The DISH Project used three approaches that were designed to reduce fertility and mortality, change behavior, build capacity, improve monitoring and evaluation, and facilitate the expansion of the program. The four approaches were:

1. Availability: Through training and support for routine supervision, DISH ensured that maternal and reproductive health services were available. Training and supervision was provided for: emergency obstetric care, life saving skills, integrated Reproductive Health(RH), Integrated Management of Childhood Illness (IMCI), Postabortion Care (PAC), Adolescent Reproductive Health (ARH), and Long-Term and Permanent Family Planning Methods (LTPM).
2. Quality in an Integrated Setting: DISH worked with the Ministry of Health (MOH) to develop and implement a systematic supervision and quality improvement system based on supportive monitoring and recognition. The system ensured that Basic Standards for Quality of Health Services appropriate to all levels of health facilities were understood, followed, and monitored regularly by supervision teams. Health facilities that met all basic standards are recognized and promoted as providers of good quality services.
3. Stimulating individual behavior change by client education, community mobilization and mass communication approaches: DISH supported the distribution of the rainbow over the yellow flower logo, which is a national symbol, in the 12 districts where the project operated, to identify health facilities that provide a full range of six services: family planning, STD management; HIV/AIDS counseling; immunizations; antenatal care; and postnatal care. The slogan for the rainbow over the yellow flower logo was Family Health Mad Easy because clients can get these services at the same facility on the same day.
   
   
   
4. Sustainability: DISH helped districts, sub-districts and non-governmental organizations increase sustainability by focusing on major and mutually supportive elements; developing improved capacity to supervise health providers and services; provide in-service training and updates; manage and account for funds; make resource-sensitive plans and budgets; collect and analyze data for decision making; and forecast, order, store and distribute necessary drugs and supplies.       Top

Expected Results

By September 2002, the project was expected to have achieved the following objectives:

• 90 percent of appropriate health facilities in the 12 districts provide reproductive and child health services.
• 80 percent of health facilities in the 12 districts provide health services that meet basic standards of quality as outlined by the MOH.
• Increases in the following behavior change indicators for the 12 DISH-supported districts would be achieved:
  • Modern contraceptive prevalence rate (CPR) increases from an average of 21.9 in 1999 to 25.4 in 2002 among women of reproductive age (WRAs).
  • Condom use by women during their last sex act with a non-regular partner increases from 47 percent in 1999 to 53 percent in 2002.
  • Percent of infants exclusively breastfed for six months increases from 24.5 percent in 1999 to 32.8 in 2002.
  • Percent of children immunized with three doses of DPT increases from 25 percent in 1999 to 60 percent in 2002.
  • Percent of children fully immunized increases from 36 percent in 1999 to 50 percent in 2002.
  • Percent of deliveries taking place in a health facility increases from 54 percent in 1999 to 58.5 percent in 2002.
  • Percent of mothers in DISH districts who know at least three signs of complicated pregnancy increases from 17.9 percent to 25.4 percent.
• The capacity of 12 districts to sustain good-quality reproductive and child health services will strengthen.    Top

Overall Achievements

The DISH I program focus was family planning; STD diagnosis and treatment; HIV/AIDS prevention; antenatal and postnatal care; delivery assistance; and breastfeeding and infant nutrition.

A glance at the some of the successes of DISH I: According to the 2000/1 DHS Evaluation Survey conducted by the MEASURE Evaluation Project, between 1995 and 2000/1, there was a marked increase in the number of married women (12.5% to 19.4%) using a modern family planning method, excluding LAM in the DISH supported districts.

There was no significant change regarding the proportion of births occuring at health facilities between 1995 and 2000/1 DHS. Between the same period, the percentage of women mentioning condoms as a means of preventing HIV infection increased from 27% to 63%.

The achievement of the DISH I Project (1994-1999) paved the way for an expanded role for DISH II, adding long term and permanent family planning methods, child health and district capacity building which were not major focuses of DISH I.

Twenty months after the launch of DISH II, the project achieved significant results and was well on the way toward meeting or exceeding most of these objectives. For example, CPR continued to increase dramatically in DISH-supported districts (from 12.5 percent in 1995 to 23.6 percent in 2000), according to preliminary results from the 2000/2001 Demographic and Health Survey (DHS). Below are key achievements in fiscal year 2001.

1. HMIS Indicators for Behavior Change
   
   1.1 CYP
   
   

   1999 Baseline: 22,256;	Estimated Growth: 5 percent per annum
   2000 Expected: 23,369;	2000 Actual: 17,338;	Actual growth: 22% decline
   2001 Expected: 24,537 ;	2001 Actual: 29,135;	Actual growth: 68% increase

   
   1.2 Ante-Natal Visits
   
   

   1999 Baseline: 166,400;	Estimated Growth: 5 percent per annum
   2000 Expected; 174,720;	2000 Actual: 137,971;	Actual growth: 17% decline
   2001 Expected: 183,456;	2001 Actual: 204,841;	Actual growth: 48.% increase

   
   1.3 Assisted Deliveries
   
   

   1999 Baseline: 31,840;	Estimated Growth: 4 percent per annum
   2000 Expected; 33,114;	Actual: 25,607;	Actual growth: 21% decline
   2001 Expected: 34,438 ;	Actual: 35,852;	Actual growth: 40% increase

   
   1.4 DPT3 Immunizations
   
   

   1999 Baseline: 20,480;	Estimated Growth: 10 percent per annum
   2000 Expected; 22,528;	Actual: 31,039;	Actual growth: 49% increase
   2001 Expected: 43,698;	Actual: 43,698	Actual growth: 40% increase

   
   1.5 Children receiving Vitamin A
   
   

   1999 Baseline: 10,820;	Estimated Growth: 5 percent per annum
   2000 Expected; 11,361	Actual: 26,078:	Actual growth: 141%
   2001 Expected: 11,929	Actual: 45,058:	Actual growth: 72.8%

   
   Detailed HMIS data and Graphs are provided in Attachment 1
   
   
2. Additional Related Accomplishments
   
   2.1 Safe Motherhood
   
   
   • Built skills of 80 Life Saving Skills (LSS) and 22 post-abortion care (PAC) trainers and districts resource-persons .
   • Developed 8 practical training sites for PAC and 13 for LSS.
   • Supported the provision of PAC services, including manual vacuum aspiration (MVA) and counseling, in 70 sites;
   • Launched the implementation of an innovative new Safe Motherhood Service Delivery and BCC strategy focusing on birth preparedness, goal-oriented antenatal care, client-focused delivery assistance, and community involvement.
   • Developed an emergency obstetric care (EOC) curriculum and related materials for physicians. This was adopted as the MOH National EOC curriculum for medical officers.
     
     
   2.2 Promoting the Use of Long-Term and Permanent Family Planning Methods
   
   
   • Supported provision of Norplant insertion and removal services at 44 sites.
   • Strengthened Three training sites for LTPM .
   • Supported provision of regular TL services at seven sites.
   • Supported provision of Vasectomy services at five sites.
   • Designed and implemented new approaches for LTPM outreaches in rural health centers. Accordingly, a total of 14 outreaches were carried out from July to September 2001, serving 382 clients (14 vasectomies, 121 tubal ligations and 247 Norplant insertion

2.3 Immunization


• Completed technical update on immunization for district child health trainers in collaboration with UNEPI.
• Strengthened training and supervision of service providers for provision of immunization as an integral part of IMCI.
• Completed technical update in seven districts for nursing assistants/vaccinators who have received an update on immunization.
• Facilitated the Development of a National Communication Strategy
• Reviewed and began dissemination of "best practices" of Rukungiri and Kabale districts in maintaining high immunization coverage
• Launched dedicated on-site technical assistance for immunization related micro-planning focusing on the weak DISH districts (Kamuli, Masaka and Ssembabule)

2.4 HIV/AIDS


• 236 service providers trained in STD case management as part of the IRH package.
• 400 service providers trained in integrated counseling, including on HIV/AIDS.
• Incorporated training materials on HIV and pregnancy, and HIV and infant feeding into IRH curriculum.
• Supported two demonstration sites for Adolescent Friendly Reproductive Health Services (AFRHS) in Jinja district with particular emphasis on STDs and HIV/AIDS and initiated the establishment of ARH services in seven additional districts.
• Organized a series of video shows on STDs and HIV ("The Dilemma," "Let's Face It," and "A Question of Children")
• Organized VCT outreach services in five districts during World AIDS Days.
• Broadcast 158 VCT radio spots.
• Produced weekly radio programs including focus on VCT, STD management, and safer sex.
• Distributed 65,000 copies of "Health Matters" issues on VCT.
• Distributed 1,000 copies of Health Education Cue Cards, including cards on STDs and HIV/AIDS.

2.5 Malaria


• Revised of IRH curriculum to include new guidelines on IPT and case management of malaria in pregnancy.
• Improved malaria case management through IMCI training and supervision of 689 service providers.
• Production and distribution of 400,000 copies of "Health Matters", which included messages about malaria prevention.
• Facilitated development of a National Communication Strategy for Malaria as part of a collaborative plan with MOH, CMS and BASICS
  
  
3. Institutional Development and Sustainability
   
   3.1 Operationalizing a QOC-Improvement System
   
   
   • Supported dissemination of the National Supervision Guidelines.
   • Developed the Yellow Star Program: a strategy for certification and reward of health facilities for improving and maintaining good-quality health services and a plan for phased expansion to all districts.
   • Prepared a communication strategy and materials for communicating the QOC program throughout district leadership and the health system, including design of a national symbol for good-quality health services.
   • Launched implementation of the Yellow Star Program for certification and reward of health facilities in six districts
   
   3.2 Strengthening Drugs Logistics and Management
   
   
   • Drafted manual on drug logistics and store management procedures for districts
   • Facilitated quarterly restocking of contraceptives at the district and facility level in collaboration with the MOH and National Medical Stores.
   • Developed and implemented a joint workplan with the MOH-DANIDA District Drug Management Program focusing on drug quantification.
   • · Completed assessment of needs for refurbishing and equipping 12 district medical stores.
   • Initiated collaboration with Deliver for adaptation of Supply Chain Manager Software to district needs
   
   3.3 Health Information and Management System (HMIS) and Surveys.
   
   HMIS
   
   • Trained the 12 District MIS Officers in the use of Access-based HMIS system.
   • Finalized the Training Information Management System (TIMS), a computerized database for tracking training, performance and supervision of health workers and health facilities.
   • Trained health facility in-charges as well as District Health Teams in the analysis and use of HMIS data for planning and management.
   • Assisted the MOH to update HMIS forms for monitoring its Health Sector Strategic Plan, including design of the quarterly indicator performance report.
   • Produced quarterly reports from the sentinel HMIS system showing trends in service utilization.
   
   Key Surveys
   
   • Completed a Study of for-profit health service delivery in Jinja, Kampala, and Luwero, and an inventory of all for-profit facilities in Kampala and Luwero.
   • Completed Radio Listenership Assessment Survey Report.
   • Completed assessment of Family Life Education Program's (FLEP) community-based activities.
   • Completed quarterly survey of more than 800 health facilities.
   
   3.4 Developing BCC Capacity
   
   
   • Facilitated the development of MOH plan for institutionalizing pre-service and in-service training programmes for health educators in Uganda.
   • Developed a business plan, budget and workplan proposal for establishing a private sector BCC agency in Uganda.
   • Provided sponsorship for District Health Educators from two districts and the Coordinator for Africa Alive! Uganda and DISH staff to participate in selected communication courses
   • Produced quarterly "Health Matters" newsletters and the weekly radio programs "Olujegere Lw'obulamu" (in Luganda) and "Orujegyere Rw'amagara" (in Runyankole). These products have provided a vehicle for disseminating information on a variety of health topics, including infant nutrition, male involvement in family planning, HIV counseling and testing, and STD prevention and treatment.
   
   3.5 Supporting Wider Coverage and Adoption of DISH Best Practices and Products
   
   
   • Documented and disseminated AFRHS best practices (in collaboration with INTRAH/PRIME).
   • · Produced project reports and sample BCC materials and distributed to other organizations and to the MOH.
   • Documented and initiated dissemination of "best practices" of Rukungiri and Kabale districts in maintaining high immunization coverage
   • Identified eight DISH best practices and related instruments and tools.
   • Finalized the DISH website
   
   3.6 Support to Family Life Education Program (FLEP)
   
   
   • Assisted FLEP in recruiting new leadership, developing a new organizational structure and workplan;
   • Established new financial and administrative system at FLEP;
   • Provided Technical assistance and self assessment tool for improving human resource management;
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