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Midterm Evaluation for CONNECT Girls Center Activity
Final Report
Submitted to
Submitted by
Contact:James Kakande +256772602680, +256776822116, +256700629083
Email: james.kakande@solandacl.com
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Table of Content
List of Tables.............................................................................................................................................................3
List of Figures ...........................................................................................................................................................3
Acronyms..................................................................................................................................................................4
Executive Summary .................................................................................................................................................5
1.0 INTRODUCTION..................................................................................................................................................9
1.1 Background......................................................................................................................................................9
1.4 Evaluation questions. ...................................................................................................................................10
2.0 APPROACH AND METHODOLOGY ..................................................................................................................12
2.1 Overall Approach ..........................................................................................................................................12
2.2 Selection of Sample Districts .......................................................................................................................12
2.3 Data Sources and Methods of Data Collection...........................................................................................13
2.3.1 Document review............................................................................................................................13
2.3.2 Key Informant interviews (KIIs)..................................................................................................14
2.3.3Focus group discussions ................................................................................................................14
2.3.4 Knowledge, Perception and Coverage (KPC) Survey...........................................................15
2.4 Data collection tools ....................................................................................................................................15
2.5 Data processing............................................................................................................................................16
2.5.1 Quantitative data.............................................................................................................................16
2.5.2 Qualitative data ...............................................................................................................................16
2.5 Limitation of the study.................................................................................................................................16
3.0 Findings:............................................................................................................................................................17
3.1 Status of indicators as per the evaluation questions..................................................................................17
3.2 What factors have constrained implementation? How are constraints being addressed?......................38
3.3 Unanticipated effects, both positive and negative?...................................................................................39
3.4 What adjustments, if any, should HealthPartners make to improve the likelihood of achieving indicator 
targets by the activity’s end?.............................................................................................................................40
3.5 Lessons learnt...............................................................................................................................................41
Annex 1:KPC Respondent Characteristics.............................................................................................................43
A1.1 Demographic characteristics......................................................................................................................43
A1.2 Water Sanitation and Hygiene...................................................................................................................45
A1.3Use of Mosquito nets..................................................................................................................................47
Annex 2: Tools-FGD & KII Guides.......................................................................................................................48
7.2 KPC Tool........................................................................................................................................................58
Annex 3 Health Facility Assessment Tool .........................................................................................................71
Annex 4: List of participants..............................................................................................................................75
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List of Tables
TABLE: 2. NUMBER OF FGDS CONDUCTED ......................................................................................................................................14
TABLE 3: KPC INTERVIEWS............................................................................................................................................................15
TABLE 4: LEVEL OF SATISFACTION WITH THE QUALITY OF SERVICES OFFERED BY COOPERATIVE HEALTH INSURANCE SCHEMES..................20
TABLE 6: HEALTHPARTNERS’ STAKEHOLDER COLLABORATION MATRIX..............................................................................................24
TABLE 7. HEALTH COOPERATIVE ORIENTED ON COOPERATIVE HEALTH INSURANCE MODEL ...................................................................25
TABLE 7. REALIZED BENEFITS OF COOPERATIVE HEALTH INSURANCE BY MEMBERS................................................................................26
TABLE 8: OTHER BENEFITS BY MEMBERS.........................................................................................................................................26
TABLE 9. PERCEIVED BENEFITS OF BEING A HEALTH INSURANCE COOPERATIVE MEMBER BY NON-MEMBERS. ............................................28
TABLE 11 REASONS WHY NON-MEMBERS OF HEALTH INSURANCE SCHEME HAVE NOT JOINED..................................................................29
TABLE 12. NON-MEMBERS WHO WOULD LIKE TO JOIN COOPERATIVE HEALTH INSURANCE.....................................................................29
TABLE 13: PERCENTAGE OF NON-MEMBERS WILLING ATTEND A SENSITIZATION EVENT ON COOPERATIVE HEALTH INSURANCE BY SEX AND AGE 
GROUP. ..............................................................................................................................................................................29
TABLE 14: PERCENTAGE OF NON-MEMBERS’ WILLING TO ATTEND SENSITIZATION AS THEY WAIT TO BE ATTENDED TO AT THE HEALTH 
FACILITY.30
TABLE 15. DIFFERENCE IN HEALTH SEEKING BEHAVIOR......................................................................................................................31
TABLE 16: MEDIAN AGE (IN YEARS) AT FIRST INTERCOURSE...............................................................................................................31
TABLE 17: AGE AT WHICH WOMAN GAVE BIRTH TO FIRST CHILD ..........................................................................................................32
TABLE 18: WHEN LAST CHILD WAS BORN.........................................................................................................................................32
TABLE 19: PLACE WHERE LAST CHILD WAS BORN..............................................................................................................................33
TABLE 20: FACTORS INFLUENCING CHOICE OF HEALTH FACILITY..........................................................................................................33
TABLE 21: NUMBER OF ANC VISITS ................................................................................................................................................34
TABLE 22. NUMBER OF DELIVERIES AND PREGNANT WOMEN ATTENDING ANTENATAL CARE...................................................................34
TABLE 23: IMMUNIZATION STATUS OF CHILDREN UNDER 2 YEARS.......................................................................................................35
TABLE 24: AVERAGE NUMBER OF SICK DAYS BEFORE SEEKING CARE.............................................................................................36
TABLE: 25. SELECTED DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS PLEASE RE-DRAW THE TABLE IN WORD ...................................43
TABLE 26: HAND-WASHING BEHAVIOR............................................................................................................................................46
TABLE 27. TREATMENT OF WATER FOR DRINKING.............................................................................................................................46
TABLE 28 PERSONS WHO SLEPT UNDER A MOSQUITO NET .................................................................................................................47
List of Figures
FIGURE 1: WILLINGNESS TO GET PREGNANT AT THE TIME OF CONCEIVING FIRST CHILD............................................................................32
FIGURE 2: BREASTFEEDING STATUS OF CHILDREN UNDER 2 YEARS ......................................................................................................36
FIGURE 3 TYPE OF TOILET FACILITY .................................................................................................................................................45
FIGURE 4 HANDWASHING FACILITY.................................................................................................................................................45
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Acronyms
CDO Community Development Officer
CGC Connect Girls’ Center
CHI Cooperative Health Insurance
CDP Cooperative Development Program
COVID 19 Corona Virus Infectious Disease
CPPT Cooperative Performance Tracking Tool
DCO District Commercial Officer
FGDs Focus Group Discussion
HF Health Facility
HPU HealthPartners Uganda
KII Key Informant Interview
KPC Knowledge, Perception and Coverage
M&E Monitoring and Evaluation
MoH Ministry of Health
MTIC Ministry of Trade Industry and Cooperatives
PDR Performance Data Review.
SACCO Saving and Credit Cooperatives
SD Standard Deviation
SoP Standard Operational Procedures.
SQIS Self-Regulatory Quality Improvement System
UCMB Uganda Catholic Medical Bureau
UHF Uganda Health Federation
UPMB Uganda Protestant Medical Bureau
USAID United States Agency for International Development.
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Executive Summary
Introduction
Community access to reliable health care is desirable, although this most often comes with costs 
which the majority of people; especially girls and boys, young people can hardly afford. To overcome 
this problem, CONNECT Girls Center is training care providers to manage health cooperative 
businesses while increasing access to design strategies and solutions for international development 
partners. This is done by use of the Cooperative Health Insurance (CHI) as one of the easiest ways to 
provide access to medical care. The Cooperative Health Insurance model empowers members to 
collectively negotiate with health care insurance providers and the members are able to access 
health care at affordable costs. At the time of evaluation, a total of 115 health facilities were found 
to have been oriented on the cooperative health insurance scheme. There are 31 health facilities in 
the south western region, 36 in the northern, 35 in the eastern and 13 in the centraltrained to provide 
health cooperative insurance in Uganda. The findings revealed that the majority of the members,
94%, accessed health services before they subscribed to health cooperative insurance.
HealthPartners Uganda commissioned Soland Associated Consults Limited to conduct a Mid-Term 
Review (MTR) study to evaluate the CHI model, pioneered and implemented by HealthPartners in 
Uganda under its five years Connect Girls Center project. The MTR aimed to assess the programs’ 
design, scope, implementation status and capacity to achieve the expected outcomes. 
Methodology 
The MTR employed quantitative and qualitative methods of data collection in addition to the desk 
review of relevant documents. Primary data collection was conducted in the southwestern 
(Mbarara, Bushenyi/Buhweju, Ibanda, Isingiro, Rukiga and Rukungiri), eastern (Sironko and Soroti) 
and northorn (Oyam and Alebtong) regions of Uganda. A knowledge, perception and coverage 
(KPC) survey that targeted the members and non-members of cooperative health insurance, aged 
18 years and above was conducted. A total of 448 out 532 people responded to the survey. A total 
of 37 key informant interviews (KII) were conducted with national stakeholders (Ministry of Health, 
Ministry of Trade), CONNECT Girl Center staff, health facility (HF) and district technical staff. In 
addition, nine focus group discussions (FGDs) were held with children 15-18 years and adult women 
and men, both members and non-members of cooperative health insurance. 
Mobile data collection was adopted for the KPC survey using the Kobotoolbox platform while for 
KIIs and FGDs, the discussions were audio recorded and notes taken. Descriptive statistics was 
generated for survey data while contextual analysis was the core for qualitative data. 
Findings
To improve the capacity of health care providers to offer cooperative health insurance services, 267 
private care provider1 staff were trained and mentored by HPU on how to manage cooperative 
health insurance and how to attract members. The trainings targeted health facility staff and 
1 MoH Partnership Report, page 6.
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governing boards. HPU conducted 17 support supervision visits to the health facilities2 to further 
provide on-site mentorships to enable care providers to learn how to sustainably manage
cooperative health insurance. The visits provided the health care providers with an opportunity for 
continuous monitoring and mentorship on aspects such as data capture and general management 
of the health cooperatives. The findings of the study established that the capacity building 
interventions supported the health facilities to improve the quality services delivered using the 
cooperative health insurance model and increased the numbers of clients accessing services at the 
respective health facilities. 
The findings of the evaluation also revealed that HPU trained 115 health facilities to operate the 
cooperative health insurance across the country. The literature review established that at the time 
of the evaluation, there are 68 health facilities offering cooperative health insurance services.
The findings also revealed that cooperative health insurance increased provider cost recovery. In 
Mbarara, for instance, the Coordinator, Ankole Archdiocesan said that there was a noticeable 
surplus registered during that year of implementation. In Kakoma HC III, one staff mentioned that 
when people pay in time, it enabled the facility to procure the medicines in time. It also helps to 
project appropriate estimation of the quantity of medical supplies that will be required during that 
quarter. The Medical Director, Villa Maria, also reported that to a large extent the premium collected 
from community health insurance members enabled the hospital to recover all costs used to 
purchase medicines and other medical supplies. 
The MTR established that HPU improved the capacity of health cooperative providers to make 
operational decisions. Among the operational decisions cited included the day to day 
implementation of the health cooperative model at the health facilities, stocking of medicines in the 
pharmacy, conducting outreaches, increasing staffing among others. At Bishop Ceasar of Asili 
hospital, for instance the in-charge said that the sales from the medicines increased significantly 
although he did not disclose details since this information was considered confidential. The 
increment was majorly attributed to the cooperative health insurance model. The management of 
medicines at the hospital also improved because there was regular inventory of drugs to reduce on 
stock outs due to the increased number of patients accessing services and the timely payment of 
the premiums by the cooperative members. 
When the cooperative health members were asked to rate the quality of services offered, the 
majority, 67%, mentioned the services are good and only 2% reported that the services were very 
poor. The members were also asked if they were satisfied with the services that are offered and the
majority, 39%, mentioned that they were satisfied with the services and only 2% were not satisfied 
with the services. 
1
MoH Partnership Report, page 4.
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Overall, the cooperative care providers and their members are satisfied with the services and 
technical support provided by HPU. The findings of KIIs with the cooperative health focal persons, 
facility in-charges from the 18 health facilities and community members, established that HPU 
conducted routine support supervision to the health facilities that deliver cooperative health 
insurance services. During the support supervision visits HPU provided technical guidance to the 
staff and addressed issues related to the management of the health cooperative model. The 
respondents mentioned that the timely guidance helped the health facility staff to resolve health 
cooperative management challenges. HPU also facilitated learning exchange visits amongst the 
cooperative health service providers. The exchange visits amongst the health cooperative facilities 
enabled the services providers to share knowledge, learn from each other, share lessons and best 
practices and to have them replicated in their respective health facilities. 
HPU provided technical support to the health cooperative through capacity building to improve the 
legal and regulatory framework for cooperatives. The findings revealed that HPU built the capacity 
of the health cooperatives to register with the Ministry of Trade, Industry and Cooperatives (MTIC.)
The support aimed at supporting the health cooperatives to have proper governance and 
management structures. 
HPU also engaged the MTIC to ensure regulatory conducive environment for the cooperative health 
insurance scheme. Out of the five health cooperatives two are registered as Uganda Health 
Cooperative and Mt. Elgon Health Cooperative.
The mid-term evaluation revealed gaps in the areas of collaboration and networking with the District 
Local Government technical persons. Apparently, in all the 13 districts the MTR team visited, the 
technical persons that is; the District Health Officers, District Commercial Officers and Community 
Development Officers did not know about the role of health cooperatives in their respective 
districts. It was only in Alebtong and Oyam districts where the technical persons seemed to be aware 
of the activities of the health cooperatives. Generally, in those districts, the role of the health 
cooperatives was associated with the work done by Abt. Associates and not HPU.
The findings revealed that the majority of the members, 94%, accessed health services before they 
subscribed to health cooperative insurance. At least nine in 10 members that participated, 91% in the 
survey, reported that they received better services with insurance and paid less than 85% in costs 
compared to before they enrolled in health insurance. 
The average difference in health seeking behavior for the cooperative members was 94% and 83% for 
non-members. This means that the cooperative members are more likely to seek for medical care 
compared to non-cooperative members.
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Over all, the median age at first intercourse for health cooperative members was 19.6 years and 18.9 
years for the non- members. The findings at the baseline showed that the median age at first 
intercourse for cooperative members was 18.5 years and 17.7 for the non-members. 
The MTR revealed that there was a slight difference between the health cooperative members and 
non-members in terms of the days taken to seek medical advice on the on-set of symptoms of illness 
or sickness. The findings indicated that 41% of the members sought treatment the same day while 
37% of the non-members also sought treatment on the first day. Those who sought treatment after 
one day were 20% and 21% for members and non-members respectively.
The findings established that 94% of the cooperative members and 84% of the non-members of the 
health cooperatives sought medical care from health facilities. The non-health cooperative members 
are likely to pay three times more for medical care than cooperative insurance members evidenced 
by reported spending at 201,308 UGX and 65,761 UGX respectively. The baseline value of the health 
care spending indicator is 77% for the cooperative insurance members and 51% for non-members.
The average annual health care expenditure made in form of premiums, copays and others was UGX 
116,974 (32 dollars) amongst the members. The percentage difference between the average annual 
health care expenditure for members and non-members was 9.2%. The expenditure for members 
(premium, copay & out of pocket) was UGX 182,735 and the expenditure for non-members 
amounted to 201,308 UGX. The percentage difference between cooperative and non-cooperative 
members was 11% and 89% for non-members respectively at baseline.
Recommendations/Lessons:
There is need for HealthPartners to improve the quality of relationships and partnerships with 
stakeholders at the implementation level especially District Local Governments, the tentacles of 
Government regulation, inspection and technical guidance. Training programs should 
demonstratively mentor documentation and engage staff to improve the quality of reports and the 
data collected by health facilities.
To increase coverage and improve cost recovery, HealthPartners should support care providers to 
develop and implement outreach plans to promote enrollment in cooperative health insurance.
To ensure sustainability, HPU should conduct more training on savings in order to aid the health 
insurance renewal rate. Saving Initiatives or cooperative investments could be explored as viable 
alternatives.
As an unanticipated positive consequence, the cooperative health insurance scheme has created a 
platform for building social cohesion and mobilization for savings initiatives which will likely improve 
accessibility to micro-credit to members. All HPU can do is to link these groups to other partners 
providing services so that they are supported to kick-start saving initiatives. This will eventually 
facilitate engagement in income generating activities which will enable members to pay their 
premiums and improve livelihoods. 
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Conclusion
The health insurance scheme benefits are justified by the fact that 23.7% non-member health 
cooperative households compared to 9.5% health cooperative member households are likely to sell 
property in order to access health services in the event of sickness. Moreover, annual average health 
expenditure for cooperative members is much lower at UGX 88,667= compared to UGX 140,000= for 
non-members. The number of cooperative health insurance members seeking health care in the 
form of antenatal care (ANC) is higher than that of the non-members. This indicates that cost 
influences the health seeking behavior of both members and non-members. Cooperative Health 
Insurance therefore enables members to access quality health care affordably.
1.0 INTRODUCTION
Soland Associated Consults Limited was contracted by HealthPartners to conduct the mid-term 
evaluation for the CONNECT Girls Center activity. As a deliverable, an inception report was prepared 
indicating in detail the evaluators’ understanding of the evaluation exercise and how the evaluation 
questions were addressed. Specifically, it included the evaluation matrix summarizing the evaluation 
design, methodology, evaluation questions, data sources and collection analysis tools as well as the 
timelines. 
1.1 Background
The Cooperative Development Program (CDP) is a global initiative that strengthens cooperative 
businesses and credit unions across multiple sectors throughout Africa, Asia, and Latin America. The 
program partners with U.S.-based cooperatives and Cooperative Development Organizations for 
five-year activities. The purpose of the program is to foster sustainable cooperative systems that 
deliver value to cooperative members and their communities. This is accomplished by improving 
cooperative business performance, creating environments where cooperatives can thrive, and 
enhancing the development community’s support to cooperatives.
At USAID, the project purpose for the CDP is to foster sustainable cooperative systems that deliver 
value to their members and contribute to the economic and social development of communities. 
The CDP theory of change anticipates that if cooperative performance is improved, if the enabling 
environment is improved to support cooperatives with access to key resources and appropriate 
legal frameworks and services, and if donor funded cooperative programs are improved through 
collaboration and learning, then cooperative systems, members, and communities will work to 
address the root causes of poverty and instability through increased social and economic value. In 
August 2018, the program awarded funding to Cooperative Development Organizations. CONNECT 
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Girls Center is a five-year project (2018-2023) that aims to improve cooperative business 
performance and strengthen the enabling environment under local leadership in order to increase 
health care access and quality for improved health outcomes and community resilience. CONNECT 
Girls Center expects to achieve its intended goal through three objectives defined as:
1. Improved cooperative business performance.
2. Improved cooperative enabling environment. 
3. Development community’s support to cooperatives.
The project is delivered through two primary interventions namely the cooperative training and 
technical assistance and connecting girls to cooperatives and cross sector networks. The 
Cooperative training approach and technical assistance intervention enhances the capacity of the 
informal sector to demand and access quality health care by training trainers and care providers to 
manage cooperative health insurance and to strengthen the sustainability and governance of new 
and existing cooperatives. Cooperative Girls Centers link health care to life skills, economic 
empowerment and leadership capacity strengthening with the ultimate goal of expanding 
membership and adding value for members and their communities with a focus on youth age 10-24.
Purpose and scope of the mid- term evaluation
HPU commissioned a mid-term evaluation that aimed to understand progress towards achieving 
project objectives and outcomes, draw lessons for learning, increase the rate of sustainable change 
during the remaining project implementation period. The study also assessed the programs’ design, 
scope, implementation status, the capacity to achieve expected outcomes, performance of the 
program against planned results and the preliminary indications of potential impact and 
sustainability of results. The MTR focused on implementation period August 14, 2018 -December 31, 
2020.
1.4 Evaluation questions
The mid-term evaluation was informed and guided by the following questions:
i. To what extent has HPU supported health facilities to offer cooperative health insurance? 
ii. To what extent has HPU increased the number of health providers offering cooperative 
insurance? 
iii. To what extent is health cooperative insurance increasing provider cost recovery?
iv. To what extent has HPU improved the capacity of cooperative care providers to make 
operational decisions? 
v. To what extent are members satisfied with benefits they are receiving through cooperative 
health insurance? 
vi. To what extent are cooperative care providers and their members satisfied with the services 
and technical support provided by HealthPartners? What factors contributed to satisfaction, 
and why?
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vii. To what extent has adoption of preventive behaviors (LLINs, hand washing, nutrition) and 
health-seeking behavior among girls age 10-24 improved? What activities have most 
facilitated that? 
viii. To what extent has HPU improved the legal and regulatory framework for cooperatives? 
ix. Has HPU improved the capacity of cooperatives to meet national regulatory requirements? 
x. How successful has HPU been in linking MTIC to support health cooperatives in terms of 
registering cooperatives 
xi. In what ways has HPU contributed to the improved collaboration between implementing 
partners? 
xii. What factors have constrained implementation? How are constraints being addressed?
To address the above questions, the evaluation team detailed a matrix and thereafter developed the 
indicators for each question, the data collection method, and determined the source of the data. 
The findings were organized around each of the evaluation questions. 
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2.0 APPROACH AND METHODOLOGY
2.1 Overall Approach
The mid- term evaluation team used a combination of data collection methods. These 
included: 1) a review of secondary data sources, 2) KIIs with health cooperatives, health 
provider facilities offering cooperative insurance, Uganda Catholic Medical Bureau (UCMB) , 
Uganda Healthcare Federation (UHF) Uganda Protestant Medical Bureau (UPMB) , Abt. 
Associates, central and local government officials and Technical Advisor Steering Committee 
(TASC) members from the Ministry of Health (MoH), Ministry of Gender, Labour and Social 
Development (MoGLSD), MTIC, District health and commercial officers, Development 
partners that include United States Agency for International Development (USAID), 
Cooperative Girls Center members age 15-24, and HPU staff. Quantitative and qualitative data 
were collected in addition to document what was done to review and evaluate project 
implementation and performance. 
2.2 Selection of Sample Districts
The mid -term evaluation was conducted in 13 implementation districts. They include;
Alebtong and Oyam in the northern region, Bushenyi, Ibanda, Isingiro, Mbarara, Rukiga and 
Rukungiri in the south western region, Kalungu, Luweero and Wakiso in the central region, 
Sironko and Soroti in the eastern region. Table 1 details the sampled districts. 
Table 1. List of health facilities and health cooperatives assessed 
Region District Health Facility/Cooperative
Western region Rukungiri Kadoth Clinic
Rukiga Kitanga HC III
Ankole Diocese Health 
cooperative (ADHC)
Mbarara Ruharo Mission Hospital
Ibanda Ibanda Mission Hospital
West Ankole Health 
cooperative (WADHC)
South Western Region
Bushenyi Katungu Mission health center
Archdiocese of Mbarara Health 
cooperative (ADMHC)
Isingiro Kakoma Health Center III
Eastern Region Soroti
Bethesda Hospital
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Elgon Community Health 
Cooperative
Sironko Divine health center
Central Region Luwero Bishop Asili Hospital
Kalungu Villa Maria hospital
Wakiso St. Francis of Asisi Naddangira 
HC
Northern Region Alebtong Alleluyah Joint Maternity Clinic
Oyam Aero Medical Clinic
2.3 Data Sources and Methods of Data Collection
The midterm evaluation adopted a mixed methods approach to data collection. This was in 
line with the objectives and evaluation questions highlighted in the evaluation matrix. A 
participatory and consultative approach was adopted and ensured that all stakeholders are 
involved including HPU staff and stakeholders at various levels of implementation and the 
development partners. 
Data for the mid -term evaluation were drawn from both secondary and primary data sources. 
The data collection methods included a desk review of relevant documents such as records 
and KIIs at health cooperative provider facilities listed in Table 1, and consultative meetings 
with selected stakeholders, survey with individual members and non-members of 
cooperatives (KPC) and facilitated group discussions with selected members of the 
community. The next sub-sections discuss the data sources and data collection methods in 
detail.
2.3.1 Document review
Document review was performed to gain a deeper understanding of the project including 
the project theory of change, to gather secondary data from various sources, and to identify 
milestones and challenges. 
The evaluation team reviewed and compiled information from documents or records available 
with cooperatives and implementing health provider facilities. These included; the
Cooperative Performance Tracking Tools (CPTTs) available with cooperatives, and provider 
treatment records, reports submitted by the Cooperative Coordinators and partners, studies 
done in the health sector to provide information related to the project outcomes e.g. Uganda 
Demographic Health Survey (UDHS), health management information system (HMIS), and 
nutrition data from the cooperative Girls Center assessment reports. Other documents 
reviewed included the partnership report that was submitted to MoH, Connect Girls Center 
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baseline survey report, HealthPartners CONNECT Girls Center Monitoring, Evaluation and 
Learning Plan (MELP) and annual progress reports. The evaluation team reviewed and 
compiled information from documented the records of the cooperatives and health provider 
facilities which included CPTT forms and membership lists, among other documents. 
2.3.2 Key Informant interviews 
A total of 37 KIIs were conducted, three with informants from the national-level institutions:
MoH, MTIC, UHF, 31 district technical staff, cooperative/group leaders and health facilities and 
three HPU staff. The data from the KIIs was used to validate information obtained from the 
KPC data and to provide deeper insight into the extent to which the cooperatives complied 
with the regulatory framework, the challenges encountered by the healthcare providers and
the changes brought about by the project. (A list of informants is presented in the annex 4).
2.3.3Focus group discussions
FGDs comprising of not more than five participants were conducted with selected members 
of the community and the Girls Centers committees. The FGDs aimed to assess the 
participants’ perception about the different components of the project including its 
contribution, challenges and areas that needed to be improved. The participants were 
purposively selected in consultation with the leadership of the different health cooperatives, 
health facility providers and community leaders. Each FGD was facilitated by a moderator and 
note-taker, the proceedings were audio recorded and followed the COVID_19 standard 
operating procedures. The discussions were conducted in the local language. A total of nine 
FGDs were conducted, each with five participants, from Isingiro, Mbarara, and Sironko as 
detailed in Table 2., The MTR was designed for 16 FGDs, but during data collection it was 
observed that some could not be conducted because of the inactive membership at time of 
data collection. The table details the number of FGDs achieved. 
Table: 2. Number of FGDs conducted
Category Number of FGDs
Girls Center Committee members, Isingiro 1
Boys and girls 15-18years in Isingiro District 1
Women 25-49 years, non- health insurance members, Mbarara 1
Men non- health insurance members, Mbarara 1
Men, coop/health insurance members, Mbarara 1
Females aged 25-49 years cooperative members, Sironko 1
Females aged 25-49 years, non -cooperative members, Sironko 1
Males aged 25-54 years, cooperative members, Sironko 1
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2.3.4 Knowledge, Perception and Coverage Survey
The KPC survey aimed to gather data related to health services seeking behavior, satisfaction 
of members with the benefits got at the health facility, and satisfaction with the services of 
the health facilities and HPU. The respondents of the KPC survey tool were adult members 
and non-members of health cooperatives between 18 t0 24 years and those above 25 years in 
the selected districts.
The sampling design adopted the Lot Quality Assurance Sampling method that required at 
least 19 respondents of a given category in one cluster to facilitate comparison of members 
and non-members of health insurance cooperatives. The table below shows the number of 
KPC interviews conducted by district and type of respondent. 
Table 3: KPC interviews
District. Member Status
Health Cooperative 
member
Non-member health 
insurance/cooperative
Total
Alebtong 21 18 39
Bushenyi 18 22 40
Ibanda 20 15 35
Isingiro 21 17 38
Kalungu 19 18 37
Luwero 18 19 37
Mbarara 19 19 38
Oyam 17 26 43
Rukiga 16 25 41
Rukungiri 0 19 12
Sironko 15 18 33
Soroti 14 20 34
Wakiso 20 17 37
Total 218 253 464
The response rate was 84%, out of the 532 target responses, a total of 448 responses were 
obtained from the KPC study. Of these 213 (48%) were for members of health 
insurance/cooperatives (42% males and 58% females) and 235 (40% males and 60% females) 
were non-members. A total of 73 respondents (16 %) were aged 18-24 years and 375 (84 %) 
were aged 25 years and above. 
2.4 Data collection tools
The evaluation team used nine broad types of tools to gather information attached in in 
annexes two and three. The tools were translated into the local languages Runyankole, Langi, 
Luganda and Atesot to ensure that the respondents understood the questions. The tools 
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were administered while adhering to the COVID-19 standard operating procedures. The data 
collection tools include KII guides, FGDs, KPC and health facility assessments. The guides were 
tailored to different informants at different levels of participation in the planning and 
implementation of the cooperative health insurance scheme.
• FGD guides for the various categories of participants detailed in table 2
• KPC survey for members and non-members of health cooperatives 
• Health cooperative provider facility assessment tools 
2.5 Data processing
The evaluation team used different methods of data capture and analysis in line with the 
methods of data collection. For the quantitative data, descriptive statistics was used to 
generate the information while for the qualitative data, themes and patterns were developed 
to address the evaluation questions. Information from the primary data sources were
triangulated with the findings from the desk review. 
2.5.1 Quantitative data
Data Coding: Field coding was minimized given that most questions were closed. For the 
open-ended questions, the interviewer entered the verbatim which was coded to numerical 
values. 
Data capture: Data was captured using Kobo Toolbox collect on tablets/ smart phones. Data 
was uploaded onto the main server daily to avoid data loss. The data analyst downloaded the 
uploaded data for storage and checks. In addition, data compiled from records of health 
facilities and HMIS was captured in MS Excel. 
Data analysis: The collected data for this study was analyzed using the Statistical Package for 
Social Scientists (SPSS) computer software, version 22. MS Excel software was also used for 
drawing interactive graphs. Descriptive statistics was generated and relevant comparisons 
were made between the different groups of informants in consonance with the objectives of 
the study. 
2.5.2 Qualitative data
The team used contextual analysis as the core analytical framework for qualitative data. The 
process involved analyzing documents, KIIs, group discussions and focus groups notes to 
identify emerging common trends, themes and patterns for each objective. Content analysis 
was also used to highlight diverging views and opposing trends. 
2.5 Limitation of the study.
17 | Page
The mid-term evaluation was affected by the incomplete and sometimes inaccurate data from 
CPTTs. This proved a challenge and in many instances the evaluation team held back and forth 
discussions in order to verify the data.
3.0 Findings:
The Midterm review was guided by a number of evaluation questions already stated above in 
section 1.4. These focused on the different aspects and result areas of the project. The next 
sections within this chapter presents the findings of the MTR. The sections, highlight the 
status of the different indicators as per the evaluation question that guided the mid-term 
evaluation.
3.1 Status of indicators as per the evaluation questions
1. To what extent has HPU supported health facilities to offer cooperative health 
insurance? 
The extent to which HPU supported health facilities to offer cooperative health insurance.
HPU built the capacity of health facilities that offer cooperative health insurance during 
trainings and mentorship sessions on the operations of the cooperative health insurance 
model. The trainings targeted health facility staff and governing boards. 
HPU conducted 17support supervision visits to the health facilities3. The visits provided the 
health cooperative workers with an opportunity for continuous monitoring and mentorship 
on aspects such as data capture and general management of the health cooperatives. The 
findings further established that the capacity building interventions supported the health 
facilities to improve the quality services delivered using the cooperative health insurance
model and increased the number of clients accessing services at the respective health 
facilities. 
The findings from the FGDs established that the HPU built the capacity of the health facility 
staff on data collection, interpretation, and utilization to guide reporting and decision making. 
This was evidenced when a respondent from Villa Maria Hospitalsaid “HealthPartners trained 
and oriented staff on cooperative health insurance management, how to complete CPTT forms 
1
MoH Partnership Report, page 4.
18 | Page
and interpret data during the monthly review meetings”. Similar responses were obtained from 
164 other health facilities the evaluation team visited. 
This was further evidenced by the responses from the proprietor Aero Medical Centre, in 
Oyam District who mentioned that the learning exchange visit that was conducted to Bishop 
Asili Hospital exposed him to the health cooperative health insurance model, its operation 
and management. The knowledge he got made him appreciate the model and internalize the 
best practices. The focal person of cooperative health insurance at Bishop Asili Hospital also 
said “HPU facilitated online performance data review (PDR) trainings that led to improved 
implementation of the model and data utilization at his health facility. 
When the cooperative and non-cooperative health insurance members were asked about 
their opinion on the quality of services obtained at the health facilities in the last two years, 
during the KPC, the majority, 78%, reported that the services are better, while 19% reported 
that they remained the same and only 2% were not able to tell a difference in the services. The 
findings affirmed that, to an extent, the improvement in the quality of services at the 
cooperative health facilities was attributable to the capacity building interventions provided 
by HPU. 
The Desk Officer, Cooperative health insurance at the MITC, in an interview mentioned that 
HPU pioneered the registration of health cooperatives in Uganda. It was established that out 
of the ten registered cooperatives in the database five of them were registered much earlier. 
Despite the limited implementation period, a lot was done to market the concept of health 
cooperatives in different parts of the country.
2. To what extent has HPU increased the number of health providers offering 
cooperative insurance? 
The findings of the evaluation established that HPU accepted applications and trained 115 
health facilities to manage cooperative health insurance across the country. The literature 
review established that, at the time of the evaluation, there were 68 health facilities offering 
cooperative health insurance and reporting consistently.
In 2019, there were 27 health facilities (two in the North, 24 in the South Western and one in 
central region) offering cooperative health insurance services. During 2020, an additional 41 
facilities (four in the North, two in the East, 30 in the Southwestern and five in Central region) 
4
Kadoth Clinic, Kitanga HC III, Ankole Diocese Health cooperative (ADHC), Ruharo Mission Hospital, West Ankole 
Health cooperative (WADHC), Katungu Mission HC III, Archdiocese of Mbarara Health cooperative (ADMHC), 
Kakoma Health Center III, Bethesda Hospital, Elgon Community Health Cooperative, Divine HC II, Bishop Asili 
Hospital, Villa Maria hospital, St. Francis of Asisi Naddangira HC III, Alleluyah Joint Maternity Clinic, Aero Medical 
Clinic
19 | Page
were trained to offer health insurance services. This reflected a increase in the number of 
health facilities offering cooperative health insurance services by 60%. 
However, the regional distribution of the health facilities is uneven. For instance, in the south￾western region there are 51, Central six, Eastern region two and in the northern region 10 
health facilities. In terms of regional distribution, the evaluation team noted that the health 
cooperative insurance model is more rooted in the south-western region and the eastern 
region has the lowest number of health providers offering cooperative health insurance.
Albeit the imbalance in the regional distribution, it is valid to conclude that to a big extent, 
HPU increased the number of health providers offering cooperative health insurance. 
3. To what extent is health cooperative insurance increasing provider cost recovery?
In all the health facilities the evaluation team visited, the findings of the MTR established the
cooperative health insurance increased provider cost recovery. In Mbarara, for instance, the 
Coordinator, Ankole Archdiocesan said that there was a noticeable surplus registered during 
that year of implementation. In Kakoma Health Center III, one staff mentioned that when 
people pay in time, it enables the facility to purchase the medicine in time. It also helps to 
project appropriate estimation of the quantity of medical supplies that will be required during 
that quarter. The Medical Director, Villa Maria, also reported that to a large extent the 
premium collected from CHI members enabled the hospital to recover all costs used to 
purchase medicines and other medical supplies.
It was however noted that there are some stakeholders who reported that they did not 
believe the cooperative health insurance increased provider cost recovery. The Cooperative 
Health Insurance Desk Officer at the MITC reported that “There was no cost recovery for 
health providers because the fees paid as co-pay and membership fees are very low. She 
mentioned that the health providers are likely not to provide quality services at 1,000 UGX as 
copay.”
4. To what extent has HPU improved the capacity of cooperative care providers to make 
operational decisions? 
The evaluation team established that operational decisions included the day-to-day 
implementation of the health cooperative model at the health facilities, stocking of medicines 
in the pharmacy, conducting outreaches, increasing staffing among others. At Bishop Asili 
hospital, for instance the in-charge said that the sales from the medicines increased
significantly although he did not disclose details since this information was considered 
confidential. The increment was majorly attributed to the cooperative health insurance 
model. The management of medicines at the hospital also improved because there was 
regular inventory of drugs to reduce on stock outs due to the increased number of patients 
accessing services and the timely payment of the premiums by the cooperative members. 
20 | Page
The proprietor Aero Medical Centre, in Oyam District, also mentioned that at every end of 
month, the staff compiled the monthly reports that are submitted to HPU. The feedback that 
HPU provides was used to discuss challenges affecting the implementation of the health 
cooperative model. Together with HPU staff, the health facilities are supported to get 
solutions to overcome the challenges. Consequently, data utilization helped the health 
providers to make informed decisions. In addition, sex disaggregated data enabled the health 
care providers to target potential members during outreaches. In Villa Maria Hospital, the 
health cooperative focal person also said that he used the cooperative health insurance data 
to inform outreach programs. The data showed poor health seeking behavior compared to 
the women. This was one example how the data was used to inform operational decisions on 
stock management, management of outreaches and improve staffing.
5. To what extent are members satisfied with benefits they are receiving through 
cooperative health insurance? 
When the cooperative health members were asked to rate the quality of services offered, as 
detailed in table 4, the majority (67%) mentioned the services are good and only 2% reported 
that the services were very poor. The members were also asked if they were satisfied with the 
services that are offered. The majority (39%) mentioned that they were satisfied with the 
services and only 2% were not satisfied with the services. 
Table 4: level of satisfaction of cooperative health services 
Rating Level of 
satisfacti
on for 
members 
N=203
Percentage level of 
satisfaction for non -members 
Sex
N=
Male = 85 Female = 118
% %
Satisfaction with the quality of services offered
Very poor 2 2 2 1
Poor 1 1 1 2
Average 16 16 17 15
Good 67 67 67 67
Excellent 15 15 14 15
i) satisfaction with the management of health cooperative insurance 
Very Dissatisfied 5 5 6 5
Dissatisfied 2 2 1 2
Average 21 21 24 20
Satisfied 39 39 32 44
Very Satisfied 33 33 38 30
21 | Page
To further appreciate the level of satisfaction with how cooperative insurance is managed, 
the survey focused on assessing the satisfaction level among members. The findings in table 
4 shows, 39% said they are satisfied, 33% are very satisfied, 21% are average while those who 
are very satisfied and dissatisfied combined at 7%. The findings showed that to a great extent, 
the majority of the members are satisfied with the services they received at the health 
facilities.
6. To what extent are cooperative care providers and their members satisfied with the 
services and technical support provided by HPU? What factors contributed to 
satisfaction, and why?
The findings of KIIs with the cooperative health focal persons, facility in-charges from the 18 
health facilities5and the community members, established that HPU conducted routine 
support supervision to the health facilities that deliver cooperative health services. During the 
support supervision visits HPU provided technical guidance to the staff and addressed issues 
related to the management of the health cooperative model. The respondents also 
mentioned that the timely guidance helped the health facility staff to resolve health 
cooperative management challenges. HPU also facilitated learning exchange visits amongst 
the cooperative health service providers. The exchange visits amongst the health cooperative 
facilities enabled the services providers to share knowledge, learn from each other, share 
lessons and best practices and to have them replicated in their respective health facilities. 
HPU also built the capacity of the health care providers. At the time of the MTR a total of 90 
service providers were trained in the south western region of Uganda. This was evidenced 
during the KIIs where 90% reported that they are satisfied with the capacity building that was 
provided to the health cooperatives during the mentorship and training sessions that 
addressed data management and reporting, the management of cooperative health 
insurance, and financial management of health insurance. Interviews with HPU staff also 
revealed that HPU is in a process of developing a virtual training package that will be offered 
to health cooperative providers during a series of eight sessions. 
The findings from the KIIs also established that 10/13 of the service providers that participated 
in the MTR are satisfied with the timely feedback provided by HPU on the reports that are 
submitted. The health facility staff used the feedback to make informed decisions to address 
management and operational challenges faced during implementation. 
5
Kadoth Clinic, Kitanga HC III, Ankole Diocese Health cooperative (ADHC), Ruharo Mission Hospital, West Ankole 
Health cooperative (WADHC), Katungu Mission HC III, Archdiocese of Mbarara Health cooperative (ADMHC), 
Kakoma Health Center III, Bethesda Hospital, Elgon Community Health Cooperative, Divine HC II, Bishop Asili 
Hospital, Villa Maria hospital, St. Francis of Asisi Naddangira HC III, Alleluyah Joint Maternity Clinic, Aero Medical 
Clinic
22 | Page
The findings also established that HPU, in collaboration with UHF, initiated the use of the Self￾Regulatory Quality Improvement System (SQIS) tool at the cooperative health facilities. The 
tool is a comprehensive checklist with guiding questions and clear definitions focusing on 19 
key quality health management standards including infrastructure and amenities, laboratory 
services, occupational health and safety, infection control and prevention, records, imaging 
and radiology, and mortuary services. SQIS is aimed at improving and standardizing the quality 
of health services availed to the general public through the private health sector. The findings 
of the KIIs with the health facility staff revealed that they used the tool to assess quality of 
their health facilities and services offered and also developed action plans to address the gaps 
identified. 
The findings of the KPC further established that the cooperative health facilities made 
investments to improve the quality of care. Half of the participants in the KPC agreed to this 
and 78% of the members interviewed reported that the services provided at the cooperative 
health facilities are better compared to the time they visited the facilities the last 12 months. 
This was an indication that the support provided by HPU to the health facilities improved the 
quality of health care offered by health providers thus yielding good results.
Despite the improvement in the quality of services, the respondents from five out of the 13 
cooperative health facilities reported that they were doing a lot of work without any 
additional payment. To them, the delivery of services through the cooperative health 
insurance model was viewed as additional work and considered a burden. They advised HPU 
to engage with the management of the health facilities to devise a mechanism of addressing 
this issue. 
7. To what extent has HPU improved the legal and regulatory framework for 
cooperatives? 
HPU provided technical support through capacity building to improve the legal and regulatory 
framework for cooperatives. This was done during trainings to the pre-cooperatives and the 
existing cooperatives to ensure that they operate in conformity with the Uganda policies and
regulations. HPU engaged MITC to play the pivotal role in the regulation and supervision of 
cooperatives aimed to increase access to quality and affordable health care.
Currently there are five health cooperatives that are registered with the MITC. It is anticipated 
that the conducive and supportive working relationship that HPU established with MITC will 
be leveraged to ensure cooperatives meet the regulatory requirements especially pre￾cooperatives that have not yet registered.
The document review established that HPU organized a two-day sensitization meeting that 
was attended by 15 members of parliament. The meeting aimed to sensitize the participants 
about health cooperatives and to create an enabling environment for health cooperatives to 
operate in Uganda. The meeting was also attended by the district technical staff from three 
23 | Page
districts6. It is envisaged that the lessons will be utilized by legislators to inform the National 
Health Insurance Scheme bill. HPU also conducted a number of support supervision and 
mentorship visits to the health cooperatives to improve compliance with the legal framework 
that governs cooperatives.
8. Has HPU improved the capacity of cooperatives to meet national regulatory 
requirements?
The contribution of HPU towards the cooperatives to meet national regulatory requirements 
is demonstrated through the capacity building to support health cooperatives to register with 
the MITC. HPU supported the health facilities to have proper governance and management 
structures. Out of the 18 cooperatives visited, the facility in-charges mentioned that HPU 
trained them on the need to have the health cooperatives to be registered. From the 
document review it was noted that HPU conducted a number of support supervision visits to 
11 facilities in partnership with Abt. Associates and 43 staff were engaged to ascertain whether 
they had completed steps necessary to prepare them to manage the health cooperative
before enrolling members. Support supervision was also conducted for six providers in the 
central region and aimed to guide on proper documentation, reporting and timely payment 
of premiums by membersi7
.Working with the MITC, a number of activities prior to successful 
registration were conducted. Activities included training health care providers, training health 
cooperatives on the operations of the health cooperative model, training the Board of 
Directors in governance as well as sensitization on the legal and institutional framework for 
cooperatives in Uganda. 
HPU, in partnership with UHF, launched implementation of SQIS among the private health 
providers offering cooperative health insurance. It is anticipated that the tool will be used to 
standardize the delivery of services in private sector health facilities to identify gaps and 
challenges during the delivery of services. 
9. How successful has HealthPartners been in linking MTIC to support health 
cooperatives in terms of registering cooperatives 
The Desk Officer for Cooperatives, reported that HPU engaged the MTIC to ensure a sound 
regulatory environment for health cooperatives. Out of the five health cooperatives, two are 
registered: Uganda Health Cooperative and Mt. Elgon Health Cooperative. Four of the health 
cooperatives are not registered because their temporary registration expired. HPU will 
continue to engage with the cooperatives to ensure that their registration is renewed. In 
addition, HPU was working with MITC to build the capacity of the health cooperatives and 
pre-cooperatives to engage board members and create awareness on the statutory 
requirements for registration of the cooperatives to fast track the registration process. HPU 
6
Buhweju, Bushenyi and Mbarara
7 Ministry of Health and HealthPartners Uganda Partnership Report March to June 2020
24 | Page
also built the capacity of health care providers on how to sustainably manage cooperative 
health insurance and offer quality health care.
10. In what ways has HealthPartners contributed to the improved collaboration 
between implementing partners? 
To appreciate the level of collaboration and the extent to which HPU improved collaboration 
with the implementing partners, a collaboration matrix was developed. This matrix shows the 
level of collaboration between HPU and partners and not between the partners because this 
is not something HPU can directly influence. From the Table 6 and as per the findings, the level 
of collaboration between HPU and the different partners including MTIC, Abt. Associates, 
MoH, UHF, UCMB, UPMB, and key policy makers at the national level is high. The collaboration 
between HPU and Abt Associates and UHF is at a moderate level.
Table 6: HealthPartners’ Stakeholder Collaboration Matrix
Name of Stakeholder Level of Collaboration ( High, 
Medium, Low)
Comments
District Local Governments Low MoUs not signed
Ministry of Trade Industries 
and Cooperatives.
High Mou Signed
Abt Associates Moderate MoU not signed 
Uganda Healthcare Federation Moderate MoU not signed
Uganda Catholic Medical 
Bureau
High MoU signed
Uganda Protestant Medical 
Bureau
High MoU signed
Private Health Facilities High MoU signed
MoH High MoU signed
Policy Makers-Parliament Moderate
The mid-term evaluation also revealed gaps in the area of collaboration and networking with 
the District Local Government technical persons. Apparently, in all the 13 districts the MTR 
team visited, the technical persons like the District Health Officers, District Commercial 
Officers and Community Development Officers did not know about the role of health 
cooperatives in their respective districts. It was in Alebtong and Oyam districts where the 
technical persons seemed to be aware of the activities of the health cooperatives. The role of 
the health cooperatives was associated with the work done by Abt. Associates and not HPU. 
11. What is the penetration rate of health cooperative membership in different regions in 
Uganda?
At the time of evaluation, a total of 115 health facilities were oriented on the cooperative 
health insurance scheme as indicated in Table 7.
25 | Page
Table 7. Stakeholders oriented on Cooperative Health Insurance
Region
Health Care Provider Category
Private Health 
Provider
Uganda 
Catholic 
Medical 
Bureau
Uganda 
Protestant 
Medical Bureau
Total Providers 
Offering 
CHI
Northern 33 - 3 36 6
Eastern 33 - 2 35 4
Central 3 5 5 13 6
South 
Western
4 13 14 31 54
Total 73 18 24 115 68
In the south western region of Uganda, the number of health facilities providing health 
cooperative insurance as indicated in table7 are more than those oriented. This is majorly 
attributed to the fact that health providers were recruited after the formal orientation was 
done.
Considering the number of health care providers trained and those currently offering 
cooperative health insurance in table 7, it is evident that apart from the south western region, 
the coverage in the northern, eastern and central is very low. As already noted above, there 
is a regional imbalance in the distribution of health facilities offering cooperative health 
insurance. The Eastern region has the lowest number of health providers offering cooperative 
health insurance.
HPUshould focus on addressing the low coverage in the northern, eastern and central regions
where the health cooperative insurance model is lowest. Efforts should be made to 
strengthen the implementation of the model in the central and south western regions among 
the private healthcare providers. There is also need to engage the UCMB on the possibility of 
piloting the model in northern and eastern regions. Overall, there was lot of unmet need for 
this model. Across the different regions, there was low uptake of the health cooperative 
model. HPU should devise deliberate strategies on how to increase the numbers of health 
facilities implementing the model and also ensure that the issue of regional imbalance is fully 
addressed. 
To further appreciate the current coverage of health cooperative insurance, the MTR 
established that 23% of the non-members were not aware of cooperative health insurance as 
shown in table 10. This calls for sensitization about health insurance in all districts of 
implementation.
12. Non-health Household Economic Benefits of Cooperative Health Insurance.
26 | Page
The findings in table 7 indicate that health insurance members are more aware of the house 
hold benefits compared to non-members. Of the 203 members interviewed, access to quality 
health care was ranked highest (80%) as the major benefit, 74% mentioned lower cost due to 
shared risk, 62% mentioned that they avoided borrowing to pay for care, while those who 
mentioned avoiding high bills and reduced worry and stress were both at 54%. This means, 
HPU should focus on improving the quality of services offered at the health facilities and since 
health cooperative members are accessing health services at small private facilities especially 
in the northern and eastern regions.
Table 7. Realized benefits of cooperative health insurance by members.
Benefits 
Total Sex Age Group
Male Female 18-24 25 and 
above
N % N % N % N % N %
Lower cost due to shared risk 150 74 58 68 92 78 23 77 127 73
Access to quality health care 163 80 64 75 99 84 27 90 136 79
Avoid borrowing to pay for care 126 62 45 53 81 69 19 63 107 62
Avoid unexpected possibly 
catastrophic bills
109 54 40 47 69 58 15 50 94 54
Ability to plan to pay premiums 55 27 12 14 43 36 11 37 44 25
Reduced worry and stress 109 54 33 39 76 64 18 60 91 53
Improved relationship with partner 
now that care seeking is no longer an 
issue
63 31 14 16 49 42 15 50 48 28
Other specify 1 0 0 0 1 1 0 0 1 1
Don’t know/None 2 1 1 1 1 1 0 0 2 1
Total 203 85 118 30 173
The findings in table 8 indicate that the majority of the members (94%) realized that it is easier 
to access health services now than before they subscribed to health cooperative insurance. 
At least nine in 10 members indicated that they received better services (91%) with insurance 
and they paid less (85%) compared to before they enrolled in health insurance. 
Table 8: Other benefits by members
Number Percent (%)
Based on your experience, does being a member of a health cooperative make it easier, 
more difficult or the same in accessing health services?
Much easier 190 94
The same 12 6
More difficult 1 0
Total 203 100
In your opinion, do you get a better service or not from a health facility if you are a 
member of a health cooperative compared to a non-member?
Better 185 91
27 | Page
Same 17 8
Worse 1 0
Total 203 100
In your opinion, do health cooperative members pay less, the same or more than non￾members?
Less 172 85
Same 14 7
More 3 1
Don’t Know 14 7
Total 203 100
The findings further revealed that 93% of the health insurance members reported that they 
recommended to their neighbors and friends to enroll for health cooperative insurance having 
realized or experienced the benefits. 
From the above findings and testimonies, it is evident that health cooperatives provided a 
number of household benefits to members. One community member, just like several others 
who accessed a health facility from the group said;
“The mode of upfront payment made my life easy when my wife came for treatment at the 
facility. I was scared to borrow money from friends and microfinance institutions to pay for her 
treatment, though at first I never saw the use paying money when no one was sick”. When I 
learnt that I was [not required] to pay any money at all for treatment, I went and encouraged 
other men to have their families join saving groups for health,” Wamboga ERIC.
The above conclusion was corroborated with the responses given by a member during the 
FGDs who said that the health cooperatives helped him to reduce expenditure on health care 
and he used the savings to cater for other household needs. Kamuntu Fredrico (not his real 
name) also told us that his income boosted through the savings made on health expenditure 
through the health cooperatives. Murebembezi Tanasio (not his real name) told us that the 
saving made was channeled to paying school fees.
The findings in table 9 show that non- members were aware of benefits associated with being 
health cooperative members. The majority (78%) indicated access to quality health care, 77% 
mentioned lower cost due to shared risk, and 67% mentioned that they avoided borrowing, 
while those who mentioned avoiding high bills and reduced worry and stress and both were 
60%. As per non-member responses, the quality of services was paramount; facilities needed 
to be supported to provide quality services to attract more members.
28 | Page
Table 9. Perceived benefits of being a health insurance cooperative member by non-members.
Perceived benefits Gender Age group Total 
Male Female 18 to 24 25 and 
Above
No % No % No % No % No %
Lower cost due to shared 
risk 19 73 26 77 2 67 43 75 45 77
Access to quality health care 21 81 26 77 2 67 45 79 47 78
Avoid borrowing 17 65 23 68 3 68 37 65 40 67
Avoid unexpected possibly 
catastrophic bills 16 61 20 59 2 67 34 60 36 60
Ability to plan to pay 
premiums 1 4 4 12 1 33 4 7 5 8
Reduced worry and stress 15 58 19 56 1 33 33 58 34 57
Improved relationship with 
partner now that care 
seeking is no longer an issue 9 35 12 35 1 33 20 35 21 35
Other specify 1 4 1 3 0 0 2 4 2 3
Don’t know/None 0 0 0 0 0 0 0 0 0 0
Awareness about Health Insurance by non-members
The evaluation also inquired on the level of awareness of the non-members about the health 
insurance scheme. Table 10 shows that majority mentioned that they lacked information and 
knowledge on the benefits of health insurance and how to join the model. Other reasons 
included the high cost of premiums while others also indicated an outright lack of interest. 
This showed the area of investment for HPU was although there was no baseline figure for 
this indicator at the beginning of the project.
Table 10. Awareness about Health Insurance by non-members
Awareness 
about Health 
Insurance
Gender Age group Overall 
Male Female 18 to 24 yrs 25+ years 
No % No % No % No % No %
Aware 26 70 34 77 3 43 57 80 60 77
Not Aware 11 30 7 23 4 57 14 20 18 23
To further understand the reasons why non-members have not joined the insurance schemes, 
the MTR inquired why the non-members were not enrolled in the health insurance scheme. 
As indicated, in table 11, the majority, 47% said they had limited information about the benefits, 
40% said they did not know how to join and the rest mentioned other reasons such as long 
distance to the health facilities, high cost of premium and lack of interest.
29 | Page
Table 11 Reasons why non-members of health insurance scheme have not joined
Awareness about Health Insurance Gender
Male = 91 Female = 139 Total = 230
No % No % Total %
Long distance to health care facility 3 3 8 6 11 5
Limited information on benefits 37 41 70 50 107 47
High cost of premium 19 21 26 19 45 20
Don’t know how to join 34 37 59 42 93 40
Not interested 22 24 19 14 41 18
Other specify 19 21 20 14 39 17
The MTR also investigated the non-members who would like to join cooperative health 
insurance. The mid-term evaluation findings as detailed in table 12 show that 66% (56 males 
and 95 females) of the non-members would like to join cooperative health insurance. The 
baseline value for this indicator was 87%. This showed a slight reduction of 11% of the non￾members who would like to enroll. Of those that reported, 34% (35 males and 13 females) are
not interested. The mid-term evaluation findings found a decline in the percentage of people 
interested in joining the health cooperatives at 21%.
Table 12. Non-members who would like to join Cooperative Health Insurance
Non-members who would like 
to join cooperative health 
insurance
Total
Gender Age Group
Male Female 18-24 Yrs 25+ Yrs
230 91 139 37 192
Would you like to Join the 
Health Cooperative Insurance
151 56 95 24 127
66% 62% 68% 65% 66%
Don’t like to join the health 
cooperative health insurance.
79 35 44 13 65
34% 39% 32% 35% 40%
The evaluation also probed further to find out whether those who would like to join are willing 
to attend a sensitization session on aspects of cooperative health insurance. Table 13 details 
the findings. Out of the 230 non-members interviewed, 69% (61 males, 99 females) are willing 
to attend the session. The analysis, presents an opportunity for HPU to engage in 
sensitizations to recruit additional members to the health cooperative insurance scheme in 
the different districts of implementation as an initiative to increase coverage of the model. 
There was no baseline value for this indicator.
Table 13: Percentage of non-members willing attend a sensitization event on Cooperative Health 
Insurance by Sex and Age group.
Gender Age Group (Yrs)
30 | Page
Willingness to attend a 
sensitization of 
cooperative health 
insurance.
Male = 91 Female = 
139
Total = 230 18 to 24
= 230
25 and 
Above = 91
Total = 321
No % No % Total % No % No % Total %
Yes 61 67 99 71 160 70 160 70 61 67 221 69
No 30 33 40 29 70 30 70 30 30 33 100 31
Table 14: Percentage of Non-members’ willing to attend sensitization as they wait to be 
attended to at the health facility.
Willingness to wait at 
the health facility
Gender Age Group (Yrs)
Male Female Total 18 to 24
yrs
25 + yers Total 
No % No % Total % No % No % Total %
Yes 37 57 71 66 108 63 23 79 85 60 108 63
No 28 43 36 34 64 37 6 21 57 40 63 37
Total 65 107 172 100 29 142 171 100
The non-members of health cooperatives were also asked whether they were willing to learn 
about health insurance while they waited at the health centre during a visit for any health 
service. The mid-term evaluation findings in table 14 above indicated that majority of the non￾members represented (63%) are willing to wait and learn about the health insurance scheme 
while 37% are not willing to wait. 
This analysis presents an opportunity for organizing health facility-based sensitization 
meetings for non-members. This was further supported by the findings that indicated that the 
average waiting time most non-members spent before getting a service at the health facility 
was an average of 34 minutes and 44 minutes for men and women respectively.
This shows there is an opportunity for increasing awareness about the health cooperative if 
at all health cooperative facilities, sensitizations can be organized targeting non-members 
who come to seek health services. There was no baseline value for this particular indicator.
13. Quantify the difference in health seeking behavior of cooperative members overall 
and for those age 10-24 versus the non-health cooperative members the same age.
Table 15 details the difference in health seeking behavior for the cooperative members which 
is 94% and for non-cooperative members it was registered at 83%. Which means that the 
members are more likely to seek medical care compared to non-cooperative members. This 
shows that insurance increases the rate at which people seek needed care. The baseline 
survey indicated that 77% of the members and 51% of the non-members seek medical or health 
31 | Page
care. This clearly shows there was an increase by 17% increase in seeking behavior services 
amongst members 32% amongst the non-members. 
Table 15. Difference in health seeking behavior
Member status Gender Age Group
Member Non-member Male Female 18-24
25 and 
above
Total 448 213 235 184 264 71 375
Sought health 
care services 
88% 94% 83% 89% 87% 90% 88%
Did not seek 
health services 
12% 6% 17% 11% 13% 10% 12%
Median age at first intercourse 
Table 16 shows the median age (in years) at first intercourse for the different categories of 
respondents interviewed. In the age group of respondents between 18-24 years, the median 
age of first intercourse was 18 years while in the age category above 25 years, the median age 
was 19.3 years. The evaluation has also noted that there was a remarkable difference between 
median age at first intercourse for males and females represented by 17.9 years and 20.5 years 
for males. This means females engage in sexual intercourse at a very early age. 
Over all, the median age at first intercourse for health cooperative members was 19.6 years 
and for the non-health cooperative members, it is 18.9 years. The baseline survey findings 
indicated that the median age at first intercourse for cooperative members was 18.5 years 
while for the non-members, it was 17.7 years. Which means, the average number of members 
reporting their first age of sexual intercourse increased from 18.5 to 19.6 years while that 
reported by non-members also increased from 17.7 to 18.9 years. The delay in age at first 
intercourse has a great impact on the health of the population, reducing total birth rates
overall and other associated negative effects of beginning sexual intercourse at an early age. 
Table 16: Median Age (in years) at first intercourse
Member status
A2: Sex of 
Respondent Age Group
Member 
Non￾member Male Female
18-
24
25 and 
above
Median 19.2 19.6 18.9 20.5 17.9 18.0 19.3
Standard 
deviation 3.7 4.0 3.5 3.8 3.1 1.5 3.8
Maternal and child behavior 
Findings from the KPC survey indicate that 55% (117) and of the member and 59% (139) non￾member women or spouses to male respondents had given birth. 
Age when women gave birth to first child 
32 | Page
From Table 17 below, it is observed that the age at which the woman gave birth to her first 
child averages 23 years with slight differences between members and non-members overall. 
A comparison between regions, shows that for members, women in the North are most likely 
to give birth to their first child at a lower age (20 years.) Women in the central region are more
apt to give birth at an older age compared to other regions. 
Table 17: Age at which woman gave birth to first child
Category Members Non-members
N Mean 
years
SD N Mean 
years
SD
Age Group
18-24 3* 18 2.309 8* 20 2.925
25 and above 109 24 5.663 124 23 4.676
Region
Southwestern 44 25 5.032 59 24 4.657
East 23 21 2.741 30 22 3.589
North 18 20 2.635 22 22 4.200
Central 27 26 7.979 21 25 6.013
Overall 112 23 5.658 132 23 4.673
*The sample is so small to make any statistical conclusions 
Further analysis in Figure 1 shows that of the women who have given birth, the majority 
wanted to get pregnant at the time they conceived their first child. It was observed that there 
was a significant difference among members and non-members of health insurance, with the 
latter more likely to have wanted to get pregnant (89%) compared to the members (79%.)
Figure 1: Willingness to get pregnant at the time of conceiving first child
Table 18: When last child was born
When last child was born HC members HC Non-members
N % N %
79% 89%
21%
11%
Members (N=117) Non-members (N=139)
Willingness to get pregnant with first child at that time 
Yes No
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In the last 12 months 18 15 15 11
1-2 years ago 23 20 37 27
More than 2 years ago 76 65 87 63
Total 117 100 139 100
From table 19, it is evident that there is a difference between members and non-members 
where their last child was born. For members, most mothers gave birth in private health 
facilities (44%), a proportion significantly higher than their non-member counterparts (36%.)
Given that health insurance targeted more private health facilities, there might be a 
relationship between having health insurance and place where child is born. Notable is that it 
is a common practice for both members and non-members to utilize health facilities for 
maternal services. 
Table 19: Place where last child was born
Place of giving birth Members Non-members
N % N %
Public Health Facility 36 31 59 42
Private Health Facility 51 44 50 36
At home alone 6 5 6 4
At home with a traditional birth attendant 9 8 8 6
At traditional birth attendant’s home 7 6 9 6
Other 8 7 7 5
Total 117 100 139 100
Table 20 reveals that the quest for better services and existence of health insurance highly 
influenced the decisions for HC insurance members where they gave birth to their last child 
born prior to the survey. Although better services also influenced non-members, the health 
facility being closer to home is an important factor. Therefore, health insurance owners are 
most likely to use the facilities that provide insurance services even if they are not closer to 
their homes but can also provide better services. 
Table 20: Factors influencing choice of health facility
Factors influencing choice of place for giving birth Members Non-members
N % N %
Health insurance 31 26 - -
Better services 34 29 52 37
Nearer to my home 15 13 51 37
Was an emergency thus I had no control 19 16 16 12
Privacy 5 4 7 5
Other specify 13 11 13 9
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Total 117 100 139 100
Incidence of having a child Under 2-year child Health
Of the households with a woman that has given birth, 33% of members and 38% of non￾members, indicated having a child less than two years old. This was most common in the 
central region(49%), followed by the east (44%), north (43%) and the south western (22%). 
The average age in months of these children was 12 months. 
Number of health facility deliveries and Number of pregnant women attending four antenatal 
visits 
During the pregnancy of the children aged less than two years, 90% members and 91% of
non-members attended antenatal care. The baseline value for this indicator was 74% for 
members and 85% for non-members. Table 21 shows that the majority of both members and 
non-members attended four or more antenatal care visits. Members of health insurance 
(64%) were more apt to go for all four recommended antenatal care visits compared to non￾members (59%.)
Table 21: Number of ANC visits
Number of visits Overall Members Non-Members
N % N % N %
Less than 4 visits 89 39 37 36 52 41
4 or more visits 140 61 66 64 74 59
Total 229 100 103 100 126 100
Table 22 presents a summary of information obtained from the health facilities. It is important 
to note that information for some months within the reference period was not obtained.
Table 22. Number of Deliveries and pregnant women attending antenatal care
Health facility No. of 
deliveries 
Number of pregnant 
women attending 
antenatal (cumulative 
visits)
Reference 
period 
No. of months for 
which information 
was collected 
Kitanga HC III 218 148 August 2019 –
December 
2020
17
Ibanda Mission 300 202 April 2019 –
Dec 2020
21
Bishop Asili 
Hospital
405 880 April 2019 –
Dec 2020
6
Aero Medical 
Clinic
504 376 May 2019 –
Dec 2020
21
St. Francis of 
Asisi Naddangira 
HC
242 169 12
35 | Page
Health facility No. of 
deliveries 
Number of pregnant 
women attending 
antenatal (cumulative 
visits)
Reference 
period 
No. of months for 
which information 
was collected 
Alleluyah Joint 
Maternity Clinic
582 317 Sept 2019 -
Dec 2020
12
Note: One of the key challenges faced by the health facilities is having up-to-date records. 
Additionally, the information is seldom categorized by health insurance members or non￾members especially information on maternal and child health indicators. Thus, it was difficult 
to ascertain the health seeking behavior by insurance membership. The baseline value for 
cooperative members was not indicated while the one for non-members was 60.
Under 2 child health status 
Immunization 
Similar to the baseline, the mid-term review assessed the extent to which respondent 
households had immunized their children under two years. Overall, at least 9 out 10 children 
under 2 years had been fully or partially immunized at mid-term review. Full immunization was 
most likely to occur among children from households with health insurance as shown in Table 
23 which represents a similar trend to the baseline. 
Table 23: Immunization status of children under 2 years
Immunization status Members Non-members
N % N %
Fully immunized 25 64% 32 60%
Partially immunized 13 33% 16 30%
No record 1 3% 5 9%
Total 39 100 53 100
Breastfeeding status
In Figure 2 the proportion of mothers with a form of health insurance (62%) was higher than 
that without (47%). This trend or characteristic was similar to that observed at the baseline. 
36 | Page
Figure 2: Breastfeeding status of children under 2 years
14. Average number of sick days before seeking care.
The MTR revealed that there was a slight difference between the health cooperative member
and non-member in terms the number of days after on-set of symptoms before seeking
medical advice as shown in Table 24. Forty-one (41%) percent of members and 37% of non￾members sought treatment on day they fell sick. There was no baseline value for this indicator 
to provide a basis for comparison.
Table24: Average number of sick days before seeking care
Average 
number of 
sick days 
before 
seeking care
Member status Gender Age group 
Members Overall 
Non￾members Male Female 
18-24 
yrs 25+yrs
No % No % No % No % No % No % No %
Same day 82 41 71 37 63 38 90 39 27 42 126 38 153 39
One day 40 20 40 21 34 21 46 20 10 16 70 21 80 20
15. Percentage difference in treatment seeking behavior between cooperative members 
and non-members 
The mid-term evaluation findings established that 94% of the cooperative members and 84%
of the non-members of the health cooperatives sought medical care from health facilities. The 
interviews with the health facility staff established that cooperative health insurance 
members sought medical care and medical diagnostics more than non-members and this is 
attributed to insurance-- the lower costs involved for cooperative member care seeking. The 
findings of the KPC established that non-insurance members are likely to pay three times
more for medical care compared to insurance members represented by self-reported total 
annual expenditure on care at 201,308 UGX by non-members and at 65,761 UGX by members.
53% 62%
47% 47% 38% 53%
Overall (N=92) Members (N=39) Non-members (N=53)
Breastfeeding status of children under 2 years
Yes No
37 | Page
The baseline value for the indicator is 77% for the cooperative insurance members and 51% for 
non-members.
The findings further revealed that the health seeking behavior for members was at 4.8 times 
while for non- members it was at five times per . This shows that there was no significant 
difference in the health seeking behavior between members and non-members. The MTR 
established an increase in the treatment seeking behavior by 16.9% amongst the cooperative 
health insurance members and 31.6% amongst the non-members.
One Cooperative Health focal person mentioned during the KIIs that “Unlike non-members, 
community health insurance members have better health-seeking and preventive behaviors
because they do not worry about medical bills when they feel unwell. They timely seek for 
care and services.”
The findings of the document review revealed that despite the impact of COVID- 19 and the 
lockdown imposed by the government, the members accessing health services through the 
health cooperatives increased significantly from 24,560 UGX in 2019 to 26,000 UGX by July 
2020 as well as the number of health care providers from 41 in 2019 to 58 in 2020UGX4
16. What is the Annual health care expenditure reported by members and non-members?
Analysis of this question focused on the expenditure made using out of pocket payments for 
health related costs. The findings of the KPC conducted among health cooperative members
established that the average annual health care expenditure made in form of premiums, 
copays and others was 116,974 UGX (32 dollars).
The MTR also inquired into the estimated out of pocket household expenditure in 2020. The 
findings indicated that the health cooperative insurance members paid less compared to the 
non-members represented by 65,761 UGX (20 dollars) and 201,308 UGX respectively. The 
percentage difference on this category of payment is 67.3% (61.7 dollars) for non-members. 
There was no baseline value for the indicator.
17. Percentage difference of average annual health care expenditure reported by 
members and non-members
The percentage difference between the average annual health care expenditure for members 
and non-members of the health cooperative was almost 9.2%. The expenditure for members 
(premium, copay & out of pocket) was UGX 182,735 and the expenditure for non-members 
was purely out of pocket and amounted to 201,308 UGX. At the baseline, the percentage 
difference between cooperative and non-cooperative members was 11% and 89% for non￾members respectively. This indicates that the health cooperative non-members spend higher 
on health -related expenses compared to the health cooperative members. This correlates 
with the responses obtained regarding the challenges faced by both health cooperative 
members and non-members. 
38 | Page
3.2 What factors have constrained implementation? How are constraints being addressed?
The MTR established factors constraining the implementation of the health cooperative 
model they include the lack of good documentation and data in some of the health facilities 
the MTR team visited. In some of the health facilities the data was incompletely filled for 
example the in St Francis of Asili Naddangira Health Center III, data for 2019 was incomplete, 
and the health providers also did not have skills on how to complete the data collection tools 
such as the CPTT. This data was dis-regarded by the MTR team. In some instances, the 
computations on the CPTT were inaccurate and some of the tools were not signed off by the 
in charges of the health facilities as recommended by HPU. Inconsistencies were also noted 
in the data that was computed on the CPTTs. The interaction with the health care providers 
that complete the data collection tools established that the completing the CPTT is additional 
work thus viewed as tedious task in addition the routine roles at the health facilities since it 
does not fetch any additional payment. This is one of the likely causes of poor records at the 
health cooperative health facilities. 
The MTR also established that HPU changed tools or added variables to the existing CPTTs. 
During that period, HPU introduced three versions of CPTTs to the health facilities. The MTR 
revealed that between June 2019 and December 2020 HPU introduced three versions of the 
CPTT. This is a likely cause of validity issues in the quality of data that is collected and 
submitted to HPU. 
The KIIs with MITC revealed that the coverage of the model is in a few districts. It was cited 
that in the central region there is hardly any significance of the presence for the model. HPU 
is not reaching out to other health providers to have the model embraced. 
Another factor that has affected implementation and achievement of sustainable results is 
the limited involvement of key stakeholders such as the district technical staff at the 
implementation level. Some of the participants in the MTR such as the District Commercial 
Officers, District Community Development Officers and District Health Officers in the districts 
the MTR team visited did not know about HPU and the role of the health cooperatives in the 
districts. There is a possibility that if the model is introduced to the districts this will facilitate 
the increase in the coverage of the model in the districts as well as provision of technical 
support through the offices of the District Commercial Officers and other relevant offices.
In Alebtong, for example, the Acting DHO/Maternal child health officer said “I don’t know the 
details about HPU and the health cooperative insurance scheme in the district but sometime 
back I was told about its presence” Similar responses were obtained from Kalungu, Wakiso, 
and Luwero districts. In some of the districts, the MTR was the first time the district staff 
heard about health cooperatives in the districts. In Oyam and Alebtong, Abt Associates was 
more pronounced and associated with cooperative health insurance than HPU. 
COVID-19 affected the implementation of the health cooperative services in the districts. The 
trainings, support supervision visits, review meetings and all other stakeholder engagement 
39 | Page
activities that required direct interaction with clients could not take place. Many of the newly 
recruited health providers as well as the cooperatives could not start operating until when 
HPU rolled out a virtual support supervision tool.
3.3 Unanticipated effects, both positive and negative?
The evaluation also established the positive unanticipated effects related to the Connect Girls 
Center activity. Below are some of the incipient signs of the positive effects.
The interaction with cooperative members showed an increased number of cooperative 
health insurance schemes and an increase in the number of members who had enrolled. The
increased number of cooperative health insurance schemes and the members who have 
enrolled provided a good platform for networking and building social cohesion among the 
members at the community level. This social capital is a stepping stone for the community to 
utilize to self-organize and mobilize. It was noticed that the cooperative health insurance 
groups in some areas such as Wakiso and Sironko started mobilizing themselves to utilize the 
group as a platform to bring members together and form a savings group. It is envisaged that 
the savings initiative will improve the accessibility to micro credit for members to engage in 
different income generating activities and thereby improve upon their earnings and 
affordability for the premiums.
One of the anticipated negative effects lies in the relationship between the CONNECT Girls 
Centers and the health cooperatives.
During the KII, an Officer from the MTIC said “Connect Girls Center is straining the 
cooperatives it is intended to serve. Buhweju Girls Center is not adding value to the 
cooperative. There is no satisfaction because there is a gap between the boards and the 
cooperative members. The cooperatives were not ready to take on Connect Girl Centers. 
Connect Girl Center is not in any way linked to the board and they therefore lack the capacity 
to influence decision making.” 
During the KIIs, eight facility focal persons mentioned that health cooperative insurance led
to an increase in the demand for health services and products at the health facilities. In some 
of the health facilities, the demand was so sudden that it presented challenges due to the lack 
of capacity of the health care provider to offer adequate services to the big numbers of clients 
they received. The health facilities are gradually beginning to adjust their mode of operation 
to accommodate this sudden surge in numbers of members seeking health care services.
There was another challenge of health cooperative members abusing the scheme. In some of 
the facilities, it was reported that health cooperative members sought medical services for 
even the slightest health related issues. This, apart from depleting the profits, made it hard 
for the facilities to recover their costs. This was shared by the facility in charge of Villa Maria 
Hospital, Alleluyah and Bishop Asili hospital in Luwero.
40 | Page
The evaluation established that out of the CONNECT Girls Centers established in Isingiro, 
Buhweju, Ibanda and Rukungiri, there are only two active Girls Centers. The KIIs with the 
districts in Isingiro revealed that while Girls Centers were established in the districts, the 
district technical staff was not aware of HPU presence in the district and the role of health 
cooperative insurance. 
The District Health Officer for Isingiro said “I have never heard about HealthPartners or Girls 
Connect project in Isingiro District. I advise the organization to go and register with the office of 
the Chief Administrative Officer and the District Communications Officer for it to be recognized 
in Isingiro district.”
3.4 What adjustments, if any, should HealthPartners make to improve the likelihood of 
achieving indicator targets by the activity’s end?
The findings of the MTR revealed that seven8 out of the 13 districts were not aware of HPU 
presence and operation in the districts and the role of health cooperatives. HPU needed to 
improve the collaboration with the respective District Local Governments since they are in 
charge of regulation, inspection and providing technical guidance to such initiatives in the 
districts. 
The Acting DHO in Alebtong said “Personally I think partnership as far as the program is 
concerned is good for our community members and the question is how is it implemented? 
How was Alleluia Joint Medical Clinic selected to be a health cooperative provider? Can the 
facility be disqualified if it’s not giving quality services? The last question is how is the district 
involved in this project? The district is not involved but when it comes to evaluation, the 
district is involved. Does the district have any say, any contribution or whatever?”
a) Provide more support towards the health facilities to improve the quality of the 
reports and data collected from the health facilities. This will help to address the gaps 
regarding accuracy, completeness and correctness of the reports especially the CPTTs. 
It is also recommended that a conversation with the staff at the facility should be 
explored in order to comprehensively map the different challenges they find in 
documentation and thereby jointly come to amicable solutions.
b) The KPC survey findings indicated that 70% of the non-members are willing to attend 
sensitization events while 63% of those willing to learn more about the health 
insurance expressed willingness to be sensitized as they wait for services at the facility. 
Additional support should be extended to the health facilities to develop sensitization 
plans and also implement them. This will facilitate uptake of the cooperative health 
insurance scheme. 
8 Please name these seven districts here
41 | Page
c) HPU should continue to facilitate learning and experience sharing visits amongst the 
health cooperative service providers. These should be structured in a way that they 
facilitate learning and sharing of experiences on the cross cutting emerging issues, 
best practices, innovations and adaptive mechanism being adopted by different health 
providers. The learning exchange visits brought together different stakeholders to 
learn and share experiences amongst themselves. The knowledge gained was 
replicated elsewhere in the respective health centers. 
d) A review of the data submitted to HPU established that out of the 24 health 
cooperative providers under UPMB, only six are currently reporting. Under the UCMB, 
17 out of 18 are reporting while under the category of Private health Facility, 3 out of 
73 are currently reporting to HealthPartners. HPU should devise ways to improve 
reporting by the health facilities. It is important that HPU appreciates the challenges 
faced by the health facilities and devise solutions to overcome them. 
e) HealthPartners should invest more into the management of the Girls Centers and align 
this investment with the felt needs of the girls as opposed to leaving the management 
of the Girl Centers entirely to the cooperatives. This is because Girls Centers are owned 
by cooperatives but the cooperatives that are already constrained are unable to 
support the activities of the Girls Centers. 
In an interview with the Chairperson of the cooperative Girls Centers said, “There is need for 
a change of the name to accommodate both boys and girls. The documents indicated that the 
Girl Centers are supposed to host children and youth of both sexes aged from 10-24. However, 
Girls Centers did not host boys until Feb 2021 when four boys joined Buhweju Girls Center. The 
untrained boys continue to exercise their socially given right to be ‘men,’ they will 
consequently water down whatever training, information and empowerment that is given to 
girls. This is so much the case because these same girls will end up getting married to the boys 
who are not enlightened. To create an enabling environment for both boys and girls, there is 
a need to adopt an accommodating name, for example, ‘Youth Centers’ to recruit boys into 
the centers.”
3.5 Lessons learnt
1. Changes in program implementation that will lead to achieving set targets.
The consulting team recommends timely and consistent follow-up on plans and commitments 
made between HPU and the different partners especially the health cooperatives and health 
facilities in Rukungiri. One a staff from potential partner, Kadoth, informed the evaluation 
team that she established the center even though her application was not approved then
waited for funding from HPU in vain. So, another partner got in touch and took over the 
project. According to the responses from the key informant interviews in Mbarara, initial 
contacts and discussions were made but no follow up was made so the process of establishing 
the Girl Center stalled. 
42 | Page
The limited collaboration between the health providers and the health cooperatives on one 
side and the district local governments on the other side might affect the smooth 
implementation of the Connect Girls Center activity and the level of achievement of results. 
Much as the health cooperatives are linked to the MTIC, it would be better to have them linked 
to the District to be able to access technical support cheaply and conveniently.
The mid-term evaluation revealed that the coverage rate of cooperative health insurance is 
very minimal in Northern, Eastern and Central regions of Uganda. On that note, it is important 
to invest effort in ensuring that more health care providers are enrolled into the scheme.
43 | Page
Annex 1: KPC Respondent Characteristics
A1.1 Demographic characteristics
Out of the 532 target responses, a total of 448 responses were obtained from the KPC study, 
giving a response rate of 84.2%. Of these 213 (48%) were for members of health 
insurance/cooperatives (41.8% males and 58.2% females)and 235 (40.4% males and 59.6% 
females) were non-members. The average age for respondents was 40 years with 42 years 
among the health insurance members and 39 years for non-members. A total of 73 (15.8%) 
were aged were aged 18-24 years and 375 (84.2%) were 25 years and above. 
The majority of the respondents were married or cohabiting (65.2%). 
A similar trend is observed by membership to health cooperative/insurance and gender. 
Notable is that females were more likely to be separated/divorced or widowed compared to 
males.
Almost 88% of the respondents had ever attended school with most obtaining primary 
education as the highest level (37.3%). Further analysis showed that women were most likely 
not to have attended school (15.9%) compared to their male counterparts (6.5%). With majority 
of the members of health insurance have ever attended school, it is envisaged that it becomes 
easier for them to understand the operations and the need to participate in health insurance 
and given that a majority (74.8%) are able to read and write in any language. The major source 
of income for the majority of households was crop production (45.3%). With this source of 
income, it is envisaged that beneficiaries will often earn seasonally, and hence, find difficulties 
to incur expenses related to health more often, if they are not part of a health insurance 
scheme. Similarly, affects the salaried workers who earn mostly on a monthly basis. 
The average household size is six persons with health insurance members having a lower 
household size (about six) compared to non-members (about seven). Of these, overall, only 
four persons earn an income in the household; a big difference is observed between members 
and non-members of health insurance with the latter (five persons) having a bigger number 
of household members contributing than the former (around four persons). Therefore, it is 
implied that with many persons contributing to household income, the non-members most 
probably do not see the need to have insurance. 
Table: 25. Selected demographic characteristics of respondents.
Characteristics Total
Health insurance/Health Coop 
Member status Sex
Member Non￾Member Male Female
Total Number 448 213 235 184 264
i) Marital Status
Single 103 44 59 50 53
23.0% 20.7% 25.1% 27.2% 20.1%
Married/cohabiting 292 146 146 123 169
65.2% 68.5% 62.1% 66.8% 64.0%
44 | Page
Divorced/separated 28 12 16 9 19
6.3% 5.6% 6.8% 4.9% 7.2%
Widowed 25 11 14 2 23
5.6% 5.2% 6.0% 1.1% 8.7%
ii) Highest level of education attained
Never attended 54 26 28 12 42
12.1% 12.2% 11.9% 6.5% 15.9%
Primary 167 90 77 63 104
37.3% 42.3% 32.8% 34.2% 39.4%
O level 122 45 77 49 73
27.2% 21.1% 32.8% 26.6% 27.7%
A level 39 23 16 23 16
8.7% 10.8% 6.8% 12.5% 6.1%
University 39 12 27 25 14
8.7% 5.6% 11.5% 13.6% 5.3%
Other tertiary 27 17 10 12 15
6.0% 8.0% 4.3% 6.5% 5.7%
iii) Literacy level
Neither able to 
read nor write
74 35 39 17 57
16.5% 16.4% 16.6% 9.2% 21.6%
Able to read only 27 12 15 7 20
6.0% 5.6% 6.4% 3.8% 7.6%
Able to read and 
write
335 160 175 156 179
74.8% 75.1% 74.5% 84.8% 67.8%
Able to write, not 
read
12 6 6 4 8
2.7% 2.8% 2.6% 2.2% 3.0%
iv) Main income generating activity for the household
Salaried worker 83 45 38 43 40
18.5% 21.1% 16.2% 23.4% 15.2%
Self-employment 
e.g personal shop, 
Grocery
86 33 53 36 50
19.2% 15.5% 22.6% 19.6% 18.9%
Farming (livestock) 22 15 7 8 14
4.9% 7.0% 3.0% 4.3% 5.3%
Farming (crop 
production)
203 97 106 78 125
45.3% 45.5% 45.1% 42.4% 47.3%
Casual labourer 33 12 21 16 17
7.4% 5.6% 8.9% 8.7% 6.4%
Remittances/gifts 21 11 10 3 18
4.7% 5.2% 4.3% 1.6% 6.8%
v) Household size 
Average household 
size
6.2
(SD =10.2)
5.7
(SD =6.8)
6.7
(12.5) 
Average members 
earning income 
4.4
(SD=0.9) 
3.6
(SD=1.0)
5.2
(SD=0.74)
45 | Page
A1.2 Water Sanitation and Hygiene
Figure 3 below shows that the most common toilet facility used is the pit latrine by almost 
nine (9) in 10 households (88%). Only 6 percent have a VIP latrine. The type of toilet facility 
owned or accessed by most households does not differ from what is normally used in rural 
and upcountry areas. 
Figure 3 Type of toilet facility
By type of hand washing facility owned, majority use the jerry can (59%) with no significant 
differences observed between members and non-members of health insurance as shown in 
Figure 4 below. Use of the jerry can might not necessarily imply there is a designated item for 
hand washing but probably any jerry can with water can be used. 
Figure 4 Handwashing facility
Results of Hand-washing behavior at mid-term do not differ much from the baseline as the 
most common behaviors are similar between the two periods. Majority was hands after 
visiting the toilet (94.6%) followed by before meals (90.8%) and after meals (89.7%) as shown 
in Table 20 below. The likelihood to wash hands before preparing the meal is low (35.9%) 
which behavior is mostly likely to cause spread of diseases. 
1% 1% 0%
88% 87% 90%
3% 2% 4% 2% 3% 2% 6% 6% 6%
Total (N=448) Member (N=213) Non-member (N=235)
None Pit latrine Flush toilet Community latrine VIP latrine
14% 12% 16% 15% 15% 16%
8% 8% 9%
2% 3% 1%
59% 60% 57%
2% 1% 2%
Total (N=448) Member (N=213) Non-member (N=235)
None Tap Tippy tap Bowl and cup Jerry can Others
46 | Page
Table 26: Hand-washing behavior
Hand-washing behaviour Total Health insurance 
Member status
Gender
Member 
household 
Non￾member 
household 
Male Female
Number 448 213 235 184 264
After Visiting the toilet
424 199 225 169 255
94.6% 93.4% 95.7% 91.8% 96.6%
Before meals
407 194 213 161 246
90.8% 91.1% 90.6% 87.5% 93.2%
After meals
402 190 212 159 243
89.7% 89.2% 90.2% 86.4% 92.0%
After changing baby’s diaper
48 26 22 3 45
10.7% 12.2% 9.4% 1.6% 17.0%
Before breastfeeding
61 33 28 11 50
13.6% 15.5% 11.9% 6.0% 18.9%
Before preparing meals
161 77 84 40 121
35.9% 36.2% 35.7% 21.7% 45.8%
Other specify
24 12 12 14 10
5.4% 5.6% 5.1% 7.6% 3.8%
In regards to water sources, Table 27 shows that majority of the households use protected 
sources (88.8%) like boreholes, taps etc. Results further reveal that 77.7 percent of the 
households do treat water to make it safe for drinking. The most common method used is 
boiling (86.2%). This is common amongst both members and non-members of health 
insurance. However, observed is that there is a difference amongst the proportion of 
members and non-members with the former most likely to boil (88%) than the latter (84%). 
Table 27. Treatment of water for drinking
Treatment 
Total
Health insurance 
Member status Gender 
Member 
Non￾member Male Female
348 170 178 148 200
By chlorination (adding aquatab, 
Watergate etc)
48 18 30 19 29
13.8% 10.6% 16.9% 12.8% 14.5%
By boiling
300 150 150 127 173
86.2% 88.2% 84.3% 85.8% 86.5%
Other specify
5 3 2 5 0
1.4% 1.8% 1.1% 3.4% .0%
None
0 0 0 0 0
.0% .0% .0% .0% .0%
47 | Page
A1.3Use of Mosquito nets
Overall, 96 percent of the households interview least at least one mosquito net with health 
cooperative insurance members (97%) most likely to do so compared to non-members (94%). 
Of those owning a mosquito net, these 95.1 percent of the household had at least a member 
sleeping in a net a night before the interview. The household members who slept under the 
mosquito net mostly included the respondent (61.3%) (either male or non-pregnant woman), 
spouse (44.6%) and other household members who are not children (20.3%) as shown in Table 
28. Observed is that male respondents and their spouses were most likely to sleep under a 
mosquito net than the females. 
Table 28 Persons who slept under a mosquito net
Hand-washing behaviour
Total
Health insurance Member 
status Gender
Member 
household 
Non￾member 
household Male Female
Number 448 213 235 184 264
Myself, pregnant
60 26 34 12 48
14.7% 13.1% 16.2% 7.2% 19.9%
Myself, not pregnant
250 119 131 108 142
61.3% 60.1% 62.4% 64.7% 58.9%
Spouse
182 80 102 86 96
44.6% 40.4% 48.6% 51.5% 39.8%
Child Under 5
127 59 68 48 79
31.1% 29.8% 32.4% 28.7% 32.8%
Child 5-10
87 35 52 34 53
21.3% 17.7% 24.8% 20.4% 22.0%
Child 11-18
105 45 60 38 67
25.7% 22.7% 28.6% 22.8% 27.8%
Other specify
83 43 40 28 55
20.3% 21.7% 19.0% 16.8% 22.8%
48 | Page
Annex 2: Tools-FGD & KII Guides
(a) FGD Guide for Cooperative Members.
Introduction
HealthPartners CONNECT Girls Center is a five-year project (2018-2023) to increase community 
resilience and cooperative business performance, to improve the cooperative enabling 
environment and to increase access to design strategies and solutions in Uganda, sharing 
lessons and exploring potential to create impact in Kenya and with partners more broadly. At 
the moment, the CONNECT Girls Center is due for the planned mid-term evaluation. The
objective of the mid-term evaluation is to understand progress so far towards achieving 
project objectives and outcomes to draw out lessons for learning and increasing the rate of 
sustainable change in the remaining project implementation period.
The mid-term evaluation will capture effectively lessons learnt and provide information on the 
nature, extent and where possible, the potential impact and sustainability of the health 
cooperative insurance model.
You have been identified as a key stakeholder to participate and inform the mid-term 
evaluation study. The information you provide will be solely for the purpose of getting 
information to inform the above stated objectives and will be treated with confidentiality.
Guiding Questions
• Kindly introduce yourselves; your name, the health cooperative you belong to and 
your position?
• To what extent has HealthPartners supported health cooperatives to expand? 
o To what extent has CONNECT Girls Center increased the number of health 
providers offering cooperative insurance? What activities have most facilitated 
that? 
o To what extent has CONNECT Girls Center improved the capacity of 
cooperative boards and cooperative care providers to make operational 
decisions? To what extent are members satisfied with benefits they are 
receiving through their cooperative? To what extent are members satisfied 
with decision-making in cooperatives? (for South West only-Ruharo, 
Kyabirukwa, Buhweju)
• To what extent are cooperative care providers and their members satisfied with the 
services and technical support provided by HealthPartners? What factors contributed
to satisfaction, and why?
• Have HealthPartners activities led to any unanticipated effects, both positive and 
negative? 
49 | Page
• What adjustments, if any, should HealthPartners make to improve the likelihood of 
increasing cooperative membership by the activity’s end?
• Are you satisfied with benefits being received from your cooperative membership? 
(Note)
• If so why? If not, not why?
• Are you satisfied with your partnership with your cooperative care provider? 
• If so why? If not, why not?
• Do you have any questions for me?
 
 Thank you for taking part in this study.
50 | Page
(b) FGD Guide for Girls age 15-18(SW only)
Introduction
HealthPartners CONNECT Girls Center is a five-year project (2018-2023) to increase community 
resilience and cooperative business performance, to improve the cooperative enabling 
environment and to increase access to design strategies and solutions in Uganda, sharing 
lessons and exploring potential to create impact in Kenya and with partners more broadly. At 
the moment, the CONNECT Girls Center is due for the planned mid-term evaluation. The
objective of the mid-term evaluation is to understand progress so far towards achieving 
project objectives and outcomes to draw out lessons for learning and increasing the rate of 
sustainable change in the remaining project implementation period.
The mid-term evaluation will capture effectively lessons learnt and provide information on the 
nature, extent and where possible, the potential impact and sustainability of the health 
cooperative insurance model.
You have been identified as a key stakeholder to participate and inform the mid-term 
evaluation study. The information you provide will be solely for the purpose of getting 
information to inform the above stated objectives and will be treated with confidentiality.
Guiding Questions
• Kindly tell me more about yourself (name and where you come from).
• To what extent has preventive health-seeking behavior among girls age 10-24 
improved? 
o In what ways has preventive health-seeking behavior among girls age 10-24 
improved through CONNECT Girls Center support, and what activities have 
most facilitated that? 
• At what age do majority of girls engage in sexual intercourse in this community?
• Do most pregnant girls that give birth do so in a health facility? Yes or No?
• If so why? If not, why not?
• Are pregnant women aware they are supposed to attend all 4 antenatal visits as a 
result of the project activity?
• How many days does it take for you to seek health services whenever you fall sick?
• Have CONNECT Girls Center activities led to any unanticipated effects, both positive 
and negative? 
• What adjustments, if any, should CONNECT Girls Centers make to improve your health 
seeking behavior?
• Do you have any questions for me?
 Thank you for taking part in this study.
51 | Page
(c) FGD Guide for Girls age 19-24 
Introduction
HealthPartners CONNECT Girls Center is a five-year project (2018-2023) to increase community 
resilience and cooperative business performance, to improve the cooperative enabling 
environment and to increase access to design strategies and solutions in Uganda, sharing 
lessons and exploring potential to create impact in Kenya and with partners more broadly. At 
the moment, the CONNECT Girls Center is due for the planned mid-term evaluation. The
objective of the mid-term evaluation is to understand progress so far towards achieving 
project objectives and outcomes to draw out lessons for learning and increasing the rate of 
sustainable change in the remaining project implementation period.
The mid-term evaluation will capture effectively lessons learnt and provide information on the 
nature, extent and where possible, the potential impact and sustainability of the health 
cooperative insurance model.
You have been identified as a key stakeholder to participate and inform the mid-term 
evaluation study. The information you provide will be solely for the purpose of getting 
information to inform the above stated objectives and will be treated with confidentiality.
Guiding Questions
• Kindly tell me more about yourself (name and where you come from).
• To what extent has preventive health-seeking behavior among girls age 10-24 
improved? 
o In what ways has preventive health-seeking behavior among girls age 10-24 
improved through CONNECT Girls Center support, and what activities have 
most facilitated that? 
• At what age do majority of girls engage in sexual intercourse in this community?
• Do most pregnant girls that give birth do so in a health facility? Yes, or No?
• If so why? If not, why not?
• Are pregnant women aware they are supposed to attend all 4 antenatal visits as a 
result of the project activity?
• How many days does it take for you to seek health services whenever you fall sick?
• Have CONNECT Girls Center activities led to any unanticipated effects, both positive 
and negative? 
• What adjustments, if any, should CONNECT Girls Centers make to improve your health 
seeking behavior?
• Do you have any questions for me?
 Thank you for taking part in this study.
52 | Page
(d) FGD Guide for Men age 25-54 (Cooperative Members)
Introduction
HealthPartners CONNECT Girls Center is a five-year project (2018-2023) to increase community 
resilience and cooperative business performance, to improve the cooperative enabling 
environment and to increase access to design strategies and solutions in Uganda, sharing 
lessons and exploring potential to create impact in Kenya and with partners more broadly. At 
the moment, the CONNECT Girls Center is due for the planned mid-term evaluation. The
objective of the mid-term evaluation is to understand progress so far towards achieving 
project objectives and outcomes to draw out lessons for learning and increasing the rate of 
sustainable change in the remaining project implementation period.
The mid-term evaluation will capture effectively lessons learnt and provide information on the 
nature, extent and where possible, the potential impact and sustainability of the health 
cooperative insurance model.
You have been identified as a key stakeholder to participate and inform the mid-term 
evaluation study. The information you provide will be solely for the purpose of getting 
information to inform the above stated objectives and will be treated with confidentiality.
Guiding Questions
• Kindly tell me more about yourself (name and the health cooperative where you come 
from and your position there?).
• How did you get to know or become aware of health cooperatives (one that you are 
a member of)?
• Why did you make a decision to become a member? What encouraged you?
• What are the main benefits you have realized as a result of being a member? 
• Do you feel there is value in being a member? If yes, what do you value most about 
your health cooperative membership? If no, explain why?
• In what ways are these health cooperatives of benefit to you as an individual? (Probe)
• How has joining the health coop improved your health? (Probe for ability to seek and 
use treatment at the facility when you are ill).
• What role does the health cooperative play in the health of the mothers in this 
community (Further probe on access and use of specific services such as ANC, PNC, 
and health facility-based delivery).
• Does being a member of a health cooperative improve your household financial 
status? How? (Probe for ability to save, pay for children’s education, etc.)
• Are you satisfied with the benefits being received from the health cooperative? (Note 
numbers)
• If not, why?
53 | Page
• Are you satisfied with the decision-making that happens in the health cooperative?
• If not, why?
• Are you satisfied with services and technical support provided by HealthPartners? If 
no, why?
• Are there any challenges you face as a health cooperative member? (Probe)
• Do you have any questions for me?
 Thank you for taking part in this study.
54 | Page
(e) FGD Guide for Men age 25-54 (non-Cooperative Members) 
Introduction
HealthPartners CONNECT Girls Center is a five-year project (2018-2023) to increase community 
resilience and cooperative business performance, to improve the cooperative enabling 
environment and to increase access to design strategies and solutions in Uganda, sharing 
lessons and exploring potential to create impact in Kenya and with partners more broadly. At 
the moment, the CONNECT Girls Center is due for the planned mid-term evaluation. The
objective of the mid-term evaluation is to understand progress so far towards achieving 
project objectives and outcomes to draw out lessons for learning and increasing the rate of 
sustainable change in the remaining project implementation period.
The mid-term evaluation will capture effectively lessons learnt and provide information on the 
nature, extent and where possible, the potential impact and sustainability of the health 
cooperative insurance model.
You have been identified as a key stakeholder to participate and inform the mid-term 
evaluation study. The information you provide will be solely for the purpose of getting 
information to inform the above stated objectives and will be treated with confidentiality.
Guiding Questions
• Kindly tell me more about yourself (name and where you come from?).
• Have you ever heard of cooperative health insurance? (note number)
• If yes, what have you heard? (note number)
• If yes (above), why haven’t you joined one?
• From what you have heard or know about health cooperatives, what are the 
benefits?
• Are you interested in becoming a member of a health cooperative? Yes/No (note 
number)
• Why or why not?
• Are you interested in sharing information with others to join? (note number)
• If yes, what information about cooperative health insurance would make it easy for 
more people to join?
• Do you have any questions for me?
Thank you for taking part in this study
55 | Page
(f) FGD Guide for Women age 25-49 (Cooperative Members) 
Introduction
HealthPartners CONNECT Girls Center is a five-year project (2018-2023) to increase community 
resilience and cooperative business performance, to improve the cooperative enabling 
environment and to increase access to design strategies and solutions in Uganda, sharing 
lessons and exploring potential to create impact in Kenya and with partners more broadly. At 
the moment, the CONNECT Girls Center is due for the planned mid-term evaluation. The
objective of the mid-term evaluation is to understand progress so far towards achieving 
project objectives and outcomes to draw out lessons for learning and increasing the rate of 
sustainable change in the remaining project implementation period.
The mid-term evaluation will capture effectively lessons learnt and provide information on the 
nature, extent and where possible, the potential impact and sustainability of the health 
cooperative insurance model.
You have been identified as a key stakeholder to participate and inform the mid-term 
evaluation study. The information you provide will be solely for the purpose of getting 
information to inform the above stated objectives and will be treated with confidentiality.
Guiding Questions
• Kindly tell me more about yourself (name and the health cooperative where you come 
from and your position there?).
• How did you get to know or become aware of cooperative health insurance?
• Why did you make a decision to become a member? What encouraged you?
• What are the main benefits you have realized as a result of being a member? 
• Do you feel there is value in being a member? If yes, what do you value most about 
health cooperative membership? If no, explain why?
• In what ways does health cooperative membership benefit you? (Probe)
• What role does the health cooperative play in the health of the mothers in this 
community (Further probe on access and use of specific services such as ANC, PNC, 
and health facility-based delivery)
• Does being a member of a health cooperative improve your household financial 
status? How? (Probe for ability to save, pay for children’s education etc.)
• Are you satisfied with the benefits being received from the health cooperative? (Note 
numbers)
• Why or why not?
• Are you satisfied with level with decision-making in cooperatives? 
• If not, why?
56 | Page
• Are you satisfied with the decision-making that happens in your health cooperative?
• Are there any challenges you face as a health cooperative member? (Probe)
• Do you have any questions for me?
Thank you for taking part in this study
57 | Page
(g) FGD Guide for Women age 25-49 (Non-Cooperative Members) 
Introduction
HealthPartners CONNECT Girls Center is a five-year project (2018-2023) to increase community 
resilience and cooperative business performance, to improve the cooperative enabling 
environment and to increase access to design strategies and solutions in Uganda, sharing 
lessons and exploring potential to create impact in Kenya and with partners more broadly. At 
the moment, the CONNECT Girls Center is due for the planned mid-term evaluation. The
objective of the mid-term evaluation is to understand progress so far towards achieving 
project objectives and outcomes to draw out lessons for learning and increasing the rate of 
sustainable change in the remaining project implementation period.
The mid-term evaluation will capture effectively lessons learnt and provide information on the 
nature, extent and where possible, the potential impact and sustainability of the health 
cooperative insurance model.
You have been identified as a key stakeholder to participate and inform the mid-term 
evaluation study. The information you provide will be solely for the purpose of getting 
information to inform the above stated objectives and will be treated with confidentiality.
Guiding Questions
• Kindly tell me more about yourself (name and where you come from?).
• Have you ever heard of health cooperatives? (note number)
• If yes, what have you heard about them? (note number)
• If yes (above), why haven’t you joined one?
• From what you have heard or know about health cooperatives, what are the 
benefits?
• Do you have interest to be a member of a health cooperative? Yes/No (note number)
• Why or why not?
• Would you be interested to share information with others to join a cooperative 
insurance scheme? (note number)
• Why or why?
• If yes, what information would about health cooperatives would make it easy for you 
to join?
• Do you have any questions for me?
Thank you for taking part in this study
58 | Page
7.2 KPC Tool.
CONNECT GIRLS CENTER ACTIVITY
MIDTERM EVALUATION
HOUSEHOLD QUESTIONNAIRE
Part A: Identification particulars 
District: 
Sub county 
Parish 
Village 
Name of Respondent 
Name of Interviewer
Name of Supervisor 
Member status:
Health Cooperative member household..1 (10 F and 9 
Males)
Non-member health cooperative household..2 (10 F and 9 
Males)
Introduction 
Hello, my name………. working on behalf of Soland Associated Consults Limited, a legally 
registered research consultancy firm in Uganda. Soland was contracted to carry out a study 
on behalf of HealthPartners Uganda. The study aims at understanding people’s knowledge, 
attitudes and practices towards access to health services in your community and their 
contribution to healthcare. The information you provide will guide HealthPartners to 
effectively implement its project intervention in support of health cooperative development 
in Uganda. Your participation in this survey is completely voluntary and all of your answers 
will be kept in the strictest confidence. Your responses will be combined with that of others 
to show aggregated views and opinions. 
Can I continue with the interview? Yes..1 No..2(IF NO TERMINATE)
START TIME: |__|__| :|__|__| AM / PM 
59 | Page
SECTION A1: DEMOGRAPHICS 
Question Answer Options 
A1: Age (Completed years) 
A2: Sex of Respondent 1.Male
2.Female 
A3: Marital Status 1. Single
2. Married/cohabiting 
3. Divorced/separated 
4. Widowed 
A5: Highest level of education attained 1. Never attended 
2. Primary 
3. O level
4. A level
5. University
6. Other tertiary 
A6: Can you read or write in any language? 1. Neither able to read nor write
2. Able to read only
3. Able to read and write
4. Able to write, not read
A7: What is the main income generating activity for this 
household?
1. Salaried worker
2. Self-employment e.g personal 
shop, Grocery
3. Farming (livestock)
4. Farming (crop production)
5. Casual laborer
6. Remittances/gifts 
HOUSEHOLD DETAILS 
Question Answer Options 
A8: How many people live in this HH?
A9: Do any member(s) of the household have any physical or 
mental impairment or chronic illness?
Yes…1
No..2
A10: If yes, How many member(s) of the household have any 
physical or mental impairment or chronic illness?
A11: How many people in your household earn some income 
that directly benefits the household?
60 | Page
A12: What are the different sources of livelihood/income in 
your household?
(CIRCLE ALL THAT APPLY)
1. Agriculture (Crop, Livestock 
And Animal Product Sales)
2. Unskilled Wage Labor/casual 
Labor
3. Sale of Charcoal, Bricks
4. Petty Trading (e.g. Sale of 
Firewood, Poles, Thatch, Wild 
Greens)
5. Remittances and/or Gift From 
Family/Relatives 
6. Begging, Assistance
7. Skilled Labor (Artisan) 
8. Salaries, Wages (Employees) 
9. Fishing 
10. Brewing 
11. Handicrafts 
12. Government Allowance 
(Pension) 
13. Any Other Not 
Listed_____________
A13: What is the estimated household monthly income from 
all income sources mentioned? 
UGX_________________________
SANITATION AND HYGIENE
A14: What kind of toilet facility does your household use? a. None
b. Pit latrine
c. Flush toilet
d. Bush
e. Community latrine
f. VIP latrine
A15: What kind of hand washing facility do you have? a. None
b. Tap
c. Tippy tap
d. Bowl and cup
61 | Page
e. Jerry can
f. Others 
(specify)……………………….
A16: Can you show me where you usually wash your hands 
and what you use to wash hands?
ASK TO SEE AND OBSERVE
OBSERVATION ONLY: IS THERE SOAP OR DETERGENT OR 
LOCALLY USED CLEANSING AGENT? THE ITEM SHOULD 
EITHER BE IN PLACE OR BROUGHT BY THE RESPONDENT 
WITHIN ONE MINUTE. IF THE ITEM IS NOT PRESENT WITHIN 
ONE MINUTE, CHECK NONE EVEN IF BROUGHT OUT LATER.
Tick all that apply
There is evidence of clean water 
used to wash hands….1
There is evidence of use of 
soap/detergent/cleansing agent 
for hand washing….2
A17: When do you wash hands? Tick all that apply 1. After Visiting the toilet
2. Before meals
3. After meals
4. After changing baby’s diaper
5. Before breastfeeding
6. Before preparing meals
7. Other..specify
A18: What is the main source of drinking water for members 
in your household?
a. Protected E.g. Bore holes, 
taps
b. Unprotected e.g. Rivers, 
ponds
A19:Do you treat your water in any way to make it safe for 
drinking?
Yes…1
No..2
A20: If yes, what do you usually do to make it safer to drink? a. By chlorination (adding 
aqua tab, Watergate etc)
b. By boiling
c. Others 
(specify)…………….
d. None
USE OF MOSQUITO NETS
62 | Page
A21: Does your household have any mosquito nets that can be 
used while sleeping? 
Yes…1
No..2
For each mosquito net ASK: 
A22: ASK THE RESPONDENT TO SHOW YOU ALL THE NETS IN 
THE HOUSEHOLD. RECORD FOR EACH NET OBSERVED
1. Observed hanging
2. Observed Not hanging or 
packaged
3. Not observed
A23: Did anyone sleep under this mosquito net last night? Yes…1
No..2
A24: Who slept under this mosquito net last night? (Do not 
prompt. Circle all that are mentioned.)
1. Myself, pregnant
2. Myself, not pregnant
3. Spouse
4. Child Under 5
5. Child 5-10
6. Child 11-18
7. Other specify…….
SECTION B: HEALTH SEEKING BEHAVIOUR AND HYGIENE
B1In the last 12 months, has any member of your 
household needed medical care?
SELECT ONE ONLY
1. Yes
2. No
B2 How many times did you/any member of 
your family visit a health facility mentioned in 
the last 12 months (1 year)?
List number of times each facility 
B3 How many days after the symptoms began 
did you first seek advice or treatment? 
1. Same day
2. One day
3. Two days
4. More than two days
99. Did not seek treatment
B4If no treatment was sought, why was this? 1. Did not need treatment
2. Did not have money
3. Health facility is too far off
4. Due to religious reasons
5. Due to cultural reasons
6. Other..specify
B5What is the distance to the nearest health 
facility from your house? WRITE IN
Distance in KMS
63 | Page
B6Please tell me all the facilities where 
members of your household have sought advice 
or treatment in the last 12 months? 
1. Government Hospitals
2. Government Health Centers 
3. Private Hospitals
4. Private Clinic or health center
5. Pharmacy/drug shop
6. Other facility, specify ____________ 
B7What type of service did you/family seek at 
the health facility/is you mentioned? Probe for 
the entire year for each facility visited 
OUTPATIENT
1. Family planning
2. ANC/Delivery/PNC
3. Newborn care
4. Malaria
5. Fever
6. Diarrhea
7. Typhoid
8. HIV/AIDS/STI
9. High Blood Pressure
10. EAR/Nose/Throat Infection
11. Diabetes
12. Eye Infection
13. Check up/preventive care
14. Accident/Injury
15. Other outpatient services (specify)
INPATIENT
16. Pregnancy/Delivery
17. Child Illness
18. Accident/Injury
19. Other inpatient (specify)
B8 Do members of your household pay 
insurance premiums?
1. Yes
2. No
If yes, what was your estimated household 
expenditure in terms of premiums, copy, dues 
and/0r shares in 2020?
UGX_________________________
B9: If no, what was your estimated out of 
pocket household expenditure on health care, 
including health facility visits and medications in 
2020? 
UGX_________________________
B10If you do not have health insurance, where 
did you get money to pay for medical treatment 
or drugs in the last 12 months?
SELECT ALL THAT APPLY
1. Had saved enough money
2. Sold property
3. Borrowed money
4. Treatment on credit
5. Other, specify ______________
64 | Page
B11Do you have to pay out of pocket for 
medicine and services you receive in health 
facilities?
INTERVIEWER: THIS DOESN’T INCLUDE THE 
AMOUNTS PAID FOR HEALTH COOPERATIVE 
INSURANCE 
3. Yes
4. No
B12What challenges if any did you encounter in 
the health facilities visited?
SELECT ALL THAT APPLY AND ASK FOR EACH 
FACILITY VISITED 
1. None
2. Drugs out of stock
3. Lack of transport money
4. High cost of treatment
5. Facility is very far 
6. Other, specify _________
7. None
B13Was the service you sought available?
List for each service sought.
1. Yes
2. No
B9 Please rate the quality of services you 
received from the facilities you/members of 
your family visited 
on a scale of 1 to 5 where 1 is very poor and 5 is 
very good
SELECT ONE ONLY AND RATE FOR EACH 
FACILITY VISITED 
1. Very Poor
2. Poor
3. Neutral
4. Good
5. Very Good
6. No response
B10Referring to health facility/is visited in the 
last 12 months would you say their services are 
better, same or worse compared to previous 
years? RATE FOR EACH VISITED 
1. Better
2. Same
3. Worse
4. Can’t tell/Don’t know
B11To what extent do you agree that: the health 
facility you visit invests each year to improve 
the quality of care provided?
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Agree Strongly
SEXUAL ACTIVITY
ASK ALL 
B12: Check for the presence of others before continuing and 
make every effort to ensure privacy
Now I would like to ask about your sexual activity in order to 
gain a better understanding of some important life issues. 
Age:
65 | Page
How old were you when you had sexual intercourse for the 
very first time?
Never Had Sexual Intercourse (Record 00) 
First time when started living with first husband/partner (95)
Refused to answer (record 99)
SECTION B: MATERNAL AND CHILD HEALTH 
MATERNAL HEALTH
B13: Have you or has your partner (for men) ever given birth 
before?
1. Yes
2. No 
B14IF YES: When was the last child born?
SELECT ONE ONLY
1. In the last 12 months 
2. 1-2 years ago
3. More than 2 years ago
B15 Where did you/your partner give birth? 
1. Public Health Facility
2. Private Health Facility
3. At home alone
4. At home with a traditional 
birth attendant
5. At traditional birth 
attendant home
6. Other..specify
B16What influenced the decision to give birth at the place you 
have mentioned.
1. Health insurance
2. Better services
3. Nearer to my home
4. Was an emergency thus I 
had no control
5. Privacy
6. Other..specify
B17Was it a normal delivery or caesarian section
1. Normal delivery
2. Caesarian
66 | Page
B18How much was paid at the time of delivery of this child 
where you mentioned the birth took place?
Amount UGX
Other specify………………..
B19During the pregnancy of this child, did you attend 
antenatal clinics
1. Yes
2. No
B20How many ANC visits did you attend WRITE IN
B21How old were you when you/your partner gave birth to 
your first child?
WRITE IN
FAMILY PLANNING 
B22 When you got pregnant, did you want to get pregnant at 
that time?
1. Yes 
2. No 
B23 Are you currently doing something or using any methods 
to delay or avoid getting pregnant?
1. Yes
2. No
3. Not sexually active
B24 Which method are you using? 
DO NOT PROMPT
Write all responses given
1. Female Sterilization
2. Male Sterilization
3. IUD/Coil
4. Injectable
5. Implants
6. Pill
7. Male condom
8. Female condom
9. Rhythm Method/Safe days
10. Withdrawal
11. Emergency pills
12. Any other, specify ________
13. None
67 | Page
HEALTH OF CHILDREN UNDER TWO (2) YEARS (IMMUNIZATION AND FEEDING PRACTICES)
B25 Do you have any child aged less than two years? 1. Yes 
2. No 
B26How old (in months) is the child? If more than one child 
under two, ask for responses for the older child.
INTERVIEWER, PLEASE ASK FOR THE CHILD VACCINATION 
CARD/BOOK AND CHECK FOR RELEVANT VACCINATIONS
B27 Child Vaccination Card/Book available
1. Yes 
2. No 
B28: Child not immunized, no record, or only partially 
immunized
1. Fully immunized
2. Partially immunized
3. Not immunized
4. No record
B29: State reason for no immunization, partial immunization, 
or no record
1. Not able to access health 
facility
2. Against immunization
3. Other..specify
B30: Is the child still getting breastmilk?
1. Yes
2. No
3. Don’t know
B31: How old was the child when he/she started 
drinking/eating anything else apart from Milk?
1. 1 Month or Younger
2. 2 Months
3. 3 Months
4. 4 Months
5. 5 Months
6. after 5 months
SECTION C: COOPERATIVE MEMBERSHIP AND BENEFITS 
ASK ALL 
C1: Do you or any member of this household belong to a 
health cooperative?
1. Yes
2. No 
How many members of your household are currently enrolled 
in health cooperative insurance
C2a: Give the name of the health cooperative care provider Actual Name……………………..
C3: Do you belong to other cooperatives? If so, what type of 
cooperative?
1. Farmers/Agricultural 
Cooperative
2. SACCO
3. Other: specify
C4: For how long (YEARS/MONTH) have you benefitted from 
cooperative health insurance? 
1. Once a month
2. 1 time every 3 months
68 | Page
C6: How often do you pay premiums?
3. 1 time every 4 months
4. 2 times a year
5. Once a year
6. Can’t recall
C7: Have you ever not paid premiums for health insurance for 
one or more periods?
1. Yes 
2. No 
C8: Did you need to seek health care for a family member 
when you had not paid?
1. Yes 
2. No 
C9: If yes, what did you do?
C10: What services does the health cooperative give you as a 
member?
………………………………..
C11: How would you rate the quality of services offered to you 
through cooperative health insurance?
1. Excellent
2. Good
3. Average
4. Poor
5. Very Poor
C12: To what extent are you satisfied with how your health 
cooperative insurance is managed/run? (READ OUT SCALE)
1. Very Satisfied
2. Very satisfied 
3. Average
4. Dissatisfied 
5. Very Dissatisfied
C13: How have you benefitted from cooperative health 
insurance?
TICK ALL THAT APPLY 
1. Lower cost due to shared risk
2. Access to quality health care 
3. Avoid borrowing
4. Avoid unexpected possibly 
catastrophic bills
5. Ability to plan to pay 
premiums
6. Reduced worry and stress
7. Improved relationship with 
partner now that care seeking 
is no longer an issue
8. Other specify _____________
9. Don’t know/None
C14: Based on your experience, does being a member of a 
health cooperative make it easier, more difficult or the same 
in accessing health services? 
1. Much easier 
2. The same 
3. More difficult 
C15: In your opinion, do you get a better service or not from a 
health facility if you are a member of a health cooperative 
compared to a non-member? 
1. Better
2. Same 
3. Worse 
C16: In your opinion, do health cooperative members pay less, 
the same or more than non-members?
1. Less
2. Same
3. More
4. Don’t Know
69 | Page
C17: Do you recommend that your neighbors or friends enroll 
in health cooperative insurance? Why or why not?
1. Yes
2. No
Why or why not?
(ASK ONLY THOSE WHO ARE NOT MEMBERS OF A HEALTH 
COOPERATIVE)
C18: Are you aware of a health insurance scheme?
3. Yes
4. No 
C19: Please tell me all the health insurance schemes you are 
aware of
C20: How did you find out about health insurance? 
(MENTION SCHEME AWARE OF IN C15)?
SELECT ALL THAT APPLY
1. TV
2. Radio
3. Church
4. Written Material
5. Friends/Relatives
6. Group, list type___________
7. Cooperative Staff, board 
member
8. School
9. Health worker
10. Village health team volunteer
11. Other, specify 
_______________
12. Don’t know/Can’t recall
C21: Are you aware of some of the benefits of being a health 
insurance cooperative member?
1. Yes
2. No
C22: What are some of the benefits of being a health 
insurance cooperative member?
SELECT ALL THAT APPLY
1. Lower cost due to shared risk
2. Access to quality health care 
3. Avoid borrowing
4. Avoid unexpected possibly 
catastrophic bills
5. Ability to plan to pay 
premiums
6. Reduced worry and stress
7. Improved relationship with 
partner now that care seeking 
is no longer an issue
8. Other specify _____________
9. Don’t know/None
C23: In your opinion, do health cooperative members pay less, 
the same or more than people who pay out of pocket for 
care?
1. Less
2. Same
3. More
4. Don’t Know
C24: What is the distance to the nearest Cooperative health 
facility from your house? WRITE IN
Distance in KMS
70 | Page
C25: Ask if not a health cooperative member in C1&C3: Why 
are you not a member of a cooperative health insurance 
scheme?
SELECT ALL THAT APPLY
1. Long distance to health care 
facility
2. Limited information on 
benefits
3. High cost of premium
4. Don’t know how to join
5. Not interested
6. Other, specify ________
C26: Ask if not a health cooperative insurance member in C1 
& C3: C27: Would you like to join a cooperative health 
insurance scheme
1. Yes
2. No
C28: Would you attend a session at a health facility to learn 
how to join a health cooperative?
1. Yes
2. No
C29: On average, how long (in minutes) did you wait for care 
after you arrived the last time you visited the health center?
C30: If you could learn about health insurance while you are 
waiting at a health center, would you want to? Why or why 
not?
5. Yes
6. No
Why or why not?
THANK YOU.END.
71 | Page
Annex 3 Health Facility Assessment Tool
A: IDENTIFICATION 
Introduction 
Hello, my name………. working on behalf of Soland Associated Consults Limited, a legally registered 
research consultancy firm in Uganda. Soland was contracted to carry out a study on behalf of 
HealthPartners Uganda. The study aims at understanding people’s knowledge, attitudes and practices 
towards access to health services in your community and their contribution to healthcare. The 
information you provide will guide HealthPartners to effectively implement its project intervention in 
support of health cooperative development in Uganda. Your participation in this survey is completely 
voluntary and all of your answers will be kept in the strictest confidence. Your responses will be 
combined with that of others to show aggregated views and opinions. 
Can I continue with the interview? Yes..1 No..2(IF NO TERMINATE)
START TIME: |__|__| :|__|__| AM / PM 
District 
Sub county 
Name of Health Facility Level: HC II, III, IV, Hospital
Ownership status Public…1 Private…2 
Year and Month Facility began offering Cooperative Health Insurance 
Name of respondent 
Position/title of respondent 
B: PATIENT ATTENDANCE; MATERNAL & CHILD HEALTH INDICATORS & COST RECOVERY TOOL
Note to Interviewer: For this part we need to collect information for each and every month from 
January 2019 to December 2020. 
1. Cost Recovery- Actual data for each month/year where available will be documented from 
Cooperative Performance Tracking Tools (CPTT) for Coops (CR2, 3, 4,6 & 7) and from the 
72 | Page
Health Management Information System (HMIS) tools for out of pocket (OOP) treatment 
costs, number of treatments and payment received.
CR 1 Does the health facility have current records for last two financial years[the 
month](Ask to see HMIS 105, 108, 109, Financial Summary and CPTT data.)
Seen Complete filled Most recent date 
on filled form
HMIS (Health Management 
Information System) 108-
Inpatient Monthly report. 
Census Information (Number of 
admissions)
HMIS (Health Management 
Information System) Form 105: 
Health Unit Outpatient Monthly 
Report
HMIS Form 109: Health Unit 
Population Report
CPTT (Cooperative Performance 
Tracking Tools)
Please list the data that your facility includes in HMIS Section 7.
Yes No Don’t Know
Out of pocket payment Received 
that month
Payment received from OOP 
outstanding bills or line of credit
Government funds
Voucher reimbursement
Coop premiums
Coop copay
Other_______________________
Please specify
COST RECOVERY TARGETING HEALTH CARE PROVIDER (should be collected for each financial year 2019 and 
2020)
2019 and 
2020
List data 
available and 
calculate for 
each month 
for the [the 
month]
Calculation Data Source at 
facility
CR 2 What was the total 
amount of premiums 
plus copay received 
Total of Premiums 
plus copay for the 
[the month]
CPTT
73 | Page
from health co
-op 
members? 
CR 3 What was the total 
number of co
-op 
members treated [the 
month]
Total number of co
-
op members treated 
CPTT
CR 4 What was the total 
cost of the treatment 
given to co
-op 
members? 
Total cost of 
treatment given to 
co
-op members in 
CPTT
CR 5 What was the total 
number of out of 
pocket payers treated?
Total number of OOP 
payers treated in 
HMIS, OPD, IP 
registers 
CR 6 What was the total 
cost of care provided 
for out of pocket 
payers treated? 
Calculate the total 
cost of care given to 
OOP treated minus 
the total premiums 
and copay from coop 
members for each 
month (CPTT)
HMIS Financial Summary
CR 7 What was the total 
amount of money 
received for care 
provided? Calculate 
[the month]
HMIS Financial 
summary) and 
CPTT
CR 8 What was the total 
amount of money 
received from out of 
pocket payers for care 
provided? 
Calculate the total 
cost of care received 
from all patients who 
received treatment at 
the facility from [the 
month]minus the 
total cost of 
premiums and copay 
received from coop 
members for the 
same period
HMIS 105 
(Section 7 
Financial 
summary) and 
CPTT
CR 9 What was the average 
cost recovery from 
coop members from 
Jan 2019 to December 
2020
The sum of premiums 
plus copay (CR 2) 
minus treatment 
costs, CR4. Divide by 
the # of Co
-op 
members CR2. (CR2
-
CR4)= X X/CR3
CR2, CR4, CR3
CR 10 What was the average 
cost recovery from out 
of pocket payers 
between [the 
The sum of the total 
cost of care given to 
OOP, CR6 minus the 
amount of funds 
CR5, CR6, CR8
74 | Page
month](Calculate the 
total cost of care given 
to OOP (CR6) minus 
the amount of funds 
received from OOP 
(CR8) divided by the 
number of OOP visits 
(CR5).
received from OOP, 
CR7 divided by the 
number of OOP visits, 
CR5.
(CR6-CR7)=X 
X/CR5 
*CR=Cost recovery
2. Patient’s Served to determine demand and to compare coop members vs. number of non￾coop members served- data will be collected from HMIS (Form 105 for outpatient report and 
108 Inpatient Census Monthly report (total for the year will be taken)
Department Male Patients [the 
month]
Female Patients 
[the month]
Total Patients by 
department
Coop Non-c Coop Non-c Coop Non-c
Outpatient 
Inpatient
Total Overall
3. Maternal and Child Health Indicators- data will be collected from HMIS Form 105: health Unit 
Outpatient Monthly Report
Number tallied for the year[the month]
 Maternal Health Indicators Cooperative 
members
Not cooperative 
members
%
ANC 4TH Visit
Number of Deliveries in the unit
Babies born with low birth weight (less than 
2.5 kgs)
New Born Deaths
Maternal Deaths
Deliveries with TBA
 For child health indicators, HMIS 105: Health Unit Outpatient Monthly Report
75 | Page
Child Health Indicators Number tallied for the year[the month]
Cooperative member Out of pocket payers
Fully immunized ( Male and Female) Yea r 1
Children underweight below line -2sd (6-11 
months) 
Children overweight above line +3sd (6-11 
months)
Babies born with low birth weight (less than 
2.5 kgs)
Total number of children weighed at 
measles vaccination
END OF INTERVIEW
Annex 4: List of participants
Name Contact Area
1. Wetaka pies 0707616247 Sironko
2. Dijambogo Patrick 0777396238 Sironko
3. Wojukira Stephen 0783208226 Sironko
4. Nadunga Joan Sironko
5. Matrilluda Juliet 0751132823 Sironko
6. Kimono Hadijah 0789331216 Sironko
7. Neumbe Doreen 0751703394 Sironko
8. MugideInat 0702277132 Sironko
9. Nafunaphiona 0702277133 Sironko
10. WegosasaKotida 0702277133 Sironko
11. Bwayirisa Susan 0788719277 Sironko
12. Kyatusimire Prossy 0756896629 Sironko
13. Nafuna Margret 0784491800 Sironko
14. Nadudu Prossy 0784763824 Sironko
15. Neumbe Priscilla 0789487598 Sironko
16. NambozoShifah Sironko
17. NambafuShanitah Sironko
18. Nambe Vincent Kalungu Villa Maria Hosp
19. Jimmy Edema Luwero Bishop Asili Hosp
76 | Page
KPC Tables members 
and non members.xls
i
19. Dr.SSemwanga Edward Kalungu-Villa Maria Hosp
20. Ms.Akellosaranedi 0781512110 Alebtong District
21. Mr.RichardAgemu 0776059657 ADHO/MCH- Alebtong District
22. Mr. Ogwal Moses 0757925329 District agriculture 
Officer/Acting DCO- Alebtong 
District
23. Mr.OgwalPaulino 0783933703 Acting CDO- Alebtong District 
24. Mr.Enon Alex 0782562447 District Commercial Officer￾Oyam District
25. Mr.FelixOyuge 0782793074 Proprietor Aero Medical 
center- Oyam District
26. Mr.JohnsonAdinda Program Manager
27. Ms. Connie Ainebyona Connect Girl centre
28. Pamela KomugishaTumwesigye, 0782402208 Desk Officer for Health 
cooperatives- MTICD
29. Natuherwa Judith Clinical Officer Kakoma 
Health Center III- Isingiro 
District
30. MrMugarura Edward Commuity development 
Officer Isingiro District
31. MrsKalungu Clemence maternal child health 
officer Isingiro district 
32. Evas Naturinda Ankole Archdiocesan 
Coordinator for 
HealthPartners
33. John Biharwe Health Center 
34. Kirabo Alexander Deputy District Commercial 
Officer –Ibanda District
35. Dr Julius Bamwine District Health Officer –
Ibanda District
36. Moses Baguma Senior Commercial Officer –
Ibanda District
37. Dr. Sarah Byakika Commisoner for Planning 
MoH