A Practical Guide to Developing an M&E Budget

 

Research Team with TASO

SAFE believes that projects should be rooted in data–it is ethical to evaluate our work so that we understand what works and what doesn’t, because that is how we can have the most impact for moms and babies and be as responsible as possible with the funds we have available. We know that this isn’t just a struggle for us, but for many smaller organizations whose budget just doesn’t allow for huge M&E expenses.

That is why for the past year SAFE has worked hard to develop an effective, evidence-based, robust monitoring and evaluation (M&E) strategy in order to better quantify the amazing impact SAFE has in the communities where we work. Our strategy was intentionally developed to gather high quality, mixed methods data at a fraction of the cost and in a much quicker time-frame than other programs we have seen. We developed the method primarily through our work with the ACT for Child Health Initiative we recently launched, supported by the Children’s Prize, in which we surveyed 4,499 women in a comprehensive quantitative health survey, and interviewed more than 60 people as part of our baseline assessment (these included maternal death social autopsy, exit interviews, and in-depth interviews).

Yet, we really wanted to develop a methodology that could be useful in the long-term, not just to SAFE but also to other nonprofits wanting to incorporate more data collection on smaller budgets than originally anticipate as being required. That is one of the reasons we are so thrilled with a new partnership!

In January, SAFE was invited by the Center for Health Market Innovations (CHMI) to participate in their Primary Care Adaptation Partnership. This program allowed us the opportunity to learn more about a wonderful organization called Healthy Entrepreneurs (HE) that addresses health commodity security and supply chains in a sustainable, community-based business model. As part of a new partnership created with HE (more on this later!), SAFE offered its expertise in M&E in order to support the design and implementation of a survey in an area in which HE already works in Uganda. With a very modest 4 figure budget and less than 2 months to design and implement the tool, the SAFE and HE teams were able to successfully survey 913 participants in the Kibaale District of Western Uganda and will complete about 2000 added surveys by the end of April in an area where SAFE currently works in preparation for launching a new joint SAFE-HE project in that area later this year.

Now having been able to work with another organization to adapt our M&E model to their own context, SAFE wants to encourage other small organizations to prioritize monitoring and evaluation of their programs in order to better inform their interventions and ensure they are having the largest impact. The remainder of this post will be dedicated to sharing some ideas about M&E budgets in hopes of helping others (and we welcome you to reach out to us for more specific information if helpful). (Additional posts in coming weeks will focus on other aspects of M&E development, and our growing partnership with HE, so stay tuned.)

The first step in any M&E project is to draft an accurate budget to see if the work you want to accomplish can be completed with the budget at hand. We know that monitoring and evaluation can be a bit overwhelming if you have never done them before, so we wanted to offer some thoughts as to how to structure a budget and plan.

Truthfully, when we first designed an M&E budget, we didn’t really know much about what other people paid, and honestly that was probably a good thing since most M&E projects had a lot more capital to work with than we did. We just looked at the overall categories of other budget templates, and adapted them to our context. They included:

TRANSLATION: Your survey cannot be in English if the local language isn’t usually English, and it will severely compromise data quality if you have interviewers translating on the spot. For the survey to really be valid, your survey needs to be translated into the local language BEFORE you conduct any training or data collection. If you have staff who are really good at both spoken *and* written translation, and understand the differences between them, you can have an existing staff member work on it, but of course, you will have to pay them for that service. If your staff isn’t accustomed to these types of translation, you would be better to pay for translation. Remember that translation isn’t supposed to be verbatim translation, but rather it’s looking to translate the true meaning. For example, the term for “antenatal care” in our area literally translates to “drinking medicine”. So having someone translate “did you receive antenatal care during this pregnancy?” shouldn’t be translated verbatim; it should actually say “did you receive [drinking medicine] during this pregnancy?” Making sure you budget for a good translator will save you a lot of headaches later in the survey process. Don’t chintz on translation, and make sure you have the survey translated into ALL major languages (if you are in an area that has a lot of refugees, you will likely need more than one translation; not being able to survey someone because the survey isn’t in the correct language will introduce bias because the results will not longer be representative of the population on the whole; different people really do have different health indicators, especially those who don’t speak the predominate language in a particular region).

STAFF: Enumerators (quantitative surveys) and interviewers (qualitative) should be local people who are fluent in the major languages; this is very important, as having foreigners conduct the surveys, even with a translator, would introduce a tremendous amount of bias and render the results invalid. We chose to use relatively young (20s – 30s) enumerators/interviewers with at least a high school diploma and fluency in multiple languages, who were really looking to “prove” themselves, and budgeted time (and a little money) to train them. This saved us significant money, as more experienced interviewers would have been far more expensive. We budgeted to pay them a fair daily wage plus a small stipend for food and water during field work (which was very important for their health and satisfaction). We priced out compensation by asking partner organizations what they paid people of a similar training background. Additionally, as we have used these interviewers multiple times for surveys,  so our invest in their original training has paid off.

Also, don’t forget about supervisors. If you’ll have yourself, your more experienced staff, or an outsider coming to monitor the data collection (which ideally you should have), make sure that you budget for their time, food, water, and lodging.

TRAINING: Do NOT forget to budget for training: training space with electricity (how are you going to train all of these people in a small office room?), refreshments during training (as much as you might not want to pay this, it’s really crucial if you want this to work), renting a projector, and materials like notebooks, pens, a roll of big paper and markers (or a whiteboard and dry erase markers with an eraser). You should not chintz on this, as the quality of your training (and the length of your training) is directly related to the quality of the work your people will do, particularly if you’re using less-experienced interviewers.

SURVEY MATERIALS: What do you need to actually do the survey? If you have a large sample size, we found that using a tablet-based survey (rather than paper surveys) was much less expensive. But that means that you need Android-based tablets (and extra, because some will break or get stolen or malfunction or you will find you need one so you can follow along or you’ll need one more interviewer than you thought, etc.). You also need CASES to put the tablets in and a backpack for the enumerators/interviewers to carry the tablets and supporting materials. **DO NOT omit these items because they seem less important. If there aren’t cases, your tablets *will* break or not last as long because of water or dust getting inside them (we say this from experience). If you don’t have backpacks, staff will lose things (also from experience). A little upfront costs for these items can go a long ways in saving money later. Ways to cut costs include buying online, getting things donated (have a “Donate your old Android tablet party”, or a “donate your gently used backpack party”) when appropriate, going through suppliers like Amazon when you don’t have to pay shipping, getting local when appropriate (like the cloth sewn backpacks instead of commercial ones which are cheaper and have the added benefit of supporting local business), etc. Some other questions:

OTHER EQUIPMENT: If you will be doing population-based surveys, do not forget to get adequate charging equipment. We recommend getting a multi-USB charging device that you can plug into a cigarette lighter (so you can charge in the car), and/or staying somewhere that has a back-up generator or solar electricity. If you’re working in a low-middle income country where power outages are frequent, you WILL most likely have many times where power is out precisely when you want to charge.

MUAC TAPES: Will you focus on nutrition? If so, you might need tape measures, MUAC tapes, or scales. *Think about this ahead of time and budget for it.* Also remember that partner organizations might have things available you could borrow or pay a nominal fee to rent. 

AUDIO RECORDERS: Will you be recording an interview (if you need to do that)? If so, you need to either have them record with a tablet or get an audio recorder and ample batteries.

AIRTIME: Your enumerators and administrating staff will need cell phone airtime to communicate about data collection issues. We didn’t budget for this, but should have. A good rule for us was to budget about $0.50/day/enumerator and $5/day/supervisor. Encourage them to communicate by text whenever appropriate, and have the enumerator “beep” (call and hang up quickly) the supervisor to get a return call. This will save you money.

MAPPING AND ENUMERATION CENSUS: Most types of quantitative survey sampling methods will require that you generally know the number of households in each village and generally know the boundaries of each village. We found that there were no estimates available in some of our areas, and that those that were available were sometimes old and inaccurate. We used what are called “shape files” of the parishes in our area (each parish have multiple villages), and either Google Maps or QGIS (both free) to generate general maps of the area. You can also create your own map using a handheld GPS (which we did with no prior technical knowledge, and you can ask us if you want more info—we’re developing a manual!). You can then go work with village chiefs or elders to identify boundaries and number of homes. You can either ASK for the number of homes (knowing that there will be some bias here) or physically count them yourself. It’s even better if you can actually visit every home in the entire region and get a head count by gender and age, as that will be useful during sampling frame develop and survey administration… sometimes that’s possible and sometimes it’s not (for us, each “enumerator census” cost about $1,300 on average). BUT remember that you need to budget for it, the personnel, the technology (or printing), getting out to the village chiefs, often compensating them for their time in taking you around their village, etc.

FUEL AND CAR RENTAL: How will you get around the survey area? You will likely need a large vehicle that can accommodate all people. If your organization owns one, cool. If not, you’ll need to hire one with a driver, and then pay for fuel. Have your staff negotiate the price, in consideration that you will rent it for multiple days. Don’t just accept the first price that you get, and it’s even better if you develop relationships with particular drivers over time, because then you will consistently get better prices.

TERRAIN AND OTHER TRANSPORT MECHANISMS: If your region is particularly mountainous or treacherous, you may need to budget for your enumerators to get out of the hired vehicle and take local transport means (motorcycles, etc.) to get to certain areas that are inaccessible by car. Make sure you think about this and budget for it if you need to.

A WORD OF ADVICE: If you need help developing strategies, don’t be afraid to find a really dedicated MPH (or other professional) student. We use highly qualified and well-trained students in a lot our work; it saves us a lot of money, gives them really good experience, and gets us much better data than we would have if we relied only on our own devices. (If you want to use a recent MPH graduate who will do a good job and might not cost as much as a senior professional, let us know! We have some great people to recommend!!)

Now go out there and get surveying! If you or someone you know is interesting in learning more about conducting M&E on a budget or would like SAFE to consult on a project, feel free to email us at info@safemotherssafebabies.org.

Join the SAFE Team in 2016!

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Interested in getting more experience in global health, public health, or maternal and child health? Do you want to learn about development in practical terms, living and working alongside talented Ugandan community members? Do you want to contribute to improving maternal and child survival, and do something meaningful with your summer?

If you answered yes to any of these questions, consider joining the SAFE team! Our applications for internships during 2016 are open, and this year, we’ve opened up our opportunities with both short and long term placements in a variety of timeframes (dependent on skills, background, and availability). Check out these projects!

Internship/Practicum Openings for 2016

SAFE has two tracks for interns, each of which provides different experiences and caters to different backgrounds. The Experiential Living Track is designed for people who want to acquire more experience living and working in a developing-country context, and general exposure to maternal and child health and the intersection between culture and health. They live in a rural village and work with one or more of SAFE’s community groups. Experiential Living Interns’ primary purpose is to experience maternal and child health from within Busoga culture, and to support the community groups in their work. The Specialized Project Track interns work on projects that require a more technical, specialized skillset—expertise in clinical MCH skills, research skills, health communication messaging, photography or videography training, etc. Specialized Project Interns often (though not always) live in town at our office so that they can have regular connectivity to the Internet, and rotate through the village houses so they also acquire some exposure to SAFE’s community-based work if their specific project doesn’t provide it.

Projects for 2016 are described below by Track. If you’re interested in more information, fill out a volunteer form here or send us an email at info@safemotherssafebabies.org.

Experiential Living Track: (2 – 4 weeks minimum stay)

  • “Maama ne Maama” Story Capture: Intern will work with SAFE community groups to develop a contest to collect stories about birth and experience of the health care system, with a focus on communicating good outcomes from good health decisions. Prizes will also promote good MCH behaviors and/or promote SAFE’s other projects—for example, savings boxes, a mosquito net, a SAFE baby blanket or newborn hat, etc. Desired skills: experience with storytelling, health communications, and health promotions helpful, though not required. Potential for thesis/special project. Positions available: 3. Minimum stay: 4 weeks, 6-8 weeks preferable.
  • Community Group Farming and Nutrition Support: Intern will work with community groups to develop farming plan for the next planting season’s crops, incorporating both income generation and nutrition support. Desired skills: experience/expertise in nutrition, agriculture, business skills/development, and community-based income generating activities. Positions available: 2. Minimum stay: 4 weeks.
  • Showcase Success: Intern will live in one of the villages where a SAFE community group resides and learn about their projects, then identify creative ways to showcase their work and success—both in Uganda and in the U.S. This could be through a photo exhibition in Uganda, a photovoice project, a participatory documentary, a website with photos of the members and their hopes, dreams, and accomplishments, paintings of the groups displayed in Uganda or in the U.S., etc. The focus of this project is for the intern to learn about the work of the community group and to bring their experiences to a larger audience in a meaningful, creative way. It also supports SAFE’s ongoing support of the community groups by providing creative content (pictures of happy moms and babies, their stories, short video and clips of songs, paintings, etc.) for use in our publications and social media. Minimum stay: 2 weeks, with longer stays being optimal. Positions available: 6.

Specialized Project Track:
(unless otherwise noted, requires minimum stay of 6 weeks)

  • Quality of Care Evaluation: Observation of deliveries in SAFE maternal health facilities using a standardized checklist, in order to shape SAFE’s training program to address clinical deficiencies and celebrate jobs well-done. Requires a student with strong clinical skills and training; preferred MD, CNM, NP, PA, or similar. Will consider clinical student with the right passion, background, and willingness to learn before departure. Positions available: 3. **Minimum stay: 2 weeks.**
  • Three Delay Training: SAFE’s model is predicated on the Three Delays—reducing delays in decision-making, physical access to health facilities, and the receipt of quality care in a health facility. The local District Health Office has requested that SAFE implement a district-wide training program that trains all midwives, physicians, and support staff in the Three Delays and catalyzes action based on that model. Intern will work closely with SAFE’s officers and staff, and liaise with the DHO, to develop and pilot this model with a subset of health facilities in the region. Required skillset: knowledge of maternal and child health topics (especially pertaining to maternal mortality), experience/interest in participatory education, cultural competency, patience. Positions available: 2.
  • Pregnant Woman Parliament: SAFE has used a “pregnant women’s parliament” in one health facility, in which women at antenatal care gather together during the ANC clinic day (defined day per week) to hear a health message and talk together about problems they are experiencing and how to improve them. This project has been conducted somewhat loosely and needs to be refined, streamlined, implemented in added facilities, and evaluated (requiring a solid M&E plan); intern will perform all of these tasks. Required skillset: knowledge of maternal and child health topics (especially pertaining to pregnancy and delivery), experience/interest in health education, training in monitoring/evaluation methods, cultural competency. Positions available: 2.
  • Tablet-Based MCH Education: Intern will film community groups’ dramas, and/or talks and training provided by local health providers; digitize the films; and put them on organization-provided tablets that can be used by women during antenatal care to learn about maternal and child health topics. Should also include monitoring software to evaluate use of videos. Requires a student or a team of students with experience in filming, digitizing, and programming. Possibility for thesis and publication. Positions available: 4.
  • Maama Drama: SAFE community groups use drama and songs to educate community members and important maternal and child health topics. Student will work with community groups to improve their acting skills, story lines, and audience engagement techniques, towards the end-goal of improved performances and greater audience reach. A background in drama, acting, theater, or musical performance strongly preferred for this project. Possibility for publication. Positions available: 3.
  • DHO Social Media Support: The local District Health Office has requested SAFE help in learning to use social media and SMS text messaging as a way to provide health messages to local population. This intern will work with the DHO on that project as a representative of the SAFE team. Required skillset: experience/training in health messaging and using social media, cultural competence, professionalism, patience, passion for maternal and child health. Positions available: 1.

R&B/Soul Artist Rome Alexander Donates 50% Proceeds to SAFE!

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The incredibly talented, soulful musical artist, Rome Alexander, wrote and performed a cover of the Boyz II Men song “A Song for Mama” for a Mother’s Day present. But when she insisted that he share it with others, Rome decided to sell his song and donate half the proceeds to an organization working to improve maternal health. And who did he pick?

SAFE!

We couldn’t be happier to have this partnership with Rome Alexander! Rome’s “A Song for Mama” was released on November 25th, and 50% of all the sales from it will be donated towards SAFE’s life-saving partnerships with Ugandan communities, based on the belief that no mother should die while bringing life into the world.

Get your copy of Rome Alexander’s “A Song for Mama” on iTunes today for only $0.99! You’ll support SAFE while also enjoying a beautiful tribute to mothers everywhere.

Gifts that Give Life!

SAFE Holiday Email FundraiserSafe Mothers, Safe Babies (SAFE) has been partnering with rural Ugandan communities to save the lives of pregnant women and babies for the past seven years. Together, we serve more than 100,000 people every year, made possible by the generous support of people like you.

This year for the Holidays, we’ve teamed up with both Ugandan and U.S. artisans to give you many gift choices–from jewelry and cards to songs (for digital download) and paintings, along with our regular projects that you can sponsor in someone’s honor. Since all of the materials and talents were donated, 100% of your purchase goes directly to SAFE life-saving work with pregnant women, newborn babies, and young children. Shop with SAFE for Gifts that Give Life! 

Check out the catalog below. Easy online ordering here:

The SAFE Store

Or you can mail your order form and check, cash, or money order to:
Safe Mothers, Safe Babies
1160 Mayfield Dr.
Decatur, GA 30033

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Ever Newborn Action Plan

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The Every Newborn Action Plan was launched in Uganda this past week. SAFE feels honored to be a part of the global partnership striving for maternal and child survival! Read a short newsletter about the plan (and the conference in Kampala) included below, or check out an online version here.

‪#‎maternalhealth‬ ‪#‎childsurvival‬ ‪#‎first1000days‬‪#‎thisispublichealth‬

Every Newborn Action Plan

 

Join our SAFE Summer Team–Application Open!

IMG_7152 Are you passionate about maternal and child health? Committed to participatory methods? Want to gain experience in international global health–the real, on-the-ground, challenging but rewarding kind of experience? Consider joining SAFE’s internship and practicum program! Each year, SAFE brings undergraduate, graduate, and professional students (and sometimes those taking some ‘gap’ time) to Uganda to work together with rural communities towards improved maternal and child health. Students gain valuable, real-world experience learning about participatory methods of development and applying them in practice to develop, implement, and evaluate SAFE projects. Some students work on programming, others conduct monitoring and evaluation, and others work on more formal research projects. If this sounds like something that would interest you–and you feel that you have skills that would benefit SAFE and our community partners–apply to join our summer team. Some of our anticipated summer projects are listed below; and an information sheet can be accessed here: SAFE Internship Overview.

Application Procedure: If you feel it could be a good fit, apply by sending your resume/CV and a 1-page cover letter to: info@safemotherssafebabies.org. We look forward to hearing from you soon!

Some current internship and practicum openings, SAFE Summer 2015

Research:

Voices of Maternal Health: Intern will develop an in-depth interview and/or focus group discussion guide(s) to facilitate qualitative interviews about maternal health, then oversee the implementation of that guide in-country using organization-employed translators. Component of a larger research grant SAFE is implementing on reducing child mortality in the first 1,000 days. Possibility for thesis and publication.

Third Delay Maternal Referral Tracking: Intern will track emergency maternal referrals between their place of origin and their intended destination among 4 maternal health facilities, in order to better understand the situation surrounding emergency maternal referral and the Third Delay. Possibility for thesis and publication.

Maternal Health Exit Interviews: Intern will develop an in-depth interview guide to evaluate women’s experiences in partner health facilities during antenatal care, labor, delivery, and postpartum care; then oversee the implementation of that guide in-country using organization-employed translators. Component of a larger research grant SAFE is implementing on reducing child mortality in the first 1,000 days. Possibility for thesis and publication.

Verbal Autopsy: Intern will develop a methodology for conducting verbal autopsies when women die during labor or experience a stillbirth, or after a child under age 2 dies; then oversee the implementation of that guide in-country using organization-employed translators. Component of a larger research grant SAFE is implementing on reducing child mortality in the first 1,000 days. Possibility for thesis and publication.

Programmatic Support:

Maternal Health Education: Student will review and edit SAFE’s existing maternal and child health education curriculum, then conduct refresher trainings with SAFE community groups. Intern will then watch the community groups’ use of curriculum in the community and help to improve the curriculum based on performance. Possibility for thesis (or special project).

Tablet-Based Maternal and Child Health Education: Intern will film community groups’ dramas and/or talks and training provided by local health providers; digitize the films; and put them on organization provided tablets that can be used by women during antenatal care to learn about maternal and child health topics. Should also include monitoring software to evaluate use of videos. Requires a student or a team of students with experience in filming, digitizing, and programming. Possibility for thesis and publication.

Drama Support: SAFE community groups use drama and songs to educate community members and important maternal and child health topics. Student will work with community groups to improve their acting skills, story lines, and audience engagement techniques, towards the end-goal of improved performances and greater audience reach. A background in drama, acting, theater, or musical performance strongly preferred for this project. Possibility for publication.

Community Group Assessment: Student will work design and conduct needs assessment of SAFE community groups, then work with the group members to develop long-term plans to address deficiencies and promote self-sufficiency.

Holiday Gifts and SAFE Motherhood!

This Holiday Season, you can find a perfect gift for your loved ones and support safe motherhood and childhood health in Uganda at the same time! Our Holiday Giving Catalog features jewelry handmade by SAFE volunteers using beads made by SAFE community groups. It also features handcrafted holiday cards and several projects you can sponsor in a loved one’s honor. To order and pay by mail, download our SAFE Holiday Catalog 2014 or view it below and print the order form. To order and pay online, click here. Thank you in advance for your generosity!

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Success: SAFE’s Approach Achieves Results!

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SAFE recently completed an internal evaluation of our programs, and the results are exciting! Check out an overview of what we found below:

Background: Too little progress has been made in reducing maternal and perinatal mortality in Uganda since 2000, partly resulting from poor utilization of maternal healthcare services and poor facility infrastructure. Safe Mothers, Safe Babies (SAFE) addresses these deficiencies through an integrated intervention package targeting the three delays (Thaddeus and Maine), including: (1) increasing demand through participatory educational outreach with community groups; (2) improving access through motorcycle ambulances and personal savings programs; and (3) using innovative low-cost technology to improve quality of care through strengthening facility infrastructure, commodities, and medical training.

Objective: To evaluate whether Safe Mothers, Safe Babies’ approach has improved utilization of delivery care in target health facilities.

Data and Methods: We conducted a cross-sectional quantitative and qualitative evaluation through: secondary health data from 4 intervention and 3 control facilities assessing change in the number of monthly health center deliveries and distribution of types of obstetric emergency and related maternal referrals; qualitative data from 49 key informant interviews assessing program quality; a photovoice project conducted by program beneficiaries assessing community views; and six months of field notes from observing obstetric care in 14 facilities.

Results: Intervention facilities experienced a 40.63% average increase in health center deliveries 24 months after the intervention package, which three control facilities did not experience (t(5)=-2.8, p=0.038). This was confirmed by results from key informant interviews, which reported increased utilization of healthcare services in addition to satisfaction with all types of three delay projects.

Discussion and Implications: The intervention package has effectively improved the utilization of delivery care in target health facilities by addressing the three delays. This demonstrates a successful way that the three delays model can be united with community-based and facility-based approaches to improve maternal and child health, both in Uganda and potentially elsewhere.

International Women’s Day 2014!

We started the day very early in the morning at 1 AM so that we could join with 3 radio reports. Unfortunately it rained at night so we struggled, but it was still a very successful day and we reached more than 700 people in total…

The first event was organized by Matove Beads Development Association (MABEDA). They celebrated women and cleaned up the local health facility, and gave the health workers a chance to share their challenges with the community which helped the community better understand their position so they could work together to improve it. The rain had made it hard for people to reach the facility, but still more than 50 people turned up for the hour-long celebration and everyone was so happy.

The Lubira community groups–Balindhabeene, Balikyebuza and Alikyenda women groups–organized an incredibly successful day with more than 500 people attending the event! It started with cleaning Lubira Primary School, and then cleaned Lubira Health Center–they swept, slashed the grass down, and burned all the trash. With a clean health facility, each group presented a song and drama about the “war that women go through during delivery.” They were beautiful songs and dramas, and everyone loved them. One of the Lubira politicians gave a closing speech and praised the community groups for having the love and capacity to organize something so good to celebrate International Women’s Day even when the district failed to organize something. He sent his appreciation to the SAFE team for their mentorship and support, which was echoed by all the community groups and community members.

The Kalalu community groups–Kalalu Women’s Voice (KWV), Kamede Men’s Development Association (KAMEDE), Bugya Bukye, and Balibonerawo–held a cleaning activity of the local borehole along with dramas and songs, and more than 80 people attended. It was well-received and everyone celebrated the women of the community. What a successful day!