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Story and Perspective

USAID/UGANDA Family Planning Activity’s First Year

Uganda

LAUNCHING DURING A PANDEMIC

Michael Odwongwun, Village Health Team member. Photo: Sharon Adero

Michael Odwongwun has 40 children. Growing up, he learned that bigger families were prestigious families— and with seven wives, he had a huge family. But after spending a lifetime struggling to take care of his family’s needs, he has a message for his community: Family planning is the key to giving children the future they deserve.

Michael works as a Village Health Team (VHT) member with the USAID/Uganda Family Planning Activity (FPA), Pathfinder’s newest program in Uganda. As a VHT member mentored by FPA, Michael shares comprehensive knowledge on family planning with his community. FPA has also empowered Michael with skills to administer short-term contraceptive methods like injectables.

Launched one week before the start of the global COVID-19 pandemic, it hasn’t been a totally smooth road for the USAID/Uganda FPA—but for community members like Michael, the program has already proved invaluable.

FPA seeks to address underlying social, cultural, and structural barriers that keep people from accessing family planning services across 11 districts in Uganda. The program focuses specifically on reaching those in most demand of these services, including adolescents, youth, first-time parents, and low-parity women. Despite the challenges presented by COVID-19, in its first year, FPA has reached more than 70,000 clients across the country, bringing critical reproductive health care in a time when a lot of the health infrastructure was shut down.

What does launching a multi-year project in multiple districts look like? For FPA, it meant hiring staff members across the country, holding introductory meetings with key stakeholders from the government and civil society organizations, and starting trainings across the 11 districts. Through these meetings and conversations, an initial assessment of the varied needs and challenges was made—challenges ranging from harmful social norms and cultural barriers to ‘stock-outs’ of needed family planning resources. It meant taking a deep dive into the various entry points for creating a system that reduces the unmet need for family planning—amidst an increase in unplanned pregnancies due to the COVID-19 lockdown.

For Sylvia Nyangoma, a midwife at Bugoigo Health Center II in the Buliisa District of Western Uganda, these challenges were all compounded. For more than six months, she juggled deliveries, health education to mothers, antenatal care, and immunization and family planning services to clients while her one colleague was away on maternity leave. She did this as COVID-19 increased the number of clients who needed her help—and during the height of the pandemic, was serving between 20–30 mothers daily.

But she took it in stride. From her youth, Sylvia knew she wanted to be a midwife. When she was 10, her mother told her a story of how a midwife had saved her life when giving birth to Sylvia and her twin brother.

“I was so touched by the story my mother shared. It inspired me to become a midwife. My mother narrated that she bled a lot to the point of death but was saved by a midwife… and since I was 10, I wanted to be a midwife because I heard that story from my mother.”

Sylvia didn’t have to do it all alone. Through FPA’s “Training of Trainees” program, Sylvia received mentorship from Benadeta Wokusiima, an FPA-trained health worker in her district. Benadeta conducted trainings on injectables and implants, sharing family planning counseling techniques through her mentorship. This mentorship enhanced Sylvia’s ability to educate her clients on how different contraceptive methods work—and also taught her to effectively capture data into a family planning register, which feeds into Uganda’s Health Management Information System— a critical tool for understanding how family planning is being used and where the critical gaps are.

FPA also reached Sarah Nabossa, a midwife at Kiyuni Health Center III. For five years, Sarah had been advising clients to use short-term contraception like condoms, pills, and injectables —because she was unable to administer or remove implants, which prevent pregnancy for up to five years at a time. Scared to make a mistake, she simply avoided talking to her clients about implants, even if it was their preferred family planning method. But today, after mentor­ship from FPA, Sarah is administering implants regularly.

In addition to direct mentorship on administering contraceptives, FPA mentors youth champions in advocacy and communication, demystifying misconceptions and myths about family planning.

Hanifa Kwiyocwiny, 26, receiving implant. Photo: Sharon Adero.

Gloria Tusiime is one of the 61 youth champions who has become a face for family planning in her community. As a youth champion, she leads peer-education sessions with other young people, provides information and answers questions on family planning, and offers contraceptive methods of choice at the local health facility. She facilitates conversations about each contraceptive method, side effects, and existing myths and misconceptions. And the community trusts her.

Hanifa Kwiyocwiny, a 26-year-old resident in Gloria’s com­munity, received guidance from Gloria on the use of implants. “I feel encouraged to continue using family planning,” says Hanifa. “Gloria has given me the knowledge to also convince my sister to use family planning!”

“As a champion,” says Gloria, “I act as a peer educator to fellow youth…and being a mother and a midwife has helped me to understand that it’s not easy for a girl out there to know when to give birth. I talk to them positively about family planning.”

Across Uganda, it’s VHT members like Michael, midwives like Sylvia and Sarah, and champions like Gloria who are making— and will make—FPA a success.

At A Glance – Uganda’s Family Planning Statistics

  • At 3% Uganda’s annual population growth rate is among the highest in the world.
  • The main drivers of adolescent pregnancy, child marriage, and high fertility are religious influence, parenting, and lack of quality family planning services.
  • Ugandan women have a high unmet need for family planning, with 28% of married women and women in unions expressing an unmet need and only 35% of married women using modern contraception.

Community Health Worker with USAID/Uganda FPA. Photo: Sharon Adero

Family Planning Activity’s First Year:
Impact on the Ground

  • Trainings conducted on essential supply chain practices, addressing record-keeping using stock cards, stock books, and procedures for redistribution.
  • Engagement workshops held with cultural, religious, and district leaders from five kingdoms.
  • 11 youth engagement meetings held between July and September 2020, reaching 259 young people (155 female and 104 males).
  • 70 youth champions identified, who will be trained to serve as advocates to their peers, encouraging them to use family planning services.
  • Radio activities run, including 19 radio talk shows, 540 DJ mentions, and 540 spot messages.

USAID/Uganda Family Planning Activity
2020–2025

  • Engages stakeholders across government, cultural and religious institutions, civil society, private sector, and implementing partners, strengthening leadership and coordination to address barriers to family planning uptake.
  • Increases the proportion of the national health budget allocated to family planning.
  • Facilitates the updating and dissemination of national family planning standards and guidelines.
  • Builds capacity for family planning service delivery with a focus on quality counseling and expansion of providers’ technical skills to offer a full range of contraceptive options.
  • Addresses contraceptive stock-outs.
  • Works with drug shops and private pharmacies in underserved areas where there are few or no health clinics.
  • Improves data quality, reporting, and use for program design, management, and decision making.
  • Shifts social norms through evidence-based social and behavior change communication techniques to improve healthy timing and spacing of pregnancies

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