UDHA COMMUNITY LED MONITORING REGIONAL DIALOGUE

[00:01:22]humbly requesting more heart to step forward.

[00:01:27]Uh the second uh >> If deemed what?

[00:03:08]Necessary. But I've been ably informed you're familiar with the subject matter that is going to be handled.

[00:03:15]And I also want to believe that you have ably prepared yourselves.

[00:03:21]So, there's no need for any anxiety around.

[00:03:25]So, relax and be able to deliver at the end of the day.

[00:03:32]After you leave here or as you deliver your session there are outputs we must achieve at the end of it.

[00:03:40]Output number one is we need to have come up with a shared understanding of what community-led monitoring is from all the submissions each of you is going to make Our second output is about community perspectives on issues of accessibility of care acceptability of care or services, affordability and quality.

[00:04:06]These are the issues that we are interacting with on a day-to-day basis.

[00:04:12]And the other output is about understanding what the key community priorities are.

[00:04:20]And if communities have any other If it's okay, you're welcome. Sorry about that.

[00:04:52]The rules of engagement have been laid clear. Who is from Ashua?

[00:04:58]Thank you.

[00:04:59]Who is from Mbale young people living with HIV?

[00:05:02]Who is from Mityana?

[00:05:04]Bukwo, uh-huh, Namutumba. Then who is from Bukwo?

[00:05:08]And then who is from Mbale district?

[00:05:11]You're from the city.

[00:05:12]You're from the city.

[00:05:14]You're from the district. Thank you.

[00:05:17]You're welcome. So, we are going to go with the uh the first uh panelist.

[00:05:22]And this is from Busia.

[00:05:32]The issue is from the community uh led monitoring findings what quality of care issues concerning improvements are needed to ensure people receive It's about services.

[00:06:01]So, receive safe timely and effective services.

[00:06:08]Cuz we want to believe that uh you being the CBO, you've been working together with the members of the district local government and we have been monitoring services.

[00:06:18]So, we are basically here to share feedback in terms of your own experience. So, you are the one who gives it the first shot.

[00:06:27]But, be reminded that your time is 5 minutes.

[00:06:31]And where is our MC?

[00:06:34]Erasmus, I think you'll be the one uh timing.

[00:06:37]>> [clears throat] >> So, give it your first shot.

[00:06:40]Thank you.

[00:06:42]>> Okay, thank you.

[00:06:44]Uh our moderator I remain congratulating Barbara from Busia, that's Ashwa.

[00:06:50]Uh basically, the key uh quality services that we look at um when we talk about CLM and the voices in the community uh we look at basically things like the health workers. And when we talk about um the health workers, we have the inadequate uh there's shortage of health health workers at the facility. Uh this basically uh affects the quality of services, uh whereby we find that when clients come to the facility, there is always uh long waiting hours. And when when you look at the long waiting hours, some of these clients get discouraged and basically uh leave the facility. So, that basically hinders the provision of quality services. Then also, we look at um uh we are able to Sorry. Then also we are going to look at the the inadequate infrastructure.

[00:07:50]Uh most of these facilities have >> But then response but also make sure that the system also can implement the actions that actually they're suggesting as community.

[00:12:07]I come from a community and also we have seen that um communities um they don't want to just be beneficiaries rather considered only during implementation but also they want to be part and parcel of the entire health system and here we are meaning like uh we have seen uh at the district level we see DHTs meeting happen for health system that actually communicates to the needs.

[00:12:33]health system that actually communicates to the needs. But also there is where the community understands that when we when we say quality quality of care community understands that when you say quality of care for quality quality of care community understands that when you say quality of care for them they know that them they know that it must have consistent medicine it must have consistent the third kind of of that CLM.

[00:13:02]That's the list at the end of the day for us as community we are saying that to the health system to the health to the to the district leadership we are asking um because we have generated a lot of evidence and a lot of issues we are just asking is it possible for us to institutionalize some of these maybe institutionalize CLM into the district feedback mechanism like for example during the DHT for example during the um super support supervision can see them be part of that. For example, the district quality improvement plans, we want to see that CLM also has to be in a certain stage at that level. But also across all districts, even during the presentation from WHO, we saw that infrastructure is one of the key thing that CLM has always um has has always identified right from the first semester to this semester. So, we want to see that district maybe since they're here, also they can support us. And for me, this is a prime time because the new financial has started and also it opens a window for the new financial planning.

[00:13:57]So, maybe you can pick some of these things. So, um also to the to the facilities still, uh we want to strengthen our accountability mechanism.

[00:14:05]I know at as as as local government, we have the the way we get our feedback from Ministry of Health utilizing the QR code. But for us, we are saying, "Okay, we need that DHIS2 data, which is okay, but also need to hear the experiences from the community itself that are getting these services. So, maybe from to the ministry to TASO and to UDA who are our implementing partners, for us, we just want to see Our hope is that maybe at the national level, can we have uh CLM integrated maybe in the national in the national CHI plans at the end of the day, we're able to follow some of these things. But also, the Ministry of Health, I see that the commissioner is here.

[00:14:47]there Is it possible for us maybe to develop a mechanism where when districts are reporting or facilities are reporting, that the CLM new feedback is one of the things that they should report about. Like for example, something that you maybe can say, "Okay, uh for this quarter you're reporting, what was the findings from CLM and how far have you implemented them?" At the end of the day, for us, that would be very good at community.

[00:15:08]Thank you so much.

[00:15:10]>> Thank you very much, uh Mepa.

[00:15:13]I think he has uh made life very easy because he has specified and recommended to uh each and every entity that is here.

[00:15:23]But, from what you have said, patients or clients have so many demands on the health system.

[00:15:33]But, there's always one aspect that our clients don't take serious.

[00:15:39]That is responsibility on their side.

[00:15:41]I don't know whether you have ever heard of about what they call a client charter.

[00:15:46]It stipulates two arms.

[00:15:49]What the health worker's responsibility is and what the patient's responsibility is. But, most times, patients ignore their part of the what?

[00:15:59]Uh of the coin.

[00:16:01]And they they overweigh us.

[00:16:03]Otherwise, you Do you want to make a comment on that?

[00:16:06]>> Yeah, I can make some >> Because you directly interact with community.

[00:16:09]>> Yes.

[00:16:10]>> Yes.

[00:16:10]>> Um thank you so much. I think something has been happening before CLM. Because if you look at the implementation of CLM at different levels, you have interface with both the facility but also the community. So, we make sure that during the facility feedback and community feedback, both people are there, community and um and the facility. So, previously, we would hear if you go to the community, we would hear, "Ah, this is that that one is for the health workers." And then if you come to the community, they say the the the the facility will say, "But, our clients are the ones." So, what we decided what CLM is doing at a certain level, we bring these people together so that we hold each one accountable. If you're saying that I'm supposed to come for a service at 9:00 and I come at 9:00 and the health worker is not there, whose responsibility is that?

[00:16:52]So, those are the things that actually we are implementing we are appreciating CLM.

[00:16:58]Clients have come to understand that also they have a responsibility as the health health workers are also accountable at the end of the day.

[00:17:04]>> And the final one.

[00:17:05]>> Yes.

[00:17:05]>> Is we are realizing that the the the the the commodities that are supposed to support facilities deliver services are being stolen. Yes. And they are stolen by our own community what?

[00:17:19]Members. So, it's also imperative that while we interact with them, >> Mhm.

[00:17:23]>> tell them that the facilities that are offering them services are part and parcel of them.

[00:17:29]>> Yes.

[00:17:29]>> [clears throat] >> So, one of the responsibilities they should be charged with is make sure that they take care >> True.

[00:17:35]>> of these facilities. They should guard them jealously.

[00:17:37]>> Yes.

[00:17:38]>> Thank you.

[00:17:38]>> Thank you so much.

[00:17:40]>> Ah, thank you. I think uh he has given it uh his best and uh I hope members have gotten the issues.

[00:17:47]We move to our third panelist.

[00:17:50]That is uh the CBO from Namutumba.

[00:17:53]And the gentleman is my uh former friend.

[00:17:57]And he's still my friend.

[00:17:59]He's directly uh >> What What happened?

[00:18:03]>> Uh-uh, [laughter] there's nothing that happened.

[00:18:05]You went to Namutumba.

[00:18:07]Uh and you know the road to Namutumba >> That is a distance.

[00:18:12]>> So, thank you and I'm grateful that we are meeting today.

[00:18:14]>> Mhm.

[00:18:15]>> And uh you are the ED of Inshao.

[00:18:18]And I believe you're going to bring for us very good experience uh from that side.

[00:18:23]And uh from your own experience of CLM uh implementation, what is CLM in your own experience? Why is it important?

[00:18:37]And how has it strengthened accountability between communities and the health system?

[00:18:46]Accountability.

[00:18:48]I am doing this, you are doing the other. At the end of the day, we need to be accountable to one another.

[00:18:55]>> That's Mhm.

[00:18:56]>> use of blame game.

[00:18:59]>> Yeah, for the record, chair, I'm not the ED.

[00:19:02]I I head programming.

[00:19:04]>> [laughter] >> I don't want to lose a job after here.

[00:19:08]>> Protected. [laughter] >> Thank you.

[00:19:10]Uh my name is Amos Ksambira.

[00:19:13]Like I said, I head programming at Inshuti Mu Tumbo.

[00:19:17]Uh, the first segment of the question is what is CLM?

[00:19:22]Uh, CLM, according to Namutumba, is Community Led Monitoring.

[00:19:27]And our understanding of CLM is that is is based in four areas.

[00:19:33]One is the process of enabling communities one to understand their roles in the health system management system.

[00:19:43]And number two, to help them also uh, with that ability to now raise their voices in terms of factors that contribute to improvement of health services.

[00:19:57]The The other segment is that as we do that we are trying to strengthen uh, accountability.

[00:20:04]Uh, accountability in the health service system, of course, which begins with the communities themselves.

[00:20:11]Then the the service providers. Then the other segment of of of CLM is how do we bring all stakeholders together?

[00:20:19]To co-create >> [music] >> and that's to us that is very important, to co-create solutions.

[00:20:26]And our understanding of CLM then means that now it it because CLM is structured is strategy that seeks to put the communities at the lead in terms of which is which is the the the the key theme >> [snorts] >> of the community health system strategy.

[00:20:43]Now, why is it important? The importance of of of CLM lies in basically four areas.

[00:20:50]One, uh, the ability to create the ability to enhance capacity.

[00:20:55]Uh, you were talking about the the responsibilities that the charter the health charter brings. We want to inform you that based on our experience uh, Uh even some health workers did not know that this charter existed.

[00:21:11]Now, if the service provider does not know that the charter exists, how about the service user?

[00:21:17]So, the important