Mid-Term Evaluation Report for UNMU Collaboration with NNO

Background

Uganda Nurses and Midwives Union (UNMU) was formed in 2003 as an independent, non partisan and professional union representing nurses and midwives in Uganda.

The report shows the findings of a mid-term evaluation of “Organisational strengthening of Uganda Nurses and Midwives Union project” (running from 2010-2015).

The project is a partnership between the UNMU and the Norwegian Nurses Organisation (NNO) with the overall goal of strengthening UNMU. The findings of this evaluation report cover the period from December 2009 to May 2013, which is the mid-way age of the 6 year project targeting to end in 2015.

Project background was informed by the UNMU Needs Assessment Survey conducted in Uganda in 2007, which depicted poor working conditions among nurses and midwives. These conditions were as well characterised by lack of strong bargaining system to influence better conditions of nurses and midwives and service delivery of the health care system.

Purpose/objective

To conduct a mid-term evaluation of collaboration between UNMU with the NNO, with the view of determining the extent to which UNMU is fulfilling its mission and vision statements, and is performing within the framework of its constitution. The evaluation is informed by the success indicators of the UNMU and NNO collaboration as contained in the contract agreement between the two parties and annual annexes to the main contract.

Methodology

A descriptive cross-sectional study design was undertaken. Quantitative approaches (questionnaires) and qualitative approaches (key informant interviews and focus groups discussions) were used.

All filled questionnaires were entered and processed using the Statistical Package for Social Scientists (SPSS) software. For qualitative data, content analysis was applied to capture respondents’ views. Focus group discussions were carried out with groups of 4-8 participants per discussion.

From the six regions of Uganda, four regions were randomly selected (Central, Western, Eastern and West-Nile). Districts were also randomly selected. Major health units were purposively selected considering their classification as referral hospitals or with highest number of mid-wives/nurses in the districts. The findings are based on a population of 328 respondents from the four regions.

Key findings

Sustainability of the Union
UNMU has made attempts to raise funds from various activities to attain financial sustainability. Key to these include 1% of members’ net monthly salary subscriptions, rental from two office blocks (one in Entebbe and one in Kampala). UNMU has not yet succeeded in receiving the 1% monthly subscriptions from members’ salaries.

Functionality of UNMU at Different Levels
At a Congress level, UNMU held only one meeting whose minutes could not be established. This implies limited access and sharing of information.

At the national level, UNMU conducts regular meetings in which national matters of the union are discussed. Participants are drawn from Hospitals throughout Uganda. This supports evaluation findings in which 71.3% of the respondents agreed that, at the national level; UNMU ensures participation of members in Union activities. 

The National Executive Committee has advocated for social, economic and political welfare for its members, which has included:

• Introduction and recognition of nurses scheme of service in the public sector (rather than only recognized by the private sector)
• Providing legal support to members

UNMU has faint functionality at regional, district and hospital levels. Activities at these levels include recruiting and advocating for wellbeing of members.

Recruitment of members and their well-being
UNMU has used several strategies for recruiting members into the union. The most commonly used strategy is regular circulars and branch meetings. In regard to recruit students are visits to schools and sensitization in media the two most commonly used strategies. During the period reviewed UNMU has also strengthened the Union Students Chapter in various ways.

A majority (59%) of the respondents report that UNMU addresses the members’ concerns. Housing, work hours, nurse-patient ratio and remuneration are important issues for the nurses and midwives. 42% of respondents report to have had an increase in terms of remuneration, 31% report they have had improved housing.

Partnerships
UNMU has partnered with various entities with a view of raising synergy to improve conditions of nurses and midwives in Uganda. These have included the Ministry of Health in Uganda, NNO, ICN, Baylor Uganda, FIDA-Uganda, Uganda Red Cross society as well as Uganda Midwives and Nurses Council.

Support to Other Countries
UNMU has mentored Rwanda Nurses Association in their transformation to become a union. UNMU has also conducted several consultative engagements with Zambia Union of Nurses Organisation.

Recommendations

1. Develop a clear long term strategic working framework to harmonise the operations of the Union;
2. Expedite the process to have the withheld monthly subscription in the suspense account to be deposited on the UNMU bank account; 
3. Develop an advocacy framework to facilitate advocacy for recruitment of more staff to reduce the ratio of patients to nurses / midwifes and long work hours;
4. Strengthen the students’ chapter by raising more awareness in the media and visitations to nursing and midwifery schools to attract members into the Union;
5. Work out a framework through which government sponsored health workers can become automatic members of the Union to solve the challenge of subscription fees;
6. Write more funding proposals to donors;
7. Expedite completion of the wellness center and rent out some levels to other entities to raise funds for union activities;
8. Interest the Uganda Nurses and Midwives Council to publish a list of registered nurses and midwives in their website;
9. Publish a list of members, activities and benefits on the UNMU website;
10. Work out an arrangement with the nurses Council to encourage the registration of nurses.

Comments from the organisation, if any

The Norwegian Nurses Organisation has continued to support UNMU, using this evaluation as a base for further organisational development. The evaluation presents a picture of some of the challenges facing an organisation that is still in a mid-phase of organisational growth. It is the intention of NNO to continue collaboration, aiming towards the following overarching developmental goal:

“ Uganda Nurses and Midwives Union shall become a vibrant, sustainable professional organisation and trade union protecting and assisting in meeting the professional and socio-economic needs of its members, hence motivating the nursing/midwifery workforce to improve health care services in their country.”