Foreword. Christine Guwatudde Kintu Permanent Secretary, Ministry of Gender Labour and Social Development

Transcription

1 Foreword A national guide for programme implementers on Service Quality Standards for Orphans and Other Vulnerable Children (OVC) represents an important milestone in the process of defining quality services for OVC in Uganda. It is a demonstration of the government of Uganda s commitment to ensure that all children access high quality services in order to achieve a better quality of life. The Service Quality Standards are aimed at directing service providers deliver a comprehensive, equitable package to OVC, while ensuring that adequate resources are mobilized in a manner that does not undermine the family, community values, participation and capacity. By defining service quality for OVC services, it reaffirms the government s commitment to a harmonized and well-coordinated response to the care and support of OVC in an effective and sustainable manner. This guide for programme implementers highlights that children and their families should continuously have access to safe services which are appropriate to their conditions in a continuous and sustainable manner. Therefore these services should meet certain characteristics and conditions for each specific activity, as outlined in the document. The service quality promote the understanding that caring for OVC is a shared responsibility, hence the need for children, families and community participation, public-private partnerships, referrals and networks for sustainable service delivery. These were developed through a highly participatory process beginning with communities in the sampled districts across the country, with the support of Technical Services Organisations (TSOs). The CORE Initiative Project led the process and a number of technical working groups at various levels within the Ministry of Gender, Labour and Social Development (MGLSD) provided guidance and input into the document. Extensive contributions were also realized during the national technical working group with participation from different ministries, sectors and stakeholders. The document was finally validated and adopted in a varied and multi-sectoral stakeholders forum. The government therefore, expects that all service providers will mobilize resources, plan, implement and deliver, review, monitor and assess the quality and quantity of services being provided to the children based on these service. If services do not meet the, they can be changed and brought in line with requirements. If services do meet the, service provider should continue working on improving service delivery to promote good practices. It is my hope and belief that this guide will stimulate and compel all stakeholders to uphold their commitments to adopt and use the in all care, support and protection interventions for OVC. The Ministry of Gender, Labour and Social Development would like to express gratitude to all the stakeholders and districts that participated in the development, review and finalization of these service. We are also grateful to The United States Agency for International Development (USAID) for providing the financial support and CORE Initiative for leading in technical support and coordination. Christine Guwatudde Kintu Permanent Secretary, Ministry of Gender Labour and Social Development i

2 ACRONYMSANDABBREVIATIONS ABEK ACDO AIDS BEUPA CBOs CDO CIS CORE CORP CPA CPC CRC CSO DPSWO EMIS EWS FBO HIV HMIS HT HRAP HRM IGAs LCs LOGICS MGLSD MOES MOUs MVC M&E NAADS NGO NOP NSPPI OVC PSS PTA PWD RI SACCOs SMC SS TNAs TOT UDHS UNHS UPE USE VHT VSLA Alternative Basic Education for Karamoja Assistant Community Development Officer Acquired Immune Deficiency Syndrome Basic Education for Urban Poor Areas Community Based Organisations Community Development Officer Community Information System Community Response to the AIDS Epidemic Community Owned Resource Persons Core Program Area Child Protection Committees Child Rights Convention Civil Society Organisation District Probation and Social Welfare Officer Education Management information System Early Warning System Faith Based Organisation Human Immunodeficiency Virus Health Management Information System Health Teams Human Rights Approach to Programming Human Resource Management Income Generating Activities Local Councils Local Government Information and Communication System Ministry of Gender Labour and Social Development Ministry of Education and Sports Memorandum of Understanding Most Vulnerable Children Monitoring and Evaluation National Agricultural Advisory Services Non-Governmental Organisation National Orphans and Other Vulnerable Children Policy National Strategic Program Plan of Interventions (for OVC) Orphans and Other Vulnerable Children Psychosocial support Parent-Teachers Association Persons with Disabilities Religious Institutions Savings and Credit Co-operatives School Management Committees Support Supervision Training Needs Assessment Training of Trainers Uganda Demographic and Household Survey Uganda National Household Survey Universal Primary Education Universal Secondary Education Village Health Team Village savings and loaning Associations ii

3 TABLE OF CONTENTS ACRONYMSANDABBREVIATIONS...II LISTOFTABLES... IV DEFINITIONOFKEYCONCEPTS INTRODUCTION PURPOSEANDSTRUCTUREOFTHISDOCUMENT THEDEVELOPMENTPROCESSOFOVCQUALITYSTANDARDSINUGANDA BACKGROUNDTOOVCSERVICEQUALITYSTANDARDS OVERVIEWOFTHENATIONALOVCPOLICY KEYCONCEPTSANDPRINCIPLESFORQUALITYASSURANCEANDIMPROVEMENTINOVCSERVICES QUALITYSTANDARDSFORESSENTIALSERVICES...17 INTRODUCTION SOCIOECONOMICSECURITY FOODSECURITYANDNUTRITION CAREANDSUPPORT MITIGATIONOFTHEIMPACTOFCONFLICT EDUCATION PSYCHOSOCIALSUPPORT HEALTH CHILDPROTECTIONANDLEGALSUPPORT QUALITYSTANDARDSFORCAPACITYBUILDINGANDRESOURCEMOBILIZATION THELINKAGESBETWEENCAPACITYBUILDINGANDESSENTIALSERVICEAREAS APPENDIX1:NATIONALQUALITYSTANDARDSFRAMEWORKFOROVC,INCLUDINGSERVICE STANDARDSANDTHEESSENTIALACTIONSFORACHIEVINGTHEQUALITYSTANDARDS APPENDIX2:GUIDINGPRINCIPLESFORTHENATIONALOVCPOLICY APPENDIX3:PARTICIPANTSINTHESERVICEQUALITYSTANDARDSDEVELOPMENTPROCESS 266 APPENDIX4:REFERENCES iii

4 ListofTables Table 1: Table 2: Quality for NSPPI Core Program Areas. 7 Lead government sectors in OVC service quality assurance and improvement Table 3: Uganda NSPPI Building Blocks, Objectives and Core Program Areas.11 Table 4: The Dimensions of Quality Table 5: Table 6: Table 7: Table 8: Table 9: Table 10: Table 11: Table 12: Table 13: Table 14: Service level quality and essential actions necessary for achieving the quality for socio-economic security..20 Service level quality and essential actions necessary for achieving the quality for food and nutrition security.. 44 Service level quality and essential actions necessary for achieving the quality for care and support.. 74 Service level quality and essential actions necessary for achieving the quality for mitigation of the impact of conflict 104 Service level quality and essential actions necessary for achieving the quality for education Service level quality and essential actions necessary for achieving the quality for psychosocial support..157 Service level quality and essential actions necessary for achieving the quality for health 181 Service level quality and essential actions necessary for achieving the quality for child protection 202 Service level quality and essential actions necessary for achieving the quality for capacity building 218 Cross linkages between capacity building and the Essential Service Areas.246 iv

5 DEFINITIONOFKEYCONCEPTS Care-giver: The individual, who takes primary responsibility for the physical, mental and emotional needs and well-being of a child. Child: A person who is below the age of 18 years. Community: A group of people, usually living in an identifiable geographical area, who share a common culture, and are arranged in a social structure that allows them to exhibit some awareness of a common identity as a group, often referred to as a village and administratively categorized as local council(lc1). In this document community is also used in reference to a group of villages in parish (LC2), or a sub-county (LC3). These two levels represent a functional basis for OVC programme development, e.g. through the Parish Development Committee (PDC) or the Sub-county Council and the sub-county development programme. Core Program Areas: These are the ten programme areas that have been identified during the NOP and NSPPI articulation process as being essential to the well being of orphans and other vulnerable children. They include socio-economic security, food security and nutrition, care and support, mitigation of the impact of conflict, education, psychosocial support, health, child protection, legal support, and capacity strengthening. Disability: Substantial functional limitation of daily life activities of an individual caused by physical, sensory or mental impairment and environmental barriers. Empowerment: The process to increase the spiritual, political, social or economic strength of individuals and communities. This process provides marginalized, powerless, poor and vulnerable individuals and groups with the capacity to address their own needs. Essential Services Package: These are the priority elements (that will provide a supportive environment) for orphans and other vulnerable children to live to their full potential. Essential service area: Each of the eight individual elements in the essential services package as defined in the NOP, as a thematic framework in which OVC programme development and specific service activities are set. These include socio-economic security, food security and nutrition, care and support, mitigation of the impact of conflict, education, psychosocial support, health, legal and child protection. The eight essential service areas also correspond to the Core Program Areas in the NSPPI. Essential action: A set of activities necessary that will help to realize the set standard under each essential service area. Extended family: This is a collection of a number of households or families of individuals who are related biologically often with social ties and responsibilities towards one another that lead to the provision of material and other support for those members of family in need. Family: A group, consisting of one or more parents and their offspring and close relations that provides a setting for social and economic interaction, transmission of values and protection. 1

6 Gender sensitivity: refers to the ability to recognize issues related to the relationship between women and men, and especially the ability to recognize differences in perceptions and interests between males and females arising from their different social position and different gender roles. It helps to generate respective for the individual regardless of their sex. Household: A group of people who normally live and eat together in one spatial unit and share domestic functions and activities. Human Rights: These are the basic rights and freedoms to which all humans are entitled. Examples of rights and freedoms which have come to be commonly thought of as human rights include civil and political rights, such as the right to life and liberty, freedom of expression, and equality before the law; and social, cultural and economic rights, including the right to participate in culture, the right to food, the right to work, and the right to education. Marginalized: This refers to individuals or groups who as a result of social processes are confined to lower social standings within their society or community. Marginalised groups are denied degrees of power which can result in material deprivation and exclusion from services, programmes and policies. Multi-sectoral approach: The process of involving and bringing together all essential service providers including government, private sector, development partners, and civil society organizations such as international and national NGOs, faith-based organizations, religious institutions, cultural leaders and community-based organizations, in order to plan on and maximize how a population is best served and provided with a comprehensive set of services. Orphan: A child below the age of 18 years who has lost one or both parents. OVC stakeholders: The different categories of people, institutions, agencies and groups with an interest in the well-being of OVC. Such parties exist at different levels such as community, district, national or global. The interest and contribution to OVC welfare are usually different for each stakeholder, and may change with time and/or different kinds of vulnerability. Poverty: This is the shortage of common things such as food, clothing, shelter and safe drinking water, all of which determine quality of life. Psychosocial Support: all actions that enable orphans and other vulnerable children to foster resilience and reach their full potential in life. Quality: Quality in this guide should be considered as doing the right thing right, all the time and conforming to valid requirements. Quality dimensions: In the context of OVC services, quality is broken down into different characteristics to permit a more systematic, objective and transparent analysis. The ten dimensions of quality include Safety, Access, Effectiveness, Technical performance, Efficiency, Continuity, Compassionate relations, Appropriateness, Participation and Sustainability 2

7 Quality Improvement: A process or processes that systematically monitor and evaluate services or overall care to ensure that programme are being met and are regularly updated to reflect current knowledge; and the gaps between expectations and actual results/outcomes are routinely identified and addressed. Quality Standard: A level of performances, which if, attained meet the needs and interests of OVC and enable them to realize their rights. Quality Triangle: A description of the practical relationship between three elements in Quality Assurance: Defining, Measuring and Improving Quality. The three interrelated elements work together to contribute to the desired outcomes, from quality services. Standard: A statement that describes an expected level of service or performance. When applied to quality, standard means the level of performance, which if attained meet the needs and interests of OVC and enable them to realize their rights. Vulnerability: A state of being in which a person is likely to be in a risky situation, suffering significant physical, emotional or mental harm that may result in their human rights not being fulfilled. 3

8 1. INTRODUCTION Content: The purpose and structure of this document The development process of OVC quality in Uganda 1.1Purposeandstructureofthisdocument Focus at the service delivery level: This document focuses on OVC services at community, sub-county and district levels. Such services are primarily provided within in the family, by caregivers and other household members, supported by neighbours, extended family and others within the community. Delivery of services at this level can be organized and managed through Civil Society Organisations (CSOs), Community Based Organisations (CBOs), religious institutions, and government/public extension services. This document aims to guide OVC programme staff, volunteers and leaders at community, sub-county and district level in understanding and defining quality in the OVC services they deliver. Focus on quality assurance and improvement: In line with the quality triangle (see illustration below), the primary use for this document is in measuring and improving quality. Training service providers in different areas of quality assurance and improvement is the priority action in this regard. This document can be used to inform development of 4

9 proposals, design of programmes, and monitoring, review and evaluation activities to ensure quality. However it should not be used as the only guide to inform these processes. OVC Programme Managers as the primary audience: This document aims to guide OVC programme managers in understanding and defining quality of OVC services they are responsible for. It provides guidance for each agency on the aspects of quality as may be relevant in the process of programme planning and review, monitoring and reporting on programme progress, analysis of achievements and factors affecting this such as documentation and sharing of practices. It is also useful in interactions between agencies, in working out ways of collaboration. It informs considerations for OVC service coordination at community, sub-county or district level, and across districts. Use of this document by OVC service supervisors: The document is developed as a tool for sub-county and district OVC service leaders, coordinators, and supervisors; such as government staff in community development, probation and social welfare, health, education and public health inspection, and extension staff in the different social service sectors. Other users in this category include CSO staff leading large district-level programmes (usually working through a number of community-level implementing partners. The document can be used at this level in developing the necessary indicators and tools for monitoring and support supervision of OVC services, in reporting progress, gaps and challenges to improve OVC quality services. Use of this document by national level actors: This document is also useful as a reference resource on the critical quality elements in the essential OVC services prioritized in the NOP and NSPPI. In this regard, it is useful for national level actors in government, civil society, Religious Institutions and Academia to advocate for increased resource commitments for comprehensive OVC services as a right for every OVC and their household. The document is useful in development of training and learning materials, tools for research and OVC programme evaluation, and guidelines for quality analysis and quality improvement planning. When and where to use this document: The practical opportunities for application of this document include: Planning and costing quality services funding proposals, costing interventions Quality service delivery programme processes: design, implementation, training, monitoring, reporting and support supervision. Quality measurement baseline studies, programme audit, evaluation, assessments and research. In using this document, it is important to appreciate that the different essential service areas and essential actions can be addressed together in a programme. Collaborations and referrals across programmes can be based on the different service areas and actions addressed by each programme; in line with the requirements of the targeted OVC, their household members and the community. Although it may be difficult for any one programme to address all elements in the document, it is important that the total requirements of OVC, their caregiver and household members are met by different stakeholders. How this document is organized: This document is presented in four main parts: 5

10 Section 1: Introduces the document and quality assurance for OVC programme in Uganda. Section 2: Provides explanation on the National OVC policy and background to the service quality for each of the 8 essential service areas. Section 3: Explains the different quality, service level, essential actions required to achieve the and the dimensions of quality for each essential action. The details provided on dimensions and characteristics of quality addresses all elements relevant for each essential action. These characteristics may be similar for different essential actions and in the different service areas. They may, therefore, appear repetitive in the document, but this is necessary to address issues around each essential action. Section 4: Details the crosscutting capacity building and resource mobilization requirements to realize the service quality outcomes under the 8 essential service areas. (The above explanation for section 3 also applies to this section.) 1.2ThedevelopmentprocessofOVCqualityinUganda The national quality framework 1 for OVC protection, care and support for Orphans and Other Vulnerable Children in Uganda has been in use since The purpose of the quality tools (the framework and the guide) is to provide a structure and methodology to guide service providers and programme implementers supporting OVC to develop and apply relevant for comprehensive, integrated protection, care and support of OVC at all levels. The framework facilitates planning and implementation of quality services and strategies at different levels while operating within the parameters of the National OVC Policy (NOP) and the National Strategic Program Plan for Interventions for OVC (NSPPI) [Described later in this document]. The framework was developed around the 10 Core Program Areas (CPAs) in the NSPPI, with three against each CPA presented in Table 1 below. The framework has informed efforts to strengthen technical support, supervision, monitoring and evaluation of OVC services, and has shaped the criteria and process of appraising OVC programme plans and budgets for funding. 1 Refer to Guide for Interpreting and applying the national quality for the protection, care and support of Orphans and other Vulnerable Children in Uganda and the National Quality Standards Poster 6

11 Table 1: Quality for NSPPI Core Programme Areas CPA/Outcome goal CPA1: Socio-economic security OVC and their households are able to sustain their livelihood; accessing short-term emergency assistance where necessary CPA 2: Food and nutrition security All household members access adequate and appropriate food to meet their nutritional needs CPA 3: Care and support The basic physical, cognitive and psychosocial needs of OVC and their caregivers are met on a sustainable basis CPA 4: Mitigation of the impact of conflict Children affected by conflict enjoy the same rights as children elsewhere in Uganda CPA 5: Education All OVC have equitable access to education and to formal and informal systems of information acquisition, skills building and technical experience CPA 6: Psychosocial support OVC and vulnerable households access assistance to positively and meaningfully their psychological and social situations CPA7: Health All OVC enjoy a state of physical, mental and emotional wellbeing that allows them to be productive and to achieve their potential CPA8: Child Protection and CPA 9: legal support OVC are protected from all forms of abuse and exploitation; and from hazards and harm CPA 10: Strengthening capacity and resource mobilization Capacity individual, household, community and national is improved to deliver integrated care to OVC Quality The most vulnerable children and households receive priority protection, care and support services Basic livelihood resources such as agricultural inputs are provided to vulnerable households Training and capacity building programmes to equip OVC and households with skills to improve their socio-economic security Early warning systems, services and safety nets exist to identify and meet emergency food security requirements of vulnerable children and households Household members acquire skills and resources to improve food security Community programmes reduce food insecurity experienced by vulnerable children OVC & their households have basic commodities such as food, clothing & beddings; and basic facilities such as shelter, safe/adequate water, sanitation Families and communities access support and services to provide quality care to OVC Alternative care facilities/institutions meet nationally approved All actors work collaboratively to secure an environment in which essential services reach vulnerable children affected by armed conflict Conflict affected children and displaced children are resettled into non conflict areas or alternative care Family tracing and re-integration services and child soldier demobilization programme reach vulnerable children Education access and retention for OVC is supported materially and financially Alternative or non-formal basic education is available to vulnerable children who are educationally marginalized Systems are in place to ensure significant and permanent gains in achieving equitable access to education at all levels Psychosocial should be an integral part of all care and support programmes for OVC An appropriate range of PSS services is available to vulnerable children and family members including therapeutic, succession planning and recreational activities An appropriate range of PSS services is available to vulnerable children and family members including therapeutic, succession planning and recreational activities OVC access preventive curative and rehabilitative health services on an equal basis with other children Children who are living with HIV access appropriate specialized care Health status of Vulnerable Children is monitored, e.g. through the inclusion of key information on immunization cards, clinic and hospital forms OVC access legal assistance in cases related to inheritance, property and guardianship There are immediate responses to circumstances and conditions that grossly violate the rights of children, subjecting them to serious risks and hazards Vital registration (birth, death, etc) and information systems that support children s rights are in place and/or strengthened Infrastructure, personnel, training and management are adequate to deliver care, support and service to OVC Inter agency linkages, communication and coordination effectively support policies, planning and programming for OVC Meaningful community involvement in OVC related matters takes place at all stages and levels 7

12 The MGLSD has the mandate for OVC service quality assurance and improvement (QAI), while working with other government sectors responsible for the respective service areas as well as development partners, CSOs and other institutions in line with the principle of a multi-sectoral approach to all OVC work. The government sectors with a major role to play in QAI are presented in Table 2 below. Table 2: Lead government sectors in OVC service quality assurance and improvement Essential Service area Lead government sector in quality assurance Socio-economic security Ministry of Finance, Planning and Economic Development Food and nutrition security Ministry of Agriculture, Animal Industry and Fisheries Emergency welfare care and protection Ministry of Gender, Labour and Social Development Mitigation of the impact of conflict Office of the Prime Minister/Ministry for Disaster Preparedness Education Ministry of Education and Sports Psychosocial support Ministry of Gender, Labour and Social Development Health Child protection 8 Ministry of Health Ministry of Gender, Labour and Social Development In October 2008, the Ministry of Gender, Labour and Social Development facilitated a participatory process to develop detailed OVC service quality, based on the national OVC quality framework. The process was structured along the 8 zones 2 (used for OVC technical support supervision in Uganda), coordinated by the respective Technical Support Organizations (TSOs) contracted by MGLSD to support OVC service development in each zone. In each zone, one district was selected as a demonstration site. In the selected district, a total of 60 participants, categorized as Care givers, Community leaders, Service providers and Children were consulted in two sub-counties (1 rural and 1 urban) on the definition and interpretation of quality OVC services. Data collected from the selected communities were validated in zonal workshops with district technical officers and CSO representatives from all districts in each zone. The products from the 8 zonal processes were analyzed and harmonized at national level in a three-day workshop of an expanded Technical Working Group on OVC services (See Appendix 3 for participants in the zonal process and the three-day review and harmonization workshop). The zonal consultation process provided useful background in defining quality services, the characteristics and conditions of these services, most of which are implemented by community-level actors though many of them have limited technical knowledge and skills on OVC service design. It was observed that many of these service providers were meeting only the obvious needs as defined by intervening group, or as presented by OVC and caregivers. The major constraint to comprehensive service design and implementation at community level is inadequate funding; largely limited to occasional donor funding for a few elements of service, and local contributions from individuals and institutions. When all these factors are put together they limit the level of services that reach the OVC. 2 Central, East, Far East, Northeast, North, Northwest, West and Southwest

13 The definition and interpretation of the quality characteristics for each of the resulting essential actions under the respective service were developed and described using the 10 dimensions of quality (See page 18 for details on dimensions of quality). The materials from the zonal processes were merged into a national service document, by way of merging the essential actions under each service area, checking whether the actions were comprehensive and scrutinizing the dimensions of quality generated for each essential action. The national harmonization processes focused on describing the service level, essential actions necessary for achieving the ideal service quality to realize each of the national defined in the different Essential Service Areas (or commonly referred to as CPAs). After the harmonization process a broad multi-sectoral technical working group (TWG) was assembled to discuss and reach consensus on the harmonized set of service that would be implemented across the country. The TWG members were drawn from MGLSD, line ministries (Education, Health, Local government, Justice, Agriculture), technical persons from OVC donors, TSOs, CSOs and districts, with expertise and experience in quality assurance, and OVC programming. The working groups were formed based on technical expertise, experience and interest in the 10 CPAs of the NOP/NSPPI. The meeting extended over three days and concentrated on agreeing the lay out and structure of the service ; reaching consensus on service, refining the essential action and the dimensions of quality for each of the 27 national for logical flow and completeness. The meeting was also used to realize technical input from the lead sectors and multiple OVC partners in the developed and to examine if the were consistent with and aligned to existing in their sectors. After the initial 3-day workshop, the service were further subjected to a series of sectoral working groups to ensure technical accuracy and consistency to other sector The additional series of sectoral review meetings were used to harmonize the different recommendations of the TWG, establish commonalities, linkages and reconcile similarities in key activities and their dimensions across the service areas. The product of the various review meetings was further presented to stakeholders and partners at the national consensus building, validation and adoption workshop. Participants of the validation and adoption workshop included MGLSD technical persons, other sectors, donors, planners, various technical persons and programme implementers at district level and from CSOs. The validation meeting was used to orient the stakeholders on the service frame work, review and validate the, identify gaps that would render the invalid, and then make commitment to implement the across the country. It anticipated that the service quality framework (the Service, package of essential actions and their quality characteristics) will provide a basis for defining, costing and implementing a comprehensive quality OVC service package. It should also be used as an advocacy tool to engage with government, donors and CSOs to ensure commitment of the necessary resources for implementation. It is also expected to guide development of supervision and monitoring frameworks for OVC services at all levels. 9

14 2.0BACKGROUNDTOOVCSERVICEQUALITYSTANDARDS Content: Overview of the National OVC Policy Key concepts and principles for quality assurance and quality improvement in OVC services 2.1OverviewoftheNationalOVCPolicy The National OVC Policy (NOP) was adopted in 2004, with an overall goal of attaining full development and realization of the rights of orphans and other vulnerable children. It is based on the UN Charter on the Rights of Children, 1989; and the Uganda Children s Act, 2000; and their respective provisions for the rights of all children, including OVC. The NOP objectives are: To ensure that the legal, policy, and institutional framework for child protection is developed and strengthened at all levels; To ensure that orphans, vulnerable children and their families access basic essential services package; To ensure that resources for interventions that benefit orphans and other vulnerable children are mobilized and efficiently utilized; and To ensure that the capacity of duty-bearers for orphans and other vulnerable children to provide essential services is enhanced. 10

15 The NOP prioritizes services that are cost-effective and have the greatest impact in reducing vulnerability of children and improving their well-being, in 8 priority areas which together constitute the essential services package for OVC in Uganda The National OVC Policy (2004) provided the framework for development of the first National Strategic Programme Plan of Interventions for OVC (NSPPI 2005/6 2009/10). The NSPPI provides for delivery of the essential services package for OVC, and for the necessary institutional capacity and financial resources to ensure realization of the services. The strategy has 10 Core Programme Areas (CPA), grouped together under 4 building blocks as presented in Table 3 below. Table 3: Uganda NSPPI Building Blocks, Objectives and Core Programme Areas (CPA) Essential services package for OVC Building Block A: Sustaining livelihoods 1. Socio-economic security: ensuring that all families living with OVC have the necessary resources to cater for the needs of all OVC and other household members 2. Food and nutrition security: all households with OVC have the necessary capacity to produce or procure adequate and appropriate foods, and all household members have a balanced diet at all times 3. Care and support: provision of basic physical, cognitive and psycho-social needs of OVC and their caregivers on a sustainable basis 4. Mitigation of the impact of conflict: ensuring the protection and development of children in parts of the country affected by armed conflict and other forms of violence Building Block B: Linking essential social sectors 5. Education: ensuring that all OVC have access to primary and secondary education, and to appropriate business, technical and vocational training to enable them realize full productive potential 6. Psycho-social support: ensuring that families and communities are enabled to provide necessary emotional and social support to OVC as an integral element in all child care and development services 7. Health: ensuring that all OVC have access to the Uganda National Minimum Health Care Package (UNMHCP) as provided for in the national health policy Building Block C: Strengthening legal and policy frameworks 8. Child protection and legal protection: ensuring that all OVC are safe from serious risk and hazard resulting from violation of their rights; and that any infringement on such rights is promptly recognized, reported, stopped and punished Building Block D: Enhancing the capacity to deliver 10. Capacity Building and resource mobilization: A process by which individuals, households, community and national capacity is improved in order to deliver adequate care, support and services to Orphans and other vulnerable children 11

16 Both the NOP and NSPPI are based on a common set of core principles that guide OVC services in Uganda; including: Building on the human rights-based approach to programming Making the family and community the first line of response Focusing on the most vulnerable children and households Reducing vulnerability Facilitating community participation and empowerment Promoting gender equity Treating recipients with respect Reducing stigma and discrimination Ensuring the social inclusion of marginalized groups Ensuring the participation of vulnerable children and families Strengthening partnerships Delivering integrated and comprehensive services To achieve the NOP/NSPPI goals, strategies that accelerate responses to the OVC are required and these are broadly categorized in the areas below: Direct interventions - providing financial, materials and training support directly to the vulnerable children and households, all actors especially in economic, education and health sectors are fully engaged in addressing the situation of OVC and their households Mobilization, advocacy and promotion - mobilizing resources from the public and private sector, CSOs and development partners; mobilize communities to actively participate in the planning, management, monitoring and evaluation of community based initiatives focused on OVC; advocate effectively at various levels, among various sectors and stakeholders to ensure that the resources are committed to making a difference in the lives of OVC and their families; use popular media to promote prevention mitigation and care efforts Collaboration and linkages Implement interventions primarily through local governments, CSOs and the private sector, supported by central government structures and guidelines in ongoing activities, scaling up effective interventions or building consortia to increase capacity and maximize capacity Leadership Using all leadership levels to galvanize efforts to support OVC Gender Analysis Maintaining awareness about differences in impact of vulnerability on male and female, mainstreaming gender concerns in all efforts Documentation Documenting sustainable M&E structures, best practices and lessons learnt for scaling up at all levels in order to reach OVC and households with effective programmes; disseminating widely M&E, assessment, progress, trends and quality assurance at all levels of implementation. The two documents underscore the importance of quality considerations in the design and delivery of OVC services. The underlying goal for both documents is improvement in 12

17 quality of life for OVC and their households. The second objective of the NSPPI is focused on delivery of integrated and equitably distributed OVC services that are of sufficient quality. Quality assurance and improvement are further emphasized in the NSPPI coordination responsibilities of MOGLSD; in data collection and processing as part of the monitoring and evaluation framework of the NSPPI; and in the principles behind decentralization of government and service delivery, in effort to ensure access and quality in a sustainable way. 2.2KeyconceptsandPrinciplesforQualityAssuranceand ImprovementinOVCservices Quality considerations are an important element in the design and delivery of all social and development services; especially in ensuring that such services reach the targeted beneficiaries, and address their real needs. Quality is particularly important in development and delivery of OVC services, because of the multiple and inter-related needs of OVC, the differences in their living contexts and the opportunities therein. This section provides an overview on the key concepts and principles that underpin quality assurance and improvement for OVC services. Quality: In the context of OVC services, quality refers to the degree to which the cluster of services provided to children, families, and communities maximizes benefits and minimizes risks, so that children may grow and develop. Quality care means that children, families, and the community receive all needed services and no unnecessary services. Quality care implies the correct mix of services for each child, family, and community and is based on current best practices and indigenous and expert knowledge. Children, families, and communities play a leadership role in decisions about the care and services they receive. Quality improvement (QI) is a process that systematically monitors and evaluates services or overall care to ensure that programme are being met and are regularly updated to reflect current knowledge, and that gaps between expectations and actual results/outcomes are routinely identified and addressed. QI strategies address concerns about service effectiveness, access, and efficiency. They can enable service providers to innovate and scale up rapidly, so that OVC programmes and services can reach as many children as possible. Quality Improvement Principles: QI is based on several core principles, including: 1) data-based decision making, 2) a reliance on a multi-disciplinary team approach, 3) a client-focus, and 4) a methodology that stresses system modelling and process analysis. Dimensions of quality: Quality can be defined as a degree or grade of excellence or worth. However, applying this simple concept can be difficult because of the many ways that people implicitly or explicitly define excellence or worth. Defining dimensions of quality permits a more systematic, objective and transparent analysis of the quality of OVC services. The dimensions of quality presented in Table 4 below apply to the specific actions in the process of providing different forms of service to OVC, caregivers and other members in their households. The same set of dimensions equally apply to elements in OVC services that do not apply to direct care for OVC and their households, e.g., training of service providers, collection of data on the needs of OVC or available services or monitoring OVC situation. In this document, the dimensions of quality were used to describe the quality characteristics of the essential actions specifically related to direct OVC care, as well as those linked to essential 13

18 actions of a management nature. The understanding of the dimensions may differ as applied in these two different contexts. The dimensions of quality are useful as a tool for evaluation or self-assessment. They help programme managers and service providers consider different aspects of the care they provide to detect problems, correct errors, and serve children and families better. The dimensions of quality can also be used as an analytical tool to map and describe the quality characteristics for OVC services, and to make decisions about the priority characteristics that are essential to making a difference for children. Table 4: The Dimensions of Quality 3 Dimensions of Quality Safety Access Effectiveness Technical performance Efficiency Continuity Compassionate relations Appropriateness Participation Sustainability Definition The degree to which risks related to care are minimized: do no harm The lack of geographic, economic, social, cultural, organizational, or linguistic barriers to services The degree to which desired results or outcomes are achieved The degree to which tasks are carried out in accord with programme and current professional practice The extent to which the costs of achieving the desired results are minimized and the reach and impact of programmes are maximized The delivery of ongoing and consistent care as needed, including timely referrals (as may be necessary), and effective communication among providers The establishment of trust, respect, confidentiality, and responsiveness achieved through ethical practice, effective communication, and appropriate socio-emotional interactions The adaptation of services and overall care to needs or circumstances based on gender, age, disability, community context, culture, or socio-economic factors The participation of caregivers, communities, and children in the design and delivery of services and in decision-making regarding their care. The degree to which the service is designed so that it can be maintained at the community level, in terms of direction and management as well as procuring resources, in the foreseeable future 3 AdaptedfromtheGuidelinesforinterpretingandapplyingthenationalOVCqualityforUganda 14

19 Scope of quality assurance: Quality considerations cut across all elements of service development, management, delivery, monitoring and evaluation. QI efforts comprise three complementary and interdependent activities, often referred to as the quality triangle. They are: 1) defining quality, which focuses on setting and designing systems; 2) measuring quality, which gathers information about process and outcomes, both on a routine and ad hoc basis for the purpose as assuring and improving quality; and 3) improving quality, which includes a variety of methods of varying complexity that are oriented toward closing the gap between what is expected and actual performance. Improving Quality Defining Quality Desired Outcomes Measuring Quality Defining quality focuses on setting and designing systems. Measuring quality is about gathering information about OVC service process and outcomes as part of routine programme work, and through specific data collection exercises such as evaluations, for the purpose of assuring and improving quality. Improving quality includes a variety of actions that are oriented toward closing the gap between what is expected and actual performance. Quality is as important in practical service delivery action, as it is in considering and choosing management decisions such as human resource deployment, financial monitoring, and programme accountability. The quality assurance and improvement process is usually undertaken in four phases. Phases I and II are oriented toward defining the desired outcomes at the centre of the triangle and defining quality. Phases III and IV focus on implementing those and using tools related to measuring quality and improving quality. Parts of a standard: A standard is defined by three distinctive but complementary parts; i) Outcomes, ii) Key Actions (comprising of services/activities, and iii) Dimensions of quality. Below is a visual representation of a standard. 15

20 PartsofaStandard Outcome Standard DimensionsofQuality Actions(Services/Activities) Outcomes:arechangesinknowledge,attitudes,values,skills,behaviour,conditionor status.outcomesareoftenconnectedtoeachother canhaveaseriesofoutcomes,with onecontributingtoanother Dimensionsofquality(Asexplainedaboveonpage18) EssentialActions(ServicesandActivities):arethemanytaskscarriedouttoproduceeach oftheproducts.activitiesarecarriedoutasmeanstoachievethedesiredoutcome.the completionofactivitiesshouldresultindesiredoutcome 16

21 3.0QualityStandardsforEssentialServices Content: Introduction to the section Essential service areas o Socio-economic security o Food and nutrition security o Care and support o Mitigation of the impact of conflict o Education o Psychosocial support o Health o Child protection Introduction This section presents the specific service quality, structured around the essential service areas. The areas are: socio-economic security, food security and nutrition, care and support, mitigating the impact of conflict, education, psychosocial support, health, and child protection. The description on each essential service area is based on the national quality as provided in the NOP and National Quality Standards framework already in use (Ref: A Guide for Interpreting and Applying National Quality Standards for the Protection, Care and Support of OVC, Page for details). In this document, 17

22 additional explanations are provided on some, to enhance understanding and application of the standard at service delivery level. For each service areas, 3 national are presented. The national quality standard describes the broader level/longer term desired level of performance. They focus on the long term essential services desired situation. For each national standard a set of service level are provided. A service standard describes the desired situation at shortterm and medium term/intermediate level. Service focus on the day-to-day results of programmes. It is assumed that multiple service should contribute to realizing the National. It is the level of performance programmes, beneficiaries and stakeholders should expect or strive to achieve. For each of the national, a set of essential actions necessary to achieve the are presented, based on prioritization in the different reviews, discussions and harmonization meetings and processes at different levels as described in section 1.2 of this document. Each list of essential actions is a flexible guide from which organizations will pick specific elements to address, as relevant to their capacity, strategic priorities, and context in which they operate. By working together through OVC service coordination mechanisms at different levels (sub-county, district or national); service providers will contribute to ensure that all essential actions for each standard are addressed. For each essential action, the critical quality characteristics and conditions are described based on the 10 dimensions of quality (See section 2.2 for details). A quality characteristic is an observable and measurable aspect of care that indicates that it is in line with best practices and what would be expected to produce specific desired outcomes. For some essential actions a number of quality characteristics are important for OVC care. Efforts were therefore made to capture as many quality characteristics for each dimension. 18

23 3.1SocioEconomicSecurity Socio-economic security is the ability and capacity of OVC households to sustain their livelihood over the medium and long term, with or without short-term emergency assistance. Lack of socio-economic security is also described as income poverty; the inability of a household to meet the basic food and non-food needs. Effective support to ensure socio-economic security results in a household that has adequate income and ability to meet all the household livelihood requirements. Socio-economic security as an essential service area is directly linked to Food Security and Nutrition and to Care and Support. Interventions under each of these essential areas are mutually supportive and interdependent in building capacity and enabling OVC attain their right to a standard of living adequate for their physical, mental, spiritual, moral and social development. The national framework for OVC quality provides for the following three for socio-economic security: The most vulnerable children and households receive priority protection as well as care and support services. Basic livelihood resources such as agricultural inputs are provided to needy households. Training and capacity building programmes are developed to equip vulnerable children and households with skills to improve their socio- economic security. The tables below present the service level quality, essential actions for achieving the quality for socio-economic security, and the characteristics of quality to each essential action. 19