violence
• The MOH and district local governments should
construct more structures and equip them with
facilities to support quicker diagnostic

33. • Staff houses should be constructed to enable
health workers reside at their work stations
and report on time. This will also attract staff
to hard to reach areas.
• Parliament and Ministry of Finance Planning
and economic development should allocate
more resources to the health sector to enable
the sector implement what has been
promised in the Health Sector Strategic Plan III
and National HIV&AIDS strategic Plan

34. Thank you