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By Timothy Eodu, Edward Akaki
As the Family Planning narrative is not a good subject of discussion in Karamoja due to the entrenched cultural and religious beliefs, an impact has been realized and steadily being up taken in the region and Teso over the five years of the RISE program implemented by Marie Stopes Uganda on behalf of the Ministry of Health, Supported by UKaid.
This revelation was made by stakeholders in the two regions during an engagement at Hotel African in Moroto on Tuesday. This engagement was attended by District Health Officers, Religious, Political and Cultural leaders among other stakeholders.
During a panel session, the Serere District Health Officer, Dr. Daniel Ogwal stated that through the partnership with Marie Stopes to implement the RISE project, the district managed to organise several community out reaches and sensitized masses on the benefits of using family planning.
Trend of registered FP users by region
Source: Ministry of Health, DHIS 2
“These community engagements produced tremendous results in Serere because peopleat first used to fear family planning services due to misinformation. But when we sensitized them, they started appreciating these services and as we speak today, the situation has improved,” he stated.
Dr. Daniel mentioned that teenage pregnancy had skyrocketed in Serere post Covid-19 which posed a greater risk to the young mothers but with access and increased up take of FPS in the district lately, the numbers have declined.
On the other hand, Sr. Regina from Napak district reported that due to misconception that is deep rooted in the region about family planning, the district had to rebrand the project to suit the local population, in a manner they could easily understand and relate with.
She mentioned that the program provided mentorship and capacity building to health personnel across the lower facilities in the district, which resulted in data validation and improved service delivery.
“Our midwives did not have much knowledge about family planning services, how to record and report data and they used to fear attending to clients. Currently, the situation has changed totally, mothers have quick access because they are given best services due to the mentorship,” Sr. Regina remarked.
She however urged the Ministry of Health to ensure timely supply of family planning stocks because the demand and up take is increasing, yet the stock outs are very common and some clients end up missing or even losing interest.
Stock out of Depo provera in health facilities, 2019
Source: Ministry of Health, DHIS 2
Sr. Regina urged health workers to use the skills and information they gained during the five years of implementing the RISE program to offer quality services but also to pass them to other health workers for purposes of sustainability.
According to Sr. Florence Otim Awili the Abim district FPS trainer, the knowledge, experience and competence of most midwives and lower health facilities has greatly improved. She said most health workers used to only issue short term plans especially depo because it was the easiest and avoid the long term plans due to lack of knowledge and skills.
Trend of IUDs inserted by Region
Source: Ministry of Health, DHIS 2
Sr. Awili said the program supported them to move around all the lower facilities to provide hands on support and mentorship through capacity building on FPS which to date has improved service delivery, data management as well as reduced infections during and after carrying out family planning on clients.
She said majority of the health workers had a challenge of managing the side effects associated with family planning and whenever clients returned, some would go into hiding instead of providing counseling or guidance.
“Right now, I guess if anyone visited with any complication related to family planning, they will be handled at any facility or helped to reach where they can be helped. I only request that lower facilities be equipped with sterilizers and other necessities to aid in the process but also deployment of at least some FPS experts to offer other services that may not be managed by our teams in lower facilities,” she urged.
Simon Nangiro, the chairperson Karamoja Elder’s Association called for a more concerted effort and partnership with all stakeholders to ensure that the right information reaches out to the masses to avoid being misunderstood.
He said family planning is a very sensitive issue in Karamoja because they believe getting results other than preventing. Nangiro highlighted that in the past; karimojongs used to keep their animals and would only produce children they can take care of.
He called upon development partners to closely work with cultural institutions to influence the masses but also have a clear way of passing family planning information to the Karamoja communities if better results and mindset change about it is to be achieved.
According to the RISE Program Manager and head of Grants, Dr. Rita Twaheyo, the £27.5M project begun in 2018 November and will end in June 2024. She said the intended impact of the program was to reduce maternal mortality in the seven regions of implementation through increased up take of modern contraception for planned births.
Dr. Twaheyo urged people to appreciate family planning as an aid to development and not as a health matter alone because it encourages better planning and decision making which in turn can make people more productive.
She said the project had 325 health facilities under comprehensive on-job mentorship and over 750 health workers have benefited across the country, reached out to four (4) million people with Social and Behavioral Change-SBC messages, and 4.8 million contraceptives delivered in the five years.
According to the UNFPA Uganda Family Planning Atlas 2020, Karamoja region consistently ranked lowest in the number of FP users and across the different methods over the three-year period (2017-2019).
The use of natural methods is the only method where Karamoja performs well in the third position compared to the other regions. In addition, Karamoja registered a progressive improvement between 2018 and 2019 of: 24% for natural methods, 50% for vasectomy, 14% for IUDs inserted. This therefore may imply that family planning is becoming more acceptable among the men.
