i 
ADVOCACY FOR BETTER HEALTH PROJECT
Cooperative Agreement No: AID-617-A-14-0000
Submitted to
U.S. Agency for International Development (USAID), Uganda
Plot 1577 Ggaba Road, Nsambya. Kampala
Submitted by
Moses Dombo, 
Chief of Party
USAID/PATH Advocacy for Better Health Project
Tel: +256 312 393200
30th October 2017
The author’s views expressed in this publication do not necessarily reflect the views of
The United States Agency for International Development or the United States Government
MIDTERM EVALUATION REPORT
 ii
TABLE OF CONTENTS
TABLE OF CONTENTS.............................................................................................................................................. ii
ABBREVIATIONS ................................................................................................................................................ iv
LIST OF TABLES ................................................................................................................................................. v
EXECUTIVE SUMMARY.......................................................................................................................................... vi
1.0 INTRODUCTION ................................................................................................................................................ 1
1.1 Project overview............................................................................................................................................... 1
1.2 The Development Hypothesis .......................................................................................................................... 2
1.3 Implementation structure ................................................................................................................................ 3
1.4 The Results Framework .................................................................................................................................... 3
1.5 Rationale for the Midterm Evaluation.............................................................................................................. 2
1.6 The purpose and objectives of the midterm evaluation .................................................................................. 2
1.7 Midterm Evaluation Questions......................................................................................................................... 2
2.0 EVALUATION METHODOLOGY.......................................................................................................................... 4
2.1 Introduction...................................................................................................................................................... 4
2.2 Study design, participants and sampling procedure ........................................................................................ 4
2.3 Data analysis and management ....................................................................................................................... 4
2.4 Evaluation Limitations...................................................................................................................................... 4
3.0 FINDINGS: AMELP PERFORMANCE................................................................................................................... 6
3.1 Introduction...................................................................................................................................................... 6
3.2 Overall performance towards the goal ............................................................................................................ 7
3.3 Result Area 1: Citizens demand for improved quality services........................................................................ 8
3.3.1 IR 1.1: Increased citizens’ awareness of their rights and responsibilities related to health and social 
services 9
3.3.2 IR 1.2: Community groups advance priorities for improved health and social services............................10
3.3.3 IR 1.2: Improved engagement between citizens and duty bearers ...........................................................12
3.4 Result Area 2: CSOs effectively advocate for and represent communities on policies / issues of citizens 
concern in the health and social sectors. ....................................................................................................................13
3.4.1 IR2.1: Increased utilization of evidence by CSOs to inform advocacy. ......................................................15
3.4.2 IR2.2: Effective participation of CSOs in local government planning, monitoring and accountability of 
health and social services............................................................................................................................................16
3.4.3 IR2.3: Enhanced co-ordination and collaboration among CSOs ................................................................17
3.5 Result Area 3: Institutional Capacity of CSOs strengthened...........................................................................18
4.0 FINDINGS: THEMATIC AREA PERFORMANCE..................................................................................................22
4.1 Introduction....................................................................................................................................................22
4.2 Maternal and Child Health (MCH) ..................................................................................................................22
4.3 HIV/AIDS .........................................................................................................................................................23
4.4 Malaria............................................................................................................................................................25
4.5 Orphans and Vulnerable Children (OVC)........................................................................................................26
4.6 Tuberculosis (TB) ............................................................................................................................................26
4.7 Family Planning (FP) .......................................................................................................................................27
4.8 Nutrition .........................................................................................................................................................28
4.9 Cross-cutting aspects......................................................................................................................................29
5.0 COLLABORATION, LEARNING AND ADAPTATION (CLA) APPROACH...............................................................32
5.1 Introduction....................................................................................................................................................32
5.2 Collaboration ..................................................................................................................................................32
 iii
5.3 Learning ..........................................................................................................................................................33
5.4 Adaptation......................................................................................................................................................34
6.0 CRITICAL EVALUATION ASPECTS.....................................................................................................................35
6.1 Efficiency ........................................................................................................................................................35
6.1.1 Cost reduction approaches........................................................................................................................35
6.1.2 Time saving approaches.............................................................................................................................36
6.2 Effectiveness...................................................................................................................................................36
6.3 Project sustainability ......................................................................................................................................37
6.4 Relevance of the project................................................................................................................................. 40
6.4.1 Alignment with USAID Uganda’s CDCS 2016-2021 ....................................................................................40
6.4.2 Alignment with national and international policies and frameworks........................................................40
7.0 ACTIVITY IMPLEMENTATION ..........................................................................................................................41
8.0 APPROPRIATENESS OF THE PROJECT STRATEGY ............................................................................................48
9.0 LESSONS LEARNED, GOOD PRACTICES AND INNOVATIONS ...........................................................................49
10.0 IMPLEMENTATION GAPS AND CHALLENGES..............................................................................................51
11.0 CONCLUSIONS AND RECOMMENDATIONS ....................................................................................................54
11.1 Conclusions.....................................................................................................................................................54
11.2 Recommendation.......................................................................................................................................55
ANNEX 1: DETAILED EVALUATION METHODOLOGY....................................................................................................57
ANNEX 2: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – HIV/AIDS ................................................ 3
ANNEX 3: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – TB........................................................... 5
ANNEX 4: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – MALARIA ................................................ 5
ANNEX 5: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – MATERNAL, NEWBORN AND CHILD 
HEALTH (RMNCAH)........................................................................................................................................................ 6
ANNEX 6: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – FAMILY PLANNING................................. 6
ANNEX 7: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – Nutrition ................................................ 7
ANNEX 8: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – OVC & Other Cross Cutting Issues......... 8
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ABBREVIATIONS
ABH Advocacy for Better Health
AIDS Acquired Immunodeficiency Syndrome
CDCS Country Development Cooperation Strategy
CDFU Communication for Development Foundation Uganda
CIDI Community Instigated Development Initiative 
CSOs Civil Society Organisations
CPR Contraceptive Prevalence Rate 
FAA Fixed Amount Award 
FGDs Focus Group Discussions 
FP Family Planning
GoU Government of Uganda
HIV Human Immunodeficiency Virus
KIIs Key Informant Interviews 
MCH Maternal and Child Health
MMR Maternal Mortality Rate
M&E Monitoring and Evaluation
MoH Ministry of Health 
NMS National Medical Stores
MDR Multidrug Resistant
NUPAS Non-US Organization Pre-Award Survey 
SABH Strengthening Advocacy for Better Health
SRH Sexual and Reproductive Health
TB Tuberculosis
UBOS Uganda Bureau of Statistics
UNAP Uganda Nutrition Action Plan 
USAID United States Agency for International Development
WHO World Health Organisation
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LIST OF TABLES
Figure 1: Districts covered by the advocacy for better health .....................................................................2
Figure 2: Indicator number 1 progress performance at midterm ................................................................7
Figure 3: indicator number 2 performance progress at midterm ................................................................7
Figure 4: INDICATOR NUMBER 3 PERFORMANCE PROGRESS AT MIDTERM ................................................8
Figure 5: ONE OF ACTIVITIES INVOLVING CITIZENS DEMANDING FOR BETTER HEALTH SERVICES..............8
Figure 6: INDICATOR NUMBER 4 PERFORMANCE PROGRESS AT MIDTERM ................................................9
Figure 7: THE PATIENTS CHARTER DETAILING ROLES AND RESPONSIBILITIES OF CITIZENS......................10
Figure 8: ONE OF THE ACTION PLANS IMPLEMENTED BY AN ABH COMMUNITY GROUP IN BUGIRI 
DISTRICT......................................................................................................................................................11
Figure 9: INDICATOR NUMBER 5 PERFORMANCE PROGRESS AT MIDTERM ..............................................11
Figure 10: INDICATOR NUMBER 6 PERFORMANCE PROGRESS AT MIDTERM............................................12
Figure 11: Citizens attending an advocacy forum in Baitambogwe sub county, Mayuge district..............12
Figure 12: INDICATOR NUMBER 7 PERFORMANCE PROGRESS AT MIDTERM............................................13
Figure 13: INDICATOR NUMBER 8 PERFORMANCE PROGRESS AT MIDTERM............................................14
Figure 14: INDICATOR NUMBER 9 PERFORMANCE PROGRESS AT MIDTERM............................................15
Figure 15: INDICATOR NUMBER 10 PERFORMANCE PROGRESS AT MIDTERM..........................................16
Figure 16: A NEWSPAPER CAPTION ON DEMANDS BY ABH SUBGRANTEES DEMANDING FOR INCREASED 
HEALTH SECTOR FINANCING.......................................................................................................................16
Figure 17: INDICATOR NUMBER 11 PERFORMANCE PROGRESS AT MIDTERM..........................................17
Figure 18: INDICATOR NUMBER 12 PERFORMANCE PROGRESS AT MIDTERM..........................................19
Figure 19: INDICATOR NUMBER 13 PERFORMANCE PROGRESS AT MIDTERM..........................................19
Figure 20: INDICATOR NUMBER 14 PERFORMANCE PROGRESS AT MIDTERM..........................................20
Figure 21: INDICATOR NUMBER 15 PERFORMANCE PROGRESS AT MIDTERM..........................................20
Figure 22: THE PRESIDENT OF UGANDA VISITS THE STALL OF ABH SUBGRANTEE, NAFOPHANU DURING 
THE WORLD AIDS DAY IN KALANGALA DISTRICT ........................................................................................23
Figure 23: Talk show on HIV/AIDS Financing on NTV .................................................................................24
Figure 24: EVIDENCE FACT SHEET ON MALARIA POLICY ASKS FOR THE ABH PROJECT..............................25
Figure 25: THE SPEAKER OF THE PARLIAMENT OF UGANDA AND THE PRIME MINISTER OF UGANDA 
LAUNCH AND SIGN OFF THE PARLIAMENTARY NUTRITION PLATFORM ....................................................28
Figure 26: WHO Representative, Dr. Hafisa Kasule (holding mic) launching the manifesto .....................29
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EXECUTIVE SUMMARY
Project background: The USAID Advocacy for Better Health (ABH) is a five-year project (June 1, 2014 - May 
31, 2019) implemented by PATH in collaboration with Initiatives Inc. with a goal to improve the quality, 
accessibility, and availability of health and social services in 35 districts of Uganda. The purpose of the project 
is to increase the citizens’ voice for quality service delivery. The project seeks to have; Citizens demand 
improved quality of services; CSOs effectively advocate for citizen’s concern in the health and social sectors; 
and CSOs’ institutional capacity is strengthened. A midterm evaluation was conducted to gather 
comprehensive data on the progress of the project indicators in selected project districts.
Study design, participants and sampling procedure: A cross-sectional mixed methods design involving 
quantitative and qualitative methods of data collection was applied. The key MTE components included 
the; Household Survey; Health Facility Assessment (HFA); Organizational and Advocacy Capacity 
Assessment (OACA); Policy Tracking; Focus Group Discussions (FGDs); Key Informant Interviews (KIIs) 
and Data validation. These respondents were selected from 10 districts. These consisted of; males aged 
15 – 54; females aged 15 – 49; youth aged 15 – 24; and OVCs aged 10 – 14. Thirty-three (33) Key 
Informants (KIs) and ninety-eight (98) FGD participants were involved including men, women and mixed 
gender youth. The response rate was 99.2% of the 1286 respondents targeted. This included 47.7% 
males and 52.3% females. Quantitative data were entered in Epidata V3.1 and analysed using Stata V13 
software at univariate and bivariate levels. Transcriptions of qualitative data were made, typed notes 
coded and analyzed in ATLAS.ti version 6.
Key findings of the midterm evaluation
General progress on indicators: Collectively, the ABH project met targets for 10 out of 15 indicators. 
This fairly good performance was mainly attributed to objectives two (2) and three (3) of promoting 
CSOs to effectively advocate for issues of concern to citizens in health and social sectors, and building 
their institutional and technical capacity. Overall, three indicator targets vs the actual performed below 
the midterm set targets are; Indicator 8: % of districts with annual work plans that include citizens’ concerns 
for improved health and social services; and Indicator 11: Number of CSOs that are involved in joint 
advocacy initiatives. While the performance on these three indicators were below the set midterm 
targets, qualitative data suggested that project activities had improved citizens’ engagement with duty 
bearers, and the prospect of attaining end-term targets remains high. 
Result Area 1: Citizens demand for improved quality services: Overall, interventions under result area 
one (1) were below the midterm target. Only one indicator on understanding rights was achieved at 
37.1% compared to the midterm target of 32.0%. The attainment of this target was partly a result of 
support and follow up from the sub grantees. On the other hand poor performance on other indicators 
was largely due to poor mobilization of citizens since the community groups focused on a few parishes. 
Result Area 2: CSOs effectively advocate for and represent communities on policies / issues of citizens 
concern in the health and social sectors: Support was provided and enabled CSOs to effectively 
advocate for and represent communities on policies / issues of citizens concern in the health and social 
sectors. CSOs’ advocacy agenda included engagement of government authorities in various ways leading 
to some actions on health and social service issues and policy gaps and focus was put on supporting and 
encouraging CSOs to collect especially through health facility assessments and its use in advocacy 
initiatives. CSOs’ attendance of government planning meetings at national and district levels was high, 
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which was a major avenue for conveying citizens’ concerns. However, CSOs focused on achieving 
milestones to enable them recover funds used and missed out on other actions including joint advocacy. 
Result Area 3: Institutional Capacity of CSOs strengthened: There was high performance on all the four 
indicators. This good performance was largely attributed to the design of the support offered, focusing 
on the whole organization. The constant follow-up by staff and willingness of the sub grantees to learn 
were critical in having the improvements. 
Efficiency: The Fixed Amount Award (FAA) provided flexibility regarding meeting of milestones. With 
proper planning, some CSOs managed to meet their milestones at low costs and in a relatively short 
time since they controlled the whole process. There was deliberate effort by CSOs and the ABH team to 
use their facilities for some meetings and trainings. CSOs and some community groups integrated some 
of the ABH interventions into their routine activities. For instance, some CSOs trained champions and 
leaders of community group outside the ABH arrangement, leading to cost savings for the project. The 
formation and use of coalitions was a major approach and key to advocacy initiatives, that were in most 
cases, associated with co-financing interventions. Similarly, working through network organizations such 
NAFOPHANU facilitated accessibility to their structures and an avenue for cheaper and timely 
implementation of some activities such as evidence collection. Capacity building by project staff saved 
funds that would have been paid to consultants while the Integrated Support Supervision approach 
saved time and enhanced quality. The capacity building interventions improved the capacity of CSOs to 
deliver their advocacy interventions. Key informants revealed that the project provided support that was 
requested by CSOs, which led to improvements at organizational level. 
Collaboration, Learning and Adaptation approach: The project had collaborations with other USAID 
Implementing Partners through joint initiatives, performance review meetings and participation in other 
relevant coordination platforms. The project provided a platform to enhance linkages and complement 
efforts of different programs to pursue common objectives. For instance, a network of 31 CSOs was formed 
in Southwestern region. The project promoted learning ranging from OACA through training and 
participation in international events. Four editions of the Advocacy Alerts! Newsletter were produced 
and distributed, which facilitated documentation and sharing of information among staff, partners and 
donors. Staff participation in international conferences promoted learning through presentations 
Key challenges and gaps in project implementation
Community groups focus on a few parishes within their sub counties: While community groups are 
mandated to raise community awareness in all villages within their respective sub counties, they 
concentrated on a few parishes. The frequency of large scale engagement of community members 
within the reached parishes, was limited to about one per year. 
Poor perception of advocacy by some duty bearers and high demand against low supply: Some of the 
duty bearers and leaders still have negative attitudes towards advocacy. They tended to view who ever 
advocates for improved services negatively. On the other hand, the demand for services in several 
communities exceeds the resources available at health facilities. 
Evidence collection and use: While mechanisms for linking district and national level CSOs for data 
collection and use were in place including use of social media, there CSOs still expressed a gap in having 
a more formal and well-coordinated mechanism. 
 viii
Slow adaptation and understanding of the FAA mechanism: The FAA mechanism and associated 
retirement of milestones minimizes on the number of documents required to liquidate transaction 
expenses, the number of documents used as MoVs was still big. This contributed to delays in the 
retirement of milestones and subsequently negated implementation. Though sub grantees performed 
very well in meeting their milestones, they delayed to retire them. This led to a very low burn rate as 
money was held up in milestones and low burn rate below the 75% minimum. Subsequently, the project 
under spent on the year’s obligated budget. 
Key recommendations
i. Community groups covered one or two parishes largely due to limited funding. The ABH senior 
management should work with CSOs to refocus this community component to cover a small 
number of parishes within a sub county based on available funds. 
ii. Given the limited funding, the CSOs should collaborate with religious institutions and use their 
gatherings and structures to pass over the messages. The messages can be delivered at a 
convenient time, for instance during or at the end of the service or mass. 
iii. The media messages are not clearly understood by citizens at community level. The ABH project 
team should conduct an assessment of the communications component that will inform its 
further development including the design, packaging and delivery. 
iv. Most government officials had not fully appreciated the value of advocacy. The ABH project 
senior management should offer more support to CSOs in engaging the senior leadership of 
districts and the Uganda Local Governments Association to support on this. 
v. The ABH senior management should work with sub grantees to strengthen or establish more 
accountability platforms that will enable tracking of performance commitments. Linkage with 
very high ranking decision makers such as Permanent Secretaries will be more critical for the 
success of these accountability mechanisms. 
vi. To strengthen coordination for data evidence collection and use among district and national 
level CSOs, the project management should strengthen on current modalities especially 
ensuring linkage of other CSO staff. 
vii. The media messages are not clearly understood by citizens at community level. Even when some 
people hear some radio messages, it takes long for them to associate with it. The ABH project 
team should conduct an assessment of the communications component that will inform its 
further development including the design, packaging and delivery.
viii. CSOs should incorporate VHTs as resource persons to help raise aware in communities. The VHT 
structure was wide spread and VHTs commanded good respect, in their communities and good 
at communicating on health issues. However, since they work closely with health facility staff, 
their role should largely focus on raising awareness. 
1.0 INTRODUCTION
1.1 Project overview
The Advocacy for Better Health Project is a five-year initiative (1st June 2014 – 31st May 2019) funded by the United 
States Agency for International Development (USAID) with an estimated budget of $20million. The project’s goal is to 
improve the quality, accessibility, and availability of health and other social services. The project aims to enhance the 
capacity of citizens and Civil Society Organizations (CSOs) to carry out effective advocacy for increased investment 
and accountability by decision-makers so as to improve the quality and availability of essential health and social 
services in 35 target districts in Uganda. 
The project’s expected results include: 
1. Citizens demand improved quality services 
2. CSOs effectively advocate for issues of citizens’ concern in the health and social sectors
3. Institutional capacity of CSOs strengthened
The project’s strategies include; mobilizing, motivating, and empowering citizens and CSOs with information, skills, 
tools, and systems to more effectively advocate for accessible and high-quality health and social services. The project 
further sought to; strengthen platforms and mechanisms for meaningful and productive engagement between 
communities and decision-makers to influence policies and decisions that affect their citizens’ daily lives. PATH, in 
partnership with Initiatives, seek to apply a catalytic approach to empower citizens through PLHIV groups / networks, 
MARPS, munomukabi, youth, women, VHT and Health Unit Management Committees with skills, tools, and systems 
to effectively advocate for accessible, high-quality health and social services. Specifically, the project seeks to:
• Utilize multiple integrated community interventions and communication strategies that enable community 
members to tell their own stories, generate dialogue and debate, and foster critical thinking related to health and 
social service delivery needs and issues.
• Engage with existing community networks and structures to mobilize and empower citizens to become effective 
health and social services advocates.
• Strengthen CSOs organizational systems and processes to be more effective and sustainable in order to effectively 
represent community interests and collaborate and interact with local decision-makers and service providers. 
• Expand, revive, or (if necessary) establish mechanisms for citizen engagement at the health facility, sub-county, 
and district levels to improve citizens’ and CSOs’ ability to participate, act, and influence policy change in public 
and private spheres.
The projec’s implementation covered was at the national level and in the following 35 target districts; Budaka; 
Bududa; Bugiri; Bukwo; Bushenyi; Busia; Butaleja; Ibanda; Iganga; Isingiro; Kabale; Kalangala; Kaliro; Kamuli; 
Kamwenge; Kanungu; Kapchorwa; Kasese; Kayunga; Kiruhura; Kisoro; Kumi; Kyenjonjo; Luwero; Mayuge; Mbale; 
Mityana; Mpigi; Nakasongola; Namutumba; Ntungamo; Pallisa; Rukungiri; Sembabule; and Sironko.
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FIGURE 1: DISTRICTS COVERED BY THE ADVOCACY FOR BETTER HEALTH
1.2 The Development Hypothesis
Figure 1: The change process
Citizens’ 
awareness of 
their rights & 
responsibilities 
related to 
health and 
CSOs’ advocacy 
and 
organizational 
capacity 
improved
Citizens believe 
they can hold 
their leaders 
accountable & 
influence policies 
to improve 
CSOs better 
facilitate policy 
analysis, civic 
engagement and 
represent citizens’ 
interests with their 
leaders
Citizens 
demand 
solutions & 
changes in 
health & social 
policies
Decision 
makers 
change 
policies and 
become 
accountable 
Improved 
health and 
social 
services
 3 
The project’s theory of change was based on the beliefs that IF citizens’ knowledge and awareness of their rights 
and responsibilities were increased (to stimulate collective consciousness); and IF the capacity of CSOs was built 
to effectively empower and represent communities, THEN, citizens would believe and have confidence that they 
can hold their leaders accountable and influence them to change health and social policies in their favour. This 
empowerment and confidence would motivate citizens and CSOs to demand for better health and social services 
from their leaders’/decision makers. The persistent collective voice and actions from citizens and CSOs would compel 
decision makers to respond by changing the necessary policies and take other actions that lead to improvements in 
the accessibility, availability and quality of health and social services. The conceptualization of the theory is illustrated 
in figure 1 above. The project sought to ensure that these‘IF” statements are met, thereby contributing to meeting 
the project’s overall objective.
1.3 Implementation structure
PATH was the prime recipient responsible for overall implementation and success of the project. PATH’s main 
implementing partner was Initiatives Inc, which was responsible for organizational capacity building of CSOs. PATH 
also provided sub grants to 20 Ugandan CSOs to implement the project at national level and district levels. The 
project was supported by an Advocacy Advisory Group (AAG) comprised of eminent Ugandans who provide technical 
assistance and advice to the implementation team to bolster project outcomes. The AAG played a catalytic role in 
improving the health and wellbeing of Ugandan citizens by championing citizen advocacy and decision-maker 
accountability throughout the health and governance system and supporting, facilitating and promoting the project 
approaches and activities. The project team comprised of technical and management professionals as well as support 
staff based in the central office in Kampala and three regional offices in Kampala, Mbale and Mbarara. These 
provided oversight to teams employed by partner CSOs in ensuring that planned activities were timely implemented, 
adequately monitored and results thereof accurately documented and reported.
1.4 The Results Framework
The Project’s results framework was used for planning, monitoring, management and communication of the project’s 
inputs and results. The framework explains the cause-effect linkages between the intermediate results and higher 
level results; as well as the critical assumptions for successful achievement of projects results. The project modified 
and adopted the Results Framework (RF) developed by USAID/Uganda as presented in the Request for Applications 
(RFA) documents that guided the design of this project. The project was designed to contribute towards improved 
quality, accessibility and availability of health and social service delivery by working towards three strategic 
objectives. To achieve this goal, the project pursued three key results areas (KRs) as illustrated below. 
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ADVOCACY FOR BETTER HEALTH PROJECT: RESULTS FRAMEWORK
IR3.1 
CSO 
instituti
onal 
capacity 
strength
ened. 
 
Increased capacity of local 
governments and facilities to 
deliver quality services 
Goal: Improved quality, availability and accessibility of 
health and social services
R1: Citizens demand improved 
quality of services Sub R3: 
Institutional 
capacity of 
CSOs 
strengthene
d
1. Target community groups are PLHIV groups/networks, MARPS, muno mukabi, youth, women, VHT and Health Facility Management 
Committees
2. The project operates in 35 project districts of Uganda
3. Key focus services are: malaria prevention, HIV prevention, care and support, PMTCT, TB, maternal and child health, sexual 
reproductive health OVC and nutrition
R2: CSOs effectively advocate for 
issues of citizen’s concern in health 
& social sectors.
IR1.1: 
Increase
d 
citizens’ 
awaren
ess of 
their 
rights & 
responsi
bilities. 
IR1.2:
Commu
nity 
groups 
advance 
prioritie
s for 
improve
d health 
& social 
services.
IR2.1:
Increase
d 
utilizatio
n of 
evidence 
by CSOs 
to 
inform 
advocac
y 
IR1.3:
Strength
ened 
forums 
for 
citizens 
to 
engage 
with 
duty 
bearers.
IR2.3:
Enhance
d co￾ordinati
on & 
collabor
ation 
among 
CSOs
IR 2.2:
Effective 
particip
ation of 
CSOs in 
LG 
planning
, 
monitori
ng & 
account
ability 
of 
health & 
social 
services
 2 
1.5 Rationale for the Midterm Evaluation 
In accordance with the cooperative agreement between PATH and USAID, the project required to undertake 
a midterm evaluation to measure the degree to which the project is meeting its key objectives, relevance, 
efficiency, effectiveness and sustainability. This was sought to document lessons learnt, strengths and 
weakness/gaps to be improved upon so that the project achieves its objectives. In line with USAID’s policy, 
the mid-term evaluation was overseen by an external consultant. The results of the midterm evaluation were 
envisaged to be used to update performance indicators with progress to guide the project interventions. 
There was also envisaged to provide performance aspects of the project including; progress on 
implementation, expected results, and effect on partners based on the findings of subsequent evaluations.
1.6 The purpose and objectives of the midterm evaluation
The purpose of the midterm evaluation sought to gather comprehensive data on the progress of the project 
indicators in selected project districts. The objectives of the mid-term evaluation were to:
1. Determine the extent to which project deliverables (inputs, training, equipment and services) 
have been delivered and results attained;
2. Establish the extent to which citizens have been empowered to demand for improved health and 
social services in their communities.
3. Establish the extent to which service delivery has improved at the selected health facilities in terms 
of reduced absenteeism, compliance with closing and opening hours and consistent stocks of
essential drugs as per Ministry of Health guidelines. 
4. Determine the extent to which citizens are involved in making decisions concerning delivery of 
quality health and social services in their communities.
5. Establish the extent to which sub grantee CSOs have effectively advocated for citizens’ concerns 
in the health and social sectors. 
6. Establish the improvements in the organizational and advocacy capacity of sub grantee CSOs.
7. Identify key success areas and lessons, and make the appropriate recommendations to the 
project team, the donor and other stakeholders to guide decision-making and planning.
1.7 Midterm Evaluation Questions
Based on the above indicators, the midterm evaluation sought to answer the following broad questions;
• To what extent are citizens empowered to demand for improved health and social services in their 
communities.
• Are there improvements in service delivery at health facilities in terms of change in absenteeism, 
compliance with closing and opening hours and consistent stocks of essential drugs as per Ministry 
of Health guidelines? 
• To what extent are citizens involved in making decisions concerning delivery of quality health and 
social services in their communities?
• To what extent the sub grantee CSOs have effectively advocated for citizens’ concerns in the 
health and social sectors? 
• What is the current organizational and advocacy capacity of sub grantee CSOs?
• What is the extent to which districts have utilized or included CSO and citizen issues in their 
planning processes?
 3 
The midterm evaluation sought to answer the following specific areas of project strategy, design and 
implementation:
i) Relevance – Assess design and focus of the project
• To what extent did the Project achieve its overall objectives?
• What and how much progress has been made towards achieving the overall outputs and 
outcomes of the project? 
• To what extent were the results (impacts, outcomes and outputs) achieved?
• Were the inputs and strategies identified, and were they realistic, appropriate and adequate to 
achieve the results?
• Was the project relevant to the identified needs?
ii) Effectiveness- Describe the management processes and their appropriateness in supporting delivery
• Was the project effective in delivering desired/planned results?
• How effective were the strategies and tools used in the implementation of the project?
• How effective has the project been in responding to the needs of the beneficiaries, and what 
results were achieved?
• What are the future intervention strategies and issues?
iii) Efficiency - Of Project Implementation
• Was the process of achieving results efficient? Specifically did the actual or expected results 
(outputs and outcomes) justify the costs incurred? 
• Were the resources effectively utilized?
• Did project activities overlap and duplicate other similar interventions (funded nationally and/or 
by other donors? 
• Are there more efficient ways and means of delivering more and better results (outputs and 
outcomes) with the available inputs?
• Could a different approach have produced better results?
iv) Sustainability
• To what extent are the benefits of the projects likely to be sustained after the completion of this 
project? 
• What is the likelihood of continuation and sustainability of project outcomes and benefits after 
completion of the project?
• Describe key factors that will require attention in order to improve prospects of sustainability of 
Project outcomes and the potential for replication of the approach?
 4 
2.0 EVALUATION METHODOLOGY
2.1 Introduction
This section presents the study design, data collection methods, sampling and sample size estimation, 
data analysis, validity and reliability of findings, challenges and limitations faced.
2.2 Study design, participants and sampling procedure
A cross-sectional mixed methods design involving quantitative and qualitative methods of data 
collection was applied. This was generating both statistical and explanatory information relevant for 
improving the project in the next phase. Primary data collection was divided into seven (7) components 
including the; Household Survey; Health Facility Assessment (HFA); Organizational and Advocacy 
Capacity Assessment (OACA); Policy Tracking; and Data validation as well as Key Informant Interviews 
(KIIs) and Focus Group Discussions (FGDs). Several documents were reviewed as part of the MTE. 
A total of 1,276 citizens including 47.7% males and 52.3% females participated in the survey. This 
represented 99.2% of the target respondents, which is adequate for generalization of the study 
population. The sample size was selected using the formula proposed by Cochran, W. G. 1963.1 This 
sample consisted of males aged 15 – 54; females aged 15 – 49; youth aged 15 – 24; and OVCs aged 10 – 
14; selected using probability proportional to sample from the ten (10) districts that were covered by 
the baseline survey. Thirty-three (33) Key Informants (KIs) were involved including USAID Implementing 
partners; sub grantee staff; ABH project staff; Health Facility (HF) In-charges; and District Health staff. 
Ninety-eight (98) FGD participants were involved including men, women and mixed gender youth. 
Details of the methods section are in Annex 1. 
2.3 Data analysis and management
Quantitative data were entered in Epidata V3.1 and analysed using Stata V13 software. The analysis 
output requested in the TOR can be categorized into univariate and bivariate. In univariate analysis, 
charts and frequency distribution tables for single variables were used to show the values of indicators. 
In bivariate analysis cross tabulation between key variables was used to identify relationships. 
Qualitative data capture was through use of both digital voice recorders and note-taking. Transcriptions 
were made, typed notes read thoroughly and codebook developed and data analyzed in ATLAS.ti version 
6.
2.4 Evaluation Limitations
The evaluation process was faced with limitations though they were insignificant to deter progress and 
the results. The following are among possible limitations of the data collected: 
• In Key Informant Interviews, Focus Group Discussions, and Household Surveys there is the 
possibility of recall bias, as respondents may selectively remember and report elements of the 
project to study staff. 
 
1
Cochran, W. G. 1963. Sampling Techniques, 2nd Ed., New York: John Wiley and Sons, Inc.
 5 
• In Key Informant Interviews, Focus Group Discussions, and Household Surveys there is also the 
possibility of social desirability bias, where respondents provide answers that they believe study 
staff are looking for. 
• The data collection faced logistical challenges, such as difficulty reaching some places within 
Bukwo district due to heavy rains on the roads, and the busy schedules of Key Informants. These 
logistical challenges delayed data collection. 
In order to minimize the possible impacts of these limitations, probes were used to help respondents 
recall activities, and data collection questions were presented neutrally and in private in order to 
minimize social desirability bias. 
 6 
3.0 FINDINGS: AMELP PERFORMANCE
3.1 Introduction
Presented in this section are the findings of the ABH project mid-term evaluation. The assessment 
involved comparison of the mid-term values and set targets. The indicators are numbered following the 
format in the Activity Monitoring, Evaluation and Learning Plan (AMELP). The score represents the project’s 
high performance across several indicators. Details are reflected in figure below.
Table 1: Summary table on AMELP Indicator Targets
PERFORMANCE INDICATOR Baseline MTE 
Target
MTE 
Actuals
INDICATOR 1: % of men and women who say health service delivery in 
public health facilities has improved in target districts the last one year.
54.7% 62% 65%
INDICATOR 2: % health facilities that report improvements in service 
delivery2
0.0% 25% 49%
INDICATOR 3: % of citizens who report having participated in an activity to 
demand for improved health and social services in the last one year 
29.6% 45% 48%
INDICATOR 4: % of citizens who demonstrate understanding of rights and 
responsibilities related to health and social services.
14.0% 32% 51%
INDICATOR 5: % of community groups whose action plans advance into 
implementation phase. 
0.0% 48% 128%
INDICATOR 6: Number of functional3
advocacy forums at sub county level. 0 418 416
INDICATOR 7: % of sub grantee CSOs that demonstrate influence on health 
and social services agenda 
0.0% 75% 100%
INDICATOR 8: % of districts with annual work plans that include citizens’ 
concerns for improved health and social services. 
0.0% 50% 40%
INDICATOR 9: % of CSO advocacy initiatives which are supported by evidence 0.0% 60% 100%
INDICATOR 10: % CSOs actively involved in public sector planning processes. 0.0% 60% 150%
INDICATOR 11: Number of CSOs that are involved in joint advocacy initiatives 4 16 11
INDICATOR 12: % of CSO with overall improvements in organisational 
capacity. 
0.0% 70% 90%
INDICATOR 13: % of sub-grantee CSOs that demonstrate improvements on 
the Advocacy components of the OACA4
0.0% 80% 85%
INDICATOR 14: Number of sub-grantee CSOs that attain adequate 
performance as defined in Organizational and Advocacy Capacity 
Assessment.
0 6 16
 
2 Service delivery improvement will entail reduced absenteeism, personnel completing full working hours, reduction in essential
drug stock outs as per MOH guidelines
3 Functionality of advocacy forums will be measured on regular meetings, structured agenda, structure, minutes of meetings, follow up 
and attendance
4 Skills and capability strengthened in key areas including policy analysis, M&E, strategic advocacy and communications.
 7 
0% 
25% 
49% 
0%
10%
20%
30%
40%
50%
60%
Baseline Year 3 Target Y3 Achievement
55% 
62% 
65% 
45%
50%
55%
60%
65%
70%
Baseline Year 3 Target Y3 Achievement
FIGURE 2: INDICATOR NUMBER 1 PROGRESS PERFORMANCE AT 
MIDTERM
FIGURE 3: INDICATOR NUMBER 2 PERFORMANCE 
PROGRESS AT MIDTERM
PERFORMANCE INDICATOR Baseline MTE 
Target
MTE 
Actuals
INDICATOR 15: Number of sub grantee CSOs with management systems 
that qualify them to receive direct donor funding in accordance with 
USAID’s NUPAS 
0 1 2
3.2 Overall performance towards the goal
INDICATOR 1: % of men and women who say health service delivery in public health facilities has 
improved in target districts the last one year. This indicator is at goal level and was designed to 
measure the proportion of men and women who report that health service delivery in public health 
facilities has improved in target districts during the last one year. The services measured are related to 
HIV/AIDS, MCH, Malaria, Reproductive Health, TB, Nutrition and services for OVC. The performance to 
date is reflected in the chart below; 
Compared to the baseline of 55%, the 
proportion of the communities that are 
satisfied with the quality of services has 
increased to 65% of men and women that 
acknowledged improvement in health 
service delivery in public health facilities. 
Further analysis showed that malaria (40%), 
immunization (16%) and HIV/AIDS (15%) 
were cited as the major health service 
delivery improvement areas among men 
and women. The least health service 
delivery area that registered improvement 
was MCH (2%). Uganda governments’ 
efforts to reduce the disease of malaria 
and immunization through distribution of 
mosquitos nets and mass immunization of children under five against 6 killers respectively could be a 
contributing factor towards citizens’ perception about improvements in malaria and immunization 
services.
INDICATOR 2: % health facilities that report improvements in service delivery5
This indicator is at goal and was designed to measure the health facilities that report reduced absenteeism, 
personnel working full day working hours, reduction in essential drug stock outs as per MOH guidelines, 
health facility full opening hours. Improvements denote reduction in essential drug stock outs, fulfilment 
of MOH guidelines on the health unit opening hours and reduced absenteeism of the health unit 
personnel.
The project’s target of improving health facility 
service delivery has been met at 49 % of the 
surveyed health facilities at the level of health 
center III’s and health center IV’s. This is in 
 
5 Service delivery improvement will entail reduced absenteeism, personnel completing full working hours, reduction in essential 
drug stock outs as per MOH guidelines
 8 
30% 
45% 48% 
0%
10%
20%
30%
40%
50%
60%
Baseline Year 3 Target Y3 Achievement
FIGURE 4: INDICATOR NUMBER 3 PERFORMANCE
PROGRESS AT MIDTERM
comparison to the midterm evaluation targets of 25%. Improvements have been primarily realized in 
terms of health workers’ improved adherence to working time, leading to reduction in any health facility 
closures from 47% to 3%. However, there are still disruptive and rampant stock outs of drugs, 
commodities and supplies at the facilities which were prevalent in 72% of the surveyed health facilities.
3.3 Result Area 1: Citizens demand for improved quality services
This section highlights the extent to which planned activities and outputs, geared at enabling citizens to 
demand for improved quality services, were delivered. Varying action to meet set outputs resulted in 
progress on mid-term indicators. In spite of underperformance on some indicators, qualitative findings 
did suggest there has been progress in Results Area 1, as described by CSO staff:
The public was kind of sleeping. They did not know that demanding for what, for their rights, 
that you demand for it. […] But now they know that it is in their power to have these services and 
to push for them even when their services are there, to push for the better service delivery. That 
was not there before. And to me, that is one of the biggest things that has been done. 
- Executive Director, District-level CSO, July 2017
INDICATOR 3: % of citizens who report having participated in an activity to demand for improved 
health and social services in the last one year. This indicator measures ccitizens who report having 
participated in an activity to demand for improved health & social services in the last one year. Citizens 
refer to Ugandans who are entitled to healthcare rights. Citizens’ participation includes contacting a 
duty bearer and/or attending community meetings. Activities include citizens’ participation in forums, 
meetings. Demand is an action taken by citizens to improve availability, accessibility and utilization for 
health & social services. Services considered are maternal and child health, TB, SRPH, Nutrition, malaria 
prevention & OVC. The performance to date is reflected in the chart below;
At baseline, 30% of the surveyed citizens reported 
to have participated in an activity to demand for 
improved health and social services in the last one 
year was mainly through attending community 
meetings and getting together with peers to 
discuss issues of concern in their community. At 
midterm, this percentage has increased to 48% of 
the total respondents who reported having 
participated in an activity to demand for improved 
health and social services in the last one year. For 
instance, a number of focus group participants 
spoke of having contacted their duty bearers on 
health services issues: one of the FGD participants said that FIGURE 5: ONE OF ACTIVITIES INVOLVING CITIZENS
DEMANDING FOR BETTER HEALTH SERVICES
 9 
FIGURE 6: INDICATOR NUMBER 4 PERFORMANCE
PROGRESS AT MIDTERM
“You write a letter and deposit it in the suggestion, and later its opened and the letter is discussed 
among local leaders with health workers and forge a way forward.”
- Women’s FGD Participant, August 2017
Engagement activities include attending an advocacy forum, members attending community group 
meetings, monitoring availability of health workers and drugs at the facility and getting together with 
peers to discuss issues of concern in their community.
3.3.1 IR 1.1: Increased citizens’ awareness of their rights and responsibilities related to health and 
social services
Traditional platforms such as barazas (citizen engagement meetings), Munnomukabi groups (Self Help 
groups), PLHIV support group network meetings; and saving and credit cooperative (SACCO) meetings 
were applied to raise citizens’ awareness. For instance, 105 community advocacy forums including 
community dialogues, interface meetings and awareness sessions were conducted across the 35 districts 
in the first two (2) years. Drama was embraced as an edutainment approach to create awareness on 
rights and responsibilities. This aided modeling desired behaviors. Two sub-grantees; RHU and ARUWE, 
conducted 12 drama shows focusing on the Patients’ Charter. These initiatives contributed to the 51% of 
citizens who knew their health rights and 62% who knew their health responsibilities. The project 
engaged media houses in various ways including; broadcasts and placements of advocacy messages on 
radio, TV and in newspapers. 
For instance, in the first two (2) years, sub grantees conducted 284 live call-in radio talk shows on local 
FM radio stations, raising citizens’ awareness on health rights and responsibilities. Further, 24 episodes 
of a radio serial drama were broadcast under the popular award winning Rock-Point 256, aired on 22 
local FM stations across the 35 districts. In order to focus the radio talk shows, the Patient’s Charter was 
used as source of information. The project considered the different languages in the project districts. 
Accordingly, a total of 8,280 radio spots were broadcast in English and five (5) local languages including 
Runyankole - Rukiga, Luganda, Lukhonzo, Ateso and Kupsabiny on three (3) national and eight (8) 
district-based radio stations. 
INDICATOR 4: % of citizens who demonstrate understanding of rights and responsibilities related to health 
and social services. This measures the proportion of citizens who mention at least 3 health rights &
responsibilities as defined in the Government of Uganda Patients’ Charter. Rights are inalienable 
entitlements as enshrined the legal and policy frameworks that are agreed upon through consensus that 
they can be claimed by anyone based on their needs & 
aspirations. The performance to date on this indicator is 
presented in the chart below;
 10
14% 
32% 
51% 
0%
10%
20%
30%
40%
50%
60%
Baseline Year 3 Target Y3 Achievement
FIGURE 7: THE PATIENTS CHARTER
DETAILING ROLES AND RESPONSIBILITIES
OF CITIZENS
Citizen knowledge on their rights and 
responsibilities is measured by 
proportion of citizens who mention at 
least three health rights as defined in the 
Government of Uganda Patients’ 
Charter. At baseline, 28.7% of the 
sample stated at least three health rights 
thus demonstrating understanding of 
rights related to health and social 
services. The project supported all CSO 
partners with IEC materials such as the 
patient’s charter, the 90-90-90 
treatment targets poster and other 
awareness materials to support their 
activities aimed at raising awareness on citizen rights and responsibilities specifically those related to 
health. At midterm, 50.9% of citizens who knew their health rights and 62.4% who knew their health 
responsibilities. Disaggregation of the data shows no significant difference between male (18.8%) and 
female (181.3%) reporting to have understood their health rights. Among those who know their health 
rights, the main source of information was radio (27%), 
followed by health facilities (22%) and Advocacy forums 
being the least source of information. Key Informant 
Interview’s with CSO staff also found that the project was 
increasing citizens’ knowledge of their rights: 
To me I think the project has opened people’s minds and are informed. They know what they are 
supposed to get. People are getting knowledge all the time through meetings.
- DHE, July 2017
 
Among those who know their health rights, 34.9% reporting having experienced abuse on their health 
rights. Among those who experienced abuse on their health rights, 85.7% reported having taken action 
including reporting to the duty bearers, whereas 14.3% did not report cases abuse on their health rights 
to any duty bearer. 
3.3.2 IR 1.2: Community groups advance priorities for improved health and social services 
A total of 479 community groups were oriented and facilitated to identify advocacy issues and conduct 
community empowerment activities in the 35 districts. This enabled community groups to appreciate 
and learn how to mainstream advocacy in their activities. Up to 270 media champions, leaders of 
Community Based Organizations (CBOs), and Community Awareness Facilitators (CAFs) were also 
trained to appreciate and mainstream advocacy. Media and Advocacy Champions are key in mobilizing 
the community groups and following up issues. The project, through sub-grantees, supported 479 
community groups to identify advocacy issues and develop action plans. These were used to raise issues 
and seek action by decision makers in the 35 districts. 
INDICATOR 5: % of community groups whose action plans advance into implementation phase.
Community groups whose action plans advance into implementation phase. This indicator looks at the 
steps being taken by citizens to own and implement the action plan or present it to the duty bearers. 
 11
0% 
48% 
128% 
0%
20%
40%
60%
80%
100%
120%
140%
Baseline Year 3 Target Y3
Achievement
FIGURE 9: INDICATOR NUMBER 5
PERFORMANCE PROGRESS AT MIDTERM
FIGURE 8: ONE OF THE ACTION PLANS IMPLEMENTED
BY AN ABH COMMUNITY GROUP IN BUGIRI DISTRICT
For action plans to qualify to be in “implementation phase”, the community group must receive 
response from a duty bearer6 with tangible steps taken in response to the demands of the citizens. 
Community groups include MARPS associations, PLHIV networks/groups, Health Unit management 
committee, VHT, women groups, youth groups, muno mukabi groups. The indicator measurement 
considers action plans as recommendations made by community groups and the progress as below;
Community groups have been active in their grass 
root empowerment and advocacy activities 
including conducting health facility service 
delivery tracking, conducting monthly meetings to discuss evidence collected and then develop 
advocacy action plans. For instance, in Pallisa district, the health facility monitoring exercise revealed 
that Puti-Puti Health Centre III had a maternity ward but did not have delivery beds, among other gaps 
identified. A community group mobilized citizens about the issues and agreed to call a stakeholders’ 
meeting that was attended by health workers, sub county staff, group members, champions and other 
citizens. At the meeting, participants agreed to write a letter to the District Health Officer highlighting 
citizen’s dissatisfaction with having a maternity ward without beds. In response, 6 delivery beds were
allocated to Puti-Puti Health Centre III. This is anticipated to attract more mothers to come and access 
maternal health services at the health center. 
Tracking the action plans that are developed regularly, the community groups including people living 
with HIV. Key action plans involve contacting duty bearers, mobilization, health education/promotion, 
collecting evidence and holding meetings. 
For instance, the regular tracking done by Bugiri Municipal Advocacy Group in Bugiri district has helped 
to prevent persistent stock-out of HIV drugs, a community group in Bududa district caused a meeting at 
Kachonga Health Centre III where stakeholders decided to approach the district and urge it to find 
money to clear the outstanding electricity bill of over one million shillings; and all the 479 community 
groups (in 35 districts) are engaged in Monitoring and tracking availability of health workers, drugs and 
commodities at the HC III in their communities. 
 
6
 Duty Bearer is a person who has the mandate to provide a service. 
 12
0% 
418 416 
0
50
100
150
200
250
300
350
400
450
Baseline Year 3 Target Y3 Achievement
FIGURE 11: INDICATOR NUMBER 6 PERFORMANCE
PROGRESS AT MIDTERM
3.3.3 IR 1.2: Improved engagement between citizens and duty bearers
INDICATOR 6: Number of functional7
advocacy forums at sub county level. A forum will be a platform to 
share information, receive feedback, interact and build relationship among the citizens and between 
them and the service providers. Advocacy forum is said to be functional if it meets regularly, with a 
structured agenda, clear governance structures (leadership), minutes of meetings, follow up on key actions, 
full participation of diverse community members, and attendance by duty bearers to listen to citizen 
concerns and provide feedback. An advocacy forum refers to public hearings/meetings for advocacy 
purposes only. Diverse community members may include and not limited to considerations on gender, age, 
race, religion, marginalised and MARPS.
Advocacy forums as a community empowerment platform continue to provide avenues for citizens to 
interface with their duty bearers on issues of major concern. Advocacy forums continue to yield 
commendable results from the duty bearers. For instance, at a forum in Kamuli district, citizens tasked 
the DHO to explain why drug stock-outs remained widespread in their facilities. The in-charge for 
Budadiri HCIV, in Sironko district, commended the use of advocacy forums to search for solutions to 
challenges crippling service delivery. The forums were attended by the community members and have 
been able to attract key decision makers like CAOs, DHOs, Political wing, community development 
officers, health in charges, parish chiefs, LCIII chairpersons and health assistants. The issues presented 
by the community advocacy champions in the forums included but not limited staffing levels of health 
workers, inadequate essential drugs in the health facilities, lack of water in maternity wards, late coming 
and early departure of mid wives and other health workers, low ANC attendance, lack of gloves in health 
facilities, limited accommodation for health workers, lack of viral load machines and lack of ambulances 
to help expectant mothers during emergency situations, health workers are poorly motivated while 
others have no uniforms and equipment. The forums are a great opportunity for citizens to raise issues 
in the presence of their duty bearers so that they make critical decisions that will improve health service 
delivery.
 
7 Functionality of advocacy forums will be measured on regular meetings, structured agenda, structure, minutes of meetings, follow up 
and attendance
FIGURE 10: CITIZENS ATTENDING AN ADVOCACY 
FORUM IN BAITAMBOGWE SUB COUNTY, MAYUGE 
DISTRICT. 
 13
0% 
75% 
100% 
0%
20%
40%
60%
80%
100%
120%
Baseline Year 3 Target Y3 Achievement
FIGURE 12: INDICATOR NUMBER 7 PERFORMANCE
PROGRESS AT MIDTERM
3.4 Result Area 2: CSOs effectively advocate for and represent communities on policies / issues of 
citizens concern in the health and social sectors.
Result Area two (2) was designed to empower sub-grantees to capture citizens’ concerns related to health 
and social services, gather related evidence and use it to engage duty-bearers to take action. The actions 
expected from duty-bearers included: policy formulation and implementation, allocation of budgets and 
establishing programs to address citizens’ concerns for policy change, where necessary. The evaluation 
reveals largely high effectiveness of interventions and good progress. Under this result area, the strategy 
used involved PATH’s ten-part process which involves technical assistance through an e-learning course, 
a three-day workshop using PATH’s Policy Advocacy Strategy Development Curriculum, and 
accompanying tools. There was also peer-to-peer mentoring, modeling opportunities, and study visits 
regarding implementation of specific aspects of an advocacy strategy. Training of trainers was carried 
out for CSO representatives, with particular emphasis on networks and umbrella CSOs. This built a cadre 
of skilled facilitators who were resourceful during strategy development workshops and provided 
technical support within their organizations
INDICATOR 7: % of sub grantee CSOs that demonstrate influence on health and social services agenda. 
This indicator denotes the proportion of sub grantee CSOs that demonstrate influence on health and 
social services agenda. Sub grantee CSO refers to any organization that has received grants from the 
USAID Advocacy for Better Health Project. Influence refers to making government take action on the 
health and social service issues or policy gaps in response to citizens’ voice and CSO advocacy agenda. 
The sub grantees are expected to influence public sector entities to take action address improvements 
in Maternal and Child Health, Malaria, TB, HIV/AIDS, Nutrition, OVC, Sexual and Reproductive Health. 
The progress on this indicator is as below;
Sub grantee CSOs have exploited various 
windows of opportunities to engage duty 
bearers and present their packaged evidence 
and registered successes. In Kamuli, JIACOFE 
was out to ensure that district Council 
develops an ordinance for reduced 
absenteeism and school dropout of children. 
The ordinance is currently in a draft form 
pending presentation to council. In Ibanda 
district, HEPS presented evidence to district 
officials on Health worker absenteeism and 
non-functionality of HUMCS and their effect 
on Maternal and Child Health. As a result, the 
CAO recently issued circular to all civil servants 
to adhere to the code of conduct (reporting at 
duty stations on time 8:00 am and leaving at 
5:00 pm). In Budaka district, MUCOBADI 
engaged Chief Administrative Officer and DHO on health workers’ absenteeism and as a result, CAO and 
DHO have taken action and culprit health workers have since been issued with warning letters and 
urged to refer to the terms of their contracts. 
 14
0% 
50% 
40% 
0%
10%
20%
30%
40%
50%
60%
Baseline Year 3 Target Y3 Achievement
FIGURE 13: INDICATOR NUMBER 8 PERFORMANCE
PROGRESS AT MIDTERM
In Kalangala, the District Health Officer was engaged through the public advocacy forums and Joint 
stakeholders’ planning meetings to introduce a biometric machine (which has been installed) to monitor 
attendance of health workers on duty was adversely affecting public health service delivery at health 
facilities. Again, Kalangala has appointed and trained all the 7 HUMCs in the district after intervention 
from the District Health Officer who frequently wrote to sub county chiefs and health in-charges asking 
them to renew these committees. In Kasese, DHO is fast-tracking accreditation of HCII to HCIIIs and 
disciplinary action has been taken and still in Kasese, absenteeism has been tackled by cautioning 
affected duty bearers with written memos. NAFOPHANU engaged the media to popularize the 90-90-90 
strategy and create awareness on the impact of HIV/AIDS drug stock out to the attainment of 90-90-90 
targets and consequently build a critical mass of advocates for ARV/ TB drugs. NAFOPHANU further 
compiled evidence on HIV/TB drugs which was used to engage National Medical Stores to ensure 
sufficient and sustained stocks and NMS clarified that in case of any assistance or complaints, districts 
can send messages to 6090 or call the toll free lines 0800200015 (MTN), 0800300333 (AIRTEL).
INDICATOR 8: % of districts with annual work plans that include citizens’ concerns for improved health and
social services. The 35 targeted districts will incorporate citizens’ issues of concerns into their annual 
work plans for improved health and social services. Citizens’ concerns are referred to as their health and 
social needs and priorities as presented by sub grantee CSOs. The progress on this indicator is presented 
here below;
ABH staff have over time built their partnership 
with the district departments and in so doing, 
the departments have appreciated the 
advocacy gaps that are backed by evidence as 
real issues that can be prioritized and budgeted 
for. When appreciated, district local 
governments have prioritized and ensured 
budget allocations for the year FY 2017/2018. 
Among the issues that have been budgeted for 
include promoting family planning and youth 
friendly services in Mayuge and Kamuli; 
recruitment of midwives, anesthetist, 
laboratory technologists in Nakasongola, 
Luwero, Kayunga; upgrading of Minani HC II to 
HCIII in Iganga with a tune of UgShs 
100,000,000 million; the district of Kumi has 
allocated UgShs 7,000,000 for the installation 
of water, fixing doors and terracing of the maternity wards at Ongino Health Center III. Advocacy for 
Better Health engagements are expected to influence work planning process of local governments. 
During the course of Year 2, 3 districts have included priority concerns in work plan for FY 2016/2017. In 
Kamuli district, costs and schedules to pass an ordinance for reduced pupil absenteeism and school 
dropout to ensure compliance with the UPE policy have been provided for. In Bugiri district, a dialogue 
meeting in Buwunga Sub County documented inadequacy mosqito nets, lack of delivery kits for 
expectant mothers and lack of HIV testing kits at Buwunga H/C III. During the forum, the LCIII chaiperson 
committed to increase the budget for mosquito nets to ensure all mothers coming for ANC receive a 
mosquito nets and was included in the subcounty plan. During the follow up meeting, the project 
 15
0% 
60% 
100% 
0%
20%
40%
60%
80%
100%
120%
Baseline Year 3 Target Y3 Achievement
FIGURE 14: INDICATOR NUMBER 9 PERFORMANCE PROGRESS
AT MIDTERM
established that duty rosters and arrival books have been introduced both at Buwunga H/C III and 
Busoga H/C II for purposes of time management. 
While there were many districts that incorporated citizen concerns, some district officials expressed that 
there were supply-side limitations that prevented them from addressing citizen concerns, which may 
have contributed to the underperformance of this indicator. One district official explained it as such: 
Even if you advocate, people are going to overwhelm us. […] Demand has been created, fine, but 
what is it that we can do about that demand? […] We are government, yet you know our 
government. […] We can’t deliver everything even if we know.
- District Health Officer, July 2017
3.4.1 IR2.1: Increased utilization of evidence by CSOs to inform advocacy. 
The project supported the use of data in enhancing advocacy initiatives at both district and national 
levels. Sub-grantees were supported to enrich their advocacy initiatives with field data, which became vital 
in influencing action by decision makers and duty bearers. 
INDICATOR 9: % of CSO advocacy initiatives which are supported by evidence. CSO will develop initiatives 
using available or own generated data to advance citizens’ issues of concern. Advocacy initiatives are 
citizens’ issues which need to be addressed. Evidence means sub grantee CSOs should collect, analyse, 
and use information or facts to inform advocacy work. Achievement of this indicator implies that the 
data is analysed and used to advance advocacy issues to the duty bearers and have yielded results - in 
this context results shall be at least one action taken as a result of the CSO during the reporting time
towards improvement of health and social services. In order to understand citizens’ priorities, the 
project staff at different levels collected data and analyzed it. For quality data, community assessments 
and action plans were applied. Health Facility Assessments and policy mapping were conducted to 
identify policies, guidance and financial documents governing district and national service delivery 
systems and their shortcomings. Stakeholder mapping was conducted, leading to the development of 
matrices for identifying relevant decision-makers, influencers, interest groups, coalitions or networks, 
and other CSOs at various levels. The matrices included: specific interests; ability to affect the political 
environment and relationships with one another. This facilitated the advocacy process.
Generating evidence through regular 
tracking and monitoring availability of 
health commodities and health workers 
at public health facilities remains a critical 
part of the community empowerment 
process. The project supports the capacity 
of the community groups in using health 
facility assessment tools, how to write 
reports, how to collect and package 
evidence and documentation for 
meaningful engagement with the duty 
bearers. Sub grantee CSOs have 
generated community responsive 
evidence to inform advocacy efforts. All 
 16
0% 
60% 
150% 
0%
20%
40%
60%
80%
100%
120%
140%
160%
Baseline Year 3 Target Y3 Achievement
FIGURE 15: INDICATOR NUMBER 10 PERFORMANCE
PROGRESS AT MIDTERM
FIGURE 16: A NEWSPAPER CAPTION ON DEMANDS
BY ABH SUBGRANTEES DEMANDING FOR INCREASED
HEALTH SECTOR FINANCING
the implementers have continued to gather and update evidence through health facility assessments, 
desk reviews, fact finding missions and using score cards. 
The evidence has been packaged in form of fact sheets, presentations, posters and dossiers. For 
example, MAFOC was able to package project achievements into power point presentations, fact sheets 
and briefs that were shared with the duty bearers, RHU developed fact sheets on Adolescent health 
policy, HEPS developed evidence dozier on HUMCs’ non functionality, STF developed policy briefs on 
teenage pregnancies and issue papers on malaria, teenage pregnancy, HIV/AIDS, Orphans and 
Vulnerable Children (OVC), malnutrition. The findings were disseminated through decision makers 
contact meetings, district level coordination meetings and engagement with peer organization in 
coalitions. The evidence generated is being utilized to pursue a number of initiatives including convening 
a stakeholders’ dialogues to discuss strategies of maintaining sufficient stocks of the 13 Life Saving 
Commodities, taking action against absenteeism of health workers, district HIV/TB task forces meeting 
in districts presenting advocacy issues related to HIV/TB testing and treatment, banning importation of 
non-quality assured Quality Malaria Rapid Diagnostic Tests (m-RDTs) in Uganda, call for action and 
highlight Health sector gaps in the 2017 FY budget. 
CSO sub grantees continued to update their evidence to remain relevant and up to date to be able to 
engage and influence duty bearers to take action. A number of data collection tactics were employed to 
collect evidence, gathering more evidence on the issues in areas of HIV/AIDS/ TB/ Malaria/ 
MCH/FP/Nutrition, developing and updating evidence dossiers and making use of data collected by 
community groups. Evidence was collected, packaged and using different modes including letters, fact 
sheets or power point presentations and shared during district meeting, CSO coalition meetings, one on 
one meetings, community meeting or in national newspapers. 
3.4.2 IR2.2: Effective participation of CSOs in local government planning, monitoring and 
accountability of health and social services
INDICATOR 10: % CSOs actively involved in public sector planning processes. This indicator measures the 
proportion of Sub-grantee CSOs actively involved in public sector planning processes. Active 
involvement of CSOs means sub grantee CSOs must attend, present at a public planning meeting and be 
involved in monitoring or follow up of public sector programs. Public sector refers to government 
entities including the districts, sub counties, parishes and villages. The progress on this indicator is 
summarised below;
 17 4 
16 
11 
0
2
4
6
8
10
12
14
16
18
Baseline Year 3 Target Y3 Achievement
FIGURE 17: INDICATOR NUMBER 11 PERFORMANCE
PROGRESS AT MIDTERM
The CSOs have been utilising the advocacy strategies developed using the PATH’s 10-part advocacy 
strategy development to pursue goals for improvement in services related to HIV/AIDS, TB, MCH, OVC 
and Nutrition. Sub grantees utilise meetings at the districts to engage the duty bearers by presenting 
fact sheets, dossier and making presentation on the status of health services in the districts. Tis triggers 
discussion and call for action. Key meetings and platforms being utilized are Sub county council 
meetings, district council meetings, district HIV coordination meetings, extended District Health Team 
meetings. 
At national level, CSO sub grantees participated in the relevant technical working groups (like the 
HIHV/AIDS, MCH, and Nutrition) in the ministry of health where a number of issues were pushed. ABH 
was represented at MCH TWG and has been championing availability and access to LSCs including 
oxytocin. Civil Society Organizations continued to present evidence about advocacy issues and amplify 
citizens’ concerns and voices in the district meetings for integration in district priorities. A number of 
planning and budgeting meetings were attended by our sub grantee organizations. For example, 
Kyenjojo District, stock out of essential supplies in health facilities, absenteeism of health workers and 
the need to prioritize health sector were presented. In Mayuge and Iganga where stock out of essential 
medicines and limited accredited ART sites were reported through the DMC.
At the national level, CEHURD participated in Maternal and Child Health Technical Working Group 
meetings, Civil Society Budget Advocacy Group and has ensured that maternal new born are integrated. 
Advocacy for Better Health has fully participated in the review of the budget framework paper of the 
Ministry of Health with emphasis to allocate resources to recruitment of midwives. In Kasese, an 
advocacy champion in Karambi sub-county participated in the technical planning committee and his 
presentation sparked the resolution by the district to leverage funds for maternity beds and fencing of 
the health facility in Karambi. In Mbale, the issue of lack of sanitary facilities in schools was presented 
which attracted a lot of discussion and resulted in Chief Administrative Officer tasking the District 
Education Officer to make a follow up and present status report to the District Executive Committee.
3.4.3 IR2.3: Enhanced co-ordination and collaboration among CSOs
INDICATOR 11: Number of CSOs that are involved in joint advocacy initiatives. CSOs involve or partner 
with peers for collective advocacy in response to identified service/policy gaps. Joint advocacy initiatives 
are advocacy issues sub grantee CSOs would like to address collectively in relation to the project 
thematic areas. CSOs to be counted are only sub grantee CSOs funded by PATH through USAID 
Advocacy for Better Health Project.The project identified and pursued opportunities to bring CSOs 
together to promote alignment of advocacy strategies, plans and resources. This included use of forums, 
networks and communities of practice. The forums enhanced the collaboration of CSOs with other 
stakeholders to strengthen District NGO Forums to support coordination among NGOs. Within the 
forums, CSOs emphasized advocacy for operationalization of national policies and plans especially at 
district and national levels. The project supported networks or umbrella organizations, bringing 
members together for advocacy strategy development workshops to align or develop joint advocacy 
strategies. Some sub-grantee CSOs led joint 
advocacy initiatives in their respective 
districts. The progress on this indicator is as 
below;
 
Working in networks and coalitions is a 
priority for CSOs to push a common advocacy 
 18
agenda. A number of functional coalitions and networks have been formed to address particular issues 
under the advocacy for better health. NAFOPHANU is working with peers CSOs to ensure that patient 
empowerment to demand for Viral Load testing services is fulfilled. The coalition is also following up on 
the commitment by Ministry of Health that by end of October 2016, each ART clinic will be able to draw 
blood samples from patients for onward transmission to the National Laboratory in Butabika for viral 
testing. HEPS is coordinating with other CSOs on the Western Uganda Coalition for Health Advocacy 
(WUCHA) where joint initiatives on advocacy to review national HUMCs guidelines are being followed. 
Similarly, ACODEV engaged the Kasese Civil Society Network (KADDE-NET) and other CSOs and engaged 
in mass campaign to end maternal deaths in the district. CEHURD has been pursuing the immunization 
fund as established by the Immunization Act; JIACOFE continued bringing to the attention of coalition 
members the issue of HIV/TB drug stock outs at facilities in Mayuge and Kamuli; ARUWE held coalition 
network meetings to evaluate progress on previous advocacy issues fronted by coalition members as 
well as prioritizing new issues affecting service delivery under MCH and HIV/AIDS. HEPS has coordinated 
regional ABH sub grantees and CSO member’s advocacy learning and strategizing meeting for joint 
planning and engagements. 
The advocacy for better health has attracted involvement of different stakeholders including through 
the 1st National Presidential Dialogue on Quality of Health Services in the country, peoples’ parliament 
on NTV, Parliamentary forum on Quality of health services and Parliamentary forum on Nutrition. The 
project continued to promote coalition and network building both at national and in the districts. For 
example, in Kasese, ACODEV mobilized partner CSOs to follow up shortage of ARVs in the health 
facilities within the district. JIACOFE organized two coalition meetings to discuss HIV/TB issues in 
Mayuge and Kamuli districts. In Kalangala, KADINGO organized a coalition meeting for partners to 
champion push system of drugs, health emergence transport and unreliability of power supply for 
health facilities. This was part of the pre-event activities towards commemoration of World AIDS Day in 
Kalangala district. Advocacy for Better Health in partnership with FANTA have championed Uganda 
Multi-Stakeholder Nutrition Advocacy Network with World Vision Uganda and UCCOSUN, UNICEF, 
Cotton On, SPRING, USAID/RECO-PIN, HIVOS East Africa, CUAMM, Concern Worldwide and UGAN 
Society. A joint nutrition advocacy agenda was developed on strategies for advancing nutrition advocacy 
in the country.
3.5 Result Area 3: Institutional Capacity of CSOs strengthened
Result Area 3 aimed at strengthening the capacity of partner CSOs, focusing on both organizational and 
technical to effectively manage and implement their advocacy interventions. The organizational capacity 
component included Governance, Administration, Financial Management, Human Resources 
Management, Organizational management and Project Performance Management aspects; while the 
technical capacity focused on skills for carrying out effective advocacy. Under this result area, significant 
achievements have been recorded. 
INDICATOR 12: % of CSO with overall improvements in organizational capacity. This indicator 
measures proportion of sub grantee CSOs that demonstrate improved management systems as defined 
in the OCA. Overall scores in six management areas: administration, human resource management, 
financial management, organizational management, and project performance management will be 
reviewed annually. Improvement refers to an overall increase of 6% in annual OCA scores in the 6 
management components. This indicator counts the number of CSOs with improved institutional 
management scores of 0.06 units annually, up to 3.5 and the progress is below;
 19
0% 
70% 
90% 
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline Year 3 Target Y3 Achievement
0% 
80% 
85% 
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Baseline Year 3 Target Y3 Achievement
FIGURE 18: INDICATOR NUMBER 12 PERFORMANCE
PROGRESS AT MIDTERM
FIGURE 19: INDICATOR NUMBER 13 PERFORMANCE
PROGRESS AT MIDTERM
The results show remarkable progress in the 
performance of all CSOs in all the six sub 
sections. The OACA results show improvements 
in all the 6 sections. The CSOs worked very hard 
on their actions to attain the improvements. 
Leadership commitment to the OACA action 
plan was critical to achieving the improvements. 
Significant growth has been exhibited in areas of 
administration, performance and financial 
management although they scored lower than 
the rest of the sections. Governance remains the 
strongest capacity area. Each of the CSOs was 
supported to develop an action plan that will 
guide capacity building in priority areas. Key sub 
grantees with greater improvements (above 
0.18 improvements in scores) include ACODEV, 
Uganda Red Cross Society, LADA, KACSOA, FLEP, 
CIDI and IDO.
INDICATOR 13: % of sub-grantee CSOs that demonstrate improvements on the Advocacy components of 
the OACA.
8 This denotes percentage of sub grantee CSOs that demonstrate improvements on the 
advocacy components of the OACA. The advocacy component of the OACA has been adopted and 
developed from the USAID advocacy index. Improvement refers to increase in annually score for each 
advocacy area. This indicator counts the number of CSOs. The performance towards the 5 year targets is 
a s below;
This measures improvement on the advocacy 
index components which are Advocacy 
Strategy Development and Implementation, 
Policy and Budget Analysis and Development, 
Gathering and Use of Evidence, Engagement 
with Decision-Makers, Advocacy 
Communications and Outreach, Networking 
and Collaboration, Community Mobilization 
and Empowerment, Women, Youth and 
MARPs. The results show improvements on 
the key components above. Key sub grantees 
with greater improvements (above 0.18 
improvements in scores) include STF, 
NAFOPHANU, ACODEV, Uganda Red Cross 
Society, LADA, KACSOA, FLEP, CIDI, JIACOFE 
and IDO.
 
8 Skills and capability strengthened in key areas including policy analysis, M&E, strategic advocacy and communications.
 20
0 
6 
16 
0
2
4
6
8
10
12
14
16
18
Baseline Year 3 Target Y3 Achievement
0 
1 
2 
0
1
1
2
2
3
Baseline Year 3 Target Y3 Achievement
FIGURE 20: INDICATOR NUMBER 14 PERFORMANCE
PROGRESS AT MIDTERM
FIGURE 21: INDICATOR NUMBER 15
PERFORMANCE PROGRESS AT MIDTERM
INDICATOR 14: Number of sub-grantee CSOs that attain adequate performance as defined in 
Organizational and Advocacy Capacity Assessment. This denotes count of CSOs that attain adequate 
performance as defined in Organizational and Advocacy Capacity Assessment. USAID Advocacy for 
Better Project capacity building models will be assessed annually on the 7 capacity elements: g 
governance; administration, human resource management, financial management, organizational 
management, program management and project performance management. A sub grantee is regarded 
to have attained aadequate performance when it scores 3.0 to 4.0 as defined in the OACA. Progress on 
this indicator at Year 3 is summarized below.
The project has provided support to CSOs by 
offering targeted technical support in key areas 
including human resources management, 
supportive supervision, strategic planning and 
governance. Other key trainings focused on 
advocacy strategy development, resource 
mobilization, fixed amount awards and 
understanding USG compliance requirements. 
These efforts have yielded capacity 
improvement to achieve adequate performance 
for CSOs. CSOs that have achieved this capacity 
include STF, NAFOPHANU, ACODEV, Uganda Red 
Cross Society, LADA, KACSOA, FLEP, HEPS, CIDI, 
JIACOFE and IDO.
INDICATOR 15: Number of sub grantee CSOs with management systems that qualify them to receive 
direct donor funding in accordance with USAID’s NUPAS. This denotes count of CSOs that attain 
performance of at least 3.51 in the overall OACA which reflects on the qualification of direct USAID 
funding. A sub grantee is regarded to have attained strong performance when it qualifies for direct 
donor funding as defined in USAID’s NUPAS. This indicator will be measured from year three onward. 
Ccapacity building assessment for NUPAS will be assessed on all 7 capacity elements: governance; 
administration, human resource management, financial management, organizational management, 
program management and project performance management. Progress on this indicator at Year 3 is 
summarized below.
The project conducted a mock NUPAS on four selected 
CSOs to assess their readiness for the NUPAS as part 
of the expectation by USAID to have at least four CSOs 
attain the NUPAS score. The NUPAS assessment 
focused on key elements of the OACA which include 
Legal structure, Financial management and internal 
control systems, Procurement systems, Human 
Resources systems, Project performance management 
and Organizational sustainability. The two CSOs that 
have qualified this year are STF which scored 3.6 and 
JIACOFE which has scored 3.7. The two CSOs will be 
presented as ready for direct funding from USAID. The 
project plans to work with an additional six 
 21
organizations in Year four towards achieving the final project target of four CSOs.
 22 
4.0 FINDINGS: THEMATIC AREA PERFORMANCE
4.1 Introduction
Presented below are the highlights of the coverage of the thematic areas such as Malaria, HIV/AIDS, TB, 
OVCs, MCH, Family planning and nutrition. The thematic areas were designed to address the focus areas 
including health financing and HRH, covered under all thematic areas. Commodity security was planned 
to be addressed under all thematic areas except nutrition while OVC issues would be covered in all 
thematic areas except TB and family planning. However, given the limited funding for OVC, more 
attention has been on the first three (3). While the project targeted “everything on health”, coverage of 
the thematic areas was largely driven by need and the funding available. Accordingly, HIV/AIDS was 
most covered and OVC least covered respectively. Details of the policy engagements per thematic areas 
are presented in annex 2.
4.2 Maternal and Child Health (MCH)
The project did not plan for specific MCH interventions in the first two years although it partly focused 
on women under two activities in the first year. These were; developing sub-county action plans with at 
least 30%focus on interest groups including women, and establishing special forums to reach interest 
groups including women. In the third year, the project sought to address domestic health financing, 
HRH, health commodities security relating to MCNH, as well as responding to emerging health advocacy 
issues. 
While some advocacy plans were developed and forums established in the first year, they largely 
focused on engaging communities on general health and social service delivery issues affecting them, 
without specifying MCH issues. Such generalization may have led to omission of key MCH aspects. 
Conversely, whereas there were no specific MCH interventions planned in year two, related issues were 
presented in meetings at sub county and national levels. These focused on eliciting support for 
increasing the availability and security of medicines and other health commodities. To this effect, the 
project facilitated tracking of the availability of drugs and commodities, including those for MCH such as 
Oxtoccine, by CSOs and community groups. For instance, in year three (3), a total of 472 community 
groups tracked stock availability at health facilities in the 35 districts. The project also raised citizens’ 
awareness on MCH issues through four (4) radio spot messages which focused on stock-out of drugs and 
commodities, among other concerns. At national level, CEHURD collaborated with other CSOs and met the 
management of NMS. Focus was on strategies for efficient stocking of the essential life-saving commodities, 
including MCH medicines.
Realizing the limited funding for health, the project supported initiatives for mobilizing financial 
resources at sub-county, district and national levels. For instance, in Year Two, a planning meeting of 
Karambi sub-county in Kasese District led to a resolution to mobilize funds for delivery beds. Similarly, 
the project supported more related interventions in year three, including raising MCH issues at district 
level meetings, including at District Health Management Team (DHMT) meetings and budget 
conferences. For instance, lack of a maternity ward at Butunduzi HCIII in Kyenjojo District was pointed 
out at the district budget conference. The project facilitated CSOs and community groups to monitor 
HRH including midwives who are key in MCH. 
ABH presented evidence to the MOH MCH working group on the use and storage of oxytocin, conducted 
sustained media advocacy (largely through TV and radio), and held multiple face to face meetings with the PS 
 23
of health. These activities resulted in a directive by the Permanent Secretary MoH to District Health Officers 
to ensure the use and storage of oxytocin in the UNEPI cold chain fridges. This will result in availability of 
oxytocin in many remote facilities.
Working with a team of legal experts, ABH developed draft guidelines for the implementation of the 
Immunization Fund. In response to a request from the Permanent Secretary MoH, PATH supported the 
gazetting of the Immunization ACT, which clearly spells out the establishment of the Immunization Fund. The 
project will continue working with stakeholders to ensure its implementation. 
4.3 HIV/AIDS 
The project seeks to support the 
attainment of the 90-90-90 targets, 
implementation of the Test and Treat 
Policy, and respond to emerging health 
issues. The project further seeks to build 
the capacity of selected national umbrella 
and network sub-awardees in advocacy.
The project’s interventions under the 
HIV/AIDS thematic area largely focused on 
gaps relating to medicines and commodity 
security, followed by HRH issues and health 
financing. Participation in major events like 
commemoration of the World AIDS Day 
was targeted. Focus was largely on stock￾out of HIV/AIDS and TB drugs and other essential health commodities. In Year Three (3), the project 
seeks to address the limited domestic 
health financing, low levels of HRH and 
security for health commodities, including 
those for people living with HIV/AIDS. To 
this effect, the project seeks to influence 
specific policy formulation, modification or 
implementation. The project, through 
partner CSOs, participated in public 
planning processes from Sub-county to 
national levels and advanced HIV/AIDS 
drug issues. This was through various 
avenues including: DMC, DHC and TWG 
meetings. For instance, in Kalangala, 
Kamuli, Kabale, Mbale, Busia and Ibanda 
districts, stock outs of ARVs were reported 
by citizens in DMC meetings. 
The project supported gathering of 
related evidence by developing and updating evidence dossiers focusing on HIV drug issues. For 
instance, in year two, media tours were conducted to document HIV drug stock-out, while linkage 
FIGURE 22: THE PRESIDENT OF UGANDA VISITS THE STALL OF
ABH SUBGRANTEE, NAFOPHANU DURING THE WORLD AIDS
DAY IN KALANGALA DISTRICT
 24
facilitators in Kaliro District tracked and revealed stock outs of ARVs in Bumanya HC IV in year three. The 
project strengthened and enhanced coalition and network building at district and national levels to 
address HIV/AIDS issues. For instance, ACODEV mobilized other CSOs in Kasese District to follow up on 
citizens’ concern of shortage of ARVs and agreed to petition the Speaker of Parliament. NAFOPHANU 
also engaged MoFEPD, MoH, the Speaker of Parliament and NMS to address ARV stock outs while AAG
participated in reviewing the status of ARVs. Similar engagements were held at sub-county level through 
community advocacy forums.
The project’s support to address HIV/AIDS issues also focused on HRH. This was intended to reduce the 
effects of HRH on HIV/AIDS service delivery. To this effect, the project supported generation of evidence 
to advance the advocacy agenda. For instance, media tours were conducted to document HRH issues 
relating to HIV/AIDS. The project contributed to planning for HIV/AIDS services through participation in 
public planning processes at Sub-county, district and national levels, as well as through community 
advocacy forums advancing HIV/AIDS issues. The key planning avenues included: DMC, DHC, and District 
HIV Committee (DHIVC), meetings. For instance, sub-grantees attended the DMC meetings in Bugiri, 
Ibanda and Isingiro districts and demanded that health workers to handle HIV/AIDS. The project further 
strengthened community groups’ planning for HIV/AIDS. 
The project held a one-hour talk show 
on NTV that focused on health 
financing specifically for HIV. The 
panelists on the talk show came from 
Advocacy for Better Health and 
Uganda AIDS Commission. The show 
was popularized through all social 
media platforms for NTV including. 
The project implemented advocacy 
initiatives geared at increasing 
financing for HIV/AIDS services. This 
was largely through the attendance 
of DMC, DHT, TWG meetings and 
budget conferences. This ensured 
that priority advocacy issues of 
citizens’ concern are incorporated 
into the district plans and the budget 
framework papers of FY 2017/18. For instance, in Year Three, the project mobilized CSOs to advocate 
against the 30% cut in the health sector budget, which had been stipulated in FY 2017/18 Budget 
Framework Paper.
The Uganda AIDS Commission (UAC) convened a number of meetings to develop a road map for writing the 
Anti HIV Stigma and Discriminatory Policy. Through its partner, NAFOPHANU, ABH advocated for the writing 
of this policy, in which, UNAIDS has now picked interest, and is donating resources for a consultant to lead 
the policy development process. The MOH launched the consolidated Guidelines for HIV Prevention and 
Treatment in December 2016. The project has continued to work on socialization of the policy, guidelines 
and the provisions thereof, especially among PLHIV and key populations such as sex workers. 
FIGURE 23: TALK SHOW ON HIV/AIDS FINANCING ON NTV
 25
ABH regularly shares stock status updates on HIV and TB commodities with the Ministry of Health through 
the project’s sub awardee, National Forum of People Living with HIV Networks in Uganda (NAFOPHANU). 
Additionally, 479 community groups in ABH’s 35 focus districts conduct monthly health facility assessments 
(HFAs) to generate advocacy evidence on health commodity status especially at health centers II and III. 
ABH, through NAFOPHANU, convenes quarterly meetings between CSOs and National Medical Stores to 
discuss health commodity/ drugs stock-out concerns and ways to ensure increased collaborative 
accountability.
Through media engagement and advocacy efforts—including meetings with the Parliamentary HIV/AIDS 
committee, the Health Committee, the Rt. Hon. Speaker of Parliament, and CSO coalitions—the project was 
able to ensure retention of the health budget of FY 17/18 at Uganda shillings 1.8 Trillion, averting a 30% cut 
originally proposed by government.
In preparation for, and anticipation of the NHIS, the project supported members of the Parliamentary 
Committee on Health to undertake a benchmarking trip to Rwanda. Upon their return, the committee 
members worked with the project and other CSOs to secure the long awaited Certificate of Financial 
Implication from MoFPED, which adds 
to the momentum towards 
establishment of the NHIS.
4.4 Malaria
In Year Two, the project involved
participation in commemorating the 
World Malaria Day to enhance 
visibility and share the advocacy 
agenda through audio-visual print 
materials or exhibition stalls. The key 
planned products included 
newspaper articles and flyers. In Year 
Three, the project planned to address 
domestic health financing, HRH, health commodities security relating to malaria; as well as responding 
to emerging health advocacy issues. To this, the project aimed to influence policy formulation, 
modification or implementation, 
including discussion of key 
impediments to the prevention and 
control of malaria, especially related 
to ACTs, RDTs, community uptake of IRS where relevant, and ITN use. The project further planned to 
enhance sub-grantees’ capacity to capture, analyze, translate and disseminate evidence. It also involved 
raising citizens’ awareness by using active two-way SMS platform, and enhancing community tracking 
and monitoring of commodity stock status for malaria drugs.
Implementation of malaria-specific interventions was effected in Year Three, largely focusing on 
medicines and commodities security. This involved raising citizens’ awareness, especially working with 
CDFU which developed four radio spot messages on different aspects. For instance, the project 
developed posts about malaria drug stock-outs at NMS, generating interest and discussion from the 
followers. The project contributed to planning for malaria services through sub-grantees’ participation in 
various meetings. For instance, sub-grantees attended the budget conferences and raised concern about 
FIGURE 24: EVIDENCE FACT SHEET ON MALARIA POLICY ASKS FOR
THE ABH PROJECT
 26
stock-out of malaria RDTs in Sironko, Kyenjojo, Ibanda, Kiruhura, Kamwenge, Rukungiri, Kanungu, 
Kisoro, Sembabule, Kayunga, Luwero, Nakasongola, Iganga, Kaliro, Mayuge and Kamuli districts. 
The project also supported other emergent aspects that affected malaria including; on enabling 
gathering of additional evidence on various issues including malaria by developing and updating 
evidence dossiers. For instance, HEPS, a sub grantee, in collaboration with MoH generated evidence that 
informed advocacy for the implementation of the 2012 WHO malaria Test, Track and Treat policy and 
the Uganda Malaria Strategic plan (2014-2020). While advocacy to increase the budget for health also 
related to malaria, HRH and OVC aspects were not addressed. This contravenes the strategic direction of 
the project. 
4.5 Orphans and Vulnerable Children (OVC)
The project planned to elevate the plight of OVCs by advocating for necessary changes or 
implementation of related policies. It sought to enhance the quality of Universal Primary Education, 
reduce school dropout rates and teenage pregnancy, and address child labor and other forms of child 
abuse. To this effect, the project sought to support sub-grantees to participate in government planning 
and budget meetings and conferences to ensure that health and social services issues of citizens. This 
way, OVCs’ concerns would be voiced, prioritized and incorporated in district and national budget 
priorities. The general project direction was to incorporate health financing, commodity security and 
HRH in interventions targeting OVCs. In Year three (3), planned interventions included participation in 
District OVC Committees (DOVCCs) and Sub County OVC Committees (SOVCCs).
The project mapped and identified critical knowledge gaps within the population on a number of health 
issues, including insufficient mechanisms to address OVC issues. The project supported CSOs to raise 
citizens’ awareness of their rights and responsibilities. This was done through three (3) radio messages 
focusing on the plight of OVCs and other channels. In Year Two (2), the project ensured the integration 
of OVCs’ concerns into district plans and budgets through sub-grantees’ participation in related 
meetings such as the District OVC Coordination Committees (DOVCC). Further support addressed high 
school dropout and absenteeism by children, especially OVCs in Universal Primary Education schools. 
For instance, in Mityana District, RACOBAO raised a need for an ordinance on the elimination of 
absenteeism and school dropout of children in UPE schools. The district council under minute 
241/EDU/29/09/15 passed this ASK. In year three (3), the project also supported sub-grantees to 
conduct health facility assessments in districts to identify health service delivery gaps relating to OVCs. 
While the OVC program area was no longer funded in year three (3), related interventions were 
integrated in other focus areas.
However, special forums to reach specific groups, including OVCs planned in year one (1) were not 
conducted. The meeting with stakeholders and parliamentarians to kick-start the development of 
guidelines for establishing the Immunization Fund was not held. This would have been the only 
intervention directly focusing on raising domestic funding for immunization as per the 2016 
Immunization Act.
4.6 Tuberculosis (TB)
The planned TB interventions largely focused on addressing stock-out of TB drugs, with a few directed to 
HRH gaps. However, no specific interventions targeted TB in Year One (1) and only awareness raising, 
focusing on four (4) priority issues including TB drug stock-out, was planned in Year Two (2). The project 
 27
involved the development and broadcast of radio talk shows, radio spots and drama series, and the 
production and dissemination of advocacy materials. In Year Three (3), the project seeks to address the 
limited domestic health financing, low levels of human resources for health and health commodities 
security relating to TB. The project also seeks to respond to emerging health issues, as well as generate
and use evidence in advocacy. The project further seeks to raise community awareness and connect 
partners and key stakeholders using an interactive two-way SMS platform to address major TB issues. 
The implementation of TB interventions largely focused on averting drug stock-outs. In year two (2), the 
project facilitated engagements for policy advocacy regarding the TB drug stock outs. For instance, 
NAFOPHANU led engagements with MoFPED, MoH, the Speaker of Parliament and NMS, aimed at 
halting the stock-out of TB drugs. Conversely, the AAG, jointly with other USG IPs, MoH and NMS, 
reviewed the status of health commodities, including TB drugs. In year three (3), the project raised 
citizen’s awareness on various issues including TB drug stock using media platforms and interpersonal 
channels. For instance, 15 live call-in radio talk shows were hosted by 15 FM radio stations in 
commemoration of World TB Day. Similarly, four radio spot messages were developed and aired on 15 
radio stations addressing TB drugs, among other concerns. The project supported gathering of evidence 
on TB for use in developing and updating relevant dossiers. For instance, Linkage Facilitators in Kaliro 
District tracked and revealed stock-out of anti TB drugs in Bumanya HC IV.
The project supported building coalitions with other CSOs to handle TB issues. For instance, JIACOFE 
organized two coalition meetings in Mayuge and Kamuli districts focusing on integration of HIV/TB 
services across departments. National level support also included coalition building. For instance,
CEHURD, in collaboration with other CSOs, held a meeting with the management of NMS focused on 
identifying challenges and discussing strategies for efficient stocking of the TB drugs and other essential life￾saving commodities. The project worked with other key TB players and oriented members of the 
Parliamentary Caucus on TB in related policy matters, with emphasis on gaps in the prevention and 
control of TB. However, focusing only on medicines for TB largely contravened the project’s direction of 
addressing two other aspects of health financing and HRH. 
ABH worked with Champions from Parliament to establish the Parliament TB Caucus, which will steer any 
future legislation on TB issues, and also to create a platform through which the profile of issues affecting TB 
services can be raised. The need for ensuring increased funding for TB was highlighted to government 
through different forums including at the national TB day (March 24th in Tororo) and during the wider debate 
on preventing the 30% budget cuts to the FY 17/18 health sector. An appropriation analysis of how much was 
ring fenced for TB commodities is yet to be done. The project through its sub awardee—NAFOPHANU, 
partnered with the Ministry of Health National TB, Leprosy Program to develop the Desk Guide for 
prevention and control of TB. The guide is at the stage of editing and finalization
4.7 Family Planning (FP)
The project’s interventions on FP largely focused on increasing financial resources and to a lesser extent, 
the HRH issues. The project supported national level initiatives through CEHURD, as a member of the 
Civil Society Budget Advocacy Group (CSBAG), to advocate for integration of family planning issues in 
the national budget framework paper 2017 / 2018. The need to finance FP services was further affirmed 
by the participation of project staff and CSOs in analyzing the budget framework paper of the MoH. 
Emphasis of the project was on a need to allocate resources for recruitment, motivation and retention 
of critical health workers, specifically midwives. Evidence generation also involved refining through 
meetings with duty-bearers. For instance, RHU met with the DHO, the CAO and the LCV Chairperson in 
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Kabale to refine evidence on gaps affecting the delivery of FP and MCH services. Key among the issues 
fronted was a need to increase domestic health financing for FP services. The project supported sub￾grantees to generate evidence on health service delivery gaps relating to FP, through health facility 
assessments. Focus was on the availability of relevant health workers at the facilities, including the 
functionality of HUMCs. Evidence generated was packaged into reports, evidence dossier, position 
papers and factsheets, which were used in advocacy. Contrary to the project’s strategic direction, there 
was no focus on FP medicines and consumables. 
In an attempt to elicit more contribution to address FP issues, sub-grantee CSOs participated in planning 
and budgeting processes, especially at district level through DHMT and DMC meetings, and during 
budget conferences. For instance, sub-grantees asked for the prioritization of FP in the district plans and 
having related budgets during DMC meetings in Kanungu and Kamwenge districts. Sub-grantees also 
attended budget conferences. In Kumi, Mbale, Namutumba, Budaka and Mityana districts, they 
presented a need to introduce long lasting FP methods in some health facilities and asked for increase in
budgets for FP. Sub-grantees also attended DHMT meetings in Bukwo, Kapchorwa and Kabale districts 
and pushed for skilling some health workers in new and long term FP methods.
In partnership with other civil society activists under the Family Planning Budget Advocacy Group, ABH 
advocated for the prioritization of family planning in the FY 217/18 national health budget to the Ministry of 
Health and Parliamentary Committee on Health. In partnership with the Uganda Youth and Adolescent 
Health Forum, the project funded and participated in the consultations of young people on the current 
Adolescent Health Policy that is under review by MoH. In collaboration with the Ministry of Gender, Labor 
and Social Development, the project has conducted a sustained national campaign to end teenage pregnancy 
and child marriages. Despite ongoing advocacy efforts for the finalization of the School Health Policy, cabinet 
approval was deferred due to the ongoing review of the sexuality education framework by Ministry of 
Educations, Sports, Science and Technology.
4.8 Nutrition
The project raised awareness on the use of media platforms and interpersonal channels, especially 
community group meetings and advocacy forums focusing stock-out of commodities. For instance, the 
project worked with CDFU to develop four radio spot messages on nutrition commodities. The project 
supported gathering of additional evidence on issues regarding nutrition and developing and updating 
evidence dossiers, especially on data use by the community groups and ABH staff. 
FIGURE 25: THE SPEAKER OF THE PARLIAMENT OF UGANDA AND THE PRIME MINISTER OF UGANDA
LAUNCH AND SIGN OFF THE PARLIAMENTARY NUTRITION PLATFORM
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FIGURE 26: WHO REPRESENTATIVE, DR. HAFISA KASULE (HOLDING MIC) LAUNCHING THE MANIFESTO
The project contributed to planning for nutrition services through the participation of sub-grantees in 
various meetings focusing on HRH. For instance, sub grantees attended the DMC meetings in Bugiri, 
Ibanda and Isingiro districts and raised the issue of inadequate human resources to provide nutrition 
services at the health facilities. The project involved coalitions to promote delivery of nutrition services. 
For instance, it partnered with FANTA and Office of the Prime Minister to launch the Parliamentary
Forum on Nutrition. It later facilitated orientation of the members of the Parliamentary Forum on 
Nutrition, district LCV Chairpersons, CAOs and District Planners in western Uganda on nutrition issues. 
the project also organized and coordinated a regional meeting of USAID implementing partners’ meeting 
in Mbale. This led to development of strategies for regular updates on health and social service issues 
and identification of areas of collaboration, including nutrition. 
ABH was at the fore of the establishment of the Nutrition Advocacy Platform, comprised of partners such as 
World Vision, FHI 360 (USAID FANTA, and CHC), JSI SPRING Project, UNICEF and indigenous CSOs. This 
platform meets quarterly to review progress on nutrition issues that require advocacy, so as to lay out 
plausible courses of action. Working with other partners implementing nutrition interventions, ABH held two 
high level policy dialogue meetings with members of Parliament and other stakeholders, as a way of 
mobilizing their support. ABH supported the establishment of the Parliamentary Forum on Nutrition (PFN), 
which was officially launched by the Rt. Hon Speaker of Parliament (Hon. Rebecca Kadaaga) and the Rt. Hon 
Prime Minister (Hon Dr. Ruhakana Rugunda). This forum will be leveraged to expedite any legislation related 
to nutrition.
As way of ensuring that nutrition is prioritized in district plans and budgets, the project and collaborating 
partners (OPM, USAID-FANTA, World Vision) funded regional experience sharing meetings with district 
leaders in Western, Eastern and Central Uganda. Nearly 400 district leaders including Members of 
Parliament, CAOs, RDCs, District Planners, DHO and LC V Chairpersons attended these meetings. A number of 
commitments (including the establishment and functionalization of District Nutrition Coordinating 
Committees) were made during these regional meetings. The project will pursue the implementation of 
these commitments. Working with OPM, the project also ensured that a menu of all nutrition specific and 
sensitive indicators—disaggregated by sector—is generated and monitored during the Result Based 
Monitoring implemented by government.
4.9 Cross-cutting aspects 
These include: HRH absenteeism and late coming, lack of accommodation for health workers, non￾functionality of health units as raised in Bududa and Kisoro districts in Year Three (3) and non￾functionality of HUMCs as pointed out in Bugiri and Kalangala districts. Support was also provided to 
sub-grantees to focus their OACA action plans and reviewing progress covering various components and 
thematic areas. For instance, LADA addressed the HIV/AIDS workplace policy. Conversely, the project 
raised citizens’ awareness through dissemination of 
the Patients’ Charter during the World AIDS Day, 
radio and print media, including radio talk shows; 
and press conferences and press releases.
The project in partnership with other like-minded 
CSOs developed and launched a citizens’ manifesto 
that was inter alia calling upon political aspirants to 
consider increasing financing for health sector as a 
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priority when elected into office. The launch held on 15th September 2015, was well attended by CSO 
representatives, the media, and UN agencies. There were cross-cutting aspects addressed that indirectly 
affected the seven (7) thematic areas.
In a bid to generate national concern and 
conversation on the quality of health services in 
the country, Advocacy for Better Health worked 
with some members of Parliament led by Hon. 
Herbert Kinobere and Hon. Rosette Mutambi to 
establish the Uganda Parliamentary Forum on 
Quality Health Services Delivery. This forum, 
which was launched by the Rt. Hon Speaker of 
Parliament, who is also its patron, boasts a total of 
215 members. The project will continue engaging 
with this forum and others established to ensure 
legislative movement on priority advocacy issues 
related to health.
Advocacy for Better Health (ABH) also organized a 
national level dialogue to discuss the need for government of Uganda to absorb PEPFAR funded staff into the 
health system. From this dialogue, a multi-sectoral Task Force (comprised of the MoH, MoFPED, Ministry of 
Public Service, Ministry of Gender, Labor and Social Development, Health Service Commission, Public Service 
Commission, PEPFAR and USAID representatives, as well as representatives from the Private Not for Profit 
Medical Bureaus) was established. The Under Secretary of MoH chairs this task force, while PATH-ABH and 
IntraHealth- Strengthening Human Resources for Health were nominated to coordinate Secretariat 
responsibilities of this Task Force.
The project also sponsored two sessions of the popular People’s Parliament TV show on NTV with a 
major focus on MCH and HIV issues. The show on MCH was held in Mityana district that has had 
episodes of unexplainable maternal deaths in the past. It attracted the participation of districts leaders 
(District Health Officer, District Chairperson, and Resident District Commissioner) who discussed the 
critical health sector challenges in the district. These ranged from poor state of maternity wards, to 
break down of referral system, limited community sensitization on nutrition, lack of ambulance, water
shortage in health facilities, stock outs of essential drugs and other lifesaving commodities. 
ABH together with the Parliamentary Forum on Quality Health Services organised the 1st National 
Presidential Dialogue on Quality of Health Services in the country at Colline Hotel, Mukono. The dialogue 
was attended by a number of people close to 400 from civil society organisations, Government, 
Ministries, Parliament, Donor agencies, USAID and implementing partners. The President of Uganda who 
was expected to be the Chief Guest was represented by The Rt. Hon. 1st Deputy Prime Minister Gen. 
Moses Ali who read the President’s speech. This was a welcome effort to be able to discuss the 
challenges in the health sector. Gen. Moses Ali officially launched the dialogue to be a yearly event to 
take stock of what is happening in the health sector and what needs to be improved upon.
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 32
5.0 COLLABORATION, LEARNING AND ADAPTATION (CLA) APPROACH
5.1 Introduction
The Collaboration, Learning and Adaptation (CLA) model is a powerful tool in fostering development 
effectiveness. Collaborating helps to identify areas of shared interest and enables working together. It 
helps to reduce duplication of efforts, and share knowledge across sectors and institutions. The project 
developed a CLA Agenda and planned collaboration with other USAID Implementing Partners through joint 
initiatives, performance review meetings and participation in other relevant coordination platforms. The 
project planned to provide a platform to enhance linkages and complement the efforts of different programs 
to pursue common objectives. The review revealed more availability of initiatives on collaboration and 
learning than adaptation. Related achievements are presented below:
5.2 Collaboration
The project formed collaborations through sub-grantee CSOs and series of breakfast meetings with the 
Parliamentary Committee on Health were held to discuss government’s funding for health for the 
financial year (FY) 2015/16. As a result, CSOs working on health submitted issues for prioritization to the 
Parliamentary Committee on Health regarding wage bill enhancement for health workers, enhancement 
of Primary Health Care at district level and basic non-monetary needs for health workers such as 
education, capacity building and housing. The project also carried out national level policy advocacy 
engagements and formed the Advocacy Advisory Group (AAG) comprising of volunteer national and 
district-level decision-makers, CSOs, the media, private-sector and representatives of leading health and 
social service-delivery projects in Uganda. The platform has linked CSOs, ensured complementary 
efforts, and strengthened joint advocacy planning among related projects in Uganda.
One key success of the project has been revamping coalition-building by CSOs, through various avenues 
such as meetings on MNCH and life-saving commodities. This resulted in key advocacy outcomes. 
Notable among them include: advocacy for increasing stocks for Oxytocin at health facilities. This 
prompted the MoH to recommend storage of Oxytocin in UNEP refrigerators. Some CSOs like CEHURD 
presented such issues in the media at no cost. The CSOs’ involvement in the government’s budgeting
process, especially through technical working committees at national level, had improved. Joint 
advocacy activities with other CSOs both at district and national levels were initiated through 
collaborations. For instance, LADA, a CSO in the south western region led the formation of the SWANET, 
comprises of 31 like-minded CSOs in the region. This network is currently considered as a platform to 
champion health and social service advocacy issues affecting citizens, before the responsible duty 
bearers.
Collaboration with other stakeholders was deep-rooted in the project’s design and implementation. In a 
bid to understand the operating landscape and identify opportunities for collaboration and synergies, 
the project team held meetings with several USAID-funded Implementing Partners. These include; 
Communication for Health Communities (CHC), Strengthening Decentralization for Sustainability (SDS), 
STRIDES for Family Health, STAR –South West, and Governance, Accountability and Performance 
Program (GAPP). These engagements provided opportunities for introducing the project and learning 
from ongoing projects’ experiences including sub-granting mechanisms, baseline assessments, 
developing monitoring and evaluation subsystems, communication strategies and stakeholder 
management. The project worked closely with stakeholders such as the USAID Monitoring, Evaluation 
and Learning Contract; SDS and Accountability Can Transform (ACT) Health project. This aided the 
 33
finalization of the project’s Results Framework. The project team worked with CHC and CDFU to develop 
and broadcast communication (mass media) messages about the development of the project’s 
communication strategy. 
During the implementation period, collaborations were made with different stakeholders to address 
specific needs. For instance, linkage with the Strengthening Human Resources for Health project 
provided evidence on the status of human resources for health and its impact on health service delivery. 
To help identify challenges that youth and OVCs face and how they would be tackled, the project 
collaborated with the Ministry of Gender, Labor and Social Development and OVC IPs including 
Strengthening the Ugandan National Response for Implementation of Services for Orphans and other 
Vulnerable Children (SUNRISE OVC) and Sustainable Comprehensive Responses (SCORE) for Vulnerable 
Children and their families. A partnership with the Uganda Stop TB campaign aided documentation of 
critical advocacy issues affecting TB prevention and control. The project also participated in the PEPFAR 
Implementing Partners’ Meeting, leading to sharing of experiences and lessons in working with key 
populations.
5.3 Learning
The project was involved in various learning platforms and events including; regional reflection meetings 
through which sub-grantees’ progress and performance are reviewed; Grants Management Collaboratives 
(GMCs) held at regional level to enhance capacity development; and e-newsletters. The project further 
promoted learning through; documentation of lessons learnt by video new learnings of successes and best 
advocacy practices; annual performance review meetings; attendance of relevant national and international 
subject matter conferences; participation in commemoration of the international and national days; relevant 
national and international subject matter conferences; and documentation and sharing for project staff 
through papers, abstracts and presentations at national and international conferences. These platforms and 
events enabled to the project to enhance; CSOs’ continuous reflection and improvements; sharing successes 
across board; informed work planning annually; and improved the project’s outlook.
The project conducted Year One and Two Organizational and Advocacy Capacity Assessments (OACA) to 
measure progress on the capacity development plans. The reports reveal that out of the 19 sub￾awardees, 17 demonstrated improvements in their overall scores, while one maintained the same score, 
and another had a drop in the overall score. Even for sub-awardees that improved in the overall scores, 
there was a decline in some of the sub-section scores. The improvements are attributed to the support 
received from the project, and commitment of the sub awardees to implement their action plans. 
The project included CSOs’ quarterly self-review and update of OACA action plans though not fully 
adhered to. This was strengthened through the integrated support supervision that enabled CSOs to 
receive support from the project team regarding the review and update OACA plans. The review process 
enabled ascertainment of the status for each CSO’s implementation of learning actions and required 
support to address remaining actions. Project staff further, participated in Implementing Partners’ 
meetings to share experience and lessons in working with key populations. The project produced and 
disseminated four editions of the Advocacy Alerts! Newsletter9
. 
 
9
The Advocacy Alerts! Newsletter can be accessed on the following link 
https://path.box.com/s/4fkrz7flwf30fyoom4qrzqj7wxyzynns
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This facilitated documentation and sharing of information among staff, partners and donors. These 
presented simplified information about major events, meetings and other advocacy milestones that the 
project had been accomplished. These were helpful as they kept stakeholders abreast up to date. In 
order to share with and learn from other stakeholders at international level, the project supported some 
staff to attend and presented at international conferences. Some of the conferences attended include; 
the American Evaluation Association Conference (AEA), 2016 held in Atlanta GA, USA; and the Pan 
African Social Accountability Learning Lab held in Manzini Swaziland; and the National Health Insurance 
Scheme benchmarking in Rwanda; and the Annual Health and Humanitarian Logistics (HHL) Conference 
in Copenhagen, Denmark 2016; these enabled the staff to get acquainted with new areas including; 
information Systems for supply chain management; cutting-edge technology in warehousing, logistics 
and supply chain management. Other key learning events where the ABH team shared and learnt from 
include the American Evaluation Association Conference (AEA), 2016 in Atlanta GA, USA; and the Health 
Systems Research conference in Vancouver. This information is helpful in shaping advocacy.
5.4 Adaptation
The project devised means of adapting good practices learnt from various platforms and events. The 
GMCs involved the Plan Do Study Act” (PDSA) process that included the adaptation of good practices. 
For instance, during the GMC held in December 2016, sub grantees expressed gaps in ensuring effective 
use of evidence in advocacy while others shared their related successes. Subsequent GMCs also focused 
on improving evidence use in advocacy. For instance, data collection through HFAs and its use in 
community and district advocacy forums has been adopted by all sub grantees and community groups. 
Nonetheless, the adaptation from learning platforms and events was low. 
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6.0 CRITICAL EVALUATION ASPECTS
6.1 Efficiency
The MTE applied measures of efficiency addressing waste in the process; at the level of inputs - cost 
reduction approaches; and at process level, focusing on; timeliness of activities and processes leading to 
quality enhancement. 
6.1.1 Cost reduction approaches
i. There was poor understanding of the FAA mechanism at the beginning, leading to omission of some 
activities from CSO budgets, and challenges in implementation as described by CSO’s:
The challenge with ABH there, is the mode of funding. […] Because at times, as an organization 
we don’t have funds. And uh, ABH wants you to keep on running the program but you find you 
are constrained and don’t have money and they are saying, you work, and we shall reimburse 
after you have worked. So for many organizations, ours inclusive, you’ll find it is challenging.
- Executive Director, District-level CSO, July 2017
However, over time some CSO’s found the FAA mechanism provided cost savings due to its flexibility 
with a focus on milestones and not the details of expenses involved in the process, which enabled 
meeting of outputs at low cost. Staff recruited by CSOs were an additional resource for other projects. 
This ultimately led to cost savings as noted:
“… you save on some costs because they will not ask you for instance how you reached the 
ministry. What they want is the milestone. There is a lot of flexibility, I am able use these Project 
Officers on other activities link” (National level CSO stakeholder interview, August 2017). 
ii. Use of milestones and their retirement using means of verification (MoV), minimizes the time 
that staff would take to review accountability reports and supporting documents. Only MoVs 
documents were required without the usual documents required for liquidating partner 
advances. 
iii. The findings revealed that some project meetings and trainings were conducted within the PATH 
or sub grantee premises. This saved funds that would otherwise have been spent in other 
venues though such may compromise quality if not well planned. To elucidate this, one 
participant noted: 
“We said restored our coalition meetings. Civil society come together to discuss maternal and 
child health. They sit here in this board room”. (National level CSO stakeholder interview, August 
2017). 
iv. The design of the project incorporated cost saving mechanisms especially its dependency largely 
on CSOs and community groups that integrate advocacy initiatives into their routine activities. 
Some trainings of community group members and Champions on some thematic areas were 
conducted by CSOs using their own resources under other projects as noted:
 36
“We trained community groups and Champions on some areas not yet covered by ABH funds. 
We could not wait since there was a gap yet they needed the knowledge, for instance on 
reproductive health matters” (CSO staff). 
v. The use of coalitions was a major approach and key to advocacy initiatives. The project’s linkage 
with other organizations facilitated joint contribution towards the costs of key outputs. For instance, 
through joint funding under the Nutrition Advocacy Platform, the project championed improvement 
of nutrition in Uganda and co-led the launch of the PFN, graced by the Rt. Hon Speaker of 
Parliament and the Rt. Hon Prime Minister.
vi. The utilization of network structures facilitated some activities to be carried out without use of ABH 
project funds. This largely related to acquisition of data for evidence based advocacy. While there 
was no formal arrangement to enable national level CSOs to get evidence from district level CSOs, 
NAFOPHANU used her members in the districts to get the required evidence. One CSO staff 
emphasized this as stated:
“NAFOPHANU has been using her members to get evidence from across districts because it is 
easier for it. Other national level implementers like us finding it costly to reach there and get 
evidence”. (National level CSO stakeholder interview).
vii. Building the capacity of CSOs largely relying on project staff was a good cost saving approach. While 
some consultants were contracted to support some interventions, they were significantly few. 
6.1.2 Time saving approaches
The project design involved different elements that facilitated time saving during implementation. 
Notable among the time saving elements and deterrents are as follows: 
i. The establishment and use of regional offices helped provide timely support to CSOs without 
technical teams from the national office. One CSO staff noted about support from regional offices: 
“We work together with them. They come and support us conduct some activities especially at 
district level and also when we have problems to sort out” 
- National level CSO stakeholder interview, August 2017.
ii. The Integrated Support Supervision approach created an opportunity for comprehensive support 
from more than one technical area as well as strengthening of their advocacy activities during the 
same period. 
6.2 Effectiveness
Community Empowerment
The project worked with community groups to empower citizens on their rights and responsibilities 
related to health and social services. The communities through the groups demanded for policy based 
changes from decision-makers especially at sub county and district levels, and held them accountable 
for the quality of health services. The avenues leveraged for this interface include; community dialogues, 
the use of print and electronic media, and through edutainment. The Patients’ Charter formed the 
 37
foundation for the messages on rights and responsibilities. This attainment was partly a result of support 
and follow up from the sub grantees.
Advocacy
The project handled advocacy efforts on four cross-cutting priorities: health commodity security, human 
resources for health (HRH), domestic financing, and orphans and vulnerable children. CSOs advocated 
from the facility to the highest levels of decision-making. On the other hand, community members were 
engaged in advocacy at community level though in a few communities. CSOs’ advocacy agenda included 
engagement of government authorities in various ways leading to some actions on health and social 
service issues and policy gaps and focus was put on supporting and encouraging CSOs to collect 
especially through health facility assessments and its use in advocacy initiatives. CSOs’ attendance of 
government planning meetings at national and district levels was high, which was a major avenue for 
conveying citizens’ concerns. However, some of the CSOs focused on achieving milestones to enable 
them recover funds used and missed out on other actions including joint advocacy. While there was 
good representation of citizen’s concerns by CSOs at government meetings, most government 
authorities were still less supportive of advocacy to service delivery initiatives; leading to low 
incorporation of citizen’s concerns in district plans. Nonetheless, other local governments had limited 
resource to cater for the citizens’ issues raised. 
Capacity building
The capacity of sub awardees to conduct advocacy greatly improved, as exhibited by various aspects 
including; their ability to develop advocacy strategies, collection of evidence and use it to engage 
decision makers, which has resulted in duty bearers addressing some key issues affecting health service 
delivery. Sub grantees were trained in organizational areas including; strategic planning and 
development of systems and processes to enhance documentation, human resource management, 
board oversight, and resource mobilization. Some sub grantees noted that the skills gained from the 
resource mobilization training and follow up support enabled them to bid on, and win new grants. The 
training of sub grantees on advocacy enhanced their ability to continue improving on various advocacy 
fronts as reflected from results of Capacity assessments carried out including the assessment carried out 
as part of the MTE that showed meeting of all targets. 
6.3 Project sustainability
The project design has a key result area on institutional capacity development. This was envisaged to be the 
pivot for sustainability. The capacity development structure was designed to move selected partners 
through assessment, improvement and review relative to identified standards, with eventual 
independence from the program as the ultimate goal. The project team was also mandated to create a 
prospective exit strategy in collaboration with each partner organization within its first year of support. 
Over the course of the program, besides repeated assessments, technical support approaches targeted 
to each specific CSO were catered for to build technical and organizational capacity for dynamic 
development and transformation. These ought to include: e-learning curricula; workshops; training of 
trainers; short-term consultancies; mentorships; and peer-to-peer learning. The final phase of program 
support was envisaged to focus assessment and assistance on ensuring that CSOs demonstrate that the 
various components of sustainability-related strength are in place. The project was also designed to 
support CSOs to attain knowledge, access and eligibility to an array of financial support sources for 
policy advocacy.
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The mid-term evaluation incorporated key questions to assess achievement of the milestones 
demonstrating full program sustainability, including: 1) CSOs are capable of achieving “acceptable” 
NUPAS scores; 2) CSOs demonstrating ability to source additional funding; 3) CSOs demonstrate ability 
to plan and implement advocacy work; and 4) CSOs routinely initiate, execute, and evaluate advocacy 
work. 
Tentative process assessment shows that key steps have been taken along the sustainability framework 
especially considered strengthening of existing community and government institutions. The project has 
worked with community groups in target districts and mandated them to steer advocacy in their 
communities. The project has trained community groups in various components of advocacy, enabling 
them to get skills that will be utilized beyond the project lifetime. The involvement of community groups 
in government planning processes has been key in the project. The participation of CSOs in public sector 
planning processes has improved with 80% of them now actively involved, ahead of the 60% mid-term 
target. The momentum built may continue beyond the project.
The project expects to “graduate” at least four CSO partners with the systems and skills to qualify as 
prime recipients for future USAID funding. It is also expected that there will be additional networks or 
umbrella organizations and CSOs that possess the organizational and advocacy capacity, experience, and 
expertise to develop and implement programs to effectively represent community interests and 
advocate for health and social policy change. The project envisaged that the CSOs and umbrella 
organizations would be able to strengthen the capacity of their members, partners, and associated 
community groups to actively engage in joint advocacy and accountability activities. The assessment 
reveals good progress in capacity development towards these outcomes. 
Training of sub grantees on resource mobilization equipped them with key skills that they use to access 
more funding. Following the resource mobilization training conducted in year one (1), sub-awardees 
started developing and or refining their resource mobilization strategies. By the end of the year over 
50% of the CSOs had completed their strategies. These include; ARUWE, STF, ACODEV, NAFOPHANU, 
HEPS, MAFOC, LADA, CEHURD and Family Life Education Program (FLEP). Sub awardees like Literacy 
Action Development Agency (LADA), ACODEV and FLEP won new projects, an achievement they partly 
attribute to skills gained in fundraising and capacity during the first two (2) years of the project.
The support and encouragement to network and establish joint advocacy initiatives under the project 
had already lead to formation of network organizations. For instance, SWANET was established by LADA 
and comprises 31 CSOs in south-western Uganda. It has already carried out district level joint advocacy 
initiatives. The network is currently viewed as a platform to champion health and social service advocacy 
issues affecting citizens. While details of SWANET’s operations are not yet available, it is a good step in 
sustaining advocacy initiatives. 
However, some key ingredients of the sustainability approach have not been adequately handled. 
The project has worked with community groups in target districts and mandated them to steer advocacy 
in their communities. The project was envisaged to enhance the sustainability of community and 
government engagement functions and mechanisms by pursuing policies and institutional frameworks 
that require community participation in policy and planning processes. Such policies not been seen and 
institutional frameworks still require more clarity and formalization. 
 39
The project planned to use key players such as the AAG, champions’ networks, and advocacy fellowships 
to bring multiple stakeholders together to build system-wide commitment for advocacy and 
accountability, leverage resources and foster lasting working relationships. The sustainability of 
advocacy programs also needs to be enhanced by the formation of advocacy communities of practice 
and the Grants Management Collaborative. These forums would provide a platform for shared learning 
about challenges, successful practices and results arising from implementation of advocacy and 
organizational development strategies and activities. While AAG and champions are already part of the 
project, fellowships have not been recruited. Furthermore, the sharing of information between AAG and 
champions cannot easily be traced. This reduces the usefulness of the otherwise good approach. 
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6.4 Relevance of the project
6.4.1 Alignment with USAID Uganda’s CDCS 2016-2021
USAID/Uganda’s 2017/2021 Country Development Cooperation Strategy (CDCS 2.0) is vital in aligning 
UASID’s supported interventions to achieve the Uganda’s Development Cooperation Strategy. Uganda’s 
National Development goal is to become a prosperous, stable and democratic society and the 
Government of Uganda’s (GOU) “Vision 2040”. USAID Uganda’s 2017/2021 CDCS 2.0 focuses on: Health 
systems strengthening and epidemic control, increased literacy, agricultural sector development, 
enhanced food security and reduced household and community vulnerability to shocks. It also seeks to 
promote biodiversity and natural resource management, climate change adaptation and inclusive and 
accountable democratic governance. 
The project’s goal is to improve quality, availability and accessibility of health and social services. This is 
aligned to USAID Uganda CDCS’ Development Objectives One (1) and Two (2). The project’s Result Area 
one (1) promotes citizens’ demand for improved quality of services, focusing on increased citizens’ 
awareness of their rights and responsibilities. It also focuses on ensuring that community groups advance 
priorities for improved health and social services, and improved engagement between citizens and duty 
bearers. These are largely in line with CDCS’ focus on inclusive and accountable democratic governance.
The project’s Result Area Two (2) focuses on enabling CSOs to effectively advocate for issues of citizens’ 
concern in health and social sectors through increased utilization of evidence to inform advocacy. It also 
involved their effective participation in local government planning, monitoring and accountability of 
health and social services. This was done through enhancing co-ordination and collaboration, which are 
also key pillars of CDCS’ CLA approach. Result Area Three (3) promotes strengthening of institutional 
capacity of CSOs, which are clearly stipulated in USAID Uganda’s CDCS provisions on Health systems 
strengthening. 
6.4.2 Alignment with national and international policies and frameworks
The ABH project is well-aligned to various Government of Uganda (GoU) policies and frameworks on FP, 
SRH, MCH; malaria, nutrition, TB, HIV/AIDS and OVCs. Interventions under each of these components 
have been designed with due regard to the relevant policies. Some of the key initiatives of the ABH 
project that particularly conform to the GoU’s policies and strategies are: increasing the involvement of 
local communities; improving the governance and accountability of districts, improving accountability by 
duty bearers through service provision, and improving accessibility and use of services. The ABH project 
design and implementation strongly support the GoU’s initiatives, in especially health. 
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7.0 ACTIVITY IMPLEMENTATION
IR 1.1: Increased citizens’ awareness of rights and responsibilities related to health and
social services
In order to empower citizens, the project planned to employ a two-pronged approach to community 
empowerment and engagement. First, the project work supported CSOs to identify and strengthen their 
own community mobilization efforts, focusing on more inclusive engagement of marginalized groups 
and effective action planning that can be leveraged for advocacy efforts. Second, it further supported 
CSOs to work directly with community groups to ensure that they (i) are interested in advocating for 
their communities’ health, (ii) have the necessary information on their rights and responsibilities and key 
health and social issues and policies in order to advocate, (iii) develop effective action plans for 
influencing relevant planning and budgeting processes, and (iv) to participate in key platforms to ensure 
their voices are heard when decisions affecting their lives are being made.
Mapping of assets and resources: The project started with community mapping of existing assets for 
community empowerment and advocacy at national level and within the 35 project districts. Mapping 
aided the identification of existing assets and resources for community empowerment, such as Village 
Health Teams (VHTs) and communication channels that national- level CSOs use to mobilize 
communities for health and social services-related advocacy. Mapping further revealed vital 
information, including: the key role of VHTs in the dissemination of health information, limited feedback 
mechanisms and the publication of IEC materials in English, yet many Ugandans do not understand it. 
These assets and resources supported planning for project interventions. Nonetheless, VHTs have not 
been adequately utilized yet they are vital in raising community awareness.
Development / customizing of the communication strategy: Realizing the vital value of evidence, a 
formative study was conducted in three (3) districts of Sembabule, Kiruhura and Mityana to inform the 
development of a project’s communication strategy. Developed in 2017, the communication strategy 
guided all communication interventions and was later customized by all the 20 sub-grantee CSOs to suit 
their contexts and communication needs. This led to standardization and enhanced the quality of 
advocacy. However, the formative study was conducted only in districts from central and south western 
regions and could have missed salient issues specific to some communities in eastern Uganda.
Raising citizens’ awareness on health rights and responsibilities: 
Traditional platforms such as barazas (citizen engagement meetings),
Munnomukabi groups (Self Help groups), PLHIV support group 
network meetings; and saving and credit cooperative (SACCO) 
meetings were applied to raise citizens’ awareness. For instance, 105 
community advocacy forums including community dialogues, interface 
meetings and awareness sessions were conducted across the 35 
districts in the first two (2) years. Drama was embraced as an 
edutainment approach to create awareness on rights and 
responsibilities. This aided modeling desired behaviors. Two sub￾grantees; RHU and ARUWE, conducted 12 drama shows focusing on 
the Patients’ Charter. These initiatives contributed to the 50.9% of 
citizens who knew their health rights and 62.4% who knew their 
health responsibilities. 
However, 205 community advocacy forums and 1,188 drama shows 
 42
were not implemented in the same period. These would have provided more avenues for community 
members to share their concerns to duty bearers and decision makers.
Partnership and engagement with the media: The project engaged media houses in various ways 
including; broadcasts and placements of advocacy messages on radio, TV and in newspapers. For 
instance, in the first two (2) years, sub grantees conducted 284 live call-in radio talk shows on local FM 
radio stations, raising citizens’ awareness on health rights and responsibilities. Further, 24 episodes of a 
radio serial drama were broadcast under the popular award winning Rock-Point 256, aired on 22 local 
FM stations across the 35 districts. In order to focus the radio talk shows, the Patient’s Charter was used 
as source of information. The project considered the different languages in the project districts. 
Accordingly, a total of 8,280 radio spots were broadcast in English and five (5) local languages including 
Runyankole - Rukiga, Luganda, Lukhonzo, Ateso and Kupsabiny on three (3) national and eight (8) 
district-based radio stations. 
Overall, a total of 8,844 radio advocacy engagements including talk shows, serial dramas and spot 
messages were aired compared to only 550 that were planned. The focus was on the four priority 
advocacy issues including; Orphans and vulnerable children, health commodities security, human 
resources for health and domestic health financing. These engagements were on all the seven thematic 
areas of the project. These media engagements increased citizens’ awareness on their health rights and 
responsibilities as well as need for action from duty bearers as noted under progress of result area one.
The project further reached citizens through a series of 24 advocacy strip messages in Uganda’s two 
leading dailies (New Vision and Daily Monitor). These enabled citizens to get information on drug stock￾outs, health worker absenteeism, school drop-outs and citizens’ rights and responsibilities. Some sub￾grantees published a number of articles and advertorials in the same newspapers. This did not only 
increase citizens’ awareness but also the project’s visibility and the priority advocacy issues. For 
instance, RHU, a sub grantee, was behind the captivating article that hit headlines in the media talking 
about the high rates of HIV infection among commercial sex workers in Kabale and Kisoro. The article 
was published in the New Vision following the media tour organized by RHU in Kabale, targeting MARPs.
The project harnessed the power of the social media and other communication channels to target a 
certain population. To this end, Communication for Development Foundation Uganda (CDFU), a sub 
grantee, developed a social media and other communications strategy. This enabled ccitizens to write 
letters and send SMS to; and call their representatives expressing their concerns on issues that affect 
health and social service delivery. The exercise was key in bridging the gaps between citizens and their 
leaders. 
Conducting forum theatre (interactive drama) performances: The project raised citizens’ awareness of 
rights and responsibilities related to health and social services through 347 functional advocacy forums, 
conducted in different sub-counties. Specifically, Drama (forum theatre) was embraced by some of the 
sub-grantees as an educate-entertainment approach that created awareness on health rights and 
responsibilities and other advocacy issues through modeling desired behaviors using characters in the 
drama. These provided communities an avenue to ask and get response from duty bearers. The 
engagement of children in forums to promote their understanding of rights and responsibilities and use 
them as advocacy agents in their families and communities was not measured and effective not 
ascertained in the evaluation. 
 43
Development and dissemination of tools and guidelines: The project developed and disseminated tools 
and guidelines including the Patient’s Charter, which was translated into different local languages and 
comic books. The project translated, printed and disseminated 88,650 copies of the Patients’ Charter in 
eight local languages, namely; Luganda, Runyakitara, Lukhonzo, Lumasaba, Rufumbira, Kupsabiny, 
Lusoga and Ateso. These materials were the centerpiece for educating citizens about their rights and 
responsibilities and were distributed largely at HFs. However, while children’s forums and child 
parliaments play a critical role in promoting children’s participation and empowering them on issues of 
health rights, these creative approaches were not applied.
Orientation of community groups and advocacy champions: A total of 426 community groups were 
oriented and facilitated to identify advocacy issues and conduct community empowerment activities in 
the 35 districts. This enabled community groups to appreciate and learn how to mainstream advocacy in 
their activities. Up to 270 media champions, leaders of Community Based Organizations (CBOs), and 
Community Awareness Facilitators (CAFs), among others, were also trained to appreciate and 
mainstream advocacy. Media and Advocacy Champions were key in mobilizing the community groups 
and following up issues. However, most community groups still found it hard to mainstream advocacy in 
their routine activities, expressing their inability to perform well with limited funding.
Support to community groups to advance advocacy agendas: The project, through sub-grantees, 
supported 426 community groups to identify advocacy issues and develop action plans. These were used 
to raise issues and seek action by decision makers in the 35 districts. The project exceeded the mid-term 
target of 310 community groups. The project worked with Community Process Facilitators (CPFs) who 
were earlier on trained to support community groups to improve and implement their action plans. The 
training covered several aspects including guidance on how to contact duty bearers and basic evidence 
gathering to inform their next steps. For instance, HEPS supported 17 community-based organizations to 
develop action plans on the advocacy issues that they prioritized as a pertinent to the communities. 
These initiatives kept the mid-term target on course, with 47.0% of community groups whose action plans 
advanced to the implementation phase, closer to the 48.0% midterm target. Local leaders are confident 
that the activities have helped to increase citizens’ engagement with duty bearers, as noted by one 
stakeholder:
I think to me, the biggest success which I am seeing is citizens getting confidence in interfacing 
with duty bearers and telling them exactly what is affecting them and coming out with action of 
this is what we want.
- Executive Director, District-level CSO, July 2017 
Use of the community scorecard for social accountability: The project developed a “user-friendly 
version” of the community scorecard, which was piloted by KADINGO in seven (7) fishing communities in 
Kalangala District. The scorecard was not widely used; it was replaced by the Health Facility Tool that 
was viewed as to be more appropriate for community empowerment process and for collecting 
evidence for use in advocacy. Whereas change of tools can be good in project management, the short 
time taken to abandon the scorecard points to a gap in planning. 
While the project had achievements relating to increased citizens’ awareness of their health rights and 
responsibilities, there was no evidence of implementation of some planned interventions, especially in 
year two (2). These include: bi-annual meetings with media advocacy champions at regional level to 
discuss emerging advocacy issues and required media advocacy techniques, and meetings with editors 
and media champions to re-orient them on priority advocacy issues and ask them to devote more 
 44
coverage to them. Other planned but unimplemented activities include; partnerships with 200 schools 
to engage children in advocacy forums, and organizing forum theatre (interactive drama) performances 
and none was conducted in year three (3). Inability to implement the above interventions may have 
slowed the project’s progress. 
Result Area 2: CSOs effectively advocate for and represent communities on policies / issues of citizens 
concern in the health and social sectors.
Result Area two (2) was designed to empower sub-grantees to capture citizens’ concerns related to health 
and social services, gather related evidence and use it to engage duty-bearers to take action. The actions 
expected from duty-bearers included: policy formulation and implementation, allocation of budgets and 
establishing programs to address citizens’ concerns for policy change, where necessary. The evaluation 
reveals largely high effectiveness of interventions and good progress as reflected below.
Intermediate Result 2.1: Increased utilization of evidence by CSOs to inform advocacy
The project supported the use of data in enhancing advocacy initiatives at both district and national 
levels. Sub-grantees were supported to enrich their advocacy initiatives with field data, which became vital 
in influencing action by decision makers and duty bearers. In order to understand citizens’ priorities, the 
project staff at different levels collected data and analyzed it. For quality data, community assessments 
and action plans were applied. Health Facility Assessments and policy mapping were conducted to 
identify policies, guidance and financial documents governing district and national service delivery 
systems and their shortcomings. Stakeholder mapping was conducted, leading to the development of 
matrices for identifying relevant decision-makers, influencers, interest groups, coalitions or networks, 
and other CSOs at various levels. The matrices included: specific interests; ability to affect the political 
environment and relationships with one another. This facilitated the advocacy process. 
IR2.2: Development and implementation of comprehensive advocacy strategies that address health 
and social service delivery issues identified by communities. 
Under this result area, the 
strategy used involved PATH’s 
ten-part process which involves 
technical assistance through an 
e-learning course, a three-day 
workshop using PATH’s Policy 
Advocacy Strategy Development 
Curriculum, and accompanying 
tools. There was also peer-to￾peer mentoring, modeling 
opportunities, and study visits 
regarding implementation of 
specific aspects of an advocacy 
strategy. Training of trainers was 
carried out for CSO 
representatives, with particular emphasis on networks and umbrella CSOs. This built a cadre of skilled 
facilitators who were resourceful during strategy development workshops and provided technical 
support within their organizations. 
 45
IR2.3: Improved advocacy networking, coordination and collaboration among like-minded CSOs 
The project identified and pursued opportunities to bring CSOs together to promote alignment of 
advocacy strategies, plans and resources. This included use of forums, networks and communities of 
practice. The forums enhanced the collaboration of CSOs with other stakeholders to strengthen District 
NGO Forums to support coordination among NGOs. Within the forums, CSOs emphasized advocacy for 
operationalization of national policies and plans especially at district and national levels. The project 
supported networks or umbrella organizations, bringing members together for advocacy strategy 
development workshops to align or develop joint advocacy strategies. Some sub-grantee CSOs led joint 
advocacy initiatives in their respective districts. However, apart from participation in commemorative 
days, the planned activism days or advocacy weeks were not organized. This limited options for 
advocating for specific aspects where joint action would have been applied. 
IR2.4: Improved enabling environment for CSO advocacy.
In order to provide CSOs with opportunities to access decision-makers and participate in district-level 
planning, the project sought to improve the enabling environment for advocacy. This was through 
meetings with Desk Officers – who present CSOs’ issues to their wider sector teams and then up to the 
DHMT, CAO, Resident District Commissioner, and the Local Council V Chairperson. The project enhanced 
collaboration with professional associations and regulatory bodies such as the National Medical Council 
and the Nursing Council, and Nurses Union. However, even when the project planned to use the 
strategy of engaging national champions including MPs, ministry officials, leaders of professional 
associations, the media, private-sector and faith-based organization leaders, this has yet to be fully 
effected. While the above attempts were initiated, CSOs still faced challenges in conveying the nature of 
advocacy work to district officials: 
Our biggest challenges in improving service delivery are the duty bearers. For instance, we make 
noise about the health facility, then we are looked to be inciting people. District level CSO 
stakeholder interview, July 2017
3.2.3 Result Area 3: Institutional Capacity of CSOs strengthened
Result Area 3 aimed at strengthening the capacity of partner CSOs, focusing on both organizational and 
technical to effectively manage and implement their advocacy interventions. The organizational capacity 
component included Governance, Administration, Financial Management, Human Resources 
Management, Organizational management and Project Performance Management aspects; while the 
technical capacity focused on skills for carrying out effective advocacy. 
The criteria for selecting sub grantees was set up and used to the 20 sub-grantees CSO, conducting of 
Organizational and Advocacy Capacity Assessments (OACA) for each partner, and preparation of 
improvement plans for each CSO. These achievements were instrumental in project implementation. 
The project provided support to CSOs by offering targeted technical support to address specific needs. 
Such support largely addressed key areas including human resources management, supportive 
supervision, strategic planning and governance. Other key trainings focused on advocacy strategy 
development, resource mobilization, fixed amount awards and understanding USG compliance 
requirements. The specific achievements are highlighted below:
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Further, the twenty (20) CSO sub-grantees were facilitated in OACA and supported to develop capacity 
building plans with guided technical support. Nine (9) out of the twenty (20) organizations including 
KACSOA, LADA, FLEP, KADINGO, ARUWE, CIDI, RACOBAO, IDO were supported to develop strategic plans 
(one completed and three are in the process). The ones for JIACOFE, HEPS and MUCOBADI were 
reviewed and guidance provided. This facilitated the review of organizational vision, mission and 
structures. This also helped them to understand their key stakeholders and how to engage them for 
better advocacy and overall organizational growth. Furthermore, nine (9) of the organizations trained in 
support supervision including; STF, MUCOBADI, JIACOFE, MAFOC, NAFOPHANU, KACSOA, HEPS, LADA 
and IDO were also supported to develop supervision plans, checklists, and Standard Operation 
Procedures (SOP)for the different activities. Seven (7) Advocacy Officers from sub-grantee CSOs and 10 
ABH technical team members were trained in Policy Communication.
Table 2: Specific support to CSO sub grantees
No. Activity Number of sub 
grantees
1 Selected 20
2 Supported to develop strategic plans 9
3 Trained in support supervision 9
4 Trained in Policy Communication 7
Given the vital role of Boards of Directors, nine (9) organizations including; KADINGO, KACSOA, MAFOC, 
JIACOFE, LADA, IDO, ACODEV, CIDI and ARUWE, were supported to strengthen their governance 
structure and review the terms of reference for their boards. This enabled the Boards to have better 
appreciation of their roles, advocacy and how they can champion it within their organizations. Five sub￾grantees were supported to strengthen their governance systems through orientation of their board and 
management teams. Organizations have developed and (or) refined their board terms of reference and 
the board performance evaluation process. The training equipped board members to appreciate their 
roles and support organizations to achieve their project targets, a key ingredient in the success of the 
project. 
“Our board was not meeting as frequently as it ought to have been doing it. But now, with their 
help and insight we have a full board which was expanded from 5people to 9 people and it is 
meeting frequently and looking at governance issues”. 
- District level CSO stakeholder interview, July 2017
The same 20 organisations were guided to review and refine their human resources policies to ensure 
better human resource management and compliance with both national and USG requirements. The 
project provided technical support to twenty (20) organizations to review and refine their policy 
documents and guidelines including Human Resources (HR) manuals, Finance and Administrative 
manuals, and procurement procedures. This has streamlined processes for the sub-awardees and 
promoted compliance with both national and USG requirements. Whereas this activity was not planned, 
it was helpful in the implementation of the project and general organization development.
Support was also extended to eight (8) CSOs to finalize their resource mobilization strategies in the first 
two years. Some sub-awardees raised additional funding using skills gained from training. This 
intervention was also not planned for but may have contributed to the CSOs’ success in raising 
additional funding. Three (3) Grants Management Collaborative (GMC) were conducted, providing an 
 47
opportunity for 20 CSOs to share their experiences and approaches and learn from one other. 
Nonetheless, only one (1) of the two (2) GMCs planned in the first two (2) years was conducted. 
Guidance was also provided on developing policies, motivation, retention, performance management 
and supervision. While there was no clarity on the coverage of supportive supervision as a component, 
the training availed partner CSOs with skills and knowledge of better management of their staff. 
The training in resource mobilization was a good one. We came up with a resource mobilization 
strategy and we are seeing changes in terms of resources. We have mobilized resources moving 
from 700m to 1.7billion annually. 
- District level CSO stakeholder interview, July 2017.
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8.0 APPROPRIATENESS OF THE PROJECT STRATEGY
CSOs’ partnerships: CSOs’ partnership with other USAID-funded programs to support their communities 
in advocacy has been weak. CSOs’ engagement with existing health activists, such as the 800+ Popular 
Opinion Leaders trained under the USAID AFFORD health marketing project, was not evident. Important 
to note is that grassroots collectives, particularly women, young people, PWD, and MARPs, have not 
been a key focus in implementation, yet it was planned to address existing gaps. This limited the 
participation of such key groups and missed out on their experience in furthering community 
interventions. The use of one community group to cover the whole sub-county was found to be 
ineffective. Most community groups focused largely on parishes where their offices were located. As a 
result, many people in the target communities were not reached. 
Dedicated activism: Apart from participation in commemorative days, planned dedicated activism days 
and (or) advocacy weeks were not organized. This limited CSOs’ options for joint advocacy action on 
specific matters. Although the project planned to engage national champions including ministerial 
officials, leaders of professional associations, media, the private-sector and religious leaders, a few of 
these had been involved in this role. 
Adaptive initiatives: The project incorporated initiatives for operations research to enable the 
identification and sharing of evidence-based innovative practices and tools to be adapted within and 
across projects. However, this was not applied yet it could have spurred internal improvements and 
enable other organizations to learn from the project’s successes. The project design incorporated 
learning collaboratives focusing on Grants Management Collaboratives. Three (3) sets, held at regional 
level were conducted and provided opportunity for new learning, use of data and strengthening CSO 
and staff practices. These collaboratives are key to promoting continuous learning among partners.
Capacity building: The project design also catered for the application of 18-month Fellowships focused 
on advocacy and organizational development. Fellows were meant to be recruited from within the CSOs. 
The recruitment of Fellows was overly delayed due to legal issues concerning their facilitation. Ten (10) 
Fellows and ten (10) Interns were due to begin at the start of year four (4). Instead of the initial 18-
month fellowship period, it was reduced to 12 months. This reduction in the fellowship period limits the 
magnitude of skills and knowledge that Fellows will acquire. The long delay to start the program denied 
the Fellows opportunity to gain knowledge and skills in advocacy and organizational development. This, 
subsequently, denied opportunity to CSOs to build extra human resources for future project 
interventions. The project did not implement two (2) other key planned activities including; a refresher 
training on advocacy strategy development and training for 20 CSOs on Government planning processes 
and budget tracking and monitoring was also planned but not implemented. 
 49
9.0 LESSONS LEARNED, GOOD PRACTICES AND INNOVATIONS
Use of evidence to inform development of organizational and operational tools and advocacy initiatives 
was helpful. Notable among the good practices are:
1. Use of results of the formative study to inform the development of CSOs’ communication and 
advocacy plans, though its coverage was limited to only three (3) districts; two (2) in central and 
one (1) in western Uganda).
2. Use of evidence to inform the advocacy agenda was helpful in eliciting action of duty-bearers 
and decision-makers. For instance, in Ibanda district, Coalition for Health Promotion and Social 
Development (HEPS) presented evidence to district officials on Health worker absenteeism and 
non-functionality of HUMCS, as well as their effect on Maternal and Child Health. As a result, the 
Chief Administrative Officer (CAO) issued a circular to all civil servants to adhere to the code of 
conduct, including reporting to their duty stations on time (8:00 am) and leaving at 5:00 pm. 
Audio recordings of community dialogue proceedings were used during radio talk shows to 
generate further debate through live call-in from the listeners. This was very helpful in getting 
feedback based on citizens’ concerns.
3. Media analysis and use of related results to inform capacity building initiatives. The findings 
from a media analysis by CEHURD were used to orient 24 journalists in responsible media 
advocacy, which includes mainstreaming human rights in their reports on health issues.
4. Coordinated and streamlined media messages promote inclusiveness. For instance, the radio 
spot messages, radio talk shows and radio serial drama were guided by talking points and scripts 
approved by PATH and USAID. The media champions in Mbale profiled stories that were aired 
on radio and published in print media while some recordings of community dialogues were 
broadcast, generating debate from listeners on issues discussed. For instance, on Elgon Radio 
101.4 FM in Mbale district, the media champion focused on drug stock-outs and health worker 
absenteeism at Jewa HC III and Kigezi HC II in Mbale District. 
5. The use of GMCs including the PDSA process provided an opportunity for CSOs to share and 
learn from each other; identify problems or barriers to achieving their program targets. 
Conducting a root cause analysis and designing change strategies for improving performance 
were key components that promoted continuous learning. Through the change strategies, CSOs 
were able to systematically learn from their own programs and demonstrated approaches that 
are effective to improving their performance.
6. Policy advocacy is a new concept to most CSOs, and thus requires considerable time and effort 
for them to understand and implement it.
7. Engagements with relevant government Ministries, Departments and agencies not only yields 
project buy-in but also ensures the project’s invitation for participation and involvement in 
related working groups.
8. Holding consensus-building meetings with partners is an efficient way of developing common 
positions on strategic issues. This was manifested in the design and strategy consensus-building 
meeting that yielded the finalization of the Project Results Framework,
9. Sustained participation in district planning processes such as DMC and Extended District 
Technical Planning meetings not only enables the project to gain visibility and network, but also 
paves way for CSOs’ advancement of citizen’s health and social services priorities.
10. Online technical assistance needs to be supplemented with technical assistance visits to the sub￾grantees in order to ensure shared understanding on the use of tools and provide on-site 
support for some of the actions; and 
11. Coordinating joint advocacy initiatives especially at the national level requires a lot of 
commitment, astuteness and mobilization
 50
12. The provision of ample time and environment for citizens to raise their concerns and duty 
bearers provide information on any anomalies or opportunities, is critical for successful and 
harmonious relations between citizens and duty bearers. 
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10.0 IMPLEMENTATION GAPS AND CHALLENGES
Community groups focus on a few parishes within their sub counties: While community groups are 
mandated to raise community awareness in all villages within their respective sub counties. One CSO 
described the challenge of covering the entire sub-county with one community group in this way: 
The only issue there is maybe the coverage. Each of the groups I am talking about, it is one group 
in each sub county. And a sub county is such a huge establishment, […] how does it share the 
good and better pieces of their information with other groups, of other communities within the 
sub county? We don’t know.
- Executive Director, July 2017
Further, the frequency of large scale engagement of community members through forums and music 
dance and drama, was limited to about one per year. These have been linked to the limited funds 
though slightly more has been was allocated for this component in the fourth year. About half (49.3%) 
of respondents saw or heard an advocacy message from the project, about the same proportions (50%) 
listen to radio and or watch or listen to television. Reaching them through interpersonal communication 
would therefore, be helpful in raising awareness in communities, but requires expanding coverage to 
truly reach the entire sub-county
Lack of understanding of advocacy by some duty bearers: Some of the duty bearers and leaders still 
have do not understand advocacy or have negative perceptions. They tend to view who ever advocates 
for improved services as an enemy, and want CSO’s to provide the services directly instead. To this 
elucidate this one participant noted: 
Of course, ABH project, as a software project, at the initial stage was a bit of a challenge 
because [CSO] was solely known for hardware. […] But now when we came with ABH, we are 
saying hi, government, it is your role to make sure that these [services are delivered]. People 
were saying, but eh man, yesterday you were supporting us, now you are coming saying eh, do 
your work. So it was a bit of a challenge, it took long for people to understand us.
- Program Officer, District-level CSO, July 2017
Advocacy in some communities faces the same challenge. Citizens reported fear of the likely negative 
outcomes if one dared to expose wrong doing by a public official as stated:
“You see reporting these health workers wouldn’t be a problem but the challenge is that most of 
us fear to be victimized, so no one is willing to say so and so did this, or if the health workers 
come to know that the person who reported them is from Kibale, or any other village, will hate 
the whole village”. 
- FGD Participant, August 2017
Supply side constraints: The demand for services in several communities exceeds the resources 
available at health facilities and within districts. Key informants revealed that health workers operate 
under much pressure from citizens and other stakeholders, and districts do not always have adequate 
resources to provide further health services, even when they are aware of community needs. This may 
partly account for limited changes to district plans and budgets. . One stakeholder stated:
 52
So when you go there, the first meeting they will tell you, yes we have heard these things but we 
don’t have the money. Now, why should you go there in another meeting and you are talking 
about the same thing and they’ve told you they don’t have the money about?
- Executive Director, District-level CSO, July 2017
Evidence collection and use: While mechanisms for linking district and national level CSOs for data 
collection and use were in place including use of social media, there CSOs still expressed a gap in having 
a more formal and well-coordinated mechanism. Network organizations like NAFOPANU were noted to 
have performed well in terms of data collection from districts due to its extensive reach. While mapping 
was conducted involving such groups, they were not trained on their roles and responsibilities relating 
to representing community interests and ensuring community members are aware of decision-makers’ 
actions. The application of the community scorecard for social accountability was only piloted and 
replaced by HFAs. Relatedly, while public hearings where target audiences were meant to be brought 
together to share experiences and discuss potential solutions were largely not applied yet they would 
have been good avenues for discussions. The use of annual surveys of networks, umbrellas, and IPs as 
well as operations research were not conducted yet they would have facilitated generation of additional 
data. 
Efficiency
i. While the FAA mechanism and associated retirement of milestones minimizes on the number of 
documents required to liquidate transaction expenses, the number of documents used as MoVs was 
still big. This contributed to delays in the retirement of milestones and subsequently negated 
implementation. Whereas the ABH project management had supported CSOs to quicken the 
process, especially by submitting milestones early without waiting to accumulate them, the 
retirement process still took relatively long as noted: “The documents from one CSO are usually very 
many; it takes a lot of time reviewing them” (ABH staff, September 2017).
ii. Though sub grantees performed very well in meeting their milestones, they delayed to retire them. 
This led to a very low burn rate as money was held up in milestones, Consequently, the threshold 
burn rate of 75% was not met in time to enable the project management access the remaining 
obligated funds given that this situation was noted towards the end of the contractual period. 
Subsequently, the project under spent on the year’s obligated budget. 
iii. The project was designed to raise citizens’ awareness on their health rights and responsibilities using 
community groups within sub counties among others. The key strategy was that community groups 
would integrate awareness raising into their none ABH supported activities. However, most 
community groups focused on very few parishes, largely due to limited funding. For instance, in 
Bushenyi District, Kyeizoba Sub county HIV Network effectively worked in two (2) out of eight (8) 
parishes while Mastered Seed effectively worked in one (1) out of the six (6) parishes of Bitooma 
Sub county. This big gap limited the timely flow of information to citizens. 
One CSO describes it succinctly: 
Now if the champion comes from here, and the group is here, then that means there is also no 
regular mandate to support this champion to move from this parish of his and go and support, 
and support the group. So that means you realize that now, with the advocacy, it is almost 
concentrated where the group is, and where the champion is located.
- Program Officer, District-level CSO, July 2017
 53
iv. The project was hit by reduction of the year two (2) budget from the initial submission of 
approximately US dollars 4.4 million to approximately US dollars 3.5 million. This affected the 
accomplishment of major project activities. While the project management endeavored to address 
this challenge by re-prioritizing and rescheduling activities in the work-plan, several CSOs halted 
their work. This left a big back log that partly contributed to overall low performance especially at 
community level. 
v. While the use of project staff to build capacity of CSOs saved costs, it was associated with delays in 
delivery especially for tailored trainings. Each CSO have some unique needs that necessitated a 
separate training. Given the big number of CSOs with such needs, the project staff were unable to 
attend to most of them on time as noted:
“There are times when staffs are busy doing other project work and unable to provide training to 
some specific partner needs. Sometimes this delays our capacity building support” (ABH staff 
interview, September 2017). 
. 
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11.0 CONCLUSIONS AND RECOMMENDATIONS
11.1 Conclusions
Project progress: Overall, the ABH project met or surpassed targets for 10 out of 15 (66.7%) indicators. 
This fairly good project performance was mainly attributed to objectives two (2) and three (3) of 
promoting CSOs to effectively advocate for issues of concern to citizens in health and social sectors, and 
building their institutional and technical capacity. The prospect of attaining end-term targets remains 
high. Performance on most (75%) of the indicators under result one (1) geared towards enabling citizens 
to demand improved quality of services met targets.
Improvements were noted regarding service delivery at public health facilities. The midterm target of 
public health facilities recording improvements in service delivery was exceeded by 24%. This was largely 
attributed to health workers’ improved adherence to working time, leading to reduction in any health facility 
closures from 47% to 3%. 
Effectiveness: Attainment of targets was partly a result of support and follow up on the sub grantees. 
On the other hand, poor performance on other indicators was largely due to; poor mobilization of 
citizens since the community groups focused on a few parishes. More attention should be paid to 
reaching manageable communities, redesigning communication messages and approaches, and 
increasing community groups’ consistency in meeting and following up with duty bearers on issues 
raised. 
Interventions for facilitating CSOs to effectively advocate for and represent communities on policies / 
issues of citizens concern in the health and social sectors were effective with overall performance of 
60%. CSOs’ advocacy agenda included engagement of government authorities in various ways leading to 
some actions on health and social service issues and policy gaps and focus was put on supporting and 
encouraging CSOs to collect especially through health facility assessments and its use in advocacy 
initiatives. CSOs’ attendance of government planning meetings at national and district levels was high, 
which was a major avenue for conveying citizens’ concerns. However, some of the CSOs focused on 
achieving milestones to enable them recover funds used and missed out on other actions including joint 
advocacy. While there was good representation of citizen’s concerns by CSOs at government meetings,
most government authorities were still less supportive of advocacy to service delivery initiatives; leading 
to low incorporation of citizen’s concerns in district plans. Nonetheless, other local governments had 
limited resource to cater for the citizens’ issues raised. 
Efficiency: Most of the project’s strategies were executed to a good degree, leading to efficiency. The 
Fixed Amount Award (FAA) provided flexibility regarding meeting of milestones, use of sub grantee and 
PATH resources and good framework for capacity building focusing on the whole institution facilitated 
efficiency. Through implementing the capacity building framework including OACAs, action planning, 
structured and tailored training, as well as review of the action plans, the project has improved the 
quality of service delivery by CSOs. Whereas training by project staff saved costs, it delayed some 
tailored trainings due to small number of ABH project staff and big number of CSOs. While the FAA 
mechanism reduces costs, the number of documents for MoVs was relatively big and delayed the 
retirement process. One of the key strategies of reaching citizens was through the integration of 
awareness raising interventions into community groups’ routine work. However, most community 
groups worked in only few parishes denying and did not reach several citizens.
 55
Relevance of the project: The project was aligned to; USAID Uganda’s CDCS 2016-2021. For instance, it
promotes health systems strengthening and seeks to promote biodiversity and natural resource 
management, climate change adaptation and inclusive and accountable democratic governance. It is 
also aligned with national and international policies and frameworks including those on; FP, SRH, MCH; 
malaria, nutrition, TB, HIV/AIDS and OVCs. Interventions under each of these components were 
designed with due regard to the relevant policies. 
Thematic areas: District-based sub-grantees were assigned to focus on a primary and secondary 
thematic area while national sub-grantees focused on only one thematic area. There was more 
concentration on HIV/AIDS/TB (53.3% at district level, 42.9% at national level and 48.1% combined) and 
less on family planning (6.7% at district level, none at national level and 3.3% combined). Considering 
the secondary focus areas, HIV/AIDS/TB was still covered, by almost half (46.7%) of the district CSOs and 
the least covered was nutrition at 13.3%. Nutrition issues were not assigned to any CSO at district level. 
Support to OVCs was integrated into other focus areas since it was no longer receiving specific funding. 
11.2 Recommendation
ix. Community groups were supposed to integrate awareness raising on citizens’ awareness on 
their health rights and responsibilities, into their other activities in respective sub counties. 
However, most community groups have focused on one or two parishes largely due to limited 
funding. This largely accounts for the low performance on understanding of health rights and 
responsibilities. Whereas some additional resources have been allocated in year four (4) for this 
component, the gap is still big. The ABH senior management should work with CSOs to refocus 
this community component to cover a small number of parishes with a sub county. This should 
be guided by the available funds. Nevertheless, the media campaign will continue reaching all 
parishes. 
x. Given the limited funding, the CSOs should collaborate with religious institutions and use their 
gatherings and structures to pass over the messages. The messages can be delivered at a 
convenient time, for instance during or at the end of the service or mass. 
xi. The media messages are not clearly understood by citizens at community level. Even when some 
people here some radio messages, it takes long for them to associate with it. The ABH project 
team should lead a process of redesigning the media messages to make them more appealing to 
citizens at community level.
xii. CSOs should incorporate VHTs as resource persons to help raise aware in communities. The VHT 
structure was wide spread and VHTs commended good respect, in their communities and good 
at communicating on health issues. However, since they work closely with health facility staff, 
their role should largely focus on raising awareness. 
xiii. Most government officials had not fully appreciated the value of advocacy. CSOs’ presentation 
of citizens’ concerns in government planning meetings improved but very few districts 
incorporated such issues in their plans. The ABH project senior management should offer more 
support to CSOs in engaging the senior leadership of districts, with a view of getting support for 
citizens’ concerns. The senior management of ABH project should also take lead in collaborating 
with the senior management of the Uganda Local Governments Association to support on this. 
xiv. The visibility of the project is not good among some stakeholders even when it is supporting a 
lot of work. The ABH senior management should work with sub grantees and agree on a 
mechanism that will strengthen branding of the project. Partners need to acknowledge the 
support from the project at every supported event. The ABH communications team should not 
take long to post achievements on the social media platforms. 
 56
xv. The ABH senior management should work with sub grantees to strengthen or establish more 
accountability platforms that will enable tracking of performance commitments. Linkage with 
very high ranking decision makers such as Permanent Secretaries will be more critical for the 
success of these accountability mechanisms. 
xvi. To strengthen coordination for data evidence collection and use among district and national 
level CSOs, the project management should strengthen on current modalities especially 
ensuring linkage of other CSO staff apart from Executive Directors. One of the options is to 
establish an online portal for use by the project stakeholders especially sub grantees.
 57
ANNEX 1: DETAILED EVALUATION METHODOLOGY
1.0 Methodology
This section presents study design, process of the review, methods of data collection used, sampling and 
sample size estimation, data analysis, validity and reliability of findings, challenges and limitations faced.
1.1 Study design, participants and sampling procedure
A cross-sectional mixed methods design involving quantitative and qualitative methods of data 
collection was applied. This was generating both statistical and explanatory information relevant for 
improving the project in the next phase. Primary data collection was divided into seven (7) components 
including the; Household Survey; Health Facility Assessment (HFA); Organizational and Advocacy 
Capacity Assessment (OACA); Policy Tracking; and Data validation as well as Key Informant Interviews 
(KIIs) and Focus Group Discussions (FGDs). Several documents were reviewed as part of the MTE. 
A total of 1,237 citizens including 47.2% males and 52.8% females participated in the survey. This was 
selected using the formula proposed by Cochran, W. G. 196310 represents 96.2% of the target sample, 
which is good enough for generalization of the study population. This sample consisted of males aged 15 
– 54; females aged 15 – 49; youth aged 15 – 24; and OVCs aged 10 – 14; selected using probability 
proportional to sample from the ten (10) districts that were covered by the baseline survey. Thirty-three
(33) Key Informants (KIs) were involved including USAID Implementing partners; sub grantee staff; ABH 
project staff; Health Facility (HF) In-charges; and District Health staff. Ninety-eight (98) FGD participants 
were involved including men, women and mixed gender youth. 
 
10Cochran, W. G. 1963. Sampling Techniques, 2nd Ed., New York: John Wiley and Sons, Inc.
 58
Table 1: List of KIs and FGD Participants
Type of Respondent Number of interviews
National-level CSO’s 2
National-level duty bearers 1
District-level CSO’s 7
District-level duty bearers 9
Implementing partners 3
Health facility staff 7
Chief of Party 1
Other ABH staff 3
Total 33
Participant Group Number of Respondents
Men 32
Women 31
Youth 35
Total 98
1.2 Sampling methods and procedure
Table 2: List of KIs and FGD Participants
Selection level / 
criteria
Sampling 
Method
Sampling procedure
Districts Purposive In order to enhance comparability with baseline data, all the ten districts 
covered during the baseline survey will be purposively selected for this 
midterm evaluation.
Sub counties Simple 
random 
sampling
Selected from a list obtained from UBOS. A total of 22 sub counties have 
been selected.
Parishes Simple 
random 
sampling
Selected from a list obtained from UBOS. Two target parishes for each 
sub county have been selected except one where only one was due to a 
small number of respondents required.
Villages Simple 
random 
sampling
Lists of villages in each target parish will be obtained from local 
leaders. Two target villages will then be selected by simple random 
method.
Households Simple 
random 
sampling
• A list of households in each village will be obtained from local 
leaders and used in the selection process. In cases where the lists 
are not available, the Field Supervisor will work with the team 
and local leaders to make it. 
• To obtain the sampling interval k , the total number of 
households will be divided by the 15 (total of households 
required per village). 
• From the first interval we selected a random start g using 
 59
1.3 Sample size determination
The sample size has been determined using formula for proportions proposed by Cochran (1963) stated 
below: 2
2
0 d
pqz n =
Where:
z = the z-statistic is the value at α% level of significance in a two-tailed probability 
distribution;
p = probability of selection following binomial distribution (percentage of the men and 
women who have listened to a radio at least once a week);
q = probability of non-selection following binomial distribution; and
d = permissible error during study
Given that the response rate at baseline was 100%, the above sample size has been adjusted upwards 
by only 5% to cater for likely non responses. When the above are substituted in the formula, considering 
a confidence level of 95% and plus or minus 2.8% margin of sampling error, the final sample size of 
1,286 has been obtained as shown below:
Z z² p q D d² z²pq z²pq/d²
Target sample
(z²pq/d²)*1.05
1.96 3.8416 0.5 0.5 0.028 0.000784 0.9604 1,225 1,286
1.4 Operational Definitions of age groups (categories of respondents)
simple random sampling. Simple random sampling will be used 
to select the random start from the first to the fifth one, using 
papers with index numbers of each.
• From the random start g , the sampling interval k will be added 
to the random start to get the second household. This pattern 
will continue until they get all respondents. 
• In case the chosen household does not have a qualifying 
respondent, it will be replaced with the next one on the list. 
Respondents Simple 
random 
sampling
• In the situation where two or more eligible respondents are in 
one household, one person will randomly be selected after 
tossing folded pieces of paper with index numbers for each 
eligible person. 
• Only one respondent will be selected from each house. No 
respondents in the same category will be selected from 
consecutive households 
• The respondents per village will include:
 Three (3) OVCs of mixed gender
 Four Youth - 2 girls and 2 boys
 Three (3) males aged 15 – 54
 Four (4) females aged 15 – 49
 60
The operational definitions of respondents’ categories used at baseline will be applied and are listed 
below:
1. Men (15-54): Any male person aged 15 to 54 years and has a living in partner
2. Women (15-49): Any female person aged 15 and above and has a living in partner.
3. Youth (15-24) who do not have a living in partner; and
4. OVC (10-14 years): A child in this age group who are in a state of being or likely to be in a risky 
situation, where he / she is likely to suffer significant physical, emotional or mental harm that may 
result in his / her human rights not being fulfilled
1. Orphans 
2. Children infected and affected by HIV&AIDS
3. Children with disabilities 
4. Children in worst forms of child labour
5. Children from child headed households
6. Children experiencing various forms of abuse and violence e.g. survivors of sexual violence; 
7. Abandoned children/neglected children
8. Children in contact with the law
9. Out of school children
10. Children living in chronicle poverty(in poverty stricken /impoverished) households
11. Children living with the elderly persons 
 61
1.5 Sample size per district
Probability proportional to population size11 has been applied to determine the target sample per district. Details are presented in Table 1.3. 
Table 1.3: Sample distribution District No. of sub counties % contribution Male
Female
Total
Population 10 - 54 years 
(60.75% NPHC 2014)
% contribution
Sample size
After 5% over sampling
No of Researchers 
Assistants (RAs)
No. of tools per RA
No of days
No of sub counties in study
No. of parishes
Average no. of respondents 
per parish
No. of villages
Average no. of respondents 
per village
Busia 10 0.10 157,415 166,247 323,662 196,625 0.10 119 125 4 6 5 2 4 30 8 15
Bukwo 4 0.04 45,258 44,098 89,356 54,284 0.03 33 34 2 5 3 1 1 30 2 15
Kumi 7 0.07 117,007 122,261 239,268 145,355 0.07 88 92 3 6 5 2 3 30 6 15
Kaliro 5 0.05 116,787 119,412 236,199 143,491 0.07 87 91 3 6 5 2 3 30 6 15
Bushenyi 7 0.07 116,410 118,030 234,440 142,422 0.07 86 90 3 6 5 2 3 30 6 15
Isingiro 10 0.10 236,619 249,741 486,360 295,464 0.15 178 187 6 6 5 3 6 30 12 15
Kasese 29 0.28 339,455 355,537 694,992 422,208 0.21 255 267 9 6 5 4 9 30 18 15
Kabale 19 0.18 254,414 273,817 528,231 320,900 0.16 194 203 7 6 5 3 7 30 14 15
Luwero 13 0.13 230,451 226,507 456,958 277,602 0.14 167 176 6 6 5 3 6 30 12 15
Kalangala 7 0.07 31,047 23,246 54,293 32,983 0.02 20 21 2 5 2 1 1 30 1 15
Totals 104 3,343,759 2,031,334 1.00 1225 1286 45 22 86
 
11Uganda Bureau of Statistics 2016, The National Population and Housing Census 2014 – Main Report, Kampala,Uganda
 62
Note: 
I. Sample size distribution across districts is based on their proportional population sizes.
II. Given that in most surveys that involve enumeration area (EA) / cluster selection, which are 
villages in this case, the EA sizes tend to range from 5 to 20, to minimize the design effect, the 
EA selected is 15. Fifteen is normally a manageable number and lies nearly just above the mid￾way and the highest EA sizes, hence the statistical rational of the researcher’s choice. A 
maximum of 15 respondents will therefore, be considered per village.
III. A total of 86 EAs (villages) will be covered. This includes a maximum of two villages per parish.
IV. A maximum of two parishes will be considered per sub county.
V. The exact numbers of respondents per category will be determined after getting a common 
understanding with the team members about the definitions. 
1.6 Sampling methods and procedure
Given the variations of target districts in terrain, geographical location, proximity, size and language spoken 
by the inhabitants, a multi stage sampling technique will be used as showed below.
Table 1.4 Sampling methods and procedure
Selection level / 
criteria
Sampling 
Method
Sampling procedure / reason
Districts Purposive In order to enhance comparability with baseline data, all the ten 
districts covered during the baseline survey will be purposively 
selected for this midterm evaluation.
Sub counties Simple 
random 
sampling
Using the list of obtained from UBOS, target sub counties in each of 
the ten districts have been selected by applying simple random 
sampling. Sub counties have been proportionately randomly selected 
for the study using random tables. A total of 22 sub counties have 
been selected.
Parishes Simple 
random 
sampling
Applying lists of parishes for each district, the two target parishes for 
each sub county have been selected using simple random sampling. A 
total of 43 parishes have been selected.
Villages Systematic 
and Simple 
random 
sampling
Within a parish, systematic sampling will be used to select the first 
village in which the health centre II or III is located. In case the 
parish does not have a health centre II or III, the biggest communal 
facility like a church, school or market will be considered. The 
second village will be selected using simple random sampling by 
rotating a pen. In this case, the village in the direction of the pen’s 
head will be selected so long as it is located within the same parish. 
A total of 86 villages will be covered.
Households Simple 
random 
sampling
While in each EA, the Research Assistants will first locate its centre 
such as a church, health centre or market and then rotate a pen to 
get a random direction. In the direction of the pen’s head, the 
Research Assistants will skip the first household and visit the 
second one with a respondent. This pattern will continue until they 
get all respondents. In case the chosen household does not have a 
qualifying respondent, it will be replaced with the one immediately 
neighboring it in the same direction. If two households are at the 
 63
same distance in the desired direction, simple random sampling 
will be applied to select one of them after tossing folded pieces of 
paper with index numbers for each household. 
Respondents Simple 
random 
sampling
In the situation where two or more eligible respondents are in one 
household, one person is randomly selected after tossing folded 
pieces of paper with index numbers for each eligible person. In 
order to get all categories of target respondents, a female aged 15 
– 49 years is selected from the first household; males aged 15 – 54 
years from the second household; youth aged 15 – 24 years from 
the third household and an OVC from the fourth household. A 
respondent who discontinues with the interview is replaced by 
another one from within the same or neighbouring household 
depending on availability. Persons in the same household will be 
prioritized for replacement. 
Focus Group 
Discussion 
Participants
Purposive 
sampling
Groups of females; males and youth of both gender, of the same 
age group were selected purposively from one communitiesin the 
sampled sub counties, with help of the guides. Each FGD 
constituted of between six (6) and twelve (12) participants. 
Mobilisation of the groups was carried out beginning on the first 
day of data collection and appropriate time agreed on with the 
CSO.
 1 
1.7 Selected study areas and related personnel allocation
Table 1.5 Selected study areas and required 
Region District Sub county Work load No. of 'RAs & Supervisors
No. 
of 
day
s
Parish
Questionnaire
s (Qnnaires)
FGD
s
For 
Qnnaires
For 
FGDs
Supervisor
s
Central
Kalangal
a
Kalangala Town 
Council Kalangala B 21 2 2
Luwero Bamunanika Kyampisi 176 3 4 2 1 7
Sekamuli
Zirobwe Bukimu
Nakigoza
Katikamu Kyalugondo
Migadde
Wester
n Bushenyi Bitooma Nyanga 90 3 4 2 1 4
Kyeizooba Kitagata
Rutooma
Kabale Kamuganguzi Buranga 203 6 1 7
Kicumbi
Mayengo
Katuna Town Council Kiniogo
Mukarangye
Kyanamira Kanjobe
Nyabushabi
Kasese Karambi Kamasasa 267 6 1 7
Kisolholho
Munkunyu Kitsutsu
Nyakatonzi
Bugoye Bugoye
Ibanda
Katooke
Nyamwamba
Nyakasanga 
II
Rukoki
Isingiro Kakamba Kashumba 187 6 1 5
Murema
Ngarama Kagaaga
Ngarama
 2 
Birere Kasaana
Kyera
Eastern Busia Busitema Chawo 125 3 6 1 4
Syanyonja
Lumino Hasyule
Lumino
Kumi Atutur Akalaba 92 5 1 3
Kapokin
Nyero Ariet
Bukwo Bukwo Town Council Kapkorosoi 34 2 3
Torasis
Kaliro Bukamba Nangala 91 4 2 1 4
Bumanya Kasuleta
Kyani
Total 1,286 45 6 8
. 
 3 
ANNEX 2: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – HIV/AIDS
Policy targeted Key Ask or policy area / 
issue addressed 
Progress made/ achieved Key Sub grantee 
involved
The HIV/AIDS Control 
Act 2014. The Act has 
provisions that may 
increase the stigma and 
discrimination around 
HIV and discourage 
more people from being 
tested and treated. 
Government to develop 
and pass a separate HIV 
Anti-Stigma and 
Discriminatory Policy
Various meetings held at UAC, 
concept note developed. 
UNAIDS willing to fund 
consultant to write policy. 
ABH also met the Ag. DG who 
pledges to involve the team in 
planning meetings 
NAFOPHANU
The New Consolidated 
Guidelines for HIV 
Prevention and 
Treatment 2016
https://ug.usembassy.g
ov/u-s-government￾supports-ministry￾health-launching-test￾treat-guidelines￾uganda/
Government to fully 
implement the provisions 
of the test and start 
requiring ART initiation to 
all persons testing positive 
for HIV at any CD4 cell 
count 
Guidelines launched in 
December 2016. Project now 
working on socialization of 
the policy and provisions 
especially among PLHIV and 
Key and priority populations 
to demand but also educate 
others of this development 
has taken place
NAFOPHANU, 
MAFOC, STF, IDO, 
KADINGO, RHU 
(KATUNA MARPS), 
ACODEV, JIACOFE, 
ICWEA, UNASO 
National Medicines 
Policy 2015
National Medicines 
Policy 2015 whose
overall goal is to ensure 
the availability, 
accessibility, affordability 
and appropriate use of 
essential medicines of 
appropriate quality, 
safety and efficacy at all 
times
Government to ensure 
adequate supply of 
HIV/AIDS drugs and 
related supplies 
-Stock out campaign held in 
2015 that resulted in GFATM 
frontloading funds.
-Regular stock status updates 
being shared by NAFOPHANU
-Monthly HFAs generating 
advocacy evidence.
- Quarterly meetings with 
NMS 
NAFOPHANU, 
UNASO, MAFOC, 
STF, IDO, KADINGO, 
RHU (KATUNA 
MARPS), ICWEA, 
ACODEV, JIACOFE 
 4 
National budget for the 
FY 2017/18
UAC (2015) National HIV 
and AIDS Strategic Plan 
2015/2016- 2019/2020 
Government should 
increase funding for HIV to 
150bn from the current 
95bn especially in view of 
the T/S
- Gov’t to implement 
innovative ways like the 
NATF and HIS that would 
increase Domestic funding 
-Meetings held with the 
Parliamentary HIV/AIDS 
committee of and the Health 
Committee respectively.
-Joint press conference held 
and position paper on BFP 
FY17/18 shared with policy 
makers. Budget retained at 
1.8 Trillion UGX
-Part of NATF advocacy (HE 
President’s Fast Track 
Initiative on Ending AIDS by 
2030-key)
NAFOPHANU, 
UDN, UNASO, 
MAFOC, STF, IDO, 
KADINGO, RHU 
(KATUNA MARPS), 
ICWEA, ACODEV, 
JIACOFE 
Comprehensive HIV/AIDS 
services in sub counties 
with HCIIs
-Districts to establish 
outreach services, and 
upgrade facilities to HC III
-Reducing stock out of 
HIV/TB commodities 
• District level engagement 
held with leaders in Busia.
• Directive came from MoH 
asking the CAO to provide 
information on sub 
counties that require 
upgrade to HCIII
• Recruitment of critical 
cadres (from 52%-57%) in 
Busia 
• 4 HFs in Mbale received 
drugs for the 1st time in 
2017 (Jeewa, Bukasakya, 
Bumasikye, Bukiende)
MAFOC, 
NAFOPHANU, 
UNASO, MAFOC, 
STF, IDO, 
KADINGO, RHU 
(KATUNA MARPS), 
ICWEA, ACODEV, 
JIACOFE 
Comprehensive HIV/AIDS 
services in sub counties 
with HCIIs
Districts to establish 
outreach services, and 
upgrade facilities to HC III
Wrote to MoH to upgrade 
health facilities within the 
fishing communities
-Positive feedback from MoH
MAFOC, STF, IDO, 
KADINGO, RHU 
(KATUNA MARPS), 
ICWEA, ACODEV, 
JIACOFE 
 5 
ANNEX 3: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – TB
Policy targeted Key Ask or policy area / 
issue addressed 
Progress made/ achieved Key Sub grantee 
involved
Domestic Financing Increase domestic 
funding for TB activities 
in the country from 
current 4% funding to 
25% to less donor 
dependency 
-Supported the launch 
of the Parliament TB 
Caucus in anticipation of 
any legislation on TB to 
raise profile of the 
issues.
NAFOPHANU, UNASO, 
MAFOC, STF, IDO, 
KADINGO, RHU 
(KATUNA MARPS), 
ICWEA, ACODEV, 
JIACOFE 
TB Desk Guide Develop TB Desk Guide 
for the prevention and 
control of TB in health 
facilities 
- Draft developed. 
Planned retreat to 
finalize guide from 27-29 
June 2017 
NAFOPHANU 
ANNEX 4: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – MALARIA
Policy targeted Key Ask or policy 
area / issue 
addressed 
Progress made/ achieved Key Sub grantee 
involved
Test, Treat and Track 
policy 2012 
Tax exemption of 
RDTs 
• Evidence shows this as not an 
issue & done illegally
• URA invoking the East African 
Customs Union law to tax
MRDTs
• High level national level 
dialogue held 
HEPs 
Uganda Malaria 
Strategic plan 2015-
2020 
DHO to prioritize and 
allocate a budget to 
revitalize VHT 
structure to ensure 
increased 
community 
education on 
malaria prevention 
and management 
programs by 
September, 2018 
• Kamuli- DHO allocated budget 
for VHT facilitation 
• Budget for training, and IEC 
material to ease VHT- put under 
unfunded priorities in the 
2016/2017 district budget 
• Mayuge : 2 HCIII (Buwaiswa and 
Malong) and 1 HCIV (Kityerera) 
allocated part of PHC funds to 
VHT in the quarterly workplans
JIACOFE 
Malaria Test , Treat, 
and Track policy 2012 
The mandate for 
testing quality and 
approval of MRDT in 
the country to be put 
under NDA 
- Included in the in 
revised Malaria 
Control Strategy 
HEPs 
 6 
ANNEX 5: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – MATERNAL, 
NEWBORN AND CHILD HEALTH (RMNCAH)
Policy targeted Key Ask or policy area / issue 
addressed 
Progress made/ achieved Key Sub grantee 
involved
Roadmap for 
Accelerating the 
Reduction of Maternal 
and Neonatal 
Mortality and 
Morbidity in Uganda, 
2007–2015
Ensuring availability and 
accessibility of maternal and child 
UN lifesaving commodities 
(oxytocin, magnesium sulfate, 
misoprostol, implants, female 
condoms, chlorhexidine, ORS, zinc 
and Amoxicillin)
Presented status 
evidence to MCH cluster, 
who presented it to 
Commissioner RH. This is 
being pursued.
CEHURD, WRA-U
Roadmap. Strategy 3: 
strengthening human 
resources for health 
for maternal and 
newborn. 
Government to recruit 3000 
midwives 
-Prioritized in FY 17/18 
budget advocacy 
-Ministry of Health 
presented this at the 
inter-ministerial meeting 
held at MoFPED.
-Included in the GFF
-HR campaign planned 
CEHURD, WRA-U
ANNEX 6: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – FAMILY 
PLANNING
Policy targeted Key Ask or policy area / 
issue addressed 
Progress made/ 
achieved 
Key Sub grantee 
involved
Family Planning 2020 
Presidential commitments
(2012)
Reproductive Health 
Commodity Security Strategic 
Plan, 2009/10–2013/14
(To increase public 
sector/government budget 
allocation and expenditure on 
RH commodities, including 
contraceptives, to 80 percent by 
2015). 
Honoring Presidential 
commitment to allocate 
$5m for FP 
commodities every year 
for five years.
-Engaged Ministry of 
Health and 
Parliamentary 
Committee on Health to 
ensure that 2017/18 
national budget include 
the pledged funds 
-(Appropriation analysis 
of FY 17/18 budget yet 
to be done)
Reproductive Health 
Uganda
Districts prioritizing FP. Integrating FP in the 
district plan and budget.
District Costed 
Implementation Plan for 
FP developed for 
Mityana
RACOBAO
 7 
Adolescent Health Policy 
2004 
The national policy 
guidelines and service 
standards for SRHR, 
2011(guides the 
implementation of 
Adolescent health policy 
and emphasizes Youth 
Friendly Services) 
MOH to implement 
Adolescent Health 
Policy 
-Engaged MoH and commitment to scale 
up implementation was obtained.
- Participation in the current review of the 
Policy being conducted by MoH
-Some districts started implementation by 
establishing youth corners to provide 
Youth Friendly Services. For instance 
inBugiri, Namutumba and Busia
RHU, STF
School Health policy 2014 Government to 
finalize the school 
health policy 
Policy was developed.
Cabinet approval deferred due to the 
review of the sexuality education 
framework 
RHU 
Immunization ACT 2016
(Established an 
immunization fund) 
Finalize the 
immunization 
guidelines to 
operationalize 
immunization fund 
-Draft guidelines developed.
-Presentation to MoH Top Management , 
and engagements with MPs planned 
CEHURD
ANNEX 7: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – Nutrition
Policy targeted Key Ask or policy area / 
issue addressed 
Progress made/ achieved Key Sub grantee 
involved
The Uganda Food and 
Nutrition Policy 2003 
Domestic financing for 
nutrition at national and 
district levels, given the 
absence of a specific 
budget vote to finance 
nutrition activities on an 
annual basis in Uganda 
- Draft policy under review
- Established a Uganda 
National Nutrition 
Advocacy platform 
PATH leading 
Uganda Nutrition 
Action Plan (UNAP) 
2011-2016 
-Held two high level policy 
dialogue on nutrition with 
MP and other stakeholders
-Supported the 
establishment, orientation & 
recent launch of PFN as a 
platform to speed up any 
legislation 
PATH leading 
 8 
OBT Adopt performance monitoring 
indicators for nutrition track and 
monitor performance 
• Presented this to the Nutrition 
Secretariat in OPM.
• Further engagements to be held 
with them 
PATH leading 
DNAP -District Local Governments to 
empower district nutrition 
coordination committees to 
execute their mandate
-District Nutrition Coordination 
Committees to implement the 
district nutrition action plans in 
the districts
• Held regional experience sharing 
meetings with district leadership in 
Western Uganda.
• Commitments made and will be 
followed
• Experience sharing for East Central 
planned end July 
PATH leading 
ANNEX 8: THEMATIC POLICY ADVOCACY PROGRESS AND OUTCOMES – OVC & Other 
Cross Cutting Issues
Policy targeted Key Ask or policy area / 
issue addressed 
Progress made/ achieved Key Sub grantee 
involved
UPE POLICY Drop-out rate, 
absenteeism and poor 
performance in UPE 
JIACOFE- The ordinance to 
end child labor passed by 
District Council.
ACODEV 
MAFOC 
KACSOA 
LADA 
JIACOFE 
RACOBAO 
Anti- Female Genital 
Mutilation (FGM) Act 
2010 
Limited compliance with 
Anti- Female Genital 
Mutilation (FGM) Act 2010 
• Community mobilization 
to engage in OVC related 
dialogue.
• Issue was challenging and 
dropped 
KACSOA 
HRH (availability, 
motivation, and 
retention) 
-GoU should recruit more 
critical cadre in the health 
sector 
-Busia recruited 3 additional 
midwives 
STF
-Regular attendance to 
duty by HWs 
-Busia district is tracking 
attendance to duty on a 
monthly basis, and discussed 
at EDHMT 
STF
National Budget FY 
2017/18 
Government to increase 
health sector budget to 
10%. 
Dialogue was held with MoH, 
MoFPED and Parliament.
Budget now retained at 
1.8trillion UGX 
UDN 
Source: Adapted with adjustments from the Policy Tracking Tool