Katine Mid-term Review Report

Mid–Term Review of the Katine Community Partnerships Project

August 2009

Hazel Slavin

Table of Contents

Acronyms .............................................................................................................................ii Executive summary...............................................................................................................iii List of recommendations.......................................................................................................vi Introduction...........................................................................................................................1 The relationship between the Guardian and AMREF............................................................3 The Conceptual Basis of the Project.....................................................................................6 Project Activities....................................................................................................................8 Views from the District level..................................................................................................10 Views from Sub–County ......................................................................................................15 Views from three Parishes....................................................................................................16 Views from the Community...................................................................................................20 Gender and equity issues.....................................................................................................22 Questioning the Community..................................................................................................23 Achievement rating (see Annex 10)......................................................................................24 AMREF Management ..........................................................................................................25 The Project Time Frame.......................................................................................................26 Planning for Year Three........................................................................................................27 Planning workshop, 15–17 September 2009........................................................................28



2010 and beyond..................................................................................................................29

Mid–Term Review: Katine Community Partnerships Project, July 2009



Acronyms

AIDS............................ Acquired Immuno–deficiency Syndrome AMREF....................... African Medical and Research Foundation ANC............................ Ante Natal Care ARVs........................... Antiretrovirals ASRH.......................... Adolescent Sexual and Reproductive Health DAC............................ Development Assistance Committee DEO............................ District Education Officer DFID............................ Department for International Development (UK) DSC............................ District Steering Committee DWO........................... District Water Officer GoU............................. Government of Uganda HIV.............................. Human Immuno–deficiency Syndrome HSSP.......................... Health Sector Support Plan HUMC......................... Health Unit Management Committee ITNs ........................... Insecticide Treated Nets KCPP ......................... Katine Community Partnerships Project LC............................... Local Councilor MDD............................ Music Dance and Drama MDGs.......................... Millennium Development Goals M&E............................ Monitoring and Evaluation MTR............................ Mid–term review MoU............................ Memorandum of Understanding NGO............................ Non–Governmental Organisation NUSAF . ..................... Northern Uganda Social Action Fund OOP............................ Out of Pocket Expenses PTA............................. Parent/Teacher Association PDC ........................... Parish Development Committee PEAP ......................... Poverty Eradication Action Plan PHASE........................ Personal Hygiene and Sanitation Education PLWHA........................ People living with HIV and AIDS PREFA........................ Protecting Families for HIV/AIDS (an NGO) PM . ............................ Project Manager PMC ........................... Project Management Committee (at sub–county level) PO............................... Project Officer PSC . .......................... Project Steering Committee (at District level) PSC . .......................... Parish Sanitation Committee PTA ............................ Parent/Teachers’ Association RBA . .......................... Rights Based Approach SMC ........................... School Management Committee TASO ......................... The AIDS Support Organisation ToR . ........................... Terms of Reference UGX............................ Ugandan Shillings UWESO ..................... Uganda Women’s Effort to Save Orphans VCT ............................ Voluntary Counseling and Testing VDC............................ Village Development Committee VHT............................. Village Health Team VSLA .......................... Village Savings and Loan Association WATSAN .................... Water and Sanitation WSC............................ Water Source Committee

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Executive summary 1. T  he Mid–Term Review (MTR) of the KCPP took place in July 2009, led by Hazel Slavin, an independent consultant contracted by AMREF, with support from Rick Davies, the Guardian’s independent evaluator.  he KCPP is a unique development project funded by donations from readers of the Guardian with 2. T matching funds from Barclays Bank. It is an integrated Project of five components, Health, Education, Water and sanitation (WATSAN), Livelihoods (including VSLA, a sob–component separately funded by Barclays)and Community Empowerment. The KCPP works with partners from government structures from District to village. There is considerable integration between components, particularly between health, education and WATSAN.  fter the MTR was completed and a planning session held in September 2009, the Project will have 3. A one full year to run. The purpose of the MTR was to assess progress against objectives in all five components and to consider to what extent the project is on track. 4. In the absence of a LogFrame an achievement rating at the end of the MTR used the ‘specific objectives’ and ‘expected outcomes’ listed in the ToRs. The overall score for the Project at MTR is 2.9 (I highest—5 lowest).  he MTR was designed to be both inclusive and participative and used a mix of methods and constant 5. T checks. The MTR interviewed District staff across the components as well as trainers from UWESO and the veterinarian from FARM–Africa. Sub–County, Parish and Village committees were visited and villagers discussed their concerns during informal conversations.  here is no MoU between AMREF and the Guardian and no ‘rules of engagement’ between the Guard6. T ian and AMREF in London or Uganda. This has led to misunderstandings and conflict.  he many visitors to the Project has put the Team under some strain by taking up 10 per cent (lowest 7. T estimate) of its working time. 8. In terms of the activities planned for Year 2, there has been considerable achievement and success: this is not, however, an indication of impact which takes considerably longer to assess.  elf assessments by the Project team assessments show that the rate of implementation is uneven. 9. S Looking across all the components, two–thirds were behind schedule at the end of June although it is expected that at least two of the components will achieve near completion by the end of September. 10. The Project Steering committee felt that the capacity building, the setting up and training of Parish Development Committees, work with VHTs, schools and health centres, together with training, classroom building, the VHTs and boreholes are the most successful aspects. Some members expressed doubts about the level of capacity building in relation to the amount of infrastructure; many of the committee would like to see more ‘hardware’ as evidence of change; there is a perception that a lot of money has been spent on little that can be seen in terms of infrastructure. Some members of the committee had expected more of the budget to be spent in Katine. 11. The Project Management Committee, concerned with day to day implementation of the project, listed many achievements and was united in condemning the short time frame of the Project. Members are disappointed that the Project had not planned for a health centre in Merok Parish nor sunk more bore holes and there was a plea to consider irrigation to counter the lack of rain. Some members feel that there has been too much emphasis on training but did see that the committees were part of the recognised GoU structure that embodies the notion of planning at grassroots level facilitating both topic–based and process training and there are reported improvements in coordination and community ownership.

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12. Generally committee members at all levels have benefited from training and felt empowered and motivated but Sub–county committees appear to have difficulty in arranging regular meetings although some highly motivated individuals have been instrumental in outreach work on sanitation and household hygiene. 13. Procurement has been slow and, on some occasions, prevented work from taking place. Agreements to purchasing locally (as long as goods are of acceptable quality) will have the additional effect of bringing business to Soroti and creating more wealth. 14. At the time of the MTR the UWESO team had set up 140 VSLA groups with at least one in each of the 66 villages in Katine. There are also VSLA in each of the Farmers’ groups set up as part of the Livelihoods component.. UWESO has an overambitious target of setting up 200 groups and this has led to an anomalous situation. The grant for VSLA ends in September 2009 and each group needs eight months of training and supervision before it likely to be established as a self–governing concern. Groups were being formed at the time of the MTR which means, in effect, that some groups will have less than a month of supervision. 15. The VSL groups have been highly successful and for a modest investment they really make a difference to people’s lives. One group has completed a cycle and has started again. High value items, such as heifers, bulls, ploughs, cement and bricks, were bought. Loans were used for school books, drugs and small items to help income generation. 16. At Parish level there is conviction that the training received in planning, recording and making representation upwards will bring change. They have been equipped them with both knowledge and sustainable skills. The number of latrines built has jumped dramatically. Ojama Parish recorded an increase from 118 in 2008 to 565 in mid–2009. But there is much concern about lack of good quality water. 17. Two Heath Centres recorded higher levels of attendance for treatment, very high rates of immunisation and more women delivering in the Health Centre lV where, at the time of the MTR there were drugs (including Fansidar for malaria, Nivirapine for paediatric ARV and ARVs for adults) but ‘stockouts’ are normal. A laboratory has been built and equipped at the health Centre ll but there is no full time member of staff. Both health Centres have active HUMC. 18. VHTs are highly active and instrumental in helping to raise rates of ante–natal attendees, deliveries at the heath centre, improving sanitation and hygiene levels in the villages by promoting pit latrines and ‘ideal’ homesteads. 19. Two schools have been built, 10 classrooms renovated and 14 are in the process of renovation. Desks and text books have been provided to schools. Latrines have been built at all schools and three have rain water harvesting tanks. Schools report higher rates of enrollment. AMREF–facilitated training has been very successful; school sanitation has been improved through PHASE training, teachers and parents have learned how to make teaching and learning aids. There is improved performance and attendance among teachers. School Management Committee training has been very successful and will be rolled across the District. 20. The football tournament was a success and has inspired both girls and boys to take an active part in sport. Women’s football has been well received. Nets, balls and kit have been distributed by the Project and skills have improved. This is seen as emancipating for the girls involved and inspiring for the boys. 21. The Community Media Centre has a regular throughput of users and 100 have been trained to use a computer, send emails and surf the web. 22. Water Source Committees have been set up across the sub–county, those visited were clean and well maintained. The success rate for collecting money has varied. Drought has caused crops to fail and there is less income; collecting water fees may be increasingly difficult and without money a failed pump will not be repaired.

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23. The benefits of the Farmer’s groups (apart from the successful VSLA element) have been in new planting which saves money, better strains of seeds, experiments with grafting and budding, growing upland rice, communal gardens and group working. The problem for farmers is lack of rain—it is likely that all crops will fail this year. There is a plea to consider irrigation in the sub–county. 24. There is concern about the lack of gender equality in all committees and amongst teachers and VHTs. There is a predominance of women in the VSLA groups. The emphasis on rolling out training on ‘rights based approaches’ should address this to some extent. 25. Ninety per cent of 53 persons interviewed said that they had experienced some change in their and/or their family’s life since the start of 2008. Those interviewed were able to describe the changes and what they would like to see KCPP provide in the next year. This is a mix of infrastructure, school desks and books, clean water and farm animals at the top of the list. 26. There is a need for AMREF in Kampala to provide more management support to the Katine office. Decisions are seen to be made too slowly because most of them have to be referred to Kampala. 27. AMREF staff in Katine haven’t had any opportunity for staff development; they should be facilitated to go to conferences to learn from others as well as disseminate the KCPP. 28. Three years is short time for a development project, a further year would allow the KCPP to achieve its objectives and hand over to its government partners. This requires further funding from the Guardian and Barclays. 29. Year Three should focus on some key critical interventions, including what has been committed in terms of infrastructure. Critical interventions should ensure maximum impact, sustainability and reflect what the community wants. 30. A workshop in September 2009 must agree key decisions about KCPP’s future; Will there be a fourth year funded by the Guardian and Barclays? If so there must be an agreement of the partnerships roles to the end of 2010 and beyond. Agree ‘rules of engagement’ and produce an outline plan for what critical interventions can take place before then end of 2010. 31. AMREF is testing a model that can be replicated by government, AMREF is not a replacement for government and must not be considered as such. KCPP cannot provide the answer to the many problems in Katine sub–county, it can only model ways of working based on best practice. Any work that takes place in Year Four should be in total partnership with local government—and not seen as an AMREF water source, or AMREF classroom or AMREF training. Some co–funding from the government is desirable. By the end of the KCCP AMREF will hand over the Project completely to the government.

Mid–Term Review: Katine Community Partnerships Project, July 2009



List of recommendations The basis for these recommendations is discussed fully in the text.  o clarify roles and responsibilities of the two partners, The Guardian/AMREF and CARE/AMREF(in 1. T KAMPALA) should agree appropriate MoUs as soon as possible.  he Guardian and AMREF London and Uganda should discuss and agree collaborative ‘rules of en2. T gagement’ as soon as possible, preferably at the planning meeting in September 2009. 3. It would be useful if Guardian staff arranged a short workshop for AMREF staff in Uganda, to help them learn how best to respond to the blogs.  MREF should devise more creative ways of presenting the Project in a more purposeful way and be4. A gin by changing its reporting format.  MREF must engage in a team building and public relations exercise with the Steering Committee to 5. A counter misconceptions on both sides about what can, and cannot, be achieved.  he Terms of Reference for the Steering and Management Committees should be reviewed to ensure 6. T relevance and effectiveness. Each member must be made aware of the Management committee’s responsibilities in tracking the Project.  n urgent review must be made of the committees at Sub–County level to determine whether they are 7. A necessary, combined or reconstituted to take account of all Project components, Sub–county and Parish committees must be assisted to make regular reports to the Management Committee, reports from AMREF are not appropriate. 8. It is recommended that the procurement department in AMREF Kampala puts a strategy in place to deal more quickly with requests from the KCPP and makes every attempt to source items locally in the District. 9. It is recommended that Barclays continue to fund the VSLA groups in Katine for at least a further year. During this time, the existing groups should be supported and new groups set up no later than eight months before the end date of the funding. 10. Discussions between CARE and UWESO need to take place about the merits of their collaboration to try and reduce the levels of bureaucracy and transaction costs. 11. AMREF Kampala must provide more day–to–day management support at field level at the earliest opportunity. 12. All staff should be offered appropriate staff development opportunities to attend conferences or study tours. 13. It is recommended that he Guardian and Barclays continue funding a further year of the Project (until 2011) to ensure that objectives are fully achieved. 14. If no further funding is obtained from other sources, AMREF must develop an exit plan for how it will respond if a number of project staff seek to leave KCPP for other employment before the project ends in late 2010. Failure to do so could jeopardise the Project’s progress in the last months of 2010. 15. AMREF and its partners must redesign the third year budget to put the maximum funds into agreed activities and interventions. 16. KCPP cannot provide the answer to the many problems in Katine sub–county, it can only model ways of working based on best practice. Any work that takes place in Year Four should be in total partnership with local government and by the end of the Project KCPP must become the responsibility of government.

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Introduction The Mid–Term Review (MTR) of the KCPP took place in July 2009, led by Hazel Slavin, an independent consultant contracted by AMREF, with support from Rick Davies, the Guardian’s independent evaluator. His role was to advise the Consultant and produce an overview of the MTR process ((see Annex 11 for his overview). The MTR was facilitated and assisted by KCPP Team Members who helped with a number of review tasks and accompanied the Consultants to meetings and interviews. Their patience and willing assistance is gratefully acknowledged. The KCPP is a unique development project funded by donations from readers of the Guardian with matching funds from Barclays Bank. It is an integrated Project of five components: ● ● ● ● ●

Health Education Water and sanitation (WATSAN) Livelihoods (including VSLA) Community Empowerment

The Guardian runs a dedicated website to track the progress, successes and difficulties of the project which is implemented by AMREF together with specific inputs providing technical support from CARE/ UWESO and FARM–Africa. Barclays separately funds a sub–element of the Livelihoods component, to encourage the setting up and running of voluntary savings and loans associations (VSLA). The MTR was guided by Terms of Reference (ToR) written by AMREF and agreed by all partners. The ToR are Annex 1. The review took place over three weeks and a complete itinerary is Annex 2. The MTR provides a snapshot of the Project after 18 months of work from January 2008–June 2009. Initial organisation, planning and recruiting staff began in October 2007. Some initial work began in November and implementation started properly in January 2008. In effect that means that after the MTR was completed, and a planning session held in September 2009, the Project has one full year to run. The purpose of the MTR was to assess progress against objectives in all five components and to consider to what extent the project is on track. The scope of the MTR was on interim results at outcome level that contribute to achieving the longer term goal of improving the quality of lives for the people of Katine, what has helped and what has hindered (in terms of expected and unexpected outcomes) and provide recommendations on how to strengthen outcomes for sustainability for the remainder of the project. This MTR report does not reiterate all the facts and figures that are easily found in the AMREF six–monthly reports. Report Structure Because the KCPP is integrated in terms of its components and with government and the community, this MTR report is structured to highlight the perspectives of the beneficiaries, as seen from District, Sub–county, Parish and Community levels. Two major issues are discussed; the Project and its donors and the duration of the Project. The management of the Project is considered and recommendations are made for the remaining life of the Project to maximise impact, ensure sustainability and meet the wishes of the community and Project partners. Constraints A major constraint in attempting to review and give an achievement rating to the Project is the lack of a succinct LogFrame. There are lists of activities and ‘outcomes’ in different places and the nearest that the Project has to a framework that sets out what it intends to do, and how it will be measured, is the 20 page Monitoring and Evaluation (M&E) Framework listing every sub–component. The achievement rating at the  Because of a family crisis his involvement in the MTR ended unexpectedly on 9th July.  The summary of achievements annex (6) is based on the reports.  LogFrames (logical frameworks) are universally used by all donors. It is summary of the work to be done, what the expected results (impact) will be, and it will be measured and what risks and assumptions exist that may jeopardise the project.

Mid–Term Review: Katine Community Partnerships Project, July 2009



end of the report used the ‘specific objectives’ and ‘expected outcomes’ listed in the ToR. The achievement rating was devised by adapting a format used by DFID for its MTRs. MTR methods The MTR was designed to be both inclusive and participative. The methods used during this MTR included: reading both the website and un/published documents (see Annex 3) telephone interviews in the UK with AMREF, the Guardian and CARE interviews in Kampala (AMREF, CARE, UWESO), and Mbale (FARM–Africa) 39 visits/meetings in Soroti and Katine sub–county random walkabout in two parishes having informal conversations community views sought through a quick survey self–assessment of each component by the Project team production of a set of matrices showing which interventions have taken place in each of the 66 villages of Katine sub–county ● planning workshop with the AMREF team ● de–brief with AMREF Kampala ● de–brief with AMREF London ● ● ● ● ● ● ● ●

Interview and discussion questions were based on guidance developed by the OECD Development Assistance Committee (DAC), performance measures associated with the Paris Declaration and two others proposed by the External Evaluator. ● DAC  efficiency  effectiveness  relevance  impact  sustainability ● Paris Declaration  harmonisation  alignment ● External Evaluator  equity  transparency Two types of checks were put in place. A de–briefing meeting was held with team members after the review of each component. The MTR process was reviewed regularly and again after the draft report was written.

