Monitoring and Evaluation Activities. In 2011, VHTs continued to receive support for accurate, timely tracking and reporting of data from household to village and parish levels using the tools designed by the MOH. The data collected by VHT at the village level is aggregated at parish level by the VHT parish coordinators to generate parish summaries which are forwarded to health workers for aggregation at sub county levels. UHC/MCP facilitates quarterly meetings for capacity building at parish levels to enable feedback on data quality and data sharing on issues identified for action by local leaders, health workers and VHT. UHC/MCP has continued to mentor district data collectors as they use basic excel spreadsheets to aggregate parish register data into quarterly and annual health sub district and district reports. In particular the program has strengthened its support to the District HMIS focal persons to collect quarterly VHT data following the MOH approved tools for problem identification, work planning, monitoring, report preparation and sharing results with appropriate stakeholders. The program team emphasized quality, consolidation and use of data to fill MOH expectations for data reporting. As a result, district data collector capacity in sharing data and evidenced based decision making has increased. A brief monitoring study was conducted to assess the knowledge of VHTs about UHC and whether these VHTs cover health insurance in their health behavior talks within their communities. While almost all VHTs are emphasizing malaria prevention and treatment and, covering almost all of the other VHT job aid health topics in their community talks, only 77.2% talk about health insurance. Most VHTs (89.9%) acknowledged that they have never been asked about health insurance by community members. An additional 41% of ▇▇▇▇ said that when asked about UHC they failed to provide responses to community members. Most VHTs did not know where to obtain UHC registration forms. It was also noted that most of the VHTs have heard about UHC though VHT meetings and trainings, a good number of them acknowledged radio jingles as their primary source of information about UHC. When asked about frequency of topics covered in the last month VHT has the following responses: Topic No. of times Frequency (n=92) Percentage ( %) Seeking treatment for malaria in pregnancy 0 0 0 1-2 27 29.3 3-5 48 52.2 >5 17 18.5 Sleeping under insecticide treated bed nets 0 0 0 1-2 12 13.0 3-5 34 37.0 >5 46 50.0 Seeking treatment for malaria within 24 hrs of fever onset 0 0 0 3-5 30 32.6 >5 31 33.7 Health Insurance 0 23 25.0 1-2 41 44.6 3-5 19 20.7 >5 9 9.8 HIV/AIDS 0 0 0 1-2 23 25.0 3-5 34 37.0 >5 35 38.0 In response to this study and other program indicators, the project’s UHC Cascade of Sensitization and Training includes an improved VHT training of trainer’s course to close these gaps. Monitoring also included a Radio Focus Group Discussion to assess what is working and what can be improved in UHC radio copy. In addition to suggesting the best station, days and times to reach the primary target audience, this monitoring exercise exposed a major gap in UHC expansion. When respondents were asked about the action that they would or have taken to become a UHC member most answered that they would call UHC. To date no system to track or follow up telephone enquiries was in place. As a result and as part of the new UHC cascade, a Question and Answer guide will be developed to support consistent and correct answers to UHC enquiries. Staff will be trained on this task and a routine schedule for tracking and responding to enquiries is being developed. The radio transcript is being updated to include key information that was noted to be lacking by focus group respondents. Finally, monitoring was conducted to measure the impact of VSLAs on VHT. VSLAs are self managed groups that do not receive any external capital and provide people with a safe place to save their money, access small loans, and obtain emergency insurance. The approach is characterized by a focus of saving, asset building, and provision of credit proportionate to the needs and repayment capacities of the borrowers. Groups are low cost, simple to manage and can be seen as a first step for people to reach a more formal and wider array of financial services. VSLAs can dramatically raise the self-respect of individual members and help to build up social capital within communities, particularly among women who represent 70 percent of members. In addition to the saving fund, the cash box holds the social fund/welfare fund which can provide members with a small amount in the case of emergencies. Each member contributes a set value, each week, depending on the group. In the event of an emergency such as death of a family member, the fund dispenses a fixed amount towards their group member. No interest is charged for loans from the welfare fund and although members are expected to pay back the loans, repayment is not strictly enforced. This fund is managed separately from the savings and loan fund and is not shared out at the end of the cycle and is thus carried over to the next cycle. After several months, the savings shares accumulated by the group become large enough to launch the loan function. All members have the right to take out a loan regardless of the number of shares they have contributed, but can only take out a loan equal to at most three times the value of their shares. Most loans are short term, generally around one month, at an interest rate determined by group members, usually not more than 5 percent per month—this is low compared to other money lenders who often charge up to more than 20 percent per month. Each group is able to share their own repayment terms. VSLAs were adopted by the project as a sustainable strategy for increasing the financial stability of VHT and UHC members to increase investing in health. The assessment confirmed that VSLA improves the health status of members especially when combined with community health financing that guarantees access to care when needed. Compared to the general population, VSLA members adopt more healthy behaviours like use of LLINs and childhood immunization. Ninety-six point four percent (96.4%) of respondents reported an improvement in the health status of their households since joining the VSLA groups and 100% reported full immunisation of their children. Sixty-seven point three percent (67.3%) of VSLA members indicated that their children sleep under LLINs compared to the average 41.2% of children under five sleeping under LLINs reported by VHTs. This is a low cost, high impact donor investment. All respondents reported that since they joined VSLAs their status in the community has increased, their status in their families has increased and their self confidence has improved. Thirty-five point seven percent (35.7%) of respondents were UHC members before joining VLSAs. An additional 21.4% joined UHC during the year. Of the respondents who were both VHT and VSLA members, no member reported a decline in effort, 20% reported that they continue to commit the same amount of time to VHT activities as they did before joining a VSLA, while 80% stated that they contribute more time to VHT activities than they did before joining a VSLA. A summary of VLSA group performance can be found in Annex E.
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Sources: Report, Not Applicable