ACHAP Pre-conference Workshop DR PATRICK KERCHAN

February 25, 2015 HEAD OF PROGRAMMS

Three project experiences from Uganda Protestant Medical Bureau

FBO contributions to improved

MCH at country level.

– UPMB runs a network of

278 Health facilities, 35%

of the private, not-for-

profit sector in Uganda

– 90% of UPMB facilities

serve rural populations

– Began focused

investment in

strengthening FP in 2013

UPMB Background

Private, not-for-profit facilities across Uganda

Maternal and Child Health in Uganda

MCH cluster is composed of five elements;

• Sexual and Reproductive Health (SRH),

• Newborn care,

• Common childhood illnesses,

• Immunization

• Nutrition.

This emphasizes the link between maternal and child health and the cumulative nature of health problems through the entire lifecycle.

Sexual and Reproductive Health and Rights

Core HSSIP Indicators

• Maternal Mortality Ratio 438/100,000 – UDHS 2011

• % pregnant women attending 4 ANC sessions.

• % deliveries in health facilities.

• % pregnant women who have completed IPT2

• Contraceptive Prevalence Rate. Achieved 30% 2011/12 UDHS findings.

• Half of Uganda’s population is under 18 years and 57% of

women have given birth or are pregnant by age 19

• High fertility (7 children per woman) and low CPR (30%)

• 34 % unmet need for FP, particularly high in rural areas

• 25% of births occur with suboptimal spacing (<2

years after previous birth)

Top reasons for non-use of FP:

– Fear of side effects or health concerns (32%)

– Belief that they can’t get pregnant (correct

or incorrect assessment of risk) (17%)

– Woman or husband opposed (15%)

– Infrequent sex (7%)

FP in Uganda

Source: Uganda DHS 2011

Reproductive Health at UPMB UPMB

YEAR PROJECT/ FUNDER

# FACILITI

ES FOCUS

2002-04

Family Health International (FHI)

10 Facility-based strengthening local networks in integrated maternal health and SRH Services in rural communities

2006-09 Big Lottery

10 Facility-based strengthening of SRH information, particularly targeting adolescent girls

2009-13

Big Lottery

31

Voucher program for antenatal services, support to facility based maternal and neonatal health services, community outreaches, ambulances

2012-15

National Expansion for Sustainable HIV Services (NESH - CDC/PEPFAR)

16 Facility-based, comprehensive HIV care and treatment, FP included as part of PMTCT strategy

2013-15 ACHAP (Packard) 2

Facility & Community-based FP pilot, raising rural FP demand through sensitization of religious leaders , CHW & improved health facility capacity to provide FP

2014-16 E2A (Pathfinder/ USAID)

9 Facility & Community-based FP, emphasis on scaling up FP services, demand creation, reducing unmet need

2014-15 A3 (IRH) 8 Facility & Community-based FP, introduction of fertility awareness-based methods, sensitization of religious leaders

2014-15 UN Foundation/FP 2020

3

Advocacy for access to FP, demand creation, radio messages, sensitization of religious leaders, awareness raising facility providers & VHTs

Shared objectives:

• To promote healthy timing and spacing of pregnancies through expanded access to family planning at the facility and community level

• To increase involvement of religious leaders in improving family planning awareness and uptake of modern methods

FP Projects

Donor ACHAP

(Packard

Foundation)

E2A Project

(USAID)

FAITH IN

ACTION

(UN

Fund/FP2020)

Institute for

Reproductive

Health (Gates

Foundation)

Dates 2013-2015 2014-2016 2014-2015 2014-2015

Coverage 2 UPMB

facilities +

catchment area

9 UPMB

facilities +

catchment

area

6 UPMB facilities+

catchment area

8 UPMB facilities

+ catchment area

• 185 religious leaders(30-ACHAP/UPMB,80 FAM PROJECT,45-E2A and

30-FAITH IN ACTION PROJECT) were equipped with skills to deliver accurate FP messages .

• Refer clients to health centers and CHWs for provision of FP methods

Role

• Work with CHWs and Health workers

• Make referrals to the facilities.

• Engage in community sensitizations

• Create platforms for health workers to deliver messages on

RH.

• Routine updates on work data through reports

Progress to date

• When Religious Leaders are involved in RH programs such as

family planning, they serve as ambassadors and agents of

change to level the ground for the ‘conservative’ attitudes in

Family Planning usually associated with traditional religious

beliefs.

• The number of referrals for family planning services in the

two health facilities has increased three-fold (ACHAP/UPMB

FP PROJECT

Results

Voices from the –Religious leaders

“I can now confidently talk to anyone about family

planning. I wish the government would also use us

when reaching out to the communities. If I pass on a

messages to a congregation of 120 worshippers,

everyone will believe me without doubt.” - Imam

Voices from the Religious leaders

Some of my followers at

church ask: “How come

the message is now

different?”

This issue(FP) needs

action and not mere

prayers, I keep

explaining.”

Initially, I preached messages against use of modern family planning methods, But this has changed with the ACHAP family planning project training for religious leaders, Pastor

• Routine support supervision to member units

• Strengthen collaborations with public sector (District and

national level)

• Scholarship programs supporting health workers

• Extension of donor support to the rural

• Improved health information management systems.

Reaching the hard to reach

• Some myths and misconceptions have been cleared through trainings and routine interactions with health workers.

• Personal testimonies by religious leaders from permanent method users (tubal ligation and vasectomy)

• Religious leaders create platforms for sensitizations on FP/RH for health workers in their houses of worship.

• Peer education among religious leaders

Lessons Learned: Successes

• This was an opportunities to

work with other faiths

(Catholic, Protestant,

Muslim)--FAM options

create entry point for

discussion of challenging

interfaith issues

• Some religious leaders still hold some myths and misconceptions.

• Religious leaders have high expectations in terms of monthly facilitation and allowances which makes sustainability hard.

• Need for routine refresher trainings for religious leaders to keep abreast of new developments in RH

• Strong supportive supervision is needed for accurate data collection and reporting at all levels

Lessons Learned: Challenges

• Routine reviews and mentorships for religious leaders by

family planning focal persons at facility level

• Refresher trainings for religious leaders

• Strengthen collaborations with public sector (District and

national level)

• Continue engaging religious leaders as champions in FP

• Advocate for a standardized training curriculum for religious

leaders

Interventions ahead

Discussion Guide for Religious

Leaders

Useful information

For additional information, please contact:

pkerchan@upmb.co.ug

upmb@upmb.co.ug

UGANDA PROTESTANT MEDICAL BUREAU

Thank you!