Facilitator's Module
for Civic Education on Governance in
Sexual and Reproductive Health and Rights
and Family Planning
2014
Facilitator's Module
for Civic Education on Governance in
Sexual and Reproductive Health and Rights
and Family Planning
2014
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
DSW (Deutsche Stiftung Weltbevoelkerung)
Hatheru Road, Hatheru Court (Lavington)
P.O Box 2438 - 00202 Nairobi, Kenya
Tel: +254 20 2731398/20 3592302
Mobile: +254 726 603768/ 736 616491
Email: [email protected]
Website: www.dsw.org
DSW (Deutsche Stiftung Weltbevölkerung)
Arusha Tanzania
P.O Box: 14279,Tengeru-Arusha
Tel: (+255) 27 255 5020
Fax: (+255) 27 2555064
E-mail: [email protected]
Website: http//www.dsw-tanzania.org, http//www.dsw.org
DSW (Deutsche Stiftung Weltbevoelkerung)
P.O Box 33900 Kampala-Uganda
Tel: +256 0414 200 801
Fax: +256 0414 200 815
E-mail: [email protected]
Internet: www.dsw.org
Layout and Design: Sprint Design www.sprintdesign.com.pk
© DSW (Deutsche Stiftung Weltbevoelkerung)
All forms of copies,
reproductions, adaptations, and
translations through mechanical,
electrical, or electronic means,
should acknowledge DSW (Deutsche Stiftung Weltbevoelkerung)
as the source.
May 2014
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Table of Contents
Foreword
Abbreviations and Acronyms
Acknowledgement
What is Civic Education?
Why Civic Education?
Code of Conduct for Civic Education Facilitator’s
About Euroleverage Project
4
6
7
8
9
10
11
KENYA PROFILE
RWANDA PROFILE
TANZANIA PROFILE
UGANDA PROFILE
Delivery Topics
Session 1: Introductions and Background Information
Session 2: Governance
Session 3: Health Systems
Session 4: Sexual and Reproductive Health Rights
Session 5: Family Planning
Session 6: Resources for Health Sector, Policy and Budget
Development Process
Facilitation Tool Kit
Methodology
Community Sessions
Micro-consultative Forums
12
17
20
25
29
29
30
35
46
52
Target Group
Actual Civic Education Activities
Monitoring, Evaluating and Documenting Civic Education
Intervention
Annexes
Annex 1: Success story data collection tool
Annex 2: Guideline to document Civic Education success story
Annex 3: Civic Education intervention success stories sample
References
77
78
58
68
69
70
71
81
82
82
84
84
87
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Foreword
Euroleverage is a project of DSW (Deutsche Stiftung Weltbevoelkerung), which is part of a
larger Leveraging German and European Union Fund for Global health and Global Development Project funded by BMGF.
Euroleverage advocates for increased budgetary allocations from the European Union (EU),
national and sub-national governments to address the unmet need for Family Planning.
Through Euroleverage, DSW aims to leverage funds for Family Planning (FP) from EU financial resources and national funding while tracking the impact at the sub-national level.
Through the Euroleverage project, DSW implements a number of advocacy activities targeting decision-makers both in Europe and in low- and middle-income countries, in order to
increase EU and resultant national budgetary disbursements for FP programmes.
DSW’s experience demonstrates that the most effective method in achieving budget and
policy change is to develop sound budgetary analysis and dialogue at community level. The
Euroleverage project focuses on strengthening the capacity of Civil Society Organisations
(CSOs) in tracking budgets and policies and their impact on communities.
Consequently, the project employs civic education methodology to engage local community and decision makers at sub-national levels to discuss barriers to implementation of FP
related policies and budgets; and provide solutions to reduce or remove identified barriers
in order to improve FP outcomes.
This module is building on the Facilitator’s Module for Civic Education on governance and
health developed under the Healthy Action project implemented by DSW and Institute of
Education in Democracy (IED) together with other partners. It has been adapted to have a
special focus on Sexual and Reproductive Health and Rights (SRHR) and Family Planning.
The reviewed module is intended to improve Sexual and Reproductive Health and Rights
and Family Planning outcomes through civic education in Kenya, Rwanda, Tanzania and
Uganda. The module can also be useful for civic education in other countries and contexts.
It addresses among others Civil Society Organisations, Faith Based Organisations, Community Groups, Individuals and other Stakeholders with advocacy roles to increase accountability in SRHR/FP service provision and infrastructure. The project uses a variety of Civic
education activities such as meetings, role-plays, scripts, and community theatre.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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The materials that make up this module are aimed at providing information and knowledge
that guide facilitators who are implementing civic education activities. They show how to
improve social accountability in health, citizen’s participation and monitoring allocation
and use of resources. The materials also promote participation of local community members in formulation and implementation of health policies and budgets that have impact on
Sexual and Reproductive Health and Rights including Family Planning. However, it is up to
each individual facilitator to adapt and use these materials in ways that are appropriate for
its intended target group.
The facilitators’ module for civic education on Sexual and Reproductive Health and Rights
and Family Planning empowers citizens to participate in decision - making and hold leaders
accountable for their responsibilities in enhancing SRHR and FP services at national and
local levels. The main thematic areas are:
The module is organized in three sections as follows:
a)
b)
c)
Introduction: Definition of civic education and code of conduct for facilitators.
Delivery Topics/Themes: Information on areas for awareness creation and
debate.
Facilitation Guidelines and Toolkit: Advice on process of facilitation in such
aspects as organizing a workshop, conducting discussions and managing
role-plays.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Abbreviations and Acronyms
AIDS
Acquired Immune Deficiency Syndrome
CDR
Crude Death Rate
CSO
Civil Society Organisation
COMESA
Common Market for Eastern and Southern Africa
DSW
Deutsche Stiftung Weltbevoelkerung
EAC
East African Community
EU
European Union
GDP
Gross Domestic Product
HIV
Human Immunodeficiency Virus
IED
Institute for Education in Democracy
IEC
Information Education Materials
IMR
International Monetary Fund
MDG
Millennium Development Goals
MMR
Maternal Mortality Rate
NGOs
Non-Governmental Organisations
NSA
Non-State Actors
PAYE
Pay As You Earn
RDHS
Rwanda Demographic Health Survey
RIDHS
Rwanda Interim Demographic Health Survey
RHU
Reproductive Health Uganda
RWN
Rwanda Women’s Network
RRA
Rwanda Revenue Authority
SRHR
Sexual and Reproductive Health and Rights
TRA
Tanzania Revenue Authority
URA
Uganda Revenue Authority
VAT
Value Added Tax
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Acknowledgement
The original facilitators’ module on governance and health upon which the present module
is built was researched and written by the Institute of Education in Democracy (IED) under
the Healthy Action project in collaboration with the Deutsche Stiftung Weltbevoelkerung
(DSW). We wish to acknowledge the Healthy Action team and Non State Actors whose experiences and learning from civic education activities led to the development of the original
module, which provides a strong foundation for this document.
This review has been undertaken under the auspices of the Euroleverage Project and printed
by the support of EU under the ‘Working Together for Decent Work’ project. We commend
individual contributions from Manka Martin Kway (Impact Tracking Coordinator), Lucia
Chebett Laboso (International Programme Coordinator), Matthias Brucker (International
Team Manager, Research and Evaluation), Kennedy Chande (International Project Coordinator) Peter Ngure (Advocacy Team Coordinator, DSW Kenya), Annette Mukiga (Program
Officer, Rwanda Women's Network), Gitura Mwaura (Policy and Communications, Rwanda
Women Network), Elinami Mungure (Advocacy Team Coordinator, DSW Tanzania) and
Anne Alan Sizomu (Advocacy Team Coordinator, DSW Uganda) who made valuable inputs
to make the production of this module possible.
Replicating from previous work, the module is expected to improve community participation and engagement through dialogues, downward accountability and governance resulting in responsive Sexual and Reproductive Health and Rights and Family Planning service
delivery by government. Through civic education, community members will engage with
health facilities and local government decision makers to discuss Sexual and Reproductive
Health and Rights and Family Planning service provision challenges and in a consultative
manner, resolve identified challenges in time. Though the current module will initially be
used to carry out civic education sessions in seven sub-national locations (counties and
districts), i.e., Kilifi and West Pokot counties in Kenya, Gatsibo district in Rwanda, Handeni
and Shinyanga districts in Tanzania and Kamuli and Mityana districts in Uganda, it will also
be shared with other stakeholders for further scale up of the civic engagement methodology
in additional areas.
In addition to information from the previous module, this document has been enriched
by many other publications, reports, as well as organisations’ and individuals’ experiences
by the review team. These have been adapted, combined and altered substantially to suit
the narrative themes of this module. A full reference of sources appears at the end of the
publication.
Ulrike Neubert
International Director Programs and Projects
Deutsche Stiftung Weltbevoelkerung
P.O. Box 2838 – 00202 Nairobi, Kenya
Tel:- +254 20 2731398/20
E-mail:- [email protected]
Website: www.dsw.org
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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What is Civic Education?
‘Real civic education does not try to indoctrinate people but to train them to develop
their own points of view and opinions. Good civic education will develop a lively
discussion among participants and will not have one or more orators telling people
what they want participants to think or learn. Responsible civic education will treat
rect civic education will try to develop mature citizens who will look at the political
development of their country in a critical way and with true patriotism’
Kivutha Kibwana, ‘Learning Together to Build One Nation’, 1997.
Civic education is a specialized aspect of general life education: - it enables citizens to participate meaningfully in civic life. It also enables citizens to be conscious political players
and not mere bystanders in their country’s affairs.
Civic education programs take many forms and may range from voter education to human
rights workshops to the promotion of civic dialogue. The proposed civic education on Sexual and Reproductive Health and Rights and Family Planning under Euroleverage Project
seek to spearhead the process of democratic socialization by providing support for democratic behaviours and values to ordinary citizens in Kenya, Rwanda, Tanzania and Uganda.
In this view, civic education is designed to achieve three broad goals:
implementing civic education activities in the communities;
democratic process, respect for the rule of law, transparency and accountability
and human rights.
of activities including working in health campaigns, contacting public health
officials, demanding accountability from leaders, lodging complaints, attending
and contributing to budget-making meetings and monitoring public money/
resources.
Civic Education on Sexual and Reproductive Health and Rights and Family Planning aims
to create awareness on accountability relationships between the State and its citizens, and
an action focus on how Civil Society Organizations can hold State institutions, service providers, and duty bearers to account, using evidence-based approach. This is in line with a
key outcome of the Euroleverage Project seeking increased responsiveness of public service
delivery institutions to citizens’ rights and demands for integrity and accountability in the
health sector.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Why Civic Education?
In a democratic and modern country, the people are the rulers and citizens are the masters,
and the politicians are the servants of the people. When a citizen calls, the leader should
respond. A democratic system of government should be a system of the people. The State is
meant to be a State of the people . Civic education plays critical roles as enumerated below:
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
o)
p)
Enables citizens to grasp the governance system that exist in their country
Informs citizens about different political and governance systems and enables them
to evaluate the system they have
Equips citizens with knowledge and skills to hold their leadership, government
and state officials accountable
Enables citizens to exercise a check-and-balance function in the governance system
Helps citizens understand any new political system which is put in place
Enables citizens to demand their rights and stops them from being indifferent
Enables citizens to perform tasks and duties required by the democratic process
Enables citizens to appreciate the values of dialogue, negotiation, compromise
and tolerance
Provides the tools to understand, prevent or even resolve conflict at all levels in society
Enables citizens to respect minorities because it emphasizes the values of diversity
and nationhood
Assists citizens to understand the international political system, appreciate their
position in international and regional communities, and recognize the global
interdependence of human beings
Helps citizens to support the values of democracy, good governance, accountability,
participation, rule of law, human rights and constitutionalism
Citizens learn the values of respecting and caring for each other
When civic education permeates all sectors of society, leaders cannot take citizens
for granted
Strengthens people’s sense of dignity and makes them harder to manipulate or abuse
Through civic education, a liberated citizenry emerges ready to take charge of
their lives
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Code of Conduct for Civic Education Facilitators
For effective civic education facilitation, there are basic rules and regulations, and defined
code of conduct. The following is a set of ‘dos’ and ‘don’ts’ for facilitators:
Do
1.
Disseminate accurate information
and correct any misinformation as
quickly as you notice them
2. Keep time
3. Be impartial
4. Use simple and clear language
5. Acknowledge sources and purposes of
all information disseminated to the
public
6. Uphold credibility and dignity that
would enable you to command the
respect of your audience
7. Be sensitive to cultural values and
beliefs
8. Observe ground rules e.g. keeping
your phone away during facilitation
sessions
9. Acknowledge effort and good work
from your audience
10. Choose venues where your audience
will be comfortable
11. Protect confidential information
where disclosure of information may
affect the welfare of others
12. Provide breaks and fun activities
to keep participants energized and
engaged
Don't
1.
2.
3.
4.
5.
6.
7.
8.
Personalize anything except when
a participant is willing to give a
personal story
Use indecent jokes and examples
Address trainees anonymously;
memorize some of their names if not
at all
Dress provocatively
Resort to guesswork; DO seek
clarification whenever in doubt of
data or content
Guarantee results on issues beyond
your capacity or authority
Receive undisclosed gifts or payment
for professional services from the
communities
Use confidential information gained
as a result of professional activities
for personal benefit
Background
This section will help the facilitators to refresh their knowledge of specific countries and
topics set out in the module/sections. But this is not material that is expected to be ‘taught’
in any formal civic education activity. It is intended to promote discussion of country specific governance and health issues rather than teach facts. Also it is meant to explore different opinions rather than to deliver messages about what the government has done.
1
Learning together to build one nation, Kivutha Kibwana page 10.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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About Euroleverage Project
Euroleverage is part of the Leveraging German and European Union Funds for Global
Health and Development Project. The project is implemented by DSW with partners in East
and West Africa as well as South East Asia. The purpose of the project is to increase and
improve funding from Germany and the EU for global health and development. Specifically, the Euroleverage sub goal intends to increase European Union and EU states financial
resources in order to increase national and district budget allocations in targeted developing countries to address the unmet need for Family Planning. The project is executed at
regional, national and district levels. The three pillars of Euroleverage are: Advocacy, Resource Mobilisation and Impact tracking with varying pillar combinations implemented in
the different target countries.
Impact tracking under which the civic education activity falls is carried out in Kenya, Rwanda, Tanzania and Uganda. Within the four countries, target districts and regions have been
mapped. In Kenya, they are: Kilifi and West Pokot counties, Rwanda in Gatsibo district, in
Tanzania, they are: Handeni and Shinyanga and Mityana and Kamuli in Uganda,
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Geography
Kenya lies between 5 degrees North and 5 degrees South latitude and between 24 and 31
degrees East longitude. It is almost bisected by the equator. Tanzania borders it to the South,
Uganda to the West, Ethiopia and Sudan to the North, Somalia to the Northeast, and the
Indian Ocean to the Southeast.
The country is divided into 47 counties and 290 parliamentary constituencies. It has a total
area of 582,646 square kilometres of which 571,466 square kilometres form the land area.
Approximately 80% of the land area of the country is arid or semiarid, and only 20% is arable. The country has diverse physical features, including the Great Rift Valley, which runs
from North to South; Mt. Kenya, the second highest mountain in Africa; Lake Victoria, the
largest freshwater lake on the continent; Lake Nakuru, a major tourist attraction because of
its flamingos; Lake Magadi, famous for its soda ash; and a number of major rivers, including
Tana, Athi, Kerio, Nzoia and Mara.
History
Kenya is a former British colony. The independence process was met with resistance and
an armed struggle. The Mau Mau rebellion in the 1950s paved the way for constitutional
reform and political development in following years. The country achieved self-rule in 1963
and achieved independence (Uhuru) on December 12, 1963. Exactly one year later, Kenya
became a republic and in early 1990s, the country reverted to a multiparty state.
The country has about 42 ethnic groups, which are distributed, around the country. Major
tribes include Kikuyu, Luo, Kalenjin, Luhya, Kamba, Kisii, Mijikenda, Somali, and Meru. In
Kenya, English and Swahili are the official languages while Swahili is the national language.
The main religions in the country are Christianity and Islam.
Economy
The Kenyan economy is predominantly agricultural with a strong industrial base. The agriculture sector contributes 25% of the gross domestic product (GDP). Coffee, tea and horticulture (flowers, fruits, and vegetables) are the main agricultural export commodities; in
2002, the three jointly accounted for 53% of the total export earnings (Central Bureau of
Statistics, 2003). The manufacturing sector contributes about 13% of the total GDP and contributes significantly to export earnings, especially from the Common Market for Eastern
and Southern Africa (COMESA) region.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Government
The Constitution of Kenya (2010) provides for a Presidential system of government consisting of legislature, executive and judicial branches of government. Its institutions are the
presidency (the government-cabinet), parliament, and the judiciary. The system is based
on the principle of separation of powers, in which the executive branch is subject to the
confidence of the legislative branch and law guarantees the independence of the judiciary.
The President is the head of State and Government, and symbolizes the nation’s unity. The
legislature (Kenya’s bi-cameral parliament) is the country’s legislative body; composed of
two houses: National Assembly and Senate. Under the Constitution, the National Assembly
shall consist of 350 members drawn from 290 parliamentary constituencies each electing
one representative, 47 women, each elected to represent a county, 12 political party nominated members and one Speaker who is an ex officio member.
The judiciary is composed of judges and courts where the laws are upheld. There are 8 sections of the judiciary, each with courts to handle different type of law. The highest level of
authority within the judiciary is the Supreme Court. Overall, the judiciary is separate and
independent from both the executive and legislative branches of the government.
In Kenya, the central government will grant powers to the County Government headed by a
Governor and represented by a Senator in the Senate.
President
(Head of State or Government)
Legislature
Executive
Judiciary
National Assembly
(350 members)
President
Supreme Court
(Chief Justice, Deputy Chief
Justice + Five Judges)
Senate
(68 members)
Deputy President
Court of Appeal
(Not fewer than 12 Judges)
Cabinet Secretaries
(14-22)
High Court
(Headed by a
Principal Judge)
Devolved
Government
47 Country Assemblies
(Members elected from
Wards)
Attorney General
Country Executive
Committees
(47 Governors)
Electorate
(Voters)
Subordinate Court
- Magistartes Courts
- Khadis Courts
- Courts Martial
Judicial Service
Commission
(11 Members)
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Population
The population of Kenya increased from 10.9 million in 1969 to 28.7 million in 1999 and
38.9 in 2009 (Central Bureau of Statistics, 1994, 2001 and Kenya National Bureau of Statistics
2010). The results of censuses indicate that the annual population growth rate was 2.9% per
annum during the 1989-1999 period, down from 3.4 % reported for both the 1969-1979 and
1979-1989 inter-censual periods. The decline in population growth is a realization of the
efforts contained in the National Population Policy for Sustainable Development (National
Council for Population and Development, 2000) and is a result of the decline in fertility
rates since the mid-1980s. In contrast, mortality rates have risen since 1980s, presumably
due to increased deaths from HIV and AIDS epidemic, deterioration of health services, and
widespread poverty (National Council for Population and Development, 2000). As a result
of changing population dynamics, the total population of Kenya in 2009 was 38.9 (Kenya
National Bureau of Statistics, 2010).
The proportion of the population that resides in rural areas is still higher than the proportion in the urban areas. Increased urbanization levels have mainly resulted from rural-urban migration.
Kenya Health Service
As a result of health sector reforms that have decentralized health services in line with the
new constitution, services are integrated as one goes down the hierarchy of health structure
from the na¬tional level to the county and district/sub county level. Under devolution, the
county handles supervisory responsibilities.
National County and Functions on health and funding for 2013/14
34.75Bn
55.1Bn
National Govt Functions
County Govt Functions
- Health Policy formulation
- National Referral health
facilities
Run:
- County health facilities and
pharmacies
- Promotion of primary healthcare
- Ambulance services
- Licensing & control of food vendors
- Veterinary services
- Cemeteries
- Refuse removal & disposal
- Water & sanitation
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Structure of service delivery
The County Health Management Team (CHMT) provides supervision and management
support to the districts and sub-districts within the province.
At the County level, curative services are provided by county and district/sub county level
hospitals and mission hospitals. Public health services are managed by the County Health
Management Team (CHMT) and Public Health Unit of the district hospitals.
At the sub-County level, both preventive and curative services are provided by the health
centres as well as dispensaries and outreach services to the communities within the catchment areas. Basic preventive and curative services for minor ailments are being addressed
at the community and household level with the introduction of the community package.
Non-governmental organisations, faith-based organisations and the private sector. Although several health-oriented NGOs operate throughout the country, the population covered by these NGO health ser¬vices cannot be easily determined. The MOH and external
donors support the health services offered by NGOs and the private sector in several ways.
Depending on their comparative advantage, NGOs, FBOs, and community-based organisations (CBOs) undertake specific health services. The MOH provides sup¬port to mission health facilities by training their staff as well as seconding staff to these facilities and
of¬fering drugs and vaccines.
Currently, the private sector (both for-profit and not-for-profit) contributes over 40 percent
of health ser¬vices in the country, providing mainly curative health services and very few
preventive services. Modalities exist for MOH supervision and monitoring of NGO, FBO
and other private-sector facilities. The NGOs and private facilities work with communities
in collaboration with the District Health Management Team. Their activities are guided by
MOH standards and protocols.
Reference Materials
In Kenya, the project conducted Family Planning policy and budget analysis research in
Kilifi and West Pokot counties where women identified lack of male involvement and limited awareness of Family Planning methods costs and benefits as barriers to Family Planning
access and use. The following resource materials will be useful to execute an effective civic
education to improve the situation:
i.
ii.
Constitution of Kenya 2010
Sexual Offences Act 2007
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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iii. The Public Officers’ Ethics Act 2003
iv. Vision 2030 & First Medium Term Plan (208-2012) Kenya Vision 2030
v. Millennium Development Goals (MDGs) 2000
vi. National Health Sector Strategic Plan (NHSSP II)
vii. Public Health Act Cap 242
viii. National Hospital Insurance Fund Act Cap 254
ix. Ministry of Medical Services Strategic Plan 2008
x. Ministry of Public Health and Sanitation Strategic Plan 2008
xi. Population and Development Policy 2011-2020
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Geography
Rwanda is landlocked and borders Uganda to the North, Tanzania to the West, and Democratic Republic of Congo to the East and Burundi to the South. The country has 30 districts
in four provinces, namely, Northern, Eastern, Western and Southern Provinces. Kigali City
with 3 districts is categorised as a province. The country has a total area of 26,338 square
kilometres of mostly grassy uplands and hills with relief being mountainous and altitude
declining from West to East. Climate is temperate with two rainy seasons (February to April,
November to January). The climate is mild in mountains with frost and snow possible.
History
Rwanda is a former Belgian colony that gained independence in 1962. In 1959 the majority
group, the Hutus, overthrew the ruling Tutsi king. Over the next several years, thousands
of Tutsis were killed, and some 150,000 driven into exile in neighbouring countries. The
children of these exiles later formed a rebel group, the Rwandan Patriotic Front (RPF), and
began a civil war in 1990. The war, along with several political and economic upheavals,
exacerbated ethnic tensions, culminating in April 1994 in a state-orchestrated genocide,
in which Rwandans killed up to a million of their fellow citizens. The genocide ended later
that same year when the RPF defeated the national army and Hutu militias, and established
a government of national unity. Approximately 2 million Hutu refugees fled to neighbouring Burundi, Tanzania, Uganda, and former Zaire. Since then, most of the refugees have
returned to Rwanda, but several thousand remained in the neighbouring Democratic Republic of the Congo (DRC, the former Zaire) and formed an extremist insurgency bent on
retaking Rwanda. Rwanda held its first local elections in 1999 and its first post-genocide
presidential and legislative elections in 2003. Rwanda joined the Commonwealth in late
2009. In January 2013, the country assumed a non-permanent seat on the UN Security
Council for the 2013-14 term.
Economy
Rwanda is a poor rural country with about 90% of the population engaged in (mainly subsistence) agriculture and some mineral and agro-processing. Tourism, minerals, coffee
and tea are Rwanda's main sources of foreign exchange. Minerals exports declined 40% in
2009-10 due to the global economic downturn. Rwanda has made substantial progress in
stabilizing and rehabilitating its economy to pre-1994 levels. GDP has rebounded with an
average annual growth of 7%-8% since 2003 and inflation has been reduced to single digits.
However, Rwanda continues to receive substantial aid money, up to 40% of GDP. Rwanda
joined the East African Community and is aligning its budget, trade, and immigration poli-
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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cies with its regional partners. The Rwandan Government is seeking to become regional
leader in information and communication technologies.
Government
The 2003 Rwanda Constitution provides for a Presidential system of government consisting
of legislature, executive and judicial branches of government. The Executive consists of the
Head of State, the Prime Minister and Council of Ministers appointed by the president. The
legislative branch is bicameral and consists of Senate (26 seats in total; 12 members elected
by local councils, 8 appointed by the president, 4 appointed by the Political Organizations
Forum, 2 represent institutions of higher learning; members to serve eight-year terms) and
Chamber of Deputies (80 seats in total; 53 members elected by popular vote, 24 women
elected by local bodies, 3 selected by youth and disability organizations; members to serve
five-year terms).
Population
As per the last census (2010) Rwanda’s population stood at 10,537, 222, up from 8,128, 553 in
2002. This presented a 29.6 per cent rise in the population during the period. Annual population growth rate stood at 2.6 per cent, down from 2.9 per cent in 2002. Women constitute
51.8 per cent of the total population; down from approximately 53 per cent in 2002.Population density grew from 321 people per square kilometre in 2002 to 416 in 2012. The Census
put the average household size at 4.37, reflecting a drop in the fertility rate, from 5.5 to 4.6
children per woman by 2010. Close to 90 per cent of the population resides in rural areas,
though there increased urbanization mainly resulting from rural-urban migration.
Health
The Rwanda Demographic and Health Survey (RDHS) 2010 shows a significant reduction
in the maternal mortality ratio from 750 per 100,000 live births in 2005 to 476 per 100,000
live births in 2010. If the pace of this decline continues, Rwanda is likely to meet the MDGs
related to child and maternal mortality by 2015. HIV prevalence has remained constant at
3% between 2005 and 2010. This is attributed to access to antiretroviral therapy. There was a
decline of malaria prevalence by half since 2007–08 from 2.6% to 1.4% among children age
6 to 59 months, and from 1.4% to 0.7% among women aged 15–49 (RDHS 2010). The two
diseases placed a significant burden on the health system, of which in 2008, along with HIV
and AIDS-related opportunistic infections, accounted for 35% of hospital mortality cases
(Rwanda Interim Demographic Health Survey [RIDHS], 2007/2008).
18
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Reference Materials
In Rwanda the Family Planning (FP) policy and budget analysis carried out in Gatsibo district has identified myths, misconception and lack of youth involvement in reproductive
health programs as barriers to FP access and use. The following resource materials will be
useful to engage in an effective civic education to improve the situation.
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
Millennium Development Goals (MDGs) 2000
Vision 2020
Constitution of Rwanda 2003
National Population Policy for Sustainable Development (2003)
National Reproductive Health Policy (2003)
National Health Policy (2004)
Sexual Offences Act 2007
Population Census, 2010
Rwanda Demographic Health Survey (2010)
Rwanda Demographic Health Survey, 2010
Family Planning Policy (2012)
Economic Development and Poverty Reduction Strategy 2013–2018 (EDPRS II)
19
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Geography
Tanzania is located in the Eastern Africa, bordering the Indian Ocean, between Kenya and
Mozambique with a total area of 945,087 sq. km (land-886, 037 sq. km and water-59, 050 sq.
km). This includes the islands of Mafia, Pemba, and Zanzibar. The arable land of the country
is 4.52% of the total Land. The bordering countries of Tanzania include Burundi, Democratic Republic of the Congo, Kenya, Malawi, Mozambique, Rwanda, Uganda and Zambia.
History
Shortly after achieving independence from Britain in the 1961, Tanganyika and Zanzibar
merged to form the nation called Tanzania in 1964. One-party rule came to an end in 1995
with the first democratic elections held in the country since the 1970s.The Union of Tanganyika and Zanzibar adopted the name "United Republic of Tanzania" on April 26, 1964. In order to create a single ruling party in both parts of the union, Mwalimu Julius Nyerere merged
TANU (mainland) with the ASP (Zanzibar) to form the CCM (Chama Cha Mapinduzi-CCM,
Revolutionary Party) in 1977. Multipartsm was introduced in 1992. The first multiparty election was held in 1995 where the ruling party CCM won the election.
Economy
Tanzania is one of the world's poorest economies in terms of per capita income, however,
Tanzania average 7% GDP growth per year between 2000 and 2008 on strong gold production and tourism. The economy depends heavily on agriculture, which accounts for more
than one-fourth of GDP, provides 85% of exports, and employs about 60% of the work force.
Tanzania
Executive
20
Legislative
Judiciary
Mainland
Zanzibar
Mainland
Zanzibar
Mainland
Zanzibar
President
Vice President
Prime Minister
President
Chief Minister
National
Assembly of
Tanzania
House of
Representatives
5 Judicial
Courts
4 Judicial
Courts
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Population
The 2012 Population and Housing Census showed that the Population of Tanzania increased
from 34.4 million in 2002 to 44.9 million in 2012 with an average growth rate of 2.7 percent
per annum. The proportion of the population aged below 15 years was about 44 percent
while those aged 65 years and above was 4 percent, indicating that Tanzania has a young
population. This youthful age structure entails a larger population growth in future, as the
young people move into their reproductive life irrespective of whether fertility declines or
not. The population projections show that Tanzania has a population of 44.9 million in 2012
and is expected to double in the next 26 years with the growth rate of 2.8 in 2012 (Population
and Housing Census report 2012).
In Tanzania, fertility and mortality are the most important factors influencing population
growth at national level. Previous censuses have shown that the net international migration component has been negligible. However, there are certain areas in Tanzania where
migration have shown a big impact on population growth particularly the areas receiving
refugees. Fertility rate in Tanzania has declined slightly from 5.7 children per woman during
her childbearing age in 2004 (TDHS, 2004) to 5.4 children per woman in 2010 (TDHS, 2010).
In 2010, Mainland Tanzania recorded 6.1 and 3.7 births per woman in rural and urban areas, respectively. Differences related to education are inversely much wider. Fertility rate
for women with no education was 7.0, with primary education 5.5 and with secondary and
higher education 3.0 (TDHS 2010).
Mortality rate has declined substantially in Tanzania over the decades. The main contributing factors to the decline are improved access to health care and better environmental
sanitation. The crude death rate (CDR) per 1000 is estimated to have fallen from 22 deaths
per thousand in 1967 to 15 deaths in 1988 and slightly increased to 16 deaths in 2002. Infant
mortality rate (IMR) per 1000 live births is estimated to be 51 (TDHS 2010). The maternal
mortality rate (MMR) declined from 578 per 100,000 in 2004-05 to 454 in 2010 (TDHS 2010).
Health
Constitutional Provisions on health in Tanzania
According to the Constitution of Tanzania 1977, with amendments through 1998, there is
no provision on health. But Article 14 of the Bill of Rights stipulates that every person has a
right to life and to the protection of life by society.
Management of Health from the National to the Local level in Tanzania
Tanzania Mainland is divided into 25 administrative Regions. It is further divided into 120
Districts with 133 Council Authorities. Each District is subdivided into Divisions, Wards, Villages and sub villages/streets “Vitongoji/Mitaa”.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Under the current administrative set-up as provided in the revised National Health Policy
of 2007, provision of health services is divided into 3 levels, namely, National, Regional and
District. Tanzania Health System is organized in a referral pyramid, starting from the village
level, where there are village health posts; ward level, where there are community dispensaries; divisional level, where there are rural health centers; district level, where there are
district or district designated hospitals; regional level, where there are regional hospitals;
zonal level, where there are referral/consultant hospitals and national level, where there are
national and specialized hospitals.
At the National level, the Ministry of Health administers and supervises the National Hospitals, Consultant Referral Hospitals, Special Hospitals, Training Institutions, Executive Agencies and Regulatory Authorities. At the Regional level, provision of health services is vested
to the Regional Administrative Secretary with technical guidance of Regional Health Management Team.
At the district level, management and administration of health services has been devolved
into district through their respective Council Authorities, Health Service Boards, Facility
Committees and Health Management Teams.
The Ministry of Health as a technical Ministry is responsible for all matters pertaining to
health in the country. The role of the Health Sector are executed at three levels: - Central,
Regional and Districts.
At the Central level the Ministry of Health is responsible for: -
Special Hospitals;
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
At Regional level, the Regional Health Administration under the Regional Secretariat has
the following roles:
Mobilizes resources
health standards and quality of health care both public and private;
District Health Administration under the respective Council Authorities has the
following roles:
Hospitals, Health Centers and Dispensaries;
implementation
facilities and activities in the district;
the safety of medicine and equipment in their health facilities.
Local Government provision of Health services in Tanzania
Local government authorities are responsible for delivering of primary health care services.
Local government authorities are responsible for promoting public health and establishment and maintenance of district hospitals, health care centers, maternity clinics, and dispensaries, asylums for the aged, destitute or infirm or for orphans. Local government authorities share the responsibility for delivering health services with the Ministry of Health.
About one third of total health care expenditures are directly funded through local government authorities while two thirds of public funding for the provision of health care services
(either regional or national health services, or indirect funding for local health services) is
provided through the Ministry of Health.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Reference Materials
In Tanzania, the project through Family Planning policy and budget analysis conducted in
Handeni and Shinyanga districts has identified the following barriers to quality Family Planning services.
1.
2.
3.
Myths and misconception around Family Planning
Community lack confidence about the competence and skills of Family Planning
service providers
Lack of awareness and understanding of Family Planning related policies and
policy commitments by service providers
The project with its partners will therefore focus on reducing and removing identified barriers mentioned above. The following resource materials will be useful in implementing civic
education activities:
i.
ii.
iii.
iv.
v.
vi.
vii.
24
Tanzania Vision 2025
The Tanzanian Constitution 1977
Reproductive and Child health Policy Guidelines 2003
National Strategy for Growth and Reduction of Poverty (NSGRP) 2011 - 2015
Revised National Healthy Policy of 2007
Health Sector Strategic Plan 2008 - 2012
Local Government Reform Policy Paper -1996
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Geography
Uganda is located on the East African plateau, lying almost completely within the Nile Basin. It is bordered on the East by Kenya, on the North by South Sudan, on the West by Democratic Republic of Congo (DRC), on the Southwest by Rwanda and on the South by Tanzania.
The southern part of the country includes a substantial portion of Lake Victoria, which is
also bordered by Kenya and Tanzania.
Although landlocked, Uganda contains many lakes, besides Lake Victoria and Lake Kyoga.
These are Lake Albert, Lake Edward and the smaller Lake George. The Victoria Nile drains
from the lake into Lake Kyoga and then into Lake Albert on the Congolese border, and into
the South Sudan.
Kampala is the Capital City whereas other major towns include Entebbe, Jinja, Tororo,
Mbale, Kasese, masindi, Arua, Saroti, Lira, Gulu, Masaka, Fortpotal, Marutu and Mbarara.
History
Uganda gained independence from Britain in 1962 and post-independence elections held
in 1962. The country is a home to many different ethnic groups, none of whom forms a
majority of the population. About 40 different languages are spoken; with Luganda widely
spoken by majority people. English became the official language after independence.
Economy
Uganda has substantial natural resources, including fertile soils, regular rainfall, and sizable mineral deposits of copper and cobalt. Agriculture is the most important sector of the
economy, employing over 80% of the work force and supplies nearly all of Uganda’s foreign
exchange earnings. Coffee accounts for the bulk of export revenues of which Uganda is Africa’s leading producer.
After independence, chronic political instability and erratic economic management produced a record of persistent economic decline. The industrial sector is being rehabilitated
to resume production of building and construction materials, such as cement, and now
major cement manufacturers like ‘Tororo Cement Ltd’ caters to the need of building and
construction material consumers across East Africa.
25
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Government
The Constitution of Uganda (1995) provides the framework for governance and development of the country. The central government formulates policies, provides standards and
guidelines, builds capacity, and ensures supervision, coordination and resource mobilization to promote development of the country.
The president is both head of state and head of government. The president appoints the
vice president and prime minister who assists the president in governing. The parliament is
formed by a national assembly, which has 332 members elected for five-year terms during
general elections. Interest groups, including women and the army, nominate 104 of these
members.
Since 1986, the country was governed under the Movement (No Party) system until July 2005
when a multiparty dispensation was adopted. In 1992, decentralization was introduced with
devolution of powers, functions and responsibilities to Local Governments. Local Governments determine their own special development needs, programmes and strategies, acting
within the framework of national socio-economic priorities.
Uganda is divided into districts, spread across four administrative regions: Northern, Eastern, Central (Kingdom of Buganda) and Western. The districts are subdivided into counties,
sub-counties, parishes and villages. Parallel with the state administration, six traditional
Bantu kingdoms exist, enjoying mainly cultural autonomy. The kingdoms are Toro, Ankole,
Busoga, Bunyoro, Buganda and Rwenzururu.
The Judicial branch of government is composed of Court of Appeal with judges appointed
by the President and approved by the legislature; the president appoints High Court judges.
Population
Uganda’s population has grown from 4.8 million people in 1950 to 16.7 in 1991 and 24.3
million in 2002. According to the State of Uganda Population 2013, Uganda population is at
34.5 million. Uganda’s population has doubled in the last 20 years and at the current rate of
3.2% per annum population growth, Uganda’s population is expected to double yet again in
22 years to 55 million people by 2025 and 130 million people in 2050.
Uganda’s National Population Policy was promulgated by government in 1995 and elaborates clear strategies with an overall goal of contributing to the improvement of the quality
of life of the people of Uganda. It has since been revised in 2008 and its National Population
Policy and Social Transformation and Sustainable Development. It highlights the issue of
population growth being fast as compared to resources available.
26
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Health
Although poverty has reduced considerably from 56% in 1992 to 31% in 2006, infant and
maternal mortality remain high at 76 per 1000 and 435 per 100,000 live births, respectively.
Currently maternal mortality has gone up at 438 while infant mortality has reduced to 54 per
1000 live births. Fertility has remained high at 6.2 in 2011 from 6.7 in 2006. This is mainly due
to cultural and religious beliefs and preference for large families as the source of sustenance
especially during old age as well as low contraceptive use and high unmet need for Family
Planning. This situation has created a large dependent population, and engendered conditions not favourable for women’s reproductive health. Although life expectancy has started
rising, it remains low at only 50.74 years for male and 52.46 years for female.
Uganda has been among the rare HIV and AIDS success stories in curbing the pandemic in
the 1980s but these gains have not been sustained. The 2011 National HIV Indicator Survey
puts prevalence at 7.3% among 15-49 years up from 6.4 in 2004/5.
Infant mortality rate was at 54 per 1,000 live births in 2011. Life expectancy was at 50.2 for
females and 49.1 for males in 2005. There were 8 physicians per 100,000 persons in the early
2000s (Human Development Report 2009-Uganda).
Uganda eliminated user fees at public health facilities in 2001.
The government of Uganda health system consists of the district health system (communities, Village Health Teams (VHTs or health centres: HCs I, II, III and IV and general hospitals, Regional Referral Hospitals (RRH) and National Referral Hospital. The Uganda National
Minimum Health Care Package (UNMHCP) was developed and highlights services for all
levels of the health system for both public and private sectors and service delivery. Referral
Hospitals (NRH). The RRH and NRH are semi-autonomous institutions. Local governments
manage district health services. The district health system is further divided into Health
Sub-Districts (HSDs). Each HSD is supposed to have a referral facility being either a HC IV
or a general hospital (Health Systems Assessment-2011).
Health Centre II
Health Centre II is supposed to provide outpatient services and has got minimal diagnostic
capacity. They health centre II facilities do not provide ANC and maternity services; they do
provide short-term FP methods. They can carry out rapid test for pregnancy, malaria and
HCT.
27
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Health Centre III services
Health centre III provides health services to a population of 100,000 and Health III serve a
population of 20,000 people. HC IV acts as Health Sub district (HSD). They are mandated
with planning, organization, budgeting and management of the HSD at the level. It carries
oversight function of overseeing curative, promotive and rehabilitative health activities including those of PNFP and PFP service providers within the sub-county. All the Health III’s
did provide the services enumerated in the table below.
The District hospital which are sometimes referred to as general hospitals are supposed
to provide preventive, promotive, curative, maternity, in-patient health services, surgery,
blood transfusion services, laboratory and medical imaging services. They also provide in
–service training, consultation and operational research support of the community based
health care programmes. The general hospital serves a population of half a million people
(500,000).
Reference Materials
In Uganda, the project through discussion with women during Family Planning policy and
budget analysis conducted in Mityna and Kamuli districts women identified the following
as key barriers to quality Family Planning access:
1.
2.
Inadequate information on Family Planning methods before and after uptake
Limited access to Family Planning services due to Long distances to health centre.
The following resource materials will therefore be useful to execute successful civic education to improve the FP access and use:
i.
Constitution of Uganda 1995
ii. Education and Sports National Policy Guidelines on HIV/AIDS 2006
iii. National Population Policy for Social Transformation and Sustainable
Development 2008
iv. National Health Policy: Reducing Poverty Through Promoting People’s Health
2009
v. Health Sector Strategic Plan III 2010/11-2014/15
vi. National Adolescent Health Policy (Ministry of Health, Department of
Community Health and Reproductive Health Division)
28
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Delivery Topics
Session 1
Introduction
Duration: 15 Minutes
Objectives
education.
is and why their participation is necessary
Planning and development.
Introduce yourself and your main aim in organizing the civic education activity.
a)
b)
c)
Give your name and title.
State why you are there.
Relate what you are doing with what is happening in your country.
Key Observations in the Health sector
These are MDG 4, (reduce child mortality) 5 (improve maternal health) and 6
(combat HIV/AIDS, malaria and other diseases).
national budget for the health sector but countries stand at Kenya 6%, Rwanda
9.5%, Tanzania 10.2% and Uganda 9% far behind this target.
low-income countries spend an average of 4.2% on health. (World Health Report
– 2010)
infant mortality (IMF 2000)
are spread under different health legislation thus lacking harmony and difficult
to coordinate.
29
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Session 2
Governance in SRHR and FP
Duration: 50 Minutes
‘Governance’ has become an often used and popular concept when discussing the management of public affairs of society. This section deals with why and how governance goes
beyond public administration, and how and why citizens should become familiar with, and
interested in, public issues especially for health, SRH and FP.
Objectives
At the end of the session, participants should be able to:
governance’ and ‘participatory governance’ in SRH and FP
different levels in society-the family, the community and the state
of public affairs
Planning services and resources for health by government
Planning and related health services
Sexual and Reproductive Health and Rights and Family Planning service provision
Characteristics of Good Governance
Citizen participation: - participation by both men and women, the poor
and the rich, people of all persuasions, people of all races and ethnic groups
and people with different physical abilities is an essential facet of good
governance.
Empowerment: - decisions and actions in the management of societal
affairs must always be aimed at developing the capacities of all citizens,
men, women and youth equally.
30
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Rule of law: - public affairs must be done in strict accordance with
established law and legal frameworks that are enforced without favour to
any party, and full protection of human rights.
Transparency: - decisions taken and their enforcement are done in an
open manner that follows rules and regulations. Information is freely
available and directly accessible to those who will be affected by such
decisions and their enforcement.
Responsiveness: -institutions and processes try to serve all the people
within a reasonable timeframe; and priorities of public institutions
change according to the priorities of citizens.
Consensus oriented: - the different interests in society are taken into
account to reach a broad consensus in society on what is in the best
interest of the community as a whole and how this can be achieved.
Equity and inclusiveness: - Ensuring that all members of society feel that
they have a stake in it and do not feel excluded from the mainstream.
Effectiveness and efficiency: - processes and institutions produce results
that meet the needs of society while making the best use of resources at
their disposal.
Accountability: - governmental institutions as well as the private sector and
civil society organizations must be accountable to the public and to their
institutional stakeholders.
Strategic vision: - leaders and the public have a broad and long term out
look on good governance and human development, along with a sense of
what is needed for such development.
Governance is the process of managing public affairs, including the provision of services
Sexual and Reproductive Health and Rights and Family Planning within the health sector.
Citizens have given this responsibility to the government.
these are implemented in everyday life.
and fulfil their human rights.
ownership and improve chances of success and sustainability.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Organs of Governance
Parliament
Represents the interests of the people
Makes the laws of the country
Authorizes the allocation of public resources
Keeps a check and balance of power
Executive
Implements policy
Provides public services
Manages public resources
Maintains public order and security
Manages relations with other governments
Judiciary
Interprets the law
Administers justice through the courts
Arbitrates in disputes
Just and Good Governance
i.
Does the State treat citizens with respect and inform citizens about what it is doing
in the health sector?
ii. Does the State allow citizens to have a say about what they need and want from
government in relation to SRH and FP service provision?
iii. Does the State use investments and scarce resources reasonably for the benefit of
all citizens?
iv. Does the State operate by a clear set of rules, which are considered just and fair by
most citizens?
v. Does the State create mechanisms for citizen participation in health policy
formulation, decision-making and program implementation?
32
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Accountability Relationships
THE PUBLIC
(citizens, communities & residents)
FRONTLINE SERVICE PROVIDERS
(public sector nurses, social workers,
doctors & so forth)
ELECTED LEADERS
(politicians, MPs & local councils)
GOVERNMENT OFFICIALS
(ministry managerial staff, departments &
state bodies)
Levels of governance
Focusing on different levels of governance that exist in society (at State level through the
government, at community level and the family); exploring the values and norms of good
governance-focusing on different types of leadership and the relationship between good
governance and democratic leadership.
33
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Scenario Questions
How does our behaviour at the family level reflect the manner in which we handle
public affairs?
What implications do the roles played by men and women in the household have
on governance in families and in the country?
Are there big differences in the manner in which the women leaders you know
handle public affairs from that of male leaders you know?
Are the younger generation of leaders behaving differently? If so, how?
What happens when citizens are not able to participate in governance processes?
Whose right is violated and how, when citizens do not participate in governance
processes?
How important is the participation principle in diverse societies such as Kenya,
Rwanda, Uganda and Tanzania?
How can we make sure that the unique interests of disadvantaged groups like the
poor are taken care of in processes of governance?
Are we able to identify in governance processes incidents of discrimination on the
basis of gender, ethnicity, poverty or disability?
Do women participate in governance at the family, community and public levels to
the same extent as men? How do they make decisions about FP use?
How does such discrimination affect the quality of management of our public
affairs and what are the consequences in our lives?
Challenges to Good Governance
Conduct a brainstorming session with participants on what they think are the main constraints acting against good governance in health sector especially in health service provision in their country. Ask participants to share what they will personally do as their responsibility towards ensuring good governance in their country.
Some of the challenges include the following:
Corruption (bribery, extortion):- abuse or misuse of public office for personal gain
Tribalism and nepotism:- when a public official favours tribesmen, relatives and
kin over others in the provision of public services.
Political patronage:- reliance on protection of powerful people, particularly in the
course of providing public services.
Poverty
Poor infrastructure
Illiteracy/ignorance
Bureaucracy
Leadership crisis
Conflict of interest
Inequality
34
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Session 3
Health Systems
Duration: 45 Minutes
The main aim of the session is to increase the participants’ understanding of Health Systems to enable them to demand quality health care and accountability in their country
Objectives
At the end of the session, participants should be able to:
local government in provision of health, SRH and FP services.
managed from the grassroots level to national level
of SRH/FP services, transparency and accountability in their communities
Areas of Focus
i.
ii.
iii.
Management of Health, SRH/FP from the National to the local level in your country:
Role of the relevant Ministries in the management and the provision of health,
SRH/FP services in your country.
District Health Administration under respective Council Authorities in your country.
35
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Health Systems: Kenya
1. Dispensaries
The dispensaries are at the lowest level of the public health system and are mainly the first
point of contact with patients. Staff include enrolled nurses, public health technicians, and
dressers (medical assistants). The enrolled nurses provide antenatal care and treatment
for simple medical problems during pregnancy such as anemia, and occasionally conduct
normal deliveries. Enrolled nurses also provide basic outpa¬tient curative care and offer
contraceptives.
2. Health Centers
Health centres are staffed by midwives or nurses, clinical officers, and occasionally by doctors. They pro¬vide a wider range of services, such as basic curative and preventive services
for adults and children, as well as reproductive health and Family Planning services. They
also provide minor surgical services such as incision and drain¬age. They augment their
service coverage with outreach services, and refer severe and complicated condi¬tions to
the appropriate level, such as the district hospital.
3. District/Sub county Hospitals
District/Sub county hospitals are the facilities for clinical care at the district level. They are
the first referral hospital and form an integral part of the district health system. A district/
Sub county hospital should provide the following:
Curative and preventive care and promotion of health of the people in the district;
Quality clinical care by a more skilled and competent staff than those of the
health centres and dispensaries;
Treatment techniques such as surgery not available at health centres;
Laboratory and other diagnostic techniques appropriate to the medical, surgical,
and outpatient activities of the district hospital;
Inpatient care until the patient can go home or back to the health centre;
Training and technical supervision to health centres, as well as resource centre
for health centres at each district hospital;
Twenty-four hour services
Clinical services include obstetrics and gynaecology, Child health, Medicine.
SRH and contraceptive services
Surgery including anaesthesia, Accident and emergency services
Non-clinical support services
Referral services
Contribution to the district-wide information generation, collection planning,
implementation and evaluation of health service programmes
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
4. County Hospitals
County hospitals form a secondary level of health care for their location. They provide services to a geographically well-defined area. County hospitals are an integral part of the devolved health system. They provide specialized care, involving skills and competence not
available at district hospitals, which makes them the next level of referral after district/Sub
county hospitals. Their personnel include medical profession¬als, such as general surgeons,
general medical physicians, paediatricians, general and specialized nurses, midwives, and
public health staff.
County hospitals should provide clinical services in the following disciplines:
Contraceptives and Medicine
General surgery and anesthesia;
Paediatrics
Obstetrics and gynecology
Dental services
Psychiatry
Accident and emergency services;
Ear, nose and throat
Ophthalmology and Dermatology
ICU (intensive care unit) and HDU (high dependency unit) services.
Laboratory and diagnostic techniques for referrals from the lower levels
Teaching and training for health care personnel (nurses, medical officer interns)
Supervision and monitoring of district hospital activities;
Technical support to district hospitals such as specific outreach services.
5. Teaching and Referral Hospitals
Moi Referral and Teaching Hospital and Kenyatta National Hospital are the referral and
teaching hospitals in Kenya. They are centres of excellence and provide complex health care
requiring more complex technol¬ogy and highly skilled personnel. They have a high concentration of resources and are relatively expen¬sive to run. They also support the training
of health workers at both pre-service and in-service levels.
Teaching and referral hospitals have the following functions:
Health care: Referral hospitals provide complex curative tertiary care. They also
provide preventive care and participate in public health programmes for the local
community and the total primary health care system. Referrals from the districts and
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
provinces are ultimately received and managed at the referral hospitals. The referral
hospitals have a specific role in providing information on various health problems
and diseases. They provide extra-mural treatment alternatives to hospitalisation, such
as day surgery, home care, and home hospitalisation and outreach services.
Quality of care: Teaching hospitals should provide leadership in setting high clinical
standards and treat¬ment protocols. The best quality of care in the country should be
found at teaching and referral hospitals.
Access to care: Patients may only have access to tertiary care through a welldeveloped referral system.
Research: With their concentration of resources and personnel, teaching and
referral hospitals contribute in providing solutions to local and national health
problems through research, as well as contributing to policy formulation.
Teaching and training: Teaching is one of the primary functions of these hospitals.
They provide both. There are several medical training schools for various medical
cadres. The main training institutes include The University of Nairobi and Moi
University Eldoret. The aim of the government is to train adequate qualified and
motivated medical personnel at all levels of the health care system. However due
to poor pay, most professional end up in private practice.
6. Treatment Abroad
Other diseases and cases require special treatment whose facilities and equipment are not
available in the country. Depending on the foreign exchange position, some patients have
to be sent for treatment abroad.
Public Education: Public Health Education mainly is concerned with identifying prevailing
health problems and disseminating to the public methods of preventing and controlling
them. This is an integral part of community involvement in Primary Health Care (PHC).
It is assumed that, the health of an individual, the family and community at large is dependent upon factors as environment, social cultural traditions and life styles, hence public
health education focuses to strengthen and address issues related to agricultural development, child up-bringing, environmental sanitation and development in general. For
instance school children are special target group for health education through the school
health program. Public health education is provided by a variety of methods including mass
media, continuous development and dissemination of health education materials and
through dialogue with communities.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Heath Systems Structure: Rwanda
1. Village Health Service: This is the lowest level of health care delivery in the country. Three
village elected community health workers (CHW) usually delivers village Health Services.
Two of the CHWs are in charge of children under 5, and one in charge of maternal and child
health. The CHWs provide home-based care and treat malaria, pneumonia, diarrhoea, and
follow-up on pregnant women, and offer short-term Family Planning methods.
2. Health Post Services, aim to intervene where the distance to the Health Centre is more
than one hour. They essentially provide preventive and promotional services, which can be
offered in homes. Usually each Health Post has one laboratory technician and three nurses.
3. Health Centre Services: Health Centres offer general consultation services, maternity
and hospitalization, antenatal care, long-term Family Planning methods, immunization,
minor surgeries and offer supporting pharmacy and laboratory services. They also offer the
HIV package, including VCT, PMTCT and ARV provision. Clinical Officer heads the centre,
depending on population at the Sector level, one nurse per 1000 people, 4 lab technicians,
32 social workers/counsellors, one nutritionist and at least three financial officers. Health
centres are responsible for supervision of health posts.
4. District Hospitals: District Hospitals offer specialised services not available at health
centres, usually medical doctors and specialists and are responsible for technical supervision for health centres.
5. Referral Hospitals, currently four around the country, offer advanced specialized services.
6. University Hospitals, currently two (Kigali University Hospital and Butare University
Hospital), which are more research oriented and specialized medical investigation.
7. Treatment Abroad: Other diseases and cases require special treatment whose facilities
and equipment are not available in the country. Depending on the foreign exchange position, some patients have to be sent for treatment abroad.
Public Education: Public Health Education mainly is concerned with identifying prevailing
health problems and disseminating to the public methods of preventing and controlling
them. This is an integral part of community involvement in Primary Health Care (PHC).
It is assumed that, the health of an individual, the family and community at large is dependent upon factors as environment, social cultural traditions and life styles, hence public
health education focuses to strengthen and address issues related to agricultural devel-
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
opment, child up-bringing, environmental sanitation and development in general. For
instance school children are special target group for health education through the school
health program. Public health education is provided by a variety of methods including mass
media, continuous development and dissemination of health education materials and
through dialogue with communities.
Health Professional Training: There are several medical training schools for various medical cadres. The aim of the government is to train adequate, - qualified and motivated medical personnel at all levels of the health care system.
Reproductive Health: The National Family Planning Program is the sum total of all Family
Planning activities provided by various agencies – and coordinated by the Reproductive and
Child Health Unit of the Ministry of Health.
The Government formally started providing Family Planning Services as one of the MCH
components. The Family Planning Department in Rwanda is responsible for initiating and
developing Family Planning standards and guideline on service provision, training and other aspects of quality care.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Health System: Tanzania
The health system and especially the Governments referral system assumes a pyramidal
pattern of a referral system recommended by health planners, that is from dispensary to
Consultant Hospital (Better Health In Africa, 1993).
The structure of health services at various levels in the country is as follows:
1.Village Health Service: This is the lowest level of health care delivery in the country. They
essentially provide preventive services and short tern FP methods, which can be offered
in homes. Usually each village Health post have two village health workers chosen by the
village government amongst the villagers and be given a short training before they start
providing services.
2. Dispensary Services: This is the second stage of health services. The dispensaries cater
for between 6,000 to 10,000 people and supervise all the village health posts in its ward in
Tanzania. Dispensary services include health education to patients and community members in general, medical treatment and medicines for different diseases, laboratory services
where there is laboratory technician and Reproductive Health Services including services
for:
Pregnant women
Contraceptives
Under-five children
HIV testing and counselling including PMTCT
Delivery services
Provision of treated mosquito nets to pregnant women and under-five children
Malaria treatment for pregnant women
Mobile clinic
Home to home visit
Refer patients with complicated diseases to the highest level –health centre
3. Health Centre Services: A health Centre is expected to cater for 50,000 people which is
approximately the population of one administrative division in Tanzania. Health services
provided here include health education to patients and community members in general,
medical treatment and medicines for different diseases, laboratory services where there is
laboratory technician, surgery services and Reproductive Health Services including services
for:
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Pregnant women
Contraceptives
Under-five children
Management of STIs including TB, HIV testing, counselling and PMTCT
Delivery services
Provision of treated mosquito nets to pregnant women and under-five children
Malaria treatment for pregnant women
Mobile clinic
Home to home visit
Refer patients with complicated diseases to the highest level – hospital
4. District Hospitals: The district is a very important level in the provision of health services
in the country each district is supposed to have a district hospital. For those districts that
donate have Government normally negotiates with religious organizations to designate voluntary hospitals get subventions from the Government to contract terms. Services offered
include health education to patients and community members in general, medical treatment and medicines for different diseases, laboratory services where there is laboratory
technician, surgery services and Reproductive Health Services including services for:
Pregnant women
Contraceptives
Under-five children
Management of STIs including TB, HIV testing, counselling and PMTCT
Delivery services
Provision of treated mosquito nets to pregnant women and under-five children
Malaria treatment for pregnant women
Mobile clinic
Home to home visit
Refer patients with complicated diseases to the highest level – Regional and
Referral hospitals
Different clinic for mental illness, CTC, eye, dental, diabetes, physiotherapy, surgeries, XRay, ultra sound
5. Regional Hospitals: Every region is supposed to have a hospital. Regional Hospital offer
similar services like those agreed at district level, however regional hospitals have specialists
in various fields and offer additional services, which are not provided at district hospitals.
6. Referral/Consultant Hospitals: This is the highest level of hospital services in the country
presently. In Tanzania example there are four referral hospitals namely, the Muhimbili National Hospital which cater the eastern zone; Kilimanjaro Christian Medical Centre (KCMC)
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
which cater for the northern zone, Bugando Hospital which cater for the western zone; and
Mbeya Hospital which serves the southern Highlands.
7. Treatment Abroad: Other diseases and cases require special treatment whose facilities
and equipment are not available in the country. Depending on the foreign exchange position, some patients have to be sent for treatment abroad.
Public Education: Public Health Education mainly is concerned with identifying prevailing
health problems and disseminating to the public methods of preventing and controlling
them. This is an integral part of community involvement in Primary Health Care (PHC).
It is assumed that, the health of an individual, the family and community at large is dependent upon factors as environment, social cultural traditions and life styles, hence public
health education focuses to strengthen and address issues related to agricultural development, child up-bringing, environmental sanitation and development in general. For
instance school children are special target group for health education through the school
health program. Public health education is provided by a variety of methods including mass
media, continuous development and dissemination of health education materials and
through dialogue with communities.
Health Professional Training: There are several medical training schools for various medical cadres. The aim of the government is to train adequate, - qualified and motivated medical personnel at all levels of the health care system.
Reproductive Health: The National Family Planning Program is the sum total of all Family
Planning activities provided by various agencies – and coordinated by the Reproductive and
Child Health Unit of the Ministry of Health.
The Government formally started providing Family Planning Services as one of the MCH
components in the mid seventies. The Family Planning Unit (FPU) was operational in 1986,
and has been gradually strengthened to its present capacity. This FPU is responsible for
initiating and developing Family Planning standards and guideline on service provision,
training and other aspects of quality care.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
Uganda Health System
The government of Uganda health system consists of the district health system (communities, Village Health Teams (VHTs or health centres: HCs I, II, III and IV and general hospitals, Regional Referral Hospitals (RRH) and National Referral Hospital. The Uganda National
Minimum Health Care Package (UNMHCP) was developed and highlights services for all
levels of the health system for both public and private sectors and service delivery. Referral
Hospitals (NRH). The RRH and NRH are semi-autonomous institutions. Local governments
manage district health services. The district health system is further divided into Health
Sub-Districts (HSDs). Each HSD is supposed to have a referral facility being either a HC IV
or a general hospital (Health Systems Assessment-2011).
Health Centre I
It is a satellite health facility with no definite physical structure; it is where village health
team and health facility out-reach teams meet the community for Health Education, advice
and refer patients to health Centre’s.
Health Centre II
It is a parish level of the politico- administrative system and serves a population of up to
5000. Health Centre II is supposed to provide outpatient services and has got minimal diagnostic capacity. They health centre II facilities do not provide ANC and maternity services;
they do provide short-term FP methods. They can carry out rapid test for pregnancy, malaria and HCT.
Health Centre III services
Health centre III provides health services to a population of 100,000 and Health III serve a
population of 20,000 people. HC IV acts as Health Sub district (HSD). They are mandated
with planning, organization, budgeting and management of the HSD at the level. It carries
oversight function of overseeing curative, promotive and rehabilitative health activities.
Health Centre IV
Is a mini hospital and delivers the Complimentary Activity Package. It matches the county,
equivalent to parliamentary constituency. In addition to the health services found in health
Centre III it should have wards for men, women, children and should be able to admit patients. It should have a senior medical officer and another doctor as well as a theatre for
carrying out emergency operations.
District/general Hospital
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
REPRODUCTIVE HEALTH AND RIGHTS AND FAMILY PLANNING
The District hospital which are sometimes referred to as general hospitals are supposed
to provide preventive, promotive, curative, maternity, in-patient health services, surgery,
blood transfusion services, laboratory and medical imaging services. They also provide in
–service training, consultation and operational research support of the community based
health care programmes. The general hospital serves a population of half a million people
(500,000).
Key Discussion Questions
How are health care providers meant to behave towards the patients?
How far are people meant to travel to their nearest clinic?
What is meant to happen with medical emergencies?
What treatments and contraceptives are supposed to be available at this clinic?
How many beds should there be in each level of health?
How many doctors & nurses are meant to be on duty?
Are the medicines dispensed in the clinic meant to be of a certain quality?
How is district set to improve access, quality and efficiency of lower level services?
How is central government ensuring districts understand FP related policies and
guidelines for better implementation, performance monitoring and evaluation of
service delivery?
How is the central and district government implement a human resource
development program to ensure adequate supply of qualified health staff for
management services?
How is central government strengthens the national support systems for drugs
and supplies, medical equipment and physical infrastructure management?
How does central and district government increase the financial sources/support
for FP?
How is promotion of private sector involvement in the delivery of services?
How is central and district government monitor and supervise provisional of
health/FP services as per set standards?
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Session 4
Sexual and Reproductive Health and Rights
Duration: 50 Minutes
Session Objectives
At the end of the session participants should be able to understand
Definition of Reproductive Health
World Health Organization (WHO) defines Reproductive Health as a state of complete
physical, mental social wellbeing in all matters relating to the reproductive systems and to
its functions and processes. It implies that people are able to have a satisfying and safe sex
life and that they have the ability to reproduce and freedom to decide if, when, and how
often to do so.
Desirable Reproductive Health Status
Young people between the ages of 18-24 have survived the vulnerable period of childhood
and are expected to be generally healthy. The challenge for reproductive health care providers is to help young people achieve a desired state of reproductive health. The desirable
health status includes:
Adequate height and weight for age
Good nutrition.
Up-to-date with immunizations.
Free of disease and illness.
Emotional support from family/friends.
Ability to avoid substance abuse.
Ability to make an informed decision on sexual activity (whether to engage in
sexual activity, with whom, when, what type, and how to protect oneself
from pregnancy and STI/HIV) that is free of coercion.
Good self-image both in terms of physical appearance and personal character
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Sexuality and Sexual Health
Definition of Sexuality
Sexuality is one of the essentials of human life. It includes sex, gender roles, sexual pleasure
and giving birth, which are manifested in ones thinking, faith, desire, interaction and behaviour. Sexual pleasure is essential for life.
Definition of Sexual Health
Sexual Health is a state whereby a person enjoys sexual life, which, is free from coercion,
fear of unwanted pregnancy and STI’s. Sexual health implies that people are able to have a
satisfying and safe sex life and that they have the ability to reproduce and freedom to decide
if, when, and how often to do so.
Sexual Reproductive Health and Rights Components:
Family Planning
Management and prevention of STI’s/HIV/AIDS
Safe motherhood
Child Care.
Adolescent Sexual and Reproductive Health.
Rationale for youth Sexual Reproductive Health and Rights services
Youth 10-24 years present a larger number in a population. They are vulnerable to problems related to Sexual and Reproductive Health and Rights such as unwanted pregnancy,
unsafe abortion and STI’s including HIV. They are undeserved for their rights e.g. privacy,
confidentiality, respect and informed consent, information, education and counselling.
Youth experience different needs as they grow up because of their physical psychological
changes in their bodies. They have different cognitive abilities and skills, which require different counselling approaches. They tend to be less well informed and require more information on aspects around their lives. Conflicts between cultural or parental expectations
and adolescents’ emerging values present serious challenges for young people. Also sexual
experiences (not always voluntary) usually begin during adolescence and consequences of
risky behaviours can have serious and long-term effects. Therefore SRH interventions can
help youth make good decisions and take responsibility for their actions, often preventing
serious negative consequences in the future.
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There are many effective channels for reaching youth. These include:
Schools
Religious institutions
Youth organizations
Community and recreational activities
Parental communication
Peer education
The media
Health service facilities
Youth Sexual Reproductive Health and Rights
A right is something that an individual or a population can legally and justly claim. Sexual
Reproductive rights are those rights specific to personal decision-making and behaviour
in the reproductive sphere, including access to reproductive health information, guidance
from a trained professional, and SRH services.
In addition to rights established within individual countries, major international conventions have articulated reproductive rights, including those that are specific to adolescents.
These policies provide the basis for the following SRH rights:
1.
2.
3.
4.
5.
6.
7.
The right to reproductive health
The right to decide freely and responsibly on all aspects of one's sexuality.
The right to information and education about sexual and reproductive health so that
good decisions can be made about relationships and having children.
The rights to own, control, and protect one’s own body.
The right to be free of discrimination, coercion, and violence in one’s sexual decisions
and sexual life
The right to expect and demand equality, full consent, and mutual respect in sexual
relationships.
The right to quality and affordable reproductive health care regardless of sex, creed,
color, marital status, or location. This care includes:
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
The right to privacy and confidentiality when dealing with health workers and doctors.
The right to be treated with dignity, courtesy, attentiveness, and respect.
The right to express views on the services offered.
The right to gender equality and equity.
The right to receive reproductive health services for as long as needed.
The right to feel comfortable when receiving services.
The right to choose freely one's life/sexual partners.
The right to celibacy.
The right to refuse marriage.
The right to say no to sex within marriage.
Barriers to fulfil youth Sexual Reproductive Health and Rights
Presented below is the list of barriers and bottlenecks that limits fulfilment of youth SRHR.
Provider’s personal views.
Heavy client load at facility level and lack of time.
Local laws, customs, or policies.
Religion.
Provider was not adequately trained.
No clinic guidelines exist to ensure adolescent rights are met.
Community pressure.
Family pressure.
Peer pressure.
RH services are not accessible to young people.
Hours of RH services for young people are inconvenient.
There is no method for providing client feedback.
Key Youth Sexual Reproductive Health and Rights Policies
There are several International and Regional conventions that commit for full implementation of necessary legislative and administrative measures to create an enabling environment for young people’s SRHR. National governments have ratified different the global and
regional conventions therefore they have the responsibility to fully deliver SRHR services as
stipulated in those conventions.
These policies include:
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Youth Sexual Reproductive Health and Rights Collaborators and their Roles
Ministry of Health:
Provision of SRH services
Creation of an enabling environment through policies, guidelines and standards
and coordination
Supervision, monitoring and evaluation of SRH initiatives as necessary.
Ministry of Education, Ministry of Youth, Ministry of Community Development and Gender:
Ensure strategies towards SRH achievements are incorporated in the entire
respective Ministry endeavors.
Key Questions for Discussion:
1.
2.
3.
4.
Where do young people receive SRH information and services?
Is there a youth friendly corner in the health facility?
How is the attitude of service providers towards young people?
What are the major SRHR challenges of young people?
Resource Materials
Care International.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Declaration
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Session 5
Family Planning Rights
Duration: 40 Minutes
Objectives
At the end of the session, participants should be able to
Governments should fully commit to making Family Planning services available, accessible, safe, acceptable, and affordable for its people, regardless of age, parity, marital status, creed, race, color, or sexual preference. Several health policies and strategic documents
demonstrate this commitment. Quality Family Planning services are a human right and an
ethical obligation of health care providers.
All men and women including youth (10–24 years of age), irrespective of their parity and
marital status, are eligible to access accurate and complete Family Planning information,
education, and services.
Family Planning Rights:
Right to Information
All individuals have a right to information about the benefits of Family Planning for themselves and their families. They also have the right to know where and how to obtain Family Planning information, both inside and outside a facility setting, to be able to make informed choices about their method of preference.
Right to Access
All individuals have a right to receive services from Family Planning programs, regardless of
their socioeconomic situation, religion, political beliefs, ethnic origin, age, marital status,
geographic location, or other characteristics. They have the right to access Family Planning
through various health care providers and various service-delivery systems.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Right of Choice
Individuals and couples have the right to decide freely whether or not to practice Family Planning. When seeking contraceptive services, clients should be given the freedom to
choose which method of contraception to use. Clients should be able to obtain the method
they have decided to use, provided there are no significant contraindications to their use
of the method. Clients’ decisions to discontinue or switch methods should be respected.
Clients also have a right to choose where to go for Family Planning services (i.e., physical
location or service-delivery mode such as community- based Family Planning, pharmacy or
over-the-counter service, hospital, health center or Family Planning clinic) and the type of
service provider with whom they feel most comfortable.
Right to Safety
All individuals have a right to safety in the practice of Family Planning, effective contraception, and protection against other health risks not related to a method of contraception
(e.g., against the possibility of acquiring an infection through the use of contaminated instruments).
Right to Privacy
All Family Planning clients have the right to privacy in discussing and needs or concerns.
Clients also have the right to refuse any particular type of examination if they do not feel
comfortable with it or to request that another provider conduct the examination.
Right to Confidentiality
The confidentiality of information provided to a Family Planning client or the details of the
services received needs to be assured. This information should not be communicated to
third parties without the client’s consent. The right to confidentiality is protected under the
Hippocratic oath.
A breach of confidentiality could cause shunning by the community, matrimonial difficulties, or loss of a target group’s confidence and trust in the staff of a service-delivery program.
Right to Dignity
All Family Planning clients should be treated with courtesy, consideration, attentiveness,
and respect regardless of their level of education, social status, or any other characteristics.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Right to Comfort
When receiving services, the client has a right to feel comfortable in regards to the adequacy
of the service-delivery facility (e.g., proper ventilation, lighting, seating, and toilet facilities),
the quality of services, a short waiting time, and an environment that is in keeping with the
cultural values, characteristics, and demands of the community.
Right to Continuity
Clients should receive services and supplies of contraceptives for as long as they need them,
should have unconditional access to other services within and outside the facility, and
should have the right to request transfer of their clinical records to another clinical facility
(e.g., a copy of records be sent to the new facility or given to the client). Linkages, referrals,
and follow-up are very important aspects of a client’s right to continuity of services (e.g.,
having the same provider help the client at different visits and, as much as possible, having
only one provider rather than different ones take the history, provide counseling, and conduct the examination).
Right of Opinion
The provider should view positively a client’s opinions on the quality of services (e.g., thanks
or complaints, suggestions for changes in the service provision) and include them in the
program’s ongoing efforts to monitor, evaluate, and improve its services.
Involving the client’s opinions at the planning stage aims to appropriately and acceptably
satisfies the needs and preferences of other potential clients.
Guiding Principles for Family Planning Service Provision to Meet Client Rights
Informed Choice
The individual client should only make decisions about contraceptive use.
No parental or spousal consent is needed for an individual to be given Family
Planning information and services, regardless of age or marital status.
Before provision of a Family Planning method or methods, clients should be
counseled on the range of available contraceptive options, and should be
provided with accurate and complete information to enable them to make an
informed decision.
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Family Planning Method Eligibility
Contraceptives should be provided to clients in accordance with nationally
approved method-specific guidelines, as defined by the WHO Medical Eligibility
Criteria (MEC).
Privacy and Confidentiality
A client’s privacy should be assured. The provision of Family Planning services
should be individualized and discrete. Clients should be protected from both
auditory and visual exposure.
A client’s related information, including all Family Planning and reproductive
health information, should be protected.
Dignity, Comfort, Expression of Opinion
Clients should be treated with dignity and friendliness.
Precautions should be taken to ensure minimal discomfort.
Clients’ opinions should be sought and their wishes and perspectives respected.
Continuity of Services
Clients’ wishes to continue, switch, or stop use of Family Planning should be
respected and fulfilled.
Clients should have unconditional access to other health services.
Considerations for Clients with Special Needs
Clients are considered to have special needs for Family Planning if they have biological,
social- cultural, or physical conditions that may hinder their access to Family Planning
services or if they are at high risk of an unintended pregnancy. This could include young
people, men, postpartum women, post-abortion clients, pre-menopausal women, people
with disabilities (PWD), and people living with HIV (PLWH). Despite their conditions, all of
these clients have the same rights as the general population to information and services on
Family Planning and safe conception.
Young People
ages 10–24 years. The need to provide contraceptive information and services to
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FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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young people deserves heightened attention for several reasons. When first
pregnancies occur to adolescents younger than 18 years old, the adolescents are
at a higher risk of developing pregnancy-induced hypertension, anemia, and pro
longed or obstructed labor. Their newborns are at risk of dying, being born too
soon, or being born with a low birth weight. Furthermore, unintended
pregnancies may lead to loss of educational and employment opportunities
for the young mothers.
health and welfare benefits of both delaying teenage pregnancy and protecting
against sexually transmitted infections (STIs) including HIV (dual protection).
when they want to have children, be informed and obtain information about
Family Planning services, and access a full range of contraceptives methods.
youth-friendly if they have policies and attributes that attract youth to the
services, provide a comfortable and appropriate setting for serving youth,
meet the needs of young people, and are able to retain their young clients for
follow-up and repeat visits.
Men
Involving men and boys in Family Planning helps to reduce gender inequalities and promote the health and well being of women, men, and children. Involving men in Family Planning means more than increasing the number of men using contraceptives. It also includes
men encouraging and supporting their partners and their peers to use Family Planning, and
it sensitizes men to support the reproductive and maternal needs of their spouses.
Couples counseling on Family Planning should be encouraged, but it is
not required for the provision of counseling to individuals (either men or women).
Postpartum Women
Women in the postpartum period, that is the first year after a birth, face a unique
set of issues that put them at risk of an unintended pregnancy. These issues
include the timing of when they can become pregnant again after giving birth
(return to fertility), breastfeeding status, delayed return of menses after a
birth (postpartum amenorrhea), their return to sexual activity (postpartum
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abstinence), limited mobility during the postpartum period, decision-making
related to contraceptive use, and health-seeking behaviors.
Women in the postpartum period should be given support and be advised to wait
for at least two years before trying to become pregnant again, in order to
reduce the risk of psychosocial and adverse maternal, perinatal, and infant
outcomes.
Discussion Questions
i.
ii.
iii.
iv.
v.
vi.
How is Family Planning service offered?
Are women and young people receiving counselling of different contraceptive
methods?
How is final decision on contraceptive method choice arrived; who make decision
of contraceptive method to be used?
How is contraceptive choice, is there room for women to choose method of
their choice?
How is the issue of privacy in Family Planning service provision?
How are men involved in issues of Family Planning?
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Session 6
Resources for Health Sector, Policy and
Budget Development Process
Duration: 1 hour 30 Minutes
Objectives
At the end of the session, participants should be able to:
available for health service provision at centralized and decentralized level. This
includes an understanding of devolved funds.
and management of resources for the health sector
accountability
Health Plans and Budget for the health sector
What are public Resources?
Public resources are our collective resources: they belong to all citizens of a particular country. They are our common heritage, to which an individual or section of the population cannot legitimately claim exclusive ownership of. Our public resources include:
i.
ii.
iii.
iv.
v.
vi.
The entire geographical mass that is called Kenya or Uganda or Tanzania or Rwanda
All our water masses, such as Lake Victoria and Ocean waters such as Indian Ocean
All our rivers
Our mountains and hills
Our forests and the fish in our water masses
The dry lands and minerals under the ground
The wealth of the nation that is held and managed for us by the government in the form
of money, and other assets such as building and machinery, is also part of our public resources. Individuals who are put in positions of public responsibility are also our public
resources- to the extent that they are required to serve the public.
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Where does the money part of our public resources come from?
Government has no money of its own: taxes that citizens pay directly and through different
business processes are the most important sources of government revenue. The most common taxes are:
The Kenya Revenue Authority (KRA), Rwanda Revenue Authority (RRA) Tanzania Revenue
Authority (TRA) and Uganda Revenue Authority (URA) in Kenya, Rwanda Tanzania and
Uganda countries collect all the above taxes and other levies, which generate government
revenue, respectively.
How are public resources managed?
The government is supposed to spend the revenues in accordance with citizens’ interests
and for poverty eradication- and for the overall welfare of citizens. Priorities include:
Citizen and CSO’s Participation and Engagement
Citizens have a most crucial and influential role to play in accounting for public resources.
As the principal owners of these resources, citizens must monitor how they are managed
and systematically, individually and through their organizations, put pressure on public officials to account for their use of public resources- through participatory mechanisms, such
as citizens’ report cards and social audits.
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Policy Making Process
Policy
Policy is a principled guide to action taken by the administrative executive branches of government with regard to a class of issues in a manner consistent with law and institutional
customs. The term policy is used by government agencies to describe a range of different
activities including (i) objectives, (ii) setting priorities (iii) describing a plan and (iv) specifying decision rules.
Policy Making Process
Government have policies in a number of areas such as the economy, foreign affairs, health,
education, defence, law and order etc. Before a policy come into existence there are critical
steps to be followed in the process of policy making. These include:
1.
Policy Determinant
The first stage in policy in the policy making process is for government to determine its
policy in relation to the issues on the political agenda. This will be on the basis of manifesto
or emerging issues that necessitates the development of a policy. The government cannot
anticipate all the issues that may arise in their term of office therefore they must be prepared to decide on stance as issues arise. In that regard issues are presented in either verbal
or written form at an initial meeting and then be developed via consultative process into a
written working policy.
2.
Policy Development/Analysis
At this stage the government develops detailed measures it wishes to adopt in relation to a
particular issue. Policy development has various steps such as:
i)
ii)
iii)
iv)
v)
Identifying existing constraints
Determining how such constraints are going to be overcome
Identifying the positive steps that need to be taken
Considering the financial and operational implications
Drafting changes to existing legislation or new legislation to enact the measure
In democratic countries with strong participative approach, government will often seek the
views of those outside the government on particular policy measures that are being developed. These include the private sector, professional and trade bodies, trade unions, local
government, interest groups and individuals with specific interest.
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In less developed countries the extent of debate over the measures of the government is
much restricted. However it is worth noting that CSOs need to find information from internal sources and influence policy making process at this stage.
3.
Policy approval
Policy is normally approved by the legislature. There are two steps in this process:
i)
ii)
The government being satisfied with the detailed development of the measures that
have taken place
Enactment of measures, including approval by relevant bodies within the political
structure
The enactment of policy will require the amendment of existing laws/regulations and/or
the passing of new laws/regulations. The way this is done vary from country to country. In
a democratic country this will involve elected representatives in a body such as parliament
or national assembly to: debate over the measures proposed by the government; to explore
opportunities to amend the proposed measures and issue formal approval of the measures
put before it.
However the extent of the debate will depend on a number of factors including;
i)
ii)
The nature of proposals- the more controversial the proposals the more likely and
lively debate.
The capacity and scope of the political opposition to comment on proposals.
4.
Policy Implementation
This is a stage that follows after the policies have been approved. Is the part that involves
mainly government ministries, executive agencies and other executive organs such as local
authorities as regulatory bodies.
5.
Policy Evaluation
In this step the reviewer tries to ask the following key questions:
i)
ii)
iii)
iv)
Are the measures taken, achieving the desired policy objectives.
If not, what steps need to be taken to improve the achievement of policy objectives.
Have the measures taken had any undesired effects.
Have circumstances changed to an extent that the new measures are required.
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As discusses earlier, it is important to keep in mind that policy-making takes place in a dynamic environment that policies that were once relevant may become irrelevant. New issues may emerge over which governments have to formulate policies for the first time and
also changing circumstances may demand a change in policy.
CSO’s and advocates have a role to analyse policies, identify gaps existing within the policy
or in the course of policy implementation and advocate for inclusion of emerging issues and
proper policy implementation.
After policy evaluation, the necessary changes are made and the process begins again, if
deemed necessary.
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Budget Development Process at the Local Level
Entry points for CSO’s and citizens engagement in accounting for public resources
Kenya
Budget Formulation
National treasury releases a circular to all govt agencies
starting the process, and setting out guidelines for public
participation.
July 1 - Aug 30
Counties must prepare and table a county development
plan in the county assembly by sep 1. The plan must be
made public within 7 days. By Sep 30th the CEC member
Sep 1 - 30
Opportunity to
prioritise within
health budget
Target: Submission of a
memorandum to the ministry
of health. The County Executive
Opportunity to
prioritize within
health budget.
Target: County Reps, county
Opportunity to
prioritize within
health budget.
Target: The public, other like
minded organizations (coalition),
the ministry of health
Opportunity to
prioritize within
health budget.
Target: The national assembly
through a memo, KEWOPA,
Opportunity to
prioritize within
health budget.
Opportunity to
prioritize within
health budget.
Target: The national assembly
through a memo.
Opportunity to
prioritize within
health budget.
Target: Like minded CSO and
presentation of a Memo to the
national assembly.
Opportunity to
prioritize within
health budget.
Target: The national assembly
through memos and KEWOPA.
Opportunity to
prioritize within
health budget.
Target: Members of parliament,
members of county assembly,
through presentation of Memos.
Opportunity to
prioritize within
health budget.
Target: Presentation of memos
to the National Assembly.
paper to the EC.
Sep 1 - Feb 15
Scruinity And Approval
Deadline for budget policy statement to be approved by
Feb 28
strategy paper to be tabled in each county,
Deadline for the Budget Policy to be made available to the
public.
Mar 1
This is the deadline for passing the Division of Revenue and
County Allocation of Revenue Bills.
Mar 16
The deadline for the cabinet secretary to submit the budget
proposal or estimate to parliament. It’s also the deadline
for the for the judiciary and parliamentary service commissions to submit their budgets to parliament. This is also the
date for the county budget proposal to be submitted to the
County Assembly.
This is likely when the national budget and county budget
committees will begin to hold public hearings on the budget. It is also the time when the national and county budget
committees table their recommendations on the budget
in parliament. 15th May is the deadline for the national
assembly
April 30
May - June
Execution, Monitoring & Control
National Finance Bill to authorize tax and revenue collection is tabled in parliament. A County FINANCE Bill
is tabled in the county assembly as well. By 30th June
priation Bill is passed by parliament to authorize spending
for the new budget year. The deadline is also the same for
the county Appropriation Bill
get estimates should be available to the public.
-
ADVOCACY ENTRY POSITIONS
THE BUDGET PROCESS
Public consultations and public sector review takes place
at this moment.
By January of each year CRA submits its recommendations
for division of revenue between the national and county
government and among the counties, to the rest of the
government. By 15th Feb, the Cabinet Sec for Finance to
submit the national budget policy statement to parliament.
Target: The national assembly
through a memo.
June
July
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Rwanda
Budget Formulation
Cell Plans approval
STEPS IN THE BUDGET PROCESS
District Health Planning team meet to formulate budget
Sept - Oct
Oct- Nov
Scruinity And Approval
Stakeholders recommendations
February
Budget Submitted to MoH
February
Social Services Committee reviews budget
Feb- March
Full council meet to approve budget and signed by the
Mayor
March
Submission the budget
March
Opportunity to
prioritise FP at
village level
Target: village chair, in charge
of health facility
Opportunity to
prioritise health at
ward level
Target: health committee chair
or ward councillor or in charge
of health centre
Opportunity to
make right priorities or unit health within health
within health
sector
January
ADVOCACY ENTRY POINTS
O&OD
Village level
Opportunity to
prioritise within
health budget
Target: District council planning
Opportunity to
prioritise within
health budget
Opportunity to
prioritise within
health budget
Opportunity to
prioritise within
health budget
Target: Councillors
Opportunity to
prioritise within
health budget
Target: RAS or regional Health
Management Team
Execution, Monitoring & Control
Follow up quarterly funds release
Follow up quarterly implementation reports
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July - June
July – June
Opportunity to seek Target: District Executive
accountability and Director
reallocation
Opportunity to
monitor spending
and assess value
for money (PETs)
Target: DED and DMO
FACILITATOR'S MODULE FOR CIVIC EDUCATION ON GOVERNANCE IN SEXUAL AND
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Tanzania
Budget Formulation
Ward Plans approval at WDC
STEPS IN THE BUDGET PROCESS
Counsel Health Planning team meet to formulate budget
Sept - Oct
Oct- Nov
Scruinity And Approval
LGA reworks RAS recommendations
February
Budget Submitted to MoHSW
February
Councillors Social Services Committee reviews budget
Feb- March
Full council meet to approve budget
March
Submission the budget to RAS
March
Opportunity to
prioritise FP at
village level
Target: village chair, in charge
of health facility
Opportunity to
prioritise health at
ward level
Target: health committee chair
or ward councillor or in charge
of health centre
Opportunity to
make right priorities or unit health within health
within health
sector
January
ADVOCACY ENTRY POINTS
O&OD
Village level
Opportunity to
prioritise within
health budget
Target: District council planning
Opportunity to
prioritise within
health budget
Opportunity to
prioritise within
health budget
Opportunity to
prioritise within
health budget
Target: Councillors
Opportunity to
prioritise within
health budget
Target: RAS or regional Health
Management Team
Execution, Monitoring & Control
Follow up quarterly funds release at the public notice
board
Follow up quarterly implementation reports
July - June
July – June
Opportunity to seek Target: District Executive
accountability and Director
reallocation
Opportunity to
monitor spending
and assess value
for money (PETs)
Target: DED and DMO
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Uganda
SN
ACTIVITY
CURRENT
PRACTICE
PROPOSED NEW
DEADLINE
1.
Issue the First Draft Budget Call Circular
By 30th Nov
By 15th Oct
2.
Consultations with Local Governments
Nov/Dec
Oct to Nov
3.
Sector Working Groups Consultations
Nov - Feb
Sept - Nov
4.
Submission of Sectoral Budget Framework
Papers and detailed Budget Estimates by
By 15th Feb
By 15th Nov
Finance, Planning and Economic
Development
5.
Submission of the National Budget Framework
Paper to Cabinet
By 15th Mar
By End Dec
6.
Submission of the National Budget Framework
with the Preliminary Detailed Estimates to
Parliament
By 1st Apr
By 15th Jan
7.
Submission of Semi-annual Performance
Reports by MDAs to MoFPED
By End of Feb
By End of Feb
8.
Approval of the National Budget Framework
Paper by Parliament
By 15th May
By 20th Feb
9.
Parliamentary Comments into the Budget
Framework Paper
By 15th May
N/A
10.
Submission of the Final Draft Budget Estimates
by MDAs to MoFPED
By 20th May
By End of Feb
11.
Submission of Detailed Draft Budget Estimates
to Parliament
By 15th June
By 15th Mar
12.
Submission of Ministerial Policy Statements to
Parliament
By 30th June
By 1st April
13.
Presentation of Budget Speech in Parliament
By 15th June
By 15th June
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Key Budgeting Stages
SN
ACTIVITY
CURRENT
PRACTICE
PROPOSED NEW
DEADLINE
1.
Finance Bill and Budget Appropiation under the Budget Act
By 30th Nov
By 15th Oct
2.
Presentation of Vote on Account in Parliament
By 18th June
N/A
3.
Consideration and Approval of Budget nu Parliament
October
By 31st May
5.
Budget comes into operation
By 10th July
On 1st July
6.
Repayment of Uncommitted funds from the previous
By 31st July
By 5th July of the
8.
Submission of Annual Budget Performance by MDAs to
By end of August
End of July of the next
Stage
2.
Process
Sectors consult LGs and communicate budget
issues to consider during budget
Sector working group consultations
3.
4.
12.
Compilation of frameworks for allocation and
semi-annual reports
Final budgets presented for approval
Opportunity for Advocacy agenda
FP agenda could be communicated for
prioritization in LG budgets
Advocacy for increased allocation could be
done here
Work plans and budgets for nutrition
incorporated into national budget
RH/FP plans are concluded and presented for
approval to pave way for expenditure and
implementation
Key discussion questions
their villages
at village levels
meetings
changes/cuts before budget is finally approved
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Facilitation Toolkit
This section is meant to assist the facilitator in the planning and managing of civic education activities. Before undertaking any civic education activity, you need to prepare adequately long before the activity so that you can ensure its success. One needs to develop an
activity schedule and checklist in time. The following are useful tips:
Objectives of the activity
Clearly state the objectives of your activity to the target group in the communities. As you
begin to conduct civic education, you will discover that the sessions often provoke discussions of sensitive or personal topics, which may derail the objective. Have a set of appropriate ground rules written on a flip chart or board and hanged on the wall during the activity.
Activity Schedule
This indicates specific tasks to be undertaken, persons to undertake the said tasks and a
timeline for performing tasks. Whenever, possible, include benchmarks. This should be extracted from the activity plan and it is a reminder on items to be bought and tasks to be
undertaken before the civic education activity. This includes; Budgeting, Venue, Facilities,
Resources, Transport, Reimbursements and Program.
You will need to refer to the following checklist during your planning
1)
Who are the participants?
2)
What kind of venue has been chosen for the activity?
3)
When is the event scheduled?
4)
Have you contacted your proposed participants?
5)
What resources will you need?
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Methodology
Civic education employs a variety of methodologies. It is upon the civic educator to determine the most appropriate method for different audiences. Civic education programs
have also tended to rely on a broad range of methods to teach democratic orientations and
behaviours, including lectures, discussion groups and panels, dramatizations, role-plays,
community organizing, materials distribution, and avenues of the mass media. Again, as
will be discussed in greater detail below, some methods principally more active methods
such as dramatizations and role-plays are far more successful than other methods are in
terms of encouraging change.
We encourage the facilitators who are executing civic education activities for Euroleverage
Project to use a wide range of approaches in conducting their civic education activities.
Some of the methods include:
Transmission Methods: -This is a one-way passage of information through lecture, dictation, narration, text reading etc.
Experiential Methods: - Behavioural lessons and conclusions are drawn without predictability of results for instance games, role plays, case studies, field surveys etc.
Heuristic Methods: These are also called discovery methods, which the learner finds information through library research, field visits, individual projects etc.
Creative Methods: - These include generation of new designs, insights, and perceptions
and explore individual potential through drama, drawing, sculpturing, creative writing etc.
Critical Methods: - This is the use of analysis, evaluation, re-arrangement, application of
criteria and distinctions through debates, diagrams, critical discussions, essays etc.
Experience from previous implementation of the original module revealed that participatory methodologies are more effective than a one-way passage of information without feedback from the target audiences. The participatory methodologies prosed therefore include:
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Community sessions
These are short community sessions organised by host organisation in collaboration with
district health department and local leaders of specified location. The target group for this
session include local leaders, in charge of health facilities, political leaders and general
community members (women, youth, people with disabilities, men and older people). The
purpose of the session is to discuss access to, use and availability of SRH/FP services, identify barriers to SRH/FP access and use, civic rights and responsibilities and also to empower
communities on how to question poor governance in health service provision and give
feedback to the relevant health authorities within the district health structure. The session
is also aiming at providing the community members with an opportunity to enquire freely
on specific issues regarding health policy and budgeting process and decision-making on
use of decentralised funds. Facilitators will encourage and empower the audience with information on how to demand accountability particularly from in-charge of health facilities.
The most appropriate method to provoke this discussion includes drama, puppet, dancing
and film shows. Cultural entertainment group may be consulted and provided with relevant
theme and message before actual performance. Screening the drama and dance performance prior the actual performance is necessary to control and check the quality of message and relevance. During the discussion facilitators should take note of testimonies from
community members in order to respond to the issues during the open discussion and also
to inform the concerned district authorities about of real FP situation on the ground during
exit meeting. Facilitators must also take note of active speakers especially those providing
quality, meaningful contributions and feedback. Selection of such people (women, youth,
men, people with disabilities) should be done and facilitators must enquire their names,
titles and location so that they can be invited to attend higher-level meeting i.e. micro –
consultative forums.
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Micro- consultative Forum
This is the second level meeting attended by selected members from the community session, village leaders, ward executive officer, in charge of health facilities at community level;
and district medical officer, district Reproductive Health/Family Planning coordinator/officer, district health secretary, district planning officer and community development officer
at district level. This forum provides an opportunity for the organising NGO and community representatives to present identified SRHR/FP challenges during the community sessions to the district health authority. The aim is to make the district health team aware of
identified FP issues and challenges in order to set strategies to address the identified challenges. This forum should be planned when district budgeting process and consultation
process have started in order to influence integration of identified issues in district council
comprehensive health plans. This way civic education increases public participation and
interaction with policy makers in planning, implementation of development plans and
more importantly creating development policies, budgets and plans that are responsive to
community needs.
1.
Lecture: This is an orderly presentation of information delivered by a resource person
(Facilitator). It is the delivery of verbal information from the source to the receiver
without much interaction. A lecture can be used to impart knowledge or introduce
skills. To be effective, a lecture allows for an exchange between the facilitator and the
learners.
There are two steps in using Lecture Method; preparation and delivery of the lecture.
Preparation: While preparing for using lecture method, a facilitator has to choose the topic, research on the topic and make notes, organize the information in a coherent manner,
prepare hand-outs and other learning aids and budget his/her time.
Delivery of the Lecture: The facilitator will need to introduce the topic and highlight issues
to be covered. He/she will present the lecture and make conclusions by summarizing the
main points of the lecture. The facilitator will also provide references to the audiences for
more information and lastly issue hand-outs to the audience.
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Best Practices of Using Lecture Method
Please Note: Lecture method should not be the staple method in a civic education programme for citizens.
II.
Visuals and Audio-Visuals: The visuals are items that appeal to our sense of sight.
They can be projected (overhead transparencies and slides) or non-projected
(pictures, slides, posters) information, education and communication materials (IEC).
The audio-visuals are electronic equipment used to transmit information through a
combination of image and sound for instance films, videos, video conferencing etc.
Steps in using visuals include: Secure or prepare well in advance, choose relevant topic to
use with, set up in an appropriate place, use aids at appropriate times making sure you give
participants see and understand them, explain or discuss the content of the aid, summarize
messages and end session.
Best Practices of Using Visual Method
Steps in using audio visuals include: determine topic and the need to use audio-visual aids,
select, secure and prepare equipment well in advance, test the materials in training site
and layout, study the materials thoroughly before use, design objectives to be achieved and
tasks for participants, brief participants on topic, give participants time to see and understand them, explain or discuss the content of the aid, make summarised messages and end
session.
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Best Practices in Using Audio Visual Method
that is culturally sensitive
III. Case Study: A case is a real life situation to illustrate certain facts, analyse problems
and their consequences, examine relationships among variables, open room for
debate and lead to logical conclusions. It can be presented in different forms namely;
oral (narration and dram), written or visual (picture and slides) and audio-visual
(video and film).
Steps in using case studies include: Choose a case that is relevant to the subject matter, understand the case thoroughly, design objectives of using the case for instance what lessons
do you want trainees or audience to draw? Design tasks for participants on the case, allow
participants to go through the case individually and or in groups, guide plenary discussion
of issues from the case and summarize key messages and de-brief the audience.
Best Practices in Using Case Study Method
IV. Demonstrations: - This is the use of a real life and practical illustrations for instance
the voting process in a polling station.
Steps in using demonstrations include: Choose a relevant topic, use budget time, consider
size of the audience, set up a demonstration site and test all necessary appliances, rehearse
the demonstration, briefly explain to the participants the topic, materials, process and expected results, demonstrate, assign participants tasks to practice, monitor as participants
practice, draw conclusions with involvement of participants and de-brief them.
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Best Practices in Using Demonstrations
V.
Role Plays: This is the use of short illustrative dramatic scenes exploring a specific
element.
Steps in using role plays include: Choose relevant topic or theme, discuss the topic and
develop a story line and a short script, divide roles among group members, rehearse the
play, the role play should not last more than 10 minutes, de-role and de-brief to return the
characters to their real identities and draw lessons. Is there any possibility of developing like
a role-play that can be practiced to make participants understands easily?
Best Practices in Using Role Plays
VI. Debates: This is where participants are required to articulate opposing viewpoints.
This can be in the form of pro-contra debates, trial scenes, value clarification etc.
The steps in using debates include: Choose a relevant motion and word it carefully, divide
participants into groups, give clear instructions, allow group time to generate points, hold
debate and collect ideas, de-brief participants and summarize key messages for them.
Best Practices in Using Debates
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VII. Group Work: This is the involvement of participants organized in small groups to discuss and prepare presentations based on their discussions.
Step in using group work include: determine tasks for each group and instruct carefully, divide participants into manageable groups (about 5-8 members optimal), ensure appropriate spatial arrangements for the group work and presentation, give groups ample time to go
through the tasks, monitor the progress of groups and adjust time if necessary, clarify how
groups will present their results to the plenary and allow for reporting back, allow responses
from the plenary and summarize the ideas presented.
Best Practices in Using Group Work
the group
VIII Information, Education and Communication (IEC) Materials: This leads to increased awareness on thematic issues, such as sexual and reproductive health etc. They
supplement other civic education activities. These are posters, fliers, printed t-shirts and
caps, newsletters, hand-outs, radio, television, newspaper adverts, photographs, compact
discs, branded writing materials etc.
Best Practices in Using IEC Materials
education materials
ensure the materials are relevant
preferences of the target community
network and materials distributed free of charge
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VII. Group Work: This is the involvement of participants organized in small groups to discuss and prepare presentations based on their discussions.
Step in using group work include: determine tasks for each group and instruct carefully, divide participants into manageable groups (about 5-8 members optimal), ensure appropriate spatial arrangements for the group work and presentation, give groups ample time to go
through the tasks, monitor the progress of groups and adjust time if necessary, clarify how
groups will present their results to the plenary and allow for reporting back, allow responses
from the plenary and summarize the ideas presented.
Best Practices in Using Group Work
the group
VIII Information, Education and Communication (IEC) Materials: This leads to increased
awareness on thematic issues, such as sexual and reproductive health etc. They supplement
other civic education activities. These are posters, fliers, printed t-shirts and caps, newsletters, hand-outs, radio, television, newspaper adverts, photographs, compact discs, branded
writing materials etc.
Best Practices in Using IEC Materials
education materials
ensure the materials are relevant
preferences of the target community
distribution network and materials distributed free of charge
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Target group
Civic education programs have traditionally reached out to a broad range of groups, from
opinion leaders, to women’s groups, to farmers, to youth, to community elders, to people
living with disabilities, to lawyers concerned with how to address human rights concerns
within a democratic framework. The target group for the civic education needs to be identified. There is need to have gender balance in the selection or mapping of participants/
audiences.
Civic Education for Euroleverage will have three (3) categories of target groups for its
activities:
Community Representatives
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
Women group leaders
Community group leaders
Project development leaders
Faith-based organization leaders
People living with disabilities
People living with HIV/AIDS
Youth group leaders
Professional association leaders e.g. SACCOs/ Trade Unions
Teachers
Community Health Workers
Advocacy Audiences
a) District Medical Officer evolved Fund Committee members and managers
b) Reproductive Health Coordinators
c) District Health Secretary
d) District Planning officer
e) In charge of Health Facilities
f ) Elected leaders i.e. Member of Parliament, Councillor
g) District Community Development Officers
General Community
a) Market vendors
b) Community gatherings, barazas, weddings etc
c) Public holiday/anniversary celebrations and ceremonies
d) Sports days/events/tournaments
e) School or church or mosque functions
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Actual Civic Education Activities
The execution of the civic education activities falls into three major phases, namely:
A.
B.
C.
The introductory session
The substantive sessions
The evaluation/ending
Getting Started
A complete introductory session should:
organization and what the organization does
The Sessions
While executing civic education sessions, there must be interaction between and among
participants and facilitator. The delivery must therefore systematically balance this interaction for achievement of the civic education session objectives.
The following will largely contribute to a success of a civic education session. The facilitator
should:
i. Have thorough knowledge of the subject
ii. Deliver content in a logical sequence
iii. Have reference materials ready
iv. Carefully plan his/her introduction
v. Budget his/her time so the session is not overloaded or under-loaded
vi. Plan for audience participation
vii. Plan time for questions and answers
viii. Be ready to learn from the participants
ix. Be patient
x. Use real life examples to reinforce learning
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xi. The facilitator ensures proper use and management of space
xii. Understand the participants
xiii. Be creative and flexible
xiv. Take advantage of the experienced participants and those with specialized knowledge
and skills
xv. Be aware of inappropriate mannerisms
xvi. Talk to people not at people
xvii. Use visual and other learning aids appropriately
Games and Exercises during a civic education activity
In executing civic education activities using participatory methodologies, the use of games
and exercises is very important. There are various games and exercises that can be used and
are as follows:
Game and Exercise
Purpose
Ice-breakers
To start an education session and help participants get to
know each other and buy into the purpose of the activity.
Warm ups
Undertaken in the morning to get participants prepared
mentally and physically
Done as interludes to sustain energy levels and break
monotony
Energizers
Communication games
To illustrate aspects of communication
Games for creativity
To bring out participants’ potentialities
Team building exercises
To create a sense of togetherness and eliminate unhealthy
Gender sensitization games and exercises
To make participants aware of gender dimensions and how
they affect our lives
Problem-solving games
To demonstrate approaches to tackling problems and what
happens when a group tries to do it together
Perception games and exercises
To show how and why people look at and interpret things the
way they do
Games for evaluation
To provide feedback on the value of the training
Games for ending an event
To re-emphasize the purpose of the event and create a sense
of continuity
Please note: When using games and exercises:
They should not take precedence over the serious business of the workshop
They should be slotted in judiciously, bearing in mind the time of the day and the
intended effect
There should be a purpose in using them
Instructions should be clearly stated
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Activity Ending
At the end of the civic education activity, an evaluation should be conducted. The evaluation can be focus on different aspects and can be done using different methods. Some key
areas of focus in an evaluation include:
Extent to which objectives have been achieved
What participants liked most or least in the content and process
The appropriateness of methods used
Facilitation skills
Duration of the event
Level of participation
Overall usefulness
Competencies developed i.e. what can participants do as a result of the activity
Overall organization and logistics e.g. food, venue, time management,
accommodation, adequacy of learning resources used, transportation etc.
Some of the popular methods of evaluation are:
Method
Mood meter
Rating
Description
A visualized chart with faces expressing different emotions against which
participants mark their level of satisfaction at the end of each day’s
activity. It helps to gauge the atmosphere of the workshop.
Achievement of objectives, realization of expectations and reduction of
fears on a scale
Pre-test and post-test
Gauge what changes have occurred in participants’ knowledge, skills
and attitudes as a result of the civic education activity
Daily evaluation
Feedback board
Committee which collects views and suggestions from other participants
Participants post their comments in the course of the training
Whatever the method used, the evaluation needs to;
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Monitoring and Documenting Civic Education Intervention
Monitoring and documenting the outcome of civic education activities is key in Euroleverage project. The role of monitoring and documenting lies in the hands of facilitators. It is advised that after completion of series of civic education activities facilitators must save time
to reflect together with selected community members and district authorities on lessons
learnt and results and outcome of civic education intervention. These outcomes will never
be collected without a proper follow up system and commitment through physical visits
and one to one meetings. There has to be a proper mechanism to track how the situation
was before the civic education intervention in order to clearly see changes happened after
the intervention. Therefore facilitators must collect testimonies from individuals, groups
and even government officials either by collecting stories or recording short video clips.
Monitoring schedules can be based on the agreed timeline during the micro-consultative
and higher-level meetings held and in the first and second quarter of new government financial year to check if the budget reflects identified community challenges, priorities and
needs. Monitoring can also be scheduled during budget development and consultation
processes to influence the project advocacy agenda.
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Annexes
1. Data collection tool for civic education intervention success stories
SUCCESS STORY DATA COLLECTION TOOL
Contact name:
Contact information:
Address:
Email:
Employer/Organization name:
FOCUS OF THE STORY
Proposed Title of the Success Story:
This should include your program’s name
and grab the attention of your audience.
Focus/Theme of the story:
Focus might be on collaboration with partners,
a community prevention initiative, advocacy
efforts, using data to engage stakeholders, etc.
Point of view:
The story should be from the perspective of
a participant, family member, community,
facility, etc.
BACKGROUND OF THE STORY
Time period of achievement:
Location of the story:
Program target group:
Name and contact information of
one participant to be interviewed:
challenges and what did you do to accomplish
your success?
to include their logo in a one-page document?)
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Contact information:
Name:
Address:
Telephone Number:
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Think in terms of replication. What would
your audience need to know to replicate
your program?
Environmental context and barriers to success:
How was the situation before the intervention?
Key results or implications of success:
Describe your most important results either
at the individual, community level.
Quote from a participant: Do you have any
Yes ( ) No ( )
support this story? Please include the full contact
Name:
and a signed release form.
Telephone Number
Program impact: Since the program was
implemented, how is life different for program
recipients? (Changes in health service provision,
culture/norms, and behavior; increased access to
famly planning methods, participation and
consultation, etc.)
IMPLICATIONS OF THE STORY
Next steps:
What are the next steps that need to be
taken to further or continue this effort?
Lessons learned:
What were the key elements that made
this a success? What would you do differently?
PUBLICATION INFORMATION
Do you have a photo?
Yes ( ) No ( )
consent form
Do you have a program logo?
Yes( ) No ( ) If yes, please include
an electronic copy with your submission.
By submitting this form, I am agreeing to allow (insert program name here) to use this
information to develop a success story that can be used in community presentations
and/or in written forms of communication. I have reviewed all of the information above.
Signature________________________________________
Title _________________________________________
Date___________________________________
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2. Guideline to Document Civic Education Success Story
Content
Title – brief and understandable by non expert
Sub title – a brief elaboration of the main tittle
Abstract – a short summary of the project and the result area
Quotes – from beneficiary, stakeholders
Background information – against which the project was designed
Geographical location - where is your story located
Issue - what is the main problem and people affected
Action/intervention - what you did to address the problem
Characters - Who are the main characters consulted and how they overcome
the issue
The outcome/impact – what are results
3. Civic Education Intervention Success Stories Samples
Human Resource Gap Filled in Busime Sub-County, Busia District, Uganda
With one of its two positions vacant, the Busime Health Centre II suffered a shortage of
health staff for 6 months. This meant that the remaining midwife was left alone to attend
and care for a population of 15,000. Together with its partners RHU and FOCRAV, DSW informed community members about their health entitlements and how they could formally
demand better services. Led by their community chairperson, this prompted the community to file a petition. Today, the vacancy is filled and the community is advocating for an
upgrade to their health facility.
Busime Health Centre II is located in the Eastern region of Uganda as part of the Busia district. According to national health standards, its two health workers are required to provide
the following services to Busime’s15, 000 residents:
health workers including traditional birth attendants
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Unfortunately, in 2011 a nurse was transferred
to another health facility, leaving the post vacant for 6months.Throughout Uganda, shortage
of critical staff such as midwives and doctors
has greatly compromised the delivery of quality
health services with 67% of health positions vacant at Health Centre II (HC II) level. With HC IIs
located in rural communities, absence of staff
has a big impact on local populations.
Having to cope alone with assisting pregnant
women, deliveries, prescribing and administration medications, the midwife quickly became
overwhelmed. Due to this, women seeking reproductive health and family planning services
often had to wait a long time before they were attended and seen to. Quite often this wait
would extend over many days but with the next health centre so far away, they had no choice
but to wait or to keep coming back.
Realising this, a group of Busime residents decided to take action but after visiting the District Health Officer in Busia Town, their complaint about the precarious situation in Busime
continued to remain unheard.” Initially, we had two health workers; a nurse and midwife
but, the nurse was transferred to another health centre and no replacement has been made
since then,” John Sikenyi said. “We have raised this issue over and over with the district
health office without any response so far.” John Sikenyi is the Chairperson of Bwaniha Parish, Busime Sub County.
Concerned about the situation in Busime, in October 2011 DSW and its partners decided
to organise civic education events and facilitate dialogues between citizens and the district
authorities. The meeting brought together 100 community members and 8 district officials
to discuss budget allocations and the health situation in the sub-county. For the first time,
they heard about the country’s total health budget allocations. They learned about the services they were entitled to and they got to know about the formal mechanisms in which to
file a complaint and demand better remedies.
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They understood that their verbal complaint to the District Health Officer was not sufficient
and they decided to file a petition to ask for a new health worker. The signing of the petition
was led by John Sikenyi, who formally submitted it to the District Health Officer.
“We have complained so much that perhaps with this [signing of the petition] the district
will be forced to do something. This health worker we have here is overwhelmed with the
work; she is the one who prescribes the medicine, acts as a nurse as well as a midwife,” said
Risper Nabwire, a concerned community member.
Recently, DSW and its partners conducted a follow-up meeting at the sub-county. With the
success of the petition the vacancy has since been filled. A further consequence of the petition is that Busime sub-county is now lobbying for a Health Centre III as the distance to
Lunyo which hosts the nearest HC III is too far away. Moreover, the Health Management
Committee has increased its vigilance in supervising the health centre and in working together with the community to improve services.
Although formal feedback mechanisms to improve health service delivery and channels for
citizens in Uganda exist, they are often not well known. Such civic education and dialogue
activities are helpful in helping community members understand their rights and the formal methods available in demanding better health services. DSW continues to strengthen
the voice of citizens and in improving the responsiveness of local officials.
Since 2010, DSW and RHU have implemented the Healthy Action project which aims at
empowering civil society actors to advocate effectively on health issues. The project focuses
on areas of civic education and district dialogues. These enable better understanding of
rights which people can use to better hold their leaders and governments responsible and
accountable for decisions made.
Visit: www.dsw.org
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Midwife returns to Kware, Tanzania, after 15 years of vacancy
Kware community’s demands for a midwife for their health centre were finally heard. After
leaving the position vacant for 15years, a new health worker is expected to be deployed
in the village by the end of August. This comes after a consultative meeting facilitated by
DSW between community representatives and district authorities in Hai District, Tanzania,
which led to the hiring of 36 new health workers for the district.
Hai District faces accute shortages in health
personnel with consequences at each level of
the health service pyramid. The case of Kware
is emblematic for the situation. Kware is a
village located in Masama South ward (Hai
District, Tanzania). 15years ago, its only midwife passed away. Attending of a population
of over 11,410, it has the only government
owned health facility in the ward. Since the
passing of the midwife, the area was covered
by just one doctor who would commute back
to town after 3pm.
After a series of letters were sent, the District Medical Officer promised Kware that they
would deploy a new midwife under the condition that the community would provide accommodation. Using their own resources, the community acted quickly and built the requested house. However with the district authorities failing to honour their side of the bargain, the house continued to remain vacant for over ten years.
On March 26th 2012, DSW facilitated a consultation between district authorities and community representatives at ward level. In total, 32 community representatives from three villages including Kware joined the meeting to discuss the state of reproductive health services with the District Medical Officer (DMO), District Reproductive Child Health Coordinator
(DRCHCo), and District Community Development Officer (DCDO).
It was agreed that the District Medical Officer will look for options in deploying more skilled
health workers at the community and at the district hospital. He promised to get more staff,
including midwifes, to the communities.
Three month later, positive changes were being felt in Kware. On June 13th 2012, two male
midwives were employed at the district hospital to reduce staff shortages at the maternity
ward. However, this wasn’t a satisfactory solution for the community as, due to cultural rea-
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sons, the preference is for female midwifes. As a long term improvement, the district budgeted for 36 more nurses and midwives, who have already reported since the beginning of
August. This adds to Hai district’s 330 government employed health staff - of which 40 are
skilled midwives. One of the newcomers will hopefully be a midwife for Kware village. The
decision on where newcomers will be deployed is made at the district with consultation of
the District Medical Officer. The District Health Secretary plays the biggest role for their allocation and DSW will be at the forefront in following up.
This outcome has shown ordinary Tanzanians that they can have a say in decisions affecting
their well-being and hold decision makers accountable.
Since 2010, DSW has implemented the “Healthy Action” project in Tanzania. It aims at empowering civil society actors to advocate effectively on health issues. The project focuses
on areas of civic education and district dialogues. These enable better understanding of
rights which people can use to better hold their leaders and governments responsible and
accountable for decisions made.
Visit: www.dsw.org
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References
Type of Reference
Reference
Book
Central Bureau of Statistics (CBS) [Kenya], 2004, Kenya
Demographic and Health Survey 2003, Nairobi, Kenya
Book
Education and Sports Sector National Policy Guidelines
on HIV/AIDS, 2006, Ministry of Education and Sports,
Government of Uganda.
Book
Healthy Action Facilitators’ Module for Civic Edication
on Governance and health in Kenya, Tanzania and Uganda,
2011
Report
Human Development Report 2009 2009-Uganda
Book
Baguma R. (1982) Public Policy Making in Africa, AAPAM,
Artistic Printers Addis Ababa
Book
Influencing Government Health Budgets in Tanzania;
A guide for Civil Society, 2011
Book
Kivutha Kibwana, 1997, Learning Together to Build One
Nation, a Practical Guide on How to Do Civic Education,
Nairobi, Kenya.
Book
Tanzania National Family Planning Guidelines and Standards,
2013
Policy Print
National Health Policy: Reducing Poverty through
Promoting People’s Health, 2009, Ministry of Health,
Government of Uganda.
Policy Print
National Adolescent Health Policy, Ministry of Health,
Department of Community Health Reproductive Health
Division, Government of Uganda, 2004.
Policy Print
National Population Policy for Social Transformation and
Sustainable Development, 2008, Ministry of Finance,
Planning and Economic Development, Government of
Uganda.
Resource File
Uraia (Kenya National Civic Education Programme-NCEP),
2006, Nairobi, Kenya.
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DSW (Deutsche Stiftung Weltbevoelkerung)
Hatheru Road, Hatheru Court (Lavington)
P.O Box 2438 - 00202 Nairobi, Kenya
Tel: +254 20 2731398/20 3592302
Mobile: +254 726 603768/ 736 616491
Email: [email protected]
Website: www.dsw.org
DSW (Deutsche Stiftung Weltbevölkerung)
Arusha Tanzania
P.O Box: 14279,Tengeru-Arusha
Tel: (+255) 27 255 5020
Fax: (+255) 27 2555064
E-mail: [email protected]
Website: http//www.dsw-tanzania.org, http//www.dsw.org
DSW (Deutsche Stiftung Weltbevoelkerung)
P.O Box 33900 Kampala-Uganda
Tel: +256 0414 200 801
Fax: +256 0414 200 815
E-mail: [email protected]
Internet: www.dsw.org