Institutionalising and Sustaining Social Change in Health Systems: the case for Uganda

The key to high impact Health Services is institutionalising and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method, Lot Quality Assurance Sampling. Institutionalization is defined by two C's, competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature researching institutionalization has emphasized ‘stability’, whereas in global health, the issue is how to improve the impact of services by ‘changing’ programmes. We measure the extent of institutionalization and sustainability of programme evolution that produced change in nine districts sampled to represent three largely rural regions and varying level of effective health programmes; we use the proportion of mothers with children 0-11 months who delivered in a health facility as the principal indicator measuring programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collections in the district health office, and informant interviews alone at the central government level.