REPUBLIC OF UGANDA
MOYO DISTRICT Family Planning - Costed Implementation Plan 2018/19 - 2022/23
OCTOBER 2018
MOYO 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 Moyo District Health Office. This project was funded under the UNFPA Supplies Programme and UK aid from the UK government.
Published by: Moyo District Local Government
Ownership: Reproduction of this plan for educational or other non-commercial purposes is authorized without permission from the Moyo District Local Government, provided the source is fully acknowledged.
Preferred Citation: Moyo District (2018). District Family Planning Costed Implementation Plan, 2018/19-2022/23. Moyo, Uganda
Copies available from: Moyo District Health Office iv
Table of Contents
List of Tables vi List of Figures vi FOREWORD vii PREFACE viii ACKNOWLEDGMENT ix ACRONYMS x EXECUTIVE SUMMARY xi
SECTION ONE: INTRODUCTION AND BACKGROUND 2 1.1 Introduction 3 1.2 Background 3 1.3 SWOT Analysis for Family Planning Services 11 1.4 Process of Developing the District CIP 12
SECTION TWO: THE CASE FOR MOYO DISTRICT FP 13 COSTED IMPLEMENTATION PLAN 2.1 Introduction 14 2.2 Demand Creation 14 2.3 Service Delivery and Access 15 2.4 Contraceptive Security 17 2.5 Policy and Enabling Environment 17 2.6 Financing 17 2.7 Stewardship, Management and Accountability 18
SECTION THREE: DISTRICT STRATEGIC PRIORITIES 19 3.1 Introduction 20 3.2 Vision, Mission, Core Values and Goal 20 3.3 District strategic priorities in FP 20 3.3.1 Demand creation 20 3.3.2 Service Delivery and Access 20 v
3.3.3 Contraceptive Security 22 3.3.4 Policy and Enabling Environment 23 3.3.5 Financing 23 3.3.6 Stewardship, Management & Accountability 23
SECTION FOUR: DISTRICT INSTITUTIONAL ARRANGEMENTS FOR 24 IMPLEMENTATION OF THE PLAN 4.1 Introduction 25 4.2 Management, Coordination, and Accountability Structure 25 4.3 Roles and Responsibilities of Key Actors (District Level) 25 4.4 Coordination Framework 25 4.5 Resource Mobilization Framework 25 4.6 Performance Monitoring and Accountability 26 4.7 Routine Data Collection 28 4.8 Data Management 28
SECTION FIVE: COSTING OF THE PLAN 29 5.1 Introduction 29
SECTION SIX: DISTRICT IMPLEMENTATION FRAMEWORK 32 AND ACTIVITY DETAILS REFERENCES 39 vi
List of Tables
Table 1.1 Key Geographical Indicators 4 Table 1.2 Moyo District Population as per 2014 Census by Sex and Sub-county 5 Table 1.3 Selected Demographic Health Indicators 6 Table 1.4 Staffing Levels by Public Health Facility Level in Moyo District 7 Table 1.5 Health Service Providers in Moyo District 8 Table 1.6 Health Partner Mapping in Moyo District 9 Table 1.7 SWOT Analysis. 12 Table 2.1 FY 2013/14 and FY 2014/15 Comparative Analysis of FP Services Uptake 16 Table 4.1 Illustrative List of National Indicators to Inform the District FP CIP 28 Table 5.1 Cost for Implementing the CIP 30 Table 5.2 Summary Costs per Thematic Area per Financial Year (Millions, UGX) 30
List of Figures
Figure 1.1 Moyo District map and location in Uganda 3 Figure 1.2 Map of Moyo District showing the location of health units, July 2007 8 vii
Foreword Moyo District has the lowest population growth rate in Uganda estimated at -2.9% as indicated in the Uganda Bureau of Statistics 2015 census results. The district is however faced with high infl ux of refugees which poses a serious challenge to ensure that its local population receives quality healthcare and more so family planning services.
Quality family planning services are essential in Implementation Plan, Vision 2040 and the FP2020 ensuring that Moyo District Local Government commitments. This plan is premised on six thematic attains the targets of the National Family Planning areas; Costed Implementation Plan (2014), the National • Demand Creation Development Plan (NDP) 2015 as well as the • Service Delivery and Access Sustainable Development Goals. • Contraceptive Security • Financing Moyo District Local Government mandate is to plan, • Policy and Enabling Environment develop and maintain an adequate and effective • Stewardship, Management and Accountability health care delivery system and to facilitate the provision of quality health services to its population. I would like to express my gratitude to the Ministry of Whilst better health services can ensure a healthy Health, UK aid and United Nations Population Fund population, they can, at the same time, expand (UNFPA) for providing the technical and fi nancial opportunities for productivity and contribute to resources to develop this plan and the district staff as national development. well as all stakeholders involved in the process. I now have the pleasure to present to you the Moyo District Accordingly, Moyo District Family Planning Costed Family Planning Costed Implementation Plan 2017- Implementation Plan 2017-2022 was developed in 2022 that sets a blueprint in our attempt to improve order to streamline family planning services delivery access to accurate information about family planning, in order to address the effects of population growth. improved access to high quality family planning The Moyo District FP CIP is aligned to the National services and in general to strengthen and scale up Family Planning Costed Implementation Plan (2014) provision of integrated family planning services by and focuses on ensuring that the resource envelope multi-stakeholders in the district. The District FP is increased to support women and men raise CIP will be a working document to advocate family manageable families. As a district, we will work with planning services. all key stakeholders to ensure that they promote For God and My Country family planning services as a matter of priority. The District Costed Implementation Plan (CIP) addresses key challenges, and provides practical solutions as agreed upon by key stakeholders on the 28th November 2017 and I want to note that it’s in line with the Ministry of Health National FP Costed viii
Preface The family planning concerns of communities have hitherto taken centre stage in emphasizing the low contraceptive prevalence rate in Moyo District.
This District Family Planning Costed Implementation all stakeholders in family planning to make special Plan 2017-2022 is an effort to highlight family consideration of this plan and its ideals in their planning issues and bring them into the mainstream day-to-day work. I recommend this plan to all actors of health and other social services. The District involved in supporting or implementing different Local Government has identifi ed family planning as a family planning activities that promote healthy and priority programme and increasing access to quality productive households. health services is one of the strategies to increase service uptake in the district.
A manageable and health population is a critical national resource for today and their health is a worthwhile investment for future growth and development. Manageable household sizes have great potential to contribute to development processes for their own benefi t as well as the development of society at large. The understanding, adoption and implementation of this District Family Planning Costed Implementation Plan 2017/2018- 2021/2022 will contribute positively to the efforts to manage the fertility rate for the district in the face of infl ux of refugees from South Sudan. I call upon ix
Acknowledgement The Moyo District Family Planning Costed Implementation Plan 2017-2022 is a product of concerted efforts and contributions by different stakeholders in the quest to ensure that the local population receives quality family planning services.
Moyo District Local Government would like to take I wish to congratulate all stakeholders for their this opportunity to express its deep appreciation active participation in the development of the plan, and sincere thanks to all who participated in the and above all for their invaluable and continuous development of this plan. contribution to the efforts to improve family planning services delivery in the district. I strongly hope that The process of developing the District Family with well-coordinated efforts towards implementing Planning Costed Implementation Plan was highly this plan, the benefi ts accruing will see Moyo District participatory involving key stakeholders and interest Local Government realize the targets set in this plan groups including communities of family planning and be able to address the family planning challenges service users. Its development was supported by posed to its population. UNFPA, Ministry of Health and Moyo District Local Government would like to express its appreciation in this regard. I wish to sincerely recognize the fi nancial support from UK aid from the UK government, through United Nations Population Fund (UNFPA) and the UNFPA Supplies Project for developing this FP-CIP. x
Abbreviations
ANC Antenatal Care LLG Lower Local Government BEmONC Basic Emergency Maternal and MARPS Most At Risk Populations Obstetric Care MoH Ministry of Health CAO Chief Administrative Officer NGOs Non-Governmental Organizations CEmONC Comprehensive Maternal and Obstetric NMS National Medical Stores Care OPD Out Patient Department CH Child Health PNFP Private Not For Profit CS Contraceptive Security RDC Resident District Commissioner CPD Continuous Professional Development RH Reproductive Health CPR Contraceptive Prevalence Rate RHU Reproductive Health Uganda CSO Civil Society Organization SBCC Social and Behavioural Change DHO District Health Office Communications DHS Demographic Health Survey SWOT Strength Weaknesses Opportunities DHT District Health Team and Threats DQA Data Quality Assurance TC Town Council DSW Deutsche Stiftung Weltbevölkerung TOT Training of Trainers DTPC District Technical Planning Committee UDHS Uganda Demographic Health Survey FP Family Planning UHMG Uganda Health Marketing Group FP CIP Family Planning Costed Implementation VHT Village Health Team Plan FY Financial Year HC Health Centre HMIS Health Management Information System xi
Executive Summary
The Moyo District Family Planning Costed Implementation Plan reflects the local efforts to complement the national Family Planning Costed Implementation Plan which is the Government of Uganda (GoU) commitment to reducing the unmet need for family planning (FP) to 10 percent and increasing the modern contraceptive prevalence rate to 50 percent by 2020.
In partnership with the central government, the The above strategic priorities give direction to the district CIP will not only enable Uganda reach her thematic areas of the national CIP that are reflected FP goals, but also set a precedent on the strategic in the Moyo District FP CIP namely; direction the district has towards family planning. • Demand Creation This district FP CIP is driven by the following • Service Delivery and Access strategic priorities: • Contraceptive Security 1. Increase age-appropriate information, access, and • Policy and Enabling Environment use of family planning amongst young people, ages • Financing 10-24 years • Stewardship, Management, and Accountability 2. Promote and nurture change in social and individual behaviour to address myths, This FP CIP will cost UGX 2,218.000, 000 (Two misconceptions, side effects, improve acceptance billion, Two hundred and Eighteen million Uganda and continued use of family planning to prevent Shillings) during the period 2018 to 2022. Moyo unintended pregnancies District Local Government will therefore use this plan 3. Implement task sharing to increase access, for resource mobilization and coordination of activity especially for rural and underserved populations implementation by different stakeholders. 4. Mainstream implementation of family planning policy, interventions, and delivery of services in multisectoral domains to facilitate a holistic contribution to social and economic transformation 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) MOYO DISTRICT
SECTION 01: Introduction and Background Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 3
1.1 Introduction groups and Faith to Action initiated the development The Moyo District Family Planning Costed of this district FP CIP in alignment to the national FP Implementation Plan (2018-2022) builds on the CIP through a participatory and consultative process. Ugandan government’s political commitment Below is a brief description of Moyo District profi le towards increased fi nancing of family planning at the with specifi c reference to location, demographic London Summit 2012. Implementing her strategic data, health facility staffi ng, health facilities, socio- commitment, Uganda developed the Uganda economic activities, district SWOT and the process of Family Planning Costed Implementation Plan- FP developing the district FP CIP. CIP (2015-2020). The FP CIP refl ects a “common” plan for all stakeholders involved in implementing 1.2 Background family planning activities towards a consultative, District location coordinated, streamlined management and Moyo District is located in the West Nile region accountability structure involving local government of Uganda. The Nile River forms its southern and and district multi-sectoral stakeholders. In order to eastern border, South Sudan its northern border, foster this mandate, Moyo District Local Government and Yumbe and Arua districts its western border as in collaboration with Moyo multi-sectoral technical illustrated below.
Figure 1.1: Moyo district map and location in Uganda
Moyo Lamwo Kaabong Yumbe
Kitgum
Adjumani Kotido Arua Agago Amuru Pader Moroto Gulu
Abim Zombo Nwoya Otuke Nebbi Napak Oyam Alebtong Kole Lira Amuria Kiryandongo
Dokolo Buliisa Apac Katakwi
Soroti Amudat Albert Masindi Amolatar Kumi Serere Lake Kyoga Ngora Kween Lake Nakasongola Hoima
Buyende Bulambuli Bukwo Kyankwanzi Pallisa Nakaseke Kakumiro Bududa Ntoroko Kagadi Kamuli Kiboga Kayunga Kibaale Luwero Manafwa Tororo Kyenjojo Jinja Bugiri Mubende Mukono
Busia Kyegegwa Kasese Kamwenge Gomba
Ssembabule Kazinga Channel Buvuma
Kiruhura Rubirizi Kalangala Buhweju yantonde
L Lwengo Bushenyi Mbarara Lake Victoria
Rakai Isingiro Ntungamo
Kabale Family Planning - Costed Implementation Plan 4 (2018/19 - 2022/23) MOYO DISTRICT
The district covers an area of 2,059 Km2, of which 192 Km2 is rivers and swamps, 172 Km2 is gazetted forest and game reserves. Approximately 78.9% of the districts’ land is arable or suitable for cattle grazing. The distances from the district headquarters to Kampala via Moyo and Gulu are 640 and 480 kilometres respectively. The table below provides some of the key geographical indicators of Moyo District.
Table 1.1: Key Geographical Indicators Latitude 03489000 N - 04322000 N Longitude 3252000 E -3990000 E Average altitude 1,500 m Area under water 192 Km2 Arable land area 1,867 Km2 Temperature 370 C Average rainfall 1,063 mm Total surface area 2,059 Km2
The district’s topography is characterized by low The highest temperature recorded was 450C in the planes and rolling hills along the Nile River, at 900m months of January to February and lowest 290C in above sea level rising to a series of hills and peaks. the months of August to October. The highest peak is Mt. Otze at 1,500 m above sea level. The Nile River bank raises sharply upwards Socio-economic activities producing a landscape characterized by plateaus, According to the 2002 Population and Housing flat topped hills, inter sparse with deep valleys and Census Report about 80% of the households in Moyo giving rise to steep slopes. Drainage occurs towards District depend mainly on subsistence agriculture the Nile, through a series of rivers, which are seasonal as their main economic activity. Only 9.7% of the and mainly supplied by rainwater. These features population was dependant on earned incomes and provide beautiful sceneries for tourists. Although the 0.4% on property income. The major crops grown hills in sub-counties of Metu and Itula are covered by include sweet potatoes, sorghum, cassava, simsim, forests, the major vegetation cover in the district is groundnut, finger millet, maize, cowpeas and beans. savannah woodland with isolated thorn shrubs found Fishing is another main economic activity in the near streams and rivers. Otze forest reserve in Metu district. The Nile River is the main source of fish has rich bio-diversity with high potential for eco- within the district. Majority of the households who tourism. depend on subsistence farming as their main source of livelihood use rudimental tools and methods Moyo District has a distinct dry period that begins for cultivation i.e. the hand hoe and family labour from December to February. November and March resulting in low productivity. Poverty levels in the have moderate rainfall. The two major peaks in district have continued to remain high with poverty rainfall occur in April (short rainy season) and count index of 62.3% as compared to the national between August and October (major rainy season). poverty index of 31%. Areas along the Nile receive less rain (860 mm) than the rest of the district.
Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 5
Literacy levels increased from 166.5 Kms in 2010 to 248.7 Kms in 2014 and the percentage of motorable feeder roads The literacy rate among the urban population is increased from 46.1% in 2010 to 77.0% in 2014. This higher at 76% than the rural population at 32%. has made the travel and economic activities easier However, all these are below the national average for with the district and neighbouring districts. both urban at 88% and rural at 67%. The average life expectancy in the district increased from 42 years Demographic data in 1991 to 52.7 years in 2002, slightly above the national average of 50.4 years. There was a gain of According to Uganda Bureau of Statistics (UBOS, 10.7 years in life expectancy between 1991 and 2002 2014) census, the total population of Moyo District as compared to a gain of 2.3 years for the nation in is 137,489, of which 67,937 were males and 69,552 the same period. were females. The total number of households was 25,894 and the average household size was 5.3. Table Road network 1.2 presents the district’s population per sub-county and sex. According to the second Moyo District Development Plan (DDPII, 2015-2021), the length of feeder roads
Table 1.2: Moyo District Population as per 2014 Census by Sex and Sub-county County Sub-county Household Population 2014 Number Average size Males Females Total Obongi Aliba 2,437 6.8 8,353 8,229 16,582 Obongi Gimara 2,397 5.5 6,594 6,700 13,294 Obongi Itula 2,295 5.7 6,793 6,471 13,264 West Moyo Dufile 1,642 5.5 4,427 4,556 8,983 West Moyo Laropi 1,988 4.8 4,778 4,732 9,510 West Moyo Lefori 2,236 5.5 6,014 6,419 12,433 West Moyo Metu 5,738 4.9 14,125 14,111 28,236 West Moyo Moyo 5,034 4.8 11,861 12,819 24,680 West Moyo Moyo Town 2,127 4.8 4,992 5,515 10,507 District 25,894 5.3 67,937 69,552 137,489
Source: UBOS Census Report 2014
The district’s population structure is expected to Fertility rate be youthful for the next 15 years and this poses a According to Moyo District Development Plan (2015- problem of high dependency ratio. The proportion 2020), the district has a low growth rate which stands of females to males in the district is at 98 or 1.02. at 2.9%. Children below 18 years constitute over Thus, there are 102 females for every 100 males. 52% of the population and nearly half of the district However, the following sub-counties recorded a population is below the age of 15 years. This is a higher proportion of male than females; Metu, Aliba threat which doubles population size if strategies are and Laropi recorded sex ratios of 0.99 while Itula not put in place to control the population. posted 0.95, implying that for every male there are 0.99 females and 0.95 females respectively. Family Planning - Costed Implementation Plan 6 (2018/19 - 2022/23) MOYO DISTRICT
The total fertility rate is estimated at 6.2, which lower than the national of 34%. In reference to the contradicts the low growth rate (Table 1.3). Uganda Demographic and Health Survey (UDHS, This, however, can possibly be explained by the 2011) observations were made that childbearing resettlement of the refugees back to their country. starts early with 24% of women aged 15-19 It is estimated that there are 29,481 women of already mothers or pregnant with their first child child bearing age (15-49 years) with the number of due to stigma or limited access to family planning pregnancies at 7,297 per year and expected births of services among the youth. Teenage pregnancy and 7,727 per year. Moyo has an estimated 6,276 children motherhood are a major social and health concern below one year, with a contraceptive prevalence as they are associated with higher morbidity and rate of 22%, uptake rate of 16% and an unmet mortality of both mother and the baby. need for family planning at 21.9%, which is slightly
Table 1.3: Selected Demographic Health Indicators Demographic variables Proportion Number Total population 100 137,489 Children below 18 years 55.1 80,417 Young people (10-24 years) 34.8 50,790 Adolescents (10-19 years) 24.5 35,757 Adolescents girls (10-19 years) 12.7 18,535 Orphans (for children below 18 years) 8.04 11,734 Infants (below 1 year) 4.3 6,276 Expected number of pregnancies 5 7,297 Expected number of deliveries in health units 4.85 7,272 Children aged 0-59 months (under five years) 17.7 25,833 Women of reproductive age (15-49 years) 20.2 29,481 Population that is 15 years of age 48.7 71,076 Contraceptive Prevalence Rate (CPR) 22 6,485 Unmet need of contraception 21.9 6,457
Source: Projected midyear population 2015 Population and Housing Census 2014
District human resources for health B and the increasing population that leaves essential services like family planning underserved and under- The human resource for health staffing levels in the prioritized in service delivery. Retention strategies district is at 64% (Table 1.4). This is a big gap given the particularly at health facility level, are vital so as to increasing number of emerging diseases like Hepatitis improve health services. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 7
Table 1.4: Staffing Levels by Public Health Facility Level in Moyo District S/# Facility/level Position filled Norm Vacant % filled % vacant 1 DHO’s Office 7 11 4 63.6 36.4 2 Moyo Hospital 122 197 75 61.9 38.1 3 HC IV 38 48 10 79.2 20.8 4 HC III 143 209 66 68.4 31.6 5 HC II 127 198 71 64.1 35.9 Total 430 663 226 64.9 35.1 Source: Moyo District Development Plan (2015/2021)
The shortages in health sector staffing have several facilities categorized by level. The district has one implications for service delivery. There is an absence general hospital, two HCIVs, 16 HCIIIs and 28 of key health workers required at some levels of HCIIs (Table 1.5). Physical access to health facilities health care which is caused by high staff turnover. (proportion of the population leaving within 5kms of Furthermore, some health centres do not offer a health facility) is currently at 97%. All the nine sub particular FP methods especially those that are counties (including the town council) in the district long-term because the required professionals are have a HCIII, and nearly all the parishes have a HCII. not retained or not allocated. Health facilities at the The bottleneck affecting infrastructure is the lack border with other districts serve wide catchment of a comprehensive picture of the availability and populations due to the surge of refugees from South functionality of critical medical equipment, and Sudan, often resulting in increased workloads for transport facilities hampering adequate planning. available staff. Stock-outs of some drugs and other The average distance from one health centre to related pharmaceutical supplies and long queues also another is about 5kms. The distance to health make delivery of services problematic. centers contributes to why some people don’t use family planning. The hospital and HCIV are able to Health facilities in the district offer a range of family planning services including the permanent methods. For HCII and HCIIIs, the Moyo District is comprised of two health sub districts community is able to receive ANC and short-term (Obongi and West Moyo) comprising of of 47 health family planning methods.
Table 1.5: Health Service Providers in Moyo District Service Government Private not Private Total Services outlet owned for profit Hospital 01 0 0 01 CEmONC, All FP methods HCIV 01 01 0 02 CEmONC, CH, all FP methods except PNFP HCIII 12 04 0 16 BEmONC, CH, short & long-term FP methods HCII 27 1 00 28 ANC, CH & short-term methods of FP Total 33 06 00 47
Source: Moyo District Health Plan, 2017/2018 Family Planning - Costed Implementation Plan 8 (2018/19 - 2022/23) MOYO DISTRICT
Development Partners in the district as at the end of 2015 Moyo District has several partners within the health sector supporting different areas. Table 1.6 shows the different partners and their form of support to the district.
Table 1.6: Health Partner Mapping in Moyo District
Name of Intervention area Duration Start Coverage Target Implementation mode Project/ of date group/ (tick all applicable) Partner project Estimated population Direct Funding Tech Assistance In Kind CashIn (000”) Global Alliance Immunization 5 years 2016 District- 12,608 √ √ √ 85,000 Vaccine wide Initiative (GAVI) WHO Integrated disease 5 years 2016 District- 293,199 √ √ √ 180,000 surveillance and response wide and immunization Global fund HIV/AIDS, TB and Malaria 5 years 2016 District- 145,947 √ √ √ 100,000 wide UNICEF Child Survival and 5 years 2016 District- 14,660 √ √ √ 512,000 Development (CSD) wide Belgian Result Based Financing 4 years 2016 8 health 145,947 √ √ √ 250,000 Technical (RBF) units (6 Cooperation public and (BTC) 2 PNFP) United Nation Coordination, SGBV, 5 years 2016 District- 59,226 √ √ √ 69,000 Population Fund HIV response, MNH and wide (UNFPA) integration Infectious Comprehensive HIV/AIDS 5 years 2016 District- 293,199 √ √ √ 120,000 Diseases wide Institute Marie Stopes Family planning services 7 years 2010 District- 59,226 √ √ International_ wide Uganda Uganda Health ITN/LLIN distribution 5 years 2016 District- 145,947 √ √ Marketing wide Group (UHMG) AIC (AIDS TB specimen referral and 3 years 2016 District- 145,947 √ √ Information technical support to SHWs wide Centre) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 9
Uganda Health Medicine management, 5 years 2015 District- 145,947 √ √ √ Supply Chain logistical support inform of wide (UHSC) computer, motorcycles and capacity building for staff. The Carter Neglected Tropical 5 year 2016 West 145,947 √ √ √ 100,000 Centre/RTI Diseases (NTD) Moyo HSD Sight Savers NIURE/Eye care 1 year 2016 District- 145,947 √ √ √ wide Concern World Nutritional support to 2 year 2016 District- 29,320 √ √ 100,000 Wide both national & refugee wide Medical Team Essential clinical services 1 year 2016 Itula Sub- 147,252 √ √ International to refugees county (MTI) Lutheran World WASH 1 year 2016 Itula Sub- 147,252 √ Federation county (LWF) Medical San Surveillance and MNH 1 year 2016 Itula Sub- 147,252 √ Frontier (MSF) county World Vision WASH 1 year 2016 Itula Sub- 147,252 √ county World Food Food supply & distribution 1 year 2016 Itula Sub- 147,252 √ Program (WF) to refugees county Reproductive Sexual and Reproductive 1 year 2016 District- 147,252 √ √ 180,000 Health Uganda Health wide Uganda Sanitation & hygiene 5 years 2014 Metu, 82,228 √ √ √ 115,000 Sanitation Fund Laropi & (USF) Moyo sub counties SNV/DFID Support Sanitation & 3 years 2015 Aliba, 55,722 √ √ √ (PALM CORPS hygiene Gimara, Lefori and Dufile sub- counties METS program District-led programming 5 years 2015 District- 293,199 √ √ for HIV and AIDS activities wide Family Health Health communication for 4 years 2015 District- 293,199 √ √ International behaviour change wide 360 Family Planning - Costed Implementation Plan 10 (2018/19 - 2022/23) MOYO DISTRICT
Table 1.6: Health Partner Mapping in Moyo District (Continued) Name of Intervention area Duration Start Coverage Target Implementation mode Project/ of date group/ (tick all applicable) Partner project Estimated population Trans Nile Communication for health 1 year 2008 District- 293,199 √ 6,000 Broadcasting education and promotion wide Services (TBS) Radio Station Uganda Red Disaster preparedness and 1 year 2008 District- 293,199 √ √ Cross Society response wide (URCS) Local NGOs/ Social behavior 1 year 2010 Selected 145,947 √ √ CBOs (Global communication for change sub- AIM, MODIPU, county MAWUA, CEFORD) MAHA (Moyo Advocacy for improved 18 June Gimara, 38,281 √ √ 50,000 Aids Heroes health service delivery months 2016 Lefori and Association) Laropi sub counties
Source: Moyo District Health Plan (2017/2018) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 11
1.3 SWOT Analysis for Family Planning Services The SWOT analysis examined the Strengths, Weaknesses, Opportunities, and Threats for the family planning services in Moyo District (Table 1.7).
Table 1.7: SWOT Analysis
Strengths Strategies to optimize • Availability of trained and professional • Continuous professional development for health facility staff in health staff in the public sector quantification, forecasting, ordering and monitoring of stocks • Supported community outreaches • Increase facilitation of outreaches through partnerships with • Reliable supply of family planning implementing partners or Development Partners commodities by National Medical Stores • Increasing the capacity of the health workers to quantify family to the district planning commodities according to need and on a timely basis • Existence of regulatory framework and • Creating awareness about the frameworks to enable health laws workers and clients make informed decisions about FP services • Strong political, technical and • Ensuring that all leadership positions are filled to create administrative will and commitment stronger will • Moderate staffing levels for the nursing • Training all staff members on family planning services and and health information assistant commodities
Weaknesses Strategies to minimize • Limited FP outreach services • Strengthen partnerships with FP implementing partners to • Limited FP choices support integrated FP outreaches with wider range of services
Opportunities Strategies to optimize • Additional recruitment of healthcare • Creating more partnerships for health to create a larger impact workforce by IPs in family planning service delivery or implementation • Wide stakeholder involvement and • Active involvement of all stake holders in health matters to be engagement in the health sector able to build ownership and develop practical strategies planning • Ensuring that these platforms are used to the maximum to • Availability of platforms for dialogues convey FP messages to the people using clear and simple and negotiations messages • Existence of enabling policies, laws and • Creating policies that support demand creation and provide an regulations supporting family planning in enabling environment for the uptake of FP services Uganda • Integration of the interests of IPs with those of the districts in • Existence of implementing partners and order to create a bigger impact for health PNFP in the health sector • Using the guidelines and regulatory frameworks to manage FP • Demonstrated commitment by the at district and facility level government • Continuous training and facilitation of VHTs to strengthen their • Availability & willingness of community capacity as part of the community gatekeepers for heath volunteers and VHTs • Use of the male champions to mentor other men to increase • Presence of FP male champions in the male involvement district Family Planning - Costed Implementation Plan 12 (2018/19 - 2022/23) MOYO DISTRICT
Threats Strategies to mitigate • Brain drain of public health work force • Ensuring safety of the health workers, distribution of enough due to influx of refugees in the region numbers of health workers and staff motivation to maintain • Community held misconceptions against retention rates family planning by potential FP services • Developing age and culture appropriate information on FP users to enhance voluntary informed decisions to utilization of FP • Sexual and gender-based violence services • Some religious and cultural leaders • Creating awareness about effects of GBV and strengthening continue to condemn family planning as the law to protect victims and enforce penalties it is perceived to promote immorality • Continuous engagement with religious and cultural leaders on • Lack of partner support the importance of family planning • Pressure and competition to give birth • Use male family planning champions to influence partners especially in polygamous families • Continuous community sensitization about pressures that come with big families brought about by poor FP practices
1.4 Process of Developing the District CIP Development Partners, cultural and religious leaders, The process of developing the district Family private sector, community volunteers and civil Planning Costed Implementation Plan started with society organizations (CSOs). a comprehensive desk review to systematically understand the conceptual issues around family All Lower Local Governments (LLGs) were planning in general and specifically in Moyo District. represented in the District Technical Planning Committee (DTPC) for their inputs. Content for the The process entailed wider involvement and district FP CIP was informed by both secondary and consultation of key stakeholders playing key roles primary data collected through (a) Desk reviews, (b) in the district. At district level, stakeholders were Meetings with technical staff, (c) District level key drawn from the District Council, District Health informant interviews, (d) LLG consultative meetings, Team, District Technical Planning Committee, and community and health facility visits. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 13
SECTION 02: The Case for Moyo District FP Costed Implementation Plan Family Planning - Costed Implementation Plan 14 (2018/19 - 2022/23) MOYO DISTRICT
2.1 Introduction • Supply of IEC materials about FP is limited and This section presents a detailed analysis and literal these are not always translated into local languages review of key issues that influence contraceptive • Youths are ignorant or don’t know that family prevalence rate. As detailed in the Uganda National planning services are free of charge in public health FP CIP 2015-2020, the review and analysis is facilities categorised along the following main themes: • Local people are not given information on the family planning methods of their preference but only 1. Demand Creation about the methods available 2. Service Delivery and Access • Lack of men’s support with many thinking that 3. Contraceptive Security family planning is only for women since the men 4. Policy and Enabling Environment have fewer options for FP services 5. Financing • Reproductive health services are also low in the 6. Stewardship, Management and Accountability refugee camps and there is hardly information tailored to them that pertains to family planning 2.2 Demand Creation • IEC materials on family planning that could have Demand creation which entails increasing awareness been used for demonstration are also not made of modern family planning methods, how to access available to the people who reach out to the them and their contribution to improved health and communities in health camps development outcomes is critical, and should be part • Low staff numbers at health facilities also hinder of a government’s commitment to contraceptive demand for family planning commodities greatly. security. Awareness of at least one method of As a result, there are long waiting hours at facilities contraception in Uganda is universal (UDHS, 2016). which in the end causes some clients to go back In Moyo District, there are fears of side effects home without receiving any services mixed with misconceptions about family planning services, with some local people perspective that Within the district, there were inadequacies in the contraceptives promote promiscuity, immorality knowledge levels about family planning. In a few sub- and prostitution. In addition, knowledge is given counties, mass education about the benefits of family about the available contraceptives and not about all planning through community-based meetings was methods. During the stakeholders meeting on 28th conducted by male champions and other community November 2017, it was also revealed that: volunteers. However, this was done through radio which not everyone could access. Local people did • Demand creation of family planning methods not have clear sources of information about family and services is not a multi-sectoral collective planning services, methods and side effects. responsibility which is affecting access to and utilization of FP information For the few locals who turn to health workers for • Community dialogues cease to be dialogues but technical advice and guidance, the health workers rather one-way information delivery platforms were themselves constrained with heavy workloads, • There exist knowledge gaps among VHTs about coupled with the fact that sometimes one may lack family planning capacity to fully explain the facts associated with • Most women in the district are ignorant about the contraceptive use. Furthermore, there was no age efficacy and side effects of different family planning specific information that targeted groups of persons, methods. Failure of some FP methods creates for example youths and adolescents. fears among users and such information spreads fast among peers thus contributing to high rates of discontinuation Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 15
In the family planning district stakeholders’ meeting 2.3 Service Delivery and Access the key stakeholders agreed that there was no vibrant communication and dependable messaging Moyo district family planning uptake about family planning. In addition, there was Compared to FY 2013/14 and FY 2014/15, there was generally low involvement of religious and local significant increase in FP users from 9,936 to 11,472. leaders in mobilizing the community and advocating family planning services. Fortunately, the district has Financial Year 2013/14 had the lowest coverage of development partners involved in the promotion of 1713.1 but in 2014/15 it increased to 1745.4 (Moyo family planning services such as Reproductive Health District DHIS II, 2015). Table 7 below provides an Uganda, Marie Stopes and PATH. The Development overview of FP service uptake across the district Partners have attempted to socially market some service providers. contraceptive commodities.
Table 2.1: FY 2013/14 and FY 2014/15 Comparative Analysis of FP Services Uptake among Service Providers in Moyo District
SN H/Facility FY 2013/14 FY 2014/5 Total Pop’n WCBA users FP Coverage Total Pop’n WCBA users FP Coverage 1. Aliba HC III 14,571 2,987 810 27.1 14,991 3,073 604 19.7 2. Indiliga HC II 5,477 1,123 157 14.0 5,635 1,155 81 7.0 3. Dufile HC III 5,130 1,052 24 2.3 5,278 1,082 107 9.9 4. Moyo Arra HC II Govt 3,290 674 151 22.4 3,385 694 60 8.6 5. Paanjala HC II 1,986 407 309 75.9 2,043 419 290 69.2 6. Liwa HC II 2,744 563 60 10.7 2,823 579 50 8.6 7. Lomunga HC II 1,197 245 65 26.5 1,231 252 94 37.2 8. Maduga HC II 2,073 425 63 14.8 2,133 437 143 32.7 9. Obongi HC IV 8,613 1,766 1,153 65.3 8,861 1,817 289 15.9 10. Belameling HC II 1,391 285 61 21.4 1,431 293 41 41 11. Ibakwe HC II 2,047 420 56 13.3 2,106 432 68 68 12. Iboa HC II 990 203 646 318.2 1,019 209 929 929 13. Itula HC III 2,482 509 204 40.1 2,553 523 276 276 14. Kali HC II 829 170 7 4.1 853 175 16 16 15. Palorinya HC III 2,863 587 472 80.4 2,945 604 198 198 16. Waka HC II 1,139 234 61 26.1 1,172 240 46 46 17. Gbalala HC II 1,627 334 215 64.5 1,674 343 48 48 Family Planning - Costed Implementation Plan 16 (2018/19 - 2022/23) MOYO DISTRICT
18. Laropi HC III 5,924 1,214 225 18.5 6,095 1,249 174 174 19. Panyanga HC II 1,802 369 74 20.0 1,854 380 49 49 20. Cokwe HC II 3,145 645 930 144.2 3,236 663 32 32 21. Gwere HC II 2,077 426 48 11.3 2,137 438 68 68 22. Lefori HC III 5,381 1,103 366 33.2 5,536 1,135 4,276 4,276 23. Munu HC II 1,480 303 83 27.4 1,523 312 44 44 24. Abeso HC II 1,607 329 0 0.0 1,653 339 7 7 25. Aya HC II 2,626 538 180 33.4 2,702 554 36 36 26. Eremi HC III 3,475 712 44 6.2 3,575 733 1,226 1,226 27. Erepi HC II 1,720 353 660 187.1 1,770 363 181 181 28. Fr. Bilbao/Bilbao HC III 2,717 557 0 0.0 2,795 573 0 0 29. Gbari HC II 1,930 396 151 38.2 1,986 407 155 155 30. Goopi HC II 2,164 444 258 58.2 2,226 456 69 69 31. Kweyo HC II 3,296 676 106 15.7 3,391 695 130 130 32. Metu HC III 3,434 704 159 22.6 3,533 724 143 143 33. Ori HC II 3,869 793 47 5.9 3,980 3,980 44 5.4 34. Afoji HC II 1,803 370 21 5.7 1,855 1,855 0 0.0 35. Eria HC III 2,784 571 84 14.7 2,864 2,864 78 13.3 36. Lama HC II 3,194 655 69 10.5 3,286 3,286 490 72.7 37. Logoba HC III 4,504 923 136 14.7 4,634 4,634 155 16.3 38. Moyo Mission HC III 4,137 848 0 0.0 4,256 4,256 0 0.0 39. Opiro HC II 2,177 446 73 16.4 2,240 2,240 59 12.8 40. Ramogi HC II 2,172 445 564 126.6 2,235 2,235 72 15.7 41. Besia HC III 4,423 907 248 27.4 4,550 4,550 161 17.3 42. Moyo HOSPITAL 9,080 1,861 896 48.1 9,342 9,342 483 25.2 Total 28,571 99,36 1713.1 143,387 29,394 11,472 1745.4
Source: Moyo District DHIS II
It was also reported that the only readily available Unmet need for family planning contraceptives in Moyo District are the oral Moyo District targeted to reach 14,740 family contraceptives and Depo-Provera injectable which planning users in FY 2017/2018, but has so far are delivered through a pull and push system by reached only 6,485, with an unmet need of 21.9%. National Medical Stores (NMS). The other methods This was partly due to the existing contradictory are not really known due to scarcity and delays in arguments from political and religious leaders delivery by NMS. about the role of family planning in socio-economic development. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 17
In the same report, observations were made on This is one of the causes of knowledge gaps on the fact that political leaders encouraged large family planning in health facilities especially when families to spur economic growth, which made full the ones that have been trained are not on duty implementation of family planning policies very • VHTs are not trained on FPs yet they can support challenging (Moyo District Health Plan, 2017/2018) mobilization of mothers to seek and access family planning services at health facilities and also be able According to UDHS (2011) only 16% of women to administer the easy methods in the communities (nationally) who gave birth in health facilities were they live in counselled before discharge. This could even be lower • There is lack of equipment that aids the for Moyo District than the national average given the administering of some family planning commodities low prevalence of FP use. In Moyo District, health (such as the IUD). This leaves health workers with education was provided to mothers at ANC and no option but to leave the commodity on the shelf OPD, as well as community outreaches by selected till the equipment is made available. government facilities. Community family planning • Family planning is not integrated into other health dialogues supported by technical staff and male services such as immunization days yet on such champions offered an opportunity to discuss family days it easy to access a large number of women who planning activities in the district. However, there is a don’t use any FP method still widely low male involvement in FP services. Men believed that wives should take responsibility to use 2.4 Contraceptive Security family planning (DSW, 2014) since methods available The need or demand for contraceptives, and meeting for men are very limited. Other key challenges in the demand or the supply of contraceptives, are family planning service delivery and access in Moyo dependent on each other. As women’s demand for District included: contraception increases, the need for governments, donors, manufacturers and other stakeholders • Shortage of sufficient human resources for health to supply the demand becomes increasingly • Diverse cultures and beliefs that hinder uptake of critical. Government remains the major provider FP services of contraceptive method, contributing 47% of the • Inadequate FP IEC materials free supply of contraceptives (UDHS, 2011). This • Long waiting times at health facilities guarantees freedom of choice by family planning • Poor attitudes of health workers, some health users. Indeed, this attracts many users leading to long workers ask awkward questions or are too tired as queues along the supply chain. Through this chain, they to deal with other health centre activities the government operates both push and pull systems; • Some religions do not support family planning the former for HCIIs and HCIIIs, and the latter for the • Family planning is perceived to promote immorality hospital and HCIVs. and prostitution The push system is not client-centred and does not • Lack of performance incentives/facilitation for guarantee and promote free choices in contraceptive outreach services use, while with the pull system, the hospital and • Challenges of transporting commodities to health HCIVs are able to requisition according to the needs centres of communities. According to the District Health • The lack of privacy at health centres prohibited Office (2017), the district strives to maintain an clients from freely expressing themselves adequate supply of family planning commodities but • Some health workers who may have been invited by is constrained by an inadequate Health Information implementing partners for short CMEs do not take Management System which contributes to poor the initiative to train the fellow health workers in quantification and forecasting; insufficient district their respective health facilities. and health storage facilities; and expiry of some FP commodities due to preferences to certain family planning methods. Family Planning - Costed Implementation Plan 18 (2018/19 - 2022/23) MOYO DISTRICT
2.5 Policy and Enabling Environment 2.7 Stewardship, Management and According to the national FP Costed Implementation AccountabilityDistrict Leadership Plan (2015-2020), the current policy environment The Moyo District leadership is committed is conducive for strengthened implementation of to supporting FP services delivery given the the FP programme in Uganda. Family planning is contribution a healthy population plays in social recognized as a key strategy to promote social, development. The development of this CIP was economic, and environmentally sustainable strongly supported by the district’s political and development, to realize sexual and reproductive technical leadership and there was commitment to health and reproductive rights, and to improve the support funding and coordination to actualize the health of women and their children by preventing aspirations of the plan. unintended pregnancies and improving child spacing, thus reducing maternal and neonatal morbidity and Family planning partnerships mortality. Moyo District Local Government plans to strengthen The Ugandan government has developed national its partnerships with implementing partners, policies and plans such as Uganda Population Policy, development partners, private sector, cultural and National Gender Policy, National Development Plan, religious leaders to implement this plan. It was noted National Health Policy, Health Sector Strategic and that this partnership will help in addressing the Investment Plan, National Family Planning Advocacy major family planning services access and utilization Strategy among others. However, what remains to identified in the SWOT analysis. be done is to popularize these policies among key district stakeholders. The health service providers, Data collection, analysis and use religious, cultural and the local district leaders are not sufficiently aware of the key policy provisions and Data on family planning service utilization in Moyo attendant implications for the development of the District is collected using the Health Management country. Information Systems (HMIS) tools from health centers and forwarded to the district biostatistician 2.6 Financing for onward routine reporting to Ministry of Health A review of Moyo District’s health budget for the through the DHIS2. In each health facility, there is a last five financial years (2010-2016), indicates designated staff responsible for records management extremely low provision for family planning activities using Ministry of Health standardized tools. At the but caters for some reproductive health activities. district level, the biostatistician reviews data and This is further confirmed by District Health Plan schedules review meetings with the HMIS focal (2017/2018) that family planning activities are not persons. This is to guarantee data integrity and captured in the annual health sector work plan quality. In some instances, there are supervisory but rather consolidated in public health funds and visits to lower health facilities. Data is consolidated integrated into HIV services or antenatal care and analysed at the health facility and district levels services. There is no direct funding for family and used for planning and decision making. planning services. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 19
SECTION 03: District Strategic Priorities Family Planning - Costed Implementation Plan 20 (2018/19 - 2022/23) MOYO DISTRICT
3.1 Introduction of family planning to prevent unintended pregnancies This section delves into the strategic priorities for family planning in Moyo District based on the Priority 3: Implement task sharing to increase access, priorities highlighted in the national FP CIP. The especially for rural and underserved populations priorities are aligned to the national level strategic outcomes and feed into the district vision, mission Priority 4: Mainstream implementation of FP policy, and goal. interventions and delivery of services in multi- spectral domains to facilitate a holistic contribution 3.2 Vision, Mission, Core Values and Goal to social and economic transformation. The vision of the district is “A prosperous district with sustainable high standards of living” while the mission Priority 5: Improve forecasting, procurement and is “To provide quality family planning services to the distribution and ensure full financing for commodity people of Moyo through coordinated and effective security in the public and private sectors service delivery strategies that focus on local priorities” The mission and vision are aligned to the These priorities are derived from the Health Sector national Family Planning Costed Implementation Plan Development Plan 2015/16 - 2019/20 and are 2015-2020 vision which is “Universal access to FP to the basis for financial resource allocations and help Uganda attain middle income country status by implementation performance. In order to ensure 2040.” that the limited resources are directed to areas The district’s core values are: that have the highest potential to reduce the unmet 1. Integrity need for family planning and also achieve the 2. Accountability district’s stated goal, the activities under this plan 3. Professionalism are structured around six thematic areas namely; 4. Respect 1) demand creation; 2) service delivery and access; 5. Transparency 3) contraceptive security; 4) policy and enabling; 6. Teamwork 5) financing; and 6) stewardship, management and accountability. Goal: In line with the national operational goals of reducing the unmet need for family planning to 3.3.1 Demand creation 10 percent and increase modern contraceptive Strategies prevalence rate among married and women in union Moyo District Local Government has been to 50 percent by 2020, the goal of Moyo District FP implementing social behavioural change Costed Implementation Plan is: “To increase the communication campaigns which have hitherto not modern contraceptive prevalence rate amongst adequately addressed specific information needs married and women in union to 56 percent by 2021” based on the social demographic disparities of the population sub segments. This was founded on the 3.3 District strategic priorities in FP limited capacity of the district to localize the national This plan is aligned to the national FP CIP whose social and behaviour change communication (SBCC) priorities include: strategy in order to address the local FP information needs and campaigns. Priority 1: Increase age appropriate information, As such, this plan will direct its thrust towards access and use of family planning among young population segmentation and targeting them with people ages 10-24 years clear messaging on family planning.
Priority 2: Promote and nurture change in social and This will be grounded on the need to bringing into the individual behavior to address myths, misconceptions fold the current non-users of contraception who have side effects, improve acceptance and continued use high motivation to adopt. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 21
This population sub category will then be used Deliberate efforts will be taken to use any available to act as FP champions to address myths and opportunities to advance the cause of family planning misconceptions to their non-user peers, which is among men with age specific messages. At all health deemed as important and critical to lowering the facilities, male friendly services will be established. percentage of unmet need. As a culturally diverse district, there is need to package messages in Knowledge about and use of FP services by young languages that serve different tribal segments so as people, 10–24 years increased to tackle myths and fears of both users and non- Moyo District Local Government will provide specific users of contraception. Integrating gender in family information about FP to young people with the aim planning approaches is also critical to improving male to empower them to make informed FP decisions as involvement in interventions on family planning. As one of the measures to address teenage pregnancies. informed by the District HMIS data, gender analysis Community champions and Village Health Teams shall be integrated in the district family planning (VHTs) will be re-skilled and retooled in order to approach so as to gauge male involvement. Overall, reinforce positive behaviour towards FP uptake. demand creation approach in family planning in Moyo District will be people centred coupled with innovative outlets such as mobile health advocacy 3.3.2 Service Delivery and Access campaigns and use of information communication Strategies technologies. Moyo District Local Government will adopt a rights- based approach that includes informed choice, The district will support the social marketing of free free and informed consent, respect to privacy and family planning commodities/services by the PNFP confidentiality, equality and non-discrimination, actors and social marketing organizations as well as equity, quality, client-cantered care, participation the private sector. This will facilitate the deep reach and accountability. Interventions will further address of FP services to rural underserved communities. limited geographical and economic access to FP services especially among rural and the poorest Strategic district outcomes populations. It will further reduce inequities related Demand for FP services in Moyo District increased to poverty, HIV status, gender, age, and marital status Moyo District Local Government will increase the in access to and use of FP. Local, cultural, and religious percent of women in reproductive age group (15-49 leaders will be sensitized about the importance of years) demanding family planning services using a supporting family planning. Young celebrities within social behaviour change communications strategy the district will be targeted to act as role models but that makes use of a multimedia approach. Using the also to champion the advocacy platform in FP service local community radio, infotainment and community delivery. dialogues will be organized at village levels, places of worship, other gathering places and community Strategic outcomes markets. Efforts will be made to target special groups Access to FP services increased including religious leaders, traditional and cultural Service delivery points at community level will be leaders, young people, men and Most At Risk Persons increased through FP outreaches and partnership (MARPS), including sex workers, through multilingual with the private sector like drug shops and social and age-specific messages. marketing organizations especially among the underserved communities. Efforts will be made to Support for the use of modern contraceptive by reach out to people with special needs like persons men and their partners enhanced with disabilities well as young people. Village Health Moyo District Local Government will increase the Teams and FP champions will be used to mobilize number of male champions in order to support communities, refer clients and make follow-ups of FP use of modern contraception among their peers. service users to help in addressing misconceptions Family Planning - Costed Implementation Plan 22 (2018/19 - 2022/23) MOYO DISTRICT
as well as side effects. Youth-friendly services will 3.3.3 Contraceptive Security also be integrated into FP service delivery through Strategies training of service providers in addressing their In order to guarantee availability of family planning special needs as well as FP service delivery outside commodities, Moyo District Local Government routine hours. will work closely with the central government through Ministry of Health and specifically National Referral services strengthened Medical Stores (NMS) to ensure supply of FP drugs Moyo District Local Government will create a and supplies. The district will also work with Joint referral directory for FP. The District Health Medical stores (JMS) through the alternative Officer and Assistant District Health Officer will distribution mechanism to address issues of stock- ensure appropriate referral tools are used in the outs. Storage facilities at district and health facility referral systems and that all clients referred receive level will be improved to ensure quality of drugs appropriate services. and supplies. Health facility in charges and staff responsible for forecasting and quantification of Motivation for FP health care workers enhanced drugs and supplies will be supported through training Given the specialized skills required by health and records management in order to reduce stock- workers to deliver long term reversible and outs. permanent FP methods, appropriate trainings and continuous professional development will be Strategic outcomes enhanced. This will motivate health workers to meet Availability of FP drugs and supplies improved the service needs of their clients. Furthermore, Stock-out of FP drugs and supplies will be minimized health workers will be actively involved in FP decision through effective records management that support making processes as well as provision of transport to effective forecasting and quantification as well as provide community-based FP services. tracking of stocks.
Integration of FP services into other health 3.3.4 Policy and Enabling Environment services enhanced Strategies Moyo District Local Government will integrate FP Moyo District Local Government will align all FP into other services like cervical cancer screening, activities implementation with the national FP postnatal care, postpartum care, prevention and CIP. To improve the policy environment for family treatment of sexually transmitted infections, planning, government policies and strategies will be including HIV prevention, care, and treatment and disseminated to all relevant district stakeholders. malnutrition program as a cost containment measure. Specific advocacy will also be conducted to ensure This will enable clients access a wide scope of that policies and guidelines for family planning services at one point and minimize revisits. promote access to FP services to underserved communities and youth while ensuring that provision Management of family planning side effects of FP services in accordance with human rights and improved quality of care standards. Family planning side effects are among some of the reasons for high discontinuation rates in Uganda. Strategic outcomes As such, Moyo District Local Government shall Knowledge about policies on family planning strengthen counselling and referrals as well as follow- improved up of clients to address their concerns. The New The legal framework that promotes family planning Medical Eligibility criteria will be adhered to enable will become popularised through dissemination of health workers guide the clients on the choices of these documents to District Health Teams (DHTs), family planning. and health providers. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 23
A simplified district family planning handbook with All activities of family planning (by both government standard information shall be developed and widely and Private Not For Profit) will be tracked by disseminated. DHO’s office through Ministry of Health designed tools and electronic data base. The District 3.3.5 Financing Health Management Information System (HMIS) Strategies focal person will ensure timely and quality data Family planning activities will be integrated into management and analysis to inform planning and the district’s budget framework paper to ensure decision making by the relevant stakeholders. adequate recognition and consideration of the need Mentorship and supervision of the lower level HMIS for FP services delivery. Other non-governmental focal persons and other health workers will be organizations and donors will be lobbied for enhanced. increased support to complement support from As a requirement in the Local Government Act government. Social marketing will be strengthened as (1997), the Resident District Commissioner (RDC), a basis for accessing FP services at subsidized costs District Chairperson, Secretary for Health, Health for those who can afford. Advocacy for increased Sectoral Committee and the entire District Council funding for training and support for midwives will play an oversight function to ensure that all and nurses at lower-level health facilities will be services are delivered to all people in Moyo District. strengthened to help increase the national financial All lower local political leaders will be oriented investment for human resources development for to offer oversight roles to ensure high levels of health. accountability. The district will hold quarterly review meetings with Strategic outcomes the different stakeholders in the district. Further, Financing for family planning services increased the district shall commit resources to efficiently and Advocacy for the creation of budget lines for timely monitor and supervise the family planning family planning at the district level will support the activities. prioritization and integration of family planning into district planning and budgeting processes. At least Strategic outcomes one percentage of the total local revenue shall be Capacity at the district to lead, manage and allocated to the health sector and in particular to coordinate the FP program strengthened family planning. The DHT capacity to implement this plan will be strengthened through tailored trainings 3.3.6 Stewardship, Management and improving on the monitoring and reporting & Accountability Strategies mechanisms through the District Health Information A robust stewardship will be essential in System (DHIS2). implementing this plan. As such, Moyo District Local Government leadership will provide stewardship Reporting of FP indicators strengthened through effective monitoring, management and Through training and sharing of reporting tools accountability as essential for operationalization health workers will improve their reporting on of the plan. At the district level, the District family planning indicators. The district will track Health Officer (DHO) will lead the technical level activities including financial data outputs. The supported by the District Health Team (DHT) to district will coordinate quarterly data sharing with effectively monitor, coordinate, lead and ensure good the implementing partners and other relevant governance of family planning activities at all levels stakeholders. The identified performance gaps will in the district. The DHT will be trained to effectively form a basis for refresher training. A midterm review coordinate and manage family planning services. and final evaluation of the CIP will be conducted to establish progress, success and inform future FP strategy development. Family Planning - Costed Implementation Plan 24 (2018/19 - 2022/23) MOYO DISTRICT
SECTION 04: District Institutional Arrangements for Implementation of the Plan Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 25
4.1 Introduction Consistent with the national FP-CIP, the DHO will Moyo District Local Government FP Costed work closely with the CAO to plan and allocate Implementation Plan will be implemented in line financial resources for FP within the district health with the national health framework and within budget. The DHO and the Assistant DHO will the decentralization realm. Working closely with mobilize partner efforts towards FP in Moyo District, the central government, whose leadership and as well as offer technical support to implementing governance responsibility is prescribed in the partners, institutional-based health workers, FP National Health Policy, Moyo District Health Office, champions and Village Health Teams at village level. along with the District Health Team, and the District Civil society and non-governmental organizations Council Chairperson (LC 5) will engage various Moyo District Local Government has a multiplicity stakeholders to create opportunities for coordination of Civil Society Organizations which include United and management of the national FP effort. In tandem Nations Population Fund (UNFPA), Marie Stopes with the national FP CIP, Moyo District will follow International-Uganda, JMS Uganda Health Supply management, coordination and accountability Chain (UHSC), Reproductive Health Uganda, and structures, as outlined below. Family Health International 360 amongst others. This district FP CIP will, through the CAO and DHO 4.2 Management, Coordination, and engage these actors to ensure provision of financial Accountability Structure resources towards FP and delivery of FP services, Moyo District Local Government FP CIP but also support advocacy for improved demand and recognizes that the Ministry of Health (MoH) takes quality service provision. stewardship and spearheads the planning, financing, implementation and performance monitoring of 4.4 Coordination Framework the district FP Costed Implementation Plan, to feed District level into the national FP CIP within the local government In Moyo District, coordination of this district FP CIP structures. This district FP CIP will be implemented will be led by the CAO and DHO through organized by the District Health Office and supported by civil multispectral stakeholders’ approach. This will society organizations (CSOs), community-based include the district FP steering committee, chaired by organizations (CBOs), women groups and faith-based the Local Council V (LCV) and a district FP technical organizations among others. working group, chaired by the District Health Officer or the Assistant DHO. At the technical level, it is 4.3 Roles and Responsibilities of Key Actors proposed that quarterly review meetings be held (District Level) with the DHT members and the decisions shared with Chief Administrative Office the relevant stakeholders. Consistent with the national FP CIP coordination structure, this district FP CIP will through the 4.5 Resource Mobilization Framework office of the Chief Administrative Officer (CAO) Through concerted efforts, Moyo District Local enforce coordination, planning, resource allocation, Government will commit a percentage of its local implementation, monitoring and evaluation for FP revenue towards FP and continue lobbying and services in the district. advocating increased donor support. The District District Health Officer (DHO) and Assistant DHOs Budget Framework paper will reflect a commitment Given the administrative stewardship of health towards increased financing of FP over the five-year services in Moyo District Local Government, the period. Informed by the district funding gaps, the DHO will oversee the implementation of the district Moyo District Planner and the Chief Finance Officer FP CIP. will forecast and project resource implications for FP financing. Family Planning - Costed Implementation Plan 26 (2018/19 - 2022/23) MOYO DISTRICT
4.6 Performance Monitoring and Accountability Key performance targets will be based on the Measuring Moyo District performance against the strategic priorities stipulated in the national FP CIP. national FP CIP targets will be critical during the It is anticipated that district performance towards implementation period. As expounded under the the national FP CIP will be shared in MoH review/ monitoring and evaluation section in this district strategic planning meetings. Below is a list of FP CIP, routine monitoring will be done through the indicators as adapted from the national FP CIP (2015- DHIS2. Reporting on performance will be made to 2020) the Ministry of Health through the coordination mechanism as prescribed by the national FP CIP.
Table 4.1: Illustrative List of National Indicators to Inform the District FP Category Illustrative Indicators Data Source Demographic • mCPR Track20, indicators • Percent distribution of users by modern method PMA2020, and • Number of additional FP users the UDHS • Percent of women with an unmet need for modern contraception • Percent of women whose demand is satisfied with a modern method • Couple Years of Protection • Unmet need • Teenage pregnancy rate Service • Number of women receiving counseling or services in HMIS statistics family planning—new acceptors and continuing clients • Number of women receiving FP services, by method • Number of products dispensed, by method • Number of youth receiving counseling or services in family planning—new acceptors and continuing clients • Number of HIV-positive clients using family planning Process Demand • Percent of non-users who intend to adopt a certain • Activity reports indicators Creation practice in the future • Programme • Number of radio and TV spots aired surveys • Percent of audience who recall hearing or seeing a • DHS specific message • FP-CIP • Availability of accessible, relevant, and accurate progress information about sexual and reproductive health monitoring tailored to young men database Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 27
Service • Number of providers trained on family planning by DHO Delivery and district Access • Number of mobile clinic events organized, and number of people reached by district • Number of youth-friendly service clinics established • Availability of accessible, relevant, and accurate information about sexual and reproductive health tailored to young men Contraceptive • Contraceptive stock-outs HMIS Security • Actual annual contraceptive delivered for the public sector • Percent of facilities that experienced a stock-out at any point during a given time period Policy and • Evidence of FP programmes incorporated into national DHO, CAO, RDC Enabling strategic and development plans Environment • Evidence of documented improvement in the enabling environment for family planning, using a validated instrument (e.g. the Family Planning Programme Effort Index and Contraceptive Security Index) • Evidence of targeted public and private sector officials, faith-based organizations, or community leaders publicly demonstrating a new or increased commitment to family planning • Documentation of instances in which a formal implementation or operational directive or plan is issued to accompany a national or sub national FP policy Financing • Annual expenditure on family planning from local DHO, CAO, revenue budget District Planner • Evidence of new financing mechanisms for family planning identified and tested • Evidence of private for-profit sector participation in family planning • Share of contraceptive procurement for the public sector financed by the government
Source: Adopted from National FP CIP (2015-2020) Family Planning - Costed Implementation Plan 28 (2018/19 - 2022/23) MOYO DISTRICT
4.7 Routine Data Collection Monitoring and evaluation coordination Family planning services data will be collected Once data has been collected at each facility, through the normal HMIS system. As a requirement, submission will be made to the district and finally to each health facility and associated volunteers will Ministry of Health as required. compile data using the standard tools from Ministry of Health and later on forwarded to the district Capacity building biostastician for onward submission to MoH. The primary consumption data at all health facilities It is envisaged that HMIS staff and other health (both government and PNFP) will be captured in workers will be oriented and trained in data hard copies and where possible, an electronic (HMIS) collection, assurance, and analysis. The training will database will be maintained. be on-the-job and where necessary, offsite training will be arranged by the office of DHO. This will ensure 4.8 Data Management that data tools are completed accurately. Data Quality Assurance mechanism Information dissemination and use The district biostastician will play a lead role in ensuring Data Quality Assurance (DQA) collection, It is planned that during the quarterly stakeholders’ transfer, compilation, analysis and storage. This review meetings, the consolidated and analysed data will be executed through a series of technical will always be presented to inform decision making. review meetings with the HMIS staff and health Deliberate efforts will be taken to disseminate facility assessment checks. As such routine support performance levels with the relevant stakeholders. supervision will be undertaken on a quarterly basis and technical support will be offered in areas of need to health centres both for government and the private not for profit. Due diligence will be taken to identify any inconsistencies in data by comparing the submitted data records with the original data sources. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 29
SECTION 05: Costing of the Plan
5.1 Introduction results. Additionally, it is assumed that FP drugs and The costing of the strategic activities is informed by supplies will be provided by NMS. As such, they have the concept of allocative efficiency where resources not been costed. will be prioritized to areas that generate optimal Family Planning - Costed Implementation Plan 30 (2018/19 - 2022/23) MOYO DISTRICT
Table 5.1: Cost for implementing the CIP District Priority Strategic Outcomes FP Costs per Year in UGX Millions 2017/18 2018/19 2019/20 2020/21 2021/22 Demand Creation Demand for FP services in Moyo District increased 50 60 65 65 65 Support for the use of modern contraceptive by 30 30 30 30 30 men and their partners enhanced Knowledge about and use of FP services by young 45 45 40 40 40 people, 10–24 years increased Service Delivery and Access to FP services increased 50 50 60 60 60 Access Referral services strengthened 10 10 10 10 10 Motivation for FP health care workers enhanced 16 16 16 17 17 Integration of FP services into other health 30 30 40 40 40 services enhanced Management of family planning side effects 30 30 30 40 50 improved Contraceptive Security Availability of FP drugs and supplies improved 12 12 12 12 12 Policy and Enabling Knowledge about policies on family planning 9 9 7 7 7 Environment improved Financing Financing for family planning services increased 2 2 2 3 3 Stewardship, Capacity at the district to lead, manage and 80 80 80 90 90 Management and coordinate the FP program strengthened Accountability Reporting of FP indicators is strengthened 50 50 50 50 50 TOTAL 414 424 442 464 474
Table 5.2: Summary Costs per Thematic Area per Financial Year (Millions, UGX) District Priority FP Costs per Year in UGX Millions 2017/18 2018/19 2019/20 2020/21 2021/22 Demand Creation 112.06 106.21 100.95 96.19 91.86 Service Delivery and Access 112.06 106.21 100.95 96.19 91.86 Contraceptive Security 12 12 12 12 12 Policy and Enabling Environment 9 9 7 7 7 Financing 2 2 2 3 3 Stewardship, Management and Accountability 247.12 235.42 222.9 214.38 205.72 TOTAL 494.24 470.84 445.8 428.76 411.44
The total financial outlay for implementing this plan will be 2,218 billion Uganda shillings over the five-year period. The highest percentage of this budget will go towards service delivery and access (507.27 million Uganda shillings). In the first year, it is projected that 414,000,000 shillings will be invested. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 31
SECTION 06: District Implementation Framework and Activity Details Family Planning - Costed Implementation Plan 32 (2018/19 - 2022/23) MOYO DISTRICT
SECTION SIX: DISTRICT IMPLEMENTATION FRAMEWORK AND ACTIVITY DETAILS Strategic Outcomes Expected Results Activity Sub Activities Inputs Output indicators Timeline DC1 : Demand for FP services is Women ages 15-49 years with • Align Moyo District communication strategy • Receive technical support to develop a Resources for technical District-specific communication 2018 increased demand for family planning (met with national strategy with evidence based communication strategy assistance and dissemination strategy disseminated to relevant demand and unmet demand) messaging • Disseminate strategy meetings stakeholders • Implement a mass media campaign on FP based • Purchase media space for FP messaging • Design FP messages • Number of radio spots purchased 2018 on the district communication strategy (radio and TV) • Resources for airtime for and aired per week through • Resources for airing spots on radios and radio and TV talk shows • Number of quarterly discussions to 2022 TVs held on TV • Mobilize cultural leaders and community • Engage cultural and community leaders • Resources for mobilizing, • Number of cultural leaders 2018 leaders working on HIV, PMTCT, GBV, MCH to in workshops to orient them in FP training and follow up of sensitized on FP messaging participate in sensitization to include FP in their messaging trained leaders work • Conduct follow ups of trained leaders DC2: Men support the use of Number of men who support the • Conduct monthly community outreach events • Conduct community mobilization • Resources for community • Number of men reached in Quarterly modern contraceptives for use of modern contraception for to engage men in family planning through multimedia approaches mobilization, men days and through special days scale-up themselves and partners themselves or their partners in • Conduct men special day community outreach event • Number of youth camps held. Moyo District • Facilitate community outreaches • Resources for design and 2018 • Participate in youth camp for FP distribution of IEC materials through conducted • Resources for facilitating to 2022 youth camp DC3: Young People, 10-24 years Young people 10-24 years are • Engage peers and champions to educate young • Participate in the development of youth • Resources for facilitating • Number of Moyo district youth 2018 old are knowledgeable about knowledge about FP and accessing people about family planning services plans for FP supervised by MoH development of youth plans plans supervised by MoH through family planning FP services and supervision by MoH to 2022 • Disseminate youth magazine • Resources for dissemination • Youth Magazine disseminated 2018 of youth magazines annually through distributed to youth corners to 2022 and peer educations on quarterly basis • Disseminate educational yearly youth magazine • Participate in workshops with teachers • Resources for facilitating • Number of parents, caregivers 2018 that describes youth FP activities, programs and and parents to orient them on how best workshops and house visits and teachers participating in through services to talk to youth about FP dialogues and workshops to 2022 • Facilitate house visits to support • Number of dialogues and parents on communication to young workshops conducted people about FP • Empower parents, caregivers and teachers to • Mobilize communities for edutainment • Resources for conducting • Number of events held 2018 help their children to avoid teen pregnancy, events edutainment events through including parent-child communication on sexual • Conduct community edutainment to 2022 issues shows • Hold “ edutainment” community events like Participate in youth camp for FP Resources for facilitating • Number of youth camps held. - dances , music concerts and sports competitions conducted youth camp to provide opportunity for knowledge exchange amongst young people Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 33
Strategic Outcomes Expected Results Activity Sub Activities Inputs Output indicators Timeline DC1 : Demand for FP services is Women ages 15-49 years with • Align Moyo District communication strategy • Receive technical support to develop a Resources for technical District-specific communication 2018 increased demand for family planning (met with national strategy with evidence based communication strategy assistance and dissemination strategy disseminated to relevant demand and unmet demand) messaging • Disseminate strategy meetings stakeholders • Implement a mass media campaign on FP based • Purchase media space for FP messaging • Design FP messages • Number of radio spots purchased 2018 on the district communication strategy (radio and TV) • Resources for airtime for and aired per week through • Resources for airing spots on radios and radio and TV talk shows • Number of quarterly discussions to 2022 TVs held on TV • Mobilize cultural leaders and community • Engage cultural and community leaders • Resources for mobilizing, • Number of cultural leaders 2018 leaders working on HIV, PMTCT, GBV, MCH to in workshops to orient them in FP training and follow up of sensitized on FP messaging participate in sensitization to include FP in their messaging trained leaders work • Conduct follow ups of trained leaders DC2: Men support the use of Number of men who support the • Conduct monthly community outreach events • Conduct community mobilization • Resources for community • Number of men reached in Quarterly modern contraceptives for use of modern contraception for to engage men in family planning through multimedia approaches mobilization, men days and through special days scale-up themselves and partners themselves or their partners in • Conduct men special day community outreach event • Number of youth camps held. Moyo District • Facilitate community outreaches • Resources for design and 2018 • Participate in youth camp for FP distribution of IEC materials through conducted • Resources for facilitating to 2022 youth camp DC3: Young People, 10-24 years Young people 10-24 years are • Engage peers and champions to educate young • Participate in the development of youth • Resources for facilitating • Number of Moyo district youth 2018 old are knowledgeable about knowledge about FP and accessing people about family planning services plans for FP supervised by MoH development of youth plans plans supervised by MoH through family planning FP services and supervision by MoH to 2022 • Disseminate youth magazine • Resources for dissemination • Youth Magazine disseminated 2018 of youth magazines annually through distributed to youth corners to 2022 and peer educations on quarterly basis • Disseminate educational yearly youth magazine • Participate in workshops with teachers • Resources for facilitating • Number of parents, caregivers 2018 that describes youth FP activities, programs and and parents to orient them on how best workshops and house visits and teachers participating in through services to talk to youth about FP dialogues and workshops to 2022 • Facilitate house visits to support • Number of dialogues and parents on communication to young workshops conducted people about FP • Empower parents, caregivers and teachers to • Mobilize communities for edutainment • Resources for conducting • Number of events held 2018 help their children to avoid teen pregnancy, events edutainment events through including parent-child communication on sexual • Conduct community edutainment to 2022 issues shows • Hold “ edutainment” community events like Participate in youth camp for FP Resources for facilitating • Number of youth camps held. - dances , music concerts and sports competitions conducted youth camp to provide opportunity for knowledge exchange amongst young people Family Planning - Costed Implementation Plan 34 (2018/19 - 2022/23) MOYO DISTRICT
DISTRICT IMPLEMENTATION FRAMEWORK AND ACTIVITY DETAILS (Continued) DC4: Social marketing of free Project to brand free, public-sector • Roll out pilot project to brand free, public • Conduct community awareness events • Resources for facilitating • Number of condoms distributed 2018 products and commercial sector condoms initiated and evaluated sector condoms to see if overall uptake on social marketing awareness events and through increases FP increases in Moyo • Distribute branded free public sector distribution of branded free to 2022 condoms public sector condoms AREA #2: Service Delivery (SD) SD1: Access to FP services FP service delivery points • Conduct mobile clinics in rural communities • Mobilize communities for mobile clinics • Resources for community • Number of mobile clinics 2018 increased increased in rural communities • Engage in conducting out mobile clinics mobilization and conducting established through mobile clinics to 2022 FP services are expanded through • Organizations participate in sensitization on the • Mobilize organizations for training in FP • Resources for mobilizing • Number of people from private 2018 public-private partnerships importance of promoting and using FP services • Participate in workshops to sensitize and conducting training organizations oriented on private organizations workshops provisions of FP services 2019
SD2: Referral services are A uniform FP referral is created in • Disseminate and train on FP referral forms • Identify eligible participants for training • Resources for conducting • Number of participants trained on 2018 strengthened Moyo district • DHO and ADHO participate in training trainings referral forms on new referral forms to take to health workers SD4: Family planning services FP services integrated into cervical • Disseminate FP integration protocols • Host meetings with professional • Resources for developing • Number of providers in Moyo 2018 are integrated in other health cancer screening, post-natal associations to develop FP integration and disseminating FP trained in FP service integration services care, postpartum care, STI and protocols integration protocols malnutrition programs • Facilitate dissemination meetings for FP integration protocols SD5: Family planning services FP service delivery guidelines • Develop guidelines for provision of FP services • Conduct workshops to develop • Resources for conducting • Number of providers trained on 2018 are accessible by people with developed for people with to people with disabilities guidelines for provision of FP services to workshops, training health disability service provision in disability disabilities people with disabilities workers and follow up Moyo • Train health workers on providing supervision services to FP clients with disabilities • Conduct follow up visits to trainees • Participate in sponsored courses for service • Participate in sponsored courses for • Train in sign language • Number of service providers in 2018 provision to learn sign language service provision to learn sign language • Conduct follow up visits to Moyo trained in sign language trainees SD6: Family planning side effects Counselling guidelines for family • Participate in training on FP side effects • Participate in training on FP side effects • Engage in training • Number of district health workers -2018 are managed planning is re-assessed counselling counselling trained on side effects counselling SD8: Family planning in the VHT Standardized FP training for VHTs • Participate in training of VHTs and FP • Participate in training of VHTs and FP • Participate in ToT for VHT • Number of trainers trained 2018 system is strengthened and FP champions scaled up champions on FP methods champions on FP methods and champions through • Conduct follow up visits to to 2022 trainees SD9: Youth-friendly services are Youth-friendly corners are • Establish youth –friendly corners in clinics • Map current clinics without youth • Resources for mapping and • Number of clinics mapped for 2018 provided in clinics established in clinics currently without any in Moyo corners establishing youth –friendly youth-friendly centres • Facilitate establishment of youth – corners in clinics • Number of clinics provided with friendly corners in clinics youth-friendly centres Health workers trained on how to Participate in TOT on youth-friendly services • Health workers participate in training on Resources for training and • Number of health workers trained 2018 provide youth- friendly services youth –friendly services follow ups on youth –friendly services 2018 • Conduct follow up visits to trainees • Number of health workers followed up Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 35
DC4: Social marketing of free Project to brand free, public-sector • Roll out pilot project to brand free, public • Conduct community awareness events • Resources for facilitating • Number of condoms distributed 2018 products and commercial sector condoms initiated and evaluated sector condoms to see if overall uptake on social marketing awareness events and through increases FP increases in Moyo • Distribute branded free public sector distribution of branded free to 2022 condoms public sector condoms AREA #2: Service Delivery (SD) SD1: Access to FP services FP service delivery points • Conduct mobile clinics in rural communities • Mobilize communities for mobile clinics • Resources for community • Number of mobile clinics 2018 increased increased in rural communities • Engage in conducting out mobile clinics mobilization and conducting established through mobile clinics to 2022 FP services are expanded through • Organizations participate in sensitization on the • Mobilize organizations for training in FP • Resources for mobilizing • Number of people from private 2018 public-private partnerships importance of promoting and using FP services • Participate in workshops to sensitize and conducting training organizations oriented on private organizations workshops provisions of FP services 2019
SD2: Referral services are A uniform FP referral is created in • Disseminate and train on FP referral forms • Identify eligible participants for training • Resources for conducting • Number of participants trained on 2018 strengthened Moyo district • DHO and ADHO participate in training trainings referral forms on new referral forms to take to health workers SD4: Family planning services FP services integrated into cervical • Disseminate FP integration protocols • Host meetings with professional • Resources for developing • Number of providers in Moyo 2018 are integrated in other health cancer screening, post-natal associations to develop FP integration and disseminating FP trained in FP service integration services care, postpartum care, STI and protocols integration protocols malnutrition programs • Facilitate dissemination meetings for FP integration protocols SD5: Family planning services FP service delivery guidelines • Develop guidelines for provision of FP services • Conduct workshops to develop • Resources for conducting • Number of providers trained on 2018 are accessible by people with developed for people with to people with disabilities guidelines for provision of FP services to workshops, training health disability service provision in disability disabilities people with disabilities workers and follow up Moyo • Train health workers on providing supervision services to FP clients with disabilities • Conduct follow up visits to trainees • Participate in sponsored courses for service • Participate in sponsored courses for • Train in sign language • Number of service providers in 2018 provision to learn sign language service provision to learn sign language • Conduct follow up visits to Moyo trained in sign language trainees SD6: Family planning side effects Counselling guidelines for family • Participate in training on FP side effects • Participate in training on FP side effects • Engage in training • Number of district health workers -2018 are managed planning is re-assessed counselling counselling trained on side effects counselling SD8: Family planning in the VHT Standardized FP training for VHTs • Participate in training of VHTs and FP • Participate in training of VHTs and FP • Participate in ToT for VHT • Number of trainers trained 2018 system is strengthened and FP champions scaled up champions on FP methods champions on FP methods and champions through • Conduct follow up visits to to 2022 trainees SD9: Youth-friendly services are Youth-friendly corners are • Establish youth –friendly corners in clinics • Map current clinics without youth • Resources for mapping and • Number of clinics mapped for 2018 provided in clinics established in clinics currently without any in Moyo corners establishing youth –friendly youth-friendly centres • Facilitate establishment of youth – corners in clinics • Number of clinics provided with friendly corners in clinics youth-friendly centres Health workers trained on how to Participate in TOT on youth-friendly services • Health workers participate in training on Resources for training and • Number of health workers trained 2018 provide youth- friendly services youth –friendly services follow ups on youth –friendly services 2018 • Conduct follow up visits to trainees • Number of health workers followed up Family Planning - Costed Implementation Plan 36 (2018/19 - 2022/23) MOYO DISTRICT
DISTRICT IMPLEMENTATION FRAMEWORK AND ACTIVITY DETAILS (Continued) AREA #3: Contraceptive Security (CS) CS1: District staff are able Staff are sensitized on forecasting • Integrate forecasting and quantification within • Participate in assessments to review • Resources for capacity • Number of visits by MoH to Moyo 2018 to quantify and forecast FP and quantifying of FP methods routine facility and Moyo district activities capacity of staff to quantify FP methods assessment and training of to review staff ability to quantify through commodities • Train staff in forecasting and staff FP methods to 2022 quantification of FP commodities CS2: VHTs and community-based Community-based distributors are • Ensure supply chain system provides accurate • Health centre logistics managers • Resources for training • Number of logistics manager -2018 distributors have commodities distributing FP commodities and timely re-stocking trained on quantify and distribution trained of commodities to community based distributors CS3: Commodity distribution to Joint Medical Stores (JMS) includes • Advocate inclusion of FP commodities in • Participate in assessment of the unmet • Resources for facilitating • Number of faith-based sector 2018 private not-for- profits increased FP commodities in procurement procurement by JMS need for FP in faith- based sector assessment of the unmet service delivery points assessed service delivery points need for FP in faith- based for unmet need in Moyo organizations AREA #4: Policy and Enabling Environment (PEE) PEE1: Legal framework and The legal framework that promotes • Sensitize different members of society on FP • Participate in sensitization of DHT and • Resources for sensitization • Number of DHT members trained 2018 knowledge of policies for family FP is better known rights, and correct any misconceptions stakeholders to understand FP rights of DHT and other on FP rights planning improved and correct misconceptions stakeholders PEE2: Parliament, local, cultural, A national coalition of advocates/ • Scale up FP advocacy through FP advocates and • Share best practices in advocacy and • Resources for facilitating • Number of advocates and 2018 and religious leaders are champions to support family champions in Moyo District lessons learned sharing of best practices champions from Moyo supportive of family planning planning is established and participating in meetings supported • Provide technical support to prominent • Resources for providing • Number of advocates and 2018 FP champions in Moyo technical support champions provided with through technical assistance to 2022 AREA #5: Financing (F) F1. Family planning is Family planning is prioritized and • Create a budget line for family planning at • Build capacity of district technical team • Resources for capacity • Number of visits conducted by 2018 mainstreamed in district planning integrated in district budgeting district level on budgeting for FP activities building MoH held in Moyo during district through and budgeting processes processes planning to 2022 F2: Financial investment in human Budget for training and support for • Advocate for increased funding for training and • Conduct advocacy events to different • Resources for facilitating • Documented evidence of progress -2018 resources development for health midwives and nurses in the health support for midwives and nurses at lower – decision makers advocacy events or decisions made on coverage of through is increased sector is increased. level health facilities FP in health insurance scheme to 2022 AREA #6: Stewardship, Management and Accountability (SMA) SMA1: Capacity of districts to DHTs effectively plan for, monitor , • Conduct annual review meetings • Conduct review meetings with DHT and • Resources for facilitating • Number of work plan review 2018 effectively manage their FP and report on FP services other stakeholders annual reviews meetings held through programs is strengthened to 2022 FP stakeholder coordination and • Improve FP stakeholder coordination and • Participate in workshop to orient • Resources for conducting • Number of DHT and committee 2018 performance monitoring at district performance monitoring at district level district management committees and orientation workshop and members trained on stakeholder through level is increased DHT facilitating coordination coordination and performance to 2022 • Facilitate coordination meetings meetings monitoring SMA2: Reporting of FP indicators Health care workers report on FP • FP reporting tools are widely distributed to • Distribute reporting tools • Resources for distributing • Number of FP reporting tools 2018 is strengthened indicators health care workers tools disseminated through to 2022 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 37
AREA #3: Contraceptive Security (CS) CS1: District staff are able Staff are sensitized on forecasting • Integrate forecasting and quantification within • Participate in assessments to review • Resources for capacity • Number of visits by MoH to Moyo 2018 to quantify and forecast FP and quantifying of FP methods routine facility and Moyo district activities capacity of staff to quantify FP methods assessment and training of to review staff ability to quantify through commodities • Train staff in forecasting and staff FP methods to 2022 quantification of FP commodities CS2: VHTs and community-based Community-based distributors are • Ensure supply chain system provides accurate • Health centre logistics managers • Resources for training • Number of logistics manager -2018 distributors have commodities distributing FP commodities and timely re-stocking trained on quantify and distribution trained of commodities to community based distributors CS3: Commodity distribution to Joint Medical Stores (JMS) includes • Advocate inclusion of FP commodities in • Participate in assessment of the unmet • Resources for facilitating • Number of faith-based sector 2018 private not-for- profits increased FP commodities in procurement procurement by JMS need for FP in faith- based sector assessment of the unmet service delivery points assessed service delivery points need for FP in faith- based for unmet need in Moyo organizations AREA #4: Policy and Enabling Environment (PEE) PEE1: Legal framework and The legal framework that promotes • Sensitize different members of society on FP • Participate in sensitization of DHT and • Resources for sensitization • Number of DHT members trained 2018 knowledge of policies for family FP is better known rights, and correct any misconceptions stakeholders to understand FP rights of DHT and other on FP rights planning improved and correct misconceptions stakeholders PEE2: Parliament, local, cultural, A national coalition of advocates/ • Scale up FP advocacy through FP advocates and • Share best practices in advocacy and • Resources for facilitating • Number of advocates and 2018 and religious leaders are champions to support family champions in Moyo District lessons learned sharing of best practices champions from Moyo supportive of family planning planning is established and participating in meetings supported • Provide technical support to prominent • Resources for providing • Number of advocates and 2018 FP champions in Moyo technical support champions provided with through technical assistance to 2022 AREA #5: Financing (F) F1. Family planning is Family planning is prioritized and • Create a budget line for family planning at • Build capacity of district technical team • Resources for capacity • Number of visits conducted by 2018 mainstreamed in district planning integrated in district budgeting district level on budgeting for FP activities building MoH held in Moyo during district through and budgeting processes processes planning to 2022 F2: Financial investment in human Budget for training and support for • Advocate for increased funding for training and • Conduct advocacy events to different • Resources for facilitating • Documented evidence of progress -2018 resources development for health midwives and nurses in the health support for midwives and nurses at lower – decision makers advocacy events or decisions made on coverage of through is increased sector is increased. level health facilities FP in health insurance scheme to 2022 AREA #6: Stewardship, Management and Accountability (SMA) SMA1: Capacity of districts to DHTs effectively plan for, monitor , • Conduct annual review meetings • Conduct review meetings with DHT and • Resources for facilitating • Number of work plan review 2018 effectively manage their FP and report on FP services other stakeholders annual reviews meetings held through programs is strengthened to 2022 FP stakeholder coordination and • Improve FP stakeholder coordination and • Participate in workshop to orient • Resources for conducting • Number of DHT and committee 2018 performance monitoring at district performance monitoring at district level district management committees and orientation workshop and members trained on stakeholder through level is increased DHT facilitating coordination coordination and performance to 2022 • Facilitate coordination meetings meetings monitoring SMA2: Reporting of FP indicators Health care workers report on FP • FP reporting tools are widely distributed to • Distribute reporting tools • Resources for distributing • Number of FP reporting tools 2018 is strengthened indicators health care workers tools disseminated through to 2022 Family Planning - Costed Implementation Plan 38 (2018/19 - 2022/23) MOYO DISTRICT
References 1. Health Communication Partnership (2009). A Literature Review of the Current Status of Family Planning Services in Uganda. Kampala Uganda: Health Communication Partnership.
2. MoFPED, Uganda (2008). National Population Policy for Social Transformation and Sustainable Development. Kampala, Uganda: MoFPED
3. Ministry of Health Uganda (2014). Uganda Family Planning Costed Implementation Plan, 2015- 2020. Kampala: Ministry of Health, Uganda.
4. Ministry of Health Uganda (2014). Draft Health Planning Guidelines. Kampala, Uganda: Health Planning Department, MoH.
5. Ministry of Health Uganda (2015). Health Sector Development Plan. Kampala, Uganda: Health Planning Department, MoH.
6. Ministry of Health Uganda (2010). National Health Policy. Kampala, Uganda: Ministry of Health. 7. Ministry of Health Uganda (2004). National Adolescent Health Policy for Uganda. Kampala, Uganda: Ministry of Health.
8. Moyo District Local Government, Uganda (2015). Moyo District Development Plan 2015/2016-2019/2020. Moyo, Uganda: Moyo District Local Government.
9. Uganda Bureau of Statistics (UBOS) 2015. National Population & Housing Census 2014. Kampala Uaganda: UBOS
10. Uganda Bureau of Statistics (UBOS) (2016). Uganda Demographic & Health Survey 2016. Kampala, Uganda: UBOS & Calverton, Maryland: ICF International Inc. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) MOYO DISTRICT 39 Family Planning - Costed Implementation Plan 40 (2018/19 - 2022/23) MOYO DISTRICT
MINISTRY OF HEALTH
MOYO DISTRICT Family Planning Costed Implementation Plan 2018/19 - 2022/23
Funding and Technical Support by: