REPUBLIC OF UGANDA

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

OCTOBER 2018

YUMBE DISTRICT LOCAL GOVERNMENT ii iii

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 Yumbe District Health Office. This project was funded under the UNFPA Supplies Programme and UK aid from the UK government.

Published by: Yumbe District Local Government

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

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

Copies available from: Yumbe District Health Office iv

Table of Contents List of Tables v List of Figures v FOREWORD vi PREFACE vii ACKNOWLEDGMENT viii ACRONYMS ix EXECUTIVE SUMMARY x SECTION ONE: INTRODUCTION AND BACKGROUND 1 1.1 Introduction 1 1.2 Background 2 1.3 SWOT Analysis for Family Planning Services 17 1.4 Process of Developing the District FP CIP 18 SECTION TWO: THE CASE FOR YUMBE DISTRICT FP COSTED IMPLEMENTATION PLAN 19 2.1 Introduction 20 2.2 Demand Creation 20 2.3 Access to Service Delivery and Yumbe District Family Planning Uptake 20 2.4 Contraceptive Security 20 2.5 Policy and Enabling Environment 21 2.6 Financing 21 2.7 Stewardship, Management and Accountability 21 SECTION THREE: DISTRICT STRATEGIC PRIORITIES 21 3.1 Introduction 22 3.2 Vision, Mission, Core Values and Goal 22 3.3 District Strategic Priorities in FP 23 3.3.1 Demand Creation 23 3.3.2 Service Delivery and Access 24 3.3.3 Contraceptive Security 25 3.3.4 Policy and Enabling Environment 25 3.3.5 Financing 26 3.3.6 Stewardship, Management and Accountability 26 v

SECTION FOUR: DISTRICT INSTITUTIONAL ARRANGEMENTS 27 FOR IMPLEMENTATION OF THE PLAN 4.1 Introduction 28 4.2 Management, Coordination, and Accountability Structure 28 4.3 Roles and Responsibilities of Key Actors (District Level) 28 4.4 Coordination Framework 28 4.5 Resource Mobilization Framework 29 4.6 Performance Monitoring and Accountability 29 4.7 Routine Data Collection 31 4.8 Data Management 31 SECTION FIVE: COSTING OF THE PLAN 32 5.1 Introduction 32 SECTION SIX: DISTRICT IMPLEMENTATION FRAMEWORK AND ACTIVITY DETAILS 34 REFERENCES 41

List of Tables Table 1.1: Yumbe District Population as per 2014 Census by Sex and Sub-county 14 Table 1.2: Health Service Providers in Yumbe District. 15 Table 1.3: Health Partner Mapping in Yumbe District. 16 Table 1.4: SWOT Analysis. 17 Table 4.1: Illustrative list of National Indicators to Inform the District FP CIP 29 Table 5.1: Cost for implementing the FP CIP. 32 Table 5.2: Summary costs per thematic area per Financial Year (Millions, UGX) 32

List of figures Figure 1.1: District map and location in Uganda 12 Figure 1.2: Location of health facilities and refugee population in Yumbe District 16 vi

Foreword

The Yumbe District Family Planning Costed Implementation Plan 2018/19 – 2022/23 development process was premised on the overall aspirations of the Health Sector Development Plan (2015), Vision 2040 and the FP2020 commitments as well as the National Development Plan (2015) in having a healthy and productive population.

Effort was made to align the plan to the six I call upon the Technical Planning Committee in thematic areas elucidated in the Uganda FP CIP charge of implementing the District FP CIP to namely; Demand Creation, Service Delivery and prioritize its provisions in order to address the high Access, Contraceptive Security, Financing, Policy levels of poverty occasioned by large family sizes. and Enabling Environment, and Stewardship, Management and Accountability. As a district leadership, we The development of this plan was a concerted effort commit to support all family of many family planning stakeholders including the planning interventions aimed technical and political leadership in the district. Consultations were made with the different at addressing the currently stakeholders to help identify district family planning high fertility rates of 7.9 and priorities which were the basis for costing the plan. unmet needs for family planning The vision of the district which is “An improved estimated at 34%. community from a peasant to a modern and prosperous district within the national planning continuum of 30 years” and the mission “To serve the Finally, I would like to thank all those who provided community through coordinated delivery of services input to develop the District FP CIP especially the which focus on national and local priorities and Ministry of Health and UNFPA for their technical and contribute to the improvement in the quality of life fi nancial support. I strongly hope that Yumbe District of the people” all resonate with the aspirations of the Local Government will benefi t from implementing District FP CIP. this plan.

As a district leadership, we commit to support all family planning interventions aimed at addressing the currently high fertility rates of 7.9 and unmet needs for family planning estimated at 34%. These parameters are contributed to by early onset of marriage and childbearing, religious and cultural beliefs, and preference for large family sizes as a source of sustenance and social security. vii

Preface

The Government of Uganda has for many years been faced with the challenge of a rapidly growing population with its attendant impact on the limited resources available to provide health care services in order to ensure quality of life and productivity.

The Health Sector Development Plan (2015) goal of Plan presented an opportunity for the district local accelerating movement towards Universal Health government and different stakeholders to identify Coverage (UHC) is underpinned by the notion that strategic priorities and interventions that will address UHC makes it possible to ensure that all people the low uptake of family planning services. receive essential and good quality health services they need without suffering fi nancial hardship. Participation of district local government and family planning stakeholders will be an integral feature in In this respect, the Uganda Family Planning Costed fi nancing and monitoring the implementation of the Implementation Plan, 2015-2020 has its thrust District Family Planning Costed Implementation directed towards addressing the high population Plan. Furthermore, deliberate efforts will be directed growth rate through reducing unmet need for family at harnessing the contribution of implementing planning to 10 percent as a contribution towards partners, local political leaders as well as religious having a manageable healthy and productive and cultural leaders to the achievement of the population. To realize this, the plan aims to increase desired outcomes on a sustainable basis. I wish to the modern contraceptive prevalence rate among express my appreciation to all those who worked married and women in union to 50 percent by 2020. tirelessly to produce this document. I call upon the Consequently, these aspirations needed to be population, the district local government technical cascaded to the district local government level for and political teams to spare no effort in implementing operationalization. this District Family Planning Costed Implementation Plan 2018/19-2022/23. To this end, the Ministry of Health in partnership with UNFPA set out to support Yumbe District Local Government to develop its Family Planning Costed Implementation Plan in order to increase the modern contraceptive prevalence rate among married Mr. Jalwiny Silimani and women in union. The process of preparing the CHIEF ADMINISTRATIVE OFFICER District Family Planning Costed Implementation YUMBE DISTRICT LOCAL GOVERNMENT viii

Acknowledgement

The Yumbe District Family Planning Costed Implementation Plan 2018/19-2022/23 is a product of collaborative efforts of all technical, political, religious and cultural leaders, family planning implementing partners, as well as other stakeholders.

I wish to acknowledge the input made by the District Finally, I wish to sincerely thank everyone who, in Health Team, the Planning Unit and members of the one way or the other contributed to the process of Statistical Committee, plus all other technical offi cers developing this plan but has not been acknowledged who gave valuable information during the plan above. As technical staff, we pledge to implement development process. this plan in order to contribute towards the social development of the district and Uganda at large. I wish to sincerely recognize the fi nancial support from UK aid from the UK government, through the United Nations Population Fund (UNFPA) and the UNFPA Supplies programme for developing this FP- CIP. Dr. Alfred Yayi Special recognition goes to the Ministry of Health DISTRICT HEALTH OFFICER and UNFPA for their technical support which made YUMBE DISTRICT LOCAL GOVERNMENT the plan development process successful. I also appreciate the role played by the consulting team which guided the entire process. ix

Abbreviations

ANC Antenatal Care LLG Lower Local Government BEmONC Basic Emergency Obstetric and New- MARPS Most At Risk Populations born Care MoH Ministry of Health CAO Chief Administrative Officer NGOs Non-Governmental Organizations CEmONC Comprehensive Emergency Obstetric NMS National Medical Stores and New-born Care OPD Out Patient Department CH Child Health PFP Private For Profit CS Contraceptive Security PNFP Private Not For Profit CPD Continuous Professional Development RDC Resident District Commissioner CPR Contraceptive Prevalence Rate RH Reproductive Health CSO Civil Society Organization RHU Reproductive Health Uganda DHO District Health Office SBCC Social and Behavioral Change DHS Demographic Health Survey Communications DHT District Health Team SWOT Strength, Weaknesses, Opportunities DQA Data Quality Assurance and Threats DSW Deutsche Stiftung Weltbevölkerung TC Town Council DTPC District Technical Planning Committee TOT Training of Trainers FP Family Planning UDHS Uganda Demographic Health Survey FP CIP Family Planning Costed Implementation UHMG Uganda Health Marketing Group Plan VHT Village Health Team FY Financial Year HC Health Centre HMIS Health Management Information System x

Executive Summary

The district vision is to have “An improved community from a peasant to a modern and prosperous district within the national planning continuum of 30 years” and the mission is “To serve the community through coordinated delivery of services which focus on national and local priorities and contribute to the improvement in the quality of life of the people.”

The theme/purpose is enhancing the district’s 3. Implement task sharing to increase access, effort towards sustainable wealth creation, through especially for rural and underserved populations employment and inclusive growth for improved 4. Mainstream implementation of family planning livelihood of the population.” policy, interventions, and delivery of services in multi-sectoral domains to facilitate a The Yumbe District Family Planning Costed holistic contribution to social and economic Implementation Plan reflects the local efforts to transformation complement the National Family Planning Costed 5. Improve forecasting, procurement, and Implementation Plan which is the Government of distribution and ensure full financing for Uganda commitment to reduce the unmet need for commodity security in the public and private family planning (FP) to 10 percent and increase the sectors modern contraceptive prevalence rate to 50 percent by 2020. In partnership with the central government, The above strategic priorities give direction to the the District Family Planning Costed Implementation Thematic Areas of the national CIP that are reflected Plan (2018/19-2022/23), will not only enable in the Yumbe District FP CIP namely; demand Uganda reach her FP goals, but also set a precedent creation, service delivery and access, contraceptive for the strategic direction the district has towards security, policy and enabling environment, financing, family planning. This district FP CIP is driven by the stewardship, management, and accountability. following strategic priorities: This FP CIP will cost an estimate of UGX 2,458 1. Increase age-appropriate information, access, and million Uganda shillings during the period 2018/19 use of family planning among young people, ages to 2022/23. Yumbe District Local Government will 10-24 years therefore use this plan for resource mobilization and 2. Promote and nurture change in social coordination of activity implementation by different and individual behavior to address myths, stakeholders. misconceptions, and side effects and improve acceptance and continued use of family planning to prevent unintended pregnancies Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 11

SECTION 01: Introduction and Background

1.1 Introduction Below is a brief profile of Yumbe District with The Yumbe District Family Planning Costed specific reference to location, demographic data, Implementation Plan (2018/19-2022/23) builds on health facility staffing, health facilities and socio- the Ugandan government’s political commitment economic activities, district SWOT and the process of towards increased financing of family planning at the developing the district FP CIP. London Summit 2012. Implementing her strategic commitment, Uganda developed the Uganda Family 1.2 Background Planning Costed Implementation Plan, 2015-2020. District location Yumbe District is located in the West Nile region The FP CIP reflects a “common” plan for all of Uganda. It was created in November 2000 from stakeholders involved in implementing family Arua District. It was formerly one of the counties planning activities towards a consultative, in Arua District called Aringa. It still remains a one coordinated, a streamlined management and county district. The district is located in north- accountability structure involving local government western Uganda and is bordered by the Republic of and district multi-sectoral stakeholders. South Sudan to the north, by Moyo District to the In order to foster this mandate, Yumbe District east, Koboko District to the north-west and Arua Local Government collaborated with Ministry District to the south, as illustrated in the figures of Health, UNFPA, the District Health Team, the below. Yumbe District covers a total area of 2,411 District Planning Unit, family planning implementing Km2 (which is 1.2% of the total national area), where partners, political, cultural and religious leaders 1,929 Km2 (80.01%) of the area is under agriculture, through a participatory and consultative process 411.78 Km2 (17.08%) forestry and woodlands, while to develop this district FP CIP in alignment with the water bodies and wetlands account for 70.22 Km2 national FP CIP (2015-2020). (2.912%). Family Planning - Costed Implementation Plan 12 (2018/19 - 2022/23) YUMBE DISTRICT

Figure 1.1: Yumbe District map and location in Uganda

Moyo Lamwo Kaabong Yumbe

Kitgum

Adjumani Kotido Arua Agago Amuru Pader Moroto Gulu

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

Dokolo Buliisa Apac Katakwi

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

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

Busia Kyegegwa Kasese Kamwenge Gomba

Ssembabule Kazinga Channel Buvuma

Kiruhura Rubirizi Kalangala Buhweju yantonde

L Lwengo Bushenyi Mbarara Lake Victoria

Rakai Isingiro Ntungamo

Kabale Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 13

The district is generally flat, although in its eastern Road network part are several hills, and in the north are two hills The road network in the district consists of 72 km called Midigo and Kei. Most parts of the district are of trunk, 280 km of feeder roads and 1084.4 km of agriculturally productive except the eastern part of community roads. This has made travel and economic Romogi, Kuru and Odravu sub-counties. The district activities easier within the district as the districts has loamy soil, while gravels are evident in some neighbouring Yumbe. isolated parts of Kuru, Romogi and Odravu sub- counties. The eastern part of the district along the Demographic data Nile basin is sandy. Yumbe receives an average total rainfall of 1,250 mm. The wettest months are usually Yumbe District is largely inhabited by one major August-September with more than 120 mm/month. tribe (Aringa-speaking Lugbara). They have a unified The period between December-February is dry historical origin dating as far back as 1000 A.D., with less than 60 mm/month. The rain is associated although in the mid-21st century, there was a mix with the northern and southern movements of the through intermarriages. The majority of the people inter-tropical front. Mean monthly evaporation in Yumbe District are of Nilo-Hamite origin (99%) ranges from 130 mm-180 mm. The prevailing wind is which includes Lugbara, Kuku, Kakwa and Madi, from the east to the west with frequent windstorms with those of Aringa ethnicity constituting 93% of during the dry season. Temperatures are generally the population (UPHC 2002). According to the 2014 low during the nights of dry seasons (December to Uganda Population and Housing Census (UPHC), the March) and high during day hours whereas during wet total population of Yumbe District stands at 485,582, seasons, temperatures remain high throughout. 52.7% of whom are female. Kei Sub County had the highest population of 45,759 while Ariwa had the Socio-economic activities least with 24,443. The average household size for the district stands at 7.6. The table below shows key The economy of Yumbe District is heavily dependent demographic characteristics from the preliminary on agriculture so much so that it employs over census results for 2014. 80% of the district’s population. Fertile soils and suitable climate combine to support the cultivation of a number of crops in most parts of the district. Agriculture is mainly subsistence (80%) in nature and takes place on smallholdings using simple farming tools (hoes, machetes and harrowing sticks). Only 0.5% of the population is engaged in commercial agriculture. Family members constitute the single most important source of labor.

Literacy levels The literacy rate is low at 58.7% compared to the national rate of 69.6%. Life expectancy in Yumbe District stands at an average of 45 years; 47 years for women and 43 years for men. These figures are below the national average of 63 years. Family Planning - Costed Implementation Plan 14 (2018/19 - 2022/23) YUMBE DISTRICT

Table 1.1: Yumbe District Population as per 2014 Census by Sex and Sub-county Sub County Name Average Household Size Number of Households Total Population Female Male Total Apo 7.5 5,375 21,042 19,385 40,427 Ariwa 7.2 3,380 11,956 12,487 24,443 Drajini 6.8 4,463 15,788 14,740 30,528 Kei 7.0 6,490 24,675 21,084 45,759 Kerwa 7.2 4,153 15,897 13,921 29,818 Kochi 7.5 5,379 21,366 18,876 40,242 Kululu 7.1 5,084 19,278 18,106 37,384 Kuru 8.2 5,128 23,639 19,043 42,682 Lodonga 7.6 4,146 17,033 15,559 32,592 Midigo 7.9 4,793 20,363 17,488 37,851 Odravu 6.8 6,509 23,314 21,004 44,318 Romogi 9.5 4,449 22,339 21,593 43,932 Yumbe Town Council 8.0 4,373 19,081 16,525 35,606 Yumbe District 7.6 63,722 255,771 229,811 485,582 Source: UBOS, 2014 and generated from Yumbe District harmonised database 2015 factsheet

Fertility rate This is a big gap given the increasing number of Yumbe’s total fertility rate has generally remained emerging diseases and the increasing population high, at 7.9 in 2016 (UDHS, 2016). The reasons that leaves essential services like family planning for high fertility include early onset of marriage underserved and under prioritized in service delivery. and childbearing, religious and cultural beliefs, The shortages in health sector staffing have several and preference for large family sizes as a source implications for service delivery. Key health workers of sustenance and social security. Nevertheless, required at some levels of health care are absent or the unmet need for family planning remained high not maintained which is caused by high staff turnover. at 34 percent as of 2016. The district modern Consequently, some health centers do not offer contraceptive prevalence rate is low i.e. 6.1% particular family planning services, especially long compared to the national average of 35% (UDHS, term FP methods, due to the fact that the required 2016). professionals are not retained or are not allocated.

District human resources for health Additionally, health facilities at the border with other districts serve wide catchment populations due to The human resource for health staffing levels in the the surge of refugees from South Sudan, resulting in district is low. The number of persons per doctor ratio increased workloads for available staff. This creates a is very high i.e. 63,311 persons per doctor compared need to motivate them in order to retain them in high to the national average of 18,600 persons per doctor. risk areas. To compound matters, stock-outs of some The person per nurse ratio is also alarmingly high at drugs and other related pharmaceutical supplies, as 12,666 against the national average of 7,700 persons well as long queues, also make delivery of services per nurse. problematic. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 15

Health facilities Yumbe District has 30 operational public and PNFP health facilities which include: one general hospital, one HCIV and 10 HCIIIs and 18 HCIIs. There are two PNFP units in Yumbe namely; Lodonga HCIII and Kei HCIII. The district experiences limited access to health facilities and comprehensive health care. Only 55% can access health services within five kilometres. The majority (20/30) are HCIIs with limited service scope.

Table 1.2: Health Service Providers in Yumbe District Sub county Health unit Ownership HC Level Kuru Yumbe Hospital Government V Midigo Midigo Government IV Midigo Mocha Government II YTC Yumbe Government IV Kei Kei PNFP III Kei Matuma Government III Kei Lobe Government II Kei Tuliki Government II Kei Gichara Government III Kochi Kochi Government II Kochi Lokpe Government II Kochi Goboro Government II Ariwa Ombachi Government II Lodonga Lodonga PNFP III Ariwa Ariwa Government III Ariwa Okuyu Government II Kululu Yoyo Government III Kululu Aliapi Government II Odravu Kulikulinga Government III Odravu Abiriamajo Government II Odravu Ambelechu Government II Odravu Moli Government II Drajini Dramba Government III Drajini Pajama Government II Drajini Mongoyo Government II Apo Apo Government III Kochi Alnoor Government II Romogi Barakala Government III Romogi Locomgbo Government II Kerwa Kerwa Government II Family Planning - Costed Implementation Plan 16 (2018/19 - 2022/23) YUMBE DISTRICT

Refugee Popiulation by District (As of 01 July 2017)

Indicators (Imvepi 12-22 July 2017)

Public Health Medically 4032 Screened Measles Immunisation 2030 6months - 15years Polio Immunisation 1023 0-59months

Nutrition Total Screened 827 6-59 months 5% Proxy GAM

Source: Yumbe District Development Plan (2015)

Development Partners in the district as at the end of 2015 Yumbe District has partners within the health sector supporting different areas. Table 1.3 shows the different partners and their form of support to the district.

Table 1.3: Health Partner Mapping in Yumbe District

No. Partner Intervention areas Coverage 1 Infectious Diseases Institute Comprehensive HIV care, Human Resources for DHO (sub-grants) and (IDI) Health (HRH) 8 HFs 2 UNFPA Reproductive Health Entire district 3 UNICEF Child and Maternal Health, Nutrition, HIV/AIDS, Entire district HRH, Child Protection, Basic Education 4 Belgian Technical HSS (different aspects), Results Based Financing Entire district, PNFP Cooperation Agency HFs 5 CUAAM Child and Maternal Health, Nutrition Entire district 6 Monitoring and Evaluation HIV and AIDS M&E Technical Support Entire district Technical Support Program 7 Calvary Chapel Midigo Community Based Health Services, HRH Midigo HC S/C (HCIV) 8 Marie Stopes Uganda Comprehensive FP Outreaches Entire district 9 Uganda Protestant Medical Comprehensive Support Lodonga, Kochi and Bureau and Uganda Muslim Kei S/Cs Medical Bureau 10 Refugee Health Partners Integrated PHC Services; Maternal, Child Refugee settlement Health, Mental Health , Nutrition areas (5 S/Cs) Source: Yumbe District Health Plan (2017/2018) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 17

1.3 SWOT Analysis for Family Planning Services The analysis for the district examined the Strengths, Weaknesses, Opportunities, and Threats (SWOT) for the family planning services in Yumbe District (Table 1.4). Strengths Strategies to optimize • Availability of trained and professional health • Continuous professional development for health staff in the public sector facility staff in quantification, forecasting, ordering and • Supported community outreaches monitoring of stocks • Existence of regulatory framework and laws • Increase facilitation of outreaches through partnerships • Strong political, technical and administrative with implementing partners or Development Partners will • Creating awareness of existing frameworks to help health workers and clients make informed decisions about FP services and commodities • Ensuring that all leadership positions are filled to create stronger will Weaknesses Strategies to minimize • Limited FP choices • Increase method mix and train health workers on • Inadequate transport facilities to support provision of all FP methods • Management and service delivery • Strengthen partnerships with FP implementing partners • Inadequately qualified human resource to support service delivery • Inadequate and untimely medical supplies • Focus on continuous professional development and in- • Shortage of staff accommodation at the health service training for health workers and education facilities • Continuous advocacy for NMS to respond to district • Poor health seeking behavior and supplies needs underutilization of reproductive health • Advocate increased funding for the health department facilities • Intensify community sensitization through tailored social • High population growth rate behavior change communication and promote use of FP • High level of illiteracy among the population services • High level of poverty Opportunities Strategies to optimize • Additional recruitment of healthcare • Creating more partnerships for health to create a larger workforce by IPs impact in FP service delivery or implementation • Availability of platforms for dialogue and • Ensuring that these platforms are used to the maximum negotiation to convey FP messages to the people using clear and • Existence of enabling policies, laws and simple messages regulations supporting family planning in • Creating policies that support demand creation and Uganda provide an enabling environment for the uptake of FP • Existence of implementing partners and PNFP services in the health sector • Integration of the interests of IPs with those of the • Demonstrated commitment by the districts in order to create a bigger impact for health government • Using the guidelines and regulatory frameworks to • Availability and willingness of community manage FP at district and facility level volunteers and Villages Health Teams (VHTs) • Continuous training and facilitation of VHTs to • Presence of FP male champions in the district strengthen their capacity as part of the community gatekeepers for health • Use of the male champions to mentor other men to increase male involvement Family Planning - Costed Implementation Plan 18 (2018/19 - 2022/23) YUMBE DISTRICT

Threats Strategies to mitigate • Brain drain of public health work force to • Ensuring safety of health workers, distribution humanitarian NGOs due to influx of refugees of sufficient numbers of health workers and staff in the region motivation to ensure high retention rates • Community held misconceptions against • Developing age and culture appropriate information on family planning by potential FP services users FP to enhance voluntary informed decisions to utilize FP • Some religious and cultural leaders services condemning FP as it is perceived to promote • Continuous engagement with religious and cultural immorality leaders on the importance of family planning • Lack of partner support • Use male FP champions to influence partners • Pressure and competition to give birth • Continuous community sensitization about pressures especially in polygamous families that come with big families brought about by poor FP practices

1.4 Process of Developing the District FP CIP The process of developing the district Family Planning Costed Implementation Plan started with a comprehensive desk review to systematically understand the conceptual issues around family planning in general and Yumbe District in particular. The process entailed wider involvement and consultation of key stakeholders. At district level, stakeholders were drawn from the District Council, District Health Team, District Planning Unit, FP Development Partners, cultural and religious leaders, private sector, community volunteers and civil society organizations. All lower local governments were represented in the District Technical Planning Committee for their inputs. Data for the district FP CIP was informed by both secondary and primary data collected through: (a) desk reviews, (b) meetings with technical staff (c) district level key informant interviews, (d) lower level local government consultative meetings, and (e) community and health facility visits. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 19

SECTION 02: The case for Yumbe District FP Costed Implementation Plan Family Planning - Costed Implementation Plan 20 (2018/19 - 2022/23) YUMBE DISTRICT

2.1 Introduction • There is increased gender-based violence since This section presents a detailed analysis and women do not want their spouses to know that literal review of key issues which influence the they are on family planning, contraceptive prevalence rate. As detailed in the • There are other determinants of health like Uganda National FP CIP 2015-2020, the review education and bad roads, ignorance and low school and analysis is categorised along the following main completion rates which impact on demand and use themes: of FP services, • Demand Creation • The ever growing numbers of refugees who • Service Delivery and Access access services yet the resources are inadequate • Contraceptive Security compromise the quality of health services • Policy and Enabling Environment provided, • Financing • The human resources for health are grossly • Stewardship, Management and Accountability inadequate which in turn impacts on the scope of FP services provided, 2.2 Demand Creation • Diverse cultures and beliefs hinder the uptake of Increasing awareness of modern family planning FP services, methods, how to access them and their contribution • There are inadequate FP information, education to improved health and development outcomes and communication materials, and is critical, and should be part of a government’s • Family planning is perceived to promote immorality commitment to contraceptive security. Awareness and prostitution especially among religious and of at least one method of contraception in Uganda cultural leaders. is universal (UDHS, 2016). In Yumbe District, there are fears of side effects mixed with misconceptions 2.3 Access to Service Delivery and Yumbe about family planning services. Some locals harbour District Family Planning Uptake the feeling that contraceptives promote promiscuity, Family planning services uptake in Yumbe District immorality and prostitution. In addition, information is still low. This is due to high stock-out levels of FP is given about the available contraceptives but not methods especially Depo-Provera which is the most about all methods. preferred method. This is coupled with low numbers of trained health workers as well as a limited number In order to create demand for FP services, Yumbe of health facilities which are able to provide FP District has been conducting static and outreach services. Yumbe District is, however, constrained FP services provision, FP camps by partners (RHU, to recruit and retain the critical health workers to PACE) in addition to distribution of condoms, oral offer high quality health care services due to its contraception and Sayana Press by VHTs. The district remoteness and lack of adequate housing for its staff. has also been providing information through drama conducted by FP champions as well as radio talk 2.4 Contraceptive Security shows as part of community mobilization. During the The need or demand for contraceptives, and the stakeholders’ meeting, it was also revealed that: supply of contraceptives, are dependent on each • There is a high level of stock-outs of medicines other. As women’s demand for contraception (reported at 79%), which negatively impacts on increases, the need for governments, donors, service demand creation, manufacturers and other stakeholders to supply FP • First-time family planning users are at 12% but methods becomes increasingly critical. there has been a high level of discontinuation rates The Ugandan government is the major provider due to poor management of FP side effects, of contraceptive methods, accounting for 47% • The number of health facilities to meet the health free supply of contraceptives (UDHS, 2016). This care needs of the large district population is guarantees freedom of choice by FP users. inadequate, Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 21

To supply FP commodities to the service delivery This shortage of funding is further confirmed points, the government operates both a push system in the Yumbe District Health Plan (2017/2018) (for HCIII and HCII), which is not client-centred where family planning activities are not captured and does not guarantee and promote free choices in the annual health sector work plan but rather in contraceptive use, and a pull system, where the consolidated in public health funds and integrated hospitals and HCIVs are able to requisition according into HIV services or antenatal care services. to the needs of communities. The district strives to maintain an adequate supply of FP commodities but is 2.7 Stewardship, Management and constrained by; late deliveries by NMS; an inadequate Accountability District leadership Health Information Management System which The Yumbe District leadership is committed contributes to poor quantification and forecasting; to supporting FP services delivery given the insufficient district and health unit storage contribution towards social development. The facilities; and expiry of some FP commodities due to development of this FP CIP was strongly supported preferences of certain FP methods. by the district’s political and technical leaderships and there was commitment to support funding and 2.5 Policy and Enabling Environment coordination to actualize the aspirations of this plan. According to the national FP Costed Implementation Plan (2015-2020), the current policy environment is Family planning partnerships conducive for strengthened implementation of the FP Yumbe District Local Government plans to programme in Uganda. Family planning is recognized strengthen its partnerships with implementing as a key strategy to promote social, economic, and partners, Development Partners, the private sector, environmentally sustainable development, to realize cultural and religious leaders to implement this sexual and reproductive health and reproductive plan. It was noted that this partnership will help in rights, and to improve the health of women and their addressing the major family planning services access children by preventing unintended pregnancies and and utilization challenges identified in the SWOT improving child spacing, thus reducing maternal and analysis. neonatal morbidity and mortality. Data collection, analysis and use The Ugandan government has developed Data on FP service utilization in Yumbe District is national policies and plans such as the Uganda collected using the Health Management Information Population Policy, National Gender Policy, National Systems (HMIS) tools from health centers and Development Plan, National Health Policy, Health forwarded to the district biostatistician for onward Sector Strategic and Investment Plan, and the routine reporting to Ministry of Health through the National Family Planning Advocacy Strategy among DHIS2. In each health facility, there is a designated others. What remains to be done is popularizing staff responsible for records management using these policies among key district stakeholders. Ministry of Health standardized tools. At the district Health service providers, religious, cultural and level, the biostatistician reviews data and schedules district local leaders are not sufficiently aware of the review meetings with the HMIS focal persons. This key policy provisions and attendant implications for is to guarantee data integrity and quality. In some the development of the country. instances, there are supervisory visits to lower health facilities. Data is consolidated and analysed at the 2.6 Financing health facility and district levels and used for planning A review of Yumbe District’s health budget for the and decision making. last five financial years 2010/11-2015/16, indicates no direct funding for family planning services. The budget however, caters for some reproductive health activities. Family Planning - Costed Implementation Plan 22 (2018/19 - 2022/23) YUMBE DISTRICT

SECTION 03: District Strategic Priorities

3.1 Introduction 3.2 Vision, Mission, Core Values and Goal This section delves into the strategic priorities for FP The vision of the district which is “An improved in Yumbe District based on the priorities highlighted community from a peasant to a modern and in the National FP CIP 2015-2020. The priorities are prosperous district within the national planning aligned to the national level strategic outcomes and continuum of 30 years” and the mission “To serve the feed into the district vision, mission and goal. community through coordinated delivery of services which focus on national and local priorities and contribute to the improvement in the quality of life of the people” all resonate with the aspirations of the district FP CIP. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 23

The district’s core values are: In order to ensure that the limited resources are 1. Transparency directed to areas that have the highest potential 2. Accountability to reduce the unmet need for family planning and 3. Teamwork also achieve the district’s stated goal, the activities under this plan are structured around six thematic Goal:In line with the national operational goals of areas namely; 1) demand creation; 2) service delivery reducing the unmet need for family planning to and access; 3) contraceptive security; 4) policy 10 percent and to increase modern contraceptive and enabling; 5) financing; and 6) stewardship, prevalence rates among married and women in union management and accountability. to 50 percent by 2020, the goal of Yumbe District FP 3.3.1 Demand creation Costed Implementation Plan is: “To increase the Strategies modern contraceptive prevalence rate amongst Yumbe District Local Government has been married and women in union to 56 percent by 2021” implementing social behavioral change communication campaigns which have hitherto not 3.3 District strategic priorities in FP adequately addressed specific information needs This plan is aligned to the national FP CIP whose based on the social demographic disparities of the priorities include: population sub segments. This was founded on the limited capacity of the district to localize the Priority 1: Increase age appropriate information, national social and behavior change communication access and use of family planning among young (SBCC) strategy in order to address the local FP people ages 10-24 years information needs and campaigns. As such, this plan will direct its thrust towards population Priority 2: Promote and nurture change in social and segmentation and targeting them with clear individual behavior to address myths, misconceptions messaging on family planning. This will be grounded and side effects and improve acceptance and in the need to bringing into the fold the current non- continued use of family planning to prevent users of contraception who have high motivation unintended pregnancies to adopt. This population sub category will then be used to act as FP champions to address myths Priority 3: Implement task sharing to increase access, and misconceptions to their non-user peers, which especially for rural and underserved populations is deemed as important and critical to demand creation. As a culturally diverse district, there is Priority 4: Mainstream implementation of FP policy, need to package messages in languages that serve interventions and delivery of services in multi- different tribal segments so as to tackle myths and spectral domains to facilitate a holistic contribution fears of both users and non-users of contraception. to social and economic transformation. Integrating gender in FP approaches is also critical to improving male involvement in interventions on Priority 5: Improve forecasting, procurement and FP. As informed by the District HMIS data, gender distribution and ensure full financing for commodity analysis shall be integrated into the district FP security in the public and private sectors approach so as to gauge male involvement. Overall, the demand creation approach in FP in Yumbe These priorities are derived from the Health Sector District will be people-centered, coupled with Development Plan 2015/16 - 2019/20 and are innovative outlets such as mobile health advocacy the basis for financial resource allocations and campaigns and use of information communication implementation performance. technologies. Family Planning - Costed Implementation Plan 24 (2018/19 - 2022/23) YUMBE DISTRICT

The district will support the social marketing of free 3.3.2 Service Delivery and Access FP commodities services by the PNFP actors and Strategies social marketing organizations as well as the private Yumbe District Local Government will adopt a sector. This will facilitate the reach of FP services to rights-based approach that includes informed choice, rural underserved communities through providing free and informed consent, respect to privacy and information about FP service. confidentiality, equality and non-discrimination, equity, quality, client-centered care, participation Strategic district outcomes and accountability. Interventions will further address Demand for FP services in Yumbe District increased limited geographical and economic access to FP Yumbe District Local Government will increase the services especially among rural and the poorest percentage of women in reproductive age group populations. It will further reduce inequities related (15–49 years) demanding FP services using a social to poverty, HIV status, gender, age, and marital status behaviour change communications strategy. The in access to and use of FP. Local, cultural, and religious strategy will make use of a multimedia approach leaders will be sensitized about the importance of using the local community radio, infotainment and supporting family planning. Young celebrities within community dialogues which will be organized at the district will be targeted to act as role models but village levels, places of worship, other gathering also champion the advocacy platform in FP service places and community markets. Efforts will be made delivery. to target special groups including religious leaders, traditional and cultural leaders, young people, Strategic outcomes men and Most at Risk Persons (MARPS) including Access to FP services increased sex workers through multilingual and age specific Service delivery points at community level will be messages. increased through FP outreaches and partnership with the private sector like drug shops and social Support for the use of modern contraceptives by marketing organizations especially among the men and their partners enhanced underserved communities. Efforts will be made to Yumbe District Local Government will increase reach out to people with special needs like persons the number of male champions in order to support with disabilities as well as young people. Village use of modern contraception among their peers. Health Teams and FP champions will be used to Deliberate efforts will be taken to use any available mobilize communities, refer clients and make opportunities to advance the cause of family planning follow-ups of FP service users to help in addressing among men with age specific messages. At all health misconceptions as well as side effects. Youth-friendly facilities, male friendly services will be established. services will also be integrated in FP service delivery through training of service providers in addressing Knowledge about and use of FP services by young their special needs as well as FP service delivery people, 10-24 years increased outside routine hours. Yumbe District Local Government will provide specific information about FP to young people with Referral services strengthened the aim of empowering them to make informed FP Yumbe District Local Government will create decisions as one of the measures to address teenage a referral directory for FP. The District Health pregnancies. Community champions and VHTs will be Officer and Assistant District Health Officer will reskilled and retooled in order to reinforce positive ensure appropriate referral tools are used in the behavior towards FP uptake. referral systems and that all clients referred receive appropriate services. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 25

Motivation for FP health care workers enhanced Health facility in charges and staff responsible for Given the specialized skills required by health forecasting and quantification of drugs and supplies workers to deliver long-term reversible and will be supported through training and records permanent FP methods, appropriate trainings management in order reduce stock-outs. and continuous professional development will be enhanced. This will motivate health workers to meet Strategic outcomes the service needs of their clients. Furthermore, Availability of FP commodities improved health workers will be actively involved in FP decision Stock-out of FP drugs and supplies will be minimized making processes as well as provision of transport to through effective records management that provide community-based FP services. support effective forecasting and quantification as well as tracking of stocks. The district will further Integration of FP services into other health strengthen the alternative distribution mechanisms services enhanced in order to minimize stock-outs. Yumbe District Local Government will integrate FP into other services like cervical cancer screening; post-abortion care; prevention and treatment 3.3.4 Policy and Enabling Environment of sexually transmitted infections, including HIV Strategies prevention, care, and treatment; and malnutrition Yumbe District Local Government will align all programmes as a cost containment measure. This will FP activity implementation with the national FP enable clients access a wide scope of services at one CIP. To improve the policy environment for family point and minimize revisits. planning, government policies and strategies will be disseminated to all relevant district stakeholders. Management of family planning side effects Specific advocacy will also be conducted to ensure improved that policies and guidelines for family planning Family planning side effects are among some of the promote access to FP services to underserved reasons for high discontinuation rates in Uganda. communities and youth while ensuring that provision As such, Yumbe District Local Government will of FP services is in accordance with human rights and strengthen counselling and referrals as well as follow quality of care standards. up of clients to address their concerns. The New Medical Eligibility criteria will be adhered Strategic outcomes to enable health workers guide the clients on the Knowledge about policies on family planning choices of family planning. improved The legal framework that promotes family planning 3.3.3 Contraceptive Security will be popularized through dissemination of these Strategies documents to District Health Teams (DHTs), District In order to guarantee availability of family planning Technical Team, religious and cultural leaders as well commodities, Yumbe District Local Government will as other implementing partners and stakeholders. work closely with the central government through A simplified district family planning handbook with Ministry of Health and specifically National Medical standard information shall be developed and widely Stores (NMS) to ensure supply of FP drugs and disseminated. supplies. The district will also work with Uganda Health Marketing Group (UHMG) and Joint Medical Store (JMS) through the alternative distribution mechanism to address issues of stock-outs. Storage facilities at district and health facility level will be improved to ensure quality of drugs and supplies. Family Planning - Costed Implementation Plan 26 (2018/19 - 2022/23) YUMBE DISTRICT

3.3.5 Financing The District Health Management Information System Strategies (HMIS) focal person will ensure timely and quality Family planning activities will be integrated into data management and analysis to inform planning the district’s budget framework paper to ensure and 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 government. Social marketing will be strengthened as As a requirement of the Local Government Act a basis for accessing FP services at subsidized costs (1997), the Resident District Commissioner (RDC), for those who can afford. Advocacy for increased District Chairperson, Secretary for Health, Health funding for training and support for midwives Sectoral Committee and the entire District Council and nurses at lower-level health facilities will be will play an oversight function to ensure that all strengthened to help increase the national financial services are delivered to all people in Yumbe District. investment for human resource development for The Chief Administration Officer will play the role of health. inter-departmental mainstreaming and coordination of FP interventions. All lower local political leaders Strategic outcomes will be oriented to offer oversight roles to ensure high Financing for family planning services increased levels of accountability. Advocacy for the creation of budget lines for The district will hold quarterly review meetings with family planning at the district level will support the the different stakeholders in the district. Further, prioritization and integration of family planning the district shall commit resources to efficiently and into district planning and budgeting processes. At timely monitor and supervise the family planning least one percent of the total local revenue shall be activities. allocated to the health sector and in particular to family planning. Strategic outcomes Capacity at the district to lead, manage and 3.3.6 Stewardship, Management and coordinate the FP program strengthened Accountability The DHT capacity to implement this plan will Strategies be strengthened through tailored trainings A robust stewardship will be essential in and improving on the monitoring and reporting implementing this plan. As such, Yumbe District Local mechanisms through the District Health Information Government leadership will provide stewardship System (DHIS2). through effective monitoring, management and accountability as essential for operationalization Reporting of family planning indicators strengthened of the plan. At the district level, the District Through training and sharing of reporting tools, Health Officer (DHO) will lead the technical level health workers will improve their reporting on family supported by the District Health Team (DHT) to planning indicators. The district will track activities effectively monitor, coordinate, lead and ensure including financial data outputs, and coordinate good governance of family planning activities at quarterly data sharing with the implementing all levels in the district. The DHT will be trained to partners and other relevant stakeholders. The effectively coordinate and manage family planning identified performance gaps will form a basis for services. All activities of family planning (by both refresher training. A mid-term review and final government and private not for profit organizations) evaluation of the CIP will be conducted to establish will be tracked by the DHO’s office through Ministry progress, success and inform future FP strategy of Health designed tools and electronic database. development. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 27

SECTION 04: District Institutional Arrangements for Implementation of the Plan

4.1 Introduction the national FP CIP, Yumbe District will follow Yumbe District Local Government FP-CIP will management, coordination and accountability be implemented in line with the national health structures, as outlined below. framework and within the decentralization realm. Working closely with the central government, 4.2 Management, Coordination, and whose leadership and governance responsibility Accountability Structure is prescribed in the National Health Policy, Yumbe Yumbe District Local Government FP CIP recognizes District Health Office, along with the District Health that the Ministry of Health takes stewardship and Team, the Chief Administrative Officer (CAO) and spearheads the planning, financing, implementation the District Council Chairperson (LC 5) will engage and performance monitoring of the district FP CIP, various stakeholders to create opportunities for to feed into the national FP CIP. This district FP CIP coordination and management of the national will be implemented by the District Health Office FP effort. Successful implementation of this plan and supported by civil society organizations (CSOs), will depend on how well the district effectively community based organizations (CBOs), women mainstreams FP in all departments and programmes groups and faith-based organizations among others. through stewardship by the CAO. In tandem with Family Planning - Costed Implementation Plan 28 (2018/19 - 2022/23) YUMBE DISTRICT

4.3 Roles and Responsibilities of Key Actors 4.4 Coordination Framework (District Level) District level District Local Council V Office In Yumbe District, coordination of this district FP CIP The district political leadership under the LCV will be led by the CAO and DHO through organized chairperson will among others play the role of multi-sectoral stakeholders’ approach. This will community mobilization and sensitization for FP; include the district FP steering committee, chaired by influencing allocation of resources for FP; and the Local Council V (LCV) and a district FP technical enforcement of relevant policies. working group, chaired by the District Health Officer or the Assistant DHO. At the technical level, it is Chief Administrative Office proposed that quarterly review meetings be held Consistent with the national FP CIP coordination with the DHT members and the decisions shared with structure, this district FP CIP will through the the relevant stakeholders. office of the Chief Administrative Officer (CAO) enforce coordination, planning, resource allocation, 4.5 Resource Mobilization Framework implementation, monitoring and evaluation for FP Through concerted efforts, Yumbe District Local services in the district. Government will commit a percentage of its local revenue towards FP and continue lobbying and District Health Officer (DHO) and Assistant DHOs advocating increased donor support. The district Given the administrative stewardship of health budget framework paper will reflect a commitment services in Yumbe District Local Government, towards increased financing of FP over the five-year the DHO will oversee the implementation of the period. Informed by the district funding gaps, the district FP CIP. Consistent with the national FP CIP, Yumbe District Planner and the Chief Finance Officer the DHO will work closely with the CAO to plan will forecast and project resource implications for FP and allocate financial resources for FP within the financing. district health budget. The DHO and the Assistant DHO will mobilize partner efforts towards FP in 4.6 Performance Monitoring and Accountability Yumbe District, as well as offer technical support to Measuring Yumbe District performance against the implementing partners, institutional-based health national FP CIP targets will be critical during the workers, FP champions and VHTs at village level. implementation period. As expounded under the monitoring and evaluation section in this district Civil society and non-governmental organizations FP CIP, routine monitoring will be done through the DHIS2. Reporting on performance will be made to Yumbe District Local Government has a multiplicity the Ministry of Health through the coordination of civil society organizations which include United mechanism as prescribed by the national FP CIP. Nations Population Fund (UNFPA), Marie Stopes Key performance targets will be based on the International Uganda and Reproductive Health strategic priorities stipulated in the national FP CIP. Uganda, among others. This district FP CIP will, It is anticipated that district performance towards through the CAO and DHO engage these actors to the national FP CIP will be shared in MoH review/ ensure provision of financial resources towards FP strategic planning meetings. Below is a list of and delivery of quality FP services, but also advocate indicators as adapted from the national FP CIP (2015- for increased demand for the services. 2020): Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 29

Table 4.1: Illustrative List of National Indicators to Inform the District FP CIP 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 (CYP) • Unmet need • Teenage pregnancy rate Service • Number of women receiving counseling or services in family planning— HMIS statistics 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 progress • Availability of accessible, relevant, and accurate monitoring information about sexual and reproductive health database tailored to young men Service • Number of providers trained on family planning by • Activity reports Delivery and district • Programme Access • Number of mobile clinic events organized, and number surveys of people reached by district • FP CIP progress • Number of youth-friendly service clinics established monitoring • Availability of accessible, relevant, and accurate database information about sexual and reproductive health tailored to young men Contraceptive • Contraceptive stock-outs • HMIS Security • Actual annual contraceptives delivered for the public • Activity reports sector • Programme • Percent of facilities that experienced a stock-out at surveys any point during a given time period • FP CIP progress monitoring database Policy and • Evidence of FP programmes incorporated into Enabling national 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) Family Planning - Costed Implementation Plan 30 (2018/19 - 2022/23) YUMBE DISTRICT

• Evidence of targeted public and private sector • Activity officials, faith-based organizations, or community reports leaders publicly demonstrating a new or increased • Programme commitment to family planning surveys • Documentation of instances in which a formal • FP CIP progress implementation or operational directive or plan is monitoring issued to accompany a national or sub national FP database policy Financing • Annual expenditure on family planning from local • Activity revenue budget reports • Evidence of new financing mechanisms for family • Programme planning identified and tested surveys • Evidence of private for-profit sector participation in • FP CIP progress family planning monitoring • Share of contraceptive procurement for the public database sector financed by the government Source: Adopted from National FP CIP (2015-2020)

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 forward it to the district Capacity building biostastician for onward submission to Ministry of Health. The primary consumption data at all It is envisaged that HMIS staff and other health health facilities (government, PFP and PNFP) will workers will be oriented and trained in data be captured in hard copies and where possible, an collection, assurance, and analysis. The training will electronic (HMIS) database will be maintained. be on-job and where necessary, offsite training will be arranged by the office of the DHO. This will ensure 4.8 Data Management that data tools are completed accurately. Data Quality Assurance Mechanism The district biostastician will play a lead role in Information dissemination and use ensuring Data Quality Assurance (DQA) collection, 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) YUMBE DISTRICT 31

SECTION 05: Costing of the Plan

5.1 Introduction The costing of the strategic activities is informed by the concept of allocative efficiency where resources will be prioritized to areas that generate optimal results. Additionally, it is assumed that FP drugs and supplies will be provided by NMS. As such, they have not been costed. Family Planning - Costed Implementation Plan 32 (2018/19 - 2022/23) YUMBE DISTRICT

Table 5.1: Cost for implementing the FP CIP District Priority Strategic Outcomes FP costs per year in UGX millions Total 2018/19 2019/20 2020/21 2021/22 2022/23 Demand Creation Demand for FP services in Yumbe District increased 70 70 75 75 75 365 Support for the use of modern contraceptives by men 30 30 30 30 30 150 and their partners enhanced Knowledge about and use of FP services by young 55 55 50 50 50 260 people, 10-24 years increased Service Delivery Access to FP services increased 60 60 70 70 70 330 and Access Referral services strengthened 15 15 15 15 15 75 Motivation for FP health care workers enhanced 16 16 16 17 17 82 Integration of FP services into other health services 40 40 50 50 50 230 enhanced Management of family planning side effects improved 30 30 30 40 50 180 Contraceptive Availability of FP commodities and supplies improved 13 13 13 13 13 65 Security Policy and Enabling Knowledge about policies on family planning 9 9 7 7 7 39 Environment improved Financing Financing for family planning services increased 2 2 2 3 3 12 Stewardship, Capacity at the district to lead, manage and 80 80 80 90 90 420 Management and coordinate the FP program strengthened Accountability Reporting of family planning indicators strengthened 50 50 50 50 50 250 TOTAL 470 470 488 510 520 2,458

Table 5.2: Summary costs per thematic area per Financial Year (Millions, UGX) District Priority FP costs per year in UGX millions Total 2018/19 2019/20 2020/21 2021/22 2022/23 Demand Creation 155 155 155 155 155 775 Service Delivery and Access 161 161 181 192 202 897 Contraceptive Security 13 13 13 13 13 65 Policy and Enabling Environment 9 9 7 7 7 39 Financing 2 2 2 3 3 12 Stewardship, Management and Accountability 130 130 130 140 140 670 TOTAL 470 470 488 510 520 2,458

The total financial outlay for implementing this plan will be 2,458 billion Uganda shillings over the five-year period. The highest percentage of this budget will go towards service delivery and access (897 million Uganda shillings). In the first year, it is projected that 470 million Uganda shillings will be invested. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 33

SECTION 06: District Implementation Framework and Activity Details Family Planning - Costed Implementation Plan 34 (2018/19 - 2022/23) YUMBE DISTRICT

Table 6.1: Implementation Framework by thematic areas Strategic Outcomes Expected Results Activity Sub Activities Inputs Output indicators Timeline AREA #1: Demand Creation (DC) DC1 : Demand for FP services is Women ages 15-49 years with • Align Yumbe District communication • Receive technical support to develop a • Resources for technical • District specific communication 2018 increased demand for family planning (met strategy with national strategy with communication strategy Disseminate assistance and strategy developed and disseminated demand and unmet demand) evidence-based messaging strategy dissemination meetings to relevant stakeholders • Implement a mass media campaign on FP • Design FP messages • Resources for airing spots • Number of radio spots purchased 2018 through based on the district communications • Purchase media space for FP messaging on radios and TVs, and and aired per week to 2023 strategy (radio and TV) airtime for radio and TV talk • Number of quarterly discussions held shows on TV • Mobilize cultural leaders and community • Engage cultural and community leaders • Resources for mobilizing, • Number of cultural leaders sensitized 2018 leaders working on HIV, PMTCT, GBV, MCH in workshops to orient them in FP training and follow-up of on FP messaging to participate in sensitization to include FP messaging trained leaders in their work • Conduct follow-ups of trained leaders DC2: Men support the use Number of men who support the • Conduct monthly community outreach • Conduct community mobilization • Resources for community • Number of community outreach Quarterly of modern contraceptive for use of modern contraception for events to engage men in family planning through multimedia approaches mobilization, men days events held scale-up themselves and partners themselves or their partners in • Conduct men special days and community outreach • Number of men reached through Yumbe District • Facilitate community outreaches event, and for design and special days distribution of IEC materials DC3: Young people, 10-24 years Young people 10-24 years are • Engage peers and champions to educate • Participate in youth camp for FP • Resources for facilitating • Number of youth camps held 2018 through old are knowledgeable about knowledgeable about FP and young people about family planning services conducted youth camp to 2023 family planning accessing FP services • Participate in the development of youth • Resources for facilitating • Number of Yumbe District youth 2018 through plans for FP supervised by MoH development of youth plans plans supervised by MoH to 2023 on and supervision by MoH quarterly basis • Disseminate educational yearly youth • Disseminate youth magazine • Resources for dissemination • Youth magazine disseminated 2018 through magazine that describes youth FP activities, of youth magazines annually to 2023 programs and services distributed to youth corners and peer education • Empower parents, caregivers and • Participate in workshops with teachers • Resources for facilitating • Number of parents, caregivers and 2018 through teachers to help their children to avoid and parents to orient them on how best workshops and house visits teachers participating in dialogues to 2023 teen pregnancy, including parent- child to talk to youth about FP and workshops communication on sexual issues • Facilitate house visits to support parents • Number of dialogues and workshops on communication to young people conducted about FP • Hold “edutainment” community events • Mobilize communities for edutainment • Resources for conducting • Number of events held 2018 through like dances , music concerts and sports events edutainment events to 2023 competitions to provide opportunity for • Conduct community edutainment shows knowledge exchange amongst young people 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 through products and commercial sector condoms initiated and evaluated sector condoms to see if overall uptake on social marketing awareness events and to 2023 increases FP increases in Yumbe • Distribute branded free public sector distribution of branded free condoms public sector condoms Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 35

Strategic Outcomes Expected Results Activity Sub Activities Inputs Output indicators Timeline AREA #1: Demand Creation (DC) DC1 : Demand for FP services is Women ages 15-49 years with • Align Yumbe District communication • Receive technical support to develop a • Resources for technical • District specific communication 2018 increased demand for family planning (met strategy with national strategy with communication strategy Disseminate assistance and strategy developed and disseminated demand and unmet demand) evidence-based messaging strategy dissemination meetings to relevant stakeholders • Implement a mass media campaign on FP • Design FP messages • Resources for airing spots • Number of radio spots purchased 2018 through based on the district communications • Purchase media space for FP messaging on radios and TVs, and and aired per week to 2023 strategy (radio and TV) airtime for radio and TV talk • Number of quarterly discussions held shows on TV • Mobilize cultural leaders and community • Engage cultural and community leaders • Resources for mobilizing, • Number of cultural leaders sensitized 2018 leaders working on HIV, PMTCT, GBV, MCH in workshops to orient them in FP training and follow-up of on FP messaging to participate in sensitization to include FP messaging trained leaders in their work • Conduct follow-ups of trained leaders DC2: Men support the use Number of men who support the • Conduct monthly community outreach • Conduct community mobilization • Resources for community • Number of community outreach Quarterly of modern contraceptive for use of modern contraception for events to engage men in family planning through multimedia approaches mobilization, men days events held scale-up themselves and partners themselves or their partners in • Conduct men special days and community outreach • Number of men reached through Yumbe District • Facilitate community outreaches event, and for design and special days distribution of IEC materials DC3: Young people, 10-24 years Young people 10-24 years are • Engage peers and champions to educate • Participate in youth camp for FP • Resources for facilitating • Number of youth camps held 2018 through old are knowledgeable about knowledgeable about FP and young people about family planning services conducted youth camp to 2023 family planning accessing FP services • Participate in the development of youth • Resources for facilitating • Number of Yumbe District youth 2018 through plans for FP supervised by MoH development of youth plans plans supervised by MoH to 2023 on and supervision by MoH quarterly basis • Disseminate educational yearly youth • Disseminate youth magazine • Resources for dissemination • Youth magazine disseminated 2018 through magazine that describes youth FP activities, of youth magazines annually to 2023 programs and services distributed to youth corners and peer education • Empower parents, caregivers and • Participate in workshops with teachers • Resources for facilitating • Number of parents, caregivers and 2018 through teachers to help their children to avoid and parents to orient them on how best workshops and house visits teachers participating in dialogues to 2023 teen pregnancy, including parent- child to talk to youth about FP and workshops communication on sexual issues • Facilitate house visits to support parents • Number of dialogues and workshops on communication to young people conducted about FP • Hold “edutainment” community events • Mobilize communities for edutainment • Resources for conducting • Number of events held 2018 through like dances , music concerts and sports events edutainment events to 2023 competitions to provide opportunity for • Conduct community edutainment shows knowledge exchange amongst young people 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 through products and commercial sector condoms initiated and evaluated sector condoms to see if overall uptake on social marketing awareness events and to 2023 increases FP increases in Yumbe • Distribute branded free public sector distribution of branded free condoms public sector condoms Family Planning - Costed Implementation Plan 36 (2018/19 - 2022/23) YUMBE DISTRICT

Table 6.1: Implementation Framework by thematic areas (continued) AREA #2: Service Delivery (SD) SD1: Access to FP services FP service delivery points increased • Conduct mobile clinics in rural communities • Mobilize communities for mobile clinics • Resources for community • Number of mobile clinics established 2018 through increased in rural communities • Engage in conducting out mobile clinics mobilization and conducting to 2023 mobile clinics FP services are expanded through • Organizations participate in sensitization on • Mobilize organizations for training in FP • Resources for mobilizing • Number of people from private 2018 public-private partnerships the importance of promoting and using FP • Participate in workshops to sensitize and conducting training organizations oriented on provisions 2019 services private organizations workshops of FP services SD2: Referral services are A uniform FP referral form is created • Disseminate and train on FP referral forms • Identify eligible participants for training • Resources for conducting • Number of participants trained on 2019 strengthened in Yumbe 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 • Develop and disseminate FP integration • Host meetings with professional • Resources for developing • Number of providers in Yumbe 2019 are integrated in other health cancer screening, Post-natal protocols 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 • Conduct workshops to develop • Resources for conducting • Number of providers trained on 2020 are accessible by people with developed for people with disabilities services to people with disabilities guidelines for provision of FP services to workshops, training health disability service provision in Yumbe disability people with disabilities workers and follow-up • Train health workers on providing supervision services to FP clients with disabilities • Conduct follow up visits to trainees • Participate in sponsored courses for service • Train in sign language • Resources for facilitating • Number of service providers in 2018 provision to learn sign language • Conduct follow up visits to trainees trainings in sign language Yumbe trained in sign language and follow up of trainees • Number of service providers in Yumbe trained in sign language followed up SD6: Family planning side Counselling guidelines for family • Participate in training on FP side effects • Engage in training • Resources for training • Number of district health workers 2018 effects are managed planning is re-assessed 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 ToT for VHT and • Resources for trainings and • Number of trainers trained 2018 through system is strengthened and FP champions scaled up champions on FP methods champions follow up visits to 2023 • Conduct follow up visits to 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 youth- 2018 provided in clinics established in clinics currently without any in Yumbe corners establishing youth –friendly 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 • Health workers participate in training on • Resources for training and • Number of health workers trained on 2018 provide youth- friendly services services youth-friendly services follow ups youth-friendly services • Conduct follow up visits to trainees • Number of health workers followed up Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 37

AREA #2: Service Delivery (SD) SD1: Access to FP services FP service delivery points increased • Conduct mobile clinics in rural communities • Mobilize communities for mobile clinics • Resources for community • Number of mobile clinics established 2018 through increased in rural communities • Engage in conducting out mobile clinics mobilization and conducting to 2023 mobile clinics FP services are expanded through • Organizations participate in sensitization on • Mobilize organizations for training in FP • Resources for mobilizing • Number of people from private 2018 public-private partnerships the importance of promoting and using FP • Participate in workshops to sensitize and conducting training organizations oriented on provisions 2019 services private organizations workshops of FP services SD2: Referral services are A uniform FP referral form is created • Disseminate and train on FP referral forms • Identify eligible participants for training • Resources for conducting • Number of participants trained on 2019 strengthened in Yumbe 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 • Develop and disseminate FP integration • Host meetings with professional • Resources for developing • Number of providers in Yumbe 2019 are integrated in other health cancer screening, Post-natal protocols 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 • Conduct workshops to develop • Resources for conducting • Number of providers trained on 2020 are accessible by people with developed for people with disabilities services to people with disabilities guidelines for provision of FP services to workshops, training health disability service provision in Yumbe disability people with disabilities workers and follow-up • Train health workers on providing supervision services to FP clients with disabilities • Conduct follow up visits to trainees • Participate in sponsored courses for service • Train in sign language • Resources for facilitating • Number of service providers in 2018 provision to learn sign language • Conduct follow up visits to trainees trainings in sign language Yumbe trained in sign language and follow up of trainees • Number of service providers in Yumbe trained in sign language followed up SD6: Family planning side Counselling guidelines for family • Participate in training on FP side effects • Engage in training • Resources for training • Number of district health workers 2018 effects are managed planning is re-assessed 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 ToT for VHT and • Resources for trainings and • Number of trainers trained 2018 through system is strengthened and FP champions scaled up champions on FP methods champions follow up visits to 2023 • Conduct follow up visits to 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 youth- 2018 provided in clinics established in clinics currently without any in Yumbe corners establishing youth –friendly 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 • Health workers participate in training on • Resources for training and • Number of health workers trained on 2018 provide youth- friendly services services youth-friendly services follow ups youth-friendly services • Conduct follow up visits to trainees • Number of health workers followed up Family Planning - Costed Implementation Plan 38 (2018/19 - 2022/23) YUMBE DISTRICT

Table 6.1: Implementation Framework by thematic areas (continued) AREA #3: Contraceptive Security (CS) CS1: District staff are able Staff are empowered on forecasting • Integrate forecasting and quantification • Participate in assessments to review • Resources for capacity • Number of visits by MoH to Yumbe 2018 through to quantify and forecast FP and quantifying of FP methods within routine facility and Yumbe District capacity of staff to quantify FP methods assessment and training of to review staff ability to quantify FP to 2023 commodities activities • Train staff in forecasting and staff methods quantification of FP commodities • Number of staff trained CS2: VHTs and community- Community-based distributors are • Ensure supply chain system provides • Health centre logistics managers • Resources for training • Number of logistics manager trained 2018 based distributors have distributing FP commodities accurate and timely re-stocking trained on quantify and distribution commodities of commodities to community-based distributors CS3: Commodity distribution Joint Medical Stores (JMS) includes • Advocate for JMS to include FP commodities • Participate in assessment of the unmet • Resources for facilitating • Number of faith-based sector service 2018 to private not-for- profits FP commodities in procurement in procurement need for FP in faith-based sector service assessment of the unmet delivery points assessed for unmet increased delivery points need for FP in faith-based need in Yumbe 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 and 2018 knowledge of policies for family FP is better known rights, and correct any misconceptions stakeholders to understand FP rights of DHT and other stakeholders trained 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 • Share best practices in advocacy and • Resources for facilitating • Number of advocates and champions 2018 and religious leaders are champions to support family planning and champions in Yumbe District lessons learned sharing of best practices from Yumbe participating in supportive of family planning is established and supported meetings • Provide technical support to prominent • Resources for providing • Number of advocates and champions 2018 through FP champions in Yumbe technical support provided with technical assistance to 2023 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 through mainstreamed in district integrated in district budgeting district level on budgeting for FP activities building MoH held in Yumbe during district to 2023 planning and budgeting processes planning processes F2: Financial investment in Budget for training and support for • Advocate for increased funding for training • Conduct advocacy events to different • Resources for facilitating • Documented evidence of progress or 2018 through human resources development midwives and nurses in the health and support for midwives and nurses at decision makers advocacy events decisions made on coverage of FP in to 2023 for health is increased sector is increased. lower level health facilities health insurance scheme AREA #6: Stewardship, Management and Accountability (SMA) SMA1: The capacity of districts DHTs effectively plan for, monitor, • Conduct annual review meetings • Conduct review meetings with DHT and • Resources for facilitating • Number of work plan review 2018 through to effectively manage their FP and report on FP services other stakeholders annual reviews meetings held to 2022 programmes is strengthened FP stakeholder coordination and • Improve FP stakeholder coordination and • Participate in workshop to orient district • Resources for conducting • Number of DHT and committee 2018 through performance monitoring at district performance monitoring at district level management committees and DHT orientation workshop and members trained on stakeholder to 2022 level is increased • Facilitate coordination meetings facilitating coordination coordination and performance meetings monitoring • Number of coordination meetings conducted SMA2: Reporting of FP 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 through indicators is strengthened indicators health care workers tools disseminated to 2023 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 39

AREA #3: Contraceptive Security (CS) CS1: District staff are able Staff are empowered on forecasting • Integrate forecasting and quantification • Participate in assessments to review • Resources for capacity • Number of visits by MoH to Yumbe 2018 through to quantify and forecast FP and quantifying of FP methods within routine facility and Yumbe District capacity of staff to quantify FP methods assessment and training of to review staff ability to quantify FP to 2023 commodities activities • Train staff in forecasting and staff methods quantification of FP commodities • Number of staff trained CS2: VHTs and community- Community-based distributors are • Ensure supply chain system provides • Health centre logistics managers • Resources for training • Number of logistics manager trained 2018 based distributors have distributing FP commodities accurate and timely re-stocking trained on quantify and distribution commodities of commodities to community-based distributors CS3: Commodity distribution Joint Medical Stores (JMS) includes • Advocate for JMS to include FP commodities • Participate in assessment of the unmet • Resources for facilitating • Number of faith-based sector service 2018 to private not-for- profits FP commodities in procurement in procurement need for FP in faith-based sector service assessment of the unmet delivery points assessed for unmet increased delivery points need for FP in faith-based need in Yumbe 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 and 2018 knowledge of policies for family FP is better known rights, and correct any misconceptions stakeholders to understand FP rights of DHT and other stakeholders trained 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 • Share best practices in advocacy and • Resources for facilitating • Number of advocates and champions 2018 and religious leaders are champions to support family planning and champions in Yumbe District lessons learned sharing of best practices from Yumbe participating in supportive of family planning is established and supported meetings • Provide technical support to prominent • Resources for providing • Number of advocates and champions 2018 through FP champions in Yumbe technical support provided with technical assistance to 2023 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 through mainstreamed in district integrated in district budgeting district level on budgeting for FP activities building MoH held in Yumbe during district to 2023 planning and budgeting processes planning processes F2: Financial investment in Budget for training and support for • Advocate for increased funding for training • Conduct advocacy events to different • Resources for facilitating • Documented evidence of progress or 2018 through human resources development midwives and nurses in the health and support for midwives and nurses at decision makers advocacy events decisions made on coverage of FP in to 2023 for health is increased sector is increased. lower level health facilities health insurance scheme AREA #6: Stewardship, Management and Accountability (SMA) SMA1: The capacity of districts DHTs effectively plan for, monitor, • Conduct annual review meetings • Conduct review meetings with DHT and • Resources for facilitating • Number of work plan review 2018 through to effectively manage their FP and report on FP services other stakeholders annual reviews meetings held to 2022 programmes is strengthened FP stakeholder coordination and • Improve FP stakeholder coordination and • Participate in workshop to orient district • Resources for conducting • Number of DHT and committee 2018 through performance monitoring at district performance monitoring at district level management committees and DHT orientation workshop and members trained on stakeholder to 2022 level is increased • Facilitate coordination meetings facilitating coordination coordination and performance meetings monitoring • Number of coordination meetings conducted SMA2: Reporting of FP 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 through indicators is strengthened indicators health care workers tools disseminated to 2023 Family Planning - Costed Implementation Plan 40 (2018/19 - 2022/23) YUMBE 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 (2010). National Health Policy. Kampala, Uganda: Ministry of Health. 7. 8. Ministry of Health (2004). National Adolescent Health Policy for Uganda. Kampala, Uganda: Ministry of Health.

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

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

11. Uganda Bureau of Statistics (UBOS) (2016). Uganda Demographic and Health Survey 2016. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) YUMBE DISTRICT 41 Family Planning - Costed Implementation Plan 42 (2018/19 - 2022/23) YUMBE DISTRICT

MINISTRY OF HEALTH

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

Funding and Technical Support by: