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