REPUBLIC OF UGANDA

KIRYANDONGO DISTRICT Family Planning - Costed Implementation Plan 2018/19 - 2022/23

JUNE 2018

KIRYANDONGO DISTRICT LOCAL GOVERNMENT

This District Family Planning Costed Implementation Plan has been made possible with the technical support from the Ministry of Health and the United Nations Population Fund through Kiryandongo District Health Office. This project was funded byUK aid from the UK government.

Published by: Kiryandongo District Local Government

Ownership: Reproduction of this plan for educational or other non-commercial purposes is authorized without permission from the Kiryandongo District Local Government, provided the source is fully acknowledged.

Preferred Citation: Kiryandongo District (2018). District Family Planning Costed Implementation Plan, 2018/19 – 2022/23. Kiryandongo, Uganda

Copies available from: Kiryandongo District Health Office, P. O. Box 137, Kigumba. iv

Table of Contents

List of Tables vi List of Figures vii FOREWORD viii PREFACE ix ACKNOWLEDGMENT x ACRONYMS xi EXECUTIVE SUMMARY 2 SECTION ONE: INTRODUCTION 3 1.1 Introduction 3 1.2 Background 3 1.3 Administrative Structure 3 1.4 Demographic Characteristics 3 1.5 Socio-economic Infrastructure 4 1.5.1 District Demographic Profile 5 1.5.2 District Human Resources for Health 6 1.5.3 Health Facilities in the District 6 1.5.4 Development Partners in the District as at the End of 2017 8 1.6 SWOT Analysis for Family Planning Services in Kiryandongo District 9 1.7 Process of developing the District CIP 10

SECTION TWO: THE CASE FOR KIRYANDONGO DISTRICT FP COSTED 11 IMPLEMENTATION PLAN 2.1 Introduction 12 2.2 Demand Creation 12 2.3 Service Delivery and Access 13 2.4 Contraceptive Security 13 2.5 Policy and Enabling Environment 14 2.6 Financing 14 2.7 Stewardship, Management and Accountability 14 v

SECTION THREE: DISTRICT STRATEGIC PRIORITIES 16 3.1 Introduction 17 3.2 Vision, Mission, Core Values and Goal 17 3.3 District strategic priorities in FP 17 3.3.1 Demand Creation 18 3.3.2 Service Delivery and Access 19 3.3.3 Contraceptive Security 21 3.3.4 Policy and Enabling Environment 22 3.3.5 Financing 22 3.3.6 Stewardship, Management and Accountability 22

SECTION FOUR: COSTING OF THE PLAN 24 4.1 Introduction 24

SECTION FIVE: DISTRICT INSTITUTIONAL ARRANGEMENTS FOR 27 IMPLEMENTATION OF THE PLAN 5.1 Introduction 28 5.2 Management, Coordination, and Accountability Structure 28 5.3 Roles and Responsibilities of Key Actors (District Level) 28 5.4 Coordination Framework 28 5.5 Resource Mobilization Framework 29 5.6 Performance Monitoring and Accountability 29 5.7 Routine Data Collection 31 5.8 Data Management 31

SECTION SIX: DISTRICT IMPLEMENTATION FRAMEWORK WITH FULL 32 ACTIVITY DETAIL REFERENCES 40 vi

List of Tables

Table 1: District Demographic Profile 4 Table 2: District Human Resources for Health 5 Table 3: Health Facilities in the District 6 Table 4: Development Partners in the District as at the End of 2017 7 Table 5: Health Service Providers in Kiryandongo District 7 Table 6: Partner Mapping 8 Table 7: SWOT Analysis 9 Table 8: Costing of the District FP Implementation Plan 25 Table 9: Summary Costs per Thematic Area per Financial Year (Millions, UGX 26 Table 10: Illustrative List of National Indicators to Inform the District FP CIP 29 Table 11: Implementation Framework by thematic areas 32

List of Figures

Figure 1: District map and location in Uganda 5 vii

Foreword This District Family Planning Costed Implementation Plan 2018/19 – 2022/23 provides analysis of family planning issues in the district.

The plan is a reflection of the concerted efforts We are committed to contribute significantly of Kiryandongo District Local Government family to national imperatives, as well as supporting planning stakeholders in addressing family planning individuals, families and communities to realize priorities in order to improve the health of the their rights and benefit from use of family population. planning services and contribute towards national development. On behalf of Kiryandongo District Local Government and my own behalf, we do associate with the good Our approach builds on communities’ capabilities work in family planning that the District Technical to chart their own family planning agenda as they Team; to which we provide political stewardship, has pursue their rights within the wider health sector over the years been implementing. We acknowledge imperatives. We hope that the highlights of our the importance of partnerships in creating and intents featured in this plan will inspire us all to sustaining our cause in enhancing citizen access forge forward towards empowered communities to to and utilization of family planning services in sustainably pursue their family planning needs and the district. To this end, we applaud the strong meaningfully participating in district development partnerships with Ministry of Health and UNFPA to initiatives. contribute towards improving the quality of family planning services in the district. As the political leadership, we are grateful to the development partners for the financial and technical support to Kiryandongo District Local Government to fulfill our commitments. We strongly urge communities who are beneficiaries of these efforts to make good use of this support. viii

Preface Over the years, the rapid population growth in Uganda which is estimated at 3% per year has contributed to the ever increasing demand on the limited national resources. This has brought a number of development issues to the fore.

First has been the increased burden for quality Developing this District Family Planning Costed health care service delivery in Uganda amidst the Implementation Plan 2018/19 - 2022/23 for ever reducing budgetary allocations to the health Kiryandongo district will go a long way in addressing sector. Second, the ever increasing young population the rapid population growth rate to levels that are has resulted into a large dependent population in consonance with the available resources. With considering that over 70% of Uganda’s population is the increasing refugee population, the district will made up of young people. continue to prioritize family planning as one of the key strategies in addressing its population growth Whereas in the past, large family sizes were rate. considered as viable investment in terms of agricultural production and social security against old I therefore call upon all stakeholders to come age, the current economic situation communicates together and leverage resources to actualize our to the contrary. Big family sizes have continued to aspirations as outlined in this plan. exert pressure on economic capacities of households resulting in high poverty levels thus undermining the Government’s goal of prosperity for all.

Today households are increasingly becoming more vulnerable to catastrophic health expenditures due to the high out-of-pocket health care costs. As such, having small and manageable families is no longer a debatable issue. This is because it is quality families that help to drive the economic transformation processes at household level which in turn fuels national development. ix

Acknowledgement

The development of the Kiryandongo District FP I would like to thank the consulting team that CIP 2018/19-2022/23 was made possible with the guided the development of this plan, as well as technical and fi nancial support of UK aid from the UK the communities that provided information which government, through the United Nations Population facilitated the shaping of this document. We are Fund (UNFPA), and the Ministry of Health. It was grateful to you all. developed in a participatory manner involving family planning stakeholders in Kiryandongo District Local Government. x

Abbreviations

ANC Antenatal Care NGOs Non-Governmental Organizations BEmONC Basic Emergency Obstetric and New- NMS National Medical Stores born Care OPD Out Patient Department CAO Chief Administrative Officer PEE Policy and Enabling Environment CEmONC Comprehensive Emergency Obstetric PMA Performance Monitoring and and New-born Care Accountability CH Child Health PFP Private for Profit CPD Continuous Professional Development PNFP Private Not For Profit CPR Contraceptive Prevalence Rate RDC Resident District Commissioner CS Contraceptive Security RH Reproductive Health CSO Civil Society Organization RHU Reproductive Health Uganda DC Demand Creation SBCC Social and Behavior Change DHIS District Health Information System Communications DHO District Health Office SD Service Delivery DHS Demographic Health Survey SMA Stewardship, Management and DHT District Health Team Accountability DQA Data Quality Assurance SWOT Strength, Weaknesses, Opportunities and Threats DSW Deutsche Stiftung Weltbevölkerung TC Town Council DTPC District Technical Planning Committee TOT Training of Trainers FP Family Planning UBOS Uganda Bureau of Statistics FP CIP Family Planning Costed Implementation Plan UDHS Uganda Demographic and Health Survey FY Financial Year UGX Uganda shillings GoU Government of Uganda UHMG Uganda Health Marketing Group HC Health Centre UNFPA United Nations Population Fund HMIS Health Management Information System IRC International Rescue Committee LLGs Lower Local Governments MARPS Most At Risk Persons MoH Ministry of Health xi

Executive Summary

The Kiryandongo District Family Planning Costed Implementation Plan complements the Government of Uganda (GoU) commitment to reduce the unmet need for family planning (FP) to 10 percent and increase the modern contraceptive prevalence rate to 50 percent by 2020.

In partnership with the central government, the The above strategic priorities give direction to District Costed Implementation Plan (2018/19- the six essential components or thematic areas of 2022/23), will not only enable Uganda reach her the national FP CIP, which is also adapted in the FP goals, but also set a precedent on the strategic Kiryandongo District FP CIP. Below are the six direction the district has towards family planning. thematic areas: Similar to the national FP Costed Implementation Plan 2015-2020, this district FP CIP is driven by the 1. Demand Creation. strategic priorities listed below: 2. Service Delivery and Access. 3. Contraceptive Security. • Priority # 1: Increase age and culture appropriate 4. Policy and Enabling Environment, information, access, and use of family planning 5. Financing. among young people, ages 10-24 years. 6. Stewardship, Management and Accountability. • Priority # 2: Promote and nurture change in social and individual behavior to address myths, While feeding into the national FP CIP, this district misconceptions, side effects, improve acceptance FP CIP will cost UGX 2,230,000,000,000 (Two and continued use of family planning to prevent billion, Two hundred and Thirty million Uganda unintended pregnancies. Shillings) between 2018 and 2023. The interventions, • Priority # 3: Implement task sharing to increase activities, and accompanying costs realized in this access, especially for rural and underserved plan will help the GoU and partners to mobilize populations. resources and monitor the implementation of • Priority # 4: Mainstream implementation of Uganda’s family planning programme. family planning policy, interventions, and delivery of services in multi-sectoral domains to facilitate a holistic contribution to social and economic transformation. • Priority # 5: Improve forecasting, procurement, and distribution and ensure full financing for commodity security in the public and private sectors. Family Planning - Costed Implementation Plan 2 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

SECTION 01: Introduction and Background Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 3

1.1 Introduction The percentage of the population below the poverty The Kiryandongo District Family Planning Costed line in the district is at 30%, compared to the national Implementation Plan (2018/19-2022/23) builds on figure that stands at 24% (UBOS, 2013). the Ugandan government’s political commitment towards increased financing of family planning 1.3 Administrative Structure at the London Summit in 2012. In implementing Kiryandongo District is made up of one county called her strategic commitment, Uganda developed the Kibanda, four sub-counties namely: Kiryandongo Uganda Family Planning Costed Implementation with four parishes of Kikube, Kichwabugingo, Plan, FP CIP, 2015-2020. The FP CIP reflects a Kitwara and Kyankende; Kigumba with three “common” plan for all stakeholders involved in parishes of Mboira, Kiigya and Kigumba I; Masindi implementing family planning activities towards a Port with two parishes of Kaduku and Waibango; and consultative, coordinated, streamlined management Mutunda with three parishes of Diima, Kakwokwo and accountability structure involving local and Nyamahasa. The district has one town board of government and district multi-sectoral stakeholders. Karuma and three town councils of Kiryandongo with In order to foster this mandate, Kiryandongo two wards of Northern and Southern; Bweyale with District Local Government in collaboration with three wards of Central, Northern and Southern as technical groups initiated, through a participatory well as Kigumba with three wards of A, B and C. In and consultative process, the development of this total the district has 211 gazetted villages. District Family Planning Costed Implementation Plan in alignment with the national FP CIP. 1.4 Demographic Characteristics The 2014 Uganda Bureau of Statistics (UBOS) Below is a brief description of Kiryandongo showed that Kiryandongo’s population was 268,188 District’s profile with specific reference to location, people of whom 123,541 were male, 144,647 were demographic data, health facility staffing, health female and an estimate of 12,601 were children facilities and socio-economic activities, district below one year. The population density stands at 74 Strengths, Weaknesses, Opportunities and Threats persons per square km. (SWOT) and the process of developing the district FP CIP.

1.2 Background Kiryandongo District is located in the mid-western part of Uganda, with its headquarters 218 Kms away from Kampala. It is bordered by Nwoya District to the north, Oyam to the north east, Apac to the east, Nakasongola to the south east, Masindi to the south and west. The District is at an average altitude of 1,295 meters above sea level, situated between 10 22’ and 20 20’ north of the Equator, longitude 310 22’ and 320 23’ east of Greenwich. The district covers an area of 3,621 Sq. Kms most of which is arable land with a perimeter of 478 kms. The Victoria Nile borders the district in the north, west and south east. Family Planning - Costed Implementation Plan 4 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 1: Average Household Size and Population by LLG and Refugee Settlement County Sub-county Households Population Number Average Size Males Females Total Kibanda Bweyale Town Council 6,348 4.9 5,178 16,432 31,610 Kigumba 8,565 5.2 22,667 22,612 45,279 Kigumba Town Council 4,160 4.4 8,934 9,764 18,698 Kiryandongo 15,544 5.2 40,661 39,705 80,366 Kiryandongo Refugee 2,220 5.9 6,507 6,975 13,482 Kiryandongo Town Council 1,302 4.2 2,939 2,997 5,936 Masindi Port 1,888 4.8 4,745 4,307 9,052 Mutunda 12,683 5 31,910 31,855 63,765 Total: 52,710 4.95 123,541 134,647 268,188

Source: National Population and Housing Census 2014 Report

1.5 Socio-economic Infrastructure In the education sector, Kiryandongo District has 73 government-aided primary schools; 34 private primary schools; four government-aided secondary schools; 24 private secondary schools and two government tertiary institutions as well as one private tertiary institution.

In the roads sub sector, the district has a total road network of 1,146 kms. Of these, 131.2 kms are classified as national roads with 77.2 kms tarmacked and 54 kms gravel. In total, 367 kms are classified as district roads of which 65% are in good/fair motorable condition while 126 kms are urban roads. Only 0.4 kms are tarmacked and 532 kms are major community access roads having less than 30% of the access roads as motorable.

1.5.1 District Demographic Profile With a total population of 268,188 people, Kiryandongo District has a contraceptive prevalence rate (CPR) of 31% for 2016/2017 and an unmet need for family planning of 28.8%, a figure which is slightly higher than the national rate of 28% (UDHS, 2016). Furthermore, the survey concluded that teenage pregnancy and motherhood are a major social and health concern as they are associated with higher morbidity and mortality of both mother and the baby. The district has an estimated 14,213 women of child bearing age (15-49) while the expected number of pregnancies per year stands at 14,653 as summarized in the table below. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 5

Figure 1: Kiryandongo District map and location in Uganda

Moyo Lamwo Kaabong Yumbe

Kitgum

Adjumani Kotido Arua Agago Amuru Pader Moroto Gulu

Abim Zombo Nwoya Otuke Nebbi Napak Oyam Alebtong Kole Lira Amuria Kiryandongo

Dokolo Buliisa Apac Katakwi

Soroti Amudat Albert Masindi Amolatar Kumi Serere Lake Kyoga Ngora Kween Lake Nakasongola Hoima

Buyende Bulambuli Bukwo Kyankwanzi Pallisa Nakaseke Kakumiro Bududa Ntoroko Kagadi Kamuli Kiboga Kayunga Kibaale Luwero Manafwa Tororo Kyenjojo Jinja Bugiri Mubende Mukono

Busia Kyegegwa Kasese Kamwenge Gomba

Ssembabule Kazinga Channel Buvuma

Kiruhura Rubirizi Kalangala Buhweju yantonde

L Lwengo Bushenyi Mbarara Lake Victoria

Rakai Isingiro Ntungamo

Kabale Family Planning - Costed Implementation Plan 6 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 2: Selected Demographic Health Indicators Demographic Variables Result Total Population 295,000 District HIV Prevalence Rate 5.9% Estimated no. of women of child bearing age (15- 49) 14,213 Expected number of pregnancies per year 14,653 Number of expected birth per year 14,213 Infants below one year 12,601 CPR (2016/2017) 31% Unmet need for family planning 28.8% Source: Uganda Demographic and Health Survey (2016) and Kiryandongo DHIS2 (2016)

1.5.2 District Human Resources for Health According to Ministry of Health staffing norms, Kiryandongo District has 51% approved posts filled by trained health workers compared to the 2015 national target of 90%. The gaps in health sector staffing have several implications for service delivery. Some key health workers required at some levels of health care are missing. In reference to family planning services, some health centres are not able to offer particular methods especially the long term methods due to lack of skilled professionals in these facilities. Health facilities at the border with other districts serve wide catchment populations resulting into augmented workloads for the available staff.

1.5.3 Health Facilities in the District As indicated in table 3 below, health service provision is by both the public, private not for profit (PNFP) and private sector facilities. The district has 17 Health Centre IIs, eight Health Centre IIIs and two hospitals (one in Karuma and the other in Kiryandongo Town Council). There are three PNFP facilities at HC III level.

Table 3: Distribution of Health Facilities by Location, Level and Ownership Health Sub-District Sub-county Parish Health Unit Level Ownership Kibanda Mutunda Karuma Karuma Hospital Hospital Gov’t Kiryandongo TC Northern ward Kiryandongo Hospital Hospital Gov’t Bweyale TC Southern ward Panyadoli III Gov’t Kigumba SC Kigumba I Kigumba III Gov’t Mutunda SC Diima Diima III Gov’t Mutunda SC Kakwokwo Mutunda III Gov’t Masindi port Waibango Masindi port III Gov’t Kiryandongo SC Kicwabugingo Katuliikire III PNFP Kiryandongo SC Kicwabugingo Karungu III PNFP Kigumba TC Ward C St. Mary’s Kigumba III PNFP Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 7

Kiryandongo SC Kitwara Tecwa II Gov’t Kiryandongo SC Kitwara Kitwara II Gov’t Kiryandongo SC Kyankende Diika II Gov’t Kiryandongo SC Kikube Kiroko II Gov’t Kiryandongo SC Kikube Kiryandongo prisons II Gov’t Masindi port Kaduku Kaduku II Gov’t Kigumba SC Kiigya Kiigya II Gov’t Kigumba SC Mboira Apodorwa II Gov’t Kigumba SC Kigumba I Kigumba Prisons II Gov’t Kigumba SC Kigumba I Mpumwe II Gov’t Mutunda SC Nyamahasa Yabwengi II Gov’t Mutunda SC Diima Karuma II Gov’t Mutunda SC Kakwokwo Panyadoli hills II Gov’t Bweyale TC Northern ward Kicwabugingo II Gov’t Bweyale TC Southern ward Nyakadoti II Gov’t Bweyale TC Central ward Lacor Allied II PFP Kigumba TC Ward A Kigumba medical centre II PFP

Source: Kiryandongo DHIS2 (2017)

The average distance from one health centre to another is about 10 kms. Accordingly, the distance to health centers contributes to why some people do not use family planning. This is also one of the reasons women default on FP. The hospitals and HCIVs are able to offer a range of family planning services including the permanent methods while for HCII and HCIIIs, the community is able to receive antenatal care (ANC) as well as short-term and long-term family planning methods.

Table 4: Health Service Delivery Points by Level and Ownership Health centre by level Ownership Number Hospital Govt 2 PNFP 0 HCIV 0 HCIII Govt 5 PNFP 3 HCII Govt 15 PNFP 0 PFP 2 Total 27 Source: Kiryandongo DHIS2 (2017) Family Planning - Costed Implementation Plan 8 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 5: Health Service Providers in Kiryandongo District Service outlet Public PNFP Private Total Services Hospital 02 0 0 0 02 Comprehensive Emergency Maternal and Obstetric Care (CEmOC), all FP methods HCIII 05 03 0 08 Basic Emergency Maternal and Obstetric Care (BEmOC), Child Health, short and long-term FP methods HCIV 15 00 00 22 Antenatal Care, Child Health and short-term methods of FP Total 25 07 01 33

Source: Kiryandongo DHIS2 (2017)

1.5.4 Development Partners in the District as at the End of 2017 Kiryandongo District has several partners within the health sector supporting different areas. Table 6 below captures the different partners and their various form of support to the district:

Table 6: Partner Mapping Name of Partner Intervention Area Coverage Implementation mode Direct Funding Technical Assistance In-kind RHU RH/FP Entire district No Yes Yes PACE HIV/AIDS Entire district Yes Yes Yes UHMG Social Marketing Entire district No Yes Yes AMREF HIV Entire district Yes Yes Yes Marie Stopes Family Planning Entire district No Yes Yes Source: Kiryandongo DHIS2 (2017) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 9

1.6 SWOT Analysis for Family Planning Services in Kiryandongo District The analysis for the district examined the Strengths, Weaknesses, Opportunities, and Threats (SWOT) for the family planning services.

Table 7: SWOT Analysis

Strengths Strategies to consolidate the strengths • Reliable supply of FP commodities by • Strengthen the supply chain system in quantification, NMS to the district forecasting, ordering and monitoring of stocks • Availability of trained and professional • Continuous capacity building for health facility staff health staff in the public sector • • Existence of health facilities providing • Get more FP partners to widen coverage a range of family planning and ANC • Disseminate regulatory framework and laws to all partners and services health workers • Supported community outreaches • Existence of regulatory framework and laws Weaknesses Strategies to minimize • Low staffing levels resulting into long • Developing a responsive and equally distributed number client queues, compromised counselling of staff to meet the demands of the increasing numbers of for FP patients in health faculties • Weak leadership and governance by • Promoting multi-sectoral capacity building to empower the all health unit management committees leaders with information and knowledge to harmonize health with little commitment to serving the support and information people • Increase community mobilization for male involvement • Low male involvement and support • Strengthen capacity of health worker in data management and • Compromised quality of data and late reporting reporting by some health centres • Step up advocacy for increased funding • Low budgetary allocation to family planning Opportunities Strategies to optimize opportunities • Wide stakeholder involvement and • Active involvement of all stakeholders in health matters to be engagement in the health sector able to build ownership and develop practical strategies planning • Implement policies that support demand creation and provide • Existence of enabling policies, laws and an enabling environment for the uptake of FP services regulations supporting family planning in • Strengthen partner coordination for leveraging efforts and Uganda resources • Existence of implementing partners and • Continuous capacity building for community volunteers and PNFPs in the health sector VHTs • Availability and willingness of • Increase number of male champions and support them to community volunteers and village health mobilize more fellow men teams (VHTs) • Presence of FP male champions in the district Family Planning - Costed Implementation Plan 10 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Threats Strategies to mitigate • Community-held misconceptions against • Developing age and culture appropriate information on FP family planning by potential FP services to enhance voluntary informed decisions to utilization of FP users services • High cases of sexual and gender-based • Continuous community sensation and use of male champions to violence by men on women who use FP educate fellow men • Some religious and cultural leaders • Empower religious and cultural leaders with appropriate FP continue to condemn family planning as information to mobilize communities its thought to promote immorality • Increase community sensitization on benefits of having • Pressure and competition to give birth manageable family sizes especially in polygamous families

1.7 Process of Developing the District CIP All Lower Local Governments (LLGs) were The process of developing this FP CIP started represented in the District Technical Planning with a comprehensive desk review to analytically Committee (DTPC) for their inputs. Data for District understand the conceptual issues around family FP CIP was therefore, informed by both secondary planning in general and specifically in Kiryandongo and primary data that were collected through: (a) District. Desk reviews, (b) Meetings with technical staff, (c) The process entailed wide involvement and District level key informant interviews, (d) LLGs consultation of key stakeholders. At district level, consultative meetings, and (e) community and health stakeholders were drawn from the District Council, facility visits. District Health Team (DHT), District Technical Planning Committee (DTPC), Family Planning Development Partners, cultural and religious leaders, private sector, community volunteers and civil society organizations (CSOs). Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 11

SECTION 02: The Case for Kiryandongo District FP Costed Implementation Plan Family Planning - Costed Implementation Plan 12 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

2.1 Introduction • Local people are not given adequate information This section presents a detailed analysis and literal on different family planning methods in order to review of key issues that influence contraceptive enable them make appropriate choices. prevalence rate. As detailed in the Uganda National FP CIP 2015-2020, the review and analysis is The above scenario suggests that within the district, categorised along the following main themes: there are inadequacies in the knowledge levels about family planning at all levels. In a few sub counties, 1. Demand Creation (of family planning services). mass education about the benefits of family planning 2. Service Delivery and Access. through community-based meetings are conducted 3. Contraceptive Security. by male champions and other community volunteers, 4. Policy and Enabling Environment,. partners and health workers through mass media 5. Financing. (radio). Local people do not have a clear source of 6. Stewardship, Management and Accountability. information about family planning services and related issues. For the few local people who turn to 2.2 Demand Creation health workers for technical advice and guidance, the health workers are themselves constrained Awareness of at least one method of contraception with heavy workloads, coupled with the fact that in Uganda is universal (UDHS, 2016). However, in sometimes they may lack capacity to fully explain the Kiryandongo District, there are fears of side effects facts associated with contraceptives. Additionally, mixed with misconceptions about family planning there is no age-specific information that targets services, negative attitudes towards FP with some groups of persons for example youths, adolescents locals harbouring feelings that contraceptives and the elderly. Many sensitive issues are not promote promiscuity, immorality and prostitution addressed especially among youth. Dissemination especially among adolescents. Demand for and of accurate information about FP methods and their uptake of family planning can be increased by availability as well as encouragement of FP use to expanding knowledge and addressing myths promote the health of women and their families and misconceptions through public visibility and will increase knowledge of, and demand for family campaigns. Additionally, the same report revealed planning. Champions and advocates can increase that: demand for family planning within communities, • Lack of men’s support with many thinking that producing a supportive environment; reducing family planning is only for women since the men social, cultural, and religious barriers; and mobilizing have fewer options, in addition to cultural values community support. which emphasize the need to have a high number of children by the men; In the Family Planning district stakeholders’ • Many youths are ignorant or do not know that meeting held on 27th November 2017, the key family planning services are free of charge in public stakeholders consistently agreed that there is no health facilities; clear and harmonized communication and consistent • Many women in the district are not sure about the messaging about family planning in Kiryandongo. efficacy and are worried about the side effects of Furthermore, there is generally low involvement different family planning methods as several who of religious and local leaders in mobilizing the have experienced these side effects have not been community and advocating family planning services. appropriately managed due to the lack of sufficient With the Bible and Quran being rich in their capacity to manage side effects by the health prescriptions in support of family planning, religious centres especially HCIIs and HCIIIs; leaders have greater potential to mobilize the local masses and support family planning. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 13

They also expressed concern that cultural leaders Only 16% (national) of women that gave birth in have not done much to mentor men to accept and health facilities were counselled on FP before support their women in FP utilization. discharge (UDHS, 2016). This could even be lower for Kiryandongo District than the national average. Providentially, the district has Development In Kiryandongo however, there is health education Partners (DPs) involved in the promotion of some provided to mothers at ANC and Out-Patient family planning services such as Reproductive Department, as well as community outreaches by Health Uganda and Marie Stopes Uganda. These selected government facilities although this is not partners have attempted to socially market some consistent due to lack of facilitation. Community contraceptive commodities, although one of the family planning dialogues supported by technical challenges associated with the presence of DPs is people and male champions offer an opportunity that they sometimes have pre-determined agenda to discuss family planning activities in the district, which might not have sufficient flexibility to consider but there is a still widely low male involvement in the input of district authorities. FP services. Men believe that wives should take responsibility to use family planning while in some 2.3 Service Delivery and Access cases they do not allow them to use the services. Kiryandongo District family planning situation Other key challenges in service delivery and access analysis within Kiryandongo District include: The current staffing, skill level and service structure • Lack of performance incentives and facilitation. within the Ugandan health care system do not • Challenges of transporting commodities to health provide adequate and equitable FP services to centres. the population. Without adequate training, time, • Fear of the long queues at health centres. supplies, and equipment to provide services, health • Poor attitudes by health workers who sometimes care workers struggle to perform their duties ask awkward questions making clients shy away and adequately counsel clients on contraceptive from use of health services. methods. It is necessary both to sustain the current • The lack of privacy at health facilities prohibits delivery system and to deploy new FP service clients from freely expressing themselves. approaches to optimise availability and accessibility. • Shortage of human resources resulting in a poor Reducing inequities related to poverty, HIV status, ratio of health workers to clients. gender, age, and marital status in access to and use of • Some religions do not support family planning. family planning are ongoing challenges. • Family planning is thought to promote immorality and prostitution among women and youth. Unmet need for family planning Kiryandongo District targeted to reach 45,722 family 2.4 Contraceptive Security planning users between July 2015 and June 2016, According to Uganda Demographic and Health but reached only 27,423 (60%) (Kiryandongo DHIS2, Survey (2011), Government of Uganda remains the 2017). This implies that almost half of the targeted major provider of contraceptive methods, standing at population was/is not reached with intended FP 47% of free supply of contraceptives. This guarantees services. There are several reasons for this scenario freedom of choice by family planning users. The which include political and religious leaders influence government, through NMS, operates both push and in the role of family planning in socio-economic pull systems to supply commodities to the service development. Political leaders also tend to encourage delivery points; push (for HCII and III), which does not large families to spur economic growth, making full guarantee and promote free choices in contraceptive implementation of family planning policies very use, and pull, (for the hospitals) making it possible to challenging. requisition according to the needs of communities. Family Planning - Costed Implementation Plan 14 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

As shown in Table 4, Kiryandongo has two In accordance with the Constitution of Uganda and government-owned hospitals; this compared to the the Local Government Act 1997 (as amended) and number of HCIIs and HCIIIs reflects the district’s decentralization policy, Kiryandongo District has over reliance on the push system. Additionally, the made an effort to recruit and retain the critical health turn-up in hospital is usually higher; an aspect that workers to offer high quality health care services. sometimes accounts for the frequent stock-outs of However, the district suffers a high attrition rate for some family planning commodities in the district. some health cadres.

Maintaining a robust and reliable supply of 2.6 Financing contraceptive commodities to meet clients’ needs, According to the Kiryandongo District Development prevent stock-outs, and ensure contraceptive Plan (2015), family planning is highly prioritized, security is a priority for the programme to achieve but a budget analysis as reflected in Table 8 above its goal. It is crucial to ensure that contraceptive suggests low allocation of financial resources for FP commodities and related supplies are adequate and activities. According to Kiryandongo District Health available to meet the needs and choices of FP clients. Office there is no direct funding by government to family planning services. This however does not disregard the financial contribution of various non- 2.5 Policy and Enabling Environment governmental stakeholders towards family planning According to the National FP Costed Implementation services in the district. Plan (2015-2020), the current policy environment is conducive for strengthened implementation of 2.7 Stewardship, Management and the FP programme in Uganda. Family planning is Accountability District leadership recognized as a key strategy to promote social, The district leadership is highly pro-poor growth as economic, and environmentally sustainable reflected in their vision and mission statements and development, to realize sexual and reproductive commitment to serve the people of Kiryandongo health and reproductive rights, and to improve the District. In the District Council, the chairperson health of women and their children by preventing of Health Sectoral Committee directed that CIP unintended pregnancies and improving child spacing, be developed and consistently, her committee has thus reducing maternal and neonatal morbidity and spearheaded a number of innovations in the sector. mortality. The District Health Officer and his entire District Health Team has been praised by Development The Ugandan government has developed a host Partners for good coordination and direction of the of national policies and plans such as Uganda health sector. In specific terms, the district leaders Population Policy, National Gender Policy, National are aware of their mandates and responsibilities Development Plan, National Health Policy, Health and have ensured coordination among actors in the Sector Strategic and Investment Plan, National district. Family Planning Advocacy Strategy but what remains to be done is to popularize these policies among key Family planning partnerships district stakeholders. The health service providers, The District Health Team has initiated the family religious, cultural and local district leaders are not planning partnership with the PNFPs and the substantially aware of the key policy provisions and private sector to promote contraceptive use in the attendant implications for the development of the district. There has been efforts to form Kiryandongo country. District FP Consortium for linkage and coordination, however, there is no consistency in their meetings. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 15

Additionally, the district has never developed any specific annual work plan for family planning services.

Data collection, analysis and use Data is collected using the Health Management Information Systems (HMIS) tools from health facilities and forwarded to the district biostatistician for onward routine reporting to Ministry of Health through the DHIS2. At each health facility in the district, there is a designated member of staff in charge of medical records. Within the PNFP and the private sector, attempts are made to collect and submit data to the district and Ministry of Health using standard HMIS tools, even though there are challenges with the timeliness of reporting as some health facilities, both public and private, have consistently failed to report in time. What is even more challenging is that some HMIS focal persons at health facilities lack the technical capacity for effective management of data.

The collected data is stored at both the health facility and district in both electronic and hard copies. The major challenge is that some areas have very poor internet services and therefore electronic transmission of data is delayed. At the district level, the biostatistician reviews data and schedules review meetings with the HMIS focal persons. This is to guarantee data integrity and quality. In some instances, there are supervisory visits to facilities.

Data is always easily consolidated and analyzed at the health facility and district levels. The significant challenge is the dissemination and use of data for key decisions making. Additionally, the data is rarely shared with the implementers and other relevant stakeholders. Family Planning - Costed Implementation Plan 16 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

SECTION 03: District Strategic Priorities Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 17

3.1 Introduction 3.3 District Strategic Priorities in FP Section three provides an outline of the strategic The district FP CIP is well aligned to the Health priorities for family planning in Kiryandongo District. Sector Development Plan III 2016/17-2020/21, The section is structured to fit with the priorities and Uganda FP CIP (2015- 2020). In the process of highlighted in the national FP CIP. It follows a format writing the district FP CIP, due attention was made that aligns national strategic outcomes with local to the national strategic priorities which represent district priorities. It builds on the district vision, key areas for financial resource allocations and mission, core values and goal. implementation performance. The five national strategic priorities are: 3.2 Vision, Mission, Core Values and Goal • Priority # 1: Increase age-appropriate information, The vision of the district is “A prosperous district access, and use of family planning among young with sustainable high standards of living” while the people, ages 10–24 years. mission is “To serve the people of Kiryandongo • Priority # 2: Promote and nurture change in through coordinated and effective service delivery social and individual behavior to address myths, which focuses on both national and local priorities for misconceptions, side effects, improve acceptance sustainable development”. The district’s core values and continued use of family planning to prevent are: unintended pregnancies. • Professionalism. • Priority # 3: Implement task sharing to increase • Integrity. access, especially for rural and underserved • Accountability. populations. • Transparency. • Priority # 4: Mainstream implementation of • Teamwork. family planning policy, interventions, and delivery of services in multi-sectoral domains to facilitate Vision of the District FP CIP a holistic contribution to social and economic This district FP CIP builds upon the vision of the transformation. national FP CIP which is “Universal access to family • Priority # 5: Improve forecasting, procurement, planning to help Uganda attain the middle income and distribution and ensure full financing for country status by 2040”. commodity security in the public and private sectors. Goal: In line with the national operational goals of reducing the unmet need for family planning to In order to ensure that the limited resources are 10 percent and increase modern contraceptive directed to areas that have the highest potential prevalence rate (mCPR) amongst married and women to reduce the unmet need for family planning in union to 50 percent by 2020, the goal of the district and also achieve the district’s stated goal, the is: activities are structured around six thematic areas namely; demand creation, service delivery and “Accelerate universal access to family planning access, contraceptive security, policy and enabling services in the district through coordinated environment, financing, stewardship, management multi-sectoral approach including public and and accountability. private initiatives in order to increase the modern contraceptive prevalence rate amongst married and women in union to 56 percent by 2021.” Family Planning - Costed Implementation Plan 18 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

3.3.1 Demand Creation Overall, the demand creation approach in family Strategy planning in Kiryandongo District will be people- Demand for modern contraceptives is driven centred coupled with innovative outlets such as by several factors: the number of women of mobile health advocacy campaigns and use of reproductive age, the number of contraceptive users, information communication technologies. changing method mix (more use of modern methods), increasing awareness of and knowledge on FP, and Strategic outcomes improving attitudes of society about family size. Increased demand for FP services Kiryandongo District officials in charge of family Social behavior change communication (SBCC) is a planning can act to create more demand for the multi-faceted strategy for encouraging individuals services by using BCC to raise awareness, increase and communities to adopt new health behaviors. It is knowledge, change attitudes, and motivate people one of the most effective ways to create or increase to seek services. Also important is removing the demand for family planning, and reinforce positive economic barriers that hinder potential clients from values and norms. Effective SBCC recognizes that seeking services. behavior change is a process and that individuals proceed through a series of stages before adopting Effort will be made to increase the percentage of a new belief or practice. Individuals must first learn women in reproductive age group (15-49 years) about a practice. demanding family planning services using an effective communications strategy. A series of Behavioral change communication campaigns do demand creation activities will be implemented at the exist at various levels in Kiryandongo District, district, sub-county, community, and interpersonal however there is need to localize the national CIP levels. Multiple media outlets, including mass strategy in the design of SBCC campaigns. District media,; information, education, and communication authorities and other stakeholders therefore need materials; interpersonal communications; advocacy to invest efforts towards increasing on target campaigns; and champions - will be employed to market segmentation with clear messaging on increase demand and uptake of services. family planning. As prescribed in the national FP CIP, Kiryandongo District shall focus efforts on SBCC Through the Interfaith Committee, religious leaders with clear messaging to target current non-users of will use their various platforms to educate their contraception. As a culturally diverse district, there is followers on the benefits and importance of family a need to package messages in languages that serve planning at individual and community levels. Equally, different tribal segments so as to tackle myths and traditional leaders will first be trained and later on fears of both users and non-users of contraception. through a cascading plan, use their structures to advocate family planning services. In order to increase male involvement in interventions on family planning, integrating a gender The use of the available local media - including approach in family planning is also critical. Men share community radios in trading centers, drama, music responsibility for reproductive health decisions. and debates will be organized at village levels at However, lack of a specific focus on them can lead to various fora such as faith-based group meetings in the belief that family planning is not a man’s concern. the mosques and churches, fathers’ union meetings, Male involvement is crucial to a successful demand sports gatherings; among others. Special groups creation campaign to achieve the desired outcome. segments of the population will be targeted, most specifically the youths, men, Most At Risk Persons (MARPS) including sex workers. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 19

Accessible radio stations will continue to run spot The district should recognize and take steps to messages (demand driven) on FP in local languages. ensure that involving men in family planning will not Social behavior change communication has potential have a negative impact on women. Programmes to result in: that add services for men must take care that new • Greater awareness of reproductive rights, activities do not take away services from women, including the right to freely decide on the erode women’s autonomy, or unintentionally number and spacing of children and the right to reinforce inequitable gender norms and values. contraceptive information and services. Given the high numbers of young men within the • Increased knowledge of contraceptive methods, district and their unique sexual and reproductive including which methods are available, their safety, health needs, increased involvement through and their effectiveness. dialogue and service provision will be critical. • Improved knowledge of where contraceptive Deliberate efforts will be taken to use any available methods can be obtained. opportunities to advance the cause of family planning • More favourable attitudes and societal norms among men with age-specific messages. regarding family planning. • Discussion of family planning with partners, family, and friends. 3.3.2 Service Delivery and Access • Increase in contraceptive communication and Strategy decision-making by couples. Kiryandongo District strategy focuses on making • Growth in joint decision-making by couples on a wide range of high-quality methods available and family planning. accessible while ensuring rights and equity amongst • Greater willingness to consult a family planning regions and population groups. Primary focus will provider or buy condoms. be placed on increasing the number of FP service • A reduction in the number of children that couples providers who can appropriately counsel and deliver say they want. a full range of methods by implementing a series • Improved health-seeking behavior, resulting in of trainings throughout the district. Kiryandongo increased contraceptive use and intentions to use District health department and Development contraception in the future. Partners will strive to train health workers - including VHTs on rights-based programming in FP. The It is important that a family planning desk is district will enhance utilization of community-based established at the district and health facility approaches (mobile clinics and distribution points) level to galvanize the inter-sectoral and partner to complement services provided at Kiryandongo collaboration. Hospital and other health centres.

Increased male awareness of the reproductive Similar to the national FP CIP prescription, healthcare Kiryandongo District will adopt a rights-based Kiryandongo District will aim at increasing numbers approach that includes informed choice, free of men that support the use of modern contraception and informed consent, respect to privacy and for themselves and their partners. The FP programs confidentiality, equality and non-discrimination, will offer information and services to men that equity, quality, client-centred care, participation and enable them to play more supportive roles to their accountability. It also responds to community factors partners. For instance, FP programmes can help men that impede access. develop their understanding of broader family health interventions. Family Planning - Costed Implementation Plan 20 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Access to FP by young people between This will be in addition to promotion of Total 15-20 years increased Marketing Approach to cater for the three population Deliberate effort will be made to increase segments (very poor - free commodities; poor/ adolescents’ access to reproductive health medium income - social marketing/PNFPs at information and services in Kiryandongo, where most subsidised prices; and middle class – PFPs). 15-20-year-olds report being sexually active but shun traditional reproductive health clinics. A media Family planning service delivery points for young campaign that promotes abstinence for younger people increased adolescents, condoms for older adolescents, and a To improve access to FP services for youth and telephone hotline for youth-friendly information shall adolescents, FP and SRH trainings will be organized be put in place. for youth centre staff across the district so they can effectively engage youth in conversation about As reflected in the national FP CIP, Kiryandongo FP, impart knowledge regarding the full spectrum District will aim to increase knowledge and of FP options available to them, and refer them empowerment of young people and empower adults to youth-friendly service providers should they to help youth avoid teenage pregnancy. Crucially, choose to receive an FP service. Further, additional health service providers including the VHTs will be health facilities will be made more youth-friendly re-educated to change their attitudes towards young by establishing youth corners and training service persons with reproductive health needs. providers on youth-friendly services. To address the FP needs of students, advocacy meetings will Social marketing of free products enhanced be organized to ensure access to contraceptive The district will continue to support the social information in schools clinics. marketing of subsidized family planning commodities services by the Private-for-Profit (PFP) and PNFP Referral services are strengthened actors. Kiryandongo District will aim to create a referral directory for FP. The District Health Officer and Strategic outcomes Assistant District Health Officer (Maternal and Number of trained health providers able to deliver Child Health) will ensure appropriate referral tools wide spectrum of FP services increased are used in the referral systems and that all clients Most women depend on a few methods of family referred receive appropriate services. planning due to the limited number and ability of health workers to provide the full spectrum FP Motivation for FP health care workers enhanced services. To address this reliance on limited methods In a bid to increase health workers’ motivation, and promote access to a full spectrum of FP methods staff participation in decision making in FP will be and services, service providers will be trained to enhanced. Staff continued capacity development provide the entire range of FP services available at will also be part of the implementation plan. The their level. district, with support of its development partners, will arrange transport means to facilitate outreaches Access to FP services is increased especially in the hard-to-reach areas. Through the Community-based service/ distribution points will District Rewards and Sanctions Committee; the be increased to serve the very rural communities district will introduce performance incentives for its at sub county level. The district will use VHTs, staff. especially with introduction of Sayana Press, as well as Community Health Extension Workers to increase access of FP services. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 21

Integration of family planning services into other 3.3.3 Contraceptive Security health services improved Strategy As stated in the national FP CIP, in Kiryandongo In order to guarantee reliable supply of District, FP services will be integrated into cervical contraceptives so that every person is able to choose, cancer screening; post-natal care; post-abortion obtain and use quality contraceptives when and care; prevention and treatment of sexually if they need them, Kiryandongo District will work transmitted infections, including HIV prevention, closely with the central government through MoH care, and treatment; and malnutrition programmes. and specifically National Medical Stores (NMS), Kiryandongo District will roll out national health and other non-government stakeholders to ensure management protocols and all relevant stakeholders supply of contraceptive commodities and relevant will be trained. consumables in the district.

Access to family planning services by people with Kiryandongo District will strengthen the existing disabilities increased procurement modalities and mechanisms for Kiryandongo District will ensure people with contraceptives in the districts and monitor the disabilities access FP services. With the availability effectiveness of existing system for quantification, of FP clinical service delivery guidelines, the district ordering, and distribution of contraceptive stock health office will ensure all relevant FP service from national to district levels and from districts to providers are trained on their use. facilities and end users in tandem with the budgeting cycles. The district will make available contraceptive Management of family planning side effects commodities and other consumables to meet client improved needs. Kiryandongo District will utilize counselling guidelines for family planning to manage and mitigate Strategic outcomes side effects, alongside utilization of appropriate Capacity of district staff able to quantify and forecast reporting tools. The New Medical Eligibility criteria FP commodities improved will be adhered to enable health workers guide the Kiryandongo District staff will forecast FP clients on the choices of family planning. commodities more accurately as possible. Efforts will be made by the District Health Office in ensuring In-service training in FP enhanced timely submission of requisitions to NMS and/ Regular Continuous Professional Development (CPD) or Development Partners. This shall ensure that will be organized by the district either at facility or facilities are stocked more efficiently to meet FP district level to improve on the knowledge levels of needs of the district clients. the health workers. Throughout the CPD, standard manuals issued by MoH will be used. Availability of FP commodities among VHTs and community drug distributors improved Family planning knowledge and skills As enjoined in the national FP CIP, VHTs and among VHT enhanced community-based distributors will be utilized to Coverage of VHTs in Kiryandongo District will be ensure timely delivery of FP commodities to the local enhanced coupled with continuous capacity building communities within the district. As such, the health and provision of necessary FP commodities through sub-districts will play a proactive role in maintaining a well-organized and coordinated system. All VHTs in the desirable stock levels of family planning the district will be supervised and monitored. commodities. Family Planning - Costed Implementation Plan 22 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Commodity distribution to private Support to FP by local, cultural, and religious not-for-profits enhanced leaders increased The district will work closely with PNFP stakeholders The district will aim to use local, cultural leaders, FP already existent in the district to increase FP coalitions and religious leaders as advocates for FP. services. As part of the district implementation Young celebrities within the district will be targeted plan, the contribution of other stakeholders will be to act as role models and champion the advocacy firmly tracked within the HMIS to help coordinate FP platform in FP service delivery. activities execution. 3.3.5 Financing 3.3.4 Policy and Enabling Environment Strategy Strategy Programme administrators mobilize resources Under this priority area, the district shall review for family planning or reproductive health (RH) the existing policies, guidelines, strategies and service provision through two main sources, direct regulations which underline provision of FP government (central or local) financing and donor services and ensure inclusion in the modalities for financing (including bilateral, multilateral, and implementation of the district FP CIP. The district private foundations). Family planning will be highly will align all FP activities implementation with the integrated in the district’s budget framework paper national FP CIP. To improve the policy environment to ensure adequate recognition and consideration of for family planning, government policies and the need for FP services delivery. strategies will be disseminated to all relevant district stakeholders. Strategic outcomes Mainstreaming of family planning into district Specific advocacy will also be conducted to ensure planning and budgeting processes improved that policies and guidelines for family planning Advocacy for the creation of budget lines for promote access to FP services rather than hamper family planning at the district level will support the access for often-marginalized groups such as the prioritization and integration of family planning into rural population and youth and to ensure the district planning and budgeting processes. At least provision of FP services in accordance with human one percentage of the total local revenue shall be rights and quality of care standards. allocated to the health sector and in particular to FP.

Strategic outcomes Knowledge about legal framework and policies for 3.3.6 Stewardship, Management and family planning are increased Accountability The legal framework that promotes family planning Strategy will become popularized through dissemination of the The national FP CIP advocates strong monitoring, revised public acts and sensitization of district health management, leadership and accountability as teams and health providers. A simplified district essential ingredients in the operationalization of the family planning handbook with standard information plan. At the district level, the District Health Office shall be developed and widely disseminated. (DHO) will lead the technical level supported by the DHT to effectively monitor, coordinate, lead and ensure good governance of family planning activities at all levels in the district. The DHT will be trained to effectively coordinate and manage family planning services. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 23

All activities of family planning (by government, The district will track activities including financial PFP and PNFP) will be tracked by DHO’s office data outputs and coordinate quarterly data sharing through MoH designed tools and electronic data with the implementing partners and other relevant base. The district HMIS focal person will ensure stakeholders. The identified performance gaps will timely and quality data management and analysis to form a basis for refresher training. inform planning and decision making by the relevant stakeholders. Consequently, mentorship and Reporting of family planning indicators supervision of the lower level HMIS focal persons strengthened and other health workers will be crucial. The district will support health facility staff in generating appropriate FP data based on the As a requirement in the Local Government Act indicators as well as ensuring the use of performance (1997), the Resident District Commissioner (RDC), data at health facility and district level in order to District Chairperson, Secretary for Health, Health improve service delivery. In this respect, health Sectoral Committee and the entire Council will play workers will be further supported through training an oversight function to ensure that all services are especially in the use of reporting tools in order to delivered to all people in Kiryandongo District. All improve reporting on FP indicators. lower local political leaders will be oriented to offer oversight roles to ensure high levels of accountability. District capacity to collect, analyse and use data to track progress strengthened Strategic outcomes The district capacity to collect, analyse and use data Capacity of the District to lead, manage and will be strengthened through well-tailored trainings coordinate the FP programme enhanced and hands-on experience. A midterm review and final The DHT will be trained and supported to develop evaluation of the CIP will be executed by the district annual work plans for FP, and reporting mechanism to determine progress, success and inform future will be strengthened. The district will hold quarterly FP strategy development and programming. Multi- review meetings with the different stakeholders stakeholders will be engaged during the evaluation in the district. Further, the district will commit process to fairly reflect community-held opinions. resources to efficiently and timely monitor and supervise FP activities. Family Planning - Costed Implementation Plan 24 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

SECTION 04: Costing of the plan

4.1 Introduction The costing of the strategic activities is premised on the assumption that the limited resources are committed to areas with the greatest potential to achieve the stated district goal. It is also important to note that contraceptive commodities are not costed as it is assumed that NMS will procure, supply and distribute the commodities to and within the district. Additionally, a sustainability mechanism is in-built and it is for this reason that for some thematic areas, the costs reduce in the last years. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 25

Table 8: Costing of the District FP Implementation Plan District Strategic Outcomes FP Costs per year in UGX millions Total Priority 2018/19 2019/20 2020/21 2021/22 2022/23 Demand Increase demand for FP services 53 61 61 64 65 304 Creation Increased male awareness of reproductive healthcare 22 22 22 20 20 106 Access of FP information to young people between 19 19 18 18 18 92 15-20 years increased Social marketing of free products enhanced 2 2 2 2 2 10 Service Number of trained health providers able to deliver 10 10 10 10 10 50 Delivery and wide spectrum of FP services increased Access Access to FP services is increased 70 70 80 80 80 380 Family planning service delivery points for young 15 15 15 15 15 75 people increased Referral services are strengthened 10 10 10 10 10 50 Motivation for FP health care workers enhanced 20 20 20 20 20 100 Integration of family planning services into other 10 10 10 10 10 50 health services improved Access to family planning services by people with 30 30 30 30 30 150 disabilities increased Management of family planning side effects improved 35 35 35 35 35 175 In-service training in FP enhanced 10 10 10 10 10 50 Family planning knowledge and skills among VHT 30 30 30 30 30 150 enhanced Contraceptive Capacity of district staff able to quantify and forecast 15 15 15 15 15 75 Security FP commodities improved Availability of FP commodities among VHTs and 20 20 20 22 22 104 community drug distributors improved Commodity distribution to private not-for-profits 10 10 10 12 12 54 enhanced Family Planning - Costed Implementation Plan 26 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 8: Costing of the District FP Implementation Plan (continued) Policy and Knowledge about legal framework and policies for 11 11 11 11 11 55 Enabling family planning are increased Environment Support to FP by local, cultural, and religious leaders 15 15 15 15 15 75 increased Reporting of Family Planning Indicators strengthened 5 5 5 5 5 25 Capacity of the District to lead, manage and 10 10 10 10 10 50 coordinate the FP programme enhanced Financing Mainstreaming of family planning into district 5 5 5 5 5 25 planning and budgeting processes improved Stewardship, District capacity to use data for family planning 5 5 5 5 5 25 Management advocacy and programming strengthened and Accountability

Table 9: Summary Costs per Thematic Area per Financial Year (Millions, UGX) District Priority/FY FP Costs per year in UGX millions Total 2017/18 2018/19 2019/20 2020/21 2021/22 Demand Creation 96 104 103 104 105 512 Service Delivery and Access 240 240 250 250 250 1,230 Contraceptive Security 45 45 45 49 49 233 Policy and Enabling Environment 26 26 26 26 26 130 Financing 20 20 20 20 20 100 Stewardship, Management and Accountability 5 5 5 5 5 25 Total 432 440 449 454 455 2,230

The total financial outlay for implementing this plan will be 2.23 billion Uganda shillings over the five-year period. The highest percentage of this budget will go towards service delivery and access (1.23 billion Uganda shillings). In the first year, it is projected that 432,000,000 shillings will be invested. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 27

SECTION 05: District Institutional arrangements for Implementation of the plan Family Planning - Costed Implementation Plan 28 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

5.1 Introduction Consistent with the national FP CIP, the DHO will Kiryandongo District FP Costed Implementation work closely with the CAO to plan and allocate Plan will be implemented in line with the national financial resources for FP within the district health health framework and within the decentralization budget. The DHO and the Assistant DHO will realm. Working closely with central government mobilize partner efforts towards FP in Kiryandongo, - whose leadership and governance responsibility as well as offer technical support to implementing is prescribed in the National Health Policy, partners, institutional-based health workers and Kiryandongo District Health Office, along with VHTs at village level. the District Health Team, and the District Council Chairperson (LC 5) will engage various stakeholders Civil society and non-governmental organizations to create opportunities for coordination and Kiryandongo District has a multiplicity of civil society management of the national FP effort. In tandem organizations such as Straight Talk Foundation, with the national FP CIP, Kiryandongo District will Mildmay Uganda, Reproductive Health-Uganda, follow management, coordination and accountability Population Action International, DSW, Marie Stopes- structures, as outlined below: Uganda, Family Health International 360, Uganda Health Marketing Group, including faith-based 5.2 Management, Coordination, and Accountability organizations (Church of Uganda, Catholic Church, Structure Pentecostal Churches and Muslim Supreme Council), cultural leaders (Bunyoro Kingdom representatives), Kiryandongo District FP CIP recognizes that private sector (private clinics and drug shop owners) the MoH takes stewardship and spearheads the and the media; among others. This district FP CIP planning, financing, implementation and performance will, through the CAO and DHO engage these actors monitoring of the district FP CIP, to feed into to ensure provision of financial resources towards the national FP CIP within the local government FP and delivery of FP services, but also participate in structures. This district FP CIP will be implemented advocacy for improved demand and quality service by the District Health Office and supported by provision. civil society organizations, community-based organizations, women groups and faith-based 5.4 Coordination Framework organizations; among others. In Kiryandongo District, coordination of this FP CIP will be led by the CAO and DHO through an 5.3 Roles and Responsibilities of Key Actors organized multi-sectoral stakeholders’ approach. (District Level) This will include the district FP steering committee, Chief Administrative Office chaired by the Local Council V (LC V) and a district Consistent with the national FP CIP coordination FP technical working group, chaired by the District structure, this district FP CIP will through the office Health Officer. At the technical level, it is proposed of the Chief Administrative Officer (CAO) enforce that quarterly inter-departmental coordination better coordination, planning, resource allocation, review meetings be held chaired by the CAO and implementation, monitoring and evaluation for FP decisions later on shared with the relevant key services in Kiryandongo District. stakeholders. District Health Officer (DHO) and Assistant DHOs Given the administrative stewardship of health services in Kiryandongo District, the DHO will oversee the implementation of the district FP CIP. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 29

5.5 Resource Mobilization Framework 5.6 Performance Monitoring and Accountability Through concerted efforts, Kiryandongo District will Measuring Kiryandongo District performance against commit a percentage of its local revenue towards FP the national FP CIP targets will be critical and crucial and continue lobbying and advocating for increased during the implementation period. As expounded donor support. The district budget framework under the monitoring and evaluation section in this paper will reflect a commitment towards increased district FP CIP, routine monitoring will occur through financing of FP over the five-year period. Informed the DHIS2. Performance reports will be shared by the district funding gaps, Kiryandongo District with MoH through the coordination mechanism as Planner and the Chief Finance Officer will provide prescribed by the national FP CIP. Key performance technical leadership in forecasting and determining targets will hinge on the strategic priorities as project resource implications for FP financing. informed by the national FP CIP. It is anticipated that district performance towards the national FP CIP will be shared in MoH review/ strategic planning meetings. Below is a list of indicators as adapted from the national FP CIP:

Table 10: Illustrative List of National Indicators to Inform the District FP CIP Category Illustrative Indicators Data Source Demographic • Modern contraceptive prevalence rates • Track20, indicators • Percent distribution of users by modern method Performance • Number of additional FP users Monitoring and • Percent of women with an unmet need for modern Accountability contraception (PMA) 2020 • Percent of women whose demand is satisfied with a • UDHS modern method • Couple Years of Protection • Unmet need of FP • Teenage pregnancy rate Service • Number of women receiving counselling or services in • HMIS statistics family planning - new acceptors and continuing clients • Activity • Number of women receiving FP services, by method Reports • Number of products dispensed, by method • Number of youth receiving counselling or services in family planning - new acceptors and continuing clients • Number of HIV-positive clients using family planning Process Demand Process indicators • Activity reports indicators Creation • Number of non-users who intend to adopt a certain • Programme practice in the future surveys • Number of radio and TV spots aired • DHS Outcome indicators • FP-CIP • Percent of audience who recall hearing or seeing a progress specific message monitoring • Availability of accessible, relevant, and accurate database information about sexual and reproductive health tailored to young men Family Planning - Costed Implementation Plan 30 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 10: Illustrative List of National Indicators to Inform the District FP CIP (continued) Service Process indicators • Activity reports Delivery and • Number of providers trained on family planning by • Programme Access district surveys • Number of mobile clinic events organized, and number • FP-CIP of people reached by district progress • Number of youth-friendly service clinics established monitoring Outcome indicator database • Availability of accessible, relevant, and accurate information about sexual and reproductive health tailored to young men Contraceptive Process indicator • HMIS Security • Actual annual contraceptives delivered for the public • Activity reports sector • Programme Outcome indicator surveys • Percent of facilities that experienced a stock-out at any point during a given time period Policy and Process indicator • Activity reports Enabling • Documentation of instances in which a formal • Programme Environment implementation or operational directive or plan is surveys issued to accompany a national or sub national FP • FP-CIP policy progress Outcome indicators monitoring • Evidence of FP programmes incorporated into national database strategic and development plans • Evidence of documented improvement in the enabling environment for family planning, using a validated instrument (e.g., the Family Planning Programme Effort Index and Contraceptive Security Index) • Evidence of targeted public and private sector officials, faith-based organizations, or community leaders publicly demonstrating a new or increased commitment to family planning Financing Outcome indicators • Activity reports • Annual expenditure on family planning from local • Programme revenue budget surveys • Evidence of new financing mechanisms for family • FP-CIP planning identified and tested progress • Evidence of private for-profit sector participation in monitoring funding for family planning database • Share of contraceptive procurement for the public sector financed by the government

Source: Adopted from National FP-CIP (2015-2020) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 31

5.7 Routine Data Collection Monitoring, evaluation and coordination Family planning services data will be collected Once data has been collected at each facility, it through the normal HMIS system. As a requirement, will first be analysed for use at that level and also each health facility will compile data using the submitted to the DHO and finally to Ministry of standard tools from MoH and later on forwarded to Health as required. the district biostastician for onward submission to MoH. The primary consumption data at all health Capacity building facilities (both government, private for profit and The HMIS staff and other health workers will be PNFP) will be captured in hard copies and where oriented and trained in data collection, quality possible, electronic (HMIS) data base will be assurance and analysis. The training will be on-the- maintained. job and where necessary, offsite training will be arranged by the office of DHO. This will ensure that 5.8 Data Management data tools are completed accurately. Data Quality Assurance mechanism The district biostastician will play a lead role in Information dissemination and use ensuring Data Quality Assurance (DQA) collection, During the quarterly stakeholders’ review meetings, transfer, compilation, analysis and storage. This will the consolidated and analysed data will always be be executed through a series of technical review presented to inform decision making. Deliberate meetings with the HMIS staff and health facility efforts will be taken to disseminate performance assessment checks. As such a routine, support levels with the relevant stakeholders. supervision will be undertaken on a quarterly basis and technical support will be offered in areas of need to health facilities, both for government, PFPs and the PNFPs. Due care will be taken to identify any inconsistencies in data by comparing the submitted data records with the original data sources Family Planning - Costed Implementation Plan 32 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

SECTION 06: District Implementation Framework and Activity Details

Table 11: Implementation Framework by thematic areas Strategic Outcomes Expected Results Activity Sub Activities Inputs Output indicators Timeline DC1 : Demand for FP services is Women ages 15-49 years with • Align Kiryandongo District communication • Disseminate communication strategy • Resources for dissemination • District-specific communication 2018- increased demand for family planning (met strategy with national strategy with evidence meetings (1 day) strategy disseminated to 2019 demand and unmet demand) based messaging relevant stakeholders • Implement a mass media campaign on FP based • Purchase media space for FP messaging • Buy 30 min spots to play 3 times • Number of radio spots 2018 on the district communication strategy (radio and TV) a week purchased and aired per week through • Buy time and host quarterly • Number of quarterly TV to 2022 discussions on TV discussions held • Mobilize cultural leaders and community • Engage cultural and community leaders in • Resources to facilitate cultural • Number of Kiryandongo 2018- leaders to participate in sensitization on FP workshops to orient them in FP messaging leaders participate in FP District cultural leaders 2019 workshops sensitized on FP messaging DC2: Men support the use of Men support the use of modern • Conduct monthly community outreach events • Conduct men special days • Resources to facilitate holding • Number of men reached in Quarterly modern contraceptives for contraception for themselves or their to engage men in family planning of community outreach event Kiryandongo District through scale-up themselves and partners partners in Kiryandongo District for men in Kiryandongo special days • Purchase radio announcement: 30 seconds for 3-4 days • Resources to distribute advertising posters and promotional materials • Conduct FP outreach events • Resources to conduct outreach • Number of community outreach 2018 events events held through to 2023 DC3: Young People, 10-24 years old Young people in Kiryandongo, 10-24 • Engage peers in Kiryandongo to educate young • Conduct regional youth camp for peer • Resources to facilitate youth • Number of youth camps held 2018 are knowledgeable about family years are knowledge about FP people about family planning services educators selection in region in which Kiryandongo through planning lies. to 2023 • acilitate development of youth plans MoH • Resources to facilitate • Number of Kiryandongo district 2018 • Conduct support supervision visits among participation in developing youth plans supervised by MoH through youths youth plans development and and District Local Government to 2023 support supervision • Number of youth that Quarterly participate in development of Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 33

Strategic Outcomes Expected Results Activity Sub Activities Inputs Output indicators Timeline DC1 : Demand for FP services is Women ages 15-49 years with • Align Kiryandongo District communication • Disseminate communication strategy • Resources for dissemination • District-specific communication 2018- increased demand for family planning (met strategy with national strategy with evidence meetings (1 day) strategy disseminated to 2019 demand and unmet demand) based messaging relevant stakeholders • Implement a mass media campaign on FP based • Purchase media space for FP messaging • Buy 30 min spots to play 3 times • Number of radio spots 2018 on the district communication strategy (radio and TV) a week purchased and aired per week through • Buy time and host quarterly • Number of quarterly TV to 2022 discussions on TV discussions held • Mobilize cultural leaders and community • Engage cultural and community leaders in • Resources to facilitate cultural • Number of Kiryandongo 2018- leaders to participate in sensitization on FP workshops to orient them in FP messaging leaders participate in FP District cultural leaders 2019 workshops sensitized on FP messaging DC2: Men support the use of Men support the use of modern • Conduct monthly community outreach events • Conduct men special days • Resources to facilitate holding • Number of men reached in Quarterly modern contraceptives for contraception for themselves or their to engage men in family planning of community outreach event Kiryandongo District through scale-up themselves and partners partners in Kiryandongo District for men in Kiryandongo special days • Purchase radio announcement: 30 seconds for 3-4 days • Resources to distribute advertising posters and promotional materials • Conduct FP outreach events • Resources to conduct outreach • Number of community outreach 2018 events events held through to 2023 DC3: Young People, 10-24 years old Young people in Kiryandongo, 10-24 • Engage peers in Kiryandongo to educate young • Conduct regional youth camp for peer • Resources to facilitate youth • Number of youth camps held 2018 are knowledgeable about family years are knowledge about FP people about family planning services educators selection in region in which Kiryandongo through planning lies. to 2023 • acilitate development of youth plans MoH • Resources to facilitate • Number of Kiryandongo district 2018 • Conduct support supervision visits among participation in developing youth plans supervised by MoH through youths youth plans development and and District Local Government to 2023 support supervision • Number of youth that Quarterly participate in development of Family Planning - Costed Implementation Plan 34 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 11: Implementation Framework by thematic areas (continued) • Disseminate educational yearly youth magazine • Disseminate youth magazine in Kiryandongo • Resources to facilitate • Youth magazine disseminated 2018 that describes youth FP activities, programmes distribution of youth magazines annually in Kiryandongo. through and services to youth corners, peer to 2023 educations and CAO • Empower parents, caregivers and teachers to • Conduct workshops for teachers and • Resources to facilitate parents, • Number of parents, caregivers 2018 help their children to avoid teen pregnancy, parents to orient them on how best to talk to caregivers and teachers and teachers participating in through including parent- child communication on sexual youth about family planning participate in dialogues and dialogues and workshops to 2023 issues workshops on FP • Number of dialogues and workshops conducted • Hold “edutainment” community events like • Mobilize communities for the edutainment • Resources to secure • Number of events held 2018 dances, music concerts and sports competitions events information, education and through to provide opportunity for knowledge exchange • Conduct edutainment events for different communication materials and to 2023 amongst young people communities edutainment events DC4: Social marketing of free Project to brand free, public-sector • Roll out pilot project to brand free, public • Distribute branded free condoms • Resources for distribution • Number of condoms distributed 2018 products and commercial sector condoms initiated and evaluated sector condoms to see if overall uptake • Conduct sensitization events for social of subsidized condoms and through increases FP increases in Kiryandongo marketing of subsidized condoms sensitizing communities to 2023 AREA #2: Service Delivery (SD) SD1: Access to FP services Family planning service delivery • Scale up FP service delivery points through • Sensitize communities about mobile clinic • Resources for community • Number of mobile clinics 2018 increased points increased in rural communities outreach services in rural communities services sensitization and conducting established through • Conduct mobile clinics in Kiryandongo rural outreaches • Number of clients served to 2023 communities FP services are expanded through • Organizations participate in sensitization on the • Conduct workshops to sensitize private • Resources to facilitate private • Number of people from private 2018- public-private partnerships importance of promoting and using FP services organizations organization participants organizations oriented on 2019 provisions of FP services

SD2: Referral services are A uniform FP referral is created in • Train relevant staff on referral mechanisms and • Train DHT and health facilities staff on • Resources to facilitate DHT and • Number of participants trained 2018- strengthened Kiryandongo disseminate FP referral forms referral mechanisms and tools health facility staff training and on referral forms 2019 • Disseminate FP referral forms to health disseminated referral forms facilities SD4: Family planning services are FP services integrated into cervical • Develop and disseminate FP integration • Host meetings with professional • Resources to facilitate meetings • Number of meetings held with 2018- integrated in other health services cancer screening, postpartum care, protocols associations to review/ develop/ review FP and support supervisions professional associations 2019 STI, malnutrition programmes integration protocols • Number of providers in • Train provides in FP service integration Kiryandongo trained in FP • Provide support supervision to health service integration providers on FP service integration • Number of support supervision visits conducted SD5: Family planning services are FP service delivery guidelines • Develop guidelines for provision of FP services • Conduct workshop to develop guidelines on • Resources to facilitate • Number of providers trained on 2018- accessible by people with disability developed for people with disabilities to people with disabilities FP services for people with disabilities development of guidelines and disability service provision in 2019 • Train health workers on providing services training service providers Kiryandongo to FP clients with disabilities • Participate in sponsored courses for service • Train health workers in sign language • Resources to facilitate trainings • Number of service providers 2018- provision to learn sign language in sign language in Kiryandongo trained in sign 2019 language Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 35

• Disseminate educational yearly youth magazine • Disseminate youth magazine in Kiryandongo • Resources to facilitate • Youth magazine disseminated 2018 that describes youth FP activities, programmes distribution of youth magazines annually in Kiryandongo. through and services to youth corners, peer to 2023 educations and CAO • Empower parents, caregivers and teachers to • Conduct workshops for teachers and • Resources to facilitate parents, • Number of parents, caregivers 2018 help their children to avoid teen pregnancy, parents to orient them on how best to talk to caregivers and teachers and teachers participating in through including parent- child communication on sexual youth about family planning participate in dialogues and dialogues and workshops to 2023 issues workshops on FP • Number of dialogues and workshops conducted • Hold “edutainment” community events like • Mobilize communities for the edutainment • Resources to secure • Number of events held 2018 dances, music concerts and sports competitions events information, education and through to provide opportunity for knowledge exchange • Conduct edutainment events for different communication materials and to 2023 amongst young people communities edutainment events DC4: Social marketing of free Project to brand free, public-sector • Roll out pilot project to brand free, public • Distribute branded free condoms • Resources for distribution • Number of condoms distributed 2018 products and commercial sector condoms initiated and evaluated sector condoms to see if overall uptake • Conduct sensitization events for social of subsidized condoms and through increases FP increases in Kiryandongo marketing of subsidized condoms sensitizing communities to 2023 AREA #2: Service Delivery (SD) SD1: Access to FP services Family planning service delivery • Scale up FP service delivery points through • Sensitize communities about mobile clinic • Resources for community • Number of mobile clinics 2018 increased points increased in rural communities outreach services in rural communities services sensitization and conducting established through • Conduct mobile clinics in Kiryandongo rural outreaches • Number of clients served to 2023 communities FP services are expanded through • Organizations participate in sensitization on the • Conduct workshops to sensitize private • Resources to facilitate private • Number of people from private 2018- public-private partnerships importance of promoting and using FP services organizations organization participants organizations oriented on 2019 provisions of FP services

SD2: Referral services are A uniform FP referral is created in • Train relevant staff on referral mechanisms and • Train DHT and health facilities staff on • Resources to facilitate DHT and • Number of participants trained 2018- strengthened Kiryandongo disseminate FP referral forms referral mechanisms and tools health facility staff training and on referral forms 2019 • Disseminate FP referral forms to health disseminated referral forms facilities SD4: Family planning services are FP services integrated into cervical • Develop and disseminate FP integration • Host meetings with professional • Resources to facilitate meetings • Number of meetings held with 2018- integrated in other health services cancer screening, postpartum care, protocols associations to review/ develop/ review FP and support supervisions professional associations 2019 STI, malnutrition programmes integration protocols • Number of providers in • Train provides in FP service integration Kiryandongo trained in FP • Provide support supervision to health service integration providers on FP service integration • Number of support supervision visits conducted SD5: Family planning services are FP service delivery guidelines • Develop guidelines for provision of FP services • Conduct workshop to develop guidelines on • Resources to facilitate • Number of providers trained on 2018- accessible by people with disability developed for people with disabilities to people with disabilities FP services for people with disabilities development of guidelines and disability service provision in 2019 • Train health workers on providing services training service providers Kiryandongo to FP clients with disabilities • Participate in sponsored courses for service • Train health workers in sign language • Resources to facilitate trainings • Number of service providers 2018- provision to learn sign language in sign language in Kiryandongo trained in sign 2019 language Family Planning - Costed Implementation Plan 36 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 11: Implementation Framework by thematic areas (continued) SD6: Family planning side effects Capacity on FP side effects • Strengthen capacity of service providers in FP • Train District Health workers in FP side • Resources to facilitate District • Number of district health 2018- are managed counselling strengthened. side effects counselling effects counselling Health workers’ trainings; and workers trained on FP side 2019 • Produce and disseminate materials on FP producing and disseminating effects counselling side effects counselling FP side effects counselling • Number of health facilities resource materials supplied with FP side effects counselling resource materials (including job aids) SD8: Family planning in the VHT Standardized FP training for VHTs • Train VHTs on FP methods • Participate in TOT for VHT • Resources to facilitate TOTs and • Number of VHT trainers trained 2018 system is strengthened • Train VHTs on FP counselling and service VHT training • Numbers of VHTs trained through provision to 2022 SD9: Youth-friendly services are Youth-friendly corners are • Establish youth-friendly corners in clinics • Map current clinics without youth corners • Resources to facilitate mapping • Number of clinics mapped for 2018- provided in clinics established in clinics • Provide materials for youth friendly corners of clinics, procuring and youth-friendly centres 2019 distribution of materials for • Number of youth friendly youth friendly corners corners established Health workers trained on how to Train health workers on how to provide youth- • Conduct ToT on provision of youth-friendly • Resources to facilitate training • Numbers of trainers trained 2018- provide youth- friendly services friendly services services of trainers and health workers • Number of health workers 2019 • Train health workers on how to provide trained on youth-friendly youth-friendly services services AREA #3: Contraceptive Security (CS) CS2: District staff are able Staff with capacity to forecast and • Build capacity of the health workers in • Conduct assessments to review capacity of • Resources to facilitate • Availability of capacity 2018 to quantify and forecast FP quantify for FP commodities forecasting and quantification within routine staff to forecast and quantify FP methods determination of capacity assessment report through commodities facility and Kiryandongo district activities • Conduct ToT on forecasting and gaps, ToTs, and training of DHT • Number of trainers trained in to 2023 quantification of FP commodities members and health workers forecasting and quantification • Train DHT and health workers on forecasting of FP commodities and quantification of FP commodities • Number of DHT members and health workers trained CS3: VHTs and community-based Community-based distributors are • Ensure supply chain system provides timely • Conduct ToT • Resources to facilitate training • Number of trainers trained 2018- distributors have commodities distributing FP commodities stocks to community-based distributors • Train community- based distributors on how of trainers, community-based • Number of community-based 2019 to manage FP supplies distributors, and procuring distributors trained training materials AREA #4: Policy and Enabling Environment (PEE) PEE2: Legal framework and The legal framework that promotes • Sensitize different stakeholders about FP • Develop simplified versions of FP policies • Resources to facilitate • Number of stakeholders trained 2018- knowledge of policies for family FP is known by all stakeholders policies and guidelines and guidelines development of simplified on FP policies and guidelines 2019 planning improved • Conduct sensitization workshops on FP version of FP policies and policies and guidelines guidelines and conduct stakeholder workshops PEE4: Parliament, local, cultural, A national coalition of advocates/ • Scale up FP advocacy through FP advocates and • Share best practices in advocacy and lessons • Resources to facilitate • Number of advocates and 2018 and religious leaders are champions to support family planning champions learned advocates and champions champions participating in through supportive of family planning is established and supported • Provide technical support to prominent FP participate in meetings meetings to 2023 champions • Resources to facilitate • Number of advocates and advocates and champions champions provided with participate in receiving technical assistance technical assistance Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 37

SD6: Family planning side effects Capacity on FP side effects • Strengthen capacity of service providers in FP • Train District Health workers in FP side • Resources to facilitate District • Number of district health 2018- are managed counselling strengthened. side effects counselling effects counselling Health workers’ trainings; and workers trained on FP side 2019 • Produce and disseminate materials on FP producing and disseminating effects counselling side effects counselling FP side effects counselling • Number of health facilities resource materials supplied with FP side effects counselling resource materials (including job aids) SD8: Family planning in the VHT Standardized FP training for VHTs • Train VHTs on FP methods • Participate in TOT for VHT • Resources to facilitate TOTs and • Number of VHT trainers trained 2018 system is strengthened • Train VHTs on FP counselling and service VHT training • Numbers of VHTs trained through provision to 2022 SD9: Youth-friendly services are Youth-friendly corners are • Establish youth-friendly corners in clinics • Map current clinics without youth corners • Resources to facilitate mapping • Number of clinics mapped for 2018- provided in clinics established in clinics • Provide materials for youth friendly corners of clinics, procuring and youth-friendly centres 2019 distribution of materials for • Number of youth friendly youth friendly corners corners established Health workers trained on how to Train health workers on how to provide youth- • Conduct ToT on provision of youth-friendly • Resources to facilitate training • Numbers of trainers trained 2018- provide youth- friendly services friendly services services of trainers and health workers • Number of health workers 2019 • Train health workers on how to provide trained on youth-friendly youth-friendly services services AREA #3: Contraceptive Security (CS) CS2: District staff are able Staff with capacity to forecast and • Build capacity of the health workers in • Conduct assessments to review capacity of • Resources to facilitate • Availability of capacity 2018 to quantify and forecast FP quantify for FP commodities forecasting and quantification within routine staff to forecast and quantify FP methods determination of capacity assessment report through commodities facility and Kiryandongo district activities • Conduct ToT on forecasting and gaps, ToTs, and training of DHT • Number of trainers trained in to 2023 quantification of FP commodities members and health workers forecasting and quantification • Train DHT and health workers on forecasting of FP commodities and quantification of FP commodities • Number of DHT members and health workers trained CS3: VHTs and community-based Community-based distributors are • Ensure supply chain system provides timely • Conduct ToT • Resources to facilitate training • Number of trainers trained 2018- distributors have commodities distributing FP commodities stocks to community-based distributors • Train community- based distributors on how of trainers, community-based • Number of community-based 2019 to manage FP supplies distributors, and procuring distributors trained training materials AREA #4: Policy and Enabling Environment (PEE) PEE2: Legal framework and The legal framework that promotes • Sensitize different stakeholders about FP • Develop simplified versions of FP policies • Resources to facilitate • Number of stakeholders trained 2018- knowledge of policies for family FP is known by all stakeholders policies and guidelines and guidelines development of simplified on FP policies and guidelines 2019 planning improved • Conduct sensitization workshops on FP version of FP policies and policies and guidelines guidelines and conduct stakeholder workshops PEE4: Parliament, local, cultural, A national coalition of advocates/ • Scale up FP advocacy through FP advocates and • Share best practices in advocacy and lessons • Resources to facilitate • Number of advocates and 2018 and religious leaders are champions to support family planning champions learned advocates and champions champions participating in through supportive of family planning is established and supported • Provide technical support to prominent FP participate in meetings meetings to 2023 champions • Resources to facilitate • Number of advocates and advocates and champions champions provided with participate in receiving technical assistance technical assistance Family Planning - Costed Implementation Plan 38 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

Table 11: Implementation Framework by thematic areas (continued)

AREA #5: Financing (F) F4. Family planning is Family planning is prioritized and • Support district technical staff in setting • Identify partners to support funding for FP • Resources for facilitating • Amount of resources 2018 mainstreamed in district planning integrated in district budgeting priorities and budgeting for family planning activities planning and budgeting earmarked for FP in the district through and budgeting processes processes • Facilitate joint planning and budgeting for FP meetings budget to 2023 F5: Financial investment in human Budget for training and support for • Advocate increased funding for training and • Facilitate stakeholder resource mobilization • Resources for stakeholders’ • Documented evidence of -2018 resources development for health midwives and nurses in the health support for midwives and nurses at lower – meeting meeting progress or decisions made on through is increased sector is increased level health facilities increased resources for human to 2022 resources development AREA #6: Stewardship, Management and Accountability (SMA) SMA3: The capacity of districts DHTs effectively plan for, monitor • Conduct annual review meetings of • Hold meetings with DHTs • Resources to facilitate DHT • Work plan review meetings held 2018 to effectively manage their FP and report on FP services Kiryandongo district plan • Hold coordination meetings with FP participants • Number of FP stakeholder through programmes is strengthened FP stakeholder coordination and • Conduct FP stakeholder annual review stakeholders • Resources to facilitate FP coordination meetings held to 2022 performance monitoring at district meetings stakeholder coordination level is increased meetings SMA2: Reporting of FP indicators is Health managers and workers report • Strengthen capacity of health managers and • Conduct workshops to orient District • Resources to facilitate • Number of District 2018 strengthened on FP indicators workers in reporting on FP indicators management committees and DHTs on FP workshops/ meetings and Management Committee and through reporting conduct support supervision DHT members oriented on FP to 2023 • Train health workers on FP indicator indicator reporting reporting • Number of health workers • Conduct support supervision to health trained on FP indicator facilities on FP indicator reporting reporting • Number of health facilities provided with quarterly support supervision Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 39

AREA #5: Financing (F) F4. Family planning is Family planning is prioritized and • Support district technical staff in setting • Identify partners to support funding for FP • Resources for facilitating • Amount of resources 2018 mainstreamed in district planning integrated in district budgeting priorities and budgeting for family planning activities planning and budgeting earmarked for FP in the district through and budgeting processes processes • Facilitate joint planning and budgeting for FP meetings budget to 2023 F5: Financial investment in human Budget for training and support for • Advocate increased funding for training and • Facilitate stakeholder resource mobilization • Resources for stakeholders’ • Documented evidence of -2018 resources development for health midwives and nurses in the health support for midwives and nurses at lower – meeting meeting progress or decisions made on through is increased sector is increased level health facilities increased resources for human to 2022 resources development AREA #6: Stewardship, Management and Accountability (SMA) SMA3: The capacity of districts DHTs effectively plan for, monitor • Conduct annual review meetings of • Hold meetings with DHTs • Resources to facilitate DHT • Work plan review meetings held 2018 to effectively manage their FP and report on FP services Kiryandongo district plan • Hold coordination meetings with FP participants • Number of FP stakeholder through programmes is strengthened FP stakeholder coordination and • Conduct FP stakeholder annual review stakeholders • Resources to facilitate FP coordination meetings held to 2022 performance monitoring at district meetings stakeholder coordination level is increased meetings SMA2: Reporting of FP indicators is Health managers and workers report • Strengthen capacity of health managers and • Conduct workshops to orient District • Resources to facilitate • Number of District 2018 strengthened on FP indicators workers in reporting on FP indicators management committees and DHTs on FP workshops/ meetings and Management Committee and through reporting conduct support supervision DHT members oriented on FP to 2023 • Train health workers on FP indicator indicator reporting reporting • Number of health workers • Conduct support supervision to health trained on FP indicator facilities on FP indicator reporting reporting • Number of health facilities provided with quarterly support supervision Family Planning - Costed Implementation Plan 40 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

References

1. Health Communication Partnership (2009). A Literature Review of the Current Status of Family Planning Services in Uganda. Kampala Uganda: Health Communication Partnership.

2. MoFPED, Uganda (2008). National Population Policy for Social Transformation and Sustainable Development. Kampala, Uganda: MoFPED.

3. Ministry of Health, Uganda (2014). Uganda Family Planning Costed Implementation Plan, 2015- 2020. Kampala: Ministry of Health, Uganda.

4. Ministry of Health, Uganda (2014). Draft Health Planning Guidelines. Kampala, Uganda: Health Planning Department, MoH.

5. Ministry of Health (2010). National Health Policy. Kampala, Uganda: Ministry of Health.

6. Ministry of Health (2004). National Adolescent Health Policy for Uganda. Kampala, Uganda: Ministry of Health.

7. Kiryandongo District Local Government, Uganda (2015). Kiryandongo District Development Plan 2015/2016-2019/2020. Kiryandongo, Uganda: Kiryandongo District Local Government.

8. Uganda Bureau of Statistics (UBOS) (2015). National Population and Housing Census 2014. Kampala Uganda: UBOS.

9. Uganda Bureau of Statistics (UBOS) and ICF International Inc.2012. Uganda Demographic and Health Survey 2011. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KIRYANDONGO DISTRICT 41 Family Planning - Costed Implementation Plan 42 (2018/19 - 2022/23) KIRYANDONGO DISTRICT

MINISTRY OF HEALTH

KIRYANDONGO DISTRICT Family Planning Costed Implementation Plan 2018/19 - 2022/23

Funding and Technical Support by: