Universal access to Free Antiretroviral Treatment starts with taking HIV tesing services to the community. 90 90 90 strategy! 90 % tested, 90% diagnosed and 90% linked to care and treatment by 2020.
The Importance Of Involving Men In Reproductive, Maternal and Child health programs is increasingly recognized globally. In Uganda, most maternal and child health services do not actively engage expectant fathers and fathers of young children and few studies have been conducted on the challenges, benefits and opportunities for involving fathers. I recently conducted a that study explored the attitudes and beliefs of maternal and child health policymakers and practitioners regarding the benefits, challenges, risks and approaches to increasing men’s involvement in maternal and child health education and clinical services in the Pacific.
In-depth interviews were conducted with 17 senior maternal and child health policymakers and practitioners, including participants from 8 distrcits (LIRA APAC, AMOLATAR, OYAM,KOLE, ALEBTONG AND OTUKE) and four regional organisations in Lango Subregion. Qualitative data generated were analysed thematically.
Policymakers and practitioners reported that greater men’s involvement would result in a range of benefits for maternal and child health, primarily through greater access to services and interventions for women and children. Perceived challenges to greater father involvement included sociocultural norms, difficulty engaging couples before first pregnancy, the physical layout of clinics, and health worker workloads and attitudes. Participants also suggested a range of strategies for increasing men’s involvement, including engaging boys and men early in the life-cycle, in community and clinic settings, and making health services more father-friendly through changes to clinic spaces and health worker recruitment and training.
These findings suggest that increasing men’s involvement in maternal and child health services in the Lango sub-region will require initiatives to engage men in community and clinic settings, engage boys and men of all ages, and improve health infrastructure and service delivery to include men. Our findings also suggest that while most maternal and child health officials consulted perceived many benefits of engaging fathers, perceived challenges to doing so may prevent the development of policies that explicitly direct health providers to routinely include fathers in maternal and child health services. Pilot studies assessing feasibility and acceptability of context-appropriate strategies for engaging fathers will be useful in addressing concerns regarding challenges to engaging fathers.
PERIOD : 13th-17th.June, 2016.
Youth peace Alliance Uganda (YPAU) is one of the CSOs that work within Lango sub region in the Arrears of Health, Human rights, peace and conflict recovery, Education and social protection. Early this year, YPAU in its mandate collectively with other CSOs implementing in the arrears of SRH & GBV in Lira District came together and formed Lira District youth advocacy NETWORK, under Uganda youth network –UYONET, to implement the NI-YETU project funded by plan International Uganda, this project is implemented through the Lead CSO – called facilitation for integrated Rural development-‘’FIRD’’.
On the 13th, June 2016, UYONET and FIRD organized a one day training at Plan Lira offices to build capacity of the Network team, and peer educators on Participatory Learning Actions –PLA as a tool to be used in conducting a one week’s research in the arrears of SRH/R and GBV in Agweng, Ogur and Bar sub counties in Lira District. The research was then conducted from 14th-17th, June 2016 in the above sub counties, where we met different groups on a daily basis and met different categories of youth (boys & girls, men and women). The groups I met included Awiealem youth group, adolescent boys between the age of 13-19, located in Orit parish, Agweng sub county, day two we met Ogur seed- S.S students and then the third day I interviewed the DHO Lira and the
In-charge of Ober HC III in Lira. The last day my team met with Alebere Child mothers youth group at Abolet, in Bar sub county. And lastly, had a debrief of the whole exercise led by the ED of FIRD – Harriet at FIRD’s offices, where two key issues of advocacy was identified and agreed upon; i.e Youth corners establishment in health facilities/sub counties and understanding the law in SRH /GBV respectively.
2.0. Objectives of the study
a) To involve young people, CSOs, youth Networks and other community members in Lira District to identify priority GBV/SRH Issues and advocate for them.
b) To engage young people and local CSOs to increase their knowledge of youth SRH and other rights and needs, the existing social service system, as well as the policy and legal framework.
c) To enable the community identify key advocacy issues and advocate for better services to address their SRH and GBV protection rights.
3.0. Methodology and processes followed.
o Data Source:
The source of information during data collection depended on the selected youth groups. Different youth group, boys only, girls only, both boys and girls together were reached where same guided questions were asked and selected categories of Leaders at District level were reached and key informant interviews conducted.
o Data collection procedures and instruments
As mentioned earlier Focused group discussion and key informant interviews were conducted amongst the different categories of youth groups, Local leaders and community/opinion leaders. Different youth group, boys only, girls only, both boys and girls were reached where same guided questions were asked and a selected categories of Leaders at District level eg DHO, District planner, District youth councilors, disable etc were reached and key informant interviews conducted.
The following PLA tools were used: Health resource map, Body map, Power walk, pairwise ranking, activity profile, and Ven-diagram. The last two tools were only used on day one and left out; at least two tools were used per group. On the selected District Leaders, Key informant interviews were strictly used.
a) There is evidence that Domestic violence is still a major issue in the selected sub counties especially Ogur & Aromo due to seasonal effects majorily occurs during post-harvest, Defilement especially in Bar due to drug abuse (marijuana and cocaine), Rape (aggravated) noted in Bar and Amach and this has led to high rate of Girls school dropouts. This was evidenced by the field research in Bar, Ogur and Agweng group, and confirmed by the DHO Lira during Key informant interviews- details in general report.
b) It was also noted that majority of the youth do not know the Law (their rights), this has led to their SRH and gender rights to be abused. In Aballa HCIII for example its reported that majority of the youth are denied access to condom simply because they are youth!
c) Many young people and the community are still using their body organs as reflected in the Body map in committing bad behaviors, eg Drug abuse, causing Domestic violence, causing early pregnancy, etc. cases common in Bar ,and Ogur sub counties as in the research. In Ogur one girl (teenager) has been defiled and pregnanted by the cousin brother and the police failed to handle the case, she is crying for help. In bar, Alebere Child mothers youth group is evidence enough because 70% of their group members are Child mothers between the age of 13-19, who got pregnant at the age of 14 as they confessed during this study.
d) There is a general problem of Long distances when accessing Health facilities in most of the groups visited. Majority still walk for about 3-7kms to access health services. Revealed in the health resource maps drawn.
e) Gender inequality still exists in most of the communities/groups visited due to negative cultural practices, use of drugs, illiteracy/ignorance of the law etc.
f) GBV service points are also not nearer to the people eg the police outposts are few and far in the villages like in Agweng subcounty which is 7kms from the group visited at Awie alem village. The team noted that GBV is so common at the trading centers especially where there are Disco Halls, drinking Joints etc where youth take most of their time due to unemployment, poverty and school dropout.
g) There is evidence of marginalization of the vulnerable group – the physically disable, as shared daily by different groups during debriefs. Many are school drop out.
h) There is evidence that the youