REPUBLIC OF UGANDA
KOTIDO DISTRICT Family Planning - Costed Implementation Plan 2018/19 - 2022/23
JUNE 2018
KOTIDO 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 Kotido District Health Office. This project was funded with UK aid from the UK government.
Copyright ©: Kotido District Local Government
Reproduction of this plan for educational or other non- commercial purposes is authorized without permission from the Kotido District Local Government, provided the source is fully acknowledged.
Recommended Citation: Kotido District (2018). District Family Planning Costed Implementation Plan, 2018/19 – 2022/23. Kotido, Uganda
Copies available from: Kotido District Health Office. iv
Foreword
Kotido district total fertility rate continues to be one of the highest in the country with each woman bearing an average of eight children in her lifetime. A lot of effort is therefore, required to bring down the rates in accordance with the national target.
Many women would like to delay or limit their It is our belief that these joint efforts will lead to a childbearing, yet they are not using family planning. decline in the unmet need for family planning and an Some of the women cite health concerns, including increase in the modern contraceptive prevalence rate fear of side effects, or opposition from their partner (mCPR) for married and in-union women from 7.3% as the reasons for not using contraception. These (UDHS 2016) to 14.3% by 2022 based on the reality concerns need to be addressed through appropriate check modelling. interventions including male partner involvement.
The district efforts to scale up use of modern family More broadly, family planning planning methods are motivated by the knowledge improves maternal and child that family planning helps women achieve their human rights to health, education, autonomy, and health, facilitates educational decision making on the number and timing of their advances, empowers women, childbearing. More broadly, family planning improves maternal and child health, facilitates educational reduces poverty, and is a advances, empowers women, reduces poverty, and is foundational element to the a foundational element to the economic development of a nation. economic development of a nation. Uganda’s President, H.E Yoweri Museveni, made a strong commitment to family planning at the London Summit on Family Planning in July 2012, and again at The district’s ambitious goal will require an the National Family Planning Conference in Kampala equally ambitious plan of action. This is the plan of in July 2014. We need to build on this political action that the local government and civil society commitment to implement robust family planning should follow to achieve the desired goals. All the programmes to reach women, men, youth, and stakeholders must devote time and resources to its communities with quality services and information to implementation. meet their needs. Kotido District Health Office (DHO), in collaboration Kotido District Family Planning Costed with partners, has developed the Kotido District Implementation Plan concentrates on a number of Family Planning Costed Implementation Plan (FP CIP) key strategic priorities to help reach these objectives, FY 2018/19-2022/23 to guide the district efforts to including: increase knowledge of and access to family planning. v
• Strengthening the Family planning coordination structure • Strengthening Family Total Market Approach (TMA) in the district • Increasing demand creation through development of a demand creation and communication strategy • Improving contraceptive availability through support supervision • Improving service delivery through creating a district-based FP technical team that provide on- job capacity building and regular outreach services for Long Term reversible contraceptive methods.
Kotido district calls on development partners and implementing agencies to support and avail resources to ensure the success of the district FP program as a strategy to improve the lives and well-being of our people. For God and my Country.
Lotukei Ambrose DISTRICT CHAIRPERSON KOTIDO DISTRICT LOCAL GOVERNMENT
1. Total Fertility Rate of 7.9 as per Demographic Health Survey (2016) 2. Makerere University School of Public Health Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University. 2014. PMA2020: Dissemination of the preliminary fi ndings: Imperial Royal Hotel, Kampala, October 8th 2014. 3. Bongaarts, John, John C. Cleland, John Townsend, Jane T. Bertrand, and Monica Das Gupta. 2012. Family Planning Programs for the 21st Century: Rationale and Design. Retrieved 29 October 2014 from http://www.popcouncil.org/uploads/ pdfs/2012_FPfor21stCentury.pdf vi
Preface Kotido district is committed to improving access to family planning, as it is a low cost, high dividend investment for addressing the district high maternal mortality ratio and improving the health and welfare of our people.
Family planning is an essential component to As President H.E. Yoweri Kaguta Museveni has said, the district development agenda for sustainable “The wealth of a nation is not in the soils and stones, economic development. Increased access to and it is in its people, its population; we need to educate use of family planning has far-reaching benefi ts for our children, give them skills and create an enabling families and the district. If the high fertility rate environment for employment and job creation. is brought down, the district has the potential to That way, we shall create wealth, make savings and reap from the accrued demographic dividend. The Ugandans will invest and spur economic productivity demographic dividend refers to faster economic and growth.” growth caused in part by changes in population age structure that result in more working aged Full and successful implementation of the district adults and fewer dependents. This population shift FP CIP requires the concerted and coordinated can contribute to both district development and efforts of local government (executive, local council, improved well-being for families and communities departments), the private sector, civil society, and development partners. All the stakeholders must However, if we are to realize the demographic work together to ensure an enabling environment dividend, we must make substantial investments for policy, fi nancing, service delivery and advocacy to improve health outcomes and meet the need for programmes for effective mobilization of family planning, while also educating and training communities and individuals to overcome socio- workers, promoting new job opportunities for young cultural barriers to access family planning services. people, and strengthening economic stability and governance. Kotido district is committed to providing the leadership required to coordinate and implement the Therefore, let us work together to ensure the health district family planning Costed Implementation Plan and wealth of our district. By committing ourselves FY 2018/19-2022/23 to ensure that every resident to the full fi nancing and implementation of the Kotido has the right to health, education, autonomy, and district Family Planning Costed Implementation personal decision making about the number and Plan FY 2018/19-2022/23, we can realize our goals timing of their childbearing. of reducing the unmet need for family planning and increasing the modern contraceptive prevalence rate among married and in-union women (mCPR) from 7.3% to 14.3%. Uma Charles CHIEF ADMINISTRATIVE OFFICER KOTIDO DISTRICT LOCAL GOVERNMENT
1. Uganda National Planning Authority. 2014. Report: Harnessing the Demographic Dividend Accelerating Socioeconomic Transformation in Uganda. vii
Acknowledgement This document is a result of extensive consultations with stakeholders working at all levels within the district, including key sector ministries, development partners, implementing partners, individual staff and consultants.
Appreciation to the many partners and groups, both Ministry of Health and Kotido district local at the District and National level, who supported the government are specifi cally acknowledged for their development of the Kotido Family Planning Costed technical support, cooperation, and coordination that Implementation Plan (FP CIP). enabled timely completion of the assessment and costing exercise. Special mention goes to the District Health Team We would wish to thank the data collectors, the (DHT) that travelled to all health facilities collecting respondents from the different health facilities data and later undertaking data analysis to during the exit interview and the consultant who synthesize key issues affecting FP in the district. Key facilitated the process. stakeholders who attended the validation meeting and helped shape the key issues and strategies for improved access to Family Planning services deserve special recognition.
Special appreciation goes to UK aid from the UK government, through the United Nations Population Fund (UNFPA) for the fi nancial and technical support and to the consultant for the technical input. viii
Table of Contents Foreword iv Preface vi Acknowledgement vii Executive Summary xii
Section 1: Introduction 1 1.1 Why Kotido district should invest in Family Planning 2 1.2 Rationale for and use of FP-CIP 3 1.3 Key Issues and Challenges 10
Section 2: Process and Formulation of the Kotido District Family Planning CIP 21 2.1 Process followed to develop Kotido district Family Planning CIP 22 2.2 SWOT Analysis 23 Section 3: Translation of Key Issues into Strategy 24 Section 4: Modelling Achievable mCPR goal for Kotido District 26 Section 5: Costed Implementation Plan 30 5.1 Vision 31 5.2 Operational Goal 31 5.3 Strategic Priorities 31 5.4 Intervention and Activity Mapping to Strategic Priorities 31 5.5 Strategic Outcomes 31
Section 6: Institutional Arrangements for Implementation 36 6.1 Management, Coordination, and Accountability Structure 37 6.2 Roles and Responsibilities of Key Actors (District Level) 37 6.3 Coordination Framework 37 6.4 Resource Mobilization Framework 38 6.5 Performance Monitoring and Accountability 38 6.6 Monitoring, Evaluation and Learning 38
Section 7: Implementation Framework of the Kotido district Family Planning CIP 39 References 46 ix
List of Tables Table 1 Kotido district demographics 2 Table 2 National Health Facility Standards 7 Table 3 List of health facilities in the district 7 Table 4 Family Planning Partners 8 Table 5 Family Planning Users, 2016-2017 10 Table 6 Availability of Family planning services at each facility in Kotido district 10 Table 7 Availability of human resource for family planning in Kotido District 12 Table 8 FP services skills gap 12 Table 9 Number of days and hours per week that FP services are offered 13 Table 10 Status of HMIS tools at the service points of different health facilities 14 Table 11 Availability of Infrastructure for provision of Family planning services 14 Table 12 Common stock outs experienced in the last 12 months at each facility 16 Table 13 Availability of Family Planning Equipment at Each Health facility 17 Table 14 Kotido district allocation to health and Family planning 18 Table 15 Donor only-budget support to health in Kotido 19 Table 16 Ongoing Demand creation (BCC) activities in Kotido District 19 Table 17 Status of Supervision of Health workers by DHT and quality of service by Health 20 workers in Kotido District Table 18 Kotido district SWOT Analysis 23 Table 19 Contraceptive Method mix, CPR Growth, and Health Impact if trends continue 27 through 2022 Table 20 Contraceptive method mix, CPR growth, and health impacts if growth in modern 28 method use is accelerated to 1.3% annually, 2018-2022 Table 21 Monthly Case-load Per Health Facility in Business As Usual Scenario of 0.65% 29 increase in CPR per year Table 22 Monthly case load per health facility by method in the accelerated CPR of 1.3% 29 CPR increase per year Table 23 Detailed Activity Breakdown by Strategic Outcomes 40 x
List of Figures
Figure 1: Map of Uganda showing location of Kotido 6 Figure 2: Unmet need for Family Planning 8 Figure 3: FP indicators for national level and Karamoja sub-region 9 Figure 4: Availability of policies, guidelines and protocols in the health facilities 18 Figure 5: Cost for Strategic Priorities by thematic areas in Ugx Shs. 32 Figure 6: Policy and enabling environment cost, in million UGX 33 Figure 7: Service Delivery and Access costs, in million UGX 33 Figure 8: Contraceptive Security (Programs) cost, in million USD 34 Figure 9: Demand Creation cost, in million UGX 34 Figure 10: Financing costs, in millions UGX 35 Figure 11: Stewardship, Management and Accountability costs, in millions UGX 35 xi
Abbreviations
ANC Antenatal Care HMIS Health Management Information System BEmONC Basic Emergency Obstetric and New- MoH Ministry of Health born Care MHCP Minimum Health Care Package CAO Chief Administrative Officer NGOs Non-Governmental Organizations CEmONC Comprehensive Emergency Obstetric NMS National Medical Stores and New-born Care OPD Out Patient Department CH Child Health PNFP Private Not For Profit CS Contraceptive Security RDC Resident District Commissioner CPD Continuous Professional Development RH Reproductive Health CPR Contraceptive Prevalence Rate SBCC Social and Behavioural Change CSO Civil Society Organization Communications CUAMM Doctors with Africa SDGs Sustainable Development Goals DHMT District Health management team SWOT Strength Weaknesses Opportunities DHO District Health Office and Threats DHS Demographic Health Survey TC Town Council DHT District Health Team TOT Training of Trainers DQA Data Quality Assurance UDHS Uganda Demographic Health Survey DTPC District Technical Planning Committee UMSC Uganda Muslim Supreme Council EMHS Essential Medicines and Health Supplies UNFPA United Nations Population Fund FP Family Planning VHT Village Health Team FP CIP Family Planning Costed Implementation WHO World Health Organisation Plan FY Financial Year HC Health Centre HF Health Facility xii
Executive Summary This district family planning costed implementation plan presents the outcome of a consultative process that was facilitated by a consultant supported by UNFPA in partnership with the Ministry of Health.
Evaluation and costing of FP activities was conducted in many sectors of the district. Less than 50% of in thematic areas that included Contraceptive the facilities had the required tools, guidelines and Security, Demand Creation, Service Delivery and protocol for family planning. Access, Financing, Policy and Enabling Environment and Stewardship, Management and Accountability. The District Health Management Team (DHMT) is responsible for the management and coordination The process to develop the plan involved of all health activities including family planning. It stakeholders ‘buy in’ activities; Family Planning is chaired by the District Health Officer. However, situation analysis in the district, development of the structure had no establishment for a family technical strategies and activities. The report was planning focal person although roles and mandates shared with the District Health Team and District were assigned to some individuals. There were no Health Officer. Consensus was reached and a final specific family planning coordination structures and report submitted. there was no evidence of any meeting specifically conducted for family planning. The assessment revealed the presence of ongoing and concluded initiatives aiming at increasing family This Family planning Costed Implementation Plan planning awareness and services at both community therefore puts in place strategic mechanisms for and health facility levels. However, gaps could still addressing the various gaps in FP service delivery be identified under commodity security, equipment for Kotido district aiming to improve the life and was inadequate in 60% of facilities, whereas 50% wellbeing of the population in the district. These of facilities had stock out for FP commodities are structured around the following six essential and supplies in the last 12 months and there was components or thematic areas: evidently limited/inadequate knowledge for planning 1. Policy and enabling environment and forecasting for FP commodities. 2. Service delivery and access 3. Contraceptive security Under service delivery & access, a comprehensive FP 4. Demand creation package services delivery was available in less than 5. Financing 30% of the facilities. The biggest available cadre for 6. Stewardship, management and accountability FP services was VHT, there were knowledge and skills gap for the delivery of FP services and distance This FP costed implementation plan is estimated to and terrain affected access to services delivery. cost Kotido district UGX 1,831,956,000 (One billion Family planning policy documents at all levels could Eight hundred Thirty-One million Nine hundred Fifty- not be accessed and were therefore, not available Six thousand Uganda Shillings) for the 5year period. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 1
SECTION 01: Introduction Family Planning - Costed Implementation Plan 2 (2018/19 - 2022/23) KOTIDO DISTRICT
1.1 Why Kotido district should invest in give his children their basic needs (food, shelter, Family Planning (FP)? education, and better future). It also gives him time for his family and his own personal advancement a). Family planning benefits the family and when suffering from an illness, he has enough time for treatment and recovery. Benefits to the mother: Family Planning enables a mother to regain her health quickly after delivery. a). Benefits of family planning to the district It gives her enough time and opportunity to love and provide attention to her husband and children, Low FP uptake means Kotido cannot fully gives her more time for her family and own enjoy the demographic dividend. The district personal advancement. When afflicted by illness, it experiences the second highest fertility rate in the gives her enough time for treatment and recovery. country at 7.9 children per woman. The district has 59% of its population below 19 years with Benefits to the children: Because healthy mothers 25% being adolescents (See Table 1). The Uganda produce healthy children, the children will get all census results show that 7.2% of married and the attention, security, love, improved nutrition child-bearing women are 10-19 years and females and care they deserve. aged 12-19 years who have given birth are 10% in Kotido district (UBOS, 2017 ). The high youthful Benefits to father: Since family planning lightens population leads to a high dependency ratio that is the burden and responsibility in supporting the a major barrier to social-economic transformation family, this enables the father to save money and and development of the district.
Table 1: Kotido district demographics
Year years 0-19 Adolescents years) 19 to (10 of Women Reproductive years) Age (15-49 Population Total people Young years) Below 19 Adolescents years) (10-19 of Women Reproductive Age years) (15-49 2015 111,780 47,210 43,990 185,600 60% 25% 24% 2016 114,770 48,850 46,140 191,400 60% 26% 24% 2017 117,650 50,350 47,620 197,200 60% 26% 24% 2018 120,530 51,630 49,530 203,300 59% 25% 24% 2019 123,550 53,150 51,610 209,500 59% 25% 25% 2020 126,650 54,510 53,560 215,800 59% 25% 25%
Source: UBOS., National Population and Housing Census, 2014 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 3
A large average family size makes it difficult for 1.2 Rationale for and use of FP-CIP families and the district local government to make the The President of Uganda made a commitment at the requisite investments in education and health that 2012 London Summit for Family Planning (FP2020) are needed to develop high-quality human capital to increase financial allocation of USD 5 million to and achieve higher incomes and socioeconomic Reproductive Health (RH) from domestic resources. development. Savings are low because parents This was followed by the development of FP CIP spend most of their income to meet their children’s 2015- 2020 with a goal of reducing unmet need for basic needs and it is difficult for the district economy Family Planning to 10% and increasing the modern to create enough high-quality jobs for the rapidly Contraceptive Prevalence Rate (mCPR) amongst growing youthful labour force. married women and women in union to 50% by 2020. The Uganda Demographic Health Survey, 2016 Kotido district population dynamics and economic shows slow progress towards achieving the above opportunities can be turned into a valuable target with national mCPR for married women and demographic dividend if it reduces fertility, prioritizes women in union of 35% and unmet need of 28%. investments in human capital to ensure a healthy and well-educated population; accelerates economic Karamoja sub region, where Kotido is located, has growth and job creation to ensure that the “surplus” one of the lowest mCPR for married women at 6.5% labour force is gainfully employed and has strong and unmet need of 19.7%. The situation in Kotido purchasing power; and enforce accountability and district is compounded by one of the highest Total efficiency in the use of public resources and delivery Fertility Rates in Uganda standing at 7.9 children per of social services. woman and teenage pregnancy of 23.6% .
The Family Planning Costed Implementation Plan for Savings are low because parents Kotido District (2018/19-2022/23) will contribute spend most of their income to to achievement of the national target and will provide guidance for all FP programming for the meet their children’s basic needs district across all sectors, development partners and it is difficult for the district and implementing partners. Kotido district FP CIP details the necessary program activities and costs economy to create enough associated, providing clear program-level information high-quality jobs for the rapidly on the resources the district must generate at local government level and from partners. The district FP growing youthful labour force. CIP gives critical direction to Kotido’s family planning program, ensuring that all components of a successful program are addressed and budgeted for in the district plan and partner programming.
More specifically, the Kotido District FP CIP will be used to: • Ensure one district plan for FP is followed: The District FP CIP articulates consensus- driven priorities for family planning through a consultative process and becomes a social contract for donors and implementing partners in the district. Family Planning - Costed Implementation Plan 4 (2018/19 - 2022/23) KOTIDO DISTRICT
• Define key activities and an implementation Uganda Context roadmap: The district FP CIP includes all necessary activities with defined targets that are Uganda is committed and a signatory to the appropriately sequenced to deliver the outcomes international Sustainable Development Goals(SDGs) needed to reach the district family planning goals which include reduction of Maternal Mortality Ratio; by 2022/23. universal access to Sexual and Reproductive Health • Determine impact: The district FP CIP includes care services as well as gender equity. There is a high estimates of the demographic impacts, health unmet FP need that stands at 28% and low modern impacts, and economic impacts of the family Contraceptive Prevalence Rate of 35% for married planning program, providing clear evidence for women and women in union. advocates to mobilize resources. • Define a district budget: The district FP CIP Based on the UDHS 2016, this has resulted into determines detailed commodity costs and high percentage of unintended pregnancies (43%), program activity costs associated with the entire high Total Fertility Rate (5.4) and high Maternal family planning program. Mortality Ratio (336/100,000 live births). The • Mobilize resources: The district FP CIP will country response has been to develop the National form the basis for district and partners to Health Sector Development Plan 2015/16- mobilize resources for implementation of agreed 2016/20, Reproductive Maternal Newborn Child activities. and Adolescent Health (RMNCAH) Sharpened • Monitor progress: The district FP CIP Plan (2016) and Uganda Family Planning Costed performance management mechanisms measure Implementation Plan (2015-2020). The districts the extent of activity implementation and help are expected to implement the national response ensure that the district family planning program through translating the national FP-CIP into a local is meeting its objectives, ensuring coordination, government response. and guiding any necessary course corrections. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 5
Kotido District Context
Overview Rengen (Figure 1). The District is constituted of 25 Parishes and 168 villages. Kotido district has a total Kotido District is located in the North-Eastern part population of 203,300 (projected for 2018) with an of Uganda. It is one of the 7 districts that make up estimated 49,530 comprising women of reproductive Karamoja sub region. It is bordered to the north and age (WRA). The district experiences very difficult north east by Kaabong District, Agago and Kitgum terrain made out of mountains and valleys. The districts to the North West, Abim District in the west, road network is very poor. It’s generally a rural Moroto to the south east and Napak to the south. district with limited access to essential services like The district has one County, Jie and a Town council electricity and piped water. (Kotido town Council) with 5 sub counties namely Kacheri, Kotido, Nakaperiromu, Panyangara and Family Planning - Costed Implementation Plan 6 (2018/19 - 2022/23) KOTIDO DISTRICT
Figure 1: Kotido 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 (2018/19 - 2022/23) KOTIDO DISTRICT 7
Kotido district Health services and Health The sector objective is to reduce morbidity and Infrastructure mortality as the major causes of ill health and premature deaths. The Department of Health is headed by the District Health Officer (DHO) whose mandate is guided by Health facilities are categorized into hospitals, the District 5 Year Strategic Plan that focuses on the health centres IV, III and II. Health centre II is at the achievement of equity through increased access to parish level; Health Centre III at the sub county level Minimum Health Care Package (MHCP), quality care, while Health Centre IV is at the county level. Health efficiency, accountability and transparency. units’ ownership is grouped in Government, Private The overall goal of the Kotido District health sector Not-for-Profit (PNFP) and Private-For-Profit (PFP). is to provide good quality services to the population It is assumed that the above health facilities were so as to make them attain good standards of health in established based on the catchment populations as order to live a healthy and productive life. shown in Table 2 below.
Table 2: National Health Facility Standards Type of Facility Indicator Health Facility Population Ratio Standard Current Situation National Referral Hospital 1: 10,000,000 1: 30,000,000 National Referral Hospital 1: 10,000,000 1: 30,000,000 Regional Referral Hospital 1: 3,000,000 1: 2,307,692 General Hospital 1: 500,000 1: 263,157 Health Centre IV 1: 100,000 1: 187,500 Health Centre III 1: 20,000 1: 84,507 Health Centre II 1: 5,000 1: 14,940 Health Centre I / VHT 1: 1,000 or 1 per 25HHs Source: MoH HMIS 2009 Family Planning - Costed Implementation Plan 8 (2018/19 - 2022/23) KOTIDO DISTRICT
Kotido District has a total of 19 health facilities, of which 16 are Government-owned and 3 are private not for profit(Table 3 ). Table 3: List of health facilities in the district Sub-county Parish Health facility Facility level Ownership Kacheri Kacheri Kacheri HC III Gov’t Lokiding Lokiding HC II Gov’t Losakusa Losakucha HC II Gov’t Kotido Rural Kanawat Kanawat HC III PNFP Lokitelaebu Lokitelaebu HC II Gov’t Losilang Losilang HC II PNFP Kotido T.C Kotido central Karamoja Diocese HC III PNFP Kotido North Kotido HC IV Gov’t Nakapelmoru Lookorok Lookorok HC II Gov’t Watakau Nakapelimoru HC III Gov’t Panyangara Loletio Panyangara HC III Gov’t Loposa Napumpum HC II Gov’t Kamoru Kamoru HC II Gov’t Rikitae Rikitae HC II Gov’t Rengen Lokadeli Rengen HC III Gov’t Nakwakwa Nakwakwa HC II Gov’t Naponga Lopuyo HC II Gov’t Nomadic Units Floating Apa Lopus HC II Gov’t Apa Lopama HC II Gov’t
Kotido District Family Planning Partners Table 4 below shows partners implementing family planning projects in Kotido district. The list may not be very comprehensive.
Uganda demographic health survey 2016 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 9
Table 4: Family Planning Partners Partner Description Health Communication Program Obulamu Production of IEC Materials for family planning and Campaign awareness raising Straight Talk Foundation Dissemination of IEC materials and BCC United Population fund Capacity building for partners, development of strategies for implementation of family planning World Health Organisation Ensuring availability of standard guidelines and polices and supporting trainers workshops Marie Stopes International Uganda General medical services, all family planning services and HCT services Ministry of Health Service provision and communication
Unmet need for family planning Figure 2: Unmet need for Family Planning for Karamoja sub region Unmet need is the percentage of women who want to space their births or do not want to become pregnant 25 but are not using contraception. Unmet need in Kotido district decreased by 0.8 20 19.7% percentage points over the five-year period from 20.5% in 2011 to 19.7% in 2016 compared to the national level where unmet need reduced by 6.3% 15 over the same period from 34.3% in 2011 to 28% in 13.5% 2016 . 11.3% 10 9.5% As shown in Figure 2 below, the unmet need for spacing in in Karamoja sub region, where Kotido 6.2% district is located increased from 11.3% in 2011 to 5 13.5% in 2016 while the unmet need for limiting reduced from 9.5% in 2011 to 6.2% in 2016 . 0 High unmet need contributes to high number unmet need unmet need unmet need of unplanned pregnancies including teenage for FP - spacing for FP- limiting for FP- total pregnancies that leads to increased abortion and maternal mortality. UDHS 2011 UDHS 2016
Contraceptive use increase of 1.6 to 35% over the same period of time. Figure 3 below shows trend of FP indicators in Kotido is one of the districts with the lowest modern Karamoja sub region where Kotido district is located. Contraceptive Prevalence Rate (mCPR) for married The national trends for the last three demographic women and women in union. The district mCPR health surveys were compared and overall, FP reduced by 0.9 percentage point from 7.4% in 2011 indicators in the region were bellow national average. to 6.5% in 2016 compared to the national percentage
Uganda demographic health survey 2016 Family Planning - Costed Implementation Plan 10 (2018/19 - 2022/23) KOTIDO DISTRICT
Figure 3: FP indicators for national level and Karamoja sub-region
40 38 34.8 35 34 29.7 30 28.4 26 24.9 24.8 25 23.8 23.6 23.8 20.5 20 19.7 17.6 18 15 10 7.4 5 6.5
0 0 Teenage Pregnancy (%) mCPR (%) Unmet need (%)
2006 National 2011 National 2016 National 2006 Karamoja Region 2011 Karamoja Region 2016 Karamoja Region
As regards the method mix, use of implants increased by 50% from 1.6% in 2011 to 3.1% in 2016 while injectable use decreased by 50% from 2.8% in 2011 to 1.4% in 2016. Important to note, there was observed uptake of Intra Uterine devices from 0% in 2011 to 0.6% in 2016 .
The Ministry of Health HMIS data shows an increase in the number of FP users from 2,089 in 2016 to 2,581 in 2017 posting a 19% increase in FP users in Kotido district (Table 5)
Table 5: Family Planning Users, 2016-2017 Methods FP Users 2016 FP users 2017 CYP 2016 CYP 2017 Oral contraceptive Pills (OCP) 87 34 5.800 2.267 Injectable Contraceptive 307 280 0.850 0.900 Female condom 102 108 4.867 10.358 Male Condom 584 1,243 6.739 39.348 Intra Uterine Device (IUD) 31 181 76.750 70.000 Implants 81 102 542.000 402.667 Female Sterilization 1 0 Male Sterilization 3 0 0.100 0.000 Fertility Awareness Method (FAM) 813 604 0.300 0.000 Total 2,089 2,581 669.8 557.4 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 11
1.3 Key Issues and Challenges Availability of Family Planning Services Service Delivery and Access at the Facilities Family planning counselling and commodities should Findings from the data collected during the be accessible for both men and women including consultative meeting with Kotido District team and the youth. There are numerous supply side barriers the quality of care EmoNC assessment that was to accessing contraception in Kotido district that conducted in the health facilities in the district, include clients not being able to access care due showed that although several health facilities to geographical distances and lack of supplies or offer family planning services, there are a couple equipment as shown in the data collected and of facilities that do not offer the full range of FP analysed below. methods, thereby limiting method choice ( table 6 ).
Table 6: Availability of Family planning services at each facility in Kotido district HEALTH FACILITY FP METHODS AVAILABLE Losilang HC II, Apa Lopus HCII, Kanawat HC III (PNFP) Offering natural methods only Kamoru HC II, Apa Lopama HCII, Nakwakwa HCII, Male condoms, natural method Lokiding HC II, Losakucha HCII Lokitelaebu HC II Short-term (Condoms, Orals, Injectables); long-term (Implants) Kacheri HC III, Napumpum HC III, Panyangara HC III Short-term (injectable); long-term (Implants) Nakapelimoru HC III Short-term (COC,s injectable); long-term (Implants) Karamoja Diocese HC III PNFP Short-term (COC, injectable); long-term (implants especially Jadelle) Rengen HC III Short-term (Condom, Injectable); long-term (Implants IUD) Kotido HC IV, Panyangara HC III Short-term (condoms, orals, Injectables); long-term (Implants, IUD)
Provision of male condoms and natural methods Availability of Human Resources for Family for FP was found at 5 public health facilities. Half Planning Service Provision of the health facilities provided services for natural Kotido District Local Government is regarded as a methods and injectables while 5 provided services hard-to-reach and hard-to-stay area like any other for oral contraceptives, 6 provided male condoms, districts in Karamoja sub region making it difficult to and less than 2 health facilities provided services attract and retain some key personnel like medical for IUDs, Emergency contraceptives and female doctors. condoms. There was no service provision of PPIUD, The most critical medical workers i.e. medical post-abortion IUD, PAC, PPC, BTL, vasectomy and officers, midwives, radiographers, dispensers, outreaches at all the health facilities. anaesthetic officers and nurses are difficult to attract and retain. Family Planning - Costed Implementation Plan 12 (2018/19 - 2022/23) KOTIDO DISTRICT
However, Kotido HC IV is located in the Town Council and hence would not be categorised as hard-to-reach. This is demonstrated in its ability to attract 100% staffing for medical officers, clinical officers and midwives with exception of nurses (Table 7). The above staffing norms translate into a human resource gap of 8 nurses for Kotido HC IV.
Nearly all the lower-level health facilities are in hard-to-reach and hard-to-stay areas and this state of affair is reflected in the 29% clinical officer staffing norm and 10% nurses staffing norm at HC III that translates into a human resource gap of 5 clinical officers and 3 nurses. Further, there is 55% staffing norm for nurses and 82% staffing norm for midwives at HC II level, as reflected in Table 7.
Table 7: Availability of human resource for family planning in Kotido District CADRE HC IV HC III HC II Total No. HFs of Total No. HF of meeting staffing norms HF% of meeting staffing norms No. HFs of Total No. HF of meeting staffing norms HF% of meeting staffing norms No. HFs of Total No. HF of meeting staffing norms HF% of meeting staffing norms Medical Officer 1 1 100% Clinical Officer 1 1 100% 7 2 29% Midwife 1 1 100% 7 7 100% 11 9 82% Nurses 1 0 0 7 0 0 11 6 55%
It was observed that some health facilities did not have staff with the required skills to provide quality FP services. There was no staffing gap for provision of implant insertion and removal, vasectomy and tubal ligation services. However, 3 public HC IIIs had staffing gaps for provision of IUD insertion and removal services while 4 HC IIIs reported staffing gaps for provision of post-abortion IUD and postpartum IUDs respectively. Table 8 below gives a synopsis of FP skills gap in Kotido medical facilities
Table 8: FP services skills gap FP Service Existing staff gap Implant Insertion and Removal No gap IUD insertion and removal Panyangara HCIII, Nampupum HCIII and Rengen HCIII PPIUD insertion and removal Panyangara HCIII, Nampupum HCIII, Rengen HCIII, Kotido HCIV Post Abortion IUD Kotido HCIV, Rengen HCIII, Napumpum HCIII, Kacheri HC III Vasectomy No gap Tubal Ligation No gap
MO: Medical Officer (Staffing norm: Senior Medical Officer (1), Medical Officer (1)) CO: Clinical Officer (Staffing norm: Clinical Officers (2), Ophthalmic Clinical Officer (1)-not considered) MW: Enrolled Midwife (Staffing Norm: Enrolled Midwife (3)) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 13
Number of Days and Hours for FP Service Provision One health facility (Karamoja Diocese) offers the recommended 24 hours and 7 days a week schedule for FP service provision (Table 9). The lack of a 24-hour availability of FP services poses a great barrier to access to the services by the community.
Table 9: Number of days and hours per week that FP services are offered Facility name Facility level level Facility Ownership perNo. days of week, the health facility offers Planning Family services Number hours of FP that per day, services are offered Lokiding HC II Public 2 1 Losakucha HC II Public 7 2 Lokitelaebu HC II Public 5 9 Losilang HC II PNFP (UPMB) 7 4 Lookorok HC II Public 3 8 Kamoru HC II Public 7 8 Rikitae HC II Public 0 0 Nakwakwa HC II Public 7 8 Lopuyo HC II Public 3 8 Apa Lopus HC II Public 1 2 Apa Lopama HC II Public 1 2 Kacheri HC III Public 7 12 Kanawat HC III PNFP (UCMB) 7 6 Karamoja Diocese (KDDO) HC III PNFP (UPMB) 7 24 Nakapelimoru HC III Public 5 8 Panyangara HC III Public 2 4 Napumpum HC III Public 7 6 Rengen HC III Public 5 8 Kotido HC IV Public 5 8 Family Planning - Costed Implementation Plan 14 (2018/19 - 2022/23) KOTIDO DISTRICT
Availability of HMIS tools at Health Facilities As illustrated in Table 10 below, only 9 (47%) of the health facilities had FP client cards or some form of patient record. While 16 (84%) facilities reported having stock cards, 15 of these (78%) had updated stock cards with receipts, expiries, balance at hand and physical count done.
Table 10: Status of HMIS tools at the service points of different health facilities HMIS tools HC IV HC III HC II Total No. of Total HFs No. HF of HMISwith Tool HF% of with HMIS Tool No. of Total HFs No. HF of HMISwith Tool HF% of with HMIS Tool No. of Total HFs No. HF of HMISwith Tool HF% of with HMIS Tool Client cards 1 0 0 7 4 57 11 1 9 FP register 1 1 100 7 6 86 11 8 73 Stock cards 1 1 100 7 5 71 11 8 73 Stock card updated 1 1 100 7 4 57 11 7 64
Availability of Infrastructure for provision of quality Family Planning Services For health facilities to be able to provide quality FP services, there must be conducive infrastructure to ensure comfort of the provider and confidentiality of the client. There are numerous gaps in the infrastructure of the health facilities where family planning services are provided. At Kotido HC IV, the space required to ensure privacy for FP service provision but there’s neither adequate light source nor running water in the FP service point. At lower level health facilities (HC IIIs and IIs), there are infrastructure gaps for space to ensure privacy, adequate lighting source and running water(Table 11).
Table 11: Availability of Infrastructure for provision of Family planning services INFRASTRUCTURE INDICATORS FOR FP CLINIC HC IV HC III HC II Total No. HFs of Total No. HF of meeting standard the HF% of meeting standard No. HFs of Total No. HF of meeting standard the HF% of meeting standard No. HFs of Total No. HF of meeting standard the HF% of meeting standard Space with privacy for FP service provision 1 1 100 7 3 43 11 3 27 Adequate light source 1 0 0 7 3 43 11 0 0 Running water available in the FP service point 1 0 0 7 2 29 11 0 0 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 15
Contraceptive Security (Programs) The capacity and interest for higher level health facilities to update stock cards, the family planning Availability of Contraceptives and Family Planning register and use them for quantification is limited. Equipment There are also reported constrains of facilitation Contraceptive security was evaluated by assessing for the quantification planning meetings which are the supply chain management, equipment for FP often not catered for within the district health office services at facility level, stock out of Family planning budget. Additionally, ordering is usually coordinated commodities that were experienced in the last 12 by NMS and many times when organised, there is no months, availability of HMIS tools in the family prior notice given and this normally disorganises and planning service point and stock out of sundries and constrain the daily operations including failure to use drugs in the last 12 months. real health facility data. The district currently has no storage facilities and There are two supply chain systems for often relies on the District store. This is where contraceptives. The public health facilities obtain medicines and contraceptive supplies to the district their supplies from National Medical Stores (NMS) from NMS are temporarily stored. whereas the private-for-profit facilities obtain their supplies from the Alternative Distribution system and Availability of contraceptives at health facilities Joint Medical Stores for non-contraceptive related remains a challenge. Half (9) of the health facilities supplies. Supplies from NMS have a delivery schedule had a stock-out of at least one contraceptive which is known by the district/health facilities. Apart commodity. The stock-out is attributed to one- from contraceptives and other donated supplies, the size-fits all Essential Medicines and Health Supplies other medicines have an indicative budget known to (EMHS) kit for HC IIs and IIIs, and inadequate the district/facility against which orders are made. planning and quantification skills at HC IV. Table 12 For contraceptives it is only the health centre IVs and below gives the stock out status of the commodities the hospitals that can order from NMS. in the last twelve months.
Lower level facilities (HC II and III) have a pre- determined method mix and quantity in the Essential Medicines Kit that are “pushed” to the districts and eventually to the end user health facilities. Transportation is provided by NMS up to the district using NMS fleet of vehicles. From the district, NMS has sub-contracted transport companies to deliver to the user health facility. This system has proved to be effective for timeliness. Family Planning - Costed Implementation Plan 16 (2018/19 - 2022/23) KOTIDO DISTRICT
Table 12: Common stock outs experienced in the last 12 months at each facility Contraceptive Commodities HC IV HC III HC II Total No. of Total HFs No. HF of stock with HF% of with stock No. of Total HFs No. HF of stock with HF% of with stock No. of Total HFs No. HF of stock with HF% of with stock Oral COCs 1 0 0% 7 5 71% 11 9 82% Oral POPs 1 0 0% 7 5 71% 11 9 82% Injectables 1 0 0% 7 3 43% 11 6 55% Male condom 1 0 0% 7 2 29% 11 2 18% Female condom 1 1 100% 7 4 57% 11 8 73% ECPs 1 1 100% 7 2 29% 11 9 82% Implants 1 0 0% 7 3 43% 11 9 82% IUD 1 0 0% 7 4 57% 11 9 82% Cycle Beads 1 0 0% 7 5 71% 11 4 36% Latex gloves 1 1 100% 7 0 0% 11 5 45% Mixed hand solution 1 0 0% 7 2 29% 11 8 73% Solution for instrument disinfection 1 1 100% 7 3 43% 11 9 82% Surgical gloves 1 1 100% 7 4 57% 11 7 64% Surgical blades 1 0 0% 7 1 14% 11 6 55% Lignocaine 1 0 0% 7 4 57% 11 8 73% Cotton wool 1 0 0% 7 4 57% 11 8 73% Gauze 1 0 0% 7 3 43% 11 7 64% Adhesive plaster 1 0 0% 7 4 57% 11 3 27%
Family Planning Equipment Kotido HC IV has sterilizer, IUD insertion kit, PPIUD insertion kit, implant removal kit, mini-laparatomy kit, sharp boxes and coloured waste bins. However, there are no vasectomy kits, Blood pressure machine, buckets for decontamination, ultrasound machine and X-ray machine. Out of the 7 HC IIIs, only 2 had IUD insertion kits, 3-PPIUD insertion kits and 3 had implant removal kits( Table 13) . Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 17
Table 13: Availability of Family Planning Equipment at Each Health facility EQUIPMENT HC IV HC III HC II Total No. HFs of Total No. HF of with functional FP equipment HF% of with functional FP equipment No. HFs of Total No. HF of with functional FP equipment HF% of with functional FP equipment No. HFs of Total No. HF of with functional FP equipment HF% of with functional FP equipment Sterilizer 1 1 100 7 6 86 11 3 27 IUD insertion kit 1 1 100 7 2 29 11 0 0 PPIUD Insertion kit 1 1 100 7 3 43 11 0 0 Implant removal kit 1 1 100 7 3 43 11 0 0 Mini laparotomy kit 1 1 100 vasectomy kit 1 0 0 BP machine 1 0 0 7 6 86 11 7 64 Sharps Boxes 1 1 100 7 7 100 11 10 91 3 Buckets for decontamination 1 0 0 7 7 100 11 5 45 Ultrasound machine 1 0 0 7 1 14 X-ray machine 1 0 0 Coloured waste bins 1 1 100 7 6 86 11 10 91 Weighing machine 1 0 0 7 4 57 11 6 55 A couch 1 1 100 7 4 57 11 6 55
Human Resource Capacity to Manage moving the task of managing the EMHS system to the Contraceptive Commodity Supply Chain nurses, midwives and clinical officers. The availability of supply chain staff should be complemented with Efficient FP programs ensure availability of highly the necessary skills to manage contraceptives supply skilled supply chain management cadres. The supply chain effectively within an integrated EMHS system. chain cadres in Uganda are mainly storekeepers, dispensers and pharmacists. However, there is an Policy and Enabling Environment element of task-sharing by nurses and clinical officers during the day to day management at the health At national level, the Government of Uganda has facility. put in place conducive policies and guidelines for FP. It is expected that local governments The EMHS staffing norms at HCIV is supposed to be translate the enabling policies into local context for one dispenser and one stores assistant. Kotido HCIV implementation. Some of the important policies for staffing norm for the store assistant were met while noting include the National Family Planning Costed the facility lacked a dispenser. The staffing norms do Implementation Plan (2015-2020); Reproductive not cater for a stores assistant or dispenser at the Maternal Newborn Child and Adolescent (RMNCAH) lower level health facilities (HC IIs and IIIs) thereby Health Sharpened Plan (2016); Reproductive Health Family Planning - Costed Implementation Plan 18 (2018/19 - 2022/23) KOTIDO DISTRICT
Commodity Security Strategy (2016-2020); National Figure 4: Availability of policies, guidelines and Policy for Sexual and Reproductive Health and protocols in the health facilities
Rights (2012); Adolescent Health Policy (2012); 14 Guidelines for Prevention, Management of HIV and AIDS and teenage unintended pregnancy in school 12 settings of Uganda, 2015; National Strategy to end child marriage and teenage pregnancy (2015-2020); 10 National Implementation Plan for Long Acting and 8 Reversible Contraceptives and Permanent Methods (2017-2021). 6
The assessment showed that many basic policies and 4 guidelines for FP service provision are not available 2 at the health facilities. These limits evidence- based practice by health providers hence affecting 0 provision of quality FP services ( Figure 4 ). Guidelines Visual Uganda WHO Wheel FP aid WHO Wheel 2015 Handbook
Financing for Family Planning Services Implementation of FP services in Kotido district depends on the availability of financial resources. Kotido district has two streams of funding for its FP activities- central government through Primary Health Care grant, donor support (bilateral and multilateral agencies) and philanthropists through civil society organisations. Kotido district does not have a specific budget line for reproductive health/ family planning. All the FP activities are carried out in an integrated approach and hence difficult to determine FP investments in the public sector. There are several partners investing resources in FP, however, it was difficult to determine the level of investment in absolute monetary terms. In terms of prioritisation of health by the district through budget allocations, it was observed that the percentage allocation to health decreased from 18% in FY 2014/15 to 10% in FY 2016/17 ( Table 14 ).
Table 14: Kotido district allocation to health and Family planning FY District Budget District Budget Allocation to Expenditure on Allocation Allocation Expenditure health Health to FP 2014/15 11,637,663,000 1,354,698,000 2,167,530,000 372,286,000 0 2015/16 10,873,414,000 1,883,252,000 2,490,033,000 390,938,000 0 2016/17 10,233,734,000 1,117,982,000 1,422,982,000 317,341,000 0 2017/18 11,446,635,000 n/a 2,593,129,000 n/a 0 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 19
Over the same period of time, donors have demonstrated significant support to the health sector in Kotido district by increasing allocations from UGX1billion in FY 2014/15 to UGX3billion in FY 2016/17 representing a 67% increase as shown in Table 15 below.
Table 15: Donor only-budget support to health in Kotido FY Donor Allocation for Health Expenditure 2014/15 1,089,639,000 273,787,000 2015/16 809,167,000 812,167,000 2016/17 3,178,638,000 442,032,000 2017/18 3,387,000,000 n/a
Demand Creation
Socio-Cultural and Gender Norms Karamoja region has a strong culture that promotes teenage pregnancy, polygamy and nomadic lifestyle. The culture encourages male partners to leave their wives under the care of the in-laws from conception till over a year after delivering a baby. District consultations revealed that majority of the health facilities have on-going SBCC activities for FP demand generation that have resulted into growing demand and access for FP. The limited supply of IEC materials impacts on demand generation activities ( Table 16 ).
Table 16: Ongoing Demand creation (SBCC) activities in Kotido District Demand Creation Activity HC IV HC III HC II Total No. of Total HFs No. HF of with activityBCC HF% of with activityBCC No. of Total HFs No. HF of with activityBCC HF% of with activityBCC No. of Total HFs No. HF of with activityBCC HF% of with activityBCC Awareness creation sessions 1 1 100 7 5 71 11 10 91 IEC materials on FP 1 1 100 7 6 86 11 8 73 Family Planning - Costed Implementation Plan 20 (2018/19 - 2022/23) KOTIDO DISTRICT
Stewardship, Management and Accountability Family planning is not included in the budgets and Clear leadership responsibility and authority are strategic frameworks of all other departments essential for repositioning family planning in the denying their role in harnessing demographic multisectoral environment. Current bottlenecks in dividend and prolonging the journey to the national supervision, monitoring, and coordination include goal. limited dedicated staffing resources at the district, especially the DHO’s office (CIP stakeholder meeting, Table 17 below shows that there are several gaps 2018). There’s no ADHO for maternal health, no in the management of FP services across the district FP focal person and this limits coordination of district including absence of FP focal person, lack of activities in the district. supervision of health workers by the district health The RH department needs visibility amongst other management team and lack of follow up on the departments at the district in order to take on a quality of counselling and Family planning services, streamlined multisectoral approach to SRH. especially in the lower health facilities.
Table 17: Status of Supervision of Health workers by DHT and quality of service by Health workers in Kotido District MONITORING, EVALUATION AND HC IV HC III HC II MANAGEMENT OF FP SERVICES Total No. HFs of Total No. HF of with indicator met HF% of with indicator met No. HFs of Total No. HF of with indicator met HF% of with indicator met No. HFs of Total No. HF of with indicator met HF% of with indicator met HWs supervised by DHT last 6 months 1 0 0 7 3 43 11 4 36 FP focal person available 1 0 0 7 7 100 11 6 55 Follow up of FP counselling quality 1 1 100 7 4 57 11 3 27 Follow up of FP service quality 1 1 100 7 2 29 11 1 9 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 21
SECTION 02: Process & Formulation Family Planning - Costed Implementation Plan 22 (2018/19 - 2022/23) KOTIDO DISTRICT
2.1: Process followed to develop Kotido district • In-depth Interviews: Key informant interviews, Family Planning CIP focus group discussions, client exit interviews and key observations were carried out to obtain insight The consultant adapted the FHI360 CIP Resource into the status of FP implementation in the health kit as guidance for the development of the District facilities and at community level. Data collection Family Planning CIP. The process of development tools were developed based on the key thematic of district FP CIPs is a 3-phased process involving areas – Demand Creation, Service Delivery Planning Phase, CIP Development Phase and Plan and Access, Contraceptive Security, Policy and Execution phase. These phases are broken down into Enabling Environment, Financing, Stewardship, 10 steps that were followed in the CIP development Management, and Accountability. process, as highlighted in the section below. The DHT was transformed into the data collection team, trained on tools and supported to undertake Obtain key stakeholder buy-in: data analysis. This was to make sure that the DHT gets to understand first-hand the key issues facing The consultant worked closely with the district FP in the district and generate momentum for health office. The district health office was debriefed addressing the issues. The data collection tool on the process of development of the FP CIP and and analysis was based on the Engender Health the significance of the activity. The district health SEED Model that focuses on Supply, Enabling office constituted the DHT into the data collection Environment, Demand (SEED) programming model and analysis team. In addition, the district health to explore the root causes of gaps that need to be office took leadership and coordination functions in addressed. convening the validation meeting and consensus on the main issues that would be the focus of the FP CIP.
Development of a detailed roadmap and securing resources for FP- CIP: The resources for data collection, analysis and development of the FP CIP were provided by UNFPA Uganda country office. • In-depth desk review: The documents reviewed included the Uganda National Family Planning Costed Implementation Plan, the Uganda Demographic Health Survey (UDHS) for the regional performance on modern CPR that was utilised to model CPR projections for Kotido, the report on quality of care assessment of EmoNC in the 25 UNFPA-supported districts that was done in 2017 and other documents as recommended by the MOH RH division technical staff, district health office, NMS commodities distribution list, the DHMIS data and any available literature at national level. Implementing partners were contacted to provide any assessments/studies/stories regarding status of FP in Kotido district. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 23
2.2: SWOT Analysis
A SWOT analysis was undertaken during the stakeholder meeting in Kotido district to specifically examine the Strengths, Weaknesses, Opportunities and Threats that accrue to Kotido in the provision of and promotion of Family Planning services and consequent uptake (see Table 18 below). Developing the SWOT was a fundamental step in the process of putting in place an agreed district Family Planning Costed Implementation Plan.
STRENGTHS WEAKNESSES • Implementing partners that support district FP • Regular FP commodity stock-outs programs • Poor road network • Community has basic knowledge on where to • High staff turnover access FP • Poor communication channels to lower Health • Availability of mobile health workers facilities • Use of adolescent campaigns • Poor accommodation amenities for health workers • Integrated FP service provision and support • Lack of training in inventory management supervision • Inadequate funding for FP programs • Routine supply chain for FP commodities from • FP polices and guidelines are not well disseminated to NMS and JMS all health units • Presence of guidelines and policies in some health • Poor sensitization of FP polices and guidelines to units health workers • Strong political will • Limited access to FP information at the DHO office • Presence of FP focal persons in some health units • FP commodities are provided free of charge
OPPORTUNITIES THREATS • Strong political will • Changing policies and their limited applications • Availability of drug shops and private clinics for • Inadequate number of health workers FP • Regular stock-outs of FP commodities • Alternative funding from private providers • High costs of FP services at the drug shops and private • Availability of key guidelines and policies to be health facilities disseminated • High transport costs and long distances to health • Strong commitment from health workers facilities • Strong cultural norms • Vertical FP programs implemented by IPs
Family Planning - Costed Implementation Plan 24 (2018/19 - 2022/23) KOTIDO DISTRICT
SECTION 03: Translation of key issues into Strategy Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 25
Service delivery and access Policy and Enabling environment Kotido District Local Government is regarded as a The district health office should be the custodian hard-to-reach and hard-to-stay area like any other of the health policies and guidelines and ensuring districts in Karamoja region making it difficult to that they are implemented well. There was limited attract and retain key personnel at lower level availability of policies and guidelines at health facility health facilities. Kotido district experiences heavy level. rains that make it difficult for clients to access family planning services. There is less provision Financing of long-acting reversible methods and permanent There was decreasing allocation to health with methods due to limited service provision by health marked increase in on-budget support to health for facilities with the majority of health facilities not Kotido district. However, there was observed lack of providing IUDs in general, postpartum and post- investment by the district to family planning services. abortion IUDs, Implants, PPIUDs, Vasectomy and Bilateral tubal ligation. Though the UDHS data shows Demand creation increased unmet need for spacing and high teenage pregnancies, there are no health facilities providing There are ongoing demand creation activities within emergency contraceptives and female condoms. the district. However, there was a limited supply of All health facilities apart from Karamoja Diocese IEC materials and community mobilisation through HC III do not provide 24-hour FP services. The outreaches. majority of the health facilities do not have adequate infrastructure to be able to provide quality FP Stewardship, Management and Accountability services. The district has not set up coordination mechanisms There is severe lack of equipment to support family for family planning especially providing leadership planning services that include sterilizers, IUD kits, and coordination for FP implementing partners. In Mini-Lap, vasectomy, blood pressure machines and addition, the DHT does not have mechanisms to hold ultra sound machines. Availability of quality data the implementing partner accountable and a lack and information form part of quality of care and a of vision on how the district would want the family few health facilities had stock client cards and stock planning services implemented and setting priority cards. However, the majority of facilities had FP areas. This has led to duplication of efforts and registers. wastage of resources.
Contraceptive security (Programs) The majority of health facilities in Kotido district are health centre IIs and IIIs that receive the pre- packed EMHS Kit that do not contain long-acting reversible methods of family planning. However, most of the midwives at health facilities have skills and knowledge of implant and IUD insertion and removal but lack the supplies including the delivery beds that can be used during IUD insertion. Family Planning - Costed Implementation Plan 26 (2018/19 - 2022/23) KOTIDO DISTRICT
SECTION 04: Modelling achievable mCPR goals Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 27
Continue past district CPR growth trend model According to the current trends in mCPR for Kotido district, Reality Check model shows that Kotido district will reach a mCPR of approximately 11.78% among married women of reproductive age group 15-49 by 2022 (Table 19). This will represent an annual growth of 0.65 percentage points per year since 2011. The internationally recognised healthy CPR growth is between 1 and 2 percentage points per year. Therefore, there is need to accelerate CPR in Kotido district to reach acceptable levels.
Table 19: Contraceptive Method mix, CPR Growth, and Health Impact if trends continue through 2022 Continue Past Rate of mCPR Increase (among MWRA) of 0.65% CPR 2017 2018 2019 2020 2021 2022 2023 Total Any modern 8.53% 9.18% 9.83% 10.48% 11.13% 11.78% 12.43% method Number of Adopters 2017 2018 2019 2020 2021 2022 2023 Total mCPR 2023 (%) mCPR share 2023 (%) Any Modern 1,374 1,269 1,390 1,518 1,652 1,794 1943 10,939 12.43 100% Method Female Sterilization 27 24 26 28 31 33 36 204 0.53 4% Male Sterilization 0 0 0 0 0 0 0 0 0.00 0% Pill 197 103 107 110 114 118 121 870 0.63 5% IUD 33 63 70 78 86 94 102 527 0.92 7% Injectable 474 396 432 470 509 551 595 3428 3.08 25% Implant - Jadelle, 395 434 480 528 579 632 688 3735 5.29 43% Sino-implant II Implant - Implanon 94 42 44 45 47 48 50 370 0.30 2% Male Condom 154 206 232 259 287 318 350 1805 1.69 14% Female Condom 0 0 0 0 0 0 0 0 0.00 0% Other modern methods including 0 0 0 0 0 0 0 0 0.00 0% SDM
Impact 2017 2018 2019 2020 2021 2022 2023 Total Unintended pregnancies averted 755 840 929 1024 1123 1228 1339 7239 Abortions averted 242 269 297 328 359 393 428 2316 Unsafe abortions averted 232 258 285 314 345 377 411 2224 Live births averted 399 444 491 514 594 649 708 3827 Maternal deaths averted 1 2 2 2 2 2 3 14 Couple Years of Protection 3368 3624 3980 4357 4754 5172 5613 30868 Family Planning - Costed Implementation Plan 28 (2018/19 - 2022/23) KOTIDO DISTRICT
Accelerated mCPR growth and method shift model If Kotido district works with heightened and sustained efforts to increase access to, acceptability of, and availability of contraceptives, the district should be able to increase CPR by an accelerated 1.3 percentage points and achieve mCPR of 14.3% in 2022 from the current 7.3% for married women and women in union as shown in Table 20 below.
Table 20: Contraceptive method mix, CPR growth, and health impacts if growth in modern method use is accelerated to 1.3% annually, 2018-2022 Increase CPR by 1.3% per year CPR 2017 2018 2019 2020 2021 2022 2023 Any modern method 7.8% 9.1% 10.4% 11.7% 13% 14.3% 15.6% Number Number of Adopters 2017 2018 2019 2020 2021 2022 2023 Total mCPR 2023(%) mCPR share 2023 (%) Any Modern Method 1145 1336 1538 1752 1978 2217 9966 15.6 100% Female Sterilization 31 34 38 42 46 50 55 296 0.72 5% Male Sterilization 0 0 0 0 0 0 0 0 0 0% Pill 0 0 0 0 0 0 0 0 0 0% IUD 83 95 108 122 136 152 168 865 1.4 9% Injectable - Three-Month 300 354 411 471 535 602 674 3346 3.36 22% Implant - Jadelle, Implanon, 486 562 644 729 820 916 1017 5175 7.44 48% Sino-implant II Male Condom 245 290 337 388 441 497 556 2754 2.64 17% Female Condom 0 0 0 0 0 0 0 0 0 0% Other modern methods 0 0 0 0 0 0 0 0 0 0% including SDM
Impact 2017 2018 2019 2020 2021 2022 2023 Total Unintended pregnancies 693 836 987 1146 1316 1495 1685 8158 averted Abortions averted 222 267 316 367 421 478 539 2611 Unsafe abortions averted 213 257 303 352 404 459 518 2506 Live births averted 367 442 522 606 696 790 891 4313 Maternal deaths averted 1 2 2 2 3 3 3 16 Couple Years of Protection 3472 4046 4653 5297 5978 6698 7459 37604 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 29
Tables 21 and 22 below show the caseloads for the two scenarios. Table 21: Monthly Case-load Per Health Facility in Business As Usual Scenario of 0.65% increase in CPR per year Monthly caseload per facility, by method 2017 2018 2019 2020 2021 2022 2023 Continue Past Rate of mCPR Increase (among MWRA) of 0.65% Female Sterilization (n=1) 2 2 2 2 3 3 3 Male Sterilization (n=1) 0 0 0 0 0 0 0 Pill (n=17) 4 4 4 4 4 5 5 IUD (n=6) 0 1 1 1 1 1 1 Injectable (n=17) 14 15 16 18 19 21 23 Implants (n=6) 5 6 7 7 8 9 10 Male Condom (n=17) 6 7 8 9 10 11 13 Female Condom (n=17) 0 0 0 0 0 0 0 Standard Days Method (n=19) 0 0 0 0 0 0 0 Other (n=17) 0 0 0 0 0 0 0
Table 22: Monthly case load per health facility by method in the accelerated CPR of 1.3% CPR increase per year Year 2017 2018 2019 2020 2021 2022 2023 Increase CPR by 1.3% per year Female Sterilization (n=1) 3 3 3 3 4 4 5 Male Sterilization (n=1) 0 0 0 0 0 0 0 Pill (n=17) 0 0 0 0 0 0 0 IUD (n=6) 1 1 2 2 2 2 2 Injectable (n=17) 10 12 15 17 19 22 25 Implants (n=6) 7 8 9 10 11 13 14 Male Condom (n=17) 8 10 11 13 15 17 20 Female Condom (n=17) 0 0 0 0 0 0 0 Standard Days Method (n=19) 0 0 0 0 0 0 0 Family Planning - Costed Implementation Plan 30 (2018/19 - 2022/23) KOTIDO DISTRICT
SECTION 05: Costed Implementation Plan Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 31
5.1 Vision Priority area 5: Promote and nurture change in The overall vision is to contribute to the Kotido social and individual behaviour to address myths, district health sector goal of providing good quality misconceptions, side effects and improve acceptance services to the people of Kotido district so as to make and continued use of family planning to prevent them attain good standards of health in order to live a unintended pregnancies healthy and productive life. Priority 6: Due to limited number of medical doctors and clinical officers, implement task shifting to 5.2 Operational Goal increase access at health centre II and III. To contribute to the national unmet need of 10% and mCPR of 50% by implementing family planning 5.4 Intervention and Activity Mapping programs that will increase the mCPR for married to Strategic Priorities women and women in union from 7.3% in 2016 to The activities in the Kotido district FP CIP are 14.3% in 2022. structured around six essential components or thematic areas of an FP program. 5.3 Strategic Priorities 7. Policy and enabling environment The strategic priorities given in the Kotido District 8. Service delivery and access FP CIP represent key areas for financial resource 9. Contraceptive security allocation and implementation performance. 10. Demand creation Strategic priorities reflect issues and/or interventions 11. Financing that must be acted upon in order to reach the district 12. Stewardship, management and accountability operational goal of increasing mCPR from 7.3% in 2016 to 14.3% in 2022. The six strategic priorities are addressed through the various activities under the six thematic areas. Priority Areas Priority Area 1: Increase access to private sector 5.5 Strategic Outcomes through a total market approach and build human Across the six thematic areas, there are 13 total resource capacity for provision of information, strategic outcomes for implementing the full family counselling and services provision. planning costed implementation plan in Kotido district. Each area is further detailed with expected Priority Area 2: Increase funding for implementation results, activities, sub-activities, inputs, outputs and of outreach services and provision of age appropriate timeline expectations ( Figure 5). information for young people age 10-24 years. The estimated total cost of implementing the Priority Area 3: Strengthen leadership and family planning costed implementation plan is coordination within the DHO office Uganda shillings one billion eight hundred thirty- one million nine hundred fifty-six thousand (UGX Priority Area 4: Prioritise FP within the Kotido 1,831,956,000) over the 5year period. district budget framework paper, work plan and monitoring and supervision Family Planning - Costed Implementation Plan 32 (2018/19 - 2022/23) KOTIDO DISTRICT
Figure 5: Cost for Strategic Priorities by thematic areas in Ugx Shs.
1 000 900 800 00 00 00 00
300 200 100 -
2 1 1 000 23 00 000 23 00 000 23 00 000 23 00 000 ) - - - - - ) 230 000 230 000 230 000 230 000 230 000 3 800 000 800 000 800 000 800 000 800 000 130 090 000 8 90 000 8 90 000 8 90 000 8 90 000 2 000 000 31 000 000 31 000 000 31 000 000 31 000 000 00 0 000 89 2 000 89 2 000 89 2 000 3 2 000
Policy and Enabling Environment PPE2: Family planning integrated into the programming of other departments of Kotido district Strategy local government To ensure that all health workers and local Kotido district health office will develop guidelines government officials including politicians are aware on integration of FP into other department programs and knowledgeable about FP policies, guidelines and and disseminate them through capacity building and protocols. continuous technical support to the departments.
Strategic outcomes PPE3: Local, opinion, religious and cultural leaders PPE1: Legal framework and knowledge of policies for are supportive of family planning family planning improved. The district health team will identify influential Kotido district will coordinate with the Ministry persons at the district, sub-county and parish level of Health to acquire all the updated FP policies, who will be capacitated to understand FP in order to guidelines and protocols. The district will receive become family planning champions. trainers-of trainers from the Ministry of Health and Costing summary then cascade the training to health facilities and private sector. The district will develop guidelines for integration of FP into other departments more especially Finance, Planning, Production and Marketing, Education, and Community based services. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 33
Figure 6: Policy and Enabling Environment Strategic outcomes cost, in million UGX SD1: Health workers providing quality FP services The Ministry of Health will build capacity for district 250 241 family planning trainers who will build the capacity at health facility level for provision of family planning services. The same district team will be capacitated 200 with transport and equipment to be able to carry out long-acting reversible and permanent methods as an 150 outreach based at public health facilities.
SD2: Improved quality and reporting of the DHIS2 100 Kotido district working with National Medical Stores Millions and Ministry of Health Division of Health Information 50 will ensure that all health facilities have the required 24 24 24 24 HMIS tools. In addition, all health facilities will be provided with on-job support to improve data entry, 0 analysis and reporting. 2018 2019 2020 2021 2022 Costing summary
Service Delivery and Access Figure 7: Service Delivery and Access costs, in million UGX Strategy The District Health Office will constitute a highly- trained technical and motivated mobile team 450 400 possessing capacity to provide long-acting reversible 400 methods with ability to train and supervise. The 350 team hereby referred to as the district FP technical team will build the capacity for health facility-based 300 providers to improve on quality of service. The 250 team will build capacity through on-job training and provide support supervision to every health facility in 200 the district once a year.
Millions 150
100 89 89 89 In addition, the district FP technical team will 73 undertake one outreach per health facility per year. It 50 is anticipated that the district FP technical team will 0 be facilitated with a vehicle, driver and FP essential 2018 2019 2020 2021 2022 medicines and health supplies for outreaches. The team will work with the demand generation implementing partners to mobilise communities around the health facilities. The DHO will work with other departments to improve infrastructure. Family Planning - Costed Implementation Plan 34 (2018/19 - 2022/23) KOTIDO DISTRICT
Contraceptive Security Demand Creation Strategy Strategy Kotido district will strengthen the medicines Demand creation activities are usually expensive. management supervisors to ensure that health However, Kotido district will strengthen its capacity facilities can properly manage contraceptives to monitor and work with partners to strengthen and have the capacity to record and analyse demand creation. logistics management information for purposes of quantification. Strategic outcomes DC1: Increased knowledge of family planning Strategic outcomes The district will support and consolidate on the CS1: Strengthening capacities of health care existing initiatives including community dialogue providers in Logistics Management Information meetings, school outreach programmes and FP System (LMIS) and Health Management Information outreach activities among others. In addition, System the district will coordinate development and The District Health Office with support from the dissemination of IEC materials on family planning department of Pharmacy, Ministry of Health and services. Particular focus will be put on young people National Medical Stores will ensure that all health to acquire knowledge about family planning and be workers handling contraceptives have the required empowered to use the services. registers and stock-cards and have the capacity to manage inventory. DC2: Demand increased through social marketing of free products and commercial sector CS2: Commodity distribution to private not-for- Kotido district and partners will attract and profits coordinate implementation of social marketing There exists the alternative distribution system programs and support the commercial condom that is meant to ensure contraceptive commodities sector. availability in the private sector. The district health team and the district medicines management Costing summary supervisor will be trained on how to implement the Figure 9: Demand Creation cost, in million UGX system at the district level. 140 131 Costing summary 120 Figure 8: Contraceptive Security (Programs) cost, in million USD 100 86 86 86 86 80 6 5 5 5 5 5 60
5 Millions 40 4 20 3
Millions 0 2 2018 2019 2020 2021 2022
1
0 2018 2019 2020 2021 2022 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 35
Financing Stewardship, Management and Strategy Accountability Strategy The district will show commitment to improving Kotido district will strengthen the family planning family planning indicators through committing coordination mechanisms and ensure evidence-based resources from the local government revenue and approach to family planning programming in the government grants to family planning. district.
Strategic outcomes Strategic outcomes FF1: Family Planning budget line created SMA1: A well-coordinated family planning The district will use the family planning costed program implementation plan as a fundraising tool through The district will map all the stakeholders involved development of a family planning budget advocacy in provision of family planning and develop terms of strategy. reference for a coordination mechanism. The district will effectively track and monitor the district FP-CIP FF2: Family Planning resources tracked and provide support to Implementing Partners to The district using the coordination mechanism will report activities and funding and identify gaps. track resources being invested into family planning on an annual basis. In that regard, a resource tracking SMA2: Strengthen support supervision for family tool will be developed/ adapted. planning services The district health team together with the regional Costing summary reproductive health coordinator based at Moroto Figure 10: Financing costs, in millions UGX district will undertake bi-annual FP support supervision activities. A health facility league 38 40 table will be developed and updated after every 35 support supervision visit based on an agreed upon performance checklist. 30
25 Costing summary
20 Figure 11: Stewardship, Management and Accountability costs, in millions UGX
Millions 15 70 10 8 8 8 8 62 60 5 50 0 2018 2019 2020 2021 2022 40 31 31 31 31
Millions 30 The total financial investment need for implementing this plan will be UGX 741,180,000 over a 5year 20 period. The biggest investment will be required in the 10 first year. 0 2018 2019 2020 2021 2022 Family Planning - Costed Implementation Plan 36 (2018/19 - 2022/23) KOTIDO DISTRICT
SECTION 06: Institutional Arrangements for Implementation Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 37
Implementation DHT and the Assistant DHO will mobilize partner efforts towards FP in Kotido, as well as offer technical Kotido District FP CIP will be implemented in line support to implementing partners, institutional- with the national health framework and within the based health workers and Village Health Teams at decentralization realm. Working closely with central village level. government, whose leadership and governance responsibility is prescribed in the National Health Civil society and nongovernmental organizations Policy, Kotido District Health Office, along with the District Health Team, and the District Council Kotido District has only a few civil society Chairperson (LC 5) will engage various stakeholders organizations including CUAMM, Mercy Corps and to create opportunities for coordination and UNFPA; faith-based organizations- Kotido Diocese, management of the district FP effort. In tandem Muslim Supreme Council, private sector- drug shop with the National FP-CIP, Kotido District will follow owners, media, amongst others. This district FP-CIP management, coordination and accountability will, through the CAO and DHO engage these actors structures, as outlined below. to ensure provision of financial resources towards FP and delivery of FP services, but also advocacy for 6.1 Management, Coordination, and Accountability improved demand, quality service provision. Structure Kotido District will be responsible for the stewardship, spearheading the planning, financing, 6.3 Coordination Framework implementation and performance monitoring of the District level District FP Costed Implementation Plan. The District In Kotido District, coordination of this District FP-CIP FP-CIP will be implemented by District Health will be led by the CAO and DHO through organized Office and supported by civil society organizations, multispectral stakeholders’ approach. This will community-based organizations, Faith-Based include the district FP steering committee, chaired by Organizations – especially Kotido Dioceses, amongst the Local Council V (LC 5) and a district FP technical others. working group, chaired by the District Health Officer
or the Assistant DHO. At the technical level, it is 6.2 Roles and Responsibilities of Key Actors proposed that quarterly review meetings will be held (District Level) with the DHT members and later on shared with the Chief Administrative Officer relevant key stakeholders. Consistent with the national FP-CIP coordination structure, the district FP-CIP will through the office 6.4 Resource Mobilization Framework of the Chief Administrative Officer (CAO) enforce Through concerted efforts, Kotido District will better coordination, planning, resource allocation, commit a percentage of its local revenue towards FP implementation, monitoring and evaluation for FP and continue lobbying and advocating for increased services in Kotido District. donor support. The District Budget Framework paper will reflect a commitment towards increased District Health Officer (DHO) financing of FP over the 5-year period. Informed by the district funding gaps, Kotido District Planner and Given the administrative stewardship of health the Chief Finance Officer will forecast and project services in Kotido District, the DHO will oversee the resource implications for FP financing. implementation of the district FP-CIP. Consistent with the national FP-CIP, the DHO will work closely with the CAO to plan and allocate financial resources for FP within the district health budget. Family Planning - Costed Implementation Plan 38 (2018/19 - 2022/23) KOTIDO DISTRICT
6.5 Performance Monitoring and Accountability • Data Quality Assurance Mechanism Measuring Kotido District performance against the The District Biostatistician will play a lead role in national FP-CIP targets will be critical and crucial ensuring Data Quality Assurance (DQA) collection, during the implementation period. As expounded transfer, compilation, analysis and storage. This will under the monitoring and evaluation section in this be executed through a series of technical review district FP-CIP, routine monitoring will occur through meetings with the HMIS staff and health facility the DHMIS, with reporting on performance executed assessment checks. As such routine support to MoH through the coordination mechanism as supervision will be undertaken on a quarterly basis prescribed by the national FP-CIP. Key performance and technical support will be offered in areas of targets will hinge on the strategic priorities as need to health centres both for government and informed by the national FP-CIP. It is anticipated that the private not for profit. Due care will be taken to district performance towards the national FP-CIP identify any inconsistencies in data by comparing will be shared in MOH review/ strategic planning the submitted data records with the original data meetings. sources. • M&E Coordination 6.6. Monitoring, Evaluation and Learning Once data has been collected at each facility, • Routine Data Collection submission will be made to the district and finally to Family planning services data will be collected Ministry of Health as required. through the normal HMIS system. As a requirement, each health facility and associated Capacity Building volunteers will compile data using the standard It is envisaged that HMIS staff and other health tools from Ministry of Health and later on workers will be oriented and trained in data forwarded to the district Biostatistician for onward collection, assurance, and analysis. The training in submission to Ministry of Health. The primary HMIS and other data tools will be on job and where consumption data at all health facilities (both necessary, offsite training will be arranged by the government and Private) will be captured in hard office of DHO. This will ensure that data tools are copies and where possible, electronic (HMIS) data completed accurately. base will be maintained. Information Dissemination and Use It is planned that during the quarterly stakeholders’ review meetings, the consolidated and analysed data will always be presented to inform decision making. Deliberate efforts will be taken to disseminate performance levels with the relevant stakeholders. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 39
SECTION 07: Implementation Framework Family Planning - Costed Implementation Plan 40 (2018/19 - 2022/23) KOTIDO DISTRICT
Table 23: Detailed Activity Breakdown by Strategic Outcomes Strategic outcome Expected Results Activity Sub-activities Inputs Outcome indicators Timeline Policy and Enabling Environment Legal framework and knowledge Legal framework and knowledge Coordinate with Ministry of Health • Raise resources for printing • 3 Meetings Funds for • 100 copies of each FY2018/2019 of policies for family planning of policies for family planning and partners to get copies of all the printing of different policies, improved improved policies guidelines and protocols printed Establish a team within the DHT • Develop Terms of Reference for the team, invite • Ministry of Health RH • Approved Terms of FY2018/2019 and build their capacity as trainers Ministry of Health, reproductive health division trainers Reference on policies for family planning national trainers and Moroto Regional Referral • 1 training workshop • A skilled team of Hospital Obs/Gyn to train the DHT team • Training materials trainers on FP policies District trainers cascade training on • Identify health facilities both public and private • Transport and Allowances • FP health providers FY 2018/2019 FP policies at health facilities • Develop training schedule • Copies of the FP policies trained on FP policies • Mobilise resources for on-job training Continuous medical education on • Develop refresher training schedule • FP Trainers • Continuous medical FY2019/2020 FP policies, • Transport and allowances education sessions held FY 2020/2021 FY 2021/2022 PP2: Family planning integrated Family planning incorporated into Develop guidelines and strategy • Develop terms of reference and hire a • Consultant fees • Approved guidelines FY 2019/2020 into the programming of other the departmental work plans for incorporation of family planning consultant and strategy for departments of Kotido district into departmental work plans incorporation of FP local government Establish departmental FP • Hold coordination meetings with departmental • FP focal person training • Approved FP FY2019/2020 coordination structure heads • Transport and allowances coordination structure FY 2020/2021 • Identify FP focal persons per department and for FP focal persons • Departmental build their capacity for FP programming • Bi-annual meeting of workplans incorporate FY 2021/2022 departmental heads FP activities PP3: Local, opinion, religious and 50 FP champions recruited and Build capacity for leaders to • Map out leaders who are pro-family planning • Consultant fees • Number of active FP FY2019/2020 cultural leaders are supportive of trained to support family planning champion FP cause • Work with the Ministry of Health, civil society • Bi-annual training champions FY 2020/2021 family planning to build capacity for the FP champions workshop over the period • Facilitate local champions to promote Family • Develop simplified FP FY 2021/2022 planning materials • Transport and allowances • Training materials Service Delivery and Access SD1: Health workers providing Increased number of FP users Build capacity for health workers to • DHT to select an FP technical team headed by • Training workshop for FP • Increased number FY2019/2020 quality family planning services provide quality FP services the Kotido HC IV In-charge technical team of health workers FY 2020/2021 • Ministry of Health working with Moroto • Transport and allowances providing FP services FY 2021/2022 Regional Referral Hospital Obs/Gyn to train the • Annual Refresher training • District ability to team on FP methods workshops for the FP provide FP capacity • The district FP technical team will provide technical team building to health care on-job training for health workers in public and • Training materials workers developed private health facilities • On-job training for health • District FP team will carry out quarterly long- facility staff acting and reversible permanent methods • Refresher on-job training outreach camps at health facilities for health staff • Training materials Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 41
Strategic outcome Expected Results Activity Sub-activities Inputs Outcome indicators Timeline Policy and Enabling Environment Legal framework and knowledge Legal framework and knowledge Coordinate with Ministry of Health • Raise resources for printing • 3 Meetings Funds for • 100 copies of each FY2018/2019 of policies for family planning of policies for family planning and partners to get copies of all the printing of different policies, improved improved policies guidelines and protocols printed Establish a team within the DHT • Develop Terms of Reference for the team, invite • Ministry of Health RH • Approved Terms of FY2018/2019 and build their capacity as trainers Ministry of Health, reproductive health division trainers Reference on policies for family planning national trainers and Moroto Regional Referral • 1 training workshop • A skilled team of Hospital Obs/Gyn to train the DHT team • Training materials trainers on FP policies District trainers cascade training on • Identify health facilities both public and private • Transport and Allowances • FP health providers FY 2018/2019 FP policies at health facilities • Develop training schedule • Copies of the FP policies trained on FP policies • Mobilise resources for on-job training Continuous medical education on • Develop refresher training schedule • FP Trainers • Continuous medical FY2019/2020 FP policies, • Transport and allowances education sessions held FY 2020/2021 FY 2021/2022 PP2: Family planning integrated Family planning incorporated into Develop guidelines and strategy • Develop terms of reference and hire a • Consultant fees • Approved guidelines FY 2019/2020 into the programming of other the departmental work plans for incorporation of family planning consultant and strategy for departments of Kotido district into departmental work plans incorporation of FP local government Establish departmental FP • Hold coordination meetings with departmental • FP focal person training • Approved FP FY2019/2020 coordination structure heads • Transport and allowances coordination structure FY 2020/2021 • Identify FP focal persons per department and for FP focal persons • Departmental build their capacity for FP programming • Bi-annual meeting of workplans incorporate FY 2021/2022 departmental heads FP activities PP3: Local, opinion, religious and 50 FP champions recruited and Build capacity for leaders to • Map out leaders who are pro-family planning • Consultant fees • Number of active FP FY2019/2020 cultural leaders are supportive of trained to support family planning champion FP cause • Work with the Ministry of Health, civil society • Bi-annual training champions FY 2020/2021 family planning to build capacity for the FP champions workshop over the period • Facilitate local champions to promote Family • Develop simplified FP FY 2021/2022 planning materials • Transport and allowances • Training materials Service Delivery and Access SD1: Health workers providing Increased number of FP users Build capacity for health workers to • DHT to select an FP technical team headed by • Training workshop for FP • Increased number FY2019/2020 quality family planning services provide quality FP services the Kotido HC IV In-charge technical team of health workers FY 2020/2021 • Ministry of Health working with Moroto • Transport and allowances providing FP services FY 2021/2022 Regional Referral Hospital Obs/Gyn to train the • Annual Refresher training • District ability to team on FP methods workshops for the FP provide FP capacity • The district FP technical team will provide technical team building to health care on-job training for health workers in public and • Training materials workers developed private health facilities • On-job training for health • District FP team will carry out quarterly long- facility staff acting and reversible permanent methods • Refresher on-job training outreach camps at health facilities for health staff • Training materials Family Planning - Costed Implementation Plan 42 (2018/19 - 2022/23) KOTIDO DISTRICT
Table 23: Detailed Activity Breakdown by Strategic Outcomes (continued) SD2: Improved quality and All the 18 public and private health All health facilities to receive • Ministry of Health Division of Health • On-job training • Number of accurate, FY2019/2020 reporting of the DHIS2 facilities providing timely, accurate training on management of FP Information to provide refresher training to the • Transport and allowances timely and complete and complete FP data into DHIS2 information district focal person in charge of DHIS2 • Training materials reports from health • District focal person In-charge of DHIS2 facilities FY 2020/2021 provides on-job training for health facilities and bi-annual refresher training • Health facilities to order for the HMIS tools FY 2021/2022 from NMS Contraceptive Security CS1: Strengthening capacities of Number of health facilities Build capacity for health workers • The district medicines management supervisors • Transport and allowances • Increased availability FY 2018/2019 health care providers in Logistics reporting availability of full range of (public and private) to manage will be part of the district FP technical team that • Training materials of contraceptives at FY2019/2020 Management Information System allowable contraceptives contraceptive commodities will provide on-job training on management of health facilities FY 2020/2021 (LMIS) and Health Management inventory contraceptives FY 2021/2022 Information System (HMIS) CS2: Commodity distribution to Increased availability of Orient the private sector FP • Identify contraceptive commodity focal person • Meeting with Alternative • Transport and FY 2018/2019 private-not-for profits contraceptive method mix in providers on the alternative at private health facilities distribution system allowances FY2019/2020 private sector distribution system guidelines • Coordinate with the alternative distribution provider • Number of FY 2020/2021 system provider to orient the private sector • Training workshop private health FY 2021/2022 • Annual refresher trainings • Training materials facilities receiving contraceptives from the alternative distribution system Demand Creation DC1: Increased knowledge of Increased use of family planning Develop and implement a demand • Develop terms of reference and hire consultant • 3 Stakeholder workshop • Formative study report FY2018/2019 family planning services creation and communication • Carry out a formative study to gain an in- • 3 Meeting materials • Demand creation FY2019/2020 strategy depth understanding of the society dynamics • Transport and allowances and communication regarding family planning strategy developed and • Develop demand creation and communication implemented strategy • Mobilise implementing partners to buy-into the demand creation and communication strategy through its implementation DC2: Demand increased through Increased share of socially Build the capacity of the district FP • District will nominate an FP TMA focal person • Consultant fees • Increased number FY 2018/2019 social marketing of free products marketed and commercially technical team to understand and • Ministry of Health RH division to build capacity • Transport and allowances of private health FY2019/2020 and commercial sector available contraceptives implement total market approach for the FP TMA focal person and DHT • Training materials facilities selling to family planning • To create an FP TMA working group in the • Terms of reference socially marketed FY 2020/2021 district • Three (3) dissemination and commercial • Undertake rapid assessment of the FP TMA meetings contraceptives FY 2021/2022 status in district • Four (4) coordination meetings a year Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 43
SD2: Improved quality and All the 18 public and private health All health facilities to receive • Ministry of Health Division of Health • On-job training • Number of accurate, FY2019/2020 reporting of the DHIS2 facilities providing timely, accurate training on management of FP Information to provide refresher training to the • Transport and allowances timely and complete and complete FP data into DHIS2 information district focal person in charge of DHIS2 • Training materials reports from health • District focal person In-charge of DHIS2 facilities FY 2020/2021 provides on-job training for health facilities and bi-annual refresher training • Health facilities to order for the HMIS tools FY 2021/2022 from NMS Contraceptive Security CS1: Strengthening capacities of Number of health facilities Build capacity for health workers • The district medicines management supervisors • Transport and allowances • Increased availability FY 2018/2019 health care providers in Logistics reporting availability of full range of (public and private) to manage will be part of the district FP technical team that • Training materials of contraceptives at FY2019/2020 Management Information System allowable contraceptives contraceptive commodities will provide on-job training on management of health facilities FY 2020/2021 (LMIS) and Health Management inventory contraceptives FY 2021/2022 Information System (HMIS) CS2: Commodity distribution to Increased availability of Orient the private sector FP • Identify contraceptive commodity focal person • Meeting with Alternative • Transport and FY 2018/2019 private-not-for profits contraceptive method mix in providers on the alternative at private health facilities distribution system allowances FY2019/2020 private sector distribution system guidelines • Coordinate with the alternative distribution provider • Number of FY 2020/2021 system provider to orient the private sector • Training workshop private health FY 2021/2022 • Annual refresher trainings • Training materials facilities receiving contraceptives from the alternative distribution system Demand Creation DC1: Increased knowledge of Increased use of family planning Develop and implement a demand • Develop terms of reference and hire consultant • 3 Stakeholder workshop • Formative study report FY2018/2019 family planning services creation and communication • Carry out a formative study to gain an in- • 3 Meeting materials • Demand creation FY2019/2020 strategy depth understanding of the society dynamics • Transport and allowances and communication regarding family planning strategy developed and • Develop demand creation and communication implemented strategy • Mobilise implementing partners to buy-into the demand creation and communication strategy through its implementation DC2: Demand increased through Increased share of socially Build the capacity of the district FP • District will nominate an FP TMA focal person • Consultant fees • Increased number FY 2018/2019 social marketing of free products marketed and commercially technical team to understand and • Ministry of Health RH division to build capacity • Transport and allowances of private health FY2019/2020 and commercial sector available contraceptives implement total market approach for the FP TMA focal person and DHT • Training materials facilities selling to family planning • To create an FP TMA working group in the • Terms of reference socially marketed FY 2020/2021 district • Three (3) dissemination and commercial • Undertake rapid assessment of the FP TMA meetings contraceptives FY 2021/2022 status in district • Four (4) coordination meetings a year Family Planning - Costed Implementation Plan 44 (2018/19 - 2022/23) KOTIDO DISTRICT
Table 23: Detailed Activity Breakdown by Strategic Outcomes (continued)
Financing FF1: Family planning budget line Kotido district allocates, disburses Advocacy for creation of budget • Develop policy brief on benefits of investing in • Consultant fees • Increased investment FY 2018/2019 created and expends on Family planning line for family planning family planning • Meeting materials to family planning by FY2019/2020 • Hold FP budget advocacy meeting with district • 4 FP budget Advocacy district FY 2020/2021 council, district leadership (CAO, departmental workshop per year FY 2021/2022 heads) allowances FF2: Family Planning resources Improved family planning Implement resource tracking • Develop/ adapt resource tracking tool for family • Consultant fees • Increased budget FY2019/2020 tracked transparency for both private and public FP planning • Two (2) workshops allocation and FY 2020/2021 implementing partners • Track the FP resources allocations and annually expenditure on family FY 2021/2022 expenditures • Workshop materials planning in the district • Transport and allowances Stewardship, Management and Accountability SMA1: A well-coordinated family Efficient use of available resources Build capacity for FP coordination • FP stakeholder mapping • Terms of reference for • Improved family FY 2018/2019 planning program for family planning program in the district • Establish an FP technical working group (CSO, each planning service implementing partners, government and • Four (4) Meetings for each delivery FY2019/2020 donors) group annually • Establish FP subcommittee and focal person on • Transport allowance FY 2020/2021 FP total market approach • Meeting materials FY 2021/2022 • Establish a subcommittee on contraceptive security with a focal person SMA2: Strengthen support Improved quality of FP services Build capacity for support • Coordinate with Ministry of Health RH division • Consultant to develop the • Workshop materials FY 2018/2019 supervision for family planning supervision to develop a district FP supervision checklist FP supervision checklist • Transport and services • Orient the district health team on the FP for league table allowances support supervision • Meeting to validate the FP • FP supervision FY2019/2020 • DHT carries out bi-annual support supervision supervision checklist checklist developed • One training workshop to FY2020/2021 orient health workers on FP supervision checklist • One Stakeholder FY2021/2022 Workshop to share experiences among facilities Family Planning - Costed Implementation Plan (2018/19 - 2022/23) KOTIDO DISTRICT 45
Financing FF1: Family planning budget line Kotido district allocates, disburses Advocacy for creation of budget • Develop policy brief on benefits of investing in • Consultant fees • Increased investment FY 2018/2019 created and expends on Family planning line for family planning family planning • Meeting materials to family planning by FY2019/2020 • Hold FP budget advocacy meeting with district • 4 FP budget Advocacy district FY 2020/2021 council, district leadership (CAO, departmental workshop per year FY 2021/2022 heads) allowances FF2: Family Planning resources Improved family planning Implement resource tracking • Develop/ adapt resource tracking tool for family • Consultant fees • Increased budget FY2019/2020 tracked transparency for both private and public FP planning • Two (2) workshops allocation and FY 2020/2021 implementing partners • Track the FP resources allocations and annually expenditure on family FY 2021/2022 expenditures • Workshop materials planning in the district • Transport and allowances Stewardship, Management and Accountability SMA1: A well-coordinated family Efficient use of available resources Build capacity for FP coordination • FP stakeholder mapping • Terms of reference for • Improved family FY 2018/2019 planning program for family planning program in the district • Establish an FP technical working group (CSO, each planning service implementing partners, government and • Four (4) Meetings for each delivery FY2019/2020 donors) group annually • Establish FP subcommittee and focal person on • Transport allowance FY 2020/2021 FP total market approach • Meeting materials FY 2021/2022 • Establish a subcommittee on contraceptive security with a focal person SMA2: Strengthen support Improved quality of FP services Build capacity for support • Coordinate with Ministry of Health RH division • Consultant to develop the • Workshop materials FY 2018/2019 supervision for family planning supervision to develop a district FP supervision checklist FP supervision checklist • Transport and services • Orient the district health team on the FP for league table allowances support supervision • Meeting to validate the FP • FP supervision FY2019/2020 • DHT carries out bi-annual support supervision supervision checklist checklist developed • One training workshop to FY2020/2021 orient health workers on FP supervision checklist • One Stakeholder FY2021/2022 Workshop to share experiences among facilities Family Planning - Costed Implementation Plan 46 (2018/19 - 2022/23) KOTIDO DISTRICT
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MINISTRY OF HEALTH
KOTIDO DISTRICT Family Planning Costed Implementation Plan 2018/19 - 2022/23
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