included in the report cards were identi...ed as key areas subject to improvement and include utilization, quality of services, informal user charges and comparisons vis-à-vis other health facilities in the district and the country at large. Each treatment facility and its community had a unique report card summarizing, in a format easily accessible to the communities, the ...ndings from the surveys conducted in their area.

The report cards were translated into the main language spoken in the community.<sup>10</sup> To support the non-literate community members, posters were designed by a local artist so that otherwise complex information and concepts were easily understood. Because the information in the report cards was largely statistical, the posters visually conveyed the main messages, such as where people go to seek medical care and why they do so.<sup>11</sup>

# 5.2 Dissemination and Participation

Getting people to retain and use information to achieve a speci...c objective is a complex problem.<sup>12</sup> Extensive piloting concluded that simply reporting the facts would be likely to have little impact. Thus, to maximize the likelihood that the information in the report cards would be used when people decide what actions to take, a participatory approach was chosen where community members themselves actively interpreted and analyzed the information.<sup>13</sup> To this end, the process of providing information and encouraging participation and monitoring was initiated through a series of meetings: a community meeting; a sta¤ meeting; and an interface meeting. Sta¤ from various Community-based organizations (CBO) acted as facilitators in these meetings.<sup>14</sup> The community meeting was a two-day (afternoons) event with approximately 100 invited participants drawn from the surveyed villages in the catchment area of the health facility. To avoid elite capture, the invited participants consisted of a selection of representatives from di¤erent spectra of society (i.e. young, old, disabled, women,

> 10In the end, the report cards were translated into six di¤erent languages: Ateso (Soroti), Lusoga (Iganga), Lango (Apac), Luganda (Masaka, Wakiso, Mukono and Mpigi), Runyankore (Mbarara) and Lugbara (Arua).

> 11See the appendix for a prototype poster.

> 12See, for example, Lupia (2004) who systematizes and draws conclusions from clinical, psychological, and economic research on information transmission and processing.

> 13The approach we used is closed linked to the so-called "participatory rural appraisal approach". Participatory rural appraisal (PRA) is a label given to a growing family of participatory approaches and methods with the common aim of enabling people to make their own appraisal, analyses, and plans. PRA evolved from a set of informal techniques used by development practitioners in rural areas to collect and analyze data (World Bank, 1996).

14Since the CBOs were in regular interaction with the communities and had a mandate drawn from a long-term presence on the ground working with the community, these facilitators were perceived to be a good conduit through which the project could be delivered. The CBO facilitators were trained for seven days in data interpretation and dissemination, utilisation of the participatory methodology, and con‡ict resolution and management. It should be noted that various CBOs (including some participating in the project) also operate in the control districts. Thus, the presence (and numbers) of CBOs in the project communities is similar across treatment and control groups.

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