As a midwife in the Naibiri village of Iganga District in Uganda, Nabirye Maureen provides services and information on family planning benefits to many women, men and young people in her community. This is just one of the roles she plays as a midwife who supports mothers in child care and conducts health talks in schools and on radio talk shows, especially related to the use of family planning services.
In 2017, when The Challenge Initiative (TCI) started collaborating with local governments in Uganda, Iganga was one of the cities that self-selected to implement proven family planning interventions to reach the urban poor. The program was coordinated by the Iganga District health management team in collaboration with TCI and other partners and targeted increased demand for family planning services while improving the quality of services.
Nabirye, who has been a TCI coach since 2018, noted:
I was selected as part of the coaches who would provide coaching and mentorship to my peers on the provision of different contraceptive methods in our district. This put me in constant touch with health facilities and other health workers who provide family planning services. This is when I realized that some of them lacked the skills, and most of the time they had to refer clients to other facilities.
She added that TCI came at the right time because her district has a Total Fertility Rate (TFR) of 6.7%, compared to the national average of 5.2%, a teenage pregnancy rate of 27%, compared to the national average of 25% (UDHS, 2016), and meager resources to finance family planning programs.
Healthcare workers like Nabirye play an essential role in mentoring and coaching other health providers on quality family planning services. Coaching is one of TCI’s innovative capacity strengthening strategies that use counterparts to transfer knowledge and skills in the workplace. The process is structured so that the coachee observes the coach as they implement an intervention over a period of time. The coachee then takes up the task as the coach observes, and only steps in to assist when necessary.
Although most health facilities welcomed TCI, she recalls addressing challenges such as high staff turnover, lack of support to young people seeking reproductive health services and information, and a lack of data used to make informed decisions following the start of the program. Nabirye said:
At the outset of the program, family planning received minimal focus in our facilities, so I was approached by the health management team to lead the coaching session on TCI’s interventions in 22 facilities. We started by reviewing the resources on TCI University about the benefits of family planning during whole site orientations. I had to work with everyone at the facilities and community health workers to ensure uptake of family planning services increased.”
Recognizing the importance of trained health care providers as necessary to health service delivery, the health management team at Iganga District engaged technical and political leaders and advocated for more resources. In fiscal year 2020/21, of the USD $41,900 that Iganga District allocated for strengthening family planning services, 65% was expended. The district has also increased the number of facilities offering youth-friendly services.
Together, Nabirye and her co-workers that had been coached on TCI-hosted community dialogues, worked to create opportunities to discuss health problems face-to-face, and develop suitable local solutions.
Recently, with support from partners like Marie Stopes, the district was also able to conduct onsite mentorships for more than 60 midwives and nurses from 30 health facilities. The attendees were introduced to TCI University resources and coached on family planning counseling and service provision, including reporting so facilities can have better access to data and make more informed decisions.
The trainings sought to reach more facilities with TCI interventions as a way of boosting services. Village Health Teams (VHTs) also learned key information and common misconceptions to share with their communities. Now VHTs can provide sexual reproductive health education and family planning counseling in the community. They are also skilled to provide short term contraceptive methods and report the data to the attached health facility on a monthly basis.
With any new intervention, collaboration between health facilities is essential, Nabirye said.
We need collaboration to reach more women and men and especially young people with contraceptive services. This is why we involve the health workers from other service areas. We want to integrate services, so they learn what we have learned and take it to their facilities. This way, there is more chance of reaching more women and men with family planning services.”
As Iganga District continued to implement TCI interventions, the health management team invited other partners to provide more healthcare providers with additional skills such as post-pregnancy family planning.
TCI promotes local ownership to ensure long-term implementation of the interventions and ultimately sustain their impact. Iganga District graduated from TCI’s direct technical support in April 2022. Nabirye said she has been able to continue with training and mentorships with other districts.
My efforts have not gone unrecognized, I was contracted by the Uganda Midwives Private Association which received a grant from World Bank to build skilled midwives. I was able to train and mentor over 100 midwives in three districts of Kibuuka, Arua and Terego here in Uganda. My master coach skills have enabled me to extend my knowledge and skills to address critical health resource gaps beyond the borders of my District.”