Uganda continues to make strides in the use of family planning methods and service delivery according to survey results disseminated by Performance Monitoring and Accountability 2020 (PMA2020) on July 24th 2018 at Kampala Serena Hotel.

However, despite these gains, the survey results point to the need for continued efforts to improve access to all family planning methods so that all women/ couples in Uganda can choose the best method for them from a range of choices.  

In her opening remarks at the function, the Dean of Makerere University School of Public Health (MakSPH), Dr Rhoda Wanyenze, said, “We are very confident when we share these findings because we know that they represent what is happening in our communities.” She appreciated the various partnerships that have enabled the survey, and the audience of implementers and policy - makers, stressing that it is after implementation that research evidence has value.

She urged a continued working relationship with UBOS, citing the comparative advantage of UBOS and MakSPH as more reason to jointly explore what else the two institutions can do.

MakSPH at the Col­lege of Health Sciences (MakCHS) led this PMA2020 research in collaboration with the Uganda Bureau of Statistics (UBOS) and the Ministry of Health.

Sharing the findings, Dr Simon Peter Kibira, a lecturer at MakSPH and a co-investigator in this research revealed some very shocking figures. He pointed out that 46% of the women interviewed in the study reported unintended births for their last child; 15% reported that they no longer wanted children. This is an increase in “unwanted children” from last year when 40% and 13% reported unintended births and no longer wanted children respectively.

In addition, it was revealed that 26% of the women were complacent about making sure they did not have children they did not intend to have, and yet they were sexually active. This means that these women are leaving conception to chance. Also worrying was the finding that rural women show a seven – year gap between age of first sex and age of first use of contraceptives; urban women reported only a 3 and a-half – year gap. The data showed that rural women had 2 – 3 children by the time of first use of contraceptives; their urban counterparts had 1 child.

However, the long acting reversible and permanent methods especially implants are beginning to take root. And injectables were the most used method of contraception for married women. Many women are also opting for implants. Among sexually active unmarried women, the emergency pill is a growing contraception method.

The study also found that almost 50% of women are not counseled by health workers about the possible side effects of the family planning methods before enrollment. This probably explains why uptake in use in not growing as expected, because the main reason among non – users of contraceptives, was found to be fear of side – effects.

Dr Simon Peter Kibira (black suit) and Dr Frederick Makumbi (dark grey suit) answer press questions at the dissemination.

 

Dr Frederick Makumbi, a senior lecturer at MakSPH and the lead investigator in the PMA2020 study equally presented findings on the state of family planning stocks in the health centres where the study was conducted. He revealed that 36% of the 342 health centres visited were stocked out of injectables, which happen to be the most commonly used contraceptives while a third of the health facilities visited were stocked out on family planning pills. “There are many methods that are not available by policy at these health centres. But again, that’s where majority of the women have access”, he highlighted, further alluding to whether it was time to change the policy. “The fact of the matter is it does not matter whether a health centre should offer these services, to these men and women because that is where they have access. Is it a good thing, maybe it should be thought about because offering these services is a good thing”, suggested Dr Makumbi.

With this kind of findings, we might as well not be able to meet our family planning goals as a country for the year 2020.

Alain Sibenaler, the United Nations Population Fund (UNFPA) Uganda representative noted the persisting inequalities between the rural and urban population in reference to accessibility and acceptability of family planning methods, stressing the need to address these inequalities. “We need to move towards policy change at the different levels, to increase availability and affordability of different methods of family planning, and we are happy to support the Ministry of Health in doing that. It also means increased training in counseling. We must also look at girls at the age below of 15 when it comes to teenage pregnancies. He concluded with a call for leadership and coordination, especially in supply chain management, to ensure elimination of stock-outs at health centres.

Dr Placid Mihayo from the ministry of Health, while delivering the closing remarks, thanked MakSPH for the research done, promising more collaboration with MoH to inform policy. Urged partners to handle issues of re-distribution and quantification with government, for districts to know quantities within a specific time, to order for what they can use.

Commenting on the current stock – outs in the country, Dr Placid emphasized the need for partners to work with government in re-distribution and quantification of products. “We have to insist on returns and stock –at-hand before we can give you more products, to avoid shortage at national level yet some facilities are over-stocked”, he held, adding that alternative distribution was still being discussed. “Products procured by UNFPA through UHMG, we have to keep ordering them from UHMG till December this year. USAID and Global Fund 2 are already in Joint Medical Stores”, he explained.

Present at the function were members of the Parliamentary Health Committee led by its Chairperson, Hon Dr Michael Bukenya. The meeting was also graced by the Executive Director of Uganda Bureau of Statistics, Dr Ben Paul Mungyereza; Dr Jotham Musinguzi, the Director-General of National Population Council.

 

 

L-R: Dr Placid Mihayo, representing Ministry of Health ;Dr Jotham Musinguzi-Director General, National Population Council; Prof Fred Wabwire-Mangeni-Senior Lecturer at  MakSPH; Patrick Mugirwa, Program Officer at Partners in Population and Development-Africa Regional Office; Hon Justine Khainza, Woman MP, Bududa district; Dr Moses Muwonge, Executive Director-Samasha  Medical Foundation

 

About PMA2020

Overall direction and support is provided by the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and funded by the Bill & Melinda Gates Foundation.

PMA2018/Uganda Round 6, the sixth round of data collection in Uganda conducted from April to May 2018, uses a two-stage cluster design with urban-rural and region as strata. The project used the same set of 110 enumeration areas (EAs) as those that were selected in the previous round and drawn by the Uganda Bureau of Statistics from its master sampling frame. In each EA, households and health facilities were listed and mapped, with 44 households randomly selected. Households were surveyed, and occupants enumerated. All eligible females age 15 to 49 were contacted and consented for interviews. The final sample (and completion rates) included 4,558 households (96.8%), 4,225 de facto females (96.8%) and 342 health facilities (94.7%).

 

 

 

A public dialogue on the Health Sector Budget 2018/19 was hosted today afternoon at Kabira Country Club, Kampala, by Makerere School Of Public Health (MakSPH) SPEED (Supporting Policy Engagement for Evidence-based Decisions) project. The dialogue focused on the implications for Universal Health Coverage (UHC) in the Uganda Health Sector Budget for this fiscal year.

In his welcome address, Prof Freddie Ssengooba (pictured above) attributed the necessity of such dialogues to the aim of seeing how actors and key players in the health and other key sectors can be assisted to leverage money within the sector to improve health, especially for the SPEED project.

“These public dialogues can be used to help key actors in the sector partly to hold accountable those resources to improve health where they are allocated, and partly to make it clear to our key players that these resources could be potentially used in a way that improves health benefits”, he stated. He called on the audience to deliberate constructively on how to leverage monies going to other sectors that have implications for health.

In his speech representing the Dean of Makerere School of Public Health, Prof Ssengooba expressed the University’s pride in leading such discussions of policy. He also emphasized the keenness of the university in making sure that society can look to the institution’s participation in identifying solutions to communities’ challenges, because of the amount of knowledge and capacity at the disposal of Makerere University, and the School of Public Health (MakSPH) in particular. In welcoming the audience to the gathering, he urged policymakers as well as academia, to embrace the concept of Universal Health Coverage (UHC), expressing belief in the ability of the panel to generate advice and out – of – the - box solutions for the challenges in the realization of this concept.


Participants at the Uganda Health Sector Budget Public Dialogue

Dr Sarah Byakika (pictured below) the Commissioner, Planning in the Ministry of Health (MoH) appreciated the invitation extended to the Ministry of Health as a partner, asserting that such dialogues are developmental to the ministry and country in general. She underlined some key points in the budget which the sector prioritized for the fiscal year 2018/19, expressing gratitude at the increment in budget allocation to the sector from 6.4% of the 2017/18 budget to 7.4% of 2018/19. Also mentioned were the fact that wages take up 26% of the Health Sector Budget, Non – wage expenditures 20% and 8% on infrastructure development; the remaining 46% is covered by donors through projects like GAVI and Global Fund. “As part of priorities along our key sector strategic objectives, we shall continue addressing the key challenges related to human resource (which is critical to the sector) i.e. of attraction, retention, training and development”, she pledged, further revealing that 419 Scholarships would be given out in critical specialties such as in anesthesia, Biomedical engineering, Obstetrics and Gynaecology and general surgery. Dr Sarah acknowledged a World Bank financing receipt of USD 200 million but admitted to having prioritized infrastructure development such as the Special Paediatric hospital in Entebbe, and upgrading of several Health Centres IIs to Health Centre IIIs because they are the principal outlets of primary health care (PHC).

In response to the budget details presented by the commissioner of planning in the ministry of health, Dr Christine Kirunga Tashobya of MakSPH highlighted the unpredictable allocations of the health sector. “As a country, it seems we have moved to look at health as a means of production rather than as a right”, she argued, adding that the government share of expenditure on health per capita is 15% (government contributes 15% to the total expenditure of health for the country, 37% is by the people – out of pocket expenses). She also reasoned that the biggest percentage of the health sector should be wage expenditure because the sector employs a big chunk of professional labour.

In her summary of the dialogue, Dr Elizabeth Ekirapa Kiracho (pictured above) noted that a 1.2% increase in health sector budget had been realized, emphasis on prevention was being done through Q - strategy, attempts were being made to increase functionality of health centres universally so that they could provide the basic package, and the national referral hospital had been refurbished. She reminded participants of the UHC coverage even with national challenges affecting the ability to achieve their objectives, e.g. huge multi-year infrastructure projects, the huge population and the fact that professionals have taken a back bench with regard to advocacy. She reiterated the dialogue’s call for more evidence-based research from academia. She concluded by reminding the participants that everyone has a role to play; more money was needed for health, and more health for the money.

Dr Kenneth Mugambe, the Director Budget, Ministry of Finance Planning and Economic Development, assured the dialogue that the 2019/20 budget would cut back on infrastructure spending and prioritize social development services.

Mr. Julius Mukunda, Executive Director of Civil Society Budget Advocacy Group (CSBAG), Dr Ibrahim Kasirye, the Principal Research Fellow Economic Policy Research Centre (EPRC), and Mr. Tarik Kubach, the Public Finance Management Advisor, European Union delegation to Uganda, graced the function as well as several staff from MakSPH.

On Friday 20th July 2018, 25 students graduated from Makerere University of Public Health (MakSPH) with Certificates in Water, Sanitation and Hygiene (WASH). They included 8 females and 17 males from various academic backgrounds including, but not limited to, Civil Engineering, Social Sciences, Bachelor of Arts in Arts and Environmental Health. Three of the graduands were from Rwanda and South Sudan. Also, a number of course participants worked with non-governmental organisations, three were District Health Inspectors and a few were students.

On Thursday 12th July 2018, Dr. Meleckidzedeck Khayesi addressed the staff o Makerere University School of Public Health (MaKSPH)laying emphasis on the need to harvest and invest evidence in the knowledge economy.

“Knowledge drives the economy, not oil or minerals”, he stressed. Citing examples of Silicon Valley in the US, and the development of economies of Switzerland and South Korea as more knowledge-based than process-based, he insistently reminded the audience of the enormous amounts of high quality knowledge produced by Ugandan universities which is then “dumped” after extremely rigorous research. He further suggested a course unit on the “Politics and Economies of the Knowledge Economy” to be taught at university across all disciplines to especially harness the industry that knowledge can become, all the while prompting the audience on how business-minded individuals can easily exploit research findings for substantial monetary gain.

While elaborating on the key features of the Knowledge economy, he highlighted the infinite nature, the collegial ownership, and the prolific nature (massive production) of knowledge. He urged the general academia to attach importance to 2 critical areas if knowledge is to be of substantial economic significance: the need to start recognizing the importance of harvesting this knowledge as a deliberate action, and to start training in techniques and how to avail tools to harvest knowledge. He also credited Prof. Christopher Garimoi Orach for his efforts to have knowledge especially about journals in his field of interest, at his fingertips.

He concluded with a call: to develop patents for innovations, services and books; for the passion and love for knowledge production, harvesting and investment; for think tanks.

The seminar was chaired by Dr. Olive Kobusingye.

About Dr Khayesi

Dr. Meleckidzedeck Khayesi is a principal researcher and international civil servant working with the World Health Organization, Geneva, in the Department for Management of Non-communicable Diseases, Disability, Violence and Injury Prevention (NVI).Before joining the World Health Organization in 2002, Dr Khayesi was a lecturer at Kenyatta University for 11years. His extensive research and policy work has recently led him to pay attention to the importance of knowledge production and its harvesting for use in society. Dr. Khayesi holds a Bachelor of Education degree with Geography and Religion as teaching subjects, a Master of Arts degree in Geography and a PhD in Transport Geography.

 

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