REPUBLIC OF UGANDA
NAKAPIRIPIRIT District Family Planning - Costed Implementation Plan 2018/19 - 2022/23
JUNE 2018
NAKAPIRIPIRIT 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 Nakapiripirit District Health Office. This project was funded by UK aid from the UK government.
Copyright ©:Nakapiripirit District Local Government
Ownership: Reproduction of this plan for educational or other non-commercial purposes is authorized without permission from the Nakapiripirit District Local Government, provided the source is fully acknowledged.
Preferred Citation: Nakapiripirit District (2018). District Family Planning Costed Implementation Plan, 2018/19 – 2022/23. Nakapiripirit, Uganda
Copies available from: Nakapiripirit District Health Office iv
Foreword The Uganda Demographic and Health Survey (UDHS, 2016) puts Nakapiripirit district fertility rate at 7.2 children per woman, a fi gure higher than the National average of 5.4.
The high fertility is attributed to various factors key The district CIP addresses key challenges, and among them are the high rate of early marriages and provides practical solutions as agreed upon by key teenage pregnancies; low levels of education and stakeholders on March 20th 2018. The FP CIP status of women; limited access to family planning is in line with the Ministry of Health National FP services and low numbers of women in formal Costed Implementation Plan, Vision 2040, the FP employment. High consumption of alcohol is another 2020 commitments and the Nakapiripirit District factor cited. As a result of the high fertility, the Development Plan. district has a predominantly young population with 61.8% below 18 years of age. Given the district’s The district FP-CIP is both an implementation plan socio-economic status that is primarily agricultural, and a resource mobilization tool. The District Council the dependency rate is high and children are involved and the Technical Planning Committee will bolster in farm production, thus missing out on school. This the coordination efforts and call upon development district scenario implies that Nakapiripirit must invest and implementing partners to work with the district in family planning to improve the lives of its people. to implement the plan as a strategy to improve the quality of life and well-being of the people. Nakapiripirit District Family Planning Costed Implementation Plan (FP-CIP) 2018/19 – 2022/23 The Nakapiripirit District FP-CIP sets a blueprint in focuses on ensuring that the resource envelope attempt to improve access to accurate information is increased to support women and men raise about family planning, improve access to high quality manageable families. The plan will guide the family family planning services and in general to strengthen planning program so that more women and men and scale up provision of integrated family planning access FP services, consequently improving health services by multi-stakeholders in the district. and wellbeing of families, promoting maternal and For God and My Country child survival, reduce fertility and dependency, thereby transforming the economy and livelihoods of the district population.
Hon. John Nangiro DISTRICT CHAIRPERSON NAKAPIRIPIRIT DISTRICT LOCAL GOVERNMENT v
Preface This District Family Planning Costed Implementation Plan (FP-CIP -2018/19- 2022/23) originates from the Decentralisation Policy that granted District leaders authority to plan and set their district priorities.
The Ministry of Health (MoH) with support from Health Development Partners, specifi cally the United The Technical Planning Committee, development Nations Population Fund (UNFPA), developed the partners and all the stakeholders should prioritize National Family Planning Costed Implementation and support the district in the implementation of this Plan (FP-CIP). The FP-CIP calls upon all sectors to FP-CIP as a strategy to accelerate universal access cooperate and implement a family planning program to family planning services in the district. We pledge in a multi-sectoral approach. This therefore, implies total commitment and support through a coordinated that all districts should incorporate family planning multi-sectoral approach so that the district increases issues into district plans, working with economists modern contraceptive prevalence rate amongst the and statisticians. married and women in union to the target of 50% by 2022. The development and fi nalization of this document For God and my country was a consultative process that engaged different stakeholders from the national level, the district Technical Planning Committee and the District Council, as well as the local community.
Acknowledgement to all the individuals that Mr. Aloysius Aloka participated in the consultative meetings and review CHIEF ADMINISTRATIVE OFFICER, process at various stages of the development of this NAKAPIRIPIRIT DISTRICT LOCAL GOVERNMENT plan. Special appreciation to UNFPA and MoH for the technical support during the process. vi
Acknowledgement This Family Planning Costed Implementation Plan (FP CIP- 2018/19 – 2022/23) for Nakapiripirit is a result of extensive consultations with stakeholders at all levels within the district, including key sector ministries, development partners, implementing partners, individual staff and consultants.
Appreciation to the partners and groups, both at Nakapiripirit district local government is specifi cally the district and national level, who supported its acknowledged for the cooperation, participation development development of the Nakapiripirit and the wonderful coordination that enabled timely Family Planning Costed Implementation Plan. completion of the assessment and costing exercise.
All the individuals that participated in the Finally, we extend sincere gratitude to MoH and consultative meetings and review process at various UNFPA technical teams for offering technical stages of the development of this plan are greatly guidance and review of the report. acknowledged. The District Health Team (DHT), working closely with the consultant played an instrumental role to have the plan developed. The role played by data collectors, the respondents from the different health facilities during the exit interview Dr. Anguzu John and the consultant who facilitated its development DISTRICT HEALTH OFFICER, on behalf of the Ministry of Health and the district, NAKAPIRIPIRIT DISTRICT LOCAL GOVERNMENT. cannot be underrated.
We convey our sincere appreciation for the fi nancial support from UK aid from the UK government, through the United Nations Population Fund (UNFPA) for developing this FP-CIP, and the MoH for the technical guidance and leadership. vii
Table of Contents
Foreword iv Preface v Acknowledgement vi Table of contents vii List of Figures viii List of Tables ix Executive Summary xi
Section 1: Introduction 2 1.1 District Profile 3 1.2 Demographic Characteristics 5 1.3 Status of Nakapiripirit Health Services 5 1.4 Family Planning Services 12
Section 2: Formulation of the District FP CIP Process 14 2.1 The Process followed in developing FP CIP 14 2.2 SWOT Analysis for Family Planning services 15
Section 3: Translation of Key Issues into Strategy: A case for Nakapiripirit 16 District FP Costed Implementation Plan 3.1 Demand Creation 17 3.2 Service delivery and access 18 3.3 Contraceptive Security 20 3.4 Policy and enabling environment 22 3.5 Stewardship, Management and Accountability 22 3.6 Financing 23 viii
Section 4: Costed Implementation Plan; Translating Actions into Strategy 24 4.0 District strategic priorities 25 4.1 Demand Creation 25 4.2 Service delivery and access 26 4.3 Contraceptive Security 28 4.4 Policy and enabling environment 28 4.5 Stewardship, Management and Accountability 29 4.6 Financing 30
Section 5: Institutional arrangements for the District FP CIP 35 Section 6: Costing of the Plan 39 Section 7: District Implementation Framework with full Activity details 44 References 50
List of figures
Figure 1 Nakapiripirit Percentage Population distribution by age group 5 Figure 2 Disease prevalence in the district 7 Figure 3 Immunisation coverage by Sub County 10 Figure 4 Contraceptive method mix 13 ix
List of tables
Table 1 Administrative Units in Nakapiripirit District 4 Table 2 Population by broad age group and Sub-county; Nakapiripirit District, 2014 5 Table 3 Distribution of facilities by level, Sub-county and ownership 6 Table 4 Staffing in the District Health Office 8 Table 5 Utilization of ANC Services at HC per Sub-county, 2016/17 10 Table 6 Key Demographic and Health Indicators of Nakapiripirit Districts, 2016/2017 12 Table 7 Health Facilities that Provide FP Services and Ownership 13 Table 8 SWOT Analysis 15 Table 9 Summary of the interventions with key players 31 Table 10 Summary costs per thematic area per Financial Year (Millions UG X) 39 Table 11 Nakapiripirit District FP CIP detailed Cost 40 x
Abbreviations
ANC Antenatal Care MoH Ministry of Health BEmONC Basic Emergency Obstetric and New- MSU Marie Stopes Uganda born Care MUG Mild May Uganda 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 RED Reaching Every District CPR Contraceptive Prevalence Rate RH Reproductive Health CSO Civil Society Organization RHU Reproductive Health Uganda DHO District Health Office RACOBAO Rural Action Community Based DHS Demographic Health Survey Organisation DHT District Health Team SAGE Social Assistance Grants for DQA Data Quality Assurance Empowerment DSW Deutsche Stiftung Weltseveekerung SBCC Social and Behavioral Change DTPC District Technical Planning Committee Communications FAL Functional Adult Literacy S/C Sub County FOWODE Forum for Women in Democracy SWOT Strength Weaknesses Opportunities and Threats FP Family Planning TC Town Council FP CIP Family Planning Costed Implementation Plan TOT Training of Trainers FY Financial Year UDHS Uganda Demographic Health Survey HC Health Centre UHMG Uganda Health Marketing Group HMIS Health Management Information UMSC Uganda Muslim Supreme Council System UNFPA United Nations Population Fund LLG Lower Local Government VHT Village Health Team MARPS Most At Risk Populations xi
Executive Summary The Nakapiripirit District Family Planning - Costed Implementation Plan has been drafted in line with the Government of Uganda (GOU) commitment to reduce the unmet need for Family Planning (FP) to 10% and increase the modern Contraceptive Prevalence Rate (CPR) to 50% by 2020.
The District Costed Implementation Plan (2018 – The above strategic priorities give direction to the 2023), has been developed to plan for the locally six essential components or Thematic Areas of the available resources as well as tap into the Central national CIP listed below, which is also adapted in the Government allocations and partnerships support Nakapiripirit District FP-CIP. with the aim of enabling Uganda reach her FP goals as a country. The plan also sets a precedent on the 1. Demand creation strategic direction the district should take towards 2. Service delivery and access family planning. Similar to the National FP CIP 2015- 3. Contraceptive security 2020, this district FP CIP is driven by the strategic 4. Policy and enabling environment priorities – listed below- that will reduce the current 5. Financing gaps in family planning indicators. 6. Stewardship, management, and accountability
• Priority # 1: Increase age-appropriate information, The total cost of the Nakapiripirit district FP CIP is access, and use of family planning amongst young UGX 4,652,649,209 (Four billion, Six hundred Fifty- people, ages 10–24 years Two million, Six hundred Forty Nine thousand, Two • Priority # 2: Promote and nurture change in hundred and Nine Uganda Shillings) for the period social and individual behavior to address myths, 2018 to 2023. The interventions, activities, and misconceptions, and side effects and improve accompanying costs in this plan will enhance resource acceptance and continued use of family planning to mobilisation by the District Local Government and prevent unintended pregnancies partners as well as monitor the implementation of • Priority # 3: Implement task sharing to increase Uganda’s family planning programme. access, especially for rural and underserved populations • Priority # 4: Mainstream implementation of family planning policy, interventions, and delivery of services in multi-sectoral domains to facilitate a holistic contribution to social and economic transformation • Priority # 5: Improve forecasting, procurement, and distribution and ensure full financing for commodity security in the public and private sectors Family Planning - Costed Implementation Plan 2 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
SECTION 01: Introduction & Background Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 3
1.0 Background In 2012, H.E. Yoweri Kaguta Museveni, the President Internationally, Sustainable Development Goal (SDG) of Uganda, at the London Summit for Family Planning, No. 4 puts emphasis on “healthy lives and well-being committed to support Family Planning financing in for all at all ages”. Family Planning (FP) is considered Uganda to the tune of USD 5 million per year for the one of the best ways to achieve good health, mostly next 5 years (an increase from USD 3.3 million earlier for mothers and children in particular and for the committed) and to mobilize an additional USD 5 entire family and the nation in general. million from donors. In 2017, the Minister of Health, Dr Jane Ruth Aceng, recommitted allocation of USD At the national level, all development policy 5 million and to mobilise additional USD 20 million documents recognize Uganda’s rapid population from development partners for FP. growth, the young age structure and consequent high child dependency burden, among the threats to As a follow up to the London Summit commitment, the achievement of socio-economic development. in April 2014, Uganda Government through the Uganda’s Vision 2040, for example, pronounces Ministry of Health commissioned the development “harnessing the demographic dividend” as one of the of the Family Planning (FP) Costed Implementation strategies to benefit from the country’s abundant Plan (CIP) with the objectives to: reduce unmet and young population. The Local Government need for FP from 34% to 10% and increase modern Planning Guidelines 2014 recognize FP as one of contraceptive prevalence rate (mCPR) amongst the 14 crosscutting issues. Local Governments have married and women in union to 50% by 2020. therefore increasingly embraced FP in their District Development Planning cycles. Building on the political commitments, the Ministry of Health together with UNFPA have committed Family Planning (FP) services are now considered to support the development of selected District amongst the most cost-effective interventions Family Planning - Costed Implementation Plans with to prevent maternal, infant, and child deaths. By the aim of increasing financing for family planning lowering fertility and child mortality rates, Uganda in the districts. The institutional framework for will be better placed to harness the demographic the FP CIP reflects a “common” multi-sectoral dividend for economic growth as outlined in Vision plan for all stakeholders involved in implementing 2040. family planning activities towards a consultative, coordinated, streamlined management and Building on the political accountability structure.
commitments, the Ministry of The Nakapiripirit District FP - CIP (2018 – 2023) Health together with UNFPA has been developed through a participatory and consultative process in alignment with the National have committed to support FP-CIP (2015 – 2020). The District FP-CIP clearly the development of selected spells out the different roles and responsibilities that district stakeholders have to play to improve District Family Planning - family planning service delivery. The plan also Costed Implementation Plans identifies different partners that will be approached to support the interventions, with the District Local with the aim of increasing Government being the main stakeholder and major financing for family planning in source of financial resources. the districts. Family Planning - Costed Implementation Plan 4 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
The Nakapiripirit FP-CIP 2018 – 2023 also defines 1.1.1 Location the district priorities and intervention packages Nakapiripirit District is located in the southern and provides strategic direction for family planning part of Karamoja region. It is bordered to the north strengthening and promotion by all stakeholders. by Nabilatuk district, to the south by Kween and This District Strategic Plan will operationalize Bulambuli districts, to the western by Katakwi and the District RH sharpened plan and other health Kumi districts and to the east by the Republic of department policy documents in addition to being a Kenya. The district headquarters is in in Nakapiripirit mechanism for resource mobilization for the district town which is connected by a tarmac road to Moroto. FP activities. 1.1.2 Administrative and Political Structure 1.1 District Profile Like other decentralized units in the country, Nakapiripirit is one of the 7 districts that constitute Nakapiripirit District is headed by the District the Karamoja region. It was one of the 11 districts Chairman as the political head. The chairman approved by the Parliament of Uganda in 2001. heads the District Council comprised of elected It was curved out of Moroto district and became representatives from the 4 sub-counties and operational in 2002. But unlike the other districts, one Town Council, in addition to special interest Nakapiripirit had been a district before (during the groups. The District Council has three (3) period 1973-1981) then called South Karamoja standing committees and the District Executive district with its headquarters at Nakapiripirit. Committee (DEC) that monitors implementation However, in 1981, the Obote II Government reversed of its programmes on a day-to-day basis. The Chief the decision and aligned it to Moroto District to Administrative Officer (CAO) heads the Civil Service constitute Pian, Pokot and Checkwii Counties. or Technical Wing. Under the CAO are the Heads Effective July 1, 2018, Pian will break off to form of Departments which include; Finance, Production the new district of Nabilatuk and Nakapiripirit will and Marketing, Health, Education and Sports, constitute the former Checkwii County. Technical Services and Works, Natural Resources, Management, Community Based Services, Council & Statutory Bodies, Planning and Internal Audit. Nakapiripirit district comprises 1 county, 4 sub- counties and 1 Town council, 19 Parishes, and 114 Villages.
Table 1: Administrative Units in Nakapiripirit District County Sub counties/Town council No. Of parishes No. of Villages Checkwii Kakomongole 5 26 Moruita 2 19 Nakapiripirit TC 3 8 Namalu 4 41 Loregae 5 20 Total 19 114 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 5
1.2 Demographic Characteristics Figure 1: Nakapiripirit Percentage Population According to the 2014 National Population and distribution by age group Housing Census, the population of Nakapiripirit District is approximately 100,014 people, of which 50.5% are female and 49.5% are male.
The population growth rate is estimated at 3.9%. Majority of the population is rural based (97.5%) with less than 2.5% of the district population urban. The population growth rate of 3.9% implies that over 10,000 people are added to the district population annually. The population of Nakapiripirit District is largely young with 61.8% of the population below the age of 17 years. The youthful age structure has important population and development implications. It creates a high dependency ratio that places a heavy burden on the working age population and constrains the ability of family and Local Governments to provide basic needs and social services such as food, shelter, clothing, education, health and safe water. It further poses a big challenge to the ability of Local 0-17 14-64 Government to match provision of services to the 18-30 60+ rapidly growing population.
Table 2: Population by broad age group and Sub-county; Nakapiripirit District, 2014 Sub-county 0-4 0-8 0-17 13-18 18-30 14-64 60+ Loregae 4,392 8,137 13,293 3,142 4,448 10,275 1,267 Moruita 2,291 4,339 7,992 2,303 3,803 8,370 492 Nakapiripirit T/Council 645 1,131 1,902 483 932 2,032 181 Namalu 5,286 9,337 15,213 3,783 5,696 13,281 1,801 Kakomongole 3,080 5,543 9,415 2,487 3,472 7,897 1,005 District 15,694 28,487 47,815 12,198 18,351 41,855 4,746
1.3 Status of Nakapiripirit District Health Services The sector objective is to reduce morbidity and 1.3.1 Facilities mortality from the major causes of ill health and The District Health Department is comprised of the disparities therein. Health service delivery is District Health Offi ce, Health Sub District, Health mainly by Government and Non-governmental Centre IV, Health Centre IIIs, Health Centre IIs, and Organizations. The distribution of health facilities is Not for Profi t Health Units. The overall goal of the unfair as most of them are located by the main road sector is to provide good quality services to enable and far from where the communities live. Some of the the people of Nakapiripirit attain good standards of facilities lack the basic equipment to offer reasonable health and live a healthy and productive life. services. Family Planning - Costed Implementation Plan 6 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Many rural health facilities require rehabilitation and (PNFP), 8 are Government-owned. All health facilities equipment. Besides diseases, poor nutrition is a major apart from Lomuerinyangae, Moruita and Nakaale concern and as such, the district needs an integrated receive PHC grants directly to their accounts as approach to deliver quality health services. required. Table 3 below shows the names of facilities, distribution of HCs by category, County, Sub County, The district has 12 functional health facilities one of Village and ownership in the District. which is a Health Centre HC IV, 6 are HC IIIs and 5 are HC IIs. Of these, four are Private Not for Profit
Table 3: Distribution of facilities by level, Sub-county and ownership Name of facility Location Category County Sub county Village Ownership 1. Nakapiripirit HC III Checkwii Town Council Nagoromit Gov’t 2. Namalu HC III Checkwii Namalu Trading Centre Gov’t 3. Amaler HC III Checkwii Namalu Kaiku PNFP 4. Namalu Prison HC III Chekwii Namalu Kaiku Gov’t 5. Tokora HC IV Checkwii Kakomongole Trading Centre Gov’t 6. Karinga HC II Chekwii Moruita Moruita Missionary –Catholic 7. Moruita HC II Chekwii Moruita Trading Centre Gov’t 8. Moruita 407 Brigade HC III Chekwii Moruita Moruita Barracks Gov’t 9. Lemusui HC III Checkwii Moruita Katabok Gov’t 10. Nakaale HC II Chekwii Loregae Nakaale PNFP 11. Nabulenger HC II Checkwii Loregae Loasam PNFP 12. Lomuerinyangae HC II Checkwii Namaru Lomorimori Gov’t Source: Health Department, Nakapiripirit 2015
Challenges Facing Nakapiripirit District Health • Population influx from neighbouring districts: Sector. Nakapiripirit caters for the migratory communities • Poor Communication: Like the rest of Karamoja from Kenya and neighbouring districts, which region, Nakapiripirit is a hard-to-reach area with brings the district population close to 200,000 poor road network. Kakomongole and Namalu people (over 40% of the district population). This are at times cut-off during the rainy season. Some causes a strain on the existing infrastructure sub-counties like Mourita are better accessed via and associated resources for the district. The Kenya especially during the rainy season. The poor increasing demand for health services given the communication has led to a negative impact on mass sensitization of communities has also had an FP uptake, late start of ANC and drop outs from impact on the existing facilities. immunisation services amongst others. • High Illiteracy Rate: The high level of illiteracy in • Migratory Communities: The migratory nature of the district has affected the absorption of health the communities makes it difficult accessing health messages and uptake of FP and RH services. services because the populations at times migrate and settle in areas far from the health facilities. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 7
• Some well-intended interventions like the WFP Figure 2: Disease prevalence in the district nutrition programme for pregnant women have 2 8 2 undermined the promotion of family planning. 1 • WFP has been distributing food to children aged 3 0 6-23 months, pregnant women and breastfeeding 3 2 mothers throughout Karamoja to enhance their 3 nutrition and reduce the risk of stunting. This 1 jeopardises efforts to promote family planning because women and mothers are beneficiaries. So they cannot use family planning because they 0 want the food, which is only a privy for pregnant
or lactating mothers and their babies (KI Health worker).
1.3.2 Disease burden 3 According to the 2016 UDHS, Nakapiripirit like other districts in the Karamoja region, experiences high levels of maternal, child, and infant mortality despite numerous efforts put in place by government and development partners. The pie chart below (fig.2) indicates the top 10 diseases affecting Nakapiripirit district with Malaria accounting for up to 65% of the - disease burden and is the main cause of high infant ( ) mortality in the district. The district plans a holistic approach to address the disease burden and taking malaria as a priority in all interventions undertaken in the sector. Family Planning - Costed Implementation Plan 8 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
1.3.3 District Health staffing The district has 2 Medical Officers, including the DHO, 22 Enrolled midwives, 24 Enrolled nurses, 12 Nursing Officers, and 3 senior nursing officers, among others. There is a staffing gap of 29.4%. As a hard-to-reach and stay area, Nakapiripirit faces perpetual challenge of retaining critical health staff. The problem of staff turnover has affected service delivery in most parts of the district. The poor health indicators in the district is therefore, not surprising. The district drafted new plan should address this challenge as it lays out mechanisms of attracting key personnel to the health sector.
Table 4: Staffing in the District Health Office District Health Office Approved Filled Not -Filled District Health Officer 1 1 0 Assistant District Health Officer (Maternal Child Health/Nursing) 1 0 1 Assistant District Health Officer (Environmental Health) 1 1 0 Senior Health Inspector 1 1 0 Senior Health Educator 1 0 1 Bio-statistician/Health Information Scientist 1 1 0 Cold Chain Technician 1 1 0 Stenographer Secretary 1 1 0 Stores Assistant 1 1 0 Office Attendant 1 1 0 Driver 1 1 0
HEALTH CENTRE IV Approved Filled Not -Filled Senior Medical Officers 1 0 1 Medical Officer 1 1 0 Clinical Officers 2 2 0 Nursing Officers 3 3 0 Health Inspectors 2 2 0 Enrolled Nurses 3 3 0 Enrolled Midwives 3 3 0 Laboratory Personnel 3 3 0 Dental Staff 1 0 1 Health Assistants 1 1 0 Nursing Assistants 8 8 0 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 9
HEALTH CENTRE III Approved Filled Not -Filled Senior Clinical Officers 6 1 5 Clinical Officers 6 2 4 Nursing Officers 6 3 3 Enrolled Nurses 18 6 12 Enrolled Midwives 7 3 4 Laboratory Personnel 12 6 6 Nursing Assistants 18 15 3
HEALTH CENTRE II Approved Filled Not -Filled Enrolled Nurses 5 4 1 Enrolled Midwives 5 4 1 Nursing Assistants 10 8 2 Total 124 87 37
1.3.4 Essential Medicines, Supplies and Equipment encouraging population control), improving access to More than half of health facilities in Nakapiripirit lack FP services, quality education and health services in the required medicines and equipment for quality general becomes crucial. health care. These may range from contraceptives to a Blood Pressure (BP) machine, weighing scales, It is critical to address the socio-cultural issues and medical furniture or other equipment. change the community mind-set from a provider- driven to a demand-driven health care service. Additionally, there is no health unit with appropriate Communities need to increase ownership and final disposal of waste (incinerators) in use and there responsibility for their health hence, the need for are frequent stock outs of key essential supplies and good health seeking and health promotion behaviour drugs due to inadequate supplies against increasing like promotion of prevention over curative, proper demand by growing community. Inadequate funding nutrition, mental health concerns, and reduction to National Medical Stores (NMS) and occasional of smoking, sedentary lifestyle, excess alcoholism, non-delivery by the warehouse is responsible for trauma-related causes of suffering and avoidance of frequent stock outs. The stock outs commonly risky behaviours. include antimalarial, gloves, IV fluids, surgical sutures, laboratory supplies among others. Not least of all, the 1.3.5 Immunisation Coverage facilities lack standard drug and vaccine stores, with The biggest challenge on immunization lies in the vaccine and pharmaceutical fridges. dropout rate between DPT1 and DPT3 which is above 10%. This dropout rate is attributed to To improve the health status, Nakapiripirit district incentives that WFP gives to the lactating and must focus more on disease prevention than pregnant mothers in form of food. Mothers conceive treatment. To harness the demographic dividend shortly after the most recent birth and fail to take the (increased investments brought about by the huge children for the next immunization doses. potential of a skilled, healthy and employed youth, by Family Planning - Costed Implementation Plan 10 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
The district met the national target beyond 90% Figure 3: Immunisation coverage by Sub County showed by 7,043 (97%) children immunized out of 1500 7,293 under-fives expected, and places the district 1315
in good category according to RED categorization. 1200 1149 Major challenges like hard-to-reach areas in the 947 mountains and poor seeking behaviours need to be 900 873 841 thought of when planning. 594 588 600 521 Figure 3 below shows that Nabilatuk had a high percentage of children immunized with DPT3 (1,546) NO OF CHILDREN 300 and BCG (1,220) compared to the other sub-counties, 210 224 followed by Namalu with 1,315 children immunized 0 with DPT3, and 1,149 with BCG. Nakapiripirit Namalu Nakapiripirit Moruta Loregae Kokomongole Town Council Town Council had the least proportion of children immunized at 210 with DPT3 and 224 with BCG. Number of Children - Expected Number of Children - Actual
1.3.6 ANC Attendance transport also limits access to ANC services. The Nakapiripirit ANC attendance is poor especially the lack of incentives like mama kits and food handouts fourth visits. For instance, of the 8,485 pregnant in some centres explains some of the under mothers expected for the first ANC visit, 74% (6,296) achievement. attended antenatal care, but the figure dropped One important achievement was that all (100%) to only 30% for the 4th visit. The reasons for this pregnant women were counselled and tested for HIV. decline include late start of ANC visits at later stages They were also assessed for TB, their blood pressure of pregnancy giving the mothers no chance to finish checked and were diagnosed for other conditions like all the required visits. The issue of long distances syphilis and other complications that posed a risk to from the health facilities coupled with the lack of the mothers.
Table 5: Utilization of ANC Services at HC per Sub-county, 2016/17 Organization/ Unit ANC 1st Visit ANC 4th Visit First dose IPT (IPT1) Second dose (IPT2) IPT Pregnant Women Newly tested for this HIV pregnancy (TR & TRR) HIV+ Pregnant Women initiated for on ART (ART) EMTCT Kakomongole 898 510 624 587 837 1 Loregae 803 506 454 291 732 0 Moruita 604 230 510 389 558 5 Nakapiripirit 261 150 247 229 248 4 Town council Namalu 1,995 1,194 676 790 1822 8 Total 4,561 2,590 2,511 2,286 4,197 18 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 11
1.3.7 Maternal and Child Health Indicators of Management (ICCM), increased immunization Nakapiripirit District coverage, nutrition related supplementary activities, Table 6 below gives the 2016/17 demographic increased access to health services due to opening and health statistics for the district. The statistics of new health centres, increased staffing levels, audit indicate that Namalu had the largest number of ANC of all maternal deaths up to the community level to visits, followed by Kakomongole, and Loregae sub- address preventable causes of death in order to avoid counties at 1,995, 898, and 803 respectively, while future re-occurrences, improved health seeking Nakapiripirit TC had the least number, recorded at behaviour among communities as a result of mass 261 new ANC attendances. The number of pregnant sensitization through radio, drama and community women attending ANC up to at least 4th visit was still dialogue meetings. highest in Namalu sub-county and Nakapiripirit Town Council still registered the least visits of only 150 In spite of the improved maternal health services and pregnant mothers. Deliveries in health facilities were their uptake, a number of challenges still exist in the recorded at 42% overall, with live babies at 93%. district. They include low number of mothers (only 57%) attending ANC up to the 4 times recommended. Nakapiripirit district experienced a decline in the The involvement of males, who are the main decision Infant Mortality Rate (IMR), Under five Mortality makers, is still quite low (37%) and this affects access Rate (U5MR) and Maternal Mortality Ratio (MMR) to reproductive health services by mothers and the due to strengthening of preventive activities for children. Malaria (use of ITNs), Integrated Community Case Family Planning - Costed Implementation Plan 12 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Table 6: Key Demographic and Health Indicators of Nakapiripirit Districts, 2016/2017
Key Health Indicator Value 2016/17 Infant mortality rate (per 1,000 live births) 42 Under fi ve mortality rate (per 1,000 live births) 76 Maternal mortality ratio (per 100,000 live births) 527 Total Fertility Rate 7.2 Population Growth Rate 5.2 Life Expectancy 42 Contraceptive Prevalence rate (%) 6.5 Supervised deliveries 43% % of women attending ANC from skilled birth attendants 1st attendance 98% % of women attending ANC from skilled birth attendants 4th attendance 48% Full immunization 97% Percentage of under fi ve children who are Stunted 32% Proportion of under fi ve children who are Wasted 11.2% Proportion of under fi ve children who are underweight 22.3% HIV prevalence rate (%) – Population 2.5% HIV prevalence rate (%) – PMTCT 3.5% Doctor-Population Ratio (2014 population projection) 112,004 Nurse-Patient Ratio (2014 population projection) 3,503 Midwife- Pregnant Mother Ratio (2014 population projection for age group 15-49 years) 1,250
Source: District Health Offi ce (HMIS), Nakapiripirit District, 2017
1.4 Family Planning Services 1.4.2 Contraceptive method mix 1.4.1 Contraceptive uptake Like in most districts across the country, injectable Contraceptive uptake at 6.5% is very low. Out of contraceptives is the most preferred method the 45,339 women expected to attend FP, only (58.5%), followed by Intra uterine Devices (15.6%) 6,036 make revisits to the facilities, with only 1,626 and implants (10%). (See Figure 4 below). The use of (3%) reported to be new users. The low uptake of LARCs has started taking off gradually as a result of contraceptive services is attributed to a number of the community outreaches by mainly Marie Stopes factors, including; poor attitude towards FP, cultural Uganda. norms and values, religious beliefs, low levels of awareness among community members, poor access to services and shortages of contraceptive commodities. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 13
Figure 4: Contraceptive method mix • Inadequate staff for the increased population and Percentage consumption of contarceptives increased range of Family Planning services
1.4.4 Health facilities providing Family Planning Services
Table 7: Health Facilities that Provide FP Services and Ownership
Health Ownership Facility Level Govt PNFP Military Total FP HCIV 1 0 0 1 1 HC III 3 1 2 6 6
Female Condoms Implants Vasectomy HC II 2 3 0 5 5
Oral Injectables Other TOTAL 6 4 2 12 12 IUDs Tubal Ligation
1.4.3 Challenges to family planning provision The uptake of modern FP methods rose between • Low male involvement and support for family 2011 and 2013 as a result of working with partners planning. such as Marie Stopes Uganda (MSU) and UNFPA. The • Rampant myths and misconceptions. partners offered massive community mobilization • Degraded values due to over drinking and poverty and sensitization through radio talk shows, door to and parents looking for wealth thus, give away their door campaigns; mobilization and distribution of girls at tender age. contraceptives by VHTs, use of drama and music. The • Polygamy which causes competition among the co- uptake from 2014 declined when partners started wives to produce many children. supporting the nutrition of both women and their • VHTs face challenges of educating the communities children. The district has over time experienced a about family planning benefi ts, when communities slow rise in the uptake of the long acting methods, have negative attitudes and mindset to the same. especially, IUDs and implants. • Inadequate funds to support family planning activities by the district. 1.4.5 Development Partners Supporting Family • Limited support for mothers with complications Planning in the District from the FP methods. Nakapiripirit district has several partners within • Failure to train and make use of existing VHT the health sector but only three support family structures. planning, either directly or through the integration • Failure to incentivize and utilize the existing model of service delivery. These include UNFPA champions to mobilize other members of the which provides direct support to the district and communities. through implementing partners like Marie Stopes • Diffi cult to attract cadres like dispenser, and RHU. BRAC and Straight Talk Foundation anaesthetic offi cer, pharmacists, among others. support adolescent sexual and reproductive health • Poor retention of staff – to consider hard to reach information with funding from UNFPA under KOICA allowance funding. Family Planning - Costed Implementation Plan 14 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
SECTION 02: Formulation of the District FP CIP Process
2.1 The process followed in developing FP CIP Sub County chiefs and Health Sub districts. From The process of developing the Nakapiripirit District these interactions and meetings, the salient issues in FP CIP was commissioned by the Ministry of Health promoting family planning utilization in the district with support from UNFPA as a largely consultative were explored through a SWOT analysis and the undertaking. It was informed by secondary data key strategic interventions that would address the collected from Desk Reviews of relevant documents challenges were listed and agreed upon. at national and district level, and primary data that The actual costing of the plan was undertaken was collected through meetings with technical staff, with the leadership of the DHO, District Planner, interviews with district level political and opinion District Biostatistician and two health workers leaders as key informants, Lower Local Government with experience on FP issues on the ground. The consultative meetings, and community and health group adapted previous experience in developing facility visits. mainly the District Health Plans and the Plan of the Community Development Department as well as The documents reviewed included the National FP with the guidance from the GOU/UNFPA annual CIP, the Nakapiripirit District Local Government work plans. The drafting teams were guided by copies Development Plan (DLGDP) and reports from of plans developed for other districts with similar the district health office. This review guided the conditions as Nakapiripirit. analytical understanding of the conceptual issues around family planning at both the district and 2.2 SWOT Analysis for Family Planning Services national level. A SWOT analysis was undertaken on the District to specifically examine the Strengths, Weaknesses, Following the comprehensive desk review, a Opportunities and Threats that accrue to the consultative meeting was held with key family District in the provision of and promotion of planning stakeholders drawn from the District Family Planning services and consequent uptake. Council, District Health Team (DHT), District Developing the SWOT was a fundamental step in the Technical Planning Committee (DTPC), and Cultural process of getting the FP-CIP in place. Table 9 below & Religious leaders, the Private Sector, Community summarises the SWOT. Volunteers and Family Planning Development Partners in addition to other Civil Society Organizations (CSOs) that operate in the region. Consultations were also undertaken with the Lower Level Local Governments such as LC III chairpersons, Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 15
Table 8: SWOT Analysis STRENGTHS WEAKNESSES • Availability of trained and professional health staff • Inadequate funds to support FP activities. in the public sector, staffing level at 70%. • Inadequate information about FP services, including • Availability of staff i.e. staffing availability and range of services. • Support from Donors/IPs who include; WFP, • Inadequate Youth Friendly Services within the UNFPA, UK Aid, AFI, UNICEF/CUAMM. health facilities. • Donors also help in incentivizing the demand • Low male involvement and support. creation process and building technical capacity to • Limited support for mothers with complications the health staff through mentorships from the FP methods. • Sponsored incentive schemes and other support • Failure to train and make use of existing VHT to community with supplementary foods to the structures. pregnant and the children aged below 5 years • Failure to incentivize and utilize the existing • Availability of VHTs at community level charged champions to mobilize other members of the with treatment and mobilization of the communities communities. on uptake of health service packages. • Rigid cultural and religious stands that tend to limit • There is a referral network available uptake of modern FP methods. • Increasing willingness of communities to take up FP • Poor attitudes of some health workers and low • Availability of FP methods and commodities staffing levels resulting into long client queues and • Potential and willingness to integrate FP services in compromised counseling. other district services and support for FP by other • Lack of updated and appropriate IEC materials in non-health sectors in their work plans local languages. • Poor LG planning and Central Government allocation for FP services
OPPORTUNITIES THREATS • Good political will and support of District and • Irregular/erratic supply of commodities from NMS National leadership • Elaborate structure to ensure regular supply of • Existence of Implementing Partners and PNFP in commodities and technical support from the Center. the Health Sector players within the region and the • Side effects from some of the methods and poor district in particular. mechanisms for the management of these side • Existence of enabling policies, laws and service effects. standards that support family planning in Uganda • Cultural rigidities that propagate myths and • Presence of Family Planning RH male Champions misconceptions which discourage use of FP and Action Groups in the District • Resistance by some cultural and religious leaders • Long distance to access services in especially the hard to reach settlement areas • Declining donor funding for FP services in the region. Family Planning - Costed Implementation Plan 16 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
SECTION 03: Translation of key issues into strategy
3.0 Introduction 1. Demand Generation – Awareness of family This section presents a detailed analysis and planning services literature review of key issues that influence the 2. Service Delivery and access family planning agenda at district level. As detailed in 3. Contraceptive Security the Uganda National FP CIP 2015-2020, the review 4. Policy and Enabling Environment and analysis that informed the Nakapiripirit FP CIP 5. Financing is categorised along the six Thematic Areas outlined 6. Stewardship, Management and Accountability below. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 17
3.1 Demand Generation Besides, the clients visiting the health facilities Behaviour change communication, including client are limited in the amount of time available for education, community mobilization, and mass media, them to interact with the health workers during has the potential to change community norms as the counselling sessions. This ultimately limits the well as individual attitudes, thus building support amount of information that can be disseminated for reproductive rights and overcoming social to them during these interactions. Yet, unguided opposition to family planning. It can also increase discussions dispelling and propagating myths and knowledge and motivate potential clients to act. misconceptions on family planning continue among During the consultative meetings at the district, the communities. This calls for proper information several scenarios were presented on the need for to counter the negative messages, which leads correct and effective use of family planning methods to withdrawal and resistance of communities to in order to step up the gains from the investments. embrace family planning services. It however emerged that this was a mainstream challenge for the entire country. It was therefore, agreed that influencing behaviour change for family 3.1.2 Inadequate information on FP among planning requires collective efforts bringing together adolescents and youth all the stakeholders from national level, down to Young people constitute the majority of the the districts and eventually to the lower level local population in the district. However, many of the governments and user communities. members of the community still think that family planning is only for women who are married/in One key concern was the need to have coordinated union. Because extra-marital sex is culturally not efforts by all players within the sub-sector in the allowed, the communities view young people who use provision of information, setting of operational family planning services as immoral or prostitutes. standards, and service provision. It was noted that Therefore, there is a lot of stigma and fear among there were efforts at different levels, all targeted the young people and the youth in accessing and at reaching the user communities and building using FP services at the health centres and within the appreciation for FP services, but these had yielded communities. unsatisfactory results. School going children in the district are not safe from sexual activity and have fallen victim to pre-marital The following issues were identified as the major sex, teenage pregnancies and sexually transmitted challenges to demand generation. infections (STIs). Worse still, there is no clear policy or guidelines for provision of family planning information and services to schools and for school- 3.1.1 Scanty information on FP going children in particular, despite the high incidence Lack of accurate information among the communities of teenage pregnancies in the district. Without has led to negative attitudes, conflicting messages adequate information on the available services, there and myths & misconceptions about FP. cannot be demand for the services. Some IEC materials encouraging women and men to use family planning services do exist. These are Youth demand a unique set of services and in a posted in different places, more especially at the private environment. If the environment is not health facilities, but much of these materials are conducive, they will shun the services no matter not in the local languages and do not exactly appeal the packaging. The innovation about Youth Friendly to the local population. Many of them are in either Corners is excellent but these are not available in any English or Ateso which is foreign to the district and HF which obviously limits youth involvement and the population cannot appreciate the information. uptake of FP services. Family Planning - Costed Implementation Plan 18 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
3.1.3 Lack of FP role models in the district 3.2 Service delivery and access A number of the men in the district still consider Increase in inputs to the FP program should go family planning a women’s only affair. The men hand in hand with improved services delivery and therefore, rarely get involved with the practice, let enhanced access to contraceptive choice. However, alone provide support for their spouses. This is partly this is often not the case due to various existing attributed to lack of information but also due to the policies and operational barriers at the facility level. cultural and religious beliefs/practices, and the myths and misconceptions associated with family planning Over the years, there has been an increase in the in general. As a result, men do not allow their spouses number of HFs providing FP services, at the level to take up FP services. Incidences of gender-based of HC III and HC IIs. The increased spread has also violence have been reported in situations where the considerably reduced the distance to these facilities women embraced FP without the consent of their from the locations of the respective communities spouses. and therefore, granted better access to FP services. A number of development partners have also Religious beliefs and doctrines still pose a major supported efforts at building capacity of health challenge to the uptake of family planning services. workers and VHTs. Several facilities are able to offer It is difficult to use the church as an avenue LARCs, and thanks to the Ministry of Health for for promoting family planning because family offering guidance and training materials during the planning antagonizes the church doctrines as far training provided with support from UNFPA. as reproduction is concerned. The church is only supportive of the natural methods and not all The VHTs have played a significant role in community the PNFP facilities provide information on other mobilization and sensitization as well as provision contraception methods. of community-based family planning services. This has had a significant boost towards uptake of FP services. Despite the improved uptake of family 3.1.4 Some well-intended interventions undermine planning services, the district still faces a multitude the promotion of family planning of challenges in provision of services. These are Some development agencies for example WFP and summarized below. CSOs provide nutrition support and services to women, especially pregnant and lactating mothers and their children. While this is a good practice, it 3.2.1 Inaccessibility to FP services due to distance tends to undermine developments for promoting Nakapiripirit is a mountainous district that surrounds family planning. It is therefore, difficult to advance Mt. Moroto. There are a number of areas within family planning among communities with starving the mountains that are too remote and not easily mothers and children when there are options for accessible. These locations can only be accessed them to access food for their families as long as they through the neighboring districts or through Kenya. are pregnant or lactating. They also listen to radio stations from Kapchorwa and this makes it difficult to reach out to them with information and services. This is further compounded by the fact that the HC IIs in these areas have no adequate equipment and staff to provide a wide range of family planning commodities. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 19
With increasing uptake of LARCs, there is a growing Failure to effectively manage the side effects need to enhance capacity of service providers in from the respective methods has been a key LARCs or else refer the clients to bigger HFs, which discouragement for more women to take up the in most cases are a distance away. The long distances services. A number of men and women think that the are a major hindrance to the referrals which are side effects women experience after receiving the sometimes not implemented. different methods cannot be managed. It is important that adequate information on these side effects and 3.2.2 Work overload at the health centres support is provided to the affected clients. To counter As indicated in the situation analysis, Nakapiripirit the above effects, the district in its FP CIP has has significant shortage of staff particularly at lower devised a number of measures including; increasing levels for FP and other RH services. The scarcity of family planning knowledge and information, engaging human resources is further aggravated by the fact the cultural and religious institutions as well as that many of the available staff do not possess the increasing community dialogues and sensitizations needed skills to handle more advanced FP services, and scaling up the management of side effects. particularly the LAPMs. The high workload due to shortage of staff and need for frequent sterilization 3.2.4 Lack of Youth friendly services of the few instruments and the negative attitude of The youth experience stigma and discrimination from the providers has in most cases biased the few health healthcare providers in their desire to access family workers with skills to provide the LAPMs in favour planning services. There is a tendency to mix and of the easier and quick to offer pills and injectables misconceive the desire to prevent pregnancy and leaving LAPMs less often offered. other reproductive needs of the young people. Youth FP services are best provided under Youth Friendly In addition to filling the staffing gaps, staff motivation Corners in HFs, but these corners do not exist in all may be especially important when providers face the available facilities within the district. Additional the additional demands with poor and occasionally, training is required for health workers to enable them irregular payments. The district recommended provide Youth Friendly FP services, in an objective, some sources of motivation, such as recognizing and friendly and professional manner. Healthcare rewarding staff performance, supporting costs or providers should remain impartial and sensitive of leave time for continuing education and providing the reproductive health needs when interacting with career advancement opportunities. adolescents and youth.
3.2.3 Poor management of side effects of some 3.2.5 Limitation in commodity supplies family planning methods There is an improvement in the supply of Family planning methods have a wide array of side commodities for most of the facilities. However, there effects on the clients. The management of side are reported shortages for the long term methods at effects requires expertise and the mothers need most health facilities and this limits service delivery to be continually encouraged and guided on the for the prospective clients (See details in section 2.3) management of these effects. Expertise to provide this guidance is often lacking in the HFs. Most of the 3.2.6 The missed opportunity for clients health workers lack the competence and skills, and Sometimes women seek family planning services are often not supported with the commodities and and fail to get it for one reason or another. This could supplies needed to manage the side effects. There are be because the providers are busy with emergency also widespread myths on the side effects resulting services or commodities could be stocked out. from the use of commodities. Some of the myths In Karamoja region, women would benefit from depict that the side effects are not manageable postpartum family planning, because not many would clinically and will lead to permanent loss of fertility. return for family planning services once discharged from the health facilities after child birth. Family Planning - Costed Implementation Plan 20 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Despite increased attention to post natal care, Overall, weak and inefficient supply systems already women who are the target population for family pose a problem for contraceptive security in Uganda. planning programs still miss out. Unmet need for Many health facilities across the country experience family planning in the extended postpartum period contraceptive stock outs leading to missed remains high, and pregnancy risk escalates during this opportunities for women and hence, a high unmet period, suggesting that more targeted activities are need for family planning. Some of the challenges needed to effectively reach this population at scale for the contraceptive stock outs include poor with the right messages and services and avoid the adherence to contraceptive procurement schedules missed opportunities. by government and donors and weak supply chains, especially at district levels. In addition, whereas women in Karamoja exhibit external courage and heroism, they are naturally The current policy of PUSHING commodities with shy before the health workers. Privacy and short shelf life to the facilities has highly contributed confidentiality in handling family planning services to stock outs and expiries in some facilities because is compromised by inadequate space at most of the PUSH Policy does not guarantee and promote the health facilities in the district. For example, free choices in contraceptive use. The Alternative counselling and delivery of services requires privacy Distribution Strategy and Reverse Distribution but the family planning clients when counselled are strategies that were meant to assist government in supposed to receive services in open space. This getting commodities to the last mile have not been inhibits community members from expressing their successfully implemented at the district. problems in the open while other people are listening. Furthermore, the lack of equipment for PPFP The district leadership identified the following issues especially, adequate numbers of PPIUD instrument as the main setbacks to contraceptive security and kits (PPIUDs themselves are procured along with adopted a number of strategies/interventions that other contraceptive methods) remains a challenge would address them. and causes unnecessary interruptions in service delivery. There is an urgent need for the district to acquire such equipment. 3.3.1 Shortage/Stock outs of FP commodities Stock-outs of some contraceptives, oversupplies of others, and delays in delivering commodities are 3.3 Contraceptive Security some of the common problems caused by weak Without adequate and reliable supply of supply chain systems within most districts in the contraceptives, family planning programs cannot country. Strengthening these systems is essential to guarantee access to services, providers cannot ensure continued access to family planning services. do their jobs, and frustrated clients are forced to leave the clinic without their preferred method or The district through UNFPA support has tried sometimes without any method at all. Government of to build health facility capacity in forecasting, Uganda through the National Medical Stores (NMS) quantifying, procurement, supply chain management remains the major provider of contraceptives across and distribution systems. However, there are still the country. Unless contraceptives are available challenges that arise out of the poor policies that when clients want them, contraceptive prevalence the MoH has adopted. A well-run supply system will remain low. Hence an effective supply chain is should employ good procurement practices; ensuring essential to the success of family planning programs. that all supplies are in good condition; eliminating Having a diverse mix of affordable, quality-assured overstocks, spoilage, pilferage, and other kinds of contraceptives on hand also ensures that family waste; and making certain that each service delivery planning clients can have their choice of methods. point has sufficient stock to meet clients’ needs. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 21
A poor supply system not fed on the Information 3.3.3 Poor quality, size and type of condoms systems is a burden to service delivery. Developing Condoms come in all different types and sizes. The a culture in which staff members at every level leaders and communities complained that although appreciate the importance of accurately collecting the standard size will fit most men, the condoms and analysing data and consistently applying data that the district has received in the recent past were to decision-making will also strengthen logistic too tight, choking blood supply to the penis leading information systems. Typical in most districts to erectile dysfunction, defeating the purpose of however, providers may either collect more data than wearing the condom. is needed; the data may be incomplete, inaccurate, or out of date; and little of the data may be analysed and 3.3.4 Inadequate storage space for commodities disseminated or influence decisions on supply chain. The MoH experiences inadequate capacity for and Through decentralization, the MoH has supported poor contraceptive inventory management systems, districts with HMIS focal persons and Biostatisticians including lack of guidelines for storage, destruction, to take on responsibility for data analysis, but the withdrawal and re-distribution of commodities skills and competence are still wanting. between and across levels and providers. Nakapiripirit is challenged with lack of district store Nakapiripirit district would simplify the logistics for RH/FP commodities and this is also experienced system by tracking only essential family planning at some of the health facilities. The expired indicators, stick to using data capture forms to make commodities take up space at the district that would data collection quicker and easier and create simple have otherwise been used by the viable commodities. summary sheets to reduce errors in tabulating data. While the district is privileged with partners Training staff in technical skills needed to collect supporting the family planning program, many of the data, control data quality, analyse data and create partners too, fail to distribute commodities and keep user friendly interpretation packages will enhance them in the district store. the logistics supply system. 3.4 Policy and enabling environment 3.3.2 Excess commodities at the expense of others The enabling environment includes such elements The “PUSH” policy of delivering commodities to the as availability of guidelines for service delivery, lower health facilities results into some facilities strong financial management and accountability receiving excess and unwanted commodities that frameworks, training health workers, and ensuring a are not based on the contraceptive needs of the regulatory environment favourable for procurement communities. The district recommended the need to and distribution of a variety of FP methods. Below instil a client/customer focus in the supply chain by are the policy challenges that hamper an enabling concentrating on contraceptive availability at service environment for FP services in Nakapiripirit district. delivery points, seeking to understand and respond to client/customers’ needs, and collecting client/ 3.4.1 Guidelines not in place customer feedback. Some VHTs don’t have adequate knowledge and skills to understand the commodities in place and to In addition to understanding customer care needs, be able to educate the community. There are many the in-charges of the health facilities should sentiments about the age at which a girl should be helped to improve management and staff receive contraceptives. The Ministry of Health should performance by providing leadership, training and come up openly and declare through clear guidelines supervision for supply chain. Further to this, the on provision of family planning to young people. Due district should adopt the inter facility and inter to high school dropout in Karamoja, girls are married district redistribution strategy to minimize over and off at an early age, and if not helped to space their understocks. births, fertility will remain high in the region. Family Planning - Costed Implementation Plan 22 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
3.4.2 Inadequate policy implementation, policy 3.5 Stewardship, management and accountability contradictions and restrictions Strengthened stewardship within and between any The NMS is mandated to procure and distribute sectors involves leadership and active management reproductive health commodities in Uganda. The from within the country and at district level to Ministry of Health therefore, put in place guidelines provide family planning services. to support procurement & distribution of drugs The national FP –CIP recognises that leadership and and other commodities between NMS and other stewardship of family planning at all levels are critical endpoints such as district health offices, health ingredients for the success of the family planning facilities and outlets for private sector institutions program. Some districts such as Katakwi have been including NGO; Faith Based Organizations and recognised for pronounced improvement in family private for profit entities. In addition, there are planning uptake as a result of district leadership appropriate policy frameworks for cooperation taking over responsibility for family planning. Some that promote public-private partnerships in leaders in Nakapiripirit also noted and appreciated reproductive health supply chain management, that Katakwi, which is a neighbouring district, including promotion of private sector involvement supported specific individuals to become “champions” in reproductive health commodities supply chain for family planning. Nakapiripirit, however, still management and provision of related supplies/ experiences challenges of political will and support services accessed from the public sector. Most of and poor coordination for family planning services these policies are neither popularized nor being delivery. Below are some of the factors contributing effectively implemented at both national and district to stewardship and management challenges and level, leading to most of the challenges discussed in suggested solutions. 2.3 and 2.4 above. 3.5.1 Weak coordination structures For example, family planning partners should Coordination of a multi-sectoral framework through lobby/advocate for implementation of the Reverse the DHOs office will not yield the results for which Redistribution Strategy to ensure commodity the district FP-CIP has been developed. The CAO security, method mix at all levels and prevent expiry who is head of technical business in the district of commodities. There is also need to advocate for in close collaboration with the DHO should be a budget line for redistribution, bearing in mind that tasked with the responsibility of coordinating the most of health facilities are in rural areas and also implementation of the FP-CIP. Effective and efficient that the supervision tool is limited on how much coordination through CAO’s office will require the information on commodity stock at hand is collected district to plan and budget for both Health Sector from the facilities. Coordination Working Groups and coordination for family planning through the Technical Planning 3.4.3 Absence of Policy on Expired Commodities Committees. District leaders complained about the lack of guidance on how to manage the expired commodities, With support from UNFPA, the district tried to especially, in a district with limited storage space. establish Family Planning Working Group, but the group does not meet regularly and has not convinced the other departments to take family planning into the planning and budgeting cycle. Family planning therefore, remains a health issue.
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3.5.2 Inadequate facilitation of the HUMC The MoH established and supports HUMCs, constituted of community leaders, VHTs and the in-charges of the health facilities to provide overall supervision of the facilities as well as promoting community participation in health governance. Ideally, the HUMCs are supposed to be facilitated to be able to function. But the HUMCs, just like most VHTs are not sufficiently facilitated to play their representation roles, verification of goods and services at the facilities and sensitisation of communities, thus the members feel that they are detached from the facilities.
3.5.3. Poor capture and management of FP data Data capture and management is key in providing evidence for decisions that will be made when the various coordinating bodies hold meetings. It is paramount that the district invests some resources to ensure proper data is generated and utilized for the family planning programme.
In addition to the inadequate capture and FP data management at the health facilities, there is lack of information sharing with IPs who use different data capture forms.
3.6.Financing 3.6.1 Family planning is not a district priority Following the FP-CIP, family planning has become priority for the government of Uganda. The district FP-CIPs will be useful for resource mobilization, but this has to be through different sources. The district must prioritize family planning in the development plan and budget as well as undertake resource mobilization from development agencies and CSOs.
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SECTION 04: Costed Implementation Plan; Translating actions into strategy Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 25
4.0 District strategic priorities in FP 4.1.1 Local, cultural, and religious leaders are In this section, an attempt is made to outline the supportive of family planning strategic priorities for Family Planning in Nakapiripirit Targeted training will be conducted bi-annually District for the period 2018 - 2023. The district for community leaders in groups, to cover the best priorities are aligned to the thematic areas of the methods for modern FP. This will be in addition to National FP Costed Implementation Plan 2015 -2020 information sharing sessions and discussions or as well as to the District Vision, Mission and Goal. engagements that will be geared towards support The section also attempts to outline the strategic for improved information flow and enlisting their outcomes resulting from implementing the FP CIP support for mobilization and further sensitizations in line with the six Thematic Areas namely; demand as advocates for FP. FP coalitions shall also be forged creation, service delivery and access, contraceptive with champions and opinion leaders to encourage security, policy and enabling environment, them share their success stories and inspire others stewardship, management and accountability, and while well managed families will also be occasionally financing. sought to demonstrate the need for and benefits of FP. NAKAPIRIPIRIT DISTRICT VISION “To have a peaceful, transformed, self-reliant and 4.1.2 Improved male involvement and support for prosperous people by the year 2040”. modern contraceptives for themselves and their partners. DISTRICT MISSION STATEMENT: Increased involvement of men in family planning “To achieve sustainable socio-economic development interventions shall be enlisted, engaging satisfied through efficient provision of quality services to the male users through targeting males in their dwelling people of Nakapiripirit in conformity with national places or through male only dialogues. To get policies and local priorities” more men on board, these engagements could be undertaken in churches, community meetings, DISTRICT GOAL: “To improve the livelihood of the drinking places, communal burial and cultural people of Nakapiripirit by 2040.” gatherings. The district hopes to recruit champions from amongst the local political and opinion leaders 4.1 Demand creation to push for male involvement and create more Male FP champions to advance the cause of family planning The district has planned to organize a number of among men. Behavioral Change Communication (BCC) campaigns to promote family planning utilization and uptake 4.1.3 Improved family planning information among through dissemination of appropriate information. young people The approach intends to focus on community-based Youth Friendly Corners for suitable HFs and interventions that will be designed to reach out to improved information flow for youth shall be and provide information to communities to step up promoted to give information on sexuality and demand for FP services especially the increased family planning in selected schools and public health use of modern methods. Key in this strategy will facilities across the district. This shall be sustained be to invest in information dissemination using with Development Partners’ support and effort available channels within the district staffing and shall be made to fundraise for this intervention. other stakeholders to improve the messaging on This has potential to boost information sharing and family planning and to demystify the myths and reduce the knowledge gap for family planning among misconceptions on family planning. The Strategic adolescents and youth. district outcomes will include: Family Planning - Costed Implementation Plan 26 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Training and empowerment for senior women and 4.2 Service Delivery and Access male teachers, introduce FP themes in MDD, school Nakapiripirit District shall adopt a rights - based debates and sports galas and reinvigorating and approach as outlined in the National Costed incorporating FP messages in the School Family Implementation Plan. The plan entails informed Initiatives (SFIs) would be ideal interventions to boost choice, free and informed consent, respect to privacy knowledge flow and management in the youth in and and confidentiality, equality and non-discrimination, out of school. equity, quality, client-cantered care, participation and accountability. The district FP CIP shall respond 4.1.4 Increased demand for FP services in the to community and facility-based factors that impede district access and utilization of family planning. The main barriers to increased contraceptive use shall be overcome through village-based The key factors limiting service delivery included: interventions designed to provide socially distance to the health facilities; inadequate appropriate counselling to potential contraceptive information that ultimately limits/impacts the users. VHTs and the Family Planning Champions mothers’ knowledge about the benefits; possible when well organised and utilised can be very side effects of the methods; frequency of attainment instrumental and achieve high impact when providing of services; poor reproductive health services for basic health and family planning information and adolescents and lack of adolescent friendly services. counselling. The village-based interventions shall be Other limitations include; weaknesses in the referral stepped up and utilised to enhance demand for the services especially for LARCs and removal of FP services. implants; inadequate space that denies privacy to Community dialogue meetings with all stakeholders mothers during counselling and when administering including men, cultural & religious leaders and service, lack of male support that makes utilisation opinion leaders in the community are an important low and under staffing levels as well as the attitudes channel in communicating with the communities. of the health workers towards the LTPMs. These will be supported and greatly encouraged as a clearer avenue for information dissemination. The district FP CIP is cognisant of the above Further dissemination through organized community limitations and has identified the strategies rallies at village level at various fora such as faith- that must be put in place to improve access to based group meetings in the mosques and churches, contraceptive services and utilisation among women social gatherings for men, shall be utilised to increase of reproductive age, including sexually active their involvement in family planning interventions. adolescents. Strategic service delivery outcomes will For the above communication to be effective, the include; district shall invest in identifying and supporting the development and distribution of appropriate 4.2.1 Increased Access to FP Services IEC materials. These shall be developed in the local Integrated Community Based services through language and different channels of communication health-related outreaches and camps conducted shall be utilised, such as posters, fliers, music, dance & by the Health Centres (IVs, IIIs and IIs) shall be drama, debates in schools and radio talk shows. undertaken. Targeted mobile outreach services Each of the technical departments of the district involving VHTs, including door to door campaigns and will be tasked to integrate FP into their budgets and delivering services within the manyattas will also be community dialogues will be incorporated in the sub undertaken regularly in each of the sub counties and county and district workplans. villages.
Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 27
Family planning services will also be integrated in The district therefore, plans to step up the training other maternal and child health services such as ANC, and retraining programmes to include; continuing immunization and HIV/AIDS care interventions. capacity development, on–job training, mentoring Prompt adoption of contraception after childbirth and coaching as well as strengthening a task sharing (Post-partum family planning) will also help lengthen strategy that ensures there is less work load for birth intervals for women and benefit both the the health workers at the facilities. All staff and the mothers’ and children’s health. The best way to VHTs/Community Health Workers will be trained or accomplish this is to integrate family planning into a oriented not only to offer family planning services, continuum of services that extend from the beginning but will be given skills on data capture, regular of a woman’s pregnancy through delivery and infancy. data audit specific for FP and in utilization of the For women in Karamoja, antenatal attendance and data for advocacy, decision making and improved delivery at health facilities has increased due to programming. the food distribution and Maama kits provided by WFP and UNICEF respectively. Such visits offer 4.2.4 Enhanced Management of FP side effects an excellent opportunity to discuss and provide In addition to community sensitizations and dialogues postpartum contraceptive methods to mothers. in an effort to demystify myths and misconceptions, the district will train and orient health workers on 4.2.2 Improved Access to Youth the management of side effects associated with Friendly Services (YFS) different family planning methods and ensure that In order to enhance the utilization of family planning health workers adhere to the New Medical Eligibility services by the sexually active adolescents and youth, Criteria. FP counselling; champions and satisfied the district shall re-introduce and expand YFS at HFs users will be utilized to share their experiences and incorporate advocacy activities, sports & games, and the district will ensure that the supplies for outreaches to youth in school and out of school and management of side effects are available. work sites. This will call for investments beyond the available grants to the health sector and will entail 4.2.4 All HFs equipped to handle the plans to engage the DPs in the district. demand for FP services A number of villages are located far away from HC IIIs 4.2.3 Competent, skilled and motivated human which are the main focus for the Government supply resource for provision of family planning services of FP services. This implies that clients have to resort Nakapiripirit is one of the hard-to-reach and hard-to- to HCIIs that are within their vicinity but are usually stay districts. Working together with development ill-equipped to handle the demand. The District plans partners, the district has made effort to recruit and to adequately equip the HCIIs to equally handle and train a number of their health workers equipping respond to the demands of the mothers who prefer them with skills in family planning service provision. the LARCs. These facilities will be supplied with the However, the attrition rates are quite high which necessary commodities and their staff trained to continues to create gaps in the human resources handle emerging FP requirements. at health facilities. To tackle the problem of staff shortage, there have been various efforts towards delegating, where appropriate, various tasks to less specialized health workers to expand access to a wider contraceptive choice through enabling larger numbers of health workers to offer a wider range of methods. Family Planning - Costed Implementation Plan 28 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
4.3 Contraceptive security • NMS should take note of commodities about to 4.3.1 Contraceptive logistics management system expire and not supply them to the district strengthened • Implement the inter facility and inter district The rampant shortage of FP commodities is a big redistribution strategy. deterrent to family planning service delivery because of failure to quantify and make appropriate orders 4.3.3 Inadequate storage space for commodities for the facilities. In order to strengthen the logistics There are challenges with storage of supplies and system, the district leaders pointed to building commodities at the district stores as well as at the capacity of in-charges and drug dispensers for timely health facilities. The VHTs are not any better with and accurate ordering; support distribution and the way they store commodities. Proper storage calls redistribution, collection and onward movement of for expansion and provision of new storage facilities; the order forms to the district to submit to National establishment of storage cupboards at the facilities Medical Stores and allocate budget for timely and facilitation of the VHTs with strong, fire/weather distribution of commodities to the facilities from the resistant boxes for storage of commodities and centre. supplies.
4.3.2 Effective Implementation of Reverse Re- 4.3.4 Poor quality, size and type of condoms distribution Some men and women hold negative attitudes that Some Implementing Partners (IPs), mostly those the Karamojongs are naturally tall with large penis conducting health camps and outreaches keep and may not be able to easily find male condoms the balance on commodities in the district store that fit them properly. Trying to explain to the instead of sending it down to the facilities where communities that condoms come in different sizes, the commodities would be consumed. With the low shape, colour, lubrication and texture is an uphill task. uptake of contraceptives, there are also places in the Advising the communities to try different brands to district where commodities are either in excess or find out which fits best, is not an easy task either. It have been reported to have expired. Such scenarios was agreed therefore, that NMS should endeavour also pose challenges for districts in having excess to procure the big size condoms and also undertake of some commodities at the expense of others such operational research to improve the type of condoms as Condoms. The following interventions will try to for the district and within the entire Karamoja region. address the concerns above. • Ensure that IPs take commodities to the last mile/ 4.4 Policy and enabling environment end users There should be improved legal framework and • IPs should inform/report deliveries of commodities knowledge of policies for family at all levels. With to the DHOs office decentralization, district officials should anticipate • NMS should deliver commodities according to and plan for uninterrupted family planning supplies demand/orders and services in an environment where family planning • Ensure ordering forms are adequately available, is still controversial in certain settings. This is accurately filled in and sent to the district for particularly witnessed for some sub-populations such onward submission to NMS. as adolescents and unmarried couples. Therefore, • Distribution of commodities at facilities and at advocacy related to contraceptives becomes even hotspots such as at Panarowa, Bridges and at Public more difficult than that for other public health issues toilets. such as maternal health. • Supplies officer to inform status of commodities at the facilities Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 29
Linking family planning acceptance, continuation 4.5 Stewardship, Management & Accountability and contraceptive security to other maternal and The district FP-CIP requires an effective child health outcomes or development and poverty- performance management system as well as a alleviation goals is an important tactic for the leaders monitoring and evaluation system to coordinate and to create an enabling environment for family planning supervise district and partner FP activities. It also acceptance and delivery. needs a sound coordination mechanism through fully functional FP technical working group meetings with 4.4.1 Distance to health facilities district officials, their partners, and donors, if any. As presented in section 2.4 above, most communities live >5km from H/Fs due to the mountain surrounding Currently, family planning is coordinated through the the district. This calls for creation of more health FP coordinator that sits within the District Health facilities in the region to reduce the distance that Office. The coordinator’s role is to provide updates communities have to trudge in search for services. and information regarding family planning to the district health officer to help plan and implement FP 4.4.2 Absence of Guidelines programmes. However, outside of that role, there The MoH should come out clearly on the developed appears to be no clear coordination mechanism Policy Guidelines and Service Standards for SRHR for the implementing partners and donors on the including provision of family planning to allow ground to track their efforts and limit duplication. universal access. The existing guidelines have been Additionally, private for-profit organizations have no received with mixed reactions among key decision requirement to report to the FP coordinator, making makers in the country and reluctant to allow it more difficult for the district to effectively monitor adolescents of 10-14 to access contraceptives. The all FP programmes. guidelines are pending approval by the Minister of Health. If ever approved, the guidelines will call 4.5.1 Capacity to implement, coordinate and for continued mentoring of the health workers and monitor the FP programme strengthened VHTs on their use and application. Given the current Coordination of a multi-sectoral framework alarming adolescent pregnancy rate, all people of through the DHOs office will not yield the results reproductive age and sexually active should be for which the district FP-CIP has been developed. allowed to access family planning services to meet The CAO, who is head of technical business in the their reproductive health needs and rights. district, in close collaboration with the DHO will coordinate implementation of the FP-CIP so that 4.4.3 Inadequate knowledge among VHTs regular meetings at sub county and district levels are Some VHTs don’t have adequate knowledge and organised to share reports and give feedback. skills to understand the commodities in place and to be able to educate the communities on the family planning services and how and where to access services. The VHTs need regular orientation to be able to deliver on their tasks including community sensitization and distribution of commodities to the beneficiaries. Family Planning - Costed Implementation Plan 30 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
4.5.2 Lack of inter-sectoral collaboration for FP 4.5.3 Regular monitoring, midterm and end of term The National Development Plan II and the FP costed evaluation of the FP-CIP undertaken Implementation Plan call on districts to integrate Monitoring and evaluation in family planning (FP) family planning as a cross-cutting issue. The district programs should be able to yield well-established has not yet taken this recommendation seriously and results against the indicators and targets for program therefore; family planning remains a health issue in performance. The tools and materials must be the District Development Plan. The following are available to satisfactorily implement M&E strategies. planned: Nonetheless, many gaps and weaknesses in M&E still • Establish a multi-sectoral approach on need to be addressed. The district called on partners, management of issues of FP especially UNFPA to support the monitoring and • Develop multi-sectoral initiatives and integrate FP evaluation of the district FP - CIP. issues in other sectoral plans. • Hold regular multi-sectoral review meetings. • Training and sensitization of other stakeholders on 4.6 Financing FP programmes. Regardless of the increasing financial commitment for family planning at national level, Nakapiripirit 4.5.3 Effective tracking and monitoring district, like most districts across the country has of the FP-CIP no direct public funding for family planning. Family Data capture and use is relevant to improved service planning is incorporated in the Primary Health delivery but high-quality family planning data Care (PHC) grant, a conditional grant, not liable to capture is a complex enterprise with involvement flexibility, because the money has been ear marked from multiple health workers and officials, and is for what government considers to be more important vulnerable to errors and slip-ups. Effective data reproductive health and child health activities, capture and reporting are barriers to achieving the such as HIV, STI, immunization and ante natal care country’s family planning goals. services.
This is more pronounced at district level, where The district attributes the poor family panning service delivery takes place. It is important to indicators and performance to limited government understand how family planning data is captured support to family planning. The district leadership and used at the district level, and then reported for appreciates the financial revenue constraints and decision-making. Health workers and administrators calls upon government and development partners to within the district, who bear the burden of collecting support this FP-CIP. In addition, the district should and using family planning data, are not incentivized also leverage more financial resources by ensuring to do this work well. It is therefore, pertinent that the that family planning is mainstreamed in district district takes measures to facilitate the VHTs to share planning and budgeting processes, so that the various reports with the relevant health facilities; increase departments include activities and budgets for family demand for monthly and quarterly reports at S/C and planning. district level and institutionalize FP focal persons at various HC IIIs and give roles for the focal person. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 31
Table 9: Summary of the interventions with key players ISSUES STRATEGY/ INTERVENTION ACTORS DEMAND GENERATION Scanty information on FP • Regular and targeted Radio talk shows on FP DHO and FP among communities leading focal person to negative attitudes, • Bi annual family planning week celebrations including talk DHO, DHE, conflicting messages and shows on FP, family planning clinic at every health facility, FP CAO, FP Focal myths & misconceptions drama shows, tree planting during the FP week, mobilization and person education of communities on FP. • Community dialogues targeting a number of manyattas to first District Council understand perceptions of communities on family planning. and DTPC • VHTs undertake door to door campaigns DHT and CAO • Translate IEC materials into local languages to enable the NPC, MOH, community understand family planning UNFPA • Use of District Chairperson as FP role model FP • Increase male involvement through sensitization DHO and DHE • Procure TV screens for health education and provision of FP DHO, FP focal information especially at the waiting areas of health facilities. person and DHE • Use of public address systems in open air gatherings DHT and CAO • Engage in one-on-one family meetings with opinion leaders to District Council reach out and sensitize the big size families. and DTPC, religious & cultural leaders • Engage at occasions and functions where handouts are given and District Council the numbers are available, e.g. SAGE payment points, Maama and DTPC Kits or food distribution centers Inadequate information of FP • School health programs. Students are already mobilized and MOH, MOES, among adolescents and youth therefore easy for them to be sensitized about FP NPC, DEO, DHE • Identify and train peer educators in the communities to DHT & DCDO encourage the youth in union to take up family planning • Reactivate school adolescent clubs and Sexual Health Educators DEO, District (SHEs), Planner • Support young people to begin IGAs (agro-forestry, youth DHT & DCDO livelihoods etc.) • Education ordinance where all school going children should be at MOH, MOES, school except during school holidays NPC, DEO, DHE & DHT There are no role models for • Identify and build capacity of champions to model for FP CAO, LCV family planning in the district acceptance and utilization Chairman, DHO Family Planning - Costed Implementation Plan 32 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Table 9: Summary of the interventions with key players (continue) • Identify satisfied users and support them to share their DHO & DCDO experiences during organized events. • Creation of model homes (families/couples) on FP. Recognize CAO, LCV that support FP Chairman, DHO • Recognize best performing VHTs and champions (top to bottom) DHO &DCDO SERVICE DELIVERY Inaccessibility to health • Train and support more VHTs in the district, especially in hard to CAO & DHO services reach areas like Katengeto. • Provide mobile outreach services and mobile clinics CAO & DHO • Integrate family planning in other health care services, especially, CAO & DHO MCH and HIV clinics • Advocate for more health facilities in Sub-Counties in the District Council, district. Speaker and DTPC • Promote self-injection DMPA-SC, especially, for the women DHO whose choice is injectable contraceptives Work overload at the health • Build capacity of H/Ws in both basic and LARCs to have a mass CAO & DHO centres due to low staffing who can offer a range of FP services levels • Refresher trainings (CME) to health workers CAO & DHO • Advocate for recruitment and retention of more health workers CAO & DHO • Monitoring and support supervision of service provision CAO & DHO • Motivate health workers (monetary, accommodation, career CAO & DHO development etc.) • Identify and rotate health workers while recognizing the best CAO & DHO performing Failure to effectively manage • Train H/Ws to manage side effects of contraceptives CAO & DHO side effects of FP methods • Counsel for switching from one method to another • Procure commodities that counter side effect DHO • Counsel women what to expect and where to seek extra care in DHO case side effects arise • Referral CAO & DHO Stock outs of FP • Provide more FP commodities in all health facilities both short- UHMG, MOH, commodities and long-term methods DHO Lack of equipment for • Procure equipment through NMS CAO & DHO provision of LARCs Missed opportunities • Strengthen Post-Partum family planning by convincing women CAO and LCV and training H/Ws in provision of PPFP • Procure more FP equipment such as for PP IUD insertion UHMG, MOH, DHO Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 33
Table 9: Summary of the interventions with key players (continue) • Creation of rooms/space to cater for FP provision without CAO, DHO compromising privacy • Data collection from private practitioners (report to the HMIS 2) Biostat, DHO • Resource mobilization for the FP program through proposal CAO, DHO, writing LCV • Bench marking and experience sharing on how best performing CAO, DHO, districts reached there LCV CONTRACEPTIVE SECURITY Shortage of commodities for • Build capacity of in-charges and drug dispensers for timely and DHO BIO-STAT FP services accurate ordering. and HMIS FP • Support distribution and redistribution and collection of order forms • Allocate budget for timely distribution of commodities to the facilities from the centre IPs keep commodities in the • Ensure that IPs take commodities to the end users CAO and DHO district store • IPs keep commodities in the district store Excess of commodities on • NMS should deliver commodities according to demand/orders DHO BIO-STAT expense of others (Condoms) • Ensure ordering forms are adequately available and HMIS FP Low uptake of contraceptives • Redistribution of commodities at facilities and at hotspots DHO BIO-STAT leading to expiry (Panarowa, Bridges, Public toilets) and HMIS FP Poor quality, size and type • Bring sizes that fit MoH & NMS (Small/non fitting) condoms • Operational research to improve the type of condoms for the district or entire Karamoja region Inadequate and unsecure • Procure doors for each of the drug stores at the facilities. CAO and DHO storage space for • Establish storage space at the facilities. commodities • Facilitate VHTs with strong, fire/weather resistant boxes Expiry of commodities • Supplies officer to inform status of commodities at the facilities DHO BIO-STAT • Consider reverse redistribution and HMIS FP • NMS should take note of commodities about to expire and not supply them to district POLICY AND ENABLING ENVIRONMENT Most communities live >5km • Creation of H/C IIs in the district/region from H/Fs • District Council, DHO, District Engineer Guidelines for FP provision, • Ministry of Health provide guidance MoH, DHO especially to young people • Continued mentoring on the use of guidelines not in place Some VHTs don’t have • Improve capacity of the VHTs to carry out their tasks. DHO BIO-STAT adequate knowledge and • Distribute commodities to the beneficiaries and HMIS FP skills to understand the commodities in place and to be able to educate the community Family Planning - Costed Implementation Plan 34 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Table 9: Summary of the interventions with key players (continue) Expired commodities District should reject expired or near expiry commodities DHO BIO-STAT and HMIS FP STEWARDSHIP, MANAGEMENT AND ACCOUNTABILITY Inadequate funding to • Include FP in the agenda of the Health Sector Working Groups District Council, coordinate the Family • Establish a multi sectoral FP Coordination WG CAO, DTPC and Programme - The Health • Build capacities of CDOs/parish chiefs to integrate FP in Planner Sector Coordination working community development Groups • Integrate FP in existing district programs Inadequate facilitation/ • Increase the allowance from 6,000/= to 20,000/=. CAO, DHO & allowance of the HUMC to • Integrate HUMC with the standing committees of the facility to DTPC hold regular meetings for increase the allowance verification, sensitization, • Re-constitute HUMC and build their capacity to deliver link health services to • DHT provides supportive supervision and mentorship to identify communities etc gaps at H/F level and address the challenges Lack of timely and accurate • Build capacity at district (Stores records assistants/ DHO BIO-STAT FP data capture and reporting biostatisticians) and HMIS FP • Build capacity at H/F levels (Stores assistants, records assistants and in-charges) • Build capacity of VHTs to correctly capture data and report timely Inadequate data management • Harmonize data collection tools and information in line to HMIS/ (Weak information sharing DHIS2 DHO BIO-STAT from IPs interventions) and HMIS FP IPs have different data capture forms FINANCING Family planning is not a • Prioritize FP at national level by making FP a conditional grant MoH and priority at national level • Strengthen system to cascade to district level Members of Parliament, Partners Neglected financing for FP • Budget for FP through mainstreaming MoH, MoLG, • Include FP in LG assessment DHO, Planner • The Standing Committee of Health should have a budget line for family planning in their estimates • Operational research for FP uptake Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 35
SECTION 05: Institutional Arrangements for the District FP-CIP
5.0. Introduction district, the FP-CIP will act as a resource mobilization The District FP Costed Implementation Plan will be tool and will be presented for support to different implemented within the decentralization realm. It is partners at both national and local government envisaged that every year, the district will prioritize level. Many players will be involved for effective family planning in the District Development Plan so implementation, coordination and accountability as that a budget line for FP is endorsed and approved by indicated below. the District Council. Given the limited resources in the Family Planning - Costed Implementation Plan 36 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
5.1 Management, Coordination, and 5.2.2 District Health Officer (DHO) Accountability Structure and Assistant DHOs Coordination of the District FP-CIP will be led by The DHO will be the overall chief in implementation the CAO with the DHO as the line office and using of the FP-CIP, given the administrative stewardship an organized multi-sectoral stakeholders’ approach. of health services within the district. Together With the leadership from the CAO, the district with the District Health Team, the DHO will be will establish and constitute a Family Planning responsible to equip health workers with skills in Working Group chaired by the Local Council V (LC FP service delivery especially LTPM; integrate FP 5) and co-chaired by the CAO. It is proposed that in health service delivery; increase access to family quarterly review meetings will be held with the DHT planning information and services especially among members and later on shared with the relevant key the most vulnerable communities; strengthen FP stakeholders. service delivery systems and behavior change communication among communities; mobilize Each of the various stakeholders in the district will partner efforts towards FP and offer technical have a role in implementing the District FP - CIP. support to implementing partners, institutional For example, implementation will be spearheaded based health workers and Village Health Teams at by the CAO with support of the DTPC, Civil Society grassroots level. Organizations, Community Based Organizations, women groups, and faith-based organizations, 5.2.3 District Planning Unit amongst others, although the main role lies in the The District Planner who is responsible for DHO’s docket. coordinating the development of the district Development Plan will coordinate and monitor all 5.2 Roles and Responsibilities of Key Actors actors/departments to ensure that family planning is (District Level) integrated as a multi-sectoral issue and look out for budgets for family planning interventions to ensure 5.2.1 Chief Administrative Office coherence and effective service delivery. The office of the CAO will take overall responsibility for effective management and development 5.2.4 Community Based Services of human resources, institutions and systems The Community Based Services has the mandate of for delivery of family planning information and ensuring support and demand for all interventions services as one of the factors that will contribute to that aim at community development. The department successful FP outcomes. The CAO will encourage will build and support family Planning champions open communication as well as moral, task and (both individuals and groups) to promote FP material incentives that will contribute to developing messages among communities; mobilize communities committed staff and organizations that are for Family Planning e.g. support outreaches for responsive, flexible and innovative in meeting the LARCs; incorporate FP in radio programmes on FP needs of young people, men and women. The other community development issues and promote CAO will promote close collaboration and public- IEC for family planning targeting men and women at private partnerships among the district, NGOs and grassroots level. local communities to deliver quality and efficient FP information and services. In addition, the CAO will institute incentive systems (in collaboration with other actors in the field) for the best service providers in the field of FP at both individual and institutional level. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 37
5.2.5 District Education Officer 5.3 Resource Mobilization Framework With the high levels of teenage pregnancy attributed The District shall be required to commit a percentage to high fertility and early marriages, the education of the local revenue to the plan as a way to build sector has a role to play in ensuring that adolescent ownership and ensure effective implementation of girls and boys have access to family planning the FP – CIP. Additional and concerted efforts shall information in order to delay first pregnancy be made to continue lobbying and advocating for and improve knowledge and practices related to increased donor support and grants from the center. reproductive health. The DEO should therefore, work The District Budget Framework paper will reflect closely with the DHO to intensify messages on FP a commitment towards increased financing of FP and reproductive health in schools. Furthermore, for over the next 5year period. Informed by the district those out of school, the DEO should collaborate with funding gaps, the district Planner and the Chief the Community Development Office to ensure that Finance Officer will forecast and project resource messages on FP are incorporated in FAL lessons as implications for FP financing annually. well as other community engagements.
5.2.6 Finance Department 5.4 Performance Monitoring and Accountability The Finance Department manages the resource Regular monitoring through the DHMIS, with envelope for the entire district and resources reporting on performance executed to MoH through earmarked for FP are no exception. Given that the coordination mechanism as prescribed by the mandate, the finance department wields a lot of National FP CIP will be done. Key performance power in enhancing proper programme management targets will be informed by the strategic priorities and resource utilization both of which are vital for the that have been set out in the next section of this success of family planning programmes. They ensure FP - CIP. It is anticipated that district performance allocation, timely release and utilization of funds for towards the National FP - CIP will be shared in MoH FP in the most efficient and effective manner possible review/ strategic planning meetings. Measuring in order to meet the desired outcomes. the district performance against the national FP- CIP targets will be critical and crucial during the 5.2.7 Civil Society and Non-governmental implementation period. organizations With the coordination and guidance of the CAO 5.5 Routine Data Collection and DHO, this District FP - CIP will, engage the reproductive health partners in the district to ensure Family planning services data will be collected provision of financial and technical resources towards through the normal HMIS system. As a requirement, FP and delivery of better FP services. Some of their each health facility and associated volunteers effort could also be directed towards advocacy for will compile data using the standard tools from improved demand and quality service provision. Ministry of Health and later on forwarded to the The district will also source for more partners from district Biostatistician for onward submission to amongst those already operating in the area and Ministry of Health. The contraceptive stock status those outside and invest in increasing visibility to and the average monthly consumption data at all make sure this happens. health facilities (both government and PNFP) will be captured in hard copies and where possible, electronic (HMIS) data base will be maintained. Family Planning - Costed Implementation Plan 38 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
5.6 Data Management and use 5.7 Monitoring and Evaluation The District Biostatistician will play a lead role in Quarterly review meetings on the progress of ensuring Data Quality Assurance (DQA): collection, implementation will be conducted and findings transfer, compilation, analysis and storage. This will reported to the Family Planning Working Group be executed through a series of technical review meeting. Midterm and end of term evaluation will also meetings with the HMIS staff and health facility be conducted to inform stakeholder and document assessment checks. As such routine support lessons learnt and best practices that could be supervision will be undertaken on a quarterly basis replicated for successful implementation in other and technical support will be offered in areas of districts. need to health centres both for government and the private not for profit. Due care will be taken to identify any inconsistencies in data by comparing the submitted data records with the original data sources.
It is planned that during the quarterly stakeholders’ review meetings, the consolidated and analysed data will always be presented to the members in order to inform decision making. Deliberate efforts will be made to disseminate performance levels with the relevant stakeholders. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 39
SECTION 06: Costing of the plan
6.1 Summary Cost of the FP-CIP In the first year, it is projected that UGX From Table 12 below, it is projected that Nakapiripirit 1,786,099,000 will be invested and committed to District FP-CIP will cost a total of four billion family planning and that the cost of the plan will six hundred fifty two million six hundred forty gradually decrease over the years. The reason for the nine thousand two hundred nine shillings (UGX high cost of the Plan in year one is the construction of 4,652,649,209) over the next five years. Demand health facilities and establishment of youth friendly creation will consume the biggest share of the plan corners, which will not be done over the subsequent at UGX2,228,181,400,, Service delivery and access years. will cost UGX1,914,783,200, Contraceptive security UGX244,812,209; Stewardship, Management and Accountability UGX235,272,400 and Finance UGX29,600,000.
Table 10: Summary costs per thematic area per Financial Year (Millions UG X) Priority/FY YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 TOTAL Demand Creation 612,749,000 423,041,000 480,668,200 384,187,800 327,535,400 2,228,181,400 Service Delivery 993,772,000 289,333,500 265,016,800 207,822,900 158,838,000 1,914,783,200 Contraceptive 108,520,000 41,361,000 35,657,900 32,389,110 26,884,199 244,812,209 Security Stewardship, Management & 65,138,000 65,138,000 40,022,000 34,998,800 29,975,600 235,272,400 Accountability Finance 5,920,000 5,920,000 5,920,000 5,920,000 5,920,000 29,600,000 TOTAL 1,786,099,000 824,793,500 827,284,900 665,318,610 549,153,199 4,652,649,209
6.2 Detailed Cost of the FP-CIP Funding of the strategic activities will be the responsibility of the district and the development partners that support various programs in Nakapiripirit. As has been indicated, the district will also lobby for additional resources from the corporate agencies through corporate social responsibility. Family Planning - Costed Implementation Plan 40 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Table 11: Nakapiripirit District FP CIP detailed Cost NAKAPIRIPIRIT DISTRICT FP CIP BUDGET YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 Total DEMAND GENERATION Regular and targeted Radio talk shows (6 in a quarter) 7,240,000 7,964,000 8,688,000 7,964,000 5,068,000 Bi annual family planning week celebrations 24,650,000 27,115,000 22,185,000 17,255,000 12,325,000 Community dialogues in manyattas 59,200,000 65,120,000 76,960,000 65,120,000 53,280,000 VHTs undertake door to door campaigns 210,000,000 231,000,000 273,000,000 210,000,000 189,000,000 Develop and translate IEC materials into local languages 71,675,000 0 0 0 0 Support to District Chairperson as FP role model 5,430,000 5,430,000 5,430,000 5,430,000 5,430,000 Increase male involvement through sensitization 59,000,000 59,000,000 64,900,000 53,100,000 41,300,000 Procure TV screens for health education 11,600,000 0 0 0 0 Use of public address systems in open air gatherings 16,500,000 0 0 0 0 One-on-one family meetings with opinion leaders (Religious and cultural leaders) 20,932,000 20,932,000 23,025,200 18,838,800 14,652,400 Educate communities at functions where handouts are given e.g. SAGE payment points , Maama Kits or food distribution 6,480,000 6,480,000 6,480,000 6,480,000 6,480,000 centers Purchase tents for providing health education and edutainment for youth/young people 67,500,000 0 0 0 0 Youth peer leaders conduct dialogues in schools and community 52,542,000 TOTAL DEMAND GENERATION 612,749,000 423,041,000 480,668,200 384,187,800 327,535,400 2,228,181,400
SERVICE DELIVERY Train and support more VHTs, especially in hard to reach areas like Katengeto 148,772,000 148,772,000 133,894,800 104,140,400 74,386,000 Provide mobile outreach services and mobile clinics 44,240,000 48,664,000 53,088,000 39,816,000 30,968,000 Integrate family planning in other health care services, especially, MCH and HIV clinics 3,600,000 3,600,000 3,600,000 3,600,000 3,600,000 Advocate for more H/Fs in Sub-Counties 650,000,000 0 0 0 0 Promote self-injection DMPA-SC 6,080,000 6,080,000 5,472,000 4,560,000 3,040,000 Build capacity of H/Ws including PP FP, management of side effects 43,930,000 39,537,000 30,751,000 21,965,000 17,572,000 Monitoring and support supervision of service provision 44,695,000 40,225,500 35,756,000 31,286,500 26,817,000 Procure equipment for Post partum FP through NMS 50,000,000 Data collection from private practitioners 2,455,000 2,455,000 2,455,000 2,455,000 2,455,000 TOTAL FOR SERVICE DELIVERY 993,772,000 289,333,500 265,016,800 207,822,900 158,838,000 1,914,783,200 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 41
NAKAPIRIPIRIT DISTRICT FP CIP BUDGET YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 Total DEMAND GENERATION Regular and targeted Radio talk shows (6 in a quarter) 7,240,000 7,964,000 8,688,000 7,964,000 5,068,000 Bi annual family planning week celebrations 24,650,000 27,115,000 22,185,000 17,255,000 12,325,000 Community dialogues in manyattas 59,200,000 65,120,000 76,960,000 65,120,000 53,280,000 VHTs undertake door to door campaigns 210,000,000 231,000,000 273,000,000 210,000,000 189,000,000 Develop and translate IEC materials into local languages 71,675,000 0 0 0 0 Support to District Chairperson as FP role model 5,430,000 5,430,000 5,430,000 5,430,000 5,430,000 Increase male involvement through sensitization 59,000,000 59,000,000 64,900,000 53,100,000 41,300,000 Procure TV screens for health education 11,600,000 0 0 0 0 Use of public address systems in open air gatherings 16,500,000 0 0 0 0 One-on-one family meetings with opinion leaders (Religious and cultural leaders) 20,932,000 20,932,000 23,025,200 18,838,800 14,652,400 Educate communities at functions where handouts are given e.g. SAGE payment points , Maama Kits or food distribution 6,480,000 6,480,000 6,480,000 6,480,000 6,480,000 centers Purchase tents for providing health education and edutainment for youth/young people 67,500,000 0 0 0 0 Youth peer leaders conduct dialogues in schools and community 52,542,000 TOTAL DEMAND GENERATION 612,749,000 423,041,000 480,668,200 384,187,800 327,535,400 2,228,181,400
SERVICE DELIVERY Train and support more VHTs, especially in hard to reach areas like Katengeto 148,772,000 148,772,000 133,894,800 104,140,400 74,386,000 Provide mobile outreach services and mobile clinics 44,240,000 48,664,000 53,088,000 39,816,000 30,968,000 Integrate family planning in other health care services, especially, MCH and HIV clinics 3,600,000 3,600,000 3,600,000 3,600,000 3,600,000 Advocate for more H/Fs in Sub-Counties 650,000,000 0 0 0 0 Promote self-injection DMPA-SC 6,080,000 6,080,000 5,472,000 4,560,000 3,040,000 Build capacity of H/Ws including PP FP, management of side effects 43,930,000 39,537,000 30,751,000 21,965,000 17,572,000 Monitoring and support supervision of service provision 44,695,000 40,225,500 35,756,000 31,286,500 26,817,000 Procure equipment for Post partum FP through NMS 50,000,000 Data collection from private practitioners 2,455,000 2,455,000 2,455,000 2,455,000 2,455,000 TOTAL FOR SERVICE DELIVERY 993,772,000 289,333,500 265,016,800 207,822,900 158,838,000 1,914,783,200 Family Planning - Costed Implementation Plan 42 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Table 11: Nakapiripirit District FP CIP detailed Cost (continued) CONTRACEPTIVE SECURITY Train Health Workers on LMIS 23,300,000 23,300,000 18,640,000 16,310,000 11,650,000 Refresher training of Stores Assistants on ordering drugs 4,040,000 4,040,000 4,040,000 4,040,000 4,040,000 Purchase doors for the drug stores with 2 locks each 6,000,000 0 0 0 0 Install ceiling board and ventilators at drug stores 60,000,000 0 0 0 0 Regular redistribution from over stocked to less stocked facilities/districts 3,590,000 3,590,000 3,590,000 3,590,000 3,590,000 Create awareness on NMS commodities delivers 11,590,000 10,431,000 9,387,900 8,449,110 7,604,199 TOTAL CONTRACEPTIVE SECURITY 108,520,000 41,361,000 35,657,900 32,389,110 26,884,199 244,812,209
STEWARDSHIP, MANAGEMENT & ACCOUNTABILITY Include FP in the agenda of the Health Sector Working Groups 400,000 400,000 400,000 400,000 400,000 Establish and functionalize a quarterly multi sectoral FP Coordination WG to integrate FP in multi sectoral manner 8,656,000 8,656,000 8,656,000 8,656,000 8,656,000 Build capacities of CDOs/parish chiefs to integrate FP in community development 50,232,000 50,232,000 25,116,000 20,092,800 15,069,600 Orient and facilitate HUMC to play their role 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 DHT provides supportive supervision and mentorship to identify gaps at H/F level and address the challenges 0 0 0 0 0 Build capacity at district (Stores records assistants/ biostatisticians) 0 0 0 0 0 Build capacity of VHTs to correctly capture and report timely 0 0 0 0 0 TOTAL FOR STEWRDSHIP 65,138,000 65,138,000 40,022,000 34,998,800 29,975,600 235,272,400
FINANCE Integrate FP in to the DDP and budget (Orientation of TPC) 4,970,000 4,970,000 4,970,000 4,970,000 4,970,000 Integrate FP in to the district DDP and budget (District Council) 9,500,000 9,500,000 9,500,000 9,500,000 9,500,000
TOTAL FINANCE 14,470,000 14,470,000 14,470,000 14,470,000 14,470,000 72,350,000 GRAND TOTAL 1,794,649,000 833,343,500 835,834,900 673,868,610 557,703,199 4,695,399,209 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 43
CONTRACEPTIVE SECURITY Train Health Workers on LMIS 23,300,000 23,300,000 18,640,000 16,310,000 11,650,000 Refresher training of Stores Assistants on ordering drugs 4,040,000 4,040,000 4,040,000 4,040,000 4,040,000 Purchase doors for the drug stores with 2 locks each 6,000,000 0 0 0 0 Install ceiling board and ventilators at drug stores 60,000,000 0 0 0 0 Regular redistribution from over stocked to less stocked facilities/districts 3,590,000 3,590,000 3,590,000 3,590,000 3,590,000 Create awareness on NMS commodities delivers 11,590,000 10,431,000 9,387,900 8,449,110 7,604,199 TOTAL CONTRACEPTIVE SECURITY 108,520,000 41,361,000 35,657,900 32,389,110 26,884,199 244,812,209
STEWARDSHIP, MANAGEMENT & ACCOUNTABILITY Include FP in the agenda of the Health Sector Working Groups 400,000 400,000 400,000 400,000 400,000 Establish and functionalize a quarterly multi sectoral FP Coordination WG to integrate FP in multi sectoral manner 8,656,000 8,656,000 8,656,000 8,656,000 8,656,000 Build capacities of CDOs/parish chiefs to integrate FP in community development 50,232,000 50,232,000 25,116,000 20,092,800 15,069,600 Orient and facilitate HUMC to play their role 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 DHT provides supportive supervision and mentorship to identify gaps at H/F level and address the challenges 0 0 0 0 0 Build capacity at district (Stores records assistants/ biostatisticians) 0 0 0 0 0 Build capacity of VHTs to correctly capture and report timely 0 0 0 0 0 TOTAL FOR STEWRDSHIP 65,138,000 65,138,000 40,022,000 34,998,800 29,975,600 235,272,400
FINANCE Integrate FP in to the DDP and budget (Orientation of TPC) 4,970,000 4,970,000 4,970,000 4,970,000 4,970,000 Integrate FP in to the district DDP and budget (District Council) 9,500,000 9,500,000 9,500,000 9,500,000 9,500,000
TOTAL FINANCE 14,470,000 14,470,000 14,470,000 14,470,000 14,470,000 72,350,000 GRAND TOTAL 1,794,649,000 833,343,500 835,834,900 673,868,610 557,703,199 4,695,399,209 Family Planning - Costed Implementation Plan 44 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
SECTION 07: Institutional Arrangements for Implementation of the Plan
Table 14: Family Planning CIP Implementation Framework AREA 1: Demand Creation (DC) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline Increased demand for family planning Increased number of Women ages Strengthen the use of community structures to • VHTs and champions meetings/rallies/ • Number of meetings/ rallies/community 2018-2022 services in the district 15-49 years demanding for family dispel myths and misconceptions. community dialogues dialogues conducted separately by the planning (met demand and unmet • VHTs targeted outreaches/door-to-door • Satisfied users mobilizing communities to VHTs and Champions demand) campaigns and champions generate demand for FP services • No. accessing services through the • Satisfied users to inspire communities to use motivation of satisfied users. family planning services • Conduct music, dance and drama on major • Organised groups prepare and stage MDD • Number of MDD forums undertaken to 2018-2021 market days on family planning on market days promote family planning • Produce and disseminate IEC materials in local • IEC materials produced through organised • Family planning materials produced and 2018-2019 language workshops within the district disseminated • Conduct radio talk shows with the DHT and • Buy 30 min spots to play twice a week • Number of radio spots airing FP 2018-2022 the district leaders/ champions/VHTs. information per week • Prepare special communication package for • Speaking to youth CSWs about advantages • Number of youth/teenagers sensitized on 2018-2021 the youth/teenage CSWs. of FP at places where they hang out FP DC2: Cultural and religious leaders are Increased knowledge of family • In-depth dialogue with cultural and religious • Hold community dialogues with cultural and • Number of community dialogues Quarterly supportive of family planning planning among cultural and religious leaders religious leaders conducted for cultural/religious leaders Scale- up leaders • Hold sensitization meetings at sub-county • Conduct sensitization meetings for the • Number of sensitization meetings 2018-2021 level and engage all cultural and religious cultural/religious leaders conducted leaders • Number of leaders participating in the meetings DC3: Improved male involvement and Increased knowledge and support for • Target men through male only dialogues and • Hold FP community dialogues for men • Number of men supporting women to 2018-2021 support for modern contraceptives for FP among men groups and bring male satisfied users in places access FP services themselves and their partners where men are found; Churches, community meetings, drinking, burial places • Re-design the approach on male involvement • Re-package a male involvement approach • Re-designed district Specific Male 2018 (packaging) and strengthen male action groups for men Involvement Strategy • Use Male FP champions e.g., (Leaders- LCV, III, • Strengthen capacity of the male Champions • Number of male FP champions oriented 2018- 2019 GISO, Cultural leaders) for FP on FP DC4: Improved family planning Young people 10 -24 years are • Re-open the existing and create new YFCs • Youth Health clubs in schools giving • Number of functional YFCs Number 2018- 2021 information and services among young knowledgeable about FP and are across the district. (Re-introduce and expand information on sexuality and family planning of schools with health clubs giving people 10 - 24 years. accessing services YFC advocacy activities, sports & games, using the edutainment approach information on sexuality and FP outreaches to youth in school and out of school and work sites, using peer educators) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 45
AREA 1: Demand Creation (DC) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline Increased demand for family planning Increased number of Women ages Strengthen the use of community structures to • VHTs and champions meetings/rallies/ • Number of meetings/ rallies/community 2018-2022 services in the district 15-49 years demanding for family dispel myths and misconceptions. community dialogues dialogues conducted separately by the planning (met demand and unmet • VHTs targeted outreaches/door-to-door • Satisfied users mobilizing communities to VHTs and Champions demand) campaigns and champions generate demand for FP services • No. accessing services through the • Satisfied users to inspire communities to use motivation of satisfied users. family planning services • Conduct music, dance and drama on major • Organised groups prepare and stage MDD • Number of MDD forums undertaken to 2018-2021 market days on family planning on market days promote family planning • Produce and disseminate IEC materials in local • IEC materials produced through organised • Family planning materials produced and 2018-2019 language workshops within the district disseminated • Conduct radio talk shows with the DHT and • Buy 30 min spots to play twice a week • Number of radio spots airing FP 2018-2022 the district leaders/ champions/VHTs. information per week • Prepare special communication package for • Speaking to youth CSWs about advantages • Number of youth/teenagers sensitized on 2018-2021 the youth/teenage CSWs. of FP at places where they hang out FP DC2: Cultural and religious leaders are Increased knowledge of family • In-depth dialogue with cultural and religious • Hold community dialogues with cultural and • Number of community dialogues Quarterly supportive of family planning planning among cultural and religious leaders religious leaders conducted for cultural/religious leaders Scale- up leaders • Hold sensitization meetings at sub-county • Conduct sensitization meetings for the • Number of sensitization meetings 2018-2021 level and engage all cultural and religious cultural/religious leaders conducted leaders • Number of leaders participating in the meetings DC3: Improved male involvement and Increased knowledge and support for • Target men through male only dialogues and • Hold FP community dialogues for men • Number of men supporting women to 2018-2021 support for modern contraceptives for FP among men groups and bring male satisfied users in places access FP services themselves and their partners where men are found; Churches, community meetings, drinking, burial places • Re-design the approach on male involvement • Re-package a male involvement approach • Re-designed district Specific Male 2018 (packaging) and strengthen male action groups for men Involvement Strategy • Use Male FP champions e.g., (Leaders- LCV, III, • Strengthen capacity of the male Champions • Number of male FP champions oriented 2018- 2019 GISO, Cultural leaders) for FP on FP DC4: Improved family planning Young people 10 -24 years are • Re-open the existing and create new YFCs • Youth Health clubs in schools giving • Number of functional YFCs Number 2018- 2021 information and services among young knowledgeable about FP and are across the district. (Re-introduce and expand information on sexuality and family planning of schools with health clubs giving people 10 - 24 years. accessing services YFC advocacy activities, sports & games, using the edutainment approach information on sexuality and FP outreaches to youth in school and out of school and work sites, using peer educators) Family Planning - Costed Implementation Plan 46 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Table 14: Family Planning CIP Implementation Framework (continued) • Retrain the Senior Women and Male Teachers • Senior women and male teachers trained on • No. of women and male teachers trained 2018-2019 on family planning family planning • Introduce FP themes in MDD, school debates • Hold “edutainment” community events • No. of FP events held for young people 2018-2021 and sports galas MDD concerts and sports competitions to provide opportunity for knowledge exchange amongst young people AREA 2: Service Delivery (SD) Strategic Outcomes Expected Results Activity Inputs Output indicators Timeline SD 1: Increased access to and uptake Increased FP service provision/ • Strengthen capacity of service providers to • Training of Health service providers to offer • No. of H/Ws trained and offering PPFP 2018- 2020 of family planning services, including delivery points in the district provide PPFP and offering PPFP post-partum FP • Conduct camps/outreaches by H/C staffs • Outreaches and camps organised for • No. of camps/ outreaches organised for FP 2018-2022 provision of FP services • Strengthen the referral network for FP • Support referral for FP through VHTs and to • No. of referred clients receiving FP services higher level H/Cs services SD 2: Strengthened FP in VHT targeted Expanded VHT provision of FP • Undertake VHT targeted outreaches and • VHTs involved in family planning service • Number of FP clients served by VHTs 2018-2022 outreaches and door to door campaigns services door-door campaigns including for Sayana provision Press SD 3: Increased access to YFS Increased number of youths accessing • Re- introduce and expand YFCs • Establish YFCs at all H/CIII, IVs and the • No. of youth receiving FP services 2018-2022 FP services hospital • Build capacity of H/Ws to provide YF FP • Train H/Ws in provision of YFS • No. of H/Ws offering FP YFS 2018-2020 services SD 4: Family Planning services FP services integrated into HIV/AIDS • Integrate FP in other health related services • Family planning provided alongside other • FP provision through other service 2018-2022 integrated in other health services care, immunization, Cervical cancer and outreaches health services delivery points screening, post-natal care, STI and • Orient H/Ws to integrate FP in other health • Providers trained/oriented in FP service nutrition programmes care services integration SD 5: Competent, skilled and motivated H/Ws confident and motivated to • Train H/Ws in the provision of LARCs • H/Ws trained in provision of LARCs • No. of H/Ws trained to offer LARCs 2018-2020 H/Ws providing family planning provide wide range of FP methods services AREA 3: Contraceptive Security (CS) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline CS 1: Contraceptive Logistics Staff at facilities accurately quantify • Build capacity of staff to routinely quantify • Train H/C staff and managers in logistics • No. of staff and managers trained in LMIS. 2018-2022 Management System strengthened and forecast FP requirements and forecast FP needs based on stocks and management • No. of facilities stocked with all FP (staff able to quantify and forecast) consumption methods CS2: Reverse Redistribution Strategy FP commodities fully stocked at all • Ensure supply chain system tracks availability • Tracking and redistribution of FP • No. of facilities stocked with all FP 2018-2022 strengthened HFs of commodities to allow redistribution from commodities with H/Cs in the district methods over-stocked to less-stocked facilities within the district CS 3: Increased partners supporting More partners supporting FP in the • Lobby for partners to support the FP program • Advocate for the support of partners at • No. of partners supporting FP in the 2018-2022 family planning (MSU expands area of district national and district level district FP coverage) CS4: Enhanced capacity of H/Ws to H/Ws confident and motivated to • Train H/Ws in the provision of LARCs • H/Ws trained in provision of LARCs • No. of H/Ws trained to offer LARCs 2018-2020 offer method mix (LARCs) provide wide range of FP methods Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 47
• Retrain the Senior Women and Male Teachers • Senior women and male teachers trained on • No. of women and male teachers trained 2018-2019 on family planning family planning • Introduce FP themes in MDD, school debates • Hold “edutainment” community events • No. of FP events held for young people 2018-2021 and sports galas MDD concerts and sports competitions to provide opportunity for knowledge exchange amongst young people AREA 2: Service Delivery (SD) Strategic Outcomes Expected Results Activity Inputs Output indicators Timeline SD 1: Increased access to and uptake Increased FP service provision/ • Strengthen capacity of service providers to • Training of Health service providers to offer • No. of H/Ws trained and offering PPFP 2018- 2020 of family planning services, including delivery points in the district provide PPFP and offering PPFP post-partum FP • Conduct camps/outreaches by H/C staffs • Outreaches and camps organised for • No. of camps/ outreaches organised for FP 2018-2022 provision of FP services • Strengthen the referral network for FP • Support referral for FP through VHTs and to • No. of referred clients receiving FP services higher level H/Cs services SD 2: Strengthened FP in VHT targeted Expanded VHT provision of FP • Undertake VHT targeted outreaches and • VHTs involved in family planning service • Number of FP clients served by VHTs 2018-2022 outreaches and door to door campaigns services door-door campaigns including for Sayana provision Press SD 3: Increased access to YFS Increased number of youths accessing • Re- introduce and expand YFCs • Establish YFCs at all H/CIII, IVs and the • No. of youth receiving FP services 2018-2022 FP services hospital • Build capacity of H/Ws to provide YF FP • Train H/Ws in provision of YFS • No. of H/Ws offering FP YFS 2018-2020 services SD 4: Family Planning services FP services integrated into HIV/AIDS • Integrate FP in other health related services • Family planning provided alongside other • FP provision through other service 2018-2022 integrated in other health services care, immunization, Cervical cancer and outreaches health services delivery points screening, post-natal care, STI and • Orient H/Ws to integrate FP in other health • Providers trained/oriented in FP service nutrition programmes care services integration SD 5: Competent, skilled and motivated H/Ws confident and motivated to • Train H/Ws in the provision of LARCs • H/Ws trained in provision of LARCs • No. of H/Ws trained to offer LARCs 2018-2020 H/Ws providing family planning provide wide range of FP methods services AREA 3: Contraceptive Security (CS) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline CS 1: Contraceptive Logistics Staff at facilities accurately quantify • Build capacity of staff to routinely quantify • Train H/C staff and managers in logistics • No. of staff and managers trained in LMIS. 2018-2022 Management System strengthened and forecast FP requirements and forecast FP needs based on stocks and management • No. of facilities stocked with all FP (staff able to quantify and forecast) consumption methods CS2: Reverse Redistribution Strategy FP commodities fully stocked at all • Ensure supply chain system tracks availability • Tracking and redistribution of FP • No. of facilities stocked with all FP 2018-2022 strengthened HFs of commodities to allow redistribution from commodities with H/Cs in the district methods over-stocked to less-stocked facilities within the district CS 3: Increased partners supporting More partners supporting FP in the • Lobby for partners to support the FP program • Advocate for the support of partners at • No. of partners supporting FP in the 2018-2022 family planning (MSU expands area of district national and district level district FP coverage) CS4: Enhanced capacity of H/Ws to H/Ws confident and motivated to • Train H/Ws in the provision of LARCs • H/Ws trained in provision of LARCs • No. of H/Ws trained to offer LARCs 2018-2020 offer method mix (LARCs) provide wide range of FP methods Family Planning - Costed Implementation Plan 48 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
Table 14: Family Planning CIP Implementation Framework (continued)
AREA 4: Policy and Enabling Environment (PEE) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline PEE 1: Improved knowledge of the FP Adherence to the FP Policy & legal • Orient the district leadership and H/Ws on the • DHT members participants • No. of district leaders and H/Ws oriented 2018-2019 Policy & Legal framework framework policy framework for FP service delivery on the legal and policy framework for FP. • Orientation meetings on the policy and legal framework for FP service provision PEE 2: Policy change favouring National advocacy to expand range of • Scale up FP advocacy at national level • Advocates and champions participate in • No. of advocates holding discussions with 2018 provision of more FP methods at H/CIIs commodities at H/C II meetings at national level MoH and NMS
AREA 5: Financing (F) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline F 1: Family planning is mainstreamed Family planning is prioritized and • Create a budget line for family planning at • FP components integrated in District • Budget line for FP exists in the District 2018-2022 in district planning and budgeting integrated in district budgeting district level Development Plan Development Plan processes processes F2: Improved donor funding and More finances for FP from developing • Advocate for increased funding for FP among • Use the FP-CIP as a resource mobilisation • Amount of money mobilized for FP 2018-2022 corporate social responsibility for FP partners and corporate agencies development partners and corporate agencies tool to advocate/lobby partners and within the district corporate agencies to support FP F3: Integration of donor and IP More integrated planning and • Advocate for integrated planning and • Use the FP-CIP as a tool to advocate/lobby • Integrated district workplan and budget 2018 - 2023 plans and budgets into the district budgeting process budgeting IP to support FP framework
AREA 6: Stewardship, Management and Accountability (SMA) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline SMA1 : Strengthened district capacity A robust annual FP program • Conduct annual planning and quarterly review • CAO convenes planning and regular review • Work plan developed, implemented and 2018-2022 to effectively lead, manage and implemented and regularly monitored. meetings of family planning in the district meetings for FP. meetings with DHTs regularly reviewed coordinate FP programmes • Tracking and monitoring the implementation • DHO and Planning Unit with support of • Quarterly and annual monitoring reports 2018-2022 of the FP-CIP partners on FP • District efforts to collect, analyse and use FP • Train FP stakeholders to report correctly • As above 2018-2022 data for decision making strengthened and provide the tools for reporting SMA2: Mid and End of term Evaluation reports documenting • Conduct midterm and end of term evaluation • Data collection tools and manpower to • Evaluation reports with lessons and best 2020 and 2023 evaluations undertaken lessons learnt and best practices of the FP-CIP conduct the evaluation practices documented Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 49
AREA 4: Policy and Enabling Environment (PEE) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline PEE 1: Improved knowledge of the FP Adherence to the FP Policy & legal • Orient the district leadership and H/Ws on the • DHT members participants • No. of district leaders and H/Ws oriented 2018-2019 Policy & Legal framework framework policy framework for FP service delivery on the legal and policy framework for FP. • Orientation meetings on the policy and legal framework for FP service provision PEE 2: Policy change favouring National advocacy to expand range of • Scale up FP advocacy at national level • Advocates and champions participate in • No. of advocates holding discussions with 2018 provision of more FP methods at H/CIIs commodities at H/C II meetings at national level MoH and NMS
AREA 5: Financing (F) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline F 1: Family planning is mainstreamed Family planning is prioritized and • Create a budget line for family planning at • FP components integrated in District • Budget line for FP exists in the District 2018-2022 in district planning and budgeting integrated in district budgeting district level Development Plan Development Plan processes processes F2: Improved donor funding and More finances for FP from developing • Advocate for increased funding for FP among • Use the FP-CIP as a resource mobilisation • Amount of money mobilized for FP 2018-2022 corporate social responsibility for FP partners and corporate agencies development partners and corporate agencies tool to advocate/lobby partners and within the district corporate agencies to support FP F3: Integration of donor and IP More integrated planning and • Advocate for integrated planning and • Use the FP-CIP as a tool to advocate/lobby • Integrated district workplan and budget 2018 - 2023 plans and budgets into the district budgeting process budgeting IP to support FP framework
AREA 6: Stewardship, Management and Accountability (SMA) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline SMA1 : Strengthened district capacity A robust annual FP program • Conduct annual planning and quarterly review • CAO convenes planning and regular review • Work plan developed, implemented and 2018-2022 to effectively lead, manage and implemented and regularly monitored. meetings of family planning in the district meetings for FP. meetings with DHTs regularly reviewed coordinate FP programmes • Tracking and monitoring the implementation • DHO and Planning Unit with support of • Quarterly and annual monitoring reports 2018-2022 of the FP-CIP partners on FP • District efforts to collect, analyse and use FP • Train FP stakeholders to report correctly • As above 2018-2022 data for decision making strengthened and provide the tools for reporting SMA2: Mid and End of term Evaluation reports documenting • Conduct midterm and end of term evaluation • Data collection tools and manpower to • Evaluation reports with lessons and best 2020 and 2023 evaluations undertaken lessons learnt and best practices of the FP-CIP conduct the evaluation practices documented Family Planning - Costed Implementation Plan 50 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
References 1. DSW (2014).Family planning in Uganda: A Review of national and District Policies and Budgets. Kampala Uganda: Deutsche Stiftung Weltseveekerung.
2. Health Communication Partnership (2009). A Literature Review of the Current Status of Family Planning Services in Uganda. Kampala Uganda: Health Communication Partnership.
3. MoFPED, Uganda (2008). National Population Policy for Social Transformation and Sustainable Development. Kampala, Uganda: MoFPED.
4. Ministry of Health, Uganda (2014). Uganda Family Planning Costed Implementation Plan, 2015- 2020. Kampala: Ministry of Health, Uganda.
5. Ministry of Health, Uganda (2014). Draft Health Planning Guidelines. Kampala, Uganda: Health Planning Department, M.oH.
6. Ministry of Health (2010). National Health Policy. Kampala, Uganda: Ministry of Health.
7. Ministry of Health (2004). National Adolescent Health Policy for Uganda. Kampala, Uganda: Ministry of Health.
8. Mityana District Local Government, Uganda (2015). Mityana District Development Plan 2015/2016 – 2019/2020. Mityana, Uganda: Mityana District Local Government.
9. Uganda Bureau of Statistics (UBOS) 2015. National Population & Housing Census 2014. Kampala Uaganda: UBOS
10. Uganda Bureau of Statistics (UBOS) and ICF International Inc.2012. Uganda Demographic & Health Survey 2011. Kampala, Uganda: UBOS & Calverton, Maryland: ICF International Inc. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT 51 Family Planning - Costed Implementation Plan 52 (2018/19 - 2022/23) NAKAPIRIPIRIT DISTRICT
MINISTRY OF HEALTH
NAKAPIRIPIRIT DISTRICT Family Planning Costed Implementation Plan 2018/19 - 2022/23
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