MONITORING THE STATUS OF THE CHILDREN:

CHILD HEALTH AND DEVELOPMENT CENTRE

EXPERIENCE

UGANDA.

Jessica Jitta

Child Health and Development Centre

Makerere University

Uganda.

Notes for the Retreat: Giving Voice to Children

January 12-13, 1993

Rockefeller University, Seven Springs Conference Centre.

Mt. Kisco, New York.

MONITORING THE STATUS OF CHILDREN

BACKGROUND ON CHDC

The CHDC is a national institution is Uganda, based at Makerere University, one of the oldest institution of Higher learning in Sub-Saharan Africa. The Centre implements an important national project addressing priority research needs of Ugandan Children and women. The project is focussed on building capacity of nationals at all levels (at University, in community and in Government) to identify, conduct priority problem-solving research in the community and convert the results into appropriate actions for improved welfare of the children and women. Within this set up, it has been possible to effectively bring together the communities (beneficiaries), the government (policy makers/planners/service-providers) and the university (highest concentration of researchers) to work together towards a common goal.

Uganda, as most of you many be aware, has suffered almost two decades of civil unrest and declining economy which has left social institutions and infrastructures, including health care in utter disarray. As a result the Ugandan community-based research capability was widely recognised among the best in Africa in 1960's had been almost destroyed and is presently being re-built. The NCB project is only one of such endeavours.

The project was initiated 4 years ago as part of the on-going efforts of UNICEF to sustain and expand child survival achievements in the Sub-Saharan region. The initial two years of the program was jointly supported by UNICEF and FINNIDA, the Finnish International Development Aid agency. The programme is now entirely owned by the Government of Uganda and has been integrated within the UNICEF/Uganda country programme.

EXPERIENCES OF CHDC RELATED TO ADVOCACY FOR CHILDREN IN GENERAL AND MONITORING CHILDREN STATUS

Since its inception, the CHDC has played an increasingly important role as a technical arm of government, NGOs and community for providing relevant data for improved health of children. This has been achieved by carefully pursuing the CHDC overall objectives of a) promoting widespread proficiency in relevant applied research; b) promoting interdisplinary and intersectoral collaboration for training and; c) promoting university-community-government collaboration for community-empowering of health and development strategies in the county. The planning of the activities is guided by the desire to respond to the enormous and continuing need to revitalize research for health and development.

Early work of the CHDC has promoted and built up linkages among University faculties, Governmental Ministries, and representative Communities. A nucleus of operational researchers has been started at the University, including students, post-graduates, and staff of multiple departments and faculties. From this beginning, further links are being developed with ministries, districts and communities within Uganda, along with connections to other countries in Sub-Saharan Africa. Within the university, the CHDC has now been granted official status as a research unit with an established core staff to promote its activities.

Briefly, there have already been a number of NCB activities in the major areas of research, training and community. Operational research projects have been completed or initiated in a several priority areas: immunization, diarrhoeal disease, water and sanitation, nutrition, health financing, MCH care, and traditional medicine, as well as AIDS and sexually-related health issues. Among training activities, there have been experiential workshops for community health educators, paramedical tutors, university students and staff, and Government programme managers. Community activities have included assistance in training TBAs and CHWs, baseline needs assessments, and training of community-based health educators.

The Centre has participated actively in national planning and policy-making for CSD and MCH, and it is currently contributing to more than a dozen national technical planning committees. Recently, the Uganda AIDS Commission has requested the CHDC to prepare a full national integrated five year plan of action for all types of AIDS-related research.

SPECIFIC LESSONS DRAWN FROM CHDC EXPERIENCES: MONITORING CHILDREN STATUS IN DEVELOPING COUNTRY

1. There is felt need to develop indicators for monitoring the status of children. Many areas of child needs have no indicators. In areas were international indicators exist, there is need to set local versions or standards for such indicators. We need to develop indicators for the quality of health and wellbeing rather than those of mortality, morbidity and service coverage. For example in the area of the most vulnerable children, we have attempted to develop some local indicators for neglect or lack of investment in the physically handicapped children in a rural community setting. We discovered that such children were less likely than normal children to complete primary immunization, or have formal education. On the other hand, fostered or orphaned handicapped children were less likely than handicapped children living with both biological parents to have medical care, have access to mobile aids or go to school.

2. Need to monitor at different levels. There are levels that are neglected in monitoring children status. A good example is district level monitoring. Uganda, like many developing countries is slowly reverting to the district as the operational unit for provision of social services. One of the important issues to be addressed to make this fully operational, is to develop effective district level monitoring systems. Such systems need to fully incorporate information systems from the grassroots and link well into the central/national level. We have realised that on effective health information system (HIS) is only meaningful if, to some extent, information gathered can be integrated and used at an operational level (district) rather than expecting all answers from the national centre.

3. We have found capacity building of others (communities and district teams) to conceptualize ideas of monitoring to have the most productive outcomes. We have worked together with communities, counties and district teams to this effect.

4. Qualitative and quantitative methods have been useful in generating relevant information about needs/problems. Qualitative methods have given nature, range and perception aspects of the problem (depth and breadth), while quantitative methods have been useful for prevalence and distribution. Often we have adopted qualitative before quantitative methods approach, which has been of tremendous help in utilising available restricted research resources.

5. Giving feedback to beneficiary communities or districts has become a useful method of initiating further discussions and eliciting collaborative development of appropriate and feasible solutions. This has gone a long way to ensuring that data collected is actually used.

SPECIFIC EXAMPLES:

a). PHC Implementation in the Country - An interdisplinary team conducted a rapid assessment of the process of PHC in the country at the request of an Inter-ministerial Committee in charge of implementing of PHC.

b). Development of Indicators for Neglect of Disabled children. A social science student was assisted to design, conduct and analyse a qualitative and quantitative community based survey in a rural district.

c. Improving Rural Self-help Health Project - A rural community serving about 60,000 people has been assisted to ask the right the questions that will help them to improve the quality of their services.

d. Planning for Community-Based Health Project (NGO) - Baseline study was conducted with project staff for planning a five year health project for a sub-district.

e. National Nutrition Planning - Analysis of existing data set (DHS) has been conducted to generate information for formulating a National Food and Nutrition

Policy and Strategy.

KEYWORDS [ child survival, capacity building, indicators, monitoring ]