June 2001, when M&L and the Centre for African Family Studies
(CAFS) were first invited to work with FLEP, the Family Life Education
Program of Busoga Diocese of Uganda, this small church-based nongovernmental
organization (NGO) was beset with multiple crises. A once-proud
program had acquired a reputation for poor staff supervision, poor
financial management, and poor service delivery.
But following an intense year-long focus on the quality and management of health services, FLEP's service statistics and reputation improved dramatically, offering important insights into the linkage between good leadership, management systems, organizational climate, and improved health services. As they worked with M&L on a performance improvement plan, FLEP's managers and staff gained the confidence and skills to make significant changes.
A fully functional human resource management (HRM) system was established, where none had existed before. Improved staff commitment and higher self-worth were evident, as measured by a "before" and "after" survey of employee satisfaction. Despite a looming financial crisis, the survey showed that work climate including staff morale were markedly improved in 11 of 12 indicators. This sense of dedication persisted even through the organization's bleakest hour. In September 2002, at a time when FLEP's longstanding partnership with its major donor was dissolved, most of the staff agreed to stay on until a new donor was secured.
Direct HRM improvements were made in tandem with other system improvements. A transparent financial system was established, a policy manual was written, FLEP's board of directors received training, and the organization strengthened its ties to the community.
These improvements led to notable gains in the clinics. A comparison of the first two quarters of 2001 with the first two quarters of 2002 showed that family planning visits increased 64 percent. (New FP visits went from 5,427 to 10,263). Utilization statistics continued to show improvements. Through the first three quarters of 2002, the number of deliveries rose 20 percent, outpatient visits rose some 37 percent, and the number of children who completed immunization schedules rose for both infants under one year (37 percent increase) and children between one and five (24 percent). These gains were attributed to the 2001 reorganization.
FLEP's turnaround was set into motion when the organization carried out a self-assessment process coupled with strategic planning. Within several months, outside auditors certified FLEP's financial system as sound and the information systems began to produce accurate and timely service statistics.
While these tangible results were urgently needed, the most important success factor was a sense of unity and teamwork among FLEP staff that enabled them to work together to transform their organization.
The transformation of the Family Life Education Program (FLEP) in Uganda
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