Katine Community Partnerships Project Conceptual Framework Friday 25 th September

1. Katine Community Partnerships Project Conceptual Framework Friday 25th September

2. The Development need: Soroti, in eastern Uganda, is five hours drive from Uganda’s capital city, Kampala. It is one of the poorest districts in the country with more than 77% of the population living on less than a $US1 a day. AMREF identifies priorities and allocates resources on a pro-poor basis, giving priority to people and communities that we believe to be the most vulnerable. Katine is a Sub-County in Soroti district and was selected because of the high levels of poverty, the negative impacts the civil war and rural – urban migration are having on the area, and because, as an area reliant on agriculture, it is being badly affected by changing climate patterns. There is currently a gap between the formal services being provided by Government structures and interventions, and the local community, which is especially marked in a rural setting such as Katine. What we are hoping the project will achieve: Poverty reduction, better health, access to education, increased income and a role in decision making are all inter-related. In order to improve the lives of those living in Katine we will deliver an integrated project, working to support the community in all these areas. At the highest level the project has been designed with 5 goals in mind: Improved community health Improved access to quality primary education Improved access to safe water, sanitation and hygiene Improved income generating activities Communities empowered to engage in local governance By encouraging development in all these areas the project will change the lives of those living in Katine, but not just for the three years that the project is active. By empowering the community to engage in local governance, and providing them with knowledge around health, hygiene, safe water and agriculture, as well as improving the quality of education available to young people in Katine, this project can bring lasting change. How we are going to approach this: AMREF works with the poorest and most vulnerable people in Africa, therefore our interventions mirror this approach. The project will target those who will benefit from the project the most. In healthcare this means prioritising PLWHA, CU5,women and young people. In education we work to target gender imbalances, as well as working to ensure that those with disabilities can access schooling. This project will be implemented through community partnering; that means the project team will work with members of the community throughout the development, planning and implementation process. By working with Farmers’ Groups, VHTs, PTAs, and by establishing community committees, for example Water Source Committees, community members will be at the centre of their own development, and have a key stake in decision making. The project will therefore be responsive to community needs and priorities, and through community participation the interventions will be owned by the community, so that many developments can continue beyond the 3 year lifespan of the project. This project will build the capacity of these community organisations, and the local Government (at District, Sub-County and parish level) to manage their own development. This will be done by improving the gathering and use of community based information – for example, supporting health centres to monitor levels of essential medicines, providing the Sub-County with planning and budgeting training, and encouraging community management of primary schools. Across these groups the project will work to develop the skills of both formal workers (teachers, health workers, Government employees) and the community volunteers who are delivering essential services to the community, for example the village health teams. AMREF believes that in order for development to succeed the gap between communities and Government needs to be closed. Therefore this project will work with local government structures to support them to work with Katine. This project will strengthen and further develop AMREF’s model for community based development. KATINE COMMUNITY PARTNERSHIPS PROJECT CONCEPTUAL FRAMEWORK Overview

3. KATINE COMMUNITY PARTNERSHIPS PROJECT CONCEPTUAL FRAMEWORK • 66 village health teams trained to provide community integrated health package • Communities trained in health promotion strategies • Community vaccinators trained and outreach activities supported • Target groups receive preventive supplies (ITNs, FP methods, condoms) • TBAs trained in safe delivery, pregnancy danger signs and referral Improved quality of health systems and services Improved rural health systems OBJECTIVE 1: IMPROVED COMMUNITY HEALTH Outputs Context Sub-Objective Activities (Inputs) Outcomes Examples of Indicators 10 preventable diseases cause 75% of premature deaths. The most significant are peri-natal and maternal conditions, malaria, acute respiratory infections, HIV/AIDS and diarrhoea which account for 60% of the disease burden in Uganda. There is poor quality and utilization of prevention, treatment and care services due to lack of funds, lack of and uneven distribution of human resources, poor management and systems, lack of medical equipment, inadequate and interrupted supplies of medicines and other supplies. Rural areas have worst health indicators and greater inequalities in access to basic health services and safe water and sanitation. Cost and distance to health facilities prevent many people from seeking care. MOH priority focus is to operationalise health sub districts and village health teams to achieve more effective and equitable delivery of cost-effective interventions. Lack of appropriate knowledge and behaviours, with underlying social and economic factors, contribute to poor health status. And there is low community awareness and participation in political and planning process for health services and other basic services. • Exposure • % of household heads that attended a VHT health promotion activity • Awareness/knowledge • % of men and women 15-49 years that know a district source for PMTCT drugs and ART • Health facility capacity • % health facilities regularly providing all services appropriate to level • No. of diagnostic tests performed for HIV, TB and malaria • % of orders for medicines and lab supplies submitted on time as per national schedule • Systems functioning • % of VHTs that met 4 times or more a year with health centre mgmt team & HSD • % of VHT members dropped out • % VHT that submit monthly HBMF report • Service utilisation and coverage • % of pregnant women and U5s sleeping under an ITN • No. of CU5 received home-based malaria treatment (HOMAPAK) within 24 hours from CMDs • % of CU5 who had fever that received recommended anti-malaria medicine within 24 hrs from any source • % of women who recently delivered that: attended ANC; received two doses of IPT; and of those HIV+ received antiretrovirals for PMTCT • % of women 15-49 currently using a modern contraceptive • No. of deliveries performed in HCIV facility • % children age 12-23 months fully immunized • No. of registered TB patients receiving anti-TB drugs • Train VHTs on community integrated health package (malaria, diarrhoea, SRH/FP, EPI, sanitation/hygiene, HIV/AIDS, CB-DOTS) • Support VHT activities to promote awareness about health services and related activities e.g. campaigns • Train community vaccinators in EPI and record keeping and support immunization outreach • Support community-based FP sensitization and distribution of oral contraceptives and condoms • Establish a community-based ITN distribution system prioritising the U5s, pregnant women and PLWA • Train TBAs on safe delivery methods, pregnancy danger signs and referral system Improved community-based prevention, care and treatment Increased community awareness of, access to and utilisation of health services in community and health facilities • All health providers trained; facilities and labs equipped and performing full range of diagnostic and health services as appropriate per facility level • Improved availability of medicines, supplies and equipment for HIV/AIDS, malaria, TB, IMCI, reproductive health. • Improve health centre lab infrastructure and provide equipment and supplies for diagnosis of HIV/ AIDS, TB, and malaria • Train lab personnel for improved diagnostics and treatment of HIV/AIDS, TB, malaria and other common diseases e.g. anaemia, STIs • Train/retrain health workers (as appropriate to facility level andfunctions) on HIV/AIDS, TB, malaria, IMCI, normal delivery & EMOC, infection control and waste disposal • Train health workers and health unit management committees in logistics management of essential medicines and lab supplies and procurement of equipment • Health facilities and HSDs meet regularly with VHTs to solve problems and plan together to improve community health • Supervision and supply systems in place and functioning at health facilities and HSD to support VHTs • Community-based referral system in place and functioning to direct people to appropriate facility level • VHTs equipped with low-cost transport and drug storage facilities • Community informed about VHT services • Train VHTs and health unit management committees on management processes including planning and budgeting • Strengthen system for regular meetings, supervision and reporting of VHTs at health centre, parish and HSD levels • Strengthen referral system from VHT to appropriate level of health facility and track referrals • Conduct joint training of VHTs and health centre staff on referral system and VHT supply system (e.g. HOMAPAK, condoms) • Strengthen procedures for tracking and replacing VHT drop outs • Provide bicycle and drug storage kit to each VHT • Train VHTs on community-based information systems including immunization coverage, birth and death registration • Carry out local radio programmes to inform communities about VHTs • Explore options for funding motivation package

4. KATINE COMMUNITY PARTNERSHIPS PROJECT CONCEPTUAL FRAMEWORK • Biannual meetings held with each parish to sensitise communities to the importance of inclusive education • All primary school teachers trained in disability-friendly teaching methods OBJECTIVE 2: IMPROVED ACCESS TO QUALITY PRIMARY EDUCATION Outputs Context Sub-Objective Activities (Inputs) Outcomes Examples of Indicators There are fourteen primary schools and one secondary school in Katine Sub-County. School drop-out rates are high averaging 19% for boys and 22% for girls because parents need children to help with income generation. Only 3.9% of current pupils in Katine Sub-County are in P7. Out of a total of 67 parishes across the district 3 Katine parishes come in the bottom 4 parishes for progression to P7. 16% of the children of primary school age in Katine are orphans and vulnerable children. This group is less likely to receive a comprehensive education. Classrooms are overcrowded with a pupil:classroom ratio of 91. Only 47% of the pupils in Katine have seats. Schools lack basic facilities such as access to safe water and latrines. Only 37% of the need for latrines is met in Katine Sub-County. The repetition rate for pupils is 23%. Teacher are often de-motivated and absenteeism is high. Schools lack effective teaching materials and the linkage of schools to Sub-County accountability level is weak. • Train teachers on child centred methodologies to improve academic performance • Train teachers to promote adolescent friendly reproductive health counselling. • Provide teaching materials to teachers to facilitate teaching and learning (including materials for reproductive health) • Support supervision and follow up of teacher training • Rehabilitate existing classrooms • Increase seating facilities • Construct new classrooms • Use music, drama and sport to encourage children to stay in school and to strengthen the capacity of school health clubs • Improve sanitation facilities for girls and boys, providing accessibility for the disabled and special facilities for girls (including bath shelters, changing rooms and the sourcing of affordable sanitary pads or training girls on how to make their own) • Strengthen linkages between schools and the communities to promote personal hygiene and sanitation education • All primary school teachers trained in child-centred methodologies • Teaching materials circulated to all primary schools • A total of 26 classrooms constructed across the Sub-County • Separate disability-friendly sanitation facilities for boys and girls constructed for all primary schools that fall short of the required standard • Musical instruments, costumes and sports equipment provided to all primary schools • Teaching methods • Number of primary teachers trained on child-centred methodologies • Number of teaching materials circulated to primary school teachers • Number of primary schools that have reproductive health topics in curriculum • Learning facilities • Number of classrooms rehabilitated or constructed by project • Number of seating spaces provided by project • Hygiene & sanitation • Number of primary schools using improved and hygienic toilet facility • Number of primary schools that have separate latrines for boys and girls • Number of primary schools with all essential hand washing supplies readily available • Inclusive education • Percentage of girls age 6-12 years attending primary school • Number of schools with disability-friendly approaches and infrastructure • Number of primary school events held • School supervision • Number of children trained to monitor primary school progress • Number of PTA members trained in management and monitoring processes Improve teaching and learning environment Improved access to quality primary education for all children and greater community involvement in school governance • Sensitise communities about the importance of enrolling and supporting marginalised children, especially orphans and vulnerable children, and children with disabilities • Conduct an advocacy forum with female teachers to be role models for girls • Promote disability-friendly teaching methods and materials, and school infrastructure Promote inclusive education • Information sharing forums established for all primary school management committees • All primary school PTAs trained in management and monitoring processes and advocacy training • Children from each primary school trained to establish their own metrics, to monitor and report school progress • Education management information systems established in all target schools • Facilitate information sharing forums between School Management Committees and inspectors to improve performance • Train Parent Teachers Associations for improved community management of school learning and teaching processes • Equip communities through Parent Teachers Associations with information for advocacy or resource allocation with district leadership or structures • Provide training to the stakeholders, including children, to collect data and monitor progress in schools • Support the establishment of education management information systems in target schools and link to the district education system Strengthen community ownership over school supervision

5. KATINE COMMUNITY PARTNERSHIPS PROJECT CONCEPTUAL FRAMEWORK OBJECTIVE 3: IMPROVED ACCESS TO SAFE WATER, SANITATION AND HYGIENE Outputs Context Sub-Objective Activities (Inputs) Outcomes Examples of Indicators • All existing water sources in Sub-County protected and rehabilitated • 20 new boreholes drilled to serve 5000 people • 2 hand pump mechanics trained • 9 schools equipped with rain water tanks • 400 households equipped with water jars • 12 masons trained in construction • Water access and adequacy • Percent of households with an improved source for drinking water within acceptable reach (30 min) • Percentage of households with 15 or more litres per person per day • No. of schools equipped with rain water tanks • No. of households that received water jars • Sanitation • Percentage of household with improved toilet facility • Ratio of pupil to latrine stance in primary schools • Hygiene • Percentage of households where the caretaker of the youngest child (<5) reported appropriate hand-washing behaviour • Percentage of households that safely disposed of their child’s faeces the last time s/he passed stool • Percentage of U5s that had diarrhoea in the previous two weeks • Percentage of households with soap and water available for hand washing on day of visit • Community empowerment • No. of water user accounts established • Percentage of households that report water source available (uninterrupted) every day for previous two weeks There are 30 boreholes in Katine Sub-County of which 8 required rehabilitation at last survey. There are approximately 20 shallow wells and protected springs. These serve more than 24,000 people. 18 villages were identified as having no water sources at all. Water sources are not maintained consistently and community members are often forced to use unsafe water for lack of an alternative or because the cost of safe water is prohibitively expensive. Many schools do not have easy access to safe water and lack sanitation facilities. Two schools have been identified as having an acute water shortage and sanitation facilities are poor. Ojago Primary School has 394 pupils and just one pit latrine of 2 stances. Latrine coverage averages 48% across the Sub-County though Ojom and Olwelai parishes only have 24% coverage. As a result of poor sanitation and low levels of hygiene there is a high incidence of diarrhoea and other water-borne-diseases. • Rehabilitate existing boreholes, protect and rehabilitate open springs and shallow wells • Drill new boreholes and install with hand pumps • Train identified community hand pump mechanics on maintenance and rehabilitation on improved water sources • Install 10,000 litre PVC rain water tanks for rain water harvesting in schools in water scarce areas • Construct household water jars for harvesting rain water. (1,500 - 2,000 liter jars) • Provide on-the-job training to community members to construct and maintain water jars Increased access to safe water Increased community access to and utilisation of improved water and sanitation facilities Improved hygiene practices in households Improved operations and maintenance of water sources • 13 schools each have 2 Ecosan toilets and 8 new latrine stances • 240 households (1,440 people) have improved pit latrines • 66 village health teams and SC sanitation working committee trained on hygiene promotion • Approx. 3,000 households visited by VHTs for hygiene instruction • Quarterly supervision visits made to monitor hygiene conditions in communities and schools • Construct pit latrines for primary schools • Construct Ecosan toilets for primary schools • Provide sanitation kits to parishes for digging pit latrines on a monthly loan basis • Train VHTs and Sub-County sanitation working committees on hygiene and sanitation promotion (including training on the adaptation of tippy taps and drying racks) • Supervise and support trained VHTs to conduct one on one household visits for training on hygiene • Support Sub-County committee to supervise and monitor activities of hygiene in communities and schools Increased access to basic sanitation and improved hygiene practices • Facilitate the establishment of Water Source Committees for each water source as part of a Community-based Approach to Sanitation and Hygiene Education (CASHE) • Train Water Source Committees and other designated community members on operation and preventive maintenance of all the boreholes and rainwater tanks • Help make Water Source Committees operational to charge money for water access, and to set up a water user account in the bank • Train Water Source Committees on record keeping and maintaining receipt books for people in the community to pay for water • Strengthen the Sub-County sanitation working groups to be effective in supervising and monitoring maintenance of boreholes • Train Sub-County Water Source & Sanitation Committees on safe water chain management • Approx. 40 Water Source Committees established and trained on operation and maintenance • Committees assisted to mobilize communities to pay water user fees • Committees trained on record keeping and water user accounts established • Regular supervisory visits carried out by SC Water and Sanitation Committees • People trained and system and procedures established to monitor borehole maintenance and safe water chain management Facilitate community empowerment to manage water resources

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KATINE COMMUNITY PARTNERSHIPS PROJECT CONCEPTUAL FRAMEWORK • Capacity of rural institutions is enhanced: - 15 rural innovation groups established (3 per parish) • Groups’ capacity built in management, group dynamics, leadership, etc • Rural livelihoods stakeholders forum established: key stakeholders meet 3-4 times/annum • Improved coordination of livelihoods development, including co-implementation. • Technology harnessed to improve productivity • 1 contact farmer trained /group & given treatment kit to provide animal health services • Participatory on-farm trials for new varieties of priority crops carried out / group leading to increased uptake of improved agricultural technology • Farmer-to-farmer extension • Agribusiness & marketing skills enhanced-group members able to apply business management principles to enterprises & improve planning & management. • Market value chain analysis completed for 1 priority crop • Farmers actively using improved market information & linkage to increase profitability of agriculture. • Groups, children & community better able to identify & articulate environmental concerns • Practical options for improving environment & managing /mitigating severe impacts of climate change • Information centers – both sub county & school demo cites • Environmental info including early warning is shared & used OBJECTIVE 4: IMPROVED INCOME GENERATING OPPORTUNITIES Outputs Context Sub-Objective Activities (Inputs) Outcomes Examples of Indicators • Access to new technology increases percentage of productivity of both crops & livestock • Access to markets and collective marketing increases – farmers are consistently accessing at least one market outside the sub-county and making higher returns • Percentage increase in farmer incomes • Farmers realize quantifiable and qualitative improvements in their environments and ability to mitigate various environmental change impacts Katine sub-county has experienced repeated cycles of conflict over the past 20 years which have eroded the asset base of rural communities. Rural livelihoods are currently still recovering from the most recent LRA incursion in 2003. Farmers have gained access to some new varieties of crops & livestock; lack support to build the management capacity of their groups; have no linkage with research institutions to test new varieties through on-farm trials and have very limited formal access to veterinary services. The current system of farmer groups is seen by non-members as selective and exclusive. Recent upheaval and displacement has eroded organised access to markets. Farmers’ linkage to other districts is usually through middlemen who negotiate with individual farmers to drive product prices down. Farmers generally do not collectively market, store to get the best price or add value through processing and lack capacity and knowledge to put these key value addition processes in place. Climate change has made rainy seasons less predictable Farmers need to adapt to these changes through access to new crop varieties, environmental management & other livelihoods support. Valuable support has been provided through both the NAADS programme and NGO interventions, especially to assist those most affected by conflict to resume productive agriculture. But there is no formal information exchange mechanism to ensure that efforts by different agencies are better coordinated, share valuable experience or even jointly plan and support certain interventions • Group formation stage: • Wealth ranking & group formation (2-3/parish = 10-15) • Baseline benchmarking • Training needs assessment • B. Capacity building stage • Strengthening group management skills, leadership, group planning & financial management • Exchange visits with other CBOs, institutions in Uganda Enhance the capacity of rural community-based organisations • Establishment of the Sub-County Livelihoods Forum to include all implementing stakeholders and community representatives from Katine • Sub-county coordination of development stakeholders (GOs, NGOs and private sector input/marketing organisations) • Information exchange and advocacy; linkage with other institutions e.g. Serere NSARRI • Linking with vocational trainers for off-farm IGAs Improve coordination of rural livelihood support Recovery in livelihoods Strengthened ability of rural institutions to access both advisory services and markets for their products • Using farmer participatory research methodology to address production-related priorities and enhance linkage with formal research institutions such as Serere NSARRI • Diagnostic surveys to identify key crop priorities & varieties to test; farmer innovation with selected technologies; establish and support on-farm trials; on-farm open days, farmer-to-farmer extension • Community animal health worker training and follow-up Increase productivity of crop & livestock production practices • Business and marketing skills development: business management training (farm accounting, gross margins, etc) • Selection of a market commodity to demonstrate the value chain from production to market (with at least 5 groups) • Market research (market value chain analysis, etc); development of marketing mechanisms and information systems (bulking, storage, information on pricing, value addition, packaging, etc); adding value through storage, grading, processing; provision of a group-managed mobile phone to access market information; exchange visits with other market-oriented initiatives in Uganda (or the region) Improve access to and returns from markets & marketing • A participatory baseline to capture physical changes and community perspective of environmental changes and the efficacy of community coping mechanisms • Establish school environmental groups with demo sites. • Capacity building of farmers groups. • Modest funds to support evolution of innovation to address emerging environmental concerns to strengthen community coping mechanisms. • A sub-county resource centre, dissemination centre and environmental forum. Increase capacity to manage & mitigate impact of environmental changes

7. KATINE COMMUNITY PARTNERSHIPS PROJECT CONCEPTUAL FRAMEWORK OBJECTIVE 5: COMMUNITIES EMPOWERED TO ENGAGE IN LOCAL GOVERNANCE Context Sub-Objective Activities (Inputs) Outcomes Examples of Indicators Outputs Decentralisation of basic services in Uganda is stuck at the district level and is yet to make a dent in the improvement to the lives of 75% of people living below the $1 a day poverty line in rural areas. There is a disconnect between formal structures and systems and community needs and priorities. This manifests itself as a lack of participation of the vulnerable in setting priorities and deciding on resource allocation. Whilst most national government policies emphasise the role of community participation in sustainable development there are no commensurate resources and programmes to ensure that communities are fully empowered to own their own development processes. A poor information base at the community level hampers effective prioritisation and planning and pro-poor resource allocations by the formal system at district and national levels. • Number of community officials and community-based individuals trained on basic rights and planning and budgeting for basic services • Cost benefit analysis data routinely updated • Number of teachers, health workers and extension workers trained on information management • Number of community plans developed for improving basic services • Infrastructure and other improvements made in the sub-county that were achieved as a result of through community training and planning • Improved district and national health planning driven by the needs of communities based on data from the community-based HMIS • 150 community members trained per annum on basic rights to water, health and education • Evidence gathered from cost benefit analysis tracking utilised to influence participatory planning and resource allocation processes at local, district and national levels Increased community awareness and participation in obtaining basic services Increased community capacity to plan and budget for community needs Strengthen community capacity for data gathering and utilisation • Facilitate community information sessions with IEC materials on the community's rights to basic services such as water, health, education • Conduct cost benefit analysis and financial tracking for evidence-based advocacy for community sensitive planning and resource allocation at local, district and national levels Strengthened local governance • All parish development committees trained to plan and budget for the basic services needed across all villages • Parish plans incorporated into the overall district development plan • Community partnering model is documented and presented to government and partners for replication in other areas • Information management training provided to 20 teachers, health and extension workers • Establish community-based information systems • Train community officials (e.g. Parish development committees) and community based teams to plan and budget for feasible and cost-effective basic services and to make projections (such as on disease surveillance) • Pilot a model of community partnering based on a rights-based approach that can be replicated by AMREF, government and other actors • Train teachers, Community Health Centre workers and extension workers on information management • Facilitate the establishment of community-based information systems Enhance community planning to better meet community needs

8. KATINE COMMUNITY PARTNERSHIPS PROJECT CONCEPTUAL FRAMEWORK GLOSSARY OF ACRONYMS Acronym Explanation AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Care ART Anti Retroviral Therapy CASHE Community-based Approach to Sanitation and Hygiene Education CB-DOTS Community-based Directly Observed Treatment Shortcourse (for TB) CMD Community Medicine Distributor ECOSAN Ecological sanitation (a type of latrine) EMOC Emergency Obstetric Care EPI Expanded Programme on Immunization FP Family Planning HCIV Health Centre IV (District level health centre) HIV Human Immunodeficiency Virus HOMAPAK Anti-malarial drug - chloroquine plus sulfadoxine-pyrimethamine (administered to children between 2 months and 5 yrs old) HSD Health sub-district IEC Information, Education, Communication (material) IMCI Integrated Management of Childhood Illness IPT Intermittent preventive treatment (for malaria) ITN Insecticide-treated Net MOH Ministry of Health PLWA People living with AIDS PLWHA People living with HIV/AIDS PMTCT Prevention of mother-to-child HIV transmission P7 Last year of primary school PTA Parent Teacher Association PVC Polyvinyl chloride (Plastic) SC Sub-County SRH Sexual Reproductive Health STI Sexually Transmitted Infection TB Tuberculosis TBA Traditional birth attendant CU5 Children Under-five-years old VHT Village health team