Mid–Term Review: Katine Community Partnerships Project, July 2009



The relationship between the Guardian and AMREF The collaboration between a major newspaper and a development NGO is an exciting venture which allows readers to track a development project in words and images, to see things happen as they take place, understand the constraints and problems of the task and the context in which development takes place. Along with the knowns in development there are the unknowns and often these make for progress which can be two steps forward and one back—or at worst—two or three back. The MTR team saw this, starkly, in Katine. Despite the new strains of cassava and ground nuts carefully planted in a new way, weeded and tended, the crop is failing because there is inadequate rainfall. The Project Team could not have predicted that the hard work they have done with farmers would end in crop failure. Then come the ramifications; less or, at worst, no food means children are less likely to go to school, surplus crops which might have been sold aren’t available so income decreases and there is severe undernourishment. Development, by its nature, is slow, sometimes excruciatingly so. Infrastructure can take time, perhaps waiting for deliveries of cement and bricks and, if building is taking place using community members, local people may have to tend their fields and leave the building site. It is generally accepted that behaviour change in health and education may take from three to five years and only then with constant reinforcement that has to take into account the nuances of cultural pressure such as local beliefs about women, the place of children, taboos about dirt, beliefs about fate and individual self determination. Contrast this with Guardian reporters who want stories and understandably want them fast and often. On the ground there may be few stories that make the Project look effective and efficient. Stories of woe may reinforce negative stereotypes of the country, its people and of the failure of development. Added to this mix is the openness of the website with its ‘bloggers’ and respondents. This is the first experience that the Team has had with the media and a website. There was no understanding of what blogging and responding is about. It would have been hard to predict the effect of both constant scrutiny, and what is sometimes perceived as negative comment, on the Project team who go to work anticipating what they might see on the website to make them feel upset, sometimes confused and angry. Understanding the conventions of the website and blogging is new in Katine and the Guardian could help in the learning process.

Recommendation… It would be useful if Guardian staff arranged a short workshop for AMREF staff in Uganda, to help them learn how best to respond to the blogs.

This is not to say that real difficulties and mistakes haven’t been reported well. The Project continues to learn from errors of judgment and has made changes accordingly, for example, using local building contractors. Working together has been a steep learning curve; for the Guardian to learn the complexity, frustrations, disappointments, problems and pace of development and for AMREF to be in the media spotlight. AMREF certainly didn’t realise what being part of a media project would entail or, perhaps, even the purpose of it and should have been more assertive about what it could or could not do to accommodate the needs of the Guardian. Nowhere is this more evident than in the aftermath of the football tournament. Arrangements for the tournament cut across all other, planned, activities for several months and there appears to have been a breakdown in effective communication. Although Team members see the tournament as a useful, groundbreaking activity with high quality educational effects, it is now evident that they were overwhelmed by the task but did not admit this to the Guardian. The locally employed football consultant was not properly briefed about the processes that needed to be in place by either the Guardian or AMREF which made matters worse. The  “ As we know, there are known knowns. There are things we know we know. We also know there are known unknowns. That is to say we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know.” Donald Rumsfeld, former US Defence Secretary, 2002

Mid–Term Review: Katine Community Partnerships Project, July 2009



ramifications of time spent on the football tournament were still evident when the MTR took place months later and Team members were still trying to ‘catch up’ for that they see as ‘lost’ time. The Football competition is recognised as a success but an estimated 10 per cent of the Team’s time was spent on planning and helping with arrangements over several months. The KCPP has received far more visitors than any development project would expect and coping with the almost constant stream of visitors—not only from the Guardian—has put some strain on the Project team. An estimation of days spent hosting visitors and therefore lost to work has been difficult to obtain as no accurate records have been kept but the best lowest ‘guesstimate’ from September 2007 until July 2009 is 2110 person hours; 264 working days. How this figure has been calculated can be seen in Annex 4. There have been many visits not included on the table and this figure does not include any time spent on the football tournament. There are two underlying problems here; there is no agreed ‘memorandum of understanding’ (MoU) between the Guardian and AMREF about who does what and who makes decisions when new activities or events take place. Who is in charge? Is it AMREF staff or the Guardian? There should be a clear set of rules that satisfy all parties about the role of each of them. It is noted that no MoU exists between AMREF and CARE in Uganda and this too must be rectified. Secondly, there is a need to set some ‘rules of engagement’ for working together in the third year as the Guardian and AMREF would both benefit from working together creatively rather than by responding defensively after the event. At the end of 2007 a so–called Team Day took place in London to “establish clarity around governance and planning for the success of the partnership” but any agreements made at that meeting appear not to have held and the relationship has become guarded and, occasionally, adversarial. It would be worth revisiting the agreements made at the Team Day and agree a set of ‘rules’ based on some key principles such as: ● ● ● ● ● ●

always checking first asking rather than demanding responding faster honesty if expectations can’t be met not blaming but search for understanding cultural sensitivity

Furthermore, and critically, there are no ‘rules of engagement’ between the Guardian and AMREF in Uganda. Agreements made for working together are between the parties in London but the action is in Uganda.

Recommendation… The Guardian/AMREF and CARE/AMREF should agree appropriate MoUs as soon as possible.

It is fair to say that AMREF’s response to the blogs often appears defensive and the way the Project presents itself is not always clear to the Guardian or its readers. New ways must be found to report both success and problems in a more forthright and balanced manner that strikes a balance between the on–the–ground reality of community–based development and the need for interesting stories.

Recommendation… The Guardian and AMREF London and Uganda should discuss and agree collaborative ‘rules of engagement’ as soon as possible, preferably at the planning meeting in September 2009.

 Output notes, Partnership Workshop, 27th November 2007, Manny Amadi, Cause & Effect Ltd

Mid–Term Review: Katine Community Partnerships Project, July 2009



Changing the format of AMREFs six–monthly reports would help to make them lively and more than a list of achievements. The narrative reports describe a wide range of activities but are less clear on what the main measures of progress should be. Progress reporting on various indicators seems to be almost opportunistic. There are GoU objectives and national averages that could be the basis of these targets, particularly in health, education and WATSAN components and possibly others. These specific objectives need to be publicised by AMREF and its government partners perhaps using local radio. The External Evaluator has already noted the need to improve reporting and suggestions are in Annex 5.

Recommendation… AMREF should devise more creative ways of presenting the Project in a more purposeful way and begin by changing its reporting format.

Mid–Term Review: Katine Community Partnerships Project, July 2009



The Conceptual Basis of the Project From the outset the Project has sought to collaborate closely with Government and community structures at all levels; it is a ‘Partnerships Project’ and aligns local government and with National and Local government policies and priorities. The following table summarises the main areas of collaboration and Integration. Component Health

Collaboration and Integration KCPP shares work plans and works closely with the District Health Team, sources trainers on agreed training and participates in World AIDS days. Health workers in the three health centres participate in planning, selection of participants and training of VHTs and implementation of immunisation outreach. The project works with include TASO for VCT and PREFA to supply nevirapine. The Project is currently replacing the roof on the Catholic Church–run health clinic.

Education

Close cooperation and partnership with District Education Department and Soroti Primary Training College in planning and implementation of activities and implementation of capacity building activities for teachers and PTAs.

WATSAN

Material on the promotion, use, operation and maintenance of ecological in collaboration with the Directorate of Water Development and Ministry of Water and Environment.

Livelihoods

Working with District Natural Resources, Community Development, Production and Marketing, together with FARM–Africa in community–based animal health services related activities and training of para–vets (organised an exchange visit of para–vets to Karamoja). Work closely with UWESOon VSLA activities. Meetings with other development partners through the stakeholders livelihoods forum.

Community Empowerment

Coordinated project activities through partnership with PMS and PSC where sub–county and district partners discuss and align work plans and strategy for KCPP. District partners consulted and consensus reached on the rights related messages. At sub–county level, the sub–county chief and LCIII chairman consulted for join planning and mobilisation of activities. At community level work closely with the local leaders, LCs and parish chiefs, for community mobilisation.

Uganda’s Poverty Eradication Action Plan (PEAP) is the framework for both national development and for striving to achieve the (MDGs). The Project is structured around the PEAP’s 5th pillar which recognises that a healthy, well–educated, productive population is a necessary condition for development and prioritises health outcomes through the involvement of other sectors including WATSAN, education, livelihoods and community empowerment, in order to address the underlying socio–economic determinants of ill–health in Uganda. The five components have an agreed set of objectives and sub–objectives summarised here. Health The Health component of the project works closely with the Director of Health and training implemented by the Project is supported by input from District trainers. Aligned closely to the Government of Uganda’s Health Sector Support Programme 11 (HSSP 11) the health component recognises that poor health is the leading cause and consequence of poverty in Uganda so it: ● focuses on promoting health ● preventing disease ● the provision of basic curative services ● prioritises immunisation, sanitation and hygiene, reproductive health, malaria and HIV/AIDS ● emphasises the role of communities, households and the individual’s ownership of health and health services ● builds capacity of health sub district and Village Health Teams (VHT) for more effective and equitable service delivery Education The education component has close liaison with the District Inspector of Schools in Katine and the Centre Coordinating Tutor (attached to the Soroti Primary Teaching College) and seeks to: ● focus on child–centered methodologies to improve academic performance ● promote adolescent–friendly reproductive health counseling

Mid–Term Review: Katine Community Partnerships Project, July 2009



● ● ● ●

provide teaching materials to teachers and pupils to facilitate teaching and learning train teachers and parents to produce teaching and learning materials using local resources support supervision exercises and follow–up of teacher training by AMREF and the DEO strengthen links between schools and communities to promote personal hygiene and sanitation education (PHASE)

The WATSAN component works closely with the District Water office and other water–related agencies in Soroti District. It seeks to: ● increase access to safe water ● Increase access to basic sanitation ● increase personal hygiene amongst community members ● facilitate community empowerment to manage water sources effectively Livelihoods There are two distinct but related activities in the livelihoods component. One is concerned with improving farming methods to improve crop yield, encourage planting of new varieties of seeds, raise nursery beds and improve capacity. The other is to form VSLA groups—some of which are farmers associations while others are groups of villagers. The VSLA activities are technically supported by UWESO and Barclays fund this sub–component separately. This component seeks to: ● increase the capacity of rural innovation groups to manage themselves for improved and sustainable livelihoods ● establish rural livelihoods stakeholder forums for sustainable coordination of livelihoods activities ● harness technology to improve food security, nutrition and income generation ● enhance business & marketing skills to access better markets for products ● set up VSLA groups to facilitate savings Community Empowerment ● This component is instrumental in supporting the Project Steering Committee and works across all the components. It seeks to: ● strengthen local governance ● enhance community planning to meet community needs ● enable people to mobilise, organise, communicate and participate within the formal sector to demand and receive basic services Each component links both conceptually and in daily working practice. Health, Education and WATSAN are closely allied with each other; effort has been made to ensure that schools have adequate latrines and there is emphasis on health and hygiene education. The Livelihoods component underpins the need to improve the socio–economic situation of the community in Katine. Community Empowerment is a “cross–cutting” component, setting up, training and empowering committees at school, health centre, water source, village, parish and sub–county level.

 Such as row planting, budding and grafting

Mid–Term Review: Katine Community Partnerships Project, July 2009



Project Activities Both the latest Project Six–month Report together with Madeleine Bunting’s five blogs to mark the mid– way point of the Project, clearly outline achievements and problems in the delivery of the Project. A list of completed activities and achievements is in Annex 6. In terms of the activities planned for Year 2, there has been considerable achievement and success: this is not, however, an indication of impact which takes considerably longer to assess. For example, raising the school enrollment of girls is certainly happening but the impact from doing this will not be measurable for some years until after girls leave school and seek further study or employment. Similarly, the increased immunisation rates now will only begin to show in the epidemiological figures three to five years after the event. Some simpler, observable, measures do exist to track impact more quickly; rates of diarrhoea and malaria are said to be going down but in general these are anecdotal measures and more difficult to attribute to any one activity within the space of one and a half years. For example, malaria rates may be going down because more people are using ITNs but if there is drought, there is less standing water and fewer mosquitoes. Changes in day–to–day school attendance and completion rates at the end of the year have been reported and are more likely to be directly attributable to Project input. There is considerable integration between components, particularly between health, education and WATSAN (for example in the building of latrines in schools with lessons and activities on hygiene and health) and this is to be both expected and applauded. To some extent there has been work with schoolchildren on empowerment (using the media centre) and with all components in the formulation, running and training of 77 community committees. The Livelihoods component is less integrated at the moment, although the setting up of school gardens is one way to bring new agricultural methods into school work, for example. A major activity completed by the Project Team during the MTR was a self–assessment of the implementation of each component and these are shown in detail, with the sub–objectives, in Annex 7 and in summary below. The tables show implementation of activities during the first 18 months of the Project with a mix of infrastructure and training across the components. The assessments show that the rate of implementation is uneven. Looking across all the components, two–thirds were behind schedule at the end of June. It could be expected that 75 per cent would be completed by the end of September but this looks unlikely to happen except in the Health and WATSAN components. Summary of Annex 7, each objective has sub–objectives and these are in turn linked to outcomes. Health Objectives

NO of activities

% completed by June 09

Expected % by Sept 09

Improve community–based treatment and care for HIV/AIDS, malaria, TB, RH and childhood illnesses

8

93.2%

100%

Improve quality health services for HIV.AIDS, malaria, TB, RH and childhood illnesses

9

75%

88%

Strengthen rural health systems

7

60.7%

68%

NO of activities

% completed by June 09

Expected % by Sept 09

Improve teaching and learning environment

13

73.1%

92.3%

Promote inclusive education of girls, disabled children, orphans and vulnerable children (OVC)

4

50%

50%

Education Objectives

 Katine Community Partnerships Project 6 month narrative report October 2008—March 2009, prepared by Oscar Okech  Reviewing Katine, to mark the mid–way point of the Project and focusing on the five project components health, education, water and sanitation and livelihoods

Mid–Term Review: Katine Community Partnerships Project, July 2009



NO of activities

% completed by June 09

Expected % by Sept 09

4

50%

75%

NO of activities

% completed by June 09

Expected % by Sept 09

Improve access to safe water

5

34.5%

34.5%

Increase rates of personal hygiene and access to basic sanitation

3

83%

100%

Facilitate community empowerment to mange water sources effectively

5

55%

60%

NO of activities

% completed by June 09

Expected % by Sept 09

Increase capacity of rural innovation groups to manage themselves for improved and sustainable livelihoods

5

0

100%

Rural livelihoods stakeholders forum established for sustainable coordination of farmer groups

1

50%

75%

Technology is harnessed to improve food security, nutrition and income generation

1

50%

75%

Business and marketing skills are enhanced to access better markets for their products

8

18.75%

75%

NO of activities

% completed by June 09

Expected % by Sept 09

Strengthen local governance

9

33.3%

90%

Enhance Community planning to meet community needs better

12

32.3%

83.7%

Objectives Strengthen community ownership over school supervision

WATSAN Objectives

Livelihoods Objectives

Community Empowerment Objectives

The following section of the MTR attempts to provide an overview of the KCPP from the perspectives of stakeholders at different levels of local government organisation. It begins with the views of those working at District level: ● ● ● ● ● ● ● ● ● ● ●

Project Steering and Management Committees Acting District Health officer Area School Inspector Centre Coordinating Tutor District Water Officer District Production Coordinator District Natural Resources Officer Community Development Officer District Veterinary Officer FARM–Africa’s veterinarian (in Mbale) UWESO

Mid–Term Review: Katine Community Partnerships Project, July 2009



Views from the District level According to the Project Steering Committee (the overarching committee that oversees the Project at the District level) the Project links almost entirely with GoU targets. The WATSAN targets are aligned with GoU targets and the immunisation rates have almost reached 89.3 per cent (from 68 per cent at start up) almost reaching the GoU target of 90 per cent The Project, members said, augment government’s effort but its coming had raised expectations at both District and community level. The project has been described as setting up ‘model villages’ and even on one occasion, as ‘London in Katine’. The committee mentioned that the capacity building, the setting up and training of Parish Development Committees, work with VHTs, schools and health centres, together with training, classroom building, the VHTs and boreholes are the most successful aspects. There are those on the committee who expressed doubts about the level of capacity building in relation to the amount of infrastructure; many of the committee would like to see more ‘hardware’ as evidence of change. Members acknowledged that school attendance has increased but suggested that the Project is only part of District attempts to raise enrollment rates. One member of the committee described the training for School Management Committees (SMCs) as ‘wonderful’ and said the model will be rolled out across the entire district. This is a major success. The committee applauded the football tournament as it was focused solely on youth and raised the profile of sport for girls as well as boys. There is, nevertheless, a perception that a lot of money has been spent on little that can be seen in terms of infrastructure. Just how much money is available is a figure that can be misrepresented but the entire sum when broken into management, transport and staff costs leaves a reasonable—but not excessive—amount for activities and work on the ground. The figure is at least 70 per cent of the total budget and this is regarded as an acceptable amount in development projects worldwide. Some members of the committee had expected the entire budget to be spent in Katine and are disappointed and angry. This anger goes beyond financial issues; a vociferous group questions elements of AMREF’s approach, particularly on the issue of hardware/software, and this has had an effect on how some members view AMREF management.

Recommendation… AMREF must engage in a team building and public relations exercise with the Steering Committee to counter misconceptions on both sides about what can, and cannot, be achieved.

The Project Management Committee, concerned with day to day implementation of the project, is co– chaired by the Sub–county Chief. The co–chair listed many Project achievements so far: ● ● ● ● ● ● ● ● ● ● ●

functioning health clinics the work of the VHTs distribution of bicycles and motorcycles raised immunisation rates ITNs distributed and the subsequent drop in rates of malaria school construction and rehabilitation text book distribution training latrines and hand washing education in schools new seeds talk shows

 This comment was mentioned several times during the MTR, apparently by visitor from the Guardian, but no–one was able, or willing, to say who made it.

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● boreholes for safe water ● the media resource centre ● functioning local committees The committee was united in condemning the short time frame of the Project and was disappointed that the Project had not planned for a health centre in Merok Parish nor sunk more bore holes and there was a plea to consider irrigation to counter the lack of rain. Some members feel that there has been too much emphasis on training but did see that the committees were part of the recognised GoU structure that embodies the notion of planning at grassroots level, from Village Development Committee (VDC) to Parish Development Committee (PDC) to the District. It was reported that the system hadn’t functioned well before the AMREF training, it is now working better and is much more likely to be sustainable because the structure is embedded in the system. The Management Committee is charged with reading and responding to reports from the district and Sub– Counties, yet the Sub–County Health Committee has not met since October 2008 and the Management Committee has not appeared to have noted this anomaly. AMREF appears to be the main source of information about the Project, whereas it should be the various committees that report on the Project.

Recommendation… The Terms of Reference for the Steering and Management Committees should be reviewed to ensure relevance and effectiveness. Each member must be made aware of the Management committee’s responsibilities in tracking the Project. Sub–county and Parish committees must be assisted to make regular reports to the Management Committee.

The Acting District Health Officer has responsibility for the performance of Heath Centres. He applauded the training for VHTs and explained that AMREF coordinated and facilitated but much of the training was done by District government staff who also identified the appropriate participants. In outlining the problems in the sub–county he explained that staff norms were well below GoU targets. The lack of human resources for health is a critical issue in Uganda and particularly in Katine. AMREF is adding value to the health service by facilitating both topic–based and process training and there are reported improvements in coordination and community ownership. The Area School Inspector works closely with the Project team members. He referred to better running of schools through the training of School Management Committees (SMCs) with Parent/Teacher Associations (PTAs) together other parents growing engagement with schools. AMREF has facilitated training on the GoU’s new ‘thematic” curriculum10 for primary schools and worked with teachers on lesson plans that include evaluation techniques. Personal hygiene, gender issues, music, dance and drama (MDD) and sport are highlighted as successful ventures. Schools are taking action to prevent absenteeism. More children attend school in the morning than the afternoon. Many children arrive at school having had no food and although some run home at lunchtime, most do not eat until four o’clock in the afternoon. Currently there is no school feeding programme. The Inspector thought the impact from the AMREF facilitated training was “great”. Parents now see schools as part of their community and part of their responsibility. He believed that the mood in Katine had changed; teachers know what to do and are more motivated; parents feel involved and pupils know what is expected of them. Schools were cleaner, tidier and more hygienic.

10 The curriculum is taught in local language and focuses on local issues for all curriculum subjects until Primary Year 5.

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The following table indicates the depth of problems in the education sector in Katine:



Latrine Desks Text books Class size

GoU Target 40:1 3:1 3:1 60:1

Actual in Katine N=14 schools 42.5:111 6:1 11:1 73:112

Plans to be made for year three of the Project must take into account the infrastructure and material needs of schools. The Centre Coordinating Tutor is attached to the teacher training college in Soroti. He provides all newly trained teachers with support and guidance for one year. His particular concerns are the lack of houses for teachers and the lack of food in schools. He is working with AMREF as part of the training team. He sees the training as an important step in bringing equity to the education sector. The District Water Officer (DWO), together with the Water Officer in charge of hygiene and sanitation promotion and Water Officer in charge of community mobilisation spoke of improved water provision in Katine; the eight bore holes provided through the Project brought the total number to 57. The District staff work closely with the AMREF team and undertake joint work on planning and water quality testing as well as community sensitisation and training. Geological differences in Katine result in some water tasting salty whilst other water has an iron flavour. The DWO recognised that Operation and Maintenance presents a problem of sustainability but believed that the water source committees (WSCs), equipped with new skills from the training, could overcome this problem. He contrasted AMREF’s approach to that of the Northern Uganda Social Action Fund (NUSAF) that set up WSCs before construction, provided little support afterwards and saw enthusiasm and numbers dwindle within two years. Having a paid caretaker is less likely to see the committee fade. He recognised poor financial management by some committees but models exist for sustainability and financial probity. In time it may be possible for WSO to elect to become a VSLA. Monitoring is undertaken on a quarterly basis by a sub–county committee who charge the Parish Chief with responsibility to ensure functionality of water sources. A meeting was held at the District Production Office and the MTR team met the District Production Coordinator, the District Veterinary Officer, the District Natural Resources Officer and a Community Development Officer to discuss the Livelihoods component. There has been justifiable criticism that the Project is working only with 18 groups of farmers when there has been a huge demand for assistance in agricultural development and animal husbandry. Cassava crops have been affected by both Cassava Brown Streak and Cassava Mosaic. This, coupled with drought, has made farming a precarious occupation. The vision of farmers is to create wealth sufficient for chil-

Well planted cassava wilting from lack of rain.

11 The highest ratio of pupils to latrine is 115:1 and the lowest 15:1 12 Largest class = 108 pupils, smallest = 45

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dren to eat three meals each day, at present schools reported that many children are having just one meal in contrast to the baseline survey of 15 per cent of children. The Project has been successful in providing new varieties of ground nuts and cassava and the promotion of nursery beds to grow seedlings13 to plant or sell. Farmers have been taught new skills, such as the visually evident row planting, rather than scattering seeds in all directions. Nevertheless, drought has rendered much of the healthy crop useless. Farmers want more input and a variety of implements such as fertiliser, wheelbarrows and hand tools. The District team point to success in the following areas: ● ● ● ● ●

setting up a livelihoods stakeholders forum introduction of new strains/seeds the introduction of upland rice cultivation building a produce store in Katine setting up farmers/VSLA groups

However it is known that, in general, training without the necessary start–up kits for farmers is not helpful and AMREF must acknowledge this has been a mistake and ensure that kits are provided for newly formed groups. Learning good animal husbandry is a necessity. The farming system, with open, unfenced farms, leads to animal ill–health because the “sick meet the healthy.” The training of seven para–vets by the FARM–Africa veterinarian has been a successful venture and four of them were interviewed by the MTR team. The para– vets were trained in simple veterinary procedures and business skills in February 2009 but, to date, they have been prevented from working by the lack of an agreed kit of gumboots, raincoat, bag, instruments14 and drugs. The para–vets, who will make money from selling their services and drugs then re–stock their drug kit from local drug shops are frustrated by having to wait. The issue of local purchasing has been a difficult one for AMREF and hasn’t yet been solved. Buying in bulk from Kampala may, in some cases, be cost–effective and checks on quality easier but it is reported that on many occasions this has caused lengthy delays. In an interview with the FARM–Africa veterinarian it was evident that this has caused friction. She is clear that the simple equipment and drugs are easily obtainable in Soroti and could be sourced and delivered in a matter of days. There is no reason why AMREF cannot speed up the purchase process and discussions in Kampala, after the MTR field work, suggest that it will. It is acknowledged by AMREF that procurement has taken too long and action has been agreed to ensure faster local procurement as long as the quality of goods is acceptable. Faster purchasing and buying locally have the additional effect of bringing business to Soroti and creating more wealth.

Recommendation… It is recommended that the procurement department in AMREF Kampala puts a strategy in place to deal more quickly with requests from the KCPP and makes every attempt to source items locally in the District.

UWESO is implementing the VSLA programme under the guidance of CARE who pioneered the work and devised and tested the methodology. Groups must have 15 or more members but never more than 30 and there are six sessions of training on group formation, VSLA concepts and leadership, elections, by–laws and constitution, record keeping, meeting procedures and conflict resolution and practicing saving and loaning. Members are expected to attend all meetings and be smartly dressed. Those who are late pay a small fine. The procedures for the meeting are ritualised and undertaken in reverent silence.

13 mango seedlings have been amongst those raised this way 14 hoof tipper, drenching gun, thermometers, burdizzo

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At the time of the MTR the UWESO team had set up 140 VSLA groups with at least one in each of the 66 villages in Katine. There are also VSLA in each of the Farmers’ groups set up as part of the Livelihoods component. The VSLA groups are mobilised using churches, the market and trading centre, house to house visits, posters and local leaders. Women form the majority of members, 67 per cent of the total. UWESO has an overambitious target of setting up 200 groups and this has led to an anomalous situation. The grant for VSLA ends in September 2009 and each group needs eight months of training and supervision before it likely to be established as a self–governing concern. Groups were being formed at the time of the MTR which means, in effect, that some groups will have less than a month of supervision. It was agreed that no further groups would be formed and in the last two months, effort would be made to train the new groups up to a point where it might be possible for them to continue. The VSL groups have been highly successful and for a modest investment they really make a difference.

Recommendation… It is recommended that Barclays continue to fund the VSLA groups in Katine for at least one further year. During this time, the existing groups should be supported and new groups set up no later than six months before the end date of the funding.

UWESO has mastered the training and support of VSLA groups and it is debatable now whether both the UK and Kampala CARE offices can add value to this component other than as a conduit for receiving funding.

Recommendation… Discussions between CARE and UWESO need to take place about the merits of their collaboration to try and reduce the levels of bureaucracy and transaction costs.

VSLA could be introduced on a trial basis for other community committees where money changes hands. A trial of two or three committees should start if the committee has running successfully for at least one year and has proved it can manage its finances.

Mid–Term Review: Katine Community Partnerships Project, July 2009

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Views from Sub–County The Sub–County Sanitation Committee was formed to plan and supervise sanitation activities. It provides a link between the District and parish level committee and focuses particularly on sanitation promotion. The committee members explained the training pattern: Training What is sanitation? Supervision Water testing M&E

AMREF provision ● Out–of–pocket expenses (OOP) ● Food during training ● Allowance for committee meetings for first year ● OOP and transport for M&E

Materials ● 2 bicycles for each parish ● 240 toolkits for households and schools

Planning and budgeting Promotional activities

The outcome of the training includes better planning and sensitisation of the community about sanitation and hygiene. One member of the committee described changes in one village as an example. AMREF provided tool kits for Abata Village and 30 model homesteads now exist when a year ago there were less than 10 and the school now has one latrine. The committee members collect information from VHTs monthly reports. The Sub–County Health Committee has three sub–sections; sanitation, operation and management (O&M) and hygiene. Lack of funds have prevented the committee meeting regularly and the previous full meeting was in October 2008.

Recommendation… An urgent review must be made of the committees at Sub–County level to determine whether they are: ● necessary—and if not they should be disbanded ● combined ● reconstituted to take account of all Project components

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Views from three Parishes The selection of Parishes to visit was based on the MTR team’s request to visit one well– performing committee and one less–well performing committee. The MTR team held discussions with members of both Ojom and Ojama Parish Development Committees (PDCs) two of the six in the sub–county. The members organise meetings to discuss and plan ways forward for the Parish. They receive reports and plans from the village level via the PDCs and collect data to strengthen their representations upwards to the sub–county and then onwards to District level. Major concerns at present include lack of drugs, particularly to treat malaria,15 lack of adequate water sources and poor roads.

To North Uganda Tubur Sub-County

Ojama Parish

Olwelai Parish

Katine Parish

Ojom Parish Merok Parish

Ochuloi Parish

N At Ojom the PDC members felt that in previ- Lake ous years their planning had not been taken Kyoga Kamuda Sub-County seriously at District level and this caused W E disappointment. The committee’s training To Soroti Town has helped them to prioritise their needs, S keep better records and they feel themselves empowered to talk at District level. Everyone on the committee is freely elected and there are “no secrets”. It is important for the Project to track whether or not PDCs plans are considered seriously when they reach District level and whether improved planning at village and District level has any impact on District plans.

Committee members felt that the Project has brought many benefits; boreholes, permanent classrooms, bicycles for the VHTs, sanitation kits and latrines in schools. Having trial ECOSANs16 was seen as a good outcome. Again the issues of lack of adequate safe water and health facilities were raised in Ojama. However the committee is convinced that the training they have received in planning, recording and making representation upwards will bring change. The PDC was proud of its inclusive membership consisting of youth, elders, the disabled, a good gender balance and people living with HIV/AIDS (PLWHA). Although the committee had received earlier training, from the District in 1997 with refresher training in 2004, members feel that the training received from the Project has equipped them with both knowledge and sustainable skills. The members of the PHC reported that they had plans to build more latrines, keep records of meetings and have ‘smart’ work plans.

15 The GoU provides treatment for malaria but there are constant ‘stockouts’ in the Health Centres. It is outside of the mandate of an NGO such as AMREF as it cannot be seen to be replacing or interfering in the role of government. AMREF does collaborate with NGOs that do have a mandate for supplying drugs and it also advocates at National and local level. 16 The ECOSAN is sustainable and has the added value of providing dry compost and wet fertiliser. The pit for the latrine is constructed above ground with steps leading to the concrete cubicle. Each cubicle has two sets of footplates and holes, one in use and one covered, set over two concrete storage pits. Each hole separates urine from faeces. Urine drains directly into a tank which has a tap. Faeces are stored in a concrete pit with a metal lockable shutter. When the pit is full the second hole is used which feeds the second pit. After six months, the first pit is opened and the dry compost can be removed and the pit is then used again. There is doubt about the cultural acceptability of using human waste as fertiliser in Uganda.

Mid–Term Review: Katine Community Partnerships Project, July 2009

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The MTR team met with Olwelai Parish Sanitation Committee. The 11 members provided a ‘then and now’ assessment of activities since January 2008.

Then (Jan 2008)

Now (July 2009)

No ideal homesteads

Many ideal homesteads

101 pit latrines

396 pit latrines17

Outdoor defecation, excreta on ground

Clean area around homes

No hand washing

Hand washing regularly/tippy taps18

No fenced water sources

Boreholes fenced

Humans slept with animals

Animals housed separately

No dustbins

Waste kept in dustbins

Utensils left on the ground (got dirty and licked by animals) Plates and utensils washed. Drying racks constructed Shared water sources with animals

Boreholes fences

Dirty and open jerry cans

Washed and covered jerry cans/safe water chain

No sanitation committee

Active sanitation committee

Members of the committee meet once a month and have received training on mobilising the community, sanitation and health. The committee noted that women find it difficult to talk in meetings. Being healthy on the farm is important, malaria, safe water and eradication of worms are top priorities. The committee monitors the work of the VHTs. Members recognise that change is difficult and see the difference between teaching and the promotion of new behaviours as “saying it over and over until it’s done” and they use new by–laws to reinforce messages. AMREF has trained masons to produce sanitation slabs (colloquially called sanplats19) in each parish. They cost 7,000UGX (£2.03)20 compared to 15,000UGX in the market. Only 20 have been sold; this is seen as in indication of increasing poverty caused by changing economic circumstances. The Ojama Parish Sanitation Committee reported their key tasks as collecting data (population and the number of households, pit latrines and ideal homesteads) and sensitising people at village level. The data helps with planning at sub–county level and allows feedback to the community. At the start of 2008 there were 118 pit latrines in the parish, now there 565. Nineteen sanplats were made but only five have been bought. Of seven boreholes (one provided by the project) only four are providing constant water and water levels are low. Of 623 households only 154 can draw safe water. Views from two Health Centres The MTR team visited Ojom Health Centre ll and Tiriri Health Centre lV. At Ojom interviews and discussions were held with the 14 member of the VHT, four members of the Health Unit Management Committee (HUMC) and toured the facilities. The VHT reported their work as focusing on: ● encouraging pregnant women to attend for ante–natal care21 ● promoting good sanitation by encouraging latrine building ● mobilising the community for immunisation

17 A common belief is that women who use a latrine will be unable to get pregnant. The committee is trying to change this by discussion and education. 18 The Tippy Tap is a simple device for hand washing with running water. A plastic container with a small hole near the cap is filled with water and tipped by standing on a stick attached to a rope tied trough a hole in the cap. The plastic container then tilts and water runs onto the hands. 19 Sanplats are locally–made concrete platforms for latrines, they are easier to clean than logs or planks. 20 Exchange rate during July 2009: 1000UGX = 29p. 21 Women are discouraged from attending for the recommended four visits because of distance from the health facility, staff shortages and poor, unacceptable, staff attitudes.

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Ojom Health Centre II

The VHT at Ojom reported a massive increase in latrine construction from 20 to 400, representing change for 1051 households.22 Their capacity in counseling, family planning promotion, data collection and motivating others had been increased by their training. The rate for immunisation in Katine is the best in Soroti District and has reached 94% for polio and 119%23 for measles and polio together. The team suggested sugar, salt, raincoats, gumboots and bags as items to motivate them in their unpaid work. Some asked for motorcycles instead of bicycles. The VHT members spoke of their biggest disappointments as the lack of drugs and the short, three year time span of the Project, although all said they would continue to work when the Project ends as they see themselves as highly motivated and now fully embedded in the health system.

AMREF has provided a table, bench, a vaccine fridge, vaccine carriers and cold bags to equip the health centre. The recently well–equipped laboratory is currently staffed on an ad hoc basis and recruitment is underway for a full time laboratory assistant. The health centre had a supply of basic drugs such as paracetamol, doxycycline, vitamin A and fansidar. The drug store also had good supply of self–destructing, disposable syringes24 and gloves provided from the District. At Tiriri Health Centre lV, the VHT coordinator spoke of a reduction in many diseases and attributed this to the work and training of the VHTs. The distribution of ITNs for children >5 and for pregnant women, ‘friendly relationships’ with households that encourage use of nets together with a cleaner environment and less standing water has led to a reduction in rates of malaria (no figures available). The Parish has 256 ideal latrines out of a total 626 households. The rate of women delivering in the health centre has increased to 55% from 33% and since VHTs have had special psycho–social training, increased numbers of PLWHA are attending for support. VHTs are now active and recognised as front line health promotion workers, helping to identify problems and assisting the community with planning. The Health Centre IV had a selection of drugs, including anti–retroviral drugs and Nivirapine, a paediatric ARV to prevent mother–to–child transmission of HIV (PMTCT). The MTR team did not visit the third Health Centre in the sub–county financed by a Catholic church. The centre had suffered a fire and AMREF has financed the building of a new roof for the centre. Views from two schools The MTR team visited two schools, one was ‘better performing’ and one less so. Seven teachers were interviewed at Adamasiko and 13 members of the SMC and PTA. Teachers saw two major benefits of the training facilitated by AMREF. The first is the effort to improve school sanitation through PHASE (including personal hygiene, making rubbish pits and ‘tippy’ taps holding health parades to inspect fingernails and teeth and, importantly, teaching girls to make simple sanitary pads). The second most useful training was learning to make teaching and learning aids using local materials, these include; counting sticks, abacuses, reading trees, charts and maps, fibre balls for PE, flash cards and the creation of the ‘talking compound’ with health messages. Teachers described the enhancement of their own learning, including better classroom sitting arrangements and the use of concrete objects for teaching and learning. 22 Extended families living close together share a latrine 23 More than 100% of expected as children brought into the sub–county from surrounding area; as reported by the VHT 24 The self–destruct syringe prevents re–use and protects health workers from needle stick inquires

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The impact of the training was reported as children interacting, their work improved and the introduction of collaborative team work in the classroom. The training in adolescent sexual and reproductive health (ASRH) has improved guidance and counseling in the school. The SMC is monitoring teaching and learning and is involved in disciplinary action where necessary. The attendance of both teachers and pupils has improved. Women’s football, inspired by the tournament, has been very well received. Nets, balls and kit have been distributed by the Project and skills have improved. This is seen as emancipating for the girls involved. Enrollment at Ojom Primary School has improved in the past year; of the 389 puLack of desks at Adamasiko schools means many pils, 205 are girls. Ojom Primary is a comstudents have to sit on the floor. munity school with classrooms built of mud and thatch. Two permanent brick–built classrooms are currently under construction. All seven teachers were interviewed. The headmaster is the only trained teacher so for the rest of the staff the AMREF–facilitated training has been key to building their teaching skills. The PHASE workshops, ASRH, MDD and sports training together with making teaching and learning aids with local materials has been instrumental in improving the learning environment as well as boosting teachers’ morale. The school is starting to measure achievement by assessing how well children can answer questions verbally, by written, marked tests and by group work where children have role such as leader and secretary and provide group members with feedback. Views from the Media Centre Five centre users were interviewed together with Joseph Malinga the Community Media Facilitator. More than 100 people have been trained in basic computer skills. All five of the users have posted blogs on the Guardian website, they are know as ‘Katine Informer’. All five use email, four email outside Katine and two of those email outside Uganda. The users considered that the service would be sustainable; they saw the possibility of an internet café provider from Soroti running the centre although they were fearful of the cost as twenty minutes of internet time in Soroti costs the equivalent of a meal. Two on–line chat sessions have been held, linking school children in Uganda and the UK. Some equity issues exist; people with poor, or no, English are disadvantaged.

Ojom Primary is a community school with classrooms built of mud and thatch. Two permanent brick–built classrooms are currently under construction.

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Views from the Community Again, the MTR team met with a better performing WSC and a less well–performing one. The five members of the Water Source Committee at Matali (WSC) reported both ‘happiness’ at being able to collect clean water and a reduction in diarrhoea. They work to keep the compound clean, grease the chain and check the pump. Fencing work was done by the users. At first the water was ochre coloured but the system has been overhauled, the pipes washed and users are satisfied. The water has a strong iron flavour but this is reported as a natural phenomena. The committee reported a cleaner compound, fences and drying racks constructed, new latrines and bathing places. A hand pump mechanic supervises the committee; his work covers two parishes and he reported just nine days of maintenance work in June. The water source has 65 households paying 500UGX per month but no money was collected for five months, a new chairman was then elected and collections have been difficult during April and June 2009 because of lack of money.

Nine members of Omulai WSC were trained in early 2008. The water source has two caretakers; one for the borehole and another for its surroundings.

The nine members of Omulai WSC were trained in early 2008 and meet every two months. The water source has two caretakers; one for the borehole and another for its surroundings. Money is collected at the end of each month. There was no problem in May but it is anticipated that fewer people will be able to pay from July onwards. There is an LC125 on the committee who visits non– payers to get something, even a small contribution, from everyone. Nothing is hidden, savings and costs are open to scrutiny. The committee reported difficulty in getting repairs done in a timely manner. This meant that users had to use another water source for which they had to pay. Strangers are charged a flat rate of 500UGX. Users are satisfied with the bore hole and taste of the water.

Thirty eight members of Ojemorun United Farmers Group met with the MTR team to talk about their cassava ‘joint garden’, a communal endeavour in participation in planting, weeding and harvesting. There are 21 women and nine men in the group. The women consider themselves to be better at working together and making group decisions; they care for the compounds and seek support from within the group. At the moment there are constant prayers to “Papa, Papa” to bring rain to the fields; the talk is of drought and the resulting devastation to the crops. The advantages of being in the Farmers’ group which is also a VSLA, are being able to buy stationery, clothes, kitchen utensils, sell cultivated crops, growing upland rice and getting new ideas. All felt that they had benefited from new farming practices; particularly planting in rows which allowed weeding and uses less seed than ‘broadcasting’. The savings had helped farmers to set up small businesses, for example, buying cassava, taking it to market and selling it. One person talked about the business skills he has developed. It was important to advertise your business he said and he had made a sign for his store at the trading centre stating “I am buying scrap”. Record keeping was noted as being important as was group sharing and problem solving which also helped dissipate rumour–mongering. The women, in particular, enjoyed having visitors, especially when mzungu came to the village. Visits from VHTs were welcomed and they were seen as instrumental in helping to ensure homestead hygiene. A show 25 Local Councilor level 1

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of hands indicated that he vast majority now had a latrine and drying racks. They estimated that half the villagers slept under ITNs. All the members of the farmer’s group spoke of the need for anti–malarial drugs. The comments were similar at Obalanga Alamakis Farmers’ Group. Although they kept individual gardens the group had expanded to communal farming using improved strains. They summed up: Benefits of Group/ group garden

On your own/own garden

Shorter work time

Long hours

Get united and work faster

On your own

New strain Cassava with better crop

Old cassava strain and weaker crop

Rules and regulations

Do it in your own way and own time

Learn how to space plants

Old methods

Can borrow from others Friendship and unity

On your own

Promotes leadership

The training facilitated by AMREF had resulted in better knowledge about planting, using less seed and saving money. The group had saved 1million UGX (£290.00) from, for example, trading fish or a local brew made from millet. Money had been spend on items such as school fees, drugs and clinic treatment. Two VSLA groups were visited, Akiro Pote in Owelai Parish had a cumulative total (11/07/09) of 900,300UGX and a welfare fund26 of 111,400UGX. Members took loans for ‘big days’ such as Easter and Christmas, for medical treatment and one person bought a coffin. It is felt to be safe as the money is hidden and not kept at home. Members borrow for business (such as selling fish and cassava), for school fees and books. The VSLA group believed that the association benefited the entire household and was sustainable because everyone can see the benefits. The VSLA at Acanmire has completed its first cycle of saving and has started a second. All the original members have remained in the group and new members VSLA groups say the association benefits the entire have brought the total to 20 people. Loans household and is sustainable. were used for bicycle spares, seedlings, making pancakes and bread to sell at the market and school fees. After the payout from the first cycle group members bought high value items such as a cow, radio, bull, heifer and a sheep, ox–plough and bullock, cement and bricks to build a lock–up at the trading centre. The new joiners saw that those “inside had benefits and could easily access money.”

26 The welfare fund is for emergencies and can be accessed day, or night, by members who pay a flat rate of 200UGX at each meeting. The welfare fund has been used for buying food and drugs.

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Gender and equity issues It is notable that there is predominance of women only in the Farmers’ and VSLA groups. Gender is a major issue related to empowerment and it is clear that few women are engaged in positions of authority and power at District or Parish level. The table below shows the number of men and women at interviews and meetings27 during the MTR as well as the gender balance of the KCPP team in Katine. Women

Men

District level (all committees and meetings)

8

48

Sub–county committees

3

14

Parish level

25

56

Schools (teachers, SMC and PTA)

8

33

Health (Health Centres, VHTs, HUMC)

12

20

Farmers’ Groups

32

19

VSLA groups

20

12

Village (water source committees)

5

7

AMREF team in Katine (excluding administrative staff)

3

9

There are few women in positions of authority at District level, only one was present during an interview and she is responsible for nursing in the district; a profession traditionally associated with women. Both the Steering Committee (2 women: 12 men) and the Management Committee (4 women:21 men) are dominated by men and no woman spoke during these meetings. The only woman at the Sub–county Sanitation Committee meeting is also the sole woman member of a Parish Sanitation committee. There is more gender balance in the Parish and Village–level committees such as WSCs, presumably because it is women who are responsible for collecting water and the cleanliness of the surroundings. Only one committee, Ojama PDC, mentioned its attempts at equity and inclusivity. There were considerably more men in the management of both the schools visited; the current ratio of men to women teachers is 3:1. School enrollment has increased and many parents now know that the bride price for young women may be higher if they are educated and this has had the unexpected effect of increasing the enrollment of girls. The District has made an effort to recruit women teachers, wanting to promote the education of girls and provide role models. The recent AMREF facilitated training across the sub–county has resulted in women councilors speaking about the important of female education. One particular effort to improve the attendance of girls has been to train teachers in how to make sanitary pads from local materials so that girls can stay at school when they are menstruating. AMREF must make the issue of women’s leadership an important element when rolling out the ‘rights based’ approach in year three. If a rights based approach is about knowing your rights, knowing your worth and claiming your rights then women need special attention. If vacancies occur in the AMREF team in Katine every effort should be made to engage women.

Recommendation… AMREF must make the issue of women’s leadership an important element when rolling out the ‘rights based’ approach in year three.

27 These are the numbers of those who attended the meetings not the total membership but the balance is unlikely to be any different

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Questioning the Community A quick survey was devised, pre–tested and then administered by the Project team to 53 community members in all six Parishes. The questionnaire and results are in Annex 8. The questions ask about the respondent and his or her family and are designed to be a snapshot of community views. The questionnaires were collated at a team meeting.28 The first question in four of the sections was about change: YES

NO

Have their been any changes in your and your family’s life in EDUCATION since the start of 2008?

51

2

Have their been any changes in your and your family’s life in HEALTH since the start of 2008?

52

1

Have their been any changes in your and your family’s life in WATER AND SANITATION since the start of 2008?

52

1

Have their been any changes in your and your family’s life in your FARMING since the start of 2008?

38

15

Ninety per cent of respondents reported a change to their and their family’s life since January 2008. These figures are consistent with data collected by the Team. Tables show activities plotted against each village in the four parishes. Every village has received at least one intervention and some have had two or three. Tables are in Annex 9. To judge engagement with community issues the question was asked about involvement:

Are you or any of your family a member of any COMMUNITY COMMITTEES

YES

NO

27

9

At least one person is member of a community committee in 66 per cent of families surveyed. The next questions related to what changes had been noted and which were the most important. Community members were then asked what they had expected to see and what they would like to see (see Annex 8). The results of the quick survey were instrumental to the Team’s thinking about the third year of the Project.

28 The Team were split into five groups of three and each group took responsibility for entering data onto a flip chart sheet and calling the results to a group of tellers. The figures and words were entered into a copy of the original questionnaire by the Consultant and checked.

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Achievement rating (see Annex 10) As described previously, the table of achievement ratings was based on the ‘specific objectives’ and ‘expected outcomes’ as stated in the ToR. The achievement rating was devised by adapting a format used across all DFID funded programmes for its mid– term and output to purpose reviews. Further details of achievements are in Annex 6. Key points: ● All five key objectives have been addressed in the first 18 months of the KCPP. ● Unplanned outputs included the Football tournament, repairing the roof of the Catholic–funded health centre and the need to replace plastic panel latrines that were not able to withstand strong rains. ● The Livelihoods component has been less successful as it might in terms of increasing crop yield as drought has caused severe problems for farmers. The following table sums up the DFID measures for outputs (quality, sufficiency and efficiency)

Appropriateness

All outputs are appropriate



Quality

 ostly good but variable (bore holes/school building problems29) Training quality M appears good; it has engendered enthusiasm.



Sufficiency (quantity)

 ot enough infrastructure (water sources, classrooms, desks). Appropriate training N in health, education, WATSAN, livelihoods and in committee training at all levels. No rights–based training.



Efficiency and timeliness Some outputs slow. Poor procurement timing.



Overall score = 2.930

29 The use of local builders or builders contracted from Kampala has been an much–debated issue. Unfortunately school building has been held up by poor workmanship by contractors from outside the District. This has been a costly exercise in terms of time and money.. Further building work will be contracted locally. 30 1 = fully achieved, very few or no shortcomings 2 = largely achieved, despite a few shortcomings 3 = only partial achievement, benefits and shortcomings finely balanced 4 = very limited achievement, extensive shortcomings 5 = not achieved

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AMREF Management AMREF is a many–tiered organisation with a head office providing some technical support in Nairobi, liaison with UK donors and overall corporate management from London, Project management and supervision from Kampala and local management and day to day implementation from an office in Katine. Added to this is the AMREF Board of Trustees who, to ensure financial probity and good governance, sets limits on spending at field level. These are seen as non–negotiable constraints by the Kampala office although the Country Director has the ultimate responsibility and decision–making power for the Katine Project. Questions have been raised about such issues such as where procurement should be done, who replies to Guardian bloggers or defends decisions about how the Project is managed. The layers haven’t been helpful in trying to understand how decisions are made except that they are seen, by the outside world, to be made slowly. Managing a project in Katine from Kampala is fraught with difficulties, particularly with intermittent email service. The Project Manager doesn’t make any but the most simple decisions. Discussions in Kampala after the field work led to plans to change the way the field office may be managed through a team management approach by giving each Project Officer more decision–making power. This would release the current Project Manager to spend time assisting with rights–based approaches training, about which he has specialist knowledge, in year three. The Deputy Country Director has day–to–day responsibility for the Project but more frequent and regular visits to the Project site are necessary. Two possibilities are proposed; either that she spend two days in Katine every 2–3 weeks or AMREF assigns another person to provide regular management support to the team.

Recommendation… AMREF Kampala must provide more day–to–day management support at field level at the earliest opportunity.

Despite accepted good practice in most organisations, staff contracted to the Katine project have not had opportunities for staff development. In order both to share experience and learn from others, at the very least all staff should be encouraged to attend national, and where affordable and relevant, international conferences or a study tour at least once during their contract. There is of course, a cost implication to this but the opportunity to learn as well as disseminate the Project are worth it.

Recommendation… All staff should be offered appropriate staff development opportunities to attend conferences or study tours.

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The Project Time Frame Three years is a short time in the development process. The first months are taken with finding—and in this case building—premises, equipping them, selecting and engaging staff, planning and budgeting. Making relationships with government officials and other stakeholders also takes time, as does getting the confidence of the community. Taking the UK’s Department of International Development (DFID) as an example of good practice globally, it is most unusual for a project to be funded for less than four–five years and often for much longer. It is recognised that development is slow and impact takes time to monitor.31 The implication for the Katine project is that, although most activities are on track, real change is unlikely to be seen across the whole sub–county with its 66 villages by October 2010. This means either that the Project must continue, with adequate funding to complete the job or the Project ends and is seen, possibly, as a failure because it won’t have achieved everything that it set out to do. The workshop in September must agree a set of specific targets that it believes AMREF and its partners can achieve by the end of 2010. Now is the time to make decisions about further funding and to plan for, at the very least, one further year. This decision must be based on an agreement to review project outcomes and the range of activities and targets revised accordingly. Every attempt must be made to ensure sustainability by continued and further alliance with GoU and other district actors. If funding isn’t found for a fourth year, the third year must create as much sustainable impact as possible with the remaining funds. In addition, in the absence of a ‘future’, staff will leave the Project and this will deplete both its pool of expertise and enthusiasm.

Recommendation… The Guardian, Barclays and AMREF must immediately negotiate whether or not funds will be available for a further year until 2011. If no further funding is obtained from other sources, AMREF must develop an exit plan for how it will respond if a number of project staff seek to leave KCPP for other employment before the project ends in late 2010. Failure to do so could jeopardise the Project’s progress in the last months of 2010.

31 DFID Health Advisor (anon) interviewed by telephone July 2009

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Planning for Year Three As of March 2009 (the last financial reports submitted to donors) £500,000 remained available for activities in Katine which includes money committed for building more classrooms and an operating theatre. Currently this money is allocated to the different components as it was when the Project was first designed. The budget must now be re–worked to allow a number of critical interventions, to be implemented—including what has been committed. If only one (or perhaps two) years of project life remains activities and interventions must be based on these criteria: ● impact ● sustainability ● what the community wants

Recommendation… AMREF and its partners must redesign the third year budget to put the maximum funds into agreed activities and interventions.

At the Team workshop at the end of the MTR, taking into account the issues of impact and sustainability and using the quick survey to determine what the community wants it was agreed that these were the most suitable outputs: Component

What must be done in year three

WATSAN

● More water sources—as many as possible—to increase access to 80% ● Hygiene and sanitation promotion

Education

● Provide locally made desks to as many schools as possible ● Construct and rehabilitate more classrooms—additional to those already planned ● Promote packed lunches for schoolchildren

Health

● Continued training for VHT to strengthen disease prevention ● Training in health centres to build capacity for better service ● Infrastructure—including the operating theatre at Tiriri Health Centre

Livelihoods

● ‘On–farm’ trials, including provision of ‘inputs’ ● Farmer to Farmer learning ● Supporting alternative income–generating opportunities

Community Empowerment

● T  raining in ‘rights based’ approaches to ensure good governance and to strengthen planning at all levels

These activities and interventions represent the ‘bottom line’ of what should be done and concrete plans for what, where, and how many must be determined at the September workshop in Soroti. Basic information on costs will be crucial to determining the plans.

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Planning workshop, 15–17 September 2009 Soroti The September workshop must be a mixture of discussion, planning and agreements. It must give confidence to donors that the KCPP is on the right track, is flexible in relation to immediate needs (such as famine) and can do what it sets out to do within budget. It is likely to be a mix of large and task–oriented small group work. Key outcomes for the workshop: 1. A  time–bound course of action from AMREF and the Project partners about which recommendations to take on, which to ignore, what should be done differently and how it will be funded and resourced. 2. A decision of what Barclays and the Guardian will continue to do in 3. Katine until the end of 2010 and beyond. 4. An agreement on the partnership, roles and responsibilities until the end of year 3 (end 2010) and a tentative one up to the end of 2011 (with possible scenarios for ensuring sustainability). 5. A separate agreement between AMREF and the Guardian for ‘rules of engagement’ with both London and Uganda. 6. An outline plan of what is to be achieved by the end of 2010—agreeing which critical interventions are to take place A possible outline for the two days would include: ● P  resentation and discussion of the MTR recommendations ● AMREF and Project partners’ views of how to take on board the chosen recommendations, fund and manage them ● AMREF and Project partners’ scenario for end of Project Year 3 and beyond; how KCPP becomes a responsibility of local government ● An agreed series of targets to be met by the end of Year Three ● Resource allocation/what funds are needed after 2010—other sources of funding ● Plans for how the various partnerships, (KCPP partnership and Guardian/Barclays/CARE/UWESO/FARRM–Africa) will work for the remainder of the project and beyond—particularly in terms if handing over to government ● Decisions on how KCPP will respond to the drought if it continues to get worse—what funds can be diverted?

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2010 and beyond A discussion and planning process needs to take place on exactly what is to be done in Year Four both in terms of inputs and how to ensure sustainability by the engagement of government partners. AMREF is testing a model that can be replicated by government, AMREF is not a replacement for government and must not be considered as such.

Recommendation… KCPP cannot provide the answer to the many problems in Katine sub–county, it can only model ways of working based on best practice. Any work that takes place in Year Four should be in total partnership with local government—and not seen as an AMREF water source, or AMREF classroom or AMREF training. Some co–funding from the government is desirable. By the end of the KCCP AMREF will hand over the Project completely to the government.

What could be achieved in Year Four includes: Improved functioning of structures in which decisions take place More advocacy to District and National government Alignment with national targets (and, if and where possible, to the MDGs) More impact at all levels through empowerment from targeted rights–based training, providing a voice for women and minority groups ● More impact through:  schools; a small budget could provide more desks and books  health; refresher training for VHTs  more water sources  business skills for farmers  smarter meetings and functioning of different groups and services ● ● ● ●

Whenever the Project comes to an end it will be important to have a celebratory and ‘winding–down’ event, showcasing change and success; perhaps including a cultural show involving schools.

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