We overcame several barriers to implementing a US protocol. During the study period our ability to visualize the appendix with US increased and utilization of CT decreased. Our overall diagnostic accuracy with the US-based protocol was comparable to other published results and remained unchanged throughout the study.

their needs and organizing strategies to meet those needs to a desired performance. There is inadequate evidence on interest, level of influence and effects of participation on facility performance. This study sought to explore the structures, intrests and level of influnce of collaborative level representatives in provision of primary care services in Uasin Gishu County Structure/Method/Design: Case Study Methodology. Five primary health care facilities were selected purposively, from the six different sub-Counties. Study population included health facility committee representatives and other stakeholders working to represent community members in health activities. Data collection was through observation, Key Informant interviews, informal group discussions and review of documents including minutes.. Data was captured using audio recording, pictures, notetaking and a reflective journal. Data was and transcribed cleaned coded and analyzed into emerging themes. Findings: A total of 26 respondents were interviewed, and minutes of 5 facilities for s reviewed of the past 2 years starting 2014. Attended 3 public health public participation activities, and sat in three meetings. Health Facility Committee is the main formal government structure for community members to participate. There was no formal schedule for meetings attendance except for one facility. Committee mainly meet when there is funds for facility or any project going on. The facility committee's members participated majorly in projects as opposed to day to day functioning of facility. The committee members generally attended all meetings funds. Committee members with bigger influence were former political leaders or retired government officials. They are also able to lobby with government for mainly infrastructure support Sometimes the committee members whistle blow on lack of drugs or shortage of facilities to political leaders like Governor. Outcome & Evaluation: Structures of collaborative representation should be strengthened. A coordinated and collaborative response is required to tackle the complexity collaborative participation. Collaborative participation is a delicte process and needs strentnening for representation of community inteests Going Forward: Community has some level of influce which utimately affects the service delivery. Source of Funding: Consortium for Advanced Research Training in Africa (CARTA). Future heath systems.