Why Pathfinder Works in Uganda
Uganda is a country that has been plagued by political instability, high HIV and AIDS prevalence, and a lack of access to contraceptives-despite high demand. The total fertility rate in Uganda is 6.7, which is the second highest in the world. The high rate of unmet need for contraceptives (41 percent), combined with Uganda's increasing rate of population growth (3.4 percent), continues to hinder economic development, deepen poverty, and detract from the achievements that have been made in the social sector.
Pathfinder first began to work in Uganda in the late 1950s, when it helped to establish the Family Planning Association of Uganda (now known as Reproductive Health Uganda). Throughout the ongoing 20-year civil war and the changing, and often challenging, political climate, Pathfinder programs strived to ensure quality family planning assistance to those in need.
Today, Pathfinder's programs address a wide range of issues, including the lack of availability of services in post-conflict settings, the limited capacity of district health services and local community-based organizations to deliver services, the intersection of population growth, health needs and the environment, as well as youth and adolescent sexual and reproductive health. Through these programs, Pathfinder has reached some of the country's most underserved populations, including internally displaced refugees, women, youth, and the fishing communities on Lakes Victoria, Edward, and George.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In Uganda, examples of the kinds of evidence we collect to range from the "percentage of HIV-positive women seen at clinics who report unmet need for family planning services" and the "number of children under 5 years of age who received vitamin A supplements" to the "number of targeted health units offering youth-friendly services in the area of reproductive health and family planning." Some illustrative data in Uganda suggests that, in a one-year period, Pathfinder projects achieved the following results:
- 10,484 clients received antenatal care and malaria prevention services from a project-affiliated private sector service provider.
- 1,687 new adopters of family planning
- 27,370 HIV-positive women received HIV services that provided family planning.
Building Capacity, Strengthening Systems
Pathfinder is a leader in community engagement and capacity building for family planning and reproductive health in Uganda. Pathfinder's community approach supports village health teams in their family planning outreach efforts, while continuing to equip selected health facilities with basic equipment that would otherwise not be available for service delivery.
Through the Ministry of Health and district health offices, Pathfinder has trained various cadres of the health service sector, from the community to the national level. Pathfinder has also trained trainers for health workers, peer educators, and village health teams on family planning, adolescent and youth sexual and reproductive health, HIV and AIDS integration, and child survival services. The trainers play a supervisory role to the trained groups and keep orienting the members that need support in terms of knowledge updates. Pathfinder is also promoting the use of data to improve evidence of effective programming by training health facility records officers/assistants, in charges and district records officers and biostatisticians in data collection, recording, verification, storage, and strategic use. To follow up and ensure quality after these trainings, Pathfinder provides supervision and on-the-job mentorship as key components of our comprehensive systems' strengthening approach.
As a result of our community training experience in Uganda, Pathfinder has taken a central role in chairing review sessions of the village health teams' national curriculum and is a member of a coalition to advocate for increased family planning commodities and supplies, on behalf of the Ministry of Health and major family planning donors.
In Nigeria, Tanzania, and Uganda, Pathfinder aims to improve the capacity of community-based organizations to better prevent mother-to-child transmission of HIV.
The HOPE project reduces threats to biodiversity conservation and ecosystem degradation in the Lake Victoria Basin while increasing access to family planning and sexual and reproductive health to improve maternal and child health in local communities.
Pathfinder worked in Northern Uganda to impact gender norms, through behavioral research and scalable interventions, to positively influence reproductive health outcomes, reduce gender-based violence and improve gender equity among adolescents.
ARISE integrates family planning into HIV and AIDS services in 11 post-conflict districts of Uganda by working with the community to build demand and supporting facilities in quality counseling, contraceptive services and referrals.
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The Lake Victoria Basin Commission’s work has garnered political buy-in from key actors at multiple levels, resulting in projects like the Health of People and Environment Lake Victoria Basin (HoPE-LBV) project, led by Pathfinder International. HoPE-LBV has been successful in a number of ways, said Othero, including helping to shift prevailing gender roles by encouraging men to engage in family planning and reproductive health and by encouraging women to engage in sustainable livelihoods and natural resource management.