AMUDAT District Family Planning - Costed Implementation Plan 2018/19 - 2022/23

REPUBLIC OF UGANDA

JUNE 2018

AMUDAT DISTRICT LOCAL GOVERNMENT

This District Family Planning Costed Implementation Plan has been made possible with the technical support from the Ministry of Health and the United Nations Population Fund through Amudat District Health Office. This project was funded by UK aid from the UK government.

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

Recommended Citation: Amudat District (2018). District Family Planning Costed Implementation Plan, 2018/19- 2022/23. AMUDAT, Uganda

Copies Available from: Amudat District Health Office. iv

Table of Contents LIST OF TABLES vi LIST OF FIGURES vi FOREWORD vii ACKNOWLEDGMENT viii ACRONYMS ix OPERATIONAL DEFINITIONS x EXECUTIVE SUMMARY xi

SECTION ONE: INTRODUCTION AND BACKGROUND 1 1.1 Introduction 2 1.2 Background 2 District Location and Population structure 2 Administrative and Political Structure 3 1.3 Socio Economic Activities 4 1.4 Demographic Data 4 1.5 District Fertility Rates and FP indices 5 1.6 District Human Resources for Health (HRH) 6 1.7 Health Facilities in the District 6 1.8 Development Partners in the District as at the End of 2015 7

SECTION TWO: THE DEVELOPMENT PROCESS OF THE DISTRICT FP-CIP 8 2.1 The process followed to develop the FPCIP 8 2.2 SWOT Analysis for Family Planning Services in Amudat District 9

SECTION THREE: TRANSLATION OF KEY ISSUES INTO STRATEGY 10 3.0 Introduction 11 3.1 Demand Creation for Family Planning Services 11 3.2 Service Delivery and Access 12 3.3 Contraceptive Security 12 3.4 Financing 13 3.5 Policy and Enabling Environment 13 3.6 Stewardship, Management and Accountability District Leadership 14 v

SECTION FOUR: COSTED IMPLEMENTATION PLAN 15 4.1 Introduction 16 4.2 Amudat District Vision, Mission and Goal Vision 16 4.3 District Strategic Priorities in FP 17

SECTION FIVE: COSTING OF THE PLAN 20 5.1 Introduction 20

SECTION SIX: DISTRICT INSTITUTIONAL ARRANGEMENTS FOR 22 IMPLEMENTATION OF THE PLAN 6.1 Introduction 23 6.2 Management, Coordination, and Accountability Structure 23 6.3 Roles and Responsibilities of Key Actors (District Level) 23 6.4 Coordination Framework 24 6.7 Routine Data Collection 24 6.8 Data Management 26

SECTION SEVEN: DISTRICT IMPLEMENTATION FRAMEWORK WITH FULL 27 ACTIVITY DETAIL REFERENCES 34 vi

List of Tables

Table 1: Population distribution and growth over the census years 1991 – 2014 4 Table 2: Amudat District Population Distribution by Sub-county 4 Table 3: Social economic Indicators – Health Social Economic Indicators 5 Table 4: Selected Regional/National Figures for FP 5 Table 5: Selected Demographic Health Indicators 5 Table 6: District Human Resources for Health (HRH) 6 Table 7: Health Facilities in the District 6 Table 8: Partner Mapping 7 Table 9: SWOT Analysis 9 Table 10: FP User Statistics for 2015 and 2016 12 Table 11: District Funding and Projected Allocation to Health 13 Table 12: CIPImplementationCost 21 Table 13: Illustrative List of National Indicators to Inform the District FP-CIP 24

List of Figures

Figure 1: Amudat District Map and Location in Uganda 3 Figure 2: Coordination Framework 24 vii

Foreword

Ugandan population growth rate is at 3.02% according to the Uganda Demographic and Health Survey (2016). This rate is among the highest in the world and attributed to the high Total Fertility Rate of 5.4 births per woman, low contraceptive prevalence rate of 47% among married women and unmet FP need of 28% among married women.

While these national population indices are poor, the The Amudat District Family Planning Costed situation in the Karamoja region is worse. It has the Implementation Plan (FP CIP) was guided by the six lowest CPR for modern methods at just 6.5 and 7.3 thematic areas as indicated in the Uganda National for all methods. Yet achievement of a 50% CPR can FP CIP 2015-2020 which include Demand Creation, lead to a 25% reduction in maternal deaths (Salfudin Service Delivery and Access, Contraceptive Security, Ahmed). Financing, Policy and Enabling Environment, and As the population in the greater Karamoja region Stewardship, Management and Accountability. moves towards a less nomadic lifestyle with increased These are all in line with the National Health Sector number of cattle and a reduction in rustling activities Development Plan (2015) and the FP2020 Uganda as well as the prevalent peaceful environment which commitments. contribute to improved health services, there is a high likelihood of a population explosion. This may result Through this FP CIP, Amudat District Local from the prevailing situation where the husband Government leadership commits to support the and wife are likely to stay together longer now that strengthening of partnerships in the delivery of FP there are fewer cattle to rear. HIV prevalence may services and will strive to work together with the also limit the polygamous lifestyle that is part of the central government and partners in the achievement Karimojong culture. of the National FP goals in order for the country to have a healthy and productive population. The Uganda government has set goals in terms of population indicators in order for the country to For God and My Country achieve the Sustainable Development Goals (SDGs). As a country, Uganda is committed to reducing the unmet FP need to 10% (from the current 28%). It also plans to increase modern contraceptive prevalence rate to 50% by 2020 (from the current 47%). To achieve these targets, all districts and support partners need to be brought on board. It is upon this background that the MOH with partners supported Amudat District to develop a Family Planning Costed Implementation Plan that details activities and costs for achieving the national FP goals and also address the challenges of providing FP services. viii

Preface

Amudat District Local Government acknowledges the technical contribution by the Ministry of Health and the fi nancial support from UNFPA and in developing this FP- CIP (2018/19 – 2022/23).

Additional appreciation goes to the district health Our appreciation to all stakeholders who contributed team (DHT) and Family Planning (FP) implementing in one way or the other through provision of valuable partners (IPs) for their contribution, both technical information, time, resources both human towards and otherwise, towards shaping this FP-CIP for the accomplishing this FP-CIP for Amudat.. district. It is our sincere commitment as the district leadership The development and fi nalization of this document that the aspirations of this plan will be achieved in was a consultative process that involved the district an effort to support the national goals of having a leadership, politicians, partners at all levels and the healthy and productive population. District Technical Planning Committee including the local community.

The Amudat district local government and esteemed partners should prioritize the implementation of this FP-CIP. The development partners should support the district efforts of accelerating universal access to family planning services in the district. We pledge total commitment and support through a coordinated multi-sectoral approach so that the district increases modern contraceptive prevalence rate and reduces unmet need. ix

Acknowledgement

Amudat District Local Government acknowledges the technical contribution by the Ministry of Health and the fi nancial support from UNFPA in developing this FP-CIP.

Additional appreciation goes to the district health I also convey my sincere appreciation to Amudat team (DHT) and Family Planning (FP) implementing district local government for the cooperation, partners (IPs) for their contribution, both technical participation and the wonderful coordination that and otherwise, towards shaping this FP-CIP. enabled timely completion of the assessment and costing exercise. Amudat District Local Government is further grateful to the team of consultants that worked on this Finally, we shall forever remain grateful to the UK project. for a job well done. Government through UK Aid for funding the MoH and UNFPA technical teams to offer technical The District Health Team (DHT) who worked guidance and review of the report. closely with the consultant to develop this plan deserve special recognition. The consultant who offered technical advice, the data collectors and the respondents from the different health facilities all played an instrumental role in developing this plan. x

Abbreviations

ANC Antenatal Care HMIS Health Management Information BEmONC Basic Emergency Obstetric and System New-born Care LLG Lower Local Government ACAO Assistant Chief Administrative Officer MARPS Most At Risk Populations CAO Chief Administrative Officer MoH Ministry of Health CEmONC Comprehensive Emergency Obstetric NGOs Non-Governmental Organizations and New-born Care NMS National Medical Stores CH Child Health OPD Out Patient Department CS Contraceptive Security PNFP Private Not for Profit CPD Continuous Professional Development PPFP Post-Partum Family Planning CPR Contraceptive Prevalence Rate RDC Resident District Commissioner CSO Civil Society Organization RH Reproductive Health DDP District Development Plan RHU Reproductive Health Uganda DHO District Health Office SBCC Social and Behavioural Change DHS Demographic Health Survey Communications DHT District Health Team SWOT Strength Weaknesses Opportunities DQA Data Quality Assurance and Threats DSW Deutsche Stiftung Weltseveekerung 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 UNFPA United Nations Population Fund FY Financial Year VHT Village Health Team HC Health Centre xi

Operational definitions

Costed Implementation Plan (CIP): A multi-year actionable roadmap designed to help governments achieve their family planning goals that when achieved will save millions of lives and improve the health and wellbeing of women, families and communities. CIPs are a critical tool in transforming ambitious family planning commitments such as those made through Family Planning 2020 and the Ouagadougou Partnership, into concrete programs and policies.

Family Planning: Educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved.

Family Planning Situational Analysis: A systematic collection of data from various sources to inform understanding of the past and current status of a country’s family planning program. xii

Executive Summary This district family planning costed implementation plan presents the outcome of a consultative process that was facilitated by a consultant supported by UNFPA in partnership with the Ministry of Health.

The Amudat District Costed Implementation Plan Uganda’s goal of reaching 50% of women who are (2018 – 2023) is a strategic multi-year planning married or in union with modern contraceptive document detailing the activities that will support methods is ambitious and must be matched with Uganda’s National FP Goals of reducing unmet FP commensurate support in the areas of human need to 10% and increase the modern CPR to 50% resources, financing, and political commitment by 2020. This district FP CIP is driven by the national from national to community levels throughout the strategic priorities that were identified to ensure that country. To this end, the activities in the Amudat the current gaps in family planning in Uganda are FP-CIP are structured around the six thematic areas adequately addressed. These priorities include: of the National FP-CIP namely: demand creation, Priority # 1: Increase age and culture appropriate service delivery and access, contraceptive security, information, access, and use of family planning policy and enabling environment, financing, and amongst young people, ages 15–24 years. stewardship, management, and accountability.

Priority # 2: Promote and nurture change in social and individual behavior to address myths, Uganda’s goal of reaching 50% misconceptions, and side effects and improve acceptance and continued use of family planning to of women who are married prevent unintended pregnancies. or in union with modern

Priority # 3: Implement task sharing to increase contraceptive methods is access, especially for rural and underserved ambitious and must be matched populations. from national to community Priority # 4: Mainstream implementation of levels throughout the country. family planning policy, interventions, and delivery of services in multi-sectoral domains to facilitate a holistic contribution to social and economic The cost of implementing this plan over a five-year transformation. period is estimated to cost about 1. 66 billion Uganda Shillings (UGX). Amudat district is counting on the Priority # 5: Improve forecasting, procurement, Central Government, development partners and FP and distribution and ensure full financing for implementing agencies to play a significant role in contraceptive security in the public and private supporting the district realize the goal of this plan. sectors. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 1

SECTION 01: Introduction and Background Family Planning - Costed Implementation Plan 2 (2018/19 - 2022/23) AMUDAT DISTRICT

1.1 Introduction The District is bordered to the north by Moroto The Amudat District Family Planning- Costed District, Nakapiripirit to the West, Bukwo district and Implementation Plan (2018 – 2023) builds on Uganda Kween districts to the south and Kenya to the east. Government political commitment at the London The District shares 300km of borderline with the Summit 2012 towards increased financing of family Republic of Kenya on the Eastern side. Amudat town, planning. Implementing her strategic commitment, the main urban centre with the district headquarters Uganda developed the FP -CIP, 2015- 2020. The FP is located 400km by road northeast of Kampala –CIP reflects a “common” plan for all stakeholders city and about 38km northeast of Nakapiripirit, the involved in implementing family planning activities nearest town. The 2014 Uganda Population and towards a consultative, harmonized, rationalized Housing Census put Amudat district population at management and accountability structure involving 105,769. The 2015 District Development Plan (DDP) local government and district multi-sectoral put it at 111,758 persons with a population density of stakeholders. 68/sq. km. The District has an area of about 1,638 sq. In order to foster this mandate, AmudatDistrict Local km. The current population is estimated at 120,008 Government in collaboration with technical groups people as per the 2014 census projections. initiated through a participatory and consultative process the development of this District FP-CIP in Pokot is the dominant tribe in this area leading a alignment with the national FP-CIP (2015 – 2020). semi-nomadic lifestyle. The majority of Pokots live in Kenya in North Pokot, East Pokot and Baringo A brief description is presented below of Amudat districts. There is seasonal cross migration between District profile with specific reference to location, Uganda and Kenya in search of pasture and water for demographic data, health facility staffing, health their animals. facilities and socio-economic activities, district SWOT and process of developing the district FP-CIP. Administrative and Political Structure Amudat district is one of the 8 districts forming Karamoja sub-region. Amudat has 3 Sub counties 1.2 Background and one town council, 13 Parishes and 157 Villages. District Location and Population Structure New seasonal villages are formed by the migrant Amudat District is located in the Karamoja sub-region populations. These administrative units are in north eastern Uganda. It lies at 01o57’N34o57’E extremely large; some parishes are even bigger than (Latitude 1.9500; Longitude:34.9500). It covers some districts in this country. And some sub-county an estimated surface area of 1610 Sq Kms at an locations are better accessed through Kenya. altitude of 4200 Feet high (1280 Meters). The district The infrastructure is limited and predominantly is a semi-arid area and vegetation is constituted constituted by public institutions like schools, health predominantly by thorny bushes although during the centers and religious/faith establishments. However, rainy season, a lasher green environment develops. following the disarmament exercise, many indigenous The long rains last from March through to July with business people are putting up buildings in the urban more infrequent showers from September through centers. The road network is improving, though some to November. Annual rainfall is in the range of 300- of the roads become impassable during the rainy 500mm. The rains are usually torrential downpours seasons. flooding the seasonal rivers, making the roads The district has one HSD (Pokot HSD), 9 Health impassable and health service delivery difficult. The units of which one is a PNFP hospital also serving as temperatures range from 25oC to 40oC. a HCIV for the HSD, 2 HC IIIs and 6 HC IIs but one (Katabok HCII) is still under construction. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 3

The facilities are widely Figure 1: Amudat District Map and Location in Uganda spread across the district, making access a big challenge. Some people still move more than 10 Kms to access health services within the district.

Community linkage is by a team of 314 trained VHTs, about 267 reporting monthly, unfortunately 90% of these VHTs are illiterate. Community mobilization is further achieved through use of media houses such as radio stations in north western Kenya.

The health sector is characterized by poor health indicators: Only 29% established positions fi lled, OPD utilization (0.52), ANC 1 (45%), and ANC 4 (5%), and pit latrine coverage (17.2%). 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

Source: AmudatDistrict Development Plan 2015/16– 2019/2020) Family Planning - Costed Implementation Plan 4 (2018/19 - 2022/23) AMUDAT DISTRICT

1.3 Socio Economic Activities The district is one of the least developed in the country. It is characterized by high levels of illiteracy, high infant mortality rates and high under five malnutrition rates. The majority of the population lives in abject poverty (no disposable income). According to the Human Development Index, Amudat ranks as one of the lowest in the country (0.24). The development initiatives and service delivery were greatly hampered by internal and external insecurity as a result of the untamed use of illegal guns by the Karimojong, the Pokot and the Kadama. The return of relative peace following the disarmament exercise is likely to spur development. The major source of livelihood in the district is agriculture – livestock and crop cultivation, especially sorghum and maize for domestic consumption. However, because of the dry spells and lack of adequate water for livestock, the people lead a semi nomadic lifestyle moving even to neighboring districts in search of mainly water and pasture.

1.4 Demographic Data According to the Uganda Population and Housing Census 2014, Amudat district had a total population of 105,767 with about 70% of the population being young people below 18yrs. The population is comprised of 52.3% male and 47.7% female with only 1.1% of the population living in urban areas. Nutrition status, 50% children under 5 years are stunted (cf 39.1% national average).

Table 1: Population distribution and growth over the census years 1991 – 2014 Year Male Female Total 1991 5,761 5,575 11,336 2002 34,096 29,476 63,572 2014 54,246 51,523 105,769 Source: AmudatDistrict Development Plan 2015/16– 2019/2020)

Table 2: District population distribution by sub-county Sn Sub-County Population Average Size household size Males Females Total 1 Amudat 16,867 14,169 31,036 6.1 2 Amudat Town 5,750 5,867 11,617 5.0 Council 3 Karita 19,877 16,021 35,898 6.2 4 Loroo 16,004 17,203 33,207 6.9 TOTAL 58,498 53,260 111,758 Source: AmudatDistrict Development Plan 2015/16– 2019/2020) Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 5

Table 3: District Social Economic Indicators – Health Social Economic Indicators Infant Mortality Rate (IMR) 178 per 1000 live births Child Mortality Rate (CMR) 248 per 1000 live births Maternal Mortality Ratio (MMR) 527 per 100,000 live births Total Fertility Rate Source: AmudatDistrict Development Plan 2015/16– 2019/2020)

1.5 Fertility Rates and FP Indices in the District Amudat district has TFR of 7.2 and annual population growth of 4.3% between 2002 and 2014(cf 3.3% national average). The population of Amudat district has almost doubled from 63,600 in 2002 to 105,767 in 2014 reflecting a rapid population growth over the years.

Table 4: Selected Regional/National Figures for FP Indicator Karamoja region National average Unmet need for FP 19.7 24.8 CPR (all methods/modern methods) 7.3/6.5 39/34.8 Total demand for FP 27 67.3 %age demand satisfied (all methods/modern methods) 27.1/24 57.9/51.7 Source; UDHS 2016

With an estimated CPR of 6.5 for modern methods, unmet need of 19.7, high percentage of adolescent girls not in school, childbearing beginning at an early age, with 16.1% of females aged 10-19 having given birth and a TFR of 6.4, the need for family planning in Karamoja region has never been greater. This is because teenage pregnancy and motherhood are major social and health concerns associated with higher morbidity and mortality rates.

Table 5: Selected Demographic Health Indicators Demographic Variables Result Total Population 120,008 (Projected) District HIV Prevalence Rate 3.7 for the region Estimated no. of women of child bearing age (15- 49) 20.2% Expected Number of Pregnancies per year 6,000 Number of Expected births per year 5,820 Infants below one year 5,160 Contraceptive Prevalence Rate (2016/2017) (modern methods) 6.5% Unmet need for family planning 19.7%

Source: National Population and Housing Census (2014) and District HMIS 2015 Family Planning - Costed Implementation Plan 6 (2018/19 - 2022/23) AMUDAT DISTRICT

1.6 District Human Resources for Health (HRH) The district staff structure is reflected in the table below. The figures indicate acute shortages of staff at all levels Table 6: District Human Resources for Health (HRH) Facility level No of facilities Unit norm Total norms Filled % filled DHO’s office 1 11 11 2 18.2 District/general hospital 1 191 191 19 10.0 HCIV 0 0 0 0 0 HCIII 2 19 38 14 36.8 HCII 5 9 45 14 31.0 Total 9 229

The low staffing levels notwithstanding, there are gaps in the knowledge and skills of some health workers especially regarding family planning, indicating a need for training and proper and equitable deployment. Immunization reports indicate that health facilities at the border with other districts serve wider catchment population resulting into work overload for the staff and long queues for patients.

1.7 Health Facilities in the District Health service provision in Amudat district is by both Public and Private not for profit health facilities. There are eight functional and three health facilities under construction in the district. The hospital and all the other health facilities are able to offer a range of family planning services including the permanent methods.

Table 7: Health Facilities in the District County Sub-county Parish Health Facility Name Level Ownership Functionality Pokot T/C Tingas Amudat Hospital GH PNFP Fully Functional Lochengege Amudat HC II Public Fully Functional KARITA Karita Karita HC III Public Fully Functional Cheptapoyo HC II Public Fully Functional Lokales HC II Public Fully Functional Loroo Loroo Loroo HC III Public Fully Functional Achorchor HC II Public Fully Functional Amudat Amudat Alakas HC II Public Fully Functional Katabok Akuruon HC II Public Not Functional

Source: AmudatT HMIS, 2017 Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 7

1.8 Development Partners in the District as at the End of 2015 The district has several development partners that support the health sector in different areas. The support is given in various forms; some provide direct budgetary support to the district with the funds specifically ear-marked for RH services. Others provide technical assistance in form of human resource while other fund RH activities such as capacity building and support supervision. While the direct budgetary support can be quantified, sometimes it is difficult to quantify the other forms of support, because the district is sometimes not privy to the budgets for the partners that is for the in-kind activities.

Table 8: Partner Mapping Name of Intervention Coverage Target group/ Implementation mode Partner Area Estimated pop’n. (tick all applicable)

Direct Technical In Funding Assistance kind UNICEF RH/Nutrition Entire district Children and X X X Women UNFPA RH Entire district People of X X X reproductive age CUAMM RH Entire district All People X X X WFP Nutrition Entire district Mothers and X X X Children AFI Community Entire district Children X X Supplementary Feeding Program Sign of Hope Health Abilyep All People X X BRAC RH Amudat Town Youth and X X Council and Amudat adolescents Sub-county WHO Emergency Entire District All People X X X preparedness and Epidemic Control ZOA WASH Entire District All People X X X TASO HIV All People All people X X Marie Stopes FP Entire district All adolescents & X X adults Straight talk Adolescent FH Entire district Adolescent X X

Source: Amudat District Development Plan (2016/17) Family Planning - Costed Implementation Plan 8 (2018/19 - 2022/23) AMUDAT DISTRICT

SECTION 02: The Development process of the District FP-CIP

2.1: The process followed to develop the FPCIP Though constituted within another meeting, the The development of the District FP-CIP was members present gave very good constructive informed by data from primary and secondary feedback that informed part of the district CIP sources that included (a) Desk reviews, (b) Meetings development process. After the presentation, the with key stakeholders (c) District level key informant consultants were able to interact on an individual interviews and (d) Health facility visits. basis with members of the district leadership The Amudat FP-CIP development process started including the district Chairperson, the District with an entry meeting with the Assistant District Planner and the ADHO. Health Officer. Thereafter, the consultants were introduced to the ACAO. At the time of arrival, During visits to the health facility, the consultants there was an ongoing planning meeting involving were able to hold a group discussion with some both the political and technical wing of the district clients who were attending ANC at one of the health and the consultants got an opportunity to make a facilities. presentation regarding the FP-CIP development process. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 9

2.2: SWOT Analysis for Family Planning Services in AmudatDistrict The table below shows analysis of the Amudat district Strengths, Weaknesses, Opportunities and Threats for the family planning services.

Table 9: SWOT Analysis Strengths Strategies to optimise • Positive and receptive leadership (political and • Harness the goodwill through continued technical) towards FP engagement and follow up • Existence of health facilities providing a wide range • Train more staff in counselling and provision of FP of family planning & ANC services services. • Existence of mobilisation activities such as • Support the facilities to hold more frequent community dialogues mobilisation activities through adequate funding • Weaknesses • Strategies to amend • Inadequate and irregular supply of FP drugs & • Capacity building of staff in quantification, supplies and commodities. forecasting • Empower user facilities to make orders based on • Recruit more staff and post/rotate them equitably the PULL system • Construct/remodel facilities to create space for • Inadequate staffing by cadre and at all levels provision of FP services • Inadequate space for provision of FP services • Multi-sectoral approach to keep the girl-child in • Low literacy rates in the district fuelled by the school as this reduces early childbearing frequent drop out of school and early pregnancy • Get male champions in the community to sensitise • Low male involvement their male counterparts • Opportunities • Strategies to develop • Availability of implementing partners in the district • Integration of the interests and budgets of all IP into • Commitment by the Uganda government the district plans to have a coherent strategy • Use available policy guidelines and regulatory frameworks for management of FP services in the district and at the facilities

Threats Strategies to mitigate • Low contraceptive demand in the community • Use of appropriate IEC materials to enhance FP • Negative perception towards FP especially by the utilisation male partners • Identify other incentives for users of FP services • Provision of food rations to pregnant women acting • Integrated sustained outreaches aimed at directly as a driver for frequent pregnancies focusing on hard-to-reach areas and camping • Scattered, highly mobile and communities living in there to provide services as well as community extremely hard-to-reach areas sensitisation. Family Planning - Costed Implementation Plan 10 (2018/19 - 2022/23) AMUDAT DISTRICT

SECTION 03: Translation of key issues into Strategy Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 11

3. Introduction The negative perception of men towards FP is Based on the Uganda National FP CIP 2015-2020, another barrier affecting demand especially in this the Amudat FP-CIP is premised along the six region of limited women empowerment. This is thematic areas of;(i) demand creation for FP services compounded by the high rate of adolescent marriages (ii) service delivery and access, (iii) contraceptive leading to an imbalance in the power relations security, (iv) policy and enabling environment, (v) between the couple. The men feel that their wives financing and (vi) stewardship, management and should bear them as many children as possible since accountability. they paid high bride price. To improve demand therefore, it is imperative that 3.1 Demand Creation for Family Planning Services these factors are addressed, focusing on ensuring The total demand for FP is defined as the sum of contraceptive commodity security, community unmet and met need. While high unmet need may be sensitisation through dialogue and involvement of viewed as negative, this measure may also represent community leaders to demystify the misconceptions an increased demand for FP services driven by an as well as improve on the attitude of men towards increase in the knowledge of FP within the given FP. This can be done through the use of community population. The onus then falls on the healthcare dialogues as well as FP champions, both men and system to meet the demand. As the demand for women. contraception increases, the need for stakeholders such as governments, donors, and other support partners to fulfil the demand becomes increasingly Uganda’s goal of reaching 50% critical. This demand for modern contraceptives is of women who are married driven by several dynamic factors namely; • The number of contraceptive users or in union with modern • Changing eligibility criteria and method mix contraceptive methods is • Increasing knowledge, awareness, and attitudes towards family planning. ambitious and must be matched • Changing attitudes of society about family size and from national to community the roles of children. levels throughout the country. There is evidence of universal awareness of at-least one method of contraception in Uganda (UDHS, Information available indicate that the Karamojong 2011). This awareness is however not translated into embraced and practiced natural FP for years. In use and several factors contribute to this. the past, the cultural practice was that whenever a The existing demand creation initiatives in Amudat woman got pregnant, the husband would leave her include community dialogues and health education until about two years after she has given birth. The talks during the facility visits by prospective clients. wife would also identify another woman for her The community dialogue meetings have largely not spouse for the duration. With the changing norms been very effective largely because they are limited however, especially with the reduction in the number in frequency. of cattle to graze, the men may not be able to be away The issue of contraceptive supplies stock-outs in the for too long. This is further compounded by the HIV district is a major barrier to achieving reduction of pandemic which makes the culture of polygamy risky. unmet need. In addition, myths and misconceptions It therefore, becomes important to start talking on the side effects of modern contraceptives has led about modern methods of contraception in this to the community preferring to use natural family community now since the natural methods such as planning methods. abstinence are not tenable. Family Planning - Costed Implementation Plan 12 (2018/19 - 2022/23) AMUDAT DISTRICT

Another barrier to demand for FP services is the Compounding these challenges are the low literacy practice of food supplies to pregnant women by WFP. levels and negative attitude to FP by the majority This seems to act as an incentive for women to get of the community, especially the male partners. pregnant as this guarantees access to food rations. Access to services is not only limited by challenges The government’s efforts to provide FP services such as poverty, age or HIV status but also by the in Amudat district is supplemented by partners community’s generally negative perception about including Marie Stopes, UNICEF and UNFPA. FP. There is a high percentage of out of school adolescents leading to early marriages and teenage 3.2 Service Delivery and Access pregnancy.The most urgent need to improve access is Long distances between the households and health increasing awareness. facilities, low staffing levels and frequent stock outs of FP supplies remain major obstacles to access of FP Over the years, uptake of FP services has improved services. Amudat district is expansive and the health probably due to a mix in strategy such as revised facilities are widely spaced, some over 30 km from eligibility criteria and the training of health workers. the next nearest facility. The pastoral nature of the The table below shows the total users of FP at population makes it more complex to provide static selected facilities available in the district in 2015 and clinics. 2016.

Table 10: Amudat District FP User Statistics for 2015 and 2016 Health facility Total users 2015 Total users 2016 Amudat Hospital 144 202 Loroo HCIII 90 347 Karita HCIII 161 196 Alakas HCII 241 94 Achorichor HCII 0 600 Cheptapoyo HCII 25 190 Lokales HCII 8 186 Amudat HCII 0 0 Source: Amudat District HMIS data

The contraceptives method mix includes: IUDs, 3.3 Contraceptive Security Implants, Injectables, Male Condoms, Lo-Feminal, There is a challenge of shortage of FP supplies Microgynon, Female Sterilization (Tube Ligation) and reported and the health facilities needed to be Male Sterilization (Vasectomy). The most commonly supported to perform better quantification and accepted method is the natural method of abstinence forecasting. There is need for a mixture of both the but the implants were gaining prominence especially PUSH and PULL system of procurement to minimise as a method of PPFP. on stock outs. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 13

3.4 Financing budget. Support activities such as training of health Funding allocated to health accounts is less than 10% workers, community mobilisation and advocacy of the overall annual district budget as projected for RH services are not necessarily captured in the for the next 5 years from 2015. But this represents budget. These support partners have budgets for the entire district projected expenditure on health the activities that they carry out in the district but and it is not possible to verify the actual funds may not be at liberty to share these budgets with the allocated to RH or FP. The budget as indicated may district. not be a true reflection of the actual expenditure It therefore, becomes difficult to estimate with on health services in the district. This is because reasonable accuracy the actual funds spent on health some partners in the health sectors make in-kind services in the district let alone on RH and FP in contributions that may not be reflected in the district particular.

Table 11: District Funding and Projected Allocation to Health FY Budget 2015/2016 Projected 2016/17 Projected 2017/18 Projected 2018/19 Projected 2019/20 District revenue in ,000 UGX 7,362,779 6,713,065 9,820,836 9,840,836 9,850,836 Health expenditure in,000 UGX 1,338,439 1,326,776 1,339,601 1,349,601 1,353,601 Percentage expenditure on health 5.5 5.1 7.3 7.3 7.3

3.5 Policy and Enabling Environment What is not clear is if these policies have been The current policy environment is conducive for institutionalised enough for the implementers strengthened implementation of FP programme on the ground. An analysis of the knowledge of in Uganda according to the Uganda National FP- selected stakeholders about the different policies CIP 2015-2020. Family planning is appreciated as revealed that there haven’t been enough efforts by a key strategy to promote social, economic, and government to popularise many of its policies and environmentally sustainable development, to realize their implications for the development of the country sexual and reproductive health and reproductive among key stakeholders such as health service rights, and to improve the health of women and their providers, religious, cultural and the district local children by preventing unintended pregnancies and leaders. improving child spacing, thus reducing maternal and neonatal morbidity and mortality. While the Local Government Act 1997 and Decentralisation Policy empowers the districts to In this regard, Uganda has in place a number of recruit qualified staff to offer services, it has been policy documents. These include the Uganda difficult for Amudat district to attract, recruit and Population Policy, National Gender Policy, National retain vital human resource. Development Plan, National Health Policy, Health Some of the challenges Amudat district faces in the Sector Strategic and Investment Plan and National provision of an enabling environment for provision of Family Planning Advocacy Strategy. FP include; Family Planning - Costed Implementation Plan 14 (2018/19 - 2022/23) AMUDAT DISTRICT

• Lack of adequate space to carry out FP services. Family Planning Partnerships • Inadequate government funding to support FP Efforts are underway to coordinate FP activities advocacy in the communities. and services in all health facilities in the district. This • Lack of clear policies specifically targeting FP. will ensure appropriate distribution of supplies and • Shortage of contraceptive commodities. trained staff to minimize shortages of both supplies • Religious and cultural beliefs. and health workers. The PNFP hospital that is central • Inadequate support from the district politicians. to the district health system as the only hospital needs to be supported more in terms of human 3.6 Stewardship, Management and Accountability resource and supplies. District Leadership The district health office is very supportive of FP Data Collection, Analysis and Use activities. It has made strides in ensuring that health While there is adequate and appropriate data workers are updated and that services are provided collection at the health facilities that is regularly routinely at all health facilities. Concerted efforts submitted to the district and later to the MoH have also been made to coordinate all FP partners through the HMIS, there seems little utilization of this in the district so that services are not fragmented or data at source to inform decisions on supplies. This is duplicated. The district has a focal person for FP who probably driven by the PUSH system of procurement plays the role of a clearing house for all district FP of supplies hence the lack of interest in the HMIS activities. data since the health facilities do not appear to contribute to the decisions about procurement. In addition, the data generated is rarely shared with the implementers and other district relevant stakeholders which, would to some extent, contribute to accountability. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 15

SECTION 04: Costed Implementation Plan Family Planning - Costed Implementation Plan 16 (2018/19 - 2022/23) AMUDAT DISTRICT

4.1 Introduction • Priority 2: Promote and nurture change in This section presents the district strategic priorities social and individual behavior to address myths, as stipulated in the district FP-CIP based on the misconceptions and side effects and improve district Vision, Mission and Goal as stated in the acceptance and continued use of family planning to District Development Plan 2015/2016 – 2019/2020 prevent unintended pregnancies. in alignment with the priorities highlighted in the • Priority 3: Implement task sharing to increase National FP CIP 2015-2020. access, especially for rural and underserved populations. 4.2 Amudat District Vision, Mission • Priority 4: Mainstream implementation of FP policy and Goal Vision interventions and delivery of services in multi- A peaceful, transformed and prosperous people by sectoral domains to facilitate a holistic contribution the year 2020. to social and economic transformation. • Priority 5: Improve forecasting, procurement and Mission distribution and ensure full financing for commodity To achieve sustainable socio-economic development security in the public and private sectors. through efficient provision of quality services to the people in conformity with national policies, priorities In order to ensure that the limited resources are and local priorities. allocated to areas that have the highest potential to support the achievement of the national FP goals, the Goal activities are focused around the six thematic areas Improved standard of living and a socially interactive namely demand creation, service delivery and access, community. contraceptive security, policy and enabling, financing, All these are in line with the goal of the National and stewardship, management and accountability. FP-CIP 2015-2020 which aims at addressing the challenges of reproductive health by: • Increasing modern contraceptive prevalence rate to 4.3.1 Demand 50% by 2020. Strategies • Reducing unmet FP need to 10% by 2020. While it is clear that the major challenge on demand creation is the negative perceptions about FP and the 4.3 District Strategic Priorities in FP low male partner support and involvement, efforts The National FP CIP is well aligned to the Health will be made in this regard by focusing on social and Sector Strategic Plan III 2010/11-2014/15 and behavior change communication (SBCC) campaigns related strategic plans on HIV/AIDS, reproductive to target current non-users of contraception health commodity security, reduction of maternal who may have a high motivation to adopt, as this and neonatal and adolescent policies (Uganda FP CIP population will then be best positioned to become FP 2015- 2020). In the process of writing the district champions to address myths and misconceptions to FP CIP, due attention was given to the national their non-user peers. This is critical in lowering the strategic priorities which represent key areas for percentage of unmet need. Because of the patriarchal financial resource allocations and implementation nature of the community, it is important to lay performance. The five national strategic priorities emphasis on male champions as change agents since are: a lack of focus on them gives the impression that FP • Priority 1: Increase age and cultural appropriate is none of their business and therefore, leaving it to information, access and use of family planning the women who are not fully empowered as decision amongst young people ages 10- 24 years. makers in this setting. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 17

As informed by the District HMIS data, gender 4.3.2 Service Delivery and Access analysis shall be integrated in the district family Strategies planning approach so as to gauge male involvement. This will follow the National Costed Implementation Overall, demand creation approach in family planning Plan which adopted a rights-based approach that in Amudat District will be people-centered coupled includes informed choice, free and informed consent, with innovative outlets such as mobile health services respect to privacy and confidentiality, equality and provision and advocacy campaigns as well as use of non-discrimination, equity, quality, client-cantered information communication technologies. care, participation and accountability; it also responds to community factors that impede access. A key strategy to improve demand for family planning will be to engage community leaders to provide Health workers in Amudat district will be trained accurate information about family planning to men on rights-based programming in FP. This will be in their communities. Traditional, religious and done by the district with support from development community leaders will engage men to educate them partners. The district will facilitate utilisation of on the benefits of family planning and address their community-based approaches (mobile clinics, questions and concerns. Additionally, the number of integrated outreaches and distribution points) to men who support the use of modern contraception complement services provided at the fixed health for themselves or their partners will be increased by facilities. In-service training for health workers will conducting community outreach events to engage be enhanced to facilitate them provide a wider case- men in FP dialogue and services. mix as needed by the population especially PPFP and long-acting reversible contraceptives (LARCs). Additional approaches will involve mass media Support supervision, on-job training and mentorships campaigns including the use of radios, public will be conducted to provide continuous professional announcements and print media through banners. development. Every effort will be made to ensure tailored honest, objective, non-judgmental, accurate, clear, and To improve access, community outreaches will be consistent messaging around family planning in a conducted especially in the underserved and hard to multi-sectoral dimension (i.e., family planning as reach areas. Access will further be increased through a development intervention) and target various public-private partnerships during integrated mobile audiences (rural/urban youth, adolescents in and out services. The district family planning focal person of school settings, married youth, men, people living will review data on service availability and work with with HIV and other key populations at risk. implementing partners to identify and cover areas where access to family planning is low. Strategic outcomes • Increased demand for FP services High-quality FP information and services at the • More men coming out to be champions and community level will be improved through task supporting their female partners to use FP shifting to allow Community Based Drug Distributors • More young people becoming more aware about provide injectable FP drugs and refills for oral the benefits of FP and being encouraged to use FP contraceptives. Continuous trainings will be held to ensure that providers are capable of counselling on all methods and on the rights of the population to access high-quality, voluntary services. Emphasis will be laid on providing adequate information on potential side effects to all clients and mechanisms of addressing Family Planning - Costed Implementation Plan 18 (2018/19 - 2022/23) AMUDAT DISTRICT

them will be explained to FP potential and current 4.3.4 Policy and enabling environment users. This will be done by health workers, VHTs, Strategies community drug distributors and FP champions Amudat district will align implementation of all FP to ensure that there is user-continuation of their activities with the national CIP. To improve the policy methods of choice. Referrals and follow up of clients environment for family planning, government policies will be strengthened in order to manage side effects and strategies will be disseminated to all relevant in a timely manner. district stakeholders so as to align current thinking and practice to up-to-date policy guidelines. Strategic outcomes Specific advocacy will also be conducted to ensure • Improved access and utilization of FP services that policies and guidelines for family planning • Improved capacity for provision of FP services promote access to FP services rather than hamper • Better management of FP side effects. access for often-marginalized groups such as the • Improved capacity of VHTs to offer more services rural population and youth and to ensure the closer to the people. provision of FP services in accordance with human • Deeper and wider penetration of FP services while rights and quality of care standards. addressing the major sociocultural and economic barriers to FP services access and utilization in the Strategic outcomes district. • Knowledge of FP policies amongst stakeholders and health care workers improved. • Improved knowledge about policies on family 4.3.3 Contraceptive security planning Strategies • Local, cultural, and religious leaders are supportive Contraceptive security being one of a major of family planning. problems at the moment needs more emphasis as The legal framework that promotes family planning there were reported stock-outs of contraceptive will become popularised through dissemination of commodities and it is imperative that health workers these documents to District Health Teams (DHTs), are trained in LMIS. Health workers will be trained and health providers. A simplified District Family on quantification, forecasting and procurement of FP planning handbook with standard information shall supplies so that contraceptive commodities are in the be developed and widely disseminated. right place, in the right quantities at the right time. Government and partners will be encouraged to use 4.3.5 Financing a hybrid of both the PUSH and PULL systems in order Strategies to harness the strengths of each and minimise the FP will be highly integrated in the district’s budget weaknesses. framework to ensure adequate recognition and consideration of the need for FP services delivery. Strategic outcome The district will make efforts to include budget • Improved quantification, forecasting and lines for FP services. The issue of contraceptive procurement commodities will be emphasized in the district plans • Minimized stock-outs at all levels; health facility and on top of the other activities such as advocacy community (VHT) and community mobilization as well as training of • Improved LMIS and HMIS health workers will be budgeted for. Donors and implementing partners will be lobbied to share their work plans and budgets so that they are integrated in the district work plan and budgets to minimize fragmentation and duplication of service delivery. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 19

This will enable the district to allocate funds to much 4.3.6 Stewardship, Management & Accountability needed areas such as education and infrastructure Strategy since FP is a multi-sectoral issue. As reaffirmed in the National CIP, strong monitoring, management, leadership and accountability Strategic outcomes are necessary and essential ingredients in the • Funding for FP commodities and activities operationalization of the plan. increased. The DHO will take the lead as a technical person • Improved integration of planning and budgeting supported by the DHT to effectively monitor, together with other partners to improve focus of coordinate, lead and ensure good governance of investment. family planning activities at all levels in the district. • Family planning is mainstreamed in district planning The DHT will be trained to effectively monitor, and budgeting processes. coordinate and manage family planning services. All • Financial investment in human resources activities of family planning (by both government and development for health is increased. PNFP) will be tracked by DHO’s office using MoH

designed tools and electronic databases. The district Amudat District Local Government will increase HMIS focal person will ensure timely and quality financial allocation to the health department while at data management and analysis to inform planning the same time strengthen its partnership with donors and decision making by the relevant stakeholders. and implementing partners to increase resource Frontline health workers will be trained to utilise allocation to FP services through off-budget and on- HMIS data at source. budget support. As a requirement in the Local Government Act (1997), the Resident District Commissioner (RDC), District Chairperson, Secretary for Health, Health Sectoral Committee and the entire Council will play an oversight function to ensure that all services are delivered to all people in Amudat District. All lower local political leaders will be oriented to offer oversight roles to ensure high levels of accountability without undue interference in the running of the RH services.

Strategic outcomes • Improved capacity at the district to lead, manage and coordinate the FP program strengthened • Strengthened of Family Planning indicators is strengthened • Improved tracking and monitoring of FP-CIP and provide support to implementing partners to report activities and funding and identify gaps. • District and facility efforts to collect, analyze, and use data to track FP progress is strengthened. Family Planning - Costed Implementation Plan 20 (2018/19 - 2022/23) AMUDAT DISTRICT

SECTION 05: Costing of the Plan

5.1 Introduction It is also important to note that contraceptive drugs The costing of the strategic activities is premised and supplies have not been costed because it is on the assumption that the limited resources are assumed that NMS will procure, supply and distribute committed to areas with the greatest potential to the commodities to and within the district. There only achieve the stated district goal. needs to be more training of health workers in LMIS. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 21

Table 12: Cost for implementing the CIP District Priority Strategic Outcomes FP Costs per year in UGX (millions) 2017/18 2018/19 2019/20 2020/21 2021/22 Total Demand Creation Stakeholders engagement 40 40 40 50 50 220 Social Behaviour Change Communication 23 25 25 25 25 123 enhancement Men support and involvement enhancement. 13 13 13 13 13 65 Sub-total 76 78 78 88 88 408

Service delivery Outreach services improvement 28 28 28 29 29 142 and access VHTs and other service providers motivation 40 40 40 50 50 220 HRH and VHTs training 29 19 20 15 15 98 Health workers mentorship and support 16 16 16 21 21 90 supervision Facilities equipped with enough supplies 14 14 14 14 14 70 Adolescents-friendly services improvement 12 18 18 6 6 60 Sub-total 139 135 136 135 135 680

Contraceptive Family planning commodity quantification 15 21 22 24 25 107 Security and forecasting enhanced Sub=total 15 21 22 24 25 107

Policy and enabling Sensitisation of political leaders 10 10 5 5 5 35 environment Multi-sectoral approach to family planning 10 10 10 10 10 50 adopted Legal framework and knowledge of policies for 0 0 0 0 0 0 family planning are improved. Sub-total 20 20 15 15 15 85

Stewardship, Capacity building of all stake holders done 40 40 40 40 40 200 Management and Monitoring, planning and budgeting introduced 20 20 20 20 20 100 Accountability Reporting of Family Planning Indicators and 15 15 20 15 15 80 data analysis is strengthened Sub-total 75 75 80 75 75 380

The total financial outlay for implementing this plan will be 1,767 billion Uganda shillings over the five-year period. Family Planning - Costed Implementation Plan 22 (2018/19 - 2022/23) AMUDAT DISTRICT

SECTION 06: Institutional Arrangements for Implementation Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 23

6.1 Introduction The CAO of Amudat District will be overall chair of Amudat district local government recognizes that the FP CIP committee. He/she will hold quarterly the MoH through a collective national effort takes feedback meetings with different sectors and CSOs stewardship and spearheads the planning, financing, including the religious and cultural institutions implementation and performance monitoring of all (trained champions) where the different sectors will the FP activities as prescribed in the National Health present their progress report on FP CIP. The CAO Policy. will hold all heads of departments accountable for Implementation of the Amudat District Local the expected results under their departments. Government FP-CIP will require the adoption of a multi-sectoral approach, involving all sectors in the District Health Officer (DHO) and Assistant DHOs district while working with the central government. A Amudat District Health Office will be responsible committee will established under the chairmanship of for providing oversight to effectively and efficiently the LC5 with support of the CAO and District Local implement the FP-CIP. In coordination with the Council to create opportunities for coordination, CAO’s office, the DHO will plan and allocate financial engaging and management of the district FP effort resources for FP within the district health budget and for realisation of the desired results. will perform the following key functions: 1. Manage, coordinate, and monitor implementation of the plan to ensure attainment of performance 6.2 Management, Coordination and targets by a wide range of stakeholders; Accountability Structure 2. Mobilize, monitor, and ensure efficient use of The Amudat FP-CIP as a strategic multi-year planning resources. document detailing activities and costs for achieving 3. Implement enabling policies, and facilitate FP goals reflects a common plan for all sectors formulation of by-laws, and regulations that aim involved in implementing the FP program in the to improve the availability of FP commodities and district and will be implemented by different heads access to services. of units representing existing sectors including the 4. Identify new staff for recruitment by the DSC in District Health Office and supported by the Local key positions. District leadership, Civil Society Organizations (CSOs) and Community Based Organizations (CBOs Civil Society and Nongovernmental Organizations amongst others. The multiplicity of civil society organizations and NGOs in Amudat district will be harnessed to play 6.3 Roles and Responsibilities of Key Actors a crucial role in accelerating access to FP. These will (District Level) complement the public sector in delivering services Chief Administrative Office at facility and community levels through advocacy, community dialogues, outreach services and The office of the Amudat CAO will be instrumental in monitoring. coordinating the multi-sectoral collaboration efforts of planning, resource allocation, implementation, monitoring and evaluation for FP services in the district in accordance with the national FP-CIP coordination structure. Family Planning - Costed Implementation Plan 24 (2018/19 - 2022/23) AMUDAT DISTRICT

6.4 Coordination Framework The coordination framework is summarized in Figure 2 below Figure 2: Coordination Framework CAO’s Office

District FP Steering Committe

DHO’s Office CSO & NGOs District Local Councils

Demand Service Contraceptive Policy and Stewardship & Advocacy Creation Delivery & Security Enabling Financing Accountability & Resource Access Environment Mobilisation

Table 13: Illustrative List of National Indicators to Inform the District FP-CIP Category Illustrative Indicators Data Source Demographic • Percent distribution of users by modern method • mCPR Indicators • Number of additional FP users • Track20, • Percent of women with an unmet need for modern PMA2020, and contraception the UDHS • Percent of women whose demand is satisfied with a modern method • CYP • Unmet need • Teenage pregnancy rate Service • Number of women receiving counseling or services in HMIS statistics family planning—new acceptors and continuing clients • Number of women receiving FP services, by method • Number of products dispensed, by method • Number of youth receiving counseling or services in family planning—new acceptors and continuing clients • Number of HIV-positive clients using family planning Process Demand • Percent of non-users who intend to adopt a certain • Activity reports indicators creation practice in the future • Programme • Number of radio and TV spots aired surveys • Percent of audience who recall hearing or seeing a • DHS specific message • FP-CIP • Availability of accessible, relevant, and accurate progress information about sexual and reproductive health monitoring tailored to young men database Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 25

Service • Number of mobile clinic events organized, and number of DHO delivery and people reached by district access • Number of youth-friendly service clinics established • Availability of accessible, relevant, and accurate information about sexual and reproductive health tailored to young men Contraceptive • Contraceptive stock-outs HMIS security • Number of providers trained on family planning by district Actual annual contraceptive delivered for the public sector • Percent of facilities that experienced a stock-out at any point during a given time period Policy and • Evidence of FP programs incorporated into national DHO, CAO, RDC enabling strategic and development plans environment • Evidence of documented improvement in the enabling environment for family planning, using a validated instrument (e.g., the Family Planning Programme Effort Index and Contraceptive Security Index) • Evidence of targeted public and private sector officials, faith-based organizations, or community leaders publicly demonstrating a new or increased commitment to family planning • Documentation of instances in which a formal implementation or operational directive or plan is issued to accompany a national or sub national FP policy Financing • Evidence of new financing mechanisms for family DHO, CAO, planning identified and tested District Planner • Evidence of private for-profit sector participation in family planning • Share of contraceptive procurement for the public sector financed by the government

Source: Adopted from National FP-CIP (2015-2020) Family Planning - Costed Implementation Plan 26 (2018/19 - 2022/23) AMUDAT DISTRICT

6.7 Routine Data Collection 6.8 Data Management Family planning services data will be collected Data Quality Assurance Mechanism through the normal HMIS system. Each health facility The District Biostatistician will play a lead role in and VHT member will be required to compile data ensuring Data Quality Assurance (DQA) collection, using the standard tools from Ministry of Health transfer, compilation, analysis and storage. This and forwarded them to the district Biostatistician will be executed through a series of technical for onward submission to Ministry of Health. The review meetings with the HMIS staff and health primary data at all health facilities (both government facility assessment checks. As such routine support and PNFP) will be captured in hard and soft copies supervision will be undertaken on a quarterly basis where possible and service providers will be trained and technical support will be offered in areas of and encouraged to study and utilise the data at need to health centres both for government and the source to inform their performance. 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.

Capacity Building It is envisaged that HMIS staff and other health workers will be oriented and trained in data collection, assurance, and analysis. The training will be on job and where necessary, offsite training will be arranged by the office of DHO. This will ensure that data tools are completed accurately.

Information Dissemination and Use It is planned that during the quarterly stakeholders’ review meetings, the consolidated and analysed data will always be presented to inform decision making. Deliberate efforts will be taken to disseminate performance levels with the relevant stakeholders including the FP providers at their levels. This will be done in addition to other strategic fora that bring together especially political leaders to strengthen advocacy efforts. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 27

SECTION 07: Implementation Framework Family Planning - Costed Implementation Plan 28 (2018/19 - 2022/23) AMUDAT DISTRICT

SECTION 7: DISTRICT IMPLEMENTATION FRAMEWORK WITH FULL ACTIVITY DETAIL

AREA #1: Demand Creation (DC) Strategic Outcomes Expected Results Activity / Sub Activities Inputs Output indicators Timeline Increased demand for family Increased number of Women • Strengthen the use of community structures to • VHTs and Champions meetings/rallies/ • No. of meetings/ rallies/community 2018-2022 planning services in the district ages 15-49 years demanding dispel myths and misconceptions. community dialogues dialogues conducted separately with the for family planning (met and • VHTs targeted outreaches/ door-to-door • Satisfied users mobilizing communities to VHTs and Champions unmet demand) campaigns and Champions generate demand for FP services • No. accessing services through the • Satisfied users to convince communities to use FP motivation of satisfied users. services • Conduct music, dance and drama shows on major • Organised groups prepare and stage MDD on FP • No. of MDD forums undertaken to 2018-2021 market days on market days promote family planning • Produce and disseminate IEC materials in local • IEC materials produced through organised • Family planning materials produced and 2018-2019 language workshops within the district disseminated • Conduct radio talk shows with the DHT and the • Buy 30 min spots to play twice a week • No. of radio spots airing FP information 2018-2022 district leaders/ champions/VHTs. per week • Prepare special communication package for the • Speaking to youth CSWs about advantages of FP • No. of youth/teenage girls sensitized on FP 2018-2021 youth/teenage CSWs. at places where they hang out DC2: Cultural and religious leaders Increased knowledge of family • In-depth dialogue with cultural and religious • Hold community dialogues with cultural and • No. of community dialogues conducted for Quarterly are supportive of family planning planning among cultural and leaders religious leaders cultural/religious leaders Scale- up religious leaders • Hold sensitization meetings at sub-county level • Conduct sensitization meetings for the cultural/ • No. of sensitization meetings conducted 2018-2021 and engage all cultural and religious leaders religious leaders • No. of leaders participating in the meetings DC3: Improved male involvement Increased knowledge and • Target men through male only dialogues and • Hold FP community dialogues for men • No. of men supporting women to access FP 2018-2021 and support for modern support for FP among men groups and bring male satisfied users in places services contraceptives for themselves and where men are found; Churches, community their partners meetings, drinking, burial places • Re-design the approach on male involvement • Re-package a male involvement approach for • Re-designed district Specific Male 2018 (packaging) and strengthen male action groups men Involvement Strategy • Use Male FP champions e.g., (Leaders- LCV, III, • Strengthen capacity of the male Champions for • No. of male FP champions oriented on FP 2018- 2019 GISO, Cultural leaders) FP DC4: Improved family planning Young people 15 -24 years are • Re-open the existing and create new YFCs across • Youth health clubs in schools giving information • Number of functional YFCs – in schools 2018- 2021 information and services among knowledgeable about FP and the district. (Re-introduce and expand YFC on sexuality and family planning using the young people 10 - 24 years. are accessing services Advocacy activities, sports & games, outreaches edutainment approach to youth in school and out of school and work sites, using peer educators) • Retrain the Senior Women and Male Teachers on • Senior women and male teachers trained on • No. of women and male teachers trained 2018-2019 family planning family planning • Introduce FP themes in MDD, school debates and • Hold “edutainment” community events MDD • No. of FP events held for young people 2018-2021 sports galas concerts and sports competitions to provide opportunity for knowledge exchange amongst young people Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 29

SECTION 7: DISTRICT IMPLEMENTATION FRAMEWORK WITH FULL ACTIVITY DETAIL (continued) AREA #2: Service Delivery (SD) Strategic Outcomes Expected Results Activity Inputs Output indicators Timeline SD 1: Increased access to and Increased FP service • Strengthen capacity of service providers to provide • Training of health service providers to offer and • No. of H/Ws trained and offering PPFP 2018- 2020 uptake of family planning services, provision/ delivery points in PPFP offering PPFP including post-partum FP the district • Conduct camps/outreaches by H/C staffs • Outreaches and camps organised for provision • No. of camps/ outreaches organised for FP 2018-2022 of FP services • Strengthen the referral network for FP services • Support referral for FP through VHTs and to • No. of referred clients receiving FP higher level H/Cs services SD 2: Strengthened FP in VHT Expanded VHT provision of FP • Undertake VHT targeted outreaches and door- • VHTs involved in family planning service • Number of FP clients served by VHTs 2018-2022 targeted outreaches and door to services door campaigns including for Sayana Press provision door campaigns SD 3: Increased access to YFS Increased number of youths • Re- introduce and expand YF Centres • Establish YF Centres at all H/CIII, • No. of youth receiving FP services 2018-2022 accessing FP services IVs and the hospital • Build capacity of H/Ws to provide YF FP services • Train H/Ws in provision of YFS • No. of H/Ws offering FP YFS 2018-2020 SD 4: Family Planning services FP services integrated into • Integrate FP in other health related services and • Family planning provided alongside other health • FP provision through other service 2018-2022 integrated in other health services HIV/AIDS care, immunization, outreaches services delivery points Cervical cancer screening, • Orient H/Ws to integrate FP in other health care • Providers trained/oriented in FP service post-natal care, STI and services integration nutrition programmes SD 5: Competent, skilled and H/Ws confident and motivated • Train H/Ws in the provision of LARCs • H/Ws trained in provision of LARCs • No. of H/Ws trained to offer LARCs 2018-2020 motivated H/Ws providing family to provide wide range of FP planning services methods

AREA #3: Contraceptive Security (CS) CS 1: Contraceptive Logistics Staff at facilities accurately • Build capacity of staff to routinely quantify • Train H/C staff and managers in Logistics • No. of staff and managers trained in LMIS. 2018-2022 Management System quantify and forecast FP and forecast FP needs based on stocks and management • No. of facilities stocked with all FP strengthened (staff able to requirements consumption methods quantify and forecast) CS 2: Reverse Redistribution FP commodities fully stocked • Ensure supply chain system tracks availability • Tracking and redistribution of FP commodities • No. of facilities stocked with all FP 2018-2022 Strategy strengthened at all HFs of commodities to allow redistribution from with H/Cs in the district methods overstocked to less stocked facilities within the district CS 3: Increased partners More partners supporting FP • Lobby for partners to support the FP program • Advocate for the support of partners at national • No. of partners supporting FP in the 2018-2022 supporting family planning (MSU in the district and district level district expands area of FP coverage) CS4: Enhanced capacity of H/Ws H/Ws confident and motivated • Train H/Ws in the provision of LARCs • H/Ws trained in provision of LARCs • No. of H/Ws trained to offer LARCs - to offer method mix (LARCs) to provide wide range of FP method Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 31

AREA #2: Service Delivery (SD) Strategic Outcomes Expected Results Activity Inputs Output indicators Timeline SD 1: Increased access to and Increased FP service • Strengthen capacity of service providers to provide • Training of health service providers to offer and • No. of H/Ws trained and offering PPFP 2018- 2020 uptake of family planning services, provision/ delivery points in PPFP offering PPFP including post-partum FP the district • Conduct camps/outreaches by H/C staffs • Outreaches and camps organised for provision • No. of camps/ outreaches organised for FP 2018-2022 of FP services • Strengthen the referral network for FP services • Support referral for FP through VHTs and to • No. of referred clients receiving FP higher level H/Cs services SD 2: Strengthened FP in VHT Expanded VHT provision of FP • Undertake VHT targeted outreaches and door- • VHTs involved in family planning service • Number of FP clients served by VHTs 2018-2022 targeted outreaches and door to services door campaigns including for Sayana Press provision door campaigns SD 3: Increased access to YFS Increased number of youths • Re- introduce and expand YF Centres • Establish YF Centres at all H/CIII, • No. of youth receiving FP services 2018-2022 accessing FP services IVs and the hospital • Build capacity of H/Ws to provide YF FP services • Train H/Ws in provision of YFS • No. of H/Ws offering FP YFS 2018-2020 SD 4: Family Planning services FP services integrated into • Integrate FP in other health related services and • Family planning provided alongside other health • FP provision through other service 2018-2022 integrated in other health services HIV/AIDS care, immunization, outreaches services delivery points Cervical cancer screening, • Orient H/Ws to integrate FP in other health care • Providers trained/oriented in FP service post-natal care, STI and services integration nutrition programmes SD 5: Competent, skilled and H/Ws confident and motivated • Train H/Ws in the provision of LARCs • H/Ws trained in provision of LARCs • No. of H/Ws trained to offer LARCs 2018-2020 motivated H/Ws providing family to provide wide range of FP planning services methods

SECTION 7: DISTRICT IMPLEMENTATION FRAMEWORK WITH FULL ACTIVITY DETAIL (continued) AREA #4: Policy and Enabling Environment (PEE) Strategic Outcomes Expected Results Activity Inputs Output indicators Timeline PEE 1: Improved knowledge of the Adherence to the FP Policy & • Orient the district leadership and H/Ws on the • DHT members participants • No. of district leaders and H/Ws oriented 2018-2019 FP Policy & Legal framework legal framework policy framework for FP service delivery on the legal and policy framework for FP. • Orientation meetings on the policy and legal framework for FP service provision PEE 2: Policy change favouring National advocacy to expand • Scale up FP advocacy at national level • Advocates and champions participate in • No. of advocates holding discussions with 2018 provision of more FP methods at range of commodities at H/C II meetings at national level MoH and NMS H/CIIs

AREA #5: Financing (F) Expected Results Expected Results Activity Inputs Output indicators Timeline F 1: Family planning is Family planning is prioritized • Create a budget line for family planning at district • FP components integrated in District • Budget line for FP exists in the District 2018-2022 mainstreamed in district planning and integrated in district level Development Plan Development Plan and budgeting processes budgeting processes F2: Improved donor funding and More finances for FP from • Advocate for increased funding for FP among • Use the FP-CIP as a resource mobilisation tool to • Amount of money mobilized for FP 2018-2022 corporate social responsibility for development partners and development partners and corporate agencies advocate/lobby partners and corporate agencies FP within the district corporate agencies to support FP F3: Integration of donor and IP More integrated planning and • Advocate for integrated planning and budgeting • Use the FP-CIP as a tool to advocate/lobby IP to • Integrated district work plan and budget 2018 - 2023 plans and budgets into the district budgeting process support FP framework

AREA #6: Stewardship, Management and Accountability (SMA) Strategic Outcomes Expected Results Activity Inputs Output indicators Timeline SMA1 : Strengthened district A robust annual FP program • Conduct annual planning and quarterly review • CAO convenes planning and regular review • Work plan developed, implemented and 2018-2022 capacity to effectively lead, implemented and regularly meetings of family planning in the district meetings for FP. meetings with DHTs regularly reviewed manage and coordinate FP monitored. • Tracking and monitoring the implementation of the • DHO and Planning Unit with the support of • Quarterly and annual monitoring reports 2018-2022 programmes FP-CIP partners on FP • District efforts to collect, analyse and use FP data • Train FP stakeholders to report correctly and • As above 2018-2022 for decision making strengthened provide the tools for reporting SMA2: Mid and End of term Evaluation reports • Conduct midterm and end of term evaluation of the • Data collection tools and manpower to conduct • Evaluation reports with lessons and best 2020 and evaluations undertaken documenting lessons learnt FP-CIP the evaluation practices documented 2023 and best practices Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 33

AREA #4: Policy and Enabling Environment (PEE) Strategic Outcomes Expected Results Activity Inputs Output indicators Timeline PEE 1: Improved knowledge of the Adherence to the FP Policy & • Orient the district leadership and H/Ws on the • DHT members participants • No. of district leaders and H/Ws oriented 2018-2019 FP Policy & Legal framework legal framework policy framework for FP service delivery on the legal and policy framework for FP. • Orientation meetings on the policy and legal framework for FP service provision PEE 2: Policy change favouring National advocacy to expand • Scale up FP advocacy at national level • Advocates and champions participate in • No. of advocates holding discussions with 2018 provision of more FP methods at range of commodities at H/C II meetings at national level MoH and NMS H/CIIs

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, M.oH. Ministry of Health (2010). National Health Policy. Kampala, Uganda: Ministry of Health.

5. Ministry of Health (2004). National Adolescent Health Policy for Uganda. Kampala, Uganda: Ministry of Health.

6. Amudat District Local Government, Uganda (2015). AmudatDistrict Development Plan 2015/2016 – 2019/2020. AMUDAT, Uganda:

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

8. Uganda Bureau of Statistics (UBOS) and ICF International Inc.2016. Uganda Demographic & Health Survey 2016. Kampala,Uganda: UBOS & Calverton, Maryland: ICF International Inc. Family Planning - Costed Implementation Plan (2018/19 - 2022/23) AMUDAT DISTRICT 35 Family Planning - Costed Implementation Plan 36 (2018/19 - 2022/23) AMUDAT DISTRICT

MINISTRY OF HEALTH

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

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