REPUBLIC OF UGANDA ABIM DISTRICT Family Planning - Costed Implementation Plan 2018/19 - 2022/23 JUNE 2018 ABIM 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 Abim District Health Office. This project was funded by UK aid from the UK government. Published by: Abim District Local Government Ownership: Reproduction of this plan for educational or other non-commercial purposes is authorized without permission from the Abim District Local Government, provided the source is fully acknowledged. Preferred Citation: Abim District (2018). District Family Planning Costed Implementation Plan, 2018/19-2022/23. Abim, Uganda Copies available from: Abim District Health Office. iv Table of Contents FOREWORD vii PREFACE viii ACKNOWLEDGEMENTS ix ACRONYMS x EXECUTIVE SUMMARY xi SECTION ONE: INTRODUCTION AND BACKGROUND 2 1.1 Why Should Abim District Invest in Family Planning? 3 1.2 Rationale for and use of the FP CIP 4 1.3 Key Issues and Challenges 10 SECTION TWO: SWOT ANALYSIS 19 SECTION THREE: PROCESS OF DEVELOPING THE DISTRICT FP CIP 21 SECTION FOUR: TRANSLATION OF KEY ISSUES INTO STRATEGY 23 SECTION FIVE: MODELLING ACHIEVABLE mCPR GOAL FOR ABIM DISTRICT 25 SECTION SIX: INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION 29 6.1 Management, Coordination, and Accountability Structure 30 6.2 Roles and Responsibilities of Key Actors (District Level) 30 6.3 Coordination Framework 30 6.4 Resource Mobilization Framework 30 6.5 Performance Monitoring and Accountability 30 6.6 Monitoring, Evaluation and Learning 31 SECTION SEVEN: COSTED IMPLEMENTATION PLAN 32 7.1 Vision 33 7.2 Operational Goal 33 7.3 Strategic Priorities 33 7.4 Intervention and Activity Mapping to Strategic Priorities 33 Policy and Enabling Environment 34 Service Delivery and Access 35 Commodity Security 36 v Demand Creation 36 Financing 37 Stewardship, Management and Accountability 37 SECTION EIGHT: DISTRICT IMPLEMENTATION FRAMEWORK WITH FULL 38 ACTIVITY DETAIL REFERENCES 44 List of tables Table 1: Abim District demographics 3 Table 2: National health facility standards 6 Table 3: List of health facilities in the district 7 Table 4: Family planning partners 7 Table 5: Family planning users 2016-2017 10 Table 6: Availability of family planning services at each facility in Abim District 10 Table 7: Status of human resources for family planning at public health facilities 11 Table 8: Number of staff by cadre that provide the different family planning methods 11 Table 9: HMIS status at the FP service delivery points 12 Table 10: Stock-out status of FP commodities in the last 12 months 14 Table 11: Stock-out status of FP drugs and supplies 15 Table 12: Availability of FP equipment in facilities 16 Table 13: Availability of policies, guidelines and protocols in Abim health facilities 17 Table 14: Abim District allocation to health and family planning 17 Table 15: Donor on-budget support to health in Abim district 20 Table 16: SWOT Analysis for Abim District 26 Table 17: Contraceptive method mix, CPR growth, and health impact if trends continue 27 through 2022 Table 18: Contraceptive method mix, CPR growth, and health impacts if growth in modern 28 method use is accelerated to 1.3% annually, 2018-2022 Table 19: Monthly Case load per health facility in business as usual scenario of 0.65% 28 increase in CPR per year Table 20: Monthly caseload per health facility by method in the accelerated CPR of 1.3% 28 CPR increase per year Table 21: Detailed activity breakdown by strategic outcomes 38 vi List of figures Figure 1: Map of Uganda showing location of Abim District 7 Figure 2: Unmet need for family planning in Karamoja district 8 Figure 3: FP indicators for national level and Karamoja sub-region 9 Figure 4: Policy and enabling environment cost, in millions UGX 35 Figure 5: Service delivery and access cost, in millions UGX 35 Figure 6: Contraceptive security (Programs) cost, in million UGX 36 Figure 7: Demand creation costs, in millions UGX 36 Figure 8: Financing costs, in millions USD 37 Figure 9: Stewardship, Management and Accountability cost, in millions UGX 37 vii Foreword Abim District total fertility rate is one of the highest, according to the Demographic Health Survey (2016), with each woman bearing an average of eight children during her lifetime. We clearly have a lot of work to do—many women Abim District Health Offi ce (DHO), in collaboration would like to delay or limit the number of children, with partners, has developed the Abim District yet they are not using family planning. Many cite Family Planning Costed Implementation Plan FY health concerns, including fear of side effects, or 2018/19-2022/23 to guide our district efforts to opposition from their partner as reasons for not using increase knowledge of and access to family planning. contraception. We need to address these women’s We believe that our joint efforts will lead to a decline health concerns and fears, improve our counselling in the unmet need for family planning and an increase about side effects and involve men as partners. in the modern contraceptive prevalence rate (mCPR) Our efforts to scale up the use of modern family for married and in-union women from 7.3% (UDHS planning methods are motivated by the knowledge 2016) to 14.3% by 2022 based on the reality check that family planning helps women achieve their modelling. rights to health, education, autonomy, and personal I call upon Development Partners and implementing decision making about the number of children they agencies to work with us to fund and implement the have and timing of their childbearing. More broadly, Abim District FP CIP to ensure the success of the family planning improves maternal and child health, district FP programme, and to improve the lives and facilitates educational advances, empowers women, well-being of our people. reduces poverty, and is a foundational element to the For God and My Country. economic development of a nation. The President H.E Yoweri Museveni made a strong commitment to family planning at the London Summit on Family Planning in July 2012, and again at the National Family Planning Conference in Kampala in July 2014. We need to build on this political commitment to implement robust family planning programmes to reach women, men, youth, and communities with quality services and information to meet their needs. viii Preface Abim district is committed to improving access to family planning as it is a low cost, high dividend investment for addressing the district high maternal mortality ratio, and improving the health and welfare of women, men, boys and girls. Family planning is an essential component to This population shift can contribute to both our district development agenda for sustainable district development and improved well-being for economic development. families and communities. If we are to realize the Increased access to, and use of family planning has demographic dividend, however, we must make far-reaching benefi ts for families and the district. substantial investments to improve health outcomes If we manage to bring down the high fertility and meet the need for family planning, while rate, we will have the potential to benefi t from an educating and training workers, promoting new job opportunity known as the demographic dividend. opportunities for young people, and strengthening The demographic dividend refers to faster economic economic stability and governance. growth that is caused in part by changes in population age structure that result in more working adults and fewer dependents. ix Acknowledgement This document is the product of extensive consultations with stakeholders working at all levels within the district, including key sector ministries, Development Partners, implementing partners, district staff and consultants. Deserving of special mention is the District Health We would wish to thank the data collectors, the Team (DHT) that travelled to all health facilities respondents from the different health facilities collecting data and later undertaking data analysis to during the exit interview and the consultant who synthesize key issues that affect family planning in facilitated the process. the district, and stakeholders who participated in the Finally, we extend our sincere appreciation to MoH, various validation meetings. UNFPA, and technical teams for offering technical Special appreciation goes to UK aid from the UK guidance and reviewing the report. government through the United Nations Population Fund (UNFPA) for the fi nancial support and MoH for the technical guidance and leadership in developing this plan and the consultant for the technical input. Abim District Local Government is specifi cally acknowledged for the cooperation, participation and wonderful coordination that enabled timely completion of the assessment and costing exercise. x Abbreviations ADHO Assistant District Health Officer MHCP Minimum Health Care Package CAO Chief Administrative Officer mCPR modern Contraceptive Prevalence Rate CBDAs Community Based Distribution Agents MMR Maternal Mortality Rate CO Clinical Officer MoH Ministry of Health COC Combined Oral Contraceptives MW Midwife DCAO Deputy Chief Administrative Officer NDA National Drug Authority DHMT District Health Management Team NMS National Medical Stores DHO District Health Officer PFP Private for Profit DHT District Health Team PNFP Private Not For profit DIA District Internal Auditor PO Principal