For reference: Tushikamane - Methodology in detail

TUSHIKAMANE MANUAL

Index

Page

3          Tushikamane Facilitator Roles and responsibilities

3          Tushikamane Facilitator Maternal & Newborn Health knowledge

4          Being a Facilitator

5          Skills in dealing with groups

9          The cycle of Tushikamane meetings

9          Producing Tushikamane reports

11        Phase 1: identifying problems together

11        Meeting 1: The hamlet gets together to form a group

15        Meeting 2: Young women identify maternal health problems

18        Meeting 3: Young women identify neonatal health problems

20        Meeting 4: Prioritising problems

23        Meeting 5: Identifying contributing factors – the roots of the problems

26        Phase 2: Planning solutions together

26        Meeting 6: Identifying prevention and management activities

29        Meeting 7: Making plans

32        Meeting 8: Presenting progress to the community

35        Phase 3: Implementing solutions together

35        Meeting 9: Planning solutions

38        Meeting 10: Gathering resources

41        Meeting 11: Developing monitoring systems

44        Phase 4: Evaluating together

44        Meeting 12: Progress in evaluation

47        Meeting 13: Evaluating the success of projects and of Tushikamane

49        Meeting 14: Planning for the future

AKNOWLEDGEMENTS

The Institute for Global Health at University College, London, has a wonderful mission to reduce maternal and neonatal mortality in low income countries. Many countries had not been making the progress they had hoped for, and Prof Anthony Costello and his team at UCL's IGH had the vision to see that communities needed to be mobilised to participate actively in the plans for their own development.

What followed was research of the highest quality, leading to the development of a methodology which has had a substantial impact: Community mobilisation truly can bring about cost-effective and substantial reductions in mortality and improvements in the health of newborn infants, children, and mothers.

Out of this has arisen the work of the charity Women & Children First, whose mission is to amplify these benefits throughout the neediest parts of the world. Mikey Rosato is Senior Programmes manager at W&CF, and is leading further trials for the WHO on ‘participatory and learning and action’ cycles to reduce maternal death.

The work of W&CF builds on developments at the World Health Organization’s (WHO) Department of Maternal, Newborn, Child and Adolescent Health (MCA) and UNICEF. Together, they initiated the development of the materials Community Mobilisation for Maternal, Newborn and Child Health as a complement to their materials on Caring for newborns and children in the community (2012) and the joint statement on Home visits for the newborn child: a strategy to improve survival (2009).

The success of community mobilisation, participatory learning, and action cycles, has been further enhanced by the work of MaiMwana in Malawi. Florida Banda and her team have been an enormous help and inspiration to Tushikamane.

In 2015, Mikey Rosato and his team honed their materials into their WHO manual, of which this manual is an extract, simplified by me for use by Tushikamane front line staff. (Apologies for any errors!) We are deeply, deeply indebted. Asante sana sana!

REFERENCES

https://www.ucl.ac.uk/igh/

http://www.ucl.ac.uk/igh/research/a-z/improving-maternal-newborn-child-health...

http://www.womenandchildrenfirst.org.uk/

http://rds.epi-ucsf.org/ticr/syllabus/courses/67/2012/10/25/Lecture/readings/rosato%202006%20women_Malawi.pdf

http://www.maimwana.org/

http://www.ammalife.org/

http://www.who.int/pmnch/media/events/2013/au_policy_brief_community.pdf

http://www.unfpa.org/sites/default/files/pub-pdf/Maternal_Death_Surveillance_and_Response_0.pdf

http://vimeo.com/12427420

http://www.maimwana.org/

http://www.biomedcentral.com/1471-2393/14/243/abstract

http://www.who.int/maternal_child_adolescent/documents/community-mobilization-maternal-newborn/en/

http://apps.who.int/iris/bitstream/10665/127939/1/9789241507271_eng.pdf?ua=1

http://www.who.int/pmnch/countries/tanzaniamapstrategic.pdf

TUSHIKAMANE MANUAL

How to run Tushikamane Groups through a 14-meeting cycle

Tushikamane groups

Tushikamane is the Kiswahili name for the groups developed in similar projects around the world, notably in the Malawi project, ‘MaiMwana’. In that project, they were known as ‘Participatory Learning and Action Groups for Maternal and Newborn Health’. This title describes neatly their way of working and their purpose: ie that the community participate and get deeply involved in finding ways to prevent untimely deaths of mothers and their children.

Tushikamane groups also seek to bring about improvements in Maternal and Newborn Health (MNH) and reductions in mortality by creating a space for discussion where community members, and women in particular, are able to identify priority MNH problems and develop, implement and evaluate their own locally feasible solutions.

One Tushikamane group will be established per hamlet, in each of six hamlets in the first instance. In Tanzania, where hamlets are not necessarily set up with all the houses collected into a village, we will use the definition provided by the Tanzanian census, which says that a ‘hamlet’ should contain around 700 total population. 

Tushikamane groups will begin by recruiting women of reproductive age as members, so as to be sure to give young women a voice in deciding how to deal with the problems they face.  Pregnant women, new mothers and adolescent girls will particularly be encouraged to attend.  All those other community members concerned about maternal and newborn health issues, including men, older women and local leaders, will also be eligible to attend and will be made aware of the women-centred nature of the groups.  Groups will be guided through a four phase cycle of meetings by a female Facilitator, (Esther or Rehema), supported by a Supervisor, (Alex Gongwe), a Project Director, (Wilbard Mrase), and a Project Chairman, (Isaac Mgego).

STRUCTURE OF THIS MANUAL

This manual is for all the Tushikamane staff, so that they might understand what needs to be done, and how; but it is particularly for the Facilitators – a step by step guide to exactly how you set up and run the groups. 

For this reason, the guide is written directly to you, Esther and Rehema, as if it is actually talking to you! (And to anyone in future who would like to tread the same path!)

GLOSSARY

VHW               Village Health Worker

MNH               Maternal and Newborn Health

TBA                Traditional Birth Attendant

NGO               Non-Governmental Organisation – eg charities

YOUR ROLES AND RESPONSIBILITIES

During the Tushikamane Project, you Facilitators will have responsibilities in the following areas:

1.    Set-up of the Groups

2.    Implementation of the 14-meeting cycle, to identify and prioritise the problems relating to deaths of mothers and babies

3.    Referral of any mothers or children to the health centre if they seem to need it

4.    Networking with community leaders, VHWs, TBAs, local government officials, and any other potential partners

5.    Reporting back to your supervisor and to the Project Director – eg on numbers of meetings; attendance; activities covered; successes; challenges; etc.

6.    Attending monthly meetings of the entire team to receive these reports, discuss progress, share ideas, etc.

MATERNAL AND NEWBORN HEALTH (MNH) KNOWLEDGE

To facilitate the Tushikamane groups effectively and to support members, you will require basic knowledge of MNH issues.  Although your role is not to educate the group members, you require enough information to fill gaps in collective knowledge, identify dangerous practices and answer specific questions. 

You should therefore know enough about the following issues to be able to talk sensibly within the group:

·         Antenatal care – first, second, third and fourth visits

·         Home care for pregnant mothers – nutrition, resting and malaria prevention

·         Birth preparedness – place of delivery and skilled provider, transportation, money, decision-making, items needed for a clean and safe delivery, labour signs

·         Danger signs during pregnancy

·         Danger signs during delivery

·         Danger signs for mothers after delivery

·         Danger signs for newborns after delivery

·         Home care for mothers and newborns – home care for postnatal mother, cord care, infection prevention, bathing the newborn, breastfeeding, immunisation, safety and security, kangaroo mother care

·         HIV and AIDS and the importance of testing for both partners

·         Prevention of Mother to Child Transmission of HIV

·         Family planning

·         Rights and responsibilities of mothers and health workers

Your MNH knowledge should be assessed by the Supervisor and/or the Project Lead/Trainer. 

BEING A FACILITATOR

Why use the word ‘Facilitator’?

You are called a ‘Facilitator’ not a leader, because your job is not to tell people what to do, nor even teach them what to do, but instead help them to discover it for themselves, and to set their own agenda.

A Facilitator is a guide, who:

·         makes sure everyone in the group listens to each other

·         asks questions to help the group decide what to do

·         builds on the knowledge base of the group to help them find their own answers to questions

·         is responsible for helping the group get things done

·         lets the group evaluate themselves and figure out how “well” they’ve done

You are not supposed to be:

·         ‘in charge’;

·         the expert;

·         the one who knows best;

·         the one who makes all the decisions

·         the one evaluates how well the hamlet is doing

In all of these things, the Tushikamane group themselves ae the ones who are in charge; find the expertise; decide what is best; evaluate their own progress; etc.

When you are acting as a Facilitator, it offers everyone in a group the chance to express their ideas and to feel as if they are part of a team.  Since the group arrives at decisions together, it is easier for individual members to support the group’s objectives.

Rather than giving learners answers, education should increase the learner’s awareness so that they are able to identify problems and their causes, and find solutions to them. A facilitator’s role is to help a group through this process by asking questions that encourage new ways of thinking about and analysing their situation. The facilitator does not know all the answers. Their role is to help the group think critically about their own needs and interests, and make decisions for themselves.

The facilitator’s role is also to encourage each member of the group to contribute to the best of their ability. Everyone has valuable knowledge and a valuable contribution to make. But people can be reluctant to share their knowledge. They may lack the confidence or may not consider what they know to be important. Sometimes people do not want to share their knowledge because it gives them a certain amount of power and advantage over others.

However, when we do share our knowledge, everyone benefits. The person sharing it does not lose it after giving it away, and the person receiving it has received something new which they in turn can pass on to others. The facilitator’s role is to build trust and respect between the members of the group and to encourage dialogue and learning, from which the whole group will benefit.

SKILLS IN DEALING WITH GROUPS

Recruiting members for the groups

When recruiting people to attend meetings and motivating them to keep attending, you should try to use a range of different methods including:

·         Door-to-door recruitment by committee and group members

·         Letters to potential attendees

·         Announcements at village meetings, activities and events

·         Traditional songs and dances at the beginning of meetings

·         Explain the purpose and benefits of attending the meetings

·         Explaining why health of mothers and babies is important to women and the whole community

·         Do not raise expectations – be honest about what your role is

·         Holding meetings at a convenient time and location

·         Celebrating achievements and success, however small

Importantly, a vital part of your role is to remind participants when the next meeting will be held and what the topic will be.

Making rules so that the groups work well

You need to ensure that everyone participates equally and that men and older women do not dominate the discussions.  When encouraging people to actively take part during meetings remember that people do not have to participate actively during meetings, but they should have the opportunity to do so if they want to.

To ensure that people have this opportunity encourage the group to discuss and agree rules for the way the meeting works. Amongst these rules should be the rule that everyone has the right to participate and be listened to. Encourage the group to follow the rules they develop and encourage a safe meeting atmosphere. 

Basic group rules may include, for instance:

·         All participants’ inputs are equally valued.

·         Participants are expected to share all relevant information.

·         The meetings will start and end on time and will start on time after breaks.

·         Only one conversation will go on at once (unless subgroups are working on a topic).

·         The group itself, (not Tushikamane), is responsible for delivering results.

·         Discussions and criticisms will focus on interests and not on people.

Don’t take too much control of the group!

One of the greatest difficulties you can face as a Facilitator is the temptation to take control of a discussion or change process.  This is often out of a genuine desire to help the group move forwards. If you are used to a top-down teaching style, and have not had the chance to observe good facilitators at work, it can be very difficult to change your approach to sharing ideas.

One way to encourage the group to take responsibility for their own learning and progress is by asking the group to write some ground rules for participation so that each person feels free to share their ideas.  Such rules might include not interrupting, respecting different views and agreeing on a maximum number of points that each person can make to any one discussion.  If the group writes these ground rules, they will have shared ownership and a shared responsibility to ensure that they are respected. 

Other ways of avoiding taking control include:

·         Being patient

·         Listening to others and show that their opinions are valued.

·         Being open to learning from the group so that information sharing is multi-directional.

·         Encouraging the group to discover solutions for themselves

Difficult questions

Dealing with people’s questions can be difficult.  You may often feel that you need to have all the answers.  You may lack confidence in your own ability to deal with questions on a particular subject. It is up to your Supervisor and the Project lead, to help you in this, and to help you find more information, e.g. other publications, government or NGO offices, and so on.  They can also help you draw on the wisdom and knowledge of other members of the community, outside of the immediate group, who may specialise in the topic being discussed.

Other ways of dealing with difficult questions include:

·         Preparing for group discussions by reading this manual and other helpful material in advance, so to be really prepared.

·         In particular, you should be familiar with the major causes of death and ill-health for pregnant women and their babies

·         Anticipating people’s questions wherever possible and thinking of possible responses in advance.

·         Not being afraid to say that you do not know the answer to a question!  Instead say you will get back to the group with more information when you can.

Managing conflict

Sometimes people will have strong and conflicting ideas on a subject.  Tension within the group will also affect the way the group works together as a whole. You need to be sensitive to possible tensions and encourage people to work through these, keeping their common goals and interests in mind. If the conflict is not related to the topic being discussed, you need to ask people to put this to one side.

General rules in how you manage conflict include:

·         Acknowledge the conflict.

·         Try to establish the cause of the conflict.

·         If it is related to the topic in question, help lead the participants to a place of agreement, encouraging mutual respect.

·         If it is unrelated to the topic, and only involves several group members, encourage them to resolve this disagreement later, outside of the group setting.

Handling dominant people

Sometimes one person dominates the discussion, confident that they have the right answers. If this happens, you need to make sure that others have the opportunity to speak. Ways of dealing with this include:

·         Inviting others by name to give their view

·         Split the group into smaller groups.

·         Introduce a quota system, in which each person is given three stones or bits of paper, and they have to give one up every time they speak.  When they have no more, they cannot speak again!

·         Introduce a time limit, in which each person can speak for a maximum of one minute at a time, before they should hand over to another group members to speak.

·         Use a ‘talking stick’. Whoever is holding the stick is the only person that can speak. When they have finished expressing their views they pass the stick on to anyone else who would like to speak.

·         Sit next to the talkative person, not opposite them! When you sit opposite someone, especially when you sit opposite a dominant person, you tend to look at them a lot, and they feel that you are talking to them in particular.

Working with shy people

Sometimes people may be very shy or afraid to express their views in a group. This can be particularly difficult when discussing MNH issues as some women and adolescent girls may find it difficult to speak in front of others, particularly if they are family members. The most effective way of encouraging people who are shy or afraid is to refer back to and use their ideas, so they know they are important and of value. 

In addition you can either:

·         Ask people to discuss questions first in pairs.

·         Use other practical activities such as mapping, ranking and timelines to help people express their views.

·         Speak separately to shy people after the meeting to gather their views and opinions.

·         Encourage them individually, within and outside of the group.

·         Talk to them outside the group, and find the reasons for their silence.

·         Give notice of the topic before the discussion, so that they have time to prepare.

·         Give a talented shy person responsibility for note-taking and feedback.

·         Give them time.

·         Use role-play to build up confidence and skills.

In particularly difficult cases, it may be necessary to form different PLA groups for different groups within the community.  For example, a group for women of reproductive age and a group for adolescent girls.  Making this decision will result in an increased workload for you and so should be carefully considered only after all other approaches listed above have been used.

THE CYCLE OF TUSHIKAMANE GROUP MEETINGS

The phases and meetings

The Tushikamane group cycle has four phases and 14 meetings:

Phase 1:

Meeting 1: Forming the group – the whole Hamlet meets to start the process

(From this point, for Phases 1 & 2, the Tushikamane group is women only!)

Meeting 2: Women identify maternal health problems.

Meeting 3: Women identify baby health problems

Meeting 4: Women prioritise problems

Meeting 5: Women identify contributing factors

Phase 2:

Meeting 6: Women identify prevention and management activities

Meeting 7: Women discuss plans for solving problems

Meeting 8: Women present progress to the whole community

Phase 3:

Meeting 9: Plan solutions – at this stage men and other key figures join the group

Meeting 10: Gather resources, then mobilisation of those resources

Meeting 11: Develop monitoring tools

At this point the community begins to implement their chosen solutions,

(with whatever help we can find to improve chances of success).

Phase 4:

Meeting 12: Prepare to evaluate the impact of this Tushikamane Group process

Meeting 13: Collect evaluation data, then discuss how the Project has impacted on maternal and neonatal health

Meeting 14: Plan for the future – for instance, the community may want to go round the cycle again!

REPORTS

Meeting report

You should complete a meeting report after each meeting. This will feed into your monthly report. In the descriptions below of each meeting, details are given of the things your report should cover.

Monthly report

Your monthly report should be submitted to the supervisor at the end of each month.  Information should be collected from your facilitator notes, group registers, and meeting report.

You should produce a monthly report for each hamlet you are working in, and key issues to capture include:

·         Numbers of meetings held

·         Attendance at meetings (which should ideally be between 10 and 30).

·         How many of the pregnant women are members of the group? Are you managing to reach women of reproductive age, particularly pregnant women and new mothers, as well as newly married women and adolescent girls. Are the poorest and most marginalised or isolated women are specifically encouraged to join the group?

·         Which other community members are able to attend too?

·         Is there any turnover of group committee members and thus requirements for election and training of new members?

·         Is the group on schedule to complete a full cycle of meetings in 12 to 24 months?

·         Are the tools and methods used to facilitate the groups acceptable and appropriate to group members?

·         Does the time and location of group meetings make them accessible to all community members who want to attend?

·         Are the resources available to groups adequate for them to carry out their activities successfully?

·         Are the issues discussed in the meetings broadly reflecting what is expected?  For example, are they identifying the expected problems?  Are they planning to implement the expected solutions?

Spreading the news

Between meetings, you should visit the community both to meet those people who have not been involved, and who should be, as well as to encourage Group members to share their discussions with other community members who did not attend the meeting

PHASE 1: IDENTIFYING PROBLEMS TOGETHER

Purpose of Phase 1

The focus of phase one of the meeting cycle is for the groups to identify and prioritise MNH problems.

Phase one has five meetings, which take place in the following order:

·         Meeting 1: Forming the group

·         Meeting 2: Identifying maternal health problems

·         Meeting 3: Identifying baby health problems

·         Meeting 4: Prioritising problems

·         Meeting 5: Identifying contributing factors

MEETING1: THE HAMLET GETS TOGETHER TO FORM THE GROUP

Who should attend Meeting 1?

Before the Tushikamane process can begin to form groups within the hamlet, there needs to be a meeting within the hamlet of anyone who has any sort of potential involvement in the process.

This will include:

•          The young women and mothers and pregnant women – and especially those women who come from a family that has lost women in childbirth, or suffered the death of a baby

•          Key women in the hamlet – eg teachers, women in positions of leadership, as well as women who are natural leaders

•          Traditional leaders and elected representatives in the hamlet

•          Religious leaders

•          Village Health Workers

•          Traditional health practitioners

•          Any existing community group networks or any NGOs or other organisations working with that hamlet

•          etc

Hamlet first meeting description

Two hours should be allowed for the first meeting of the hamlet. The meeting should be held in a centrally located venue that has ample space for all participants.

The purpose of the meeting is to get commitment and collaboration from those present to the Tushikamane process.

This needs to begin with sharing what Tushikamane is all about: to give women – especially women of child-bearing age – a voice in discussing how to reduce deaths of mothers and their babies. This will lead, eventually, to planning with the whole hamlet what things they would like to tackle, and how.

The plan is to come up with really good ideas and priorities to be tackled, that will get the whole community working together to reduce these tragic deaths. They should realise that in doing so, many other benefits will begin to materialise in the community.

This is a much better way of working than for outsiders to come and do things which may not be wanted by all; which may cause division and jealousy; which may not be supported or maintained long term; or which do not truly tackle the root-causes of tragic death.

Topics of discussion during the meeting should include:

·         How awful the repercussions are within the community when a mother dies

·         How the people present are an amazing resource, but need a way of working together in such a way as to attract focussed help from outside agencies

·         That the people present need not fear that we are asking them to put aside a lot of time and day-to-day work.

·         Their support in general and leadership in the district will be an important element for success. 

·         Their support and cooperation during implanting solutions will be vital for ensuring not only success, but also long-term sustainability. When this sustainable success is witnessed by outside agencies, they will be much more likely to lend further help in the future to a community that is setting its own agenda and seeing it through to completion of solutions to reduce death of mothers and babies.

They do not need to provide any commitment at this stage, but should be aware they may be approached for assistance.

Hamlet first meeting agenda

The recommended agenda is to conduct the meeting as follows:

1.    Welcome by the Project Chair, Rev Mgego

2.    Introductions by the Project Director, Wilbard Mrase

3.    Objectives of the meeting set out by the Project Supervisor, Alex Gongwe

4.    20 minute presentation by about the Tushikamane programme by the Project Facilitator – Esther Paul or Rehema Semwali

(During this, you should explain that during the cycle of meetings, everyone will participate equally and that men and older women should not dominate the discussions.  To allow women to participate fully, facilitators can encourage men to talk after the group had completed their meeting discussions. Also explain that CHWs and local health and other officials will be invited to meetings and given time and space to talk to the group.) 

5.    Questions, comments and ideas from the audience;

(After the presentation, participants should be given ample time for a question and answer session on the points presented.  The meeting should also include a section where participants can identify how they may be able to support the programme if called upon to do so – for example, advice on improving village hygiene and sanitation, advice on small-scale agricultural initiative or responding to the demands of the communities.)

6.    Potential solutions that Tushikamane groups may want to implement;

(From experience the most common types of solutions identified and implemented by groups include: Health education; Transport; Group fund; Clean delivery kits; Income generation; TBA; training; Liaising and lobbying with health facilities; Vegetable gardens; Bed net; distribution.)

7.    Discussion on how participants may be able to support the programme

8.    Steering group formation

(A steering group should be formed from meeting participants.  The role of the steering group is to provide support and advice to the Facilitator while she implements the Tushilamane group programme.  The Facilitator will meet with the steering group on a regular basis to feedback progress and seek support and advice. Sometimes the Supervisor, Alex Gongwe, will attend Steering Group meetings. There should be one steering group in each hamlet – ie one steering group for each Tushikamane Group.)

9.    Summary by Wilbard Mrase

10.  Closing remarks by Rev Mgego

11.  Close.

Establishing what Tushikamane will  - and will not - provide

Before the meeting finishes, and the Tushikamane process gets formally under way, there needs to be complete clarity in the community as to what will, and will not, be provided to the hamlet by Tushikamane:

What will be provided to each hamlet:

A trained Facilitator will form a Tushikamane Group and will lead meetings.

A Supervisor will help the Facilitator achieve success with the Group.

Once the process has reached the point that the Hamlet has examined the root-causes of death of mothers and babies, and has prioritised what it wants to do about them, Tushikamane will try to help provide the hamlet with links to those who can help – for instance links to other hamlets tackling the same problem; or to local organisations or initiatives which might be able to help; or to charities and NGOs who are looking to support the kind of thing being planned.

Examples

For example, the hamlet might prioritise the development of transport solutions to help get sick pregnant women to hospital. Perhaps other hamlets locally will have prioritised the same thing. Tushikamane might be able to put the communities in touch with a charity willing to provide a motorbike ambulance, once the charity is sure that the systems for maintenance, driving, etc are all in place.

The Tushikamane groups in the hamlets would then take responsibility for making sure that such systems are implemented.

Other examples might include:

·         Skills development – eg Setting up a programme of ongoing training for Traditional Birth Attendants

·         Health Services – eg Setting up accessible services for immunisation, checking blood pressure, treating anaemia, etc; or Helping the community to embrace appropriate family planning, and to provide services

·         Agriculture and food – eg Setting up and embracing feeding schemes for weaning babies

·         Education – eg Improving maternal education about health in pregnancy

·         Environmental health and sanitation – eg all working together to improve access to clean water

What will not be provided to communities:

·         Financial support or handouts of any kind from the Tushikamane team itself

·         Incentives or ‘Asantes’

·         Things being ‘done to them’ by others without their participation. Any help which comes will begin with community self-determination, and community participation. It will not be based on what outsiders think the community might need. It will not just be ‘dumped’ onto the hamlet.

Forming a committee to take responsibility

It will make your life much easier, and will enhance the self-determination of the community, if each Tushikamane group develops its own committee to run itself with your help. You should try to set up such a committee at the end of the first meeting.

The committee should have at least a chairperson and a secretary. Later on, they may need a treasurer.  As time goes on, the committee will grow in size to become a group of maybe 5 to 10 people who run the group and make things happen. There should be men on the committee, but no more than 2 in a small committee, or 3 in a larger one.

The role of the chairperson is to lead the group, and this should be a woman.  This includes providing leadership and direction, managing the committee members and group members and representing the group at local, district and national forums.

The role of the secretary is to record group activities.  This includes filling the group register after every meeting.

The role of the treasurer is to monitor group funds and other group resources.

The role of all committee members is to encourage community members to join the group and participate in meetings. Encourage the group to discuss and elect these members by proposing and seconding group members. 

Ideally, the committee members should have had previous experience and / or relevant leadership skills. They will be taking responsibility to get things done, to deal with conflict and to provide the group with direction. They will be committed to doing things for the community, not for personal gain.

They will support you in your job.  Over time the committee members may also take the lead in facilitating meetings if you are absent.

Key issues for your report on Meeting 1

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         Who are the local committee / steering group?

·         What are the rules for the way the meetings will be run?

What to do after the first meeting

You should list all attendees in a group register.  Hopefully, from the next meeting this will become the responsibility of a secretary selected during this meeting.

MEETING 2 – YOUNG WOMEN IDENTIFY MATERNAL HEALTH PROBLEMS

Who should attend Meeting 2?

The Tushikamane process is about preventing the tragic death of women and babies, especially in relation to childbirth. Therefore, women of reproductive age should be the main ones who should attend Meeting 2, so as to begin by identifying the roots of the problems that cause death.

Group membership will be determined by these women themselves, however they should be encouraged to prioritise pregnant women and new mothers, as well as newly married women and adolescent girls.  They should also be encouraged to ensure that the poorest and most vulnerable and isolated women are invited to attend.

Traditional Birth Attendants, (‘Bibis’), should in particular be invited to be part of the process from the start.

If a Village Health Worker (VHW) is female and feels part of the community, then she should attend. If the VHW is, for instance, an older male who does not live in the hamlet, then the women may feel that it would be better to include him later in the process.

However, it is important to be flexible about group membership, and, for example, respected older women and mothers-in-law and community and religious leaders can help generate wider support for the Tushikamane groups and their activities.

How you should prepare for Meeting 2

Visit key people in the hamlet who attended meeting 1. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: giving a voice to women of reproductive age in the plans to reduce deaths of mothers and babies.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Given that time-keeping is not likely to be a strong point, choose a realistic time when women especially might well be available.

Agenda for Meeting 2

1.    Welcome people. Introductions. Review the previous meeting.

2.    Agree at what stage the women of the group would like men and other key hamlet figures should become part of the process. The recommended time to include such people would be after Meeting 8. Prior to this, the women are discussing intimate female problems, and taking things as far as looking at potential solutions amongst themselves, without any male domination.

Meeting 8 is the meeting where progress is reported back to the community. Thereafter it would be good to expand the membership to include all those who might play a part in reducing the chances of death of mothers in childbirth, and reducing deaths of babies.

Group membership will thereafter need to take into account traditional beliefs and customs, but may include Village Health Workers or any type of health care worker; local leaders; teachers; partners of the women and adolescents in the group; government or charity workers who deal with these problems; and anyone who is concerned to improve the health of women and their babies.

3.    Present the objectives of the meeting:

·         To discuss current maternal care home care and service care-seeking practices

·         To identify health problems affecting women during pregnancy, delivery and after birth

4.    Discuss how mothers currently plan their pregnancy and delivery – under what circumstances they seek health care support, and discuss under what circumstances home deliveries occur.

5.    Discuss the importance of identifying problems – Remind women that it is important to identify health problems affecting mothers and newborns because:

·         Many women get ill and die every year and some of these deaths can be prevented by local communities

·         Health problems need to be identified before solutions can be sought

·         Community members, particularly women, are in the best position and have a right to identify the health problems that affect them (although men also have an important role and should be consulted, and included in plans).

6.    Raise awareness about the key MNH problems affecting women during pregnancy, delivery and after birth and effective interventions to address these. Use the problem picture-cards to help. (The most common ones are bleeding; obstructed labour; retained placenta; malaria; anaemia making other problems worse; and malpresentation.)

7.    The main business: Get the women of the group to identify problems affecting women in the community during pregnancy, delivery and after birth. Once again, use the Problem picture-cards.

8.    Summarise the meeting and check that you have summarised correctly. Who is going to do what before the next meeting?

9.    Encourage people to ask questions

10.  Decide a date for the next meeting

How to direct the discussion in relation to maternal health problems

Information about problems can be gathered from a range of sources including: Personal experiences and stories; Local public health campaign materials; Health facilities;  and from a range of people such as the women and men of the hamlet, but also including: TBAs; VHWs; and other health professionals.

Explain that health problems are those problems affecting mothers and babies that cause illness or lead to death. It may be easier to discuss these problems by thinking of the four times in which problems occur: pregnancy, delivery, immediately after birth and up to one month after birth.

So you can begin by asking the group about problems before delivery. Use the picture cards to stimulate ideas. Make notes of what they are saying, so that you do not lose track of what you have already covered.

Remember, there are no wrong answers. The group should be encouraged to list all the health problems they can think of. Some problems are hidden, including sexual violence and HIV. Encourage women to seek help privately if the problems they want to identify are too sensitive to speak up in the group.

After the meeting the group can keep adding to the list whenever a new problem is identified.

For each problem identified make sure it is described and discussed in full until the group agrees what it is

Key issues for your report on Meeting 2

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What maternal health problems were identified?

What to do after Meeting 2

Secretaries should list all attendees in a group register.

You should complete a meeting report, recording all maternal problems identified.

You should encourage group members to share their discussions with other community members who did not attend the meeting.

MEETING 3 – YOUNG WOMEN INDENTIFY NEONATAL HEALTH PROBLEMS

How you should prepare for Meeting 3

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 2. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: giving a voice to women of reproductive age in the plans to reduce deaths of mothers and babies.

Remind women that the coming meeting is to discuss problems with babies dying.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Who should attend Meeting 3?

All those women who attended meeting 2 should attend if they can. In addition, now that they have more understanding of the process, you might want to encourage other women of childbearing age to attend – particularly those you think might be the opinion leaders in the hamlet – those who people listen to, and who are good at influencing others.

Agenda for Meeting 3

1.    Welcome people, make any introductions, and review the previous meeting.

2.    Present the objectives of the meeting:

·         To discuss the current situation with regard to care of babies during and after delivery eg to include during home delivery; and the circumstances in which mothers seek medical help for their babies.

·         To identify health problems affecting babies during pregnancy, delivery and after birth

3.    Discuss the current situation with regard to care of babies during and after delivery.

4.    Discuss the importance of identifying problems – Remember it is important to identify health problems affecting mothers and newborns because:

·         Many newborns get sick and die every year and some of these deaths can be prevented by local communities

·         Health problems need to be identified before solutions can be sought

·         Community members, particularly women, are in the best position and have a right to identify the health problems that affect their babies, (although men also have an important role and should be included).

5.    Raise awareness about the key problems affecting babies during pregnancy, delivery and after birth and effective interventions to address these. Use problem picture cards. The main issues are: babies being cold; malnutrition; sepsis; birth asphyxia; diarrhoea; malaria; respiratory tract infection; jaundice; and preterm delivery.

6.    The main business: Get the women of the group to identify problems affecting babies in the community during pregnancy, delivery and after birth – use the problem picture cards.

7.    Summarise the meeting and check that you have summarised correctly. Who is going to do what before the next meeting?

8.    Encourage people to ask questions

9.    Decide a date for the next meeting

Key issues for your report on Meeting 3

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What neonatal health problems were identified?

What to do after Meeting 3

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

MEETING 4 – PRIORITISING PROBLEMS

How you should prepare for Meeting 4

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 3. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: giving a voice to women of reproductive age in the plans to reduce deaths of mothers and babies.

Remind women that the coming meeting is to discuss prioritising problems of mothers and babies dying, to produce a list of important things to deal with.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Who should attend Meeting 4?

All those women who attended meeting 3 should attend if they can.

In addition, now that they have more understanding of the process, you might want to encourage other women of childbearing age to attend – particularly those you think might be the opinion leaders in the hamlet – those who people listen to, and who are good at influencing others. Check that the TBAs are all involved and preferably that they plan to come to each meeting.

Agenda for Meeting 4

1.    Welcome, review of previous meeting and introductions

2.    Present the objective of the meeting: To prioritise the four most important maternal and neonatal health problems that will be addressed in this cycle.

3.    Discuss the importance of prioritising problems: it is important to prioritise problems because:

·         Rather than trying to address all the health problems at once it is better to start with a small number first.

·         It is best to start with the problems that are felt to be most important.

·         In the future once these first problems have been addressed the group can go back and address the other problems that they identified.

4.    The main business: Get the women of the group to prioritise the four most important problems relating to death of mothers and/or babies that will be addressed in this cycle. Use the problem picture-cards to stimulate discussion.

See the NOTES below on how to run the meeting.

5.    Summarise the meeting:  Assess whether the objectives of the meeting have been adequately achieved.  If they have not been achieved you can go back and repeat all or parts of the meeting again. Check that you have summarised correctly. Who is going to do what before the next meeting?

6.    Encourage people to ask questions.

7.    Decide a date for the next meeting.

NOTES ON HOW TO GET THE GROUP TO PRIOITISE PROBLEMS

1.    Place the picture cards or drawings of all the problems identified in two rows on the ground: a row of picture-cards showing problems for mothers, and a row of picture-cards showing problems with babies.

2.    Encourage the group to discuss the different reasons why a health problem might be considered important. (A problem can be considered important because: it is serious; or not so serious but common; or because it has a broad impact - it affects other things as well as health. Even if it is not serious or common, it may be considered important because, for instance, it is annoying because it seems impossible to solve.)

3.    Encourage each group member to come to the row of picture cards, one at a time, and put a stone near the problem affecting mothers that they think is most important and another stone next to the problem affecting babies that they feel is most important.

Tell the women that there are no wrong answers! Whatever she thinks is most important is what we want to know.

4.    Count the number of stones next to each problem and put them in order of importance (higher number of stones means more important).

5.    Identify the two most important problems for mothers, and the two most important problems for babies.

6.    Encourage the group to discuss if they feel the four priority problems identified reflect the reality in their community. Check with the group that they feel that the ones chosen really represent what women in the group feel are the most important problems.

Example:

The twenty women in a Tushikamane Group discussed the following ten problems that cause death of mothers. They then voted with one vote each for what they thought was the worst. The votes went as follows:

1.    Bleeding after childbirth                      6 votes

2.    Obstructed labour                               4 votes

3.    Malaria                                                3 votes

4.    Eclampsia                                           2 votes

5.    Anaemia                                              2 votes

6.    Problems after retained placenta       1 vote

7.    Infection after miscarriage                  1 vote

8.    Malpresentation                                  1 vote

The group therefore thought that the most important problems were: bleeding and obstructed labour.

The votes for the problems with babies went as follows:

1.    Birth asphyxia                         7 votes

2.    Malaria                                    4 votes

3.    Respiratory tract infection      4 votes

4.    Diarrhoea                                3 votes

5.    Sepsis                                     1 vote

6.    Pre-term birth                          1 vote

7.    Malnutrition                             0 votes

8.    Hypothermia                           0 votes

9.    Tetanus                                   0 votes

10.  Jaundice                                 0 votes

As a professional you might not agree with their prioritisation – you might for instance wanted to have put sepsis and hypothermia higher in the list, if you had seen a number of babies die of these causes.

However, the whole point of the Tushikamane exercise is that we involve the community and get them mobilised to tackle the problems that they feel are the most important. In this way, we hope that there will be more activity, cooperation, continuity, determination and sustainability.

So the group have prioritised:

For mothers: Bleeding & Obstructed labour;

For babies: Birth asphyxia; & Malaria.

Key issues for your report on Meeting 4

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What was the list of priorities of the problems?

What to do after Meeting 4

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

MEETING 5 – IDENTIFYING CONTRIBUTING FACTORS – THE ROOTS OF THE PROBLEMS

How you should prepare for Meeting 5

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 4. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: giving a voice to women of reproductive age in the plans to reduce deaths of mothers and babies.

Remind women that the coming meeting is to try to identify contributing factors which make death of mothers and babies more likely to happen.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Who should attend Meeting 5?

All those women who attended meeting 4 should attend if they can.

Continue to encourage other women of childbearing age to attend – particularly those who other people listen to, and who are good at influencing others.

Agenda for Meeting 5

1.    Welcome, review of the previous meeting and introductions

2.    Present the objective of the meeting: To identify the root-causes of the priority problems identified. What contributing factors make these things more common and /or more serious?

3.    Discuss the importance of identifying contributing factors – Remember it is important to identify contributing factors for MNH problems because:

·         It is possible to prevent health problems from arising by stopping these contributing factors

·         Some, but not all, health problems have contributing factors that can be identified

·         One health problem may have several contributing factors

4.    The main business: Get the women of the group to identify contributing factors for the four MNH problems prioritised. Use both the Problem picture-cards and the Contributing factor picture-cards. See the NOTES below on how to run the meeting.

5.    Summarise the meeting and check that you have summarised correctly. Who is going to do what before the next meeting?

6.    Assess whether the objectives of the meeting have been adequately achieved

7.    If they have not been achieved you can go back and repeat all or parts of the meeting again

8.    Encourage people to ask questions

9.    Decide a date for the next meeting

NOTES ON HOW TO GET THE GROUP TO IDENTIFY CONTRIBUTING FACTORS

1.    Explain that contributing factors are those medical, social and economic factors that cause health problems to arise.

2.    Draw a tree with roots, a trunk and branches on the ground or on a piece of paper.  The trunk of the tree represents the problem.  The roots of the tree represent the contributing factors – those factors that cause the problem to grow.  The branches of the tree represent the effects of the problem - the results that grow out of the problem.

 

   

3.    Put the picture card of one of the priority problems (eg ‘Malaria’) on the trunk of the tree.

4.    Encourage the group to focus on the roots of the problem, (or, to put it another way, the contributing factors), and list all the factors they think can lead to the problem of malaria arising. 

5.    As each contributing factor / problem root is identified, put a picture-card of that factor at the roots of the tree. (If there is no picture card you can draw the contributing factor or write its name on a piece of paper and put it at the roots of the tree.)

For instance, the group might identify the following roots of the problem of malaria:  too many mosquitos!; lack of knowledge about malaria prevention; mosquito breeding sites around houses where there are water pools; not sleeping under a mosquito-net every night; not dipping mosquito-nets regularly with insecticide; unable to afford tablets at the first signs of disease; unable to get to the Health Centre at the first signs of disease.

If you feel that you have not really reached the roots of the problem, then ask the question “Why”. (eg “why can’t you get to the health centre?” “We have not transport”. “Why do you have no transport?” etc.

Try to ensure that you get a really good blend of thoughts about the roots of the problem, that include, for instance, issues of health; infra-structure; poverty; customs, social situation; families; and education.

There are no wrong answers and the group should be encouraged to list all the contributing factors and effects that they can think of.

6.    Repeat steps 3 to 5 for the other three priority problems.

Key issues for your report on Meeting 5

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What contributing factors were identified for each priority problem?

What to do after Meeting 5

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

PHASE 2: PLANNING SOLUTIONS TOGETHER

The focus of Phase 2 of the meeting cycle is for Tushikamane groups to plan solutions to address the problems identified which cause mothers and babies to die. 

This phase has three meetings which take place in the following order:

·         Meeting 6: Identifying prevention and management activities

·         Meeting 7: Identifying solutions

·         Meeting 8: Presenting progress to the community

MEETING 6 – IDENTIFYING PREVENTION AND MANAGEMENT ACTIVITIES

How you should prepare for Meeting 6

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 5. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: that is, to give a voice to women of reproductive age in the plans to reduce deaths of mothers and babies. Discuss with them how the group is making progress, and how important it is turning out to be to give a voice to women.

Remind women that the coming meeting is to try to identify activities which help prevent death of mothers and babies.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Make sure that you have the picture cards for the four problems; and the picture cards for all the contributing factors for each problem.

Who should attend Meeting 6?

All those women who attended meeting 5 should attend if they can.

Continue to encourage other women of childbearing age to attend – particularly those who other people listen to, and who are good at influencing others.

Agenda for Meeting 6

1.    Welcome, review of the previous meeting and introductions

2.    Present the objectives of the meeting: The group has chosen 4 problems to tackle – 2 of mothers, 2 of babies. In this meeting, the objective is to identify the activities that:

·         can prevent these problems from arising.

·         can manage these problems if they do arise.

Example of prevention and management in the case of malaria:

Preventative activities

Increasing awareness on malaria prevention

Clearing mosquito breeding sites around houses

Lobbying health workers to provide bed nets at ante-natal clinics

Advocating with decision-makers to ensure adequate stocks of bed nets and reduce corruption

Sleeping under bed nets every night

Dipping bed nets with insecticide on a regular basis

Delivering the baby at a health facility under bed nets

Improving the mother’s nutrition so as to improve her natural defences

Management activities

Taking malaria tablets, (if available) as instructed by health workers

Rushing her to the nearest health facility without delay if she has malaria symptoms such as fever, chills, headache, or body pains

3.    Discuss the importance of identifying prevention and management activities:

·         If contributing factors exist in the community then preventative activities can stop them leading to health problems.

·         Even if health problems occur in the community, then management activities can help stop them leading to bad effects.

Try to make the group see that too often we just put up with problems and do not even deal with them well when they occur, never mind dealing with the deep roots of the problems.

4.    The main business: Take the list of four main problems identified by the group. Ask the women of the group to think of prevention and management activities for these prioritised problems. See the NOTES below, and use the four sets of picture-cards:

·         ‘Problem picture-cards’;

·         ‘Contributing factor picture-cards;

·         ‘Prevention activity picture-cards; and

·         ‘Management activity picture-cards’.

5.    Summarise the meeting and check that you have summarised correctly. Who is going to do what before the next meeting?

6.    Assess whether the objectives of the meeting have been adequately achieved. If they have not been achieved you can go back and repeat all or parts of the meeting again.

7.    Encourage people to ask questions.

8.    Decide a date for the next meeting.

NOTES ON IDENTIFYING ACTIONS TO PREVENT AND MANAGE KEY PROBLEMS

1.    Explain that prevention actions are those actions that can block contributing factors and therefore stop health problems from arising. 

2.    Explain that management activities are those activities that can stop health problems from causing their bad effects.

3.    Put the picture card for the first priority problem on the ground. 

4.    In meeting 5, the group identified contributing factors leading to this problem occurring. As you did in the last meeting, draw a tree on the ground, and put the problem right in the middle of the tree. Then put the picture cards of the contributing factors as its roots.

5.    Encourage the group to focus on the prevention actions which help stop the contributing factors from occurring. Use the ‘Prevention Action Picture-cards, (or make your own if the group come up with something for which you do not have a card).

Do not forget to include preventative actions such as changing the culture so that people seek help earlier; or getting the community together to press for improvements; or doing things to ensure that promised changes really occur.  

Collect together all of the picture-cards the women have chosen to suggest how to tackle the roots of problems so as to prevent them from occurring.

6.    Then switch the focus to looking at management actions. Encourage the group to focus on the management actions which help stop the problem causing death or bad damage. Use the ‘Management Action Picture-cards, (or make your own if the group come up with something for which you do not have a card).

There are no wrong answers, and do not worry if the discussion gets a bit too general and off the point. Just bring the women back to the task in hand – that is to pick the picture-cards which represent the ways of preventing this problem, and, failing that, prevent it from causing death.

Collect together all of the picture-cards the women have chosen to suggest how to manage the problem so as to prevent it causing death.

7.    Repeat steps 1 to 6 for the other three priority problems. At the end of this process, you will have a set of prevention picture-cards, and a set of management picture-cards, which tell the story of all the ways that the group could take action to stop death happening.

Key issues for your report on Meeting 6

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What preventative and management activities were identified for each priority problem?

What to do after Meeting 6

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

MEETING 7 – MAKING PLANS

How you should prepare for Meeting 7

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 6. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: giving a voice to women of reproductive age in the plans to reduce deaths of mothers and babies.

Remind women that the coming meeting is to try to think of plans and identify solutions, and that this is a special time for women to have their say and to get their ideas heard.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Gather together all of the picture-cards from the last meeting:

·         Picture-cards of the four problems

·         Picture cards with the roots of the problem – the contributing factors

·         Picture-cards which women picked that talk of actions to prevent the problem

·         Picture-cards which women picked that, if the problem does occur, talk of actions to prevent it causing death

Who should attend Meeting 7?

All those women who attended meeting 6 should attend if they can.

Continue to encourage other women of childbearing age to attend – particularly those who other people listen to, and who are good at influencing others.

Agenda for Meeting 7

1.    Welcome, review of previous meeting and introductions

2.    Present the objective of the meeting: This meeting is for pulling together the thoughts from the meetings so far, and turning them into possible plans and solutions that deal with the four top problems – or better still which deal with their roots. You then carry on to discuss how some of these solutions might be made to happen. 

Today is about turning the previous discussions into actual suggestions to make to the whole hamlet.

3.    The main business: Choose one of the problems – preferably the one that everyone feels most strongly about solving. In the last three meetings, the women of the group will have looked at the roots of the problem, and then will have come up with ideas of how to tackle the problem so that it does not kill, and how to tackle its roots.

Set out on the ground, the Problem picture-card; the Contributing factor picture -cards; the Prevention activity picture-cards; and the Management activity picture-cards. You may want to continue with the idea of a tree and its roots, and put the problem as the tree, the contributing factors as the roots, and the activity cards all around as things which are going to deal with this problem.

You now have to turn all of this into actual plans. The final plans will be made when the group is expanded to include the men and all of those who might need to join. But this meeting is about the women having their say first.

Ask the women what things they feel that, now they have thought about the problem deeply, they would really like to see implemented. Don’t worry too much at this stage about finance and detail. We want a list of things that the women really want to see happen, and then we can see how possible it is to make the chosen interventions happen.

If the four chosen problems are, say: for mothers, bleeding and obstructed labour; for babies, infections (including malaria), and diarrhoea. The group will now be thinking not only of what to do when the woman or baby already has the problem, but also of how to prevent that problem from happening.

You want to turn this all into a list of possible solutions.

They might come up with a list like this:

·         Training of TBAs to know how to deal with problems, how to try to prevent them happening, and how to get the women to hospital quickly when they really need it.

·         Various income generating activities to reduce poverty and malnutrition.

·         Improving the clean water supply locally.

·         Having a group vegetable garden and which distributes food to pregnant women.

·         Having a campaign within the hamlet, to clear any mosquito breeding sites.

·         Trying somehow to get bed nets for pregnant women and for babies.

·         Trying to have these bed nets treated with insecticide regularly.

·         Making sure that women can get to an antenatal clinic, especially around 6 – 7 months, when their health can be checked, (eg for anaemia), and their risk of having problems in childbirth can be discussed, (eg a small pregnant 15 year old is much more likely to get obstructed labour than someone who has already had children).

·         Sourcing a bicycle ambulance to rush women and babies to the nearest health facility.

·         A health education programme for mothers on how to prevent babies getting serious infections, and how to prevent them dying if they do get infection.

·         Developing a group emergency transport fund.

·         Developing an ‘on-call’ system of men who can help get women to the Health Centre or Hospital in an emergency.

At this stage of the Tushikamane process, you do not have to prioritise these or work out which you will do – that will come over the next few meetings.

4.    Summarise the meeting, and check that you have summarised correctly. Who is going to do what before the next meeting?

5.    Assess whether you have really captured a good list of potential plans and solutions. If they have not been achieved you can go back and repeat all or parts of the meeting again.

6.    Encourage people to ask questions

7.    Decide a date for the next meeting

Key issues for your report on Meeting 7

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What was the final list of plans and solutions?

What to do after Meeting 7

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

·         Try to get the whole hamlet excited about the next meeting where you plan to take things to the next level!

MEETING 8 – PRESENTING PROGRESS TO THE COMMUNITY

How you should prepare for Meeting 8

Read this manual before the meeting and decide which tools and materials are needed.

In particular, you and the group, with the help of Alex, Wilbard, and Rev Isaac, need to practise the presentation that will be made during this meeting.

Visit key people in the hamlet who attended meeting 7. Make them feel that it was a worthwhile thing to do, and remind them of the importance of this critical meeting – where you get the whole hamlet engaged in the plans to reduce deaths of mothers and babies.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when all (or almost all) key hamlet figures will be available.

Who should attend Meeting 8?

Meeting 8 is the meeting where progress is reported back to the community. From this point on, it will be good to expand the membership to include all those who might play a part in reducing the chances of death of mothers in childbirth, and reducing deaths of babies.

Group membership will need to take into account traditional beliefs and customs, but may include Village Health Workers or any type of health care worker; local leaders; teachers; partners of the women and adolescents in the group; government or charity workers who deal with these problems; and anyone who is concerned to improve the health of women and their babies.

Continue to encourage all those women who attended meeting 7 to attend if they can.

Continue to encourage other women of childbearing age to attend – particularly those who other people listen to, and who are good at influencing others.

Planning the presentation to the community in Meeting 8

You need to have a formal meeting with your Supervisor Alex, and the Project Lead, Wilbard Mrase, to plan how the Tushikamane Group will make the presentation of progress to the hamlet. You might well decide together that you will have a second meeting where you present your ideas to the Project Chair, Rev Isaac Mgego, so as refine your plans and make them as good as they can be.

You, Alex and Wilbard, in consultation with the Tushikamane group, need to come up with how the meeting will run. You need to decide what you will say about the following things, and how you will say it. You may decide to split the roles up – for instance the Project Lead to do the introductions and objectives; the Supervisor to say how the programme works; and you to say what progress has been made.

In order to make it more interesting and to get people’s attention and enthusiasm, you might want to include in your presentation of progress so far, some contribution of the women of the group – eg a short bit of acting or dance or song.

Do not forget to use the picture cards to help get the message over.

When you have had the meetings with the Project Lead, the Supervisor, and maybe the Chair, you should then have a clear idea of how each bit of the meeting will be handled:

·         The structure and objectives of the meeting – eg presented by Project Lead, Wilbard Mrase

·         Background to the Tushikamane programme, and how it works – eg presented by Alex Gongwe

·         Progress of the group presented by you, plus selected women of the Tushikamane Group. Together, you explain the picking of 4 main problems; the looking at their roots; the looking at what actions might influence the problems or their roots; and the coming up with a list of potential plans and solutions.

·         Questions, comments and ideas from the audience might then be led by Alex or Wilbard.

Planning the invitation to the community to attend Meeting 8

At your planning meeting with Alex and Wilbard, you also need to decide who you want to invite to the presentation and how they will be invited. People you might want to invite are listed above.

How will they be invited? For example, going door-to-door; announcements in church; letters; asking women of the group to bring people; etc.

Running Meeting 8 – presenting progress of the Tushikamane Group to the community

1.    Welcome and introductions

2.    Present the objectives of the meeting:To feedback discussions, including prioritised problems and solutions, to all community members, to get their views; ideas; encouragement and support for the implementation of solutions

3.    Background to the Tushikamane Project and how it works.

4.    Main business: Using the methods planned in advance, present to the community the progress so far. Involve the women of the group in helping you to do this. Use other methods than just talking – eg song, dance, acting, picture-cards, etc.

Finish up by presenting to the gathering a clear list of the possible plans and solutions that the women have come up with. By this stage, the whole hamlet should be understanding that to tackle the tragic deaths of mothers and babies, you have to tackle the roots of the problems.

5.    Open the discussion for community members to share their ideas. This could go in any direction, but you to bring people back to a commitment from the hamlet that they will work together on choosing exactly what they are going to do, and how they are  going to do it.

6.    Summarise the meeting, and get agreement that you have summarised correctly. Who is going to do what before the next meeting?

7.    Decide a date for the next meeting

Key issues for your report on Meeting 8

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What Information was shared and what questions and ideas were raised by community members?

What to do after Meeting 8

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

·         Try to get the opinion leaders and people who might be really useful to reflect on the importance of what is taking place, and to join in at least for a meeting or two, so that they can see if they want to be involved.

PHASE 3: IMPLEMENTING SOLUTIONS TOGETHER

 

The focus of Phase 3 of the meeting cycle is for the Tushikamane groups to implement the solutions identified to address problems that kill mothers and their babies. 

Phase 3 has three meetings:

·         Meeting 9: Planning the solutions: in which the community forms committees – one for each solution that they plan to implement.

·         Meeting 10: Gathering resources: each committee works with partners which Tushikamane will help to find, to gather the resources they will need to implement the solution.

·         Meeting 11: Developing monitoring tools: so that you know whether your solution is having a good impact.

Thereafter, there will be a gap before Phase 4 – the final 3 meetings – in order for solutions to be implemented, and progress to have been properly monitored. This gap might be of between approximately three and six months.

MEETING 9 – PLANNING SOLUTIONS

How you should prepare for Meeting 9

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 8. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: implementing plans to reduce deaths of mothers and babies.

You should point out that the Tushikamane process will not pay for any solutions, but will help put the hamlet in touch with those who can help them make the right things happen. It is much easier to get support – for instance from government departments or charities – when such a rigorous process has been gone through, and when it includes having taken such trouble to give a voice to women of reproductive age.

If the right people in the community can now join the Tushikamane group, then together you have a real chance of bringing in support to coordinate with the community’s own efforts. This will really make a difference in preventing tragic death.

Remind the key opinion leaders in the hamlet that the coming meeting is to try to identify those solutions that you plan to take forward, and that this is a special time to have their say and to get their ideas heard, building on what the women have already discussed.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Who should attend Meeting 9?

All those women who attended Phases 1 & 2 should attend if they can.  Additionally, the group will have identified key figures at the last meeting whose attendance will make the group work well and will enhance the possibility of success.

This might for instance include the Village Chairperson, VHW, NGO workers, etc.

Continue to encourage other women of childbearing age to attend – particularly those who other people listen to, and who are good at influencing others.

Agenda for Meeting 9

1.    Welcome, introductions, and short summary of where the Tushikamane process has reached, and where it is headed.

2.    Especially welcome the new group members, particularly the men. Emphasise that they have important roles to play, but that the way the group works is to listen to and respect the views and opinions of the women. They have a huge role, however, in providing advice and support where necessary to achieve the objective of improving reducing deaths of mothers and babies.

3.    Present the objectives of the meeting:

·         To come up with a list of proposed solutions that the community will be tackling.

·         To set up a committee to tackle each solution.

·         Then each committee should agree an action plan for implementing their solution.

Explain why this detailed planning progress helps not only choose the right problems to tackle and the right way to tackle them, but also gets everybody working together and that makes the chance of success much higher.

4.    Main business of the meeting: Look at the list of solutions presented to the community in meeting 8. You now need to reduce this list to maybe three or four planned activities your group will be taking on.

5.    Write down the chosen (eg) four activities, and put one in each corner of the room, or if in a circle outside, put the four pieces of paper with the names of the 4 activities, equally spaced around the circle.

Ask the group members to get up and move to the planned activity that they especially want to get involved in. (If they want to get involved in more than one, then get them at this stage to choose the one they feel is most important.)

This process should end up by splitting the group into 3 or 4 smaller groups. Each smaller group is now the Committee for helping implement the planned activity they have chosen to be involved in.

6.    The committees should now work together for half an hour or so, to come up with an action plan for their proposed planned activity to help solve the problem/s.

At the end of this process the whole group gets back together, and each committee then reports back to the whole group:

·         The name of the planned activity which they are going to get involved with to help prevent deaths of mothers and babies

·         The name of the chair of the committee, who will keep records of what goes on, and will report to the next meeting.

·         The next steps they are going to take – what they are going to do; and by when

·         Which person exactly is going to do which thing?

7.    Summarise the meeting

8.    Assess whether the objectives of the meeting have been adequately achieved. If not you can go back and repeat all or parts of the meeting again.

9.    Encourage people to ask questions

10.  Decide a date for the next meeting

Key issues for your report on Meeting 9

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         For each solution identified, what Committee, rules and action plans were agreed?

What to do after Meeting 9

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

·         Visit each of the committee chairs, as well as any other key people that you want to be involved. Encourage them to take action, and ask what help they might need to make things actually happen.

·         Discuss these things with your supervisor, and bring them up at the monthly meeting with the Project Lead and Project Chair. At this stage of the Tushikamane Process, they need to start helping the groups be put in touch with those who can really make things happen.

To help this, they will need a really clear idea of what is happening, and what help exactly each committee is looking for.

MEETING 10 – GATHERING RESOURCES

How you should prepare for Meeting 10

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 9. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: planning to reduce deaths of mothers and babies. This will eventually bring in support which will be coordinated with the community’s own efforts, and this will really make a difference in preventing tragic death.

Remind the key opinion leaders in the hamlet that the coming meeting is to try to identify resources, and that they might have something particular to offer.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Who should attend Meeting 10?

All those women who attended Phases 1 & 2 should attend if they can, as well as those new members who attended Meeting 9.  Additionally, the group may have identified new potential members at the last meeting whose attendance will make the group work well and will enhance the possibility of success.

Continue to encourage other women of childbearing age to attend – particularly those who other people listen to, and who are good at influencing others.

Agenda for Meeting 10

1.    Welcome, review of previous meeting and introductions.

2.    Present the objective of the meeting: To plan how to gather the resources necessary for the solutions to be implemented

3.    Main business of the meeting: Plan how to gather the resources for the solutions. Although the group now has (eg) 4 committees, each trying to implement its own planned solution, it is nevertheless better to do today’s planning session altogether.  The reason is that it may well be that the others in the Tushikamane group have ideas that would help. Also, it is likely that more than one committee might be tackling a shared problem with shared needs – eg relating to transport or infrastructure.

Each committee chair presents to the whole group the solution or activity that his group is planning. S/He presents to the group how much progress has been made.

The whole Tushikamane group then discusses what resources would be needed for this solution to be implemented properly. After 10 or 15 minutes discussion, they will have a list of resources that they are going to need.

For each resource, they now need to think of the possible sources – where or who are they going to get it from?

Example

For instance, the problem might be the training of the Traditional Birth Attendants.

The resources they are going to need are:

·         Someone to do the TBA training;

·         a training manual from people who have experience of TBA training;

·         a place to do the training;

·         maybe some equipment for the TBAs to use, such as a blood pressure machine;

·         transport systems when the TBA wants to take the women to hospital;

·         etc.

They then consider the sources of these things:

Someone to do the TBA training – who are they going to ask?

Can anyone fix this for them? This is exactly the sort of resource that you, as the Tushikamane Facilitator, can help with.

What about the training materials? Again, you might help.

The place for the training, they will have to work out who they intend to ask to fix a place. Who is going to do the asking?

Maybe there is a Governmental initiative going on at the moment who might give them help in this. Who is going to find out?

For the things which cost money, do not be too ready to come in an offer to try to find a charity for them. But by all means help them to write to a charity, detailing all that they have done to reach the point of needing this money to help prevent deaths of mothers and babies.

Many charities would react generously to those communities who have showed such commitment and participation, and who have listened to the voices of women. Who will lead on this?

At the end of this process, the committee will have a list of suggested resources they might need to make their plans work out well. They will have some idea of where they are going to find these resources, and they will have a clear idea of who is going to do what before the next meeting.

4.    Repeat the process for each of the committees. Each one presents their own planned solution or activity, and the whole group then contributes to identifying resources, and identifying where those resources might come from.

5.    Summarise the meeting and check that you have summarised correctly. Who is going to do what before the next meeting?

6.    Assess whether the objective of the meeting has been adequately achieved. If they have not been achieved you can go back and repeat parts of the meeting again.

7.    Encourage people to ask questions

8.    Decide a date for the next meeting

Key issues for your report on Meeting 10

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         How will each committee take the next steps to find what they need to make the plan a reality? You need to have written this down clearly, so that you can remind them of what they said … and help them achieve it.

What to do after Meeting 10

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

·         Visit each of the committee chairs, as well as any other key people that you want to be involved or who agreed to be responsible. Encourage them to take action, and ask what help they might need to make things actually happen.

·         Discuss these things with your supervisor, and bring them up at the monthly meeting with the Project Lead and Project Chair. At this stage of the Tushikamane Process, the Project Lead and Project Chair need to start helping the groups be put in touch with those who can really make things happen.

To help this, they will need a really clear idea of what is happening, and what help exactly each committee is looking for.

MEETING 11 – DEVELOPING MONITORING SYSTEMS

How you should prepare for Meeting 11

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 10. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: giving a voice to women of reproductive age in the plans to reduce deaths of mothers and babies. This will eventually bring in support which will be coordinated with the community’s own efforts, and this will really make a difference in preventing tragic death.

Remind the key opinion leaders in the hamlet that the coming meeting is to try to identify ways of knowing whether the Tushikamane process is working, and that they might have something particular to offer.

Point out that this is not only something the hamlet wants to know for its own encouragement. Additionally, those outside agencies who might want to help will want to know that the process is truly helping. Charities like Mission Morogoro, AMREF, and other organisations with resources will be much more likely to lend support to a process if they know that it is monitoring its own success.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Who should attend Meeting 11?

All those women who attended Phases 1 & 2 should attend if they can, as well as those new members who attended Meeting 10.  Additionally, the group may have identified new potential members at the last meeting whose attendance will make the group work well and will enhance the possibility of success.

Think whether there might be some particularly useful person to attend – for instance anyone who might have any experience in monitoring. This will certainly include the Village Health Worker, but might also include the Village Chair, teachers, etc.

Agenda for Meeting 11

1.    Welcome, review of previous meeting and introductions

2.    Present the objective of the meeting: To plan how to monitor the solutions

Discuss why it is important to monitor the solutions: to celebrate successes and to identify any challenges, so that you can plan to overcome them.

3.    The main business of the meeting: Plan how to monitor the solutions.

There are (eg) four committees, and each one is responsible for monitoring whether what they plan to do is being successful.

Begin with one of the committees – let’s take as an example that one of the committees plans to introduce TBA training.

In order at arrive at the answer as to how they are going to monitor this plan, take the the Tushikamane group through the following process:

A.   Discuss and agree what benefits will come from the solution? For example, the mother will recover more quickly from childbirth and will not die; the TBA will be more competent; women will feel safer and less isolated when giving birth; more solid links will be built with the health services; etc.

B.   Ask for their view on who would receive these benefits from the solution?  For example, all women having babies obviously; also the hospital because it does not have to deal with TBA mistakes; the TBAs themselves who will be more competent; the community because the mother will recover more quickly from childbirth, etc.

C.   Discuss and agree when will these people will benefit from the solution.  For example, often; once per month; once in a lifetime; etc. There is no point trying to monitor something that only happens very infrequently.

D.   Discuss and agree where people will they benefit from the solution.  For example, just people from this hamlet, or also people from all nearby villages.

E.    These four questions give you a background to discuss and develop a monitoring system that will tell you whether the solution is really working.

For instance, it would not be enough to know that someone turned up to do the TBA training. We might also want to know, for instance, how many of the local TBAs started the training?; how many finished it?; in what main ways did their practice change?; did the Health Centre and Hospital notice a difference? Did the community notice a difference?

How will the committee discover the answers to these questions? When they have the answers they can celebrate the successes, and also tackle any issues which are preventing things working even better.

When the process has been completed for the first committee and its planned solution, the Tushikamane group then discusses the evaluation plans for the other planned actions, repeating steps A to E above.

4.    Summarise the meeting and check that you have summarised correctly. Who is going to do what before the next meeting?

5.    Assess whether the objective of the meeting has been adequately achieved. If they have not been achieved you can go back and repeat all or parts of the meeting again.

6.    Encourage people to ask questions

7.    Decide a date for the next meeting which will need to give people time to make things happen – eg 3 to 6 months from now.

Key issues for your report on Meeting 11

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What monitoring plans will there be for each solution identified?

What to do after Meeting 11

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

After meeting 11, now is the time to make the things start happening.

Each committee needs to be supported by you and the Tushikamane team, as it tries to implement the activity and solution it undertook to deal with.

They have identified the resources they need, and progress will have been made in finding these resources.

They have an action plan and know who is responsible for doing what, by when.

They have agreed a mechanism of monitoring their progress. 

You should meet the committees regularly during this period, to review the progress of implementation, celebrate achievements and identify and address any challenges. 

The frequency of meetings is determined by the group members themselves.

PHASE 4 – EVALUATING TOGETHER

The focus of Phase 4 of the meeting cycle is to evaluate the impact of the solutions implemented on the priority problems identified.  The phase has three meetings:

Meeting 12: Progress in evaluation. After this meeting, the group members will need to ensure that they are on track for gathering the data they need to evaluate the impact on the problems they were tackling.

Meeting 13: Evaluating the work of the committees, the Tushikamane group, and the Tushikamane process

Meeting 14: Planning for the future.

MEETING 12 – PROGRESS IN EVALUATION

How you should prepare for Meeting 12

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 11. Make them feel that it was a worthwhile thing to do, and remind people of where you are headed: giving a voice to women of reproductive age in the plans to reduce deaths of mothers and babies. This will eventually bring in support which will be coordinated with the community’s own efforts, and this will really make a difference in preventing tragic death.

Remind the key opinion leaders in the hamlet that the coming meeting is to try to identify ways of knowing whether the Tushikamane process is working, and that they might have something particular to offer.

Continue to point out that those outside agencies who might want to help will want to know that the process is truly working well. Organisations with resources will be much more likely to lend support to a process if they know that it is monitoring its own success.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Remind the Chair of each committee that they will be asked to update the group on how their evaluation process is going!

Who should attend Meeting 12?

All those women who attended Phases 1 & 2 should attend if they can, as well as those new members who attended Meeting 11.  Additionally, the group may have identified new potential members at the last meeting whose attendance will make the group work well and will enhance the possibility of success.

Once again, think whether there might be some particularly useful person to attend – for instance anyone who might have any experience in monitoring. This will certainly include the Vilage Health Worker, but might also include the Village Chair, teachers, etc.

Agenda for Meeting 12

1.    Welcome. Any introductions.

2.    Review Phase 3 and remind people how much has happened already.

3.    Present agree the objectives of this meeting, which is get motivated and ready to do an evaluation of the project. Discuss why evaluation is important, and especially emphasise that bringing in outside help to the community in future will be much easier to do if the community can show that they are not only working on the problems, but are also evaluating their success.

The following story presents a way of helping the group to understand why proper evaluation is so highly valued, because it helps to:

·         Look back and see progress;

·         Identify the things which went well, and which they should continue doing

·         Identify challenges and see where the problem truly lies;

·         Tackle the right problem in the right way;

·         Then celebrate achievements!

Read out the story: "Mrs. [Add name], from [Add name] Village, ventured into a bakery business. She recruited three workers who assisted her in constructing a baking oven, making a small shop, and in the baking itself. 

The first cycle of baked scones was of low quality to the extent that she only made TSH 2,000.  Mrs. [Add name] was very disappointed and thought that it must be the quality of the ingredients that caused this problem. As a result, she bought different ingredients and used them for the second cycle of baked scones. 

However, these scones were worse still!  Mrs. [Add name] was disappointed again and asked a friend who was doing a poultry business for advice.  Although, this man knew nothing about baking he suggested that perhaps the workers were stealing ingredients and selling them to other bakery owners.  Mrs. [Add name] got angry with her workers and ordered them to work for three months without pay. 

The third cycle of baked scones were still of poor quality!  Mrs. [Add name] was disappointed again and asked a fellow baker for advice. The woman knew much about baking and informed Mrs. [Add name] that her workers were not bakers, but had been employed previously as night watchmen at the bakery in the city.  They had no baking skills at all.  Mrs. [Add name] recruited new workers with good baking skills and the fourth cycle of baked scones were of excellent quality.

Have a short discussion for instance using some of the following questions:

What have we heard in this story?

Do such things happen?

Why do they happen?

What have we learnt from this story?

·         In the first cycle of baked scones, she did not recruit the correct people.

·         In the second cycle of baked scones, she made changes without investigating what was wrong. 

·         In the third cycle of baked scones, she consulted someone with no expertise in baking. 

·         In the fourth cycle of baked scones, she consulted an expert and evaluated the problem correctly.

4.    Main business of the meeting: To see what progress has been made in evaluation of each of the four projects.

Each of the (eg) four committees in turn should present what was decided in Meeting 11 about monitoring the success of their activity. How far have they got in implementing monitoring systems? Have they started to both success? Have they had problems in implementing the monitoring, and if so, can the you or the group help to solve them?

Repeat the process for each of the committees.

5.    Summarise the meeting

6.    Assess whether the objectives of the meeting have been adequately achieved. If they have not been achieved you can go back and repeat all or parts of the meeting again.

7.    Encourage people to ask questions

8.    Decide a date for the next meeting

Key issues for your report on Meeting 12

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What results did the evaluation show for impact on each priority problem identified?

What to do after Meeting 12

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You should encourage group members to share their discussions with other community members who did not attend the meeting.

·         Visit each of the committee chairs, as well as any other key people that you want to be involved or who agreed to be responsible. Encourage them to sharpen up the evaluation of their project, and ask what help they might need to make this actually happen.

·         Discuss these things with your supervisor, and bring them up at the monthly meeting with the Project Lead and Project Chair. To help this, they will need a really clear idea of what challenges the committees are facing, and what help exactly each committee is looking for.

MEETING 13 – EVALUATING THE SUCCESS OF PROJECTS AND OF TUSHIKAMANE

How you should prepare for Meeting 13

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meetings 12 and 13. Remind the key opinion leaders in the hamlet that the coming meeting is to try make a final assessment of whether the Tushikamane process is working. They might have something particular to offer, but also will surely want to know the answer.

Continue to point out that organisations with resources will be much more likely to lend support to a process if they know that it has been successful, and is able to demonstrate this.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Remind the Chair of each committee that they will be asked to update the group on how their evaluation process is going!

Who should attend Meeting 13?

All those women who have been involved in any way in the process.

Remind leaders and key figures in the community that this is a vital meeting to attend, so that they can know whether the Tushikamane process worked or not.

Agenda for Meeting 13

1.    Welcome. Any introductions.

2.    Review of the last meeting where the importance of evaluation was emphasised.

3.    Present the objectives of the meeting:

·         To evaluate how well the priority problems have been addressed

·         To evaluate the functioning of the group

·         To plan for the future

4.    Main business of the meeting: Evaluate all progress, achievements and challenges in relation to the Tushikamane process, and the work of the committees in tackling the priority problems.

As the time approaches for meeting 13, the Tushikamane team will plan together how they intend to get the Tushikamane Group to perform this evaluation.

What is wanted is to end up with a clear idea of the extent to which there was success in the following areas:

·         Participation in groups and meetings;

·         Identification of problems and their roots;

·         Effectiveness of the committees in tackling these; as well as a narrative for each which highlights the main achievements and the main obstacles.

·         New partnership and links formed.

·         Facilitation and supervision by you;

·         Evaluate the Tushikamane process itself – the 14 meeting cycle as a way of making progress

It would be good to get an actual score (eg out of 5) for each area, as well as the narrative of achievements and obstacles.

5.    How to make things even better: Where anything in the above evaluation only received a below-average score, lead a discussion as to what could make this thing or this person more effective in any future work.

6.    Summarise the meeting

7.    Assess whether the objectives of the meeting has been adequately achieved

8.    If they have not been achieved you can go back and repeat all or parts of the meeting again

9.    Encourage people to ask questions

10.  Decide a date for the next meeting

Key issues for your report on Meeting 13

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – anything particularly good or bad?

·         What have been the progress, achievements and challenges of the group as a whole, and of each committee?

What to do after Meeting 13

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         Have a half-day meeting of the entire Tushikamane Team, to discuss the evaluation and to make recommendations.

MEETING 14 – PLANNING FOR THE FUTURE

How you should prepare for Meeting 14

Read this manual before the meeting and decide which tools and materials are needed.

Visit key people in the hamlet who attended meeting 13. Remind the key opinion leaders in the hamlet that the coming meeting is to try decide what to do next, and that their view is important and needs to be heard. Remind the women who have made a significant contribution that this will be the moment to ensure that women’s voices continue to be heard.

As the meeting approaches, remind people of the time and place, and encourage them to attend. Choose a realistic time when those who made a good contribution to the last meeting will be available.

Who should attend Meeting 14?

This is a meeting for the whole hamlet. Remind leaders and key figures in the community that this is a vital meeting to attend, so that they can help plan the next steps.

The entire Tushikamane team should be there for this meeting – Rev Mgego the Chair; Wilbard Mrase the Project Lead; and Alex Gongwe, the Supervisor.

More importantly, the women who have been working with Tushikamane for the previous meetings can now come and celebrate what has been achieved – and can help ensure that they will continue to be heard, and to contribute to the future health of their sisters and daughters – and their babies.

Agenda for Meeting 14

1.    Welcome, review of previous meeting and introductions

2.    Present the objective of the meeting: To decide what to do next with the group

3.    Discuss what work is still to be done by the group

4.    Summarise the meeting

5.    Make plans for the future!

6.    Decide a date for the next meeting

1.      Select one priority problem and guide the group through the following decision flow-chart:

Has the priority problem been addressed adequately? If YES: then the group should return to Phase 1 and identify and prioritise new problems to address

If NO:

Was it the right problem to address? If not, go back and choose a different problem.

May be it was the right problem, but the solutions being implemented were the wrong ones, because they did not properly address the roots of the problem, and they did not promote appropriate preventative and/or management activities?

If that is the reason, then the group could return to Phase 2, and look again at roots of the problem, and plan different strategies to tackle the roots and to prevent the problem from arising.

Alternatively, maybe it was the right problem, and the plans for solutions were good ones, but they just did not happen. If not, then why not? Can this be fixed?

Do you just need more time?

Key issues for your report on Meeting 14

·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?

·         How did the meeting go – any particular achievements or problems?

·         What will the next steps be?

What to do after Meeting 14

·         Secretaries should list all attendees in the group register.

·         You should complete a meeting report as detailed above.

·         You need to meet with the Tushikamane Team, to discuss the evaluation and to make recommendations.