After a training conducted by The Challenge Initiative (TCI), a member of the Village Health Team in Uganda expanded his demand creation channels to help increase family planning uptake in a county.
Julius Baala, a Village Health Team member, counseling mothers on Family Planning methods at Buikwe Health Centre in Uganda in March 2022.
When Julius Baala was a child, he witnessed caregivers struggling to provide for many children in a household. These memories motivate his work as a community health worker promoting family planning in Buikwe District in Uganda. He said:
I dislike unplanned families, and so I work hard to make family planning information and services available to women and girls, especially young women.”
Julius is part of a Village Health Team (VHT) – volunteer workers who mobilize communities for health programs and strengthen the delivery of health services at the household level. In Buikwe District, where Julius works, he has heard the myths and misconceptions about family planning among community members that hinder family planning uptake.
Many men and women believe that contraceptives cause infertility.”
Because of low uptake of contraception, Buikwe District has a high teenage pregnancy prevalence rate, with 17% of girls aged between 15 and 19 already mothers, according to 2021 data from the Ministry of Health. Teenage pregnancies are a challenge in Uganda, where among all women attending their first antenatal care, one in five (19%) were teenagers in 2020, according to the Uganda Bureau of Statistics.
Despite his enthusiasm, Julius was apprehensive about persuading a community to accept family planning due to his experience working on HIV programs. Thankfully, Buikwe is one of the districts in Uganda supported by The Challenge Initiative (TCI).
TCI’s platform empowers local governments to rapidly and sustainably scale high-impact practices and other interventions among urban poor communities. These evidence-based strategies include integrating family planning into regular health services and orienting the entire staff at health facilities so everyone from the guard at the gate to the clinician welcomes the community when they come to the facility to seek family planning services.
Village health teams play a crucial role in service provision, as they generate demand for family planning. Julius had relied on talking directly to community members but after training from TCI, he added other methods to reach people and debunk myths. He has expanded demand generation activities by using community radio where he is interviewed on air with health workers such as nurses to discuss family planning and clarify myths and misconceptions. He noted:
The training helped me harness some of the methods I used to interact with the community in HIV programming, and not stop giving the people factual information about family planning, but also refer them to Buikwe Health Centre III where I am based.
Julius also employed his social capital and good standing in his community to talk to men about family planning because they are the key decision-makers in Buikwe households. In a community dialogue meeting he participated in Ssi, a Buikwe sub-county, most of the young women said their partners decide whether they use contraception or not. According to Julius, his strategy to involve men is yielding results:
It’s been very encouraging to see how men are changing their views about sexual and reproductive health, I am even seeing them accompany their wives to antenatal care.”
The increase in additional family planning users demonstrates improved uptake in Buikwe District in Uganda from Feb. 2018 to May 2022.
Dr. Richard Bbosa, the District Health Officer in charge of Buikwe District, said the collaborative effort with TCI to generate demand for family planning and strengthen the health system has increased family planning uptake. In June 2018, the number of additional family planning users in Buikwe was 2,489, which increased 97% to 78,241 additional users by May 2022. (See chart above). Nearly half of the clients listed in the family planning registers are adolescents and youth 15-24 years. Dr. Bbosa noted:
Champions and village health teams are critical allies in tackling myths and misconceptions that have hampered acceptance of family planning services, and with the training that TCI gave them, they are helping us change our story.”
Buikwe’s local government is now leading and owning the interventions it learned during its engagement with TCI. Buikwe began its TCI-supported implementation in February 2018 and graduated from TCI’s direct support in July 2022. Dr. Bbosa said the district has committed more than USD $300,558 since 2018 to fund family planning efforts, including a dedicated technical lead overseeing how Buikwe runs its health facilities. The family planning program is also now included in the district’s work plan.
