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Participatory Approaches in Malawi
- 1. 10/16/2018 1 Participatory Approaches in Malawi Wina Sangala 08 October 2018
- 2. 2 Strengthening community engagement and enhancing accountability • Used Health Centre Advisory Committees as an entry point to address drugs accountability and strengthen capacity at sub-district level
- 3. 3 Methods: 10 steps to systems thinking Intervention Design 1. Convene stakeholders 2. Collectively brainstorm 3. Conceptualize effects 4. Adapt and redesign Evaluation Design 5. Determine indicators 6. Choose methods 7. Select design 8. Develop plan and timeline 9. Set a budget 10. Source funding
- 5. 5 Results
Editor's Notes
- Context: In Financial year 2015/2016 UK Aid purchased essential drugs to the value of GBP 16 million. Around the same time, studies and media reports were revealing stocks outs in health centres and numerous reports of drug theft MoHP and DFID asked our programme to explore how to safe guard drugs at health centre level. We used HCACs as the entry point for a community engagement and accountability programme. HCACs on paper have a drug monitoring role but in practice are commonly defined as being dysfunctional. Could we re-define their role, develop some supportive tools and get them more actively engaged in drug monitoring and overall participation in their health centres? A formative evaluation was embedded to help answer the following: Has HCAC functionality improved? Has facility functionality improved? Has drug accountability improved? Has duty bearers’ responsiveness improved? To what extent has the project influenced policy at national and district level? What is the social return on investment (SROI) for strengthening HCACs? In three sites we also piloted the provision of grants directly to health facilities to help improve efficiencies in health financing and address localised challenges in rural communities
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- Endline results: improved HCAC functionality, regular meetings, minutes taken, action points followed up, resource mobilisation, awareness of roles/ToR and working with LG structures Improved facility functionality measured through happy/sad face score card; DHMT responded to staff issues in some instances; duty roster posted for public to see Drug monitoring and accountability – DMSC established and and all functional in witnessing drug deliveries, signing for them, conducting monthly stock counts and reporting to HCACs. Stocks outs reported to be less, shelving and security improved all HCACs are actively engaging the DHO, DHMT, Ward Councillors, Traditional Authorities and other influential individuals including Members of Parliament in their areas HCACs now ‘housed’ within the Preventive Health Directorate; articulated in first National Community Health Strategy with a corresponding indicator; MoHP and Districts utilizing the new guidelines, TOR and training manual along with other development partners HCIG been successfully utilized in transparent and accountable way o make prioritized HC improvements The SROI ratio is MK 8.45: MK 1 which means that for every Malawian Kwacha invested by the HCAC pilot project, a social value of MK 8.45 was created