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Uniting civil society to improve accountability and accessibility of HIV and TB service delivery: lessons learned from year one of community-led monitoring implementation in Uganda

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BACKGROUND: Community-led monitoring (CLM) is a social accountability model that aims to hold duty bearers and health facilities (HFs) accountable for improved quality of HIV and TB service delivery. In October 2020, ICWEA, HEPS, and SMUG jointly implemented CLM in Uganda, covering 108 districts (85%) and 432 HFs in total. Using a set of standardized data collection tools, program monitors visited HFs to directly observe and collect qualitative and quantitative data.
DESCRIPTION: The first year of program implementation was evaluated in December 2021. The evaluation assessed timeliness and completeness of program activities, and was guided by two research questions: 1) Was the program implemented in accordance with the operational plan? 2) Did program implementation achieve any unexpected or unintended outcomes? To answer these questions, 25 stakeholders were interviewed (including program staff, partners, advocates and duty bearers).
LESSONS LEARNED: The evaluation revealed three major areas of learning. Firstly, to optimize program governance, there is a need to improve efficiency of communication and coordination through inclusive leadership and decision-making. A key learning was the importance of continuously aligning expectations between program implementers, donors, and technical partners, to avoid scope changes and implementation delays, which the program experienced during set-up (e.g., in finalizing the program protocol), and which impacted resource allocation. Secondly, greater emphasis must be placed on the quality (rather than quantity) of CLM data generated, and on building staff's analytical capabilities to provide evidence-based insights in real-time. Thirdly, while the program's advocacy and accountability efforts are bearing fruit, establishing a system to routinely identify issues, develop solutions, and monitor progress is essential to achieve long-term impact, as is working with duty bearers to utilize program findings.
CONCLUSIONS: Key learnings from the first year of program implementation provide valuable insights for CLM initiatives globally in terms of mobilizing civil society and affected communities; operationalizing governance and technical structures to scale-up CLM; and, orienting program activities toward national HIV/TB service delivery goals. Moving forwards, the program will need to effectively harness CLM data to advocate and hold duty bearers accountable for sustainable improvements in HIV/TB service delivery.