Northern Uganda is among the regions that are grappling with the lowest percentages of married women using any modern method of family planning – 23.4% – compared to the national average of 30.4%.
Over the years, this region has been faced with notably poor health indicators. There is a low contraceptive prevalence rate of 4.7%, which is 18.3% lower than the national level. There is also a high level of teenage pregnancy of approximately 43% and high rates of unsafe abortions. Furthermore, the HIV prevalence rate is at 5.6% within the region, close to the national average of 7.2%
Reproductive Health Uganda (RHU), a Member Association of the International Planned Parenthood Association (IPPF), operates in a number of districts in the region, with one of the clinics stationed in Lira district. The 2014 National Population and Housing Census indicates that Lira has a population of slightly more than 410,000 people, predominantly rural peasant communities. The majority of the population is illiterate, in part due to the mass displacement caused by the Lord’s Resistance Army (LRA) rebellion that has ravaged the region for over 20 years.
Since 1972, RHU has been one of the main sexual and reproductive health and rights (SRHR) service providers offering a wide range of services to the poor, vulnerable, and most at-risk populations. Services are offered through clinic, mobile outreach, and community health workers. The services offered include: HIV counseling and testing, family planning, sexually transmitted infection diagnosis and treatment, Hepatitis B testing and vaccination, cervical cancer screening, and other laboratory services.
Unfortunately, despite RHU and other partners’ interventions, there is still a high unmet need for SRH services as indicated by low health indicators. RHU devised a number of strategies to increase access to SRH services to the community, but uptake was markedly slow.
Something was not right. Something needed to change.. Still in this predicament the LDP+ program was introduced as a solution to improve service delivery and demand generation. Jackson Chekweko, the Executive Director of RHU, explained the programs appeal:
“MSH, together with IPPF, trained our senior management as trainers of trainees in the LDP+ (method), and we are piloting it in five of our branches. The uniqueness of the model is that it facilitates you as a team to discuss solutions.”
In July 2014, the trainers from RHU’s central location extended the LDP+ training to its Lira clinic with the aim of empowering the staff to work as a team to discuss the challenges they faced, come up with solutions, and achieve desired results.
Six staff members underwent the LDP+ action-based training and identified challenges specific to the Lira clinic. The team then developed a common inspired vision and desired measurable results. Using the challenge model, the team identified obstacles and priority interventions to address these challenges.
The group identified their main challenge as insufficient community SRH outreach. Thus, the task at hand was to devise a program to increase the scope of the community outreach program in the Lango sub-region. The subsequent desired measurable result (DMR) was to increase the number of clients served with SRHR services in the Lango outreach by 40% monthly, from 600 – 840 clients.
To achieve this, the team developed a comprehensive action plan to realise their DMR. The RHU Lira team established contacts with 11 sub-county leaders and initiated partnerships with different stakeholders who would mobilize clients for services in their respective areas. They then conducted review meetings with the staff and stakeholders to assess progress and room for improvement, and to ensure there were available resources for the outreach programs (material and human resources).
Mobilization of communities was carried out through use of radios, partnership coordination and referrals, and the use of church leaders, sub county leaders, health centre staff, and local leaders acting as sensitization partners.
In addition, the team strategized over how to improve their stock management system through regular stock forecast meetings. This enabled the team to conduct two outreaches on a weekly basis while securing an adequate and steady supply of commodities to serve this increasing client load.
Between July and October 2014, at least 20 outreaches were conducted serving more than 4, 500 clients, compared to the previous quarterly average of about 1,400 clients between March – June of the same year.
These outreach sessions were a result of positive partnerships with other stakeholders such as schools, religious leaders, and political leaders who sent requests for SRHR services to be provided in their schools and communities. At the same time, the stakeholders also helped in the mobilization of the clients for services. This collaboration resulted in the development of strong interpersonal relationships, which enhanced effective referrals and a functioning community networking system. To review all of this progress, weekly Lira clinic meetings were initiated to evaluate service delivery progress and improve information sharing amongst the staff.
Given these tremendous successes, it is unsurprising that RHU Lira has plans are to use the challenge model to identify future challenges to enhance continuous provision of quality SRHR services to the communities beyond the project. “People should embrace the LDP+ program because it has the potential to make teams identify common challenges, work with available resources and environment to address common challenges and create improvement in service delivery,” explains Geoffrey Lapat, the RHU Lira Branch-in-charge.
RHU staff are not the only people who are noticing the transformative results of the LDP+ process. In appreciation to the project, client Odongo Patrick, from Akura sub-county, shared, “I used to be so scared about Hepatitis B but am so happy because I am now very sure of my status after conducting a test in RHU outreach in my village.” Another client, Okello Patrick, of Barr sub-county says: “We are very much appreciative because the project (resulting from the LDP+) has helped in reducing the high birth rate in my community through the provision of family planning services.”
Echoing the staff and community’s great SHRH progress, Jackson Chekweko shares, “Based on these revelations, RHU is making the LDP+ a strong, core part of its programming. And we are very grateful to IPPF and MSH, through the funding support from USAID, who have built our capacity. We, as Reproductive Health Uganda, feel that we can build the capacity of other IPPF Member Associations and other organizations in the roll-out of the LDP+.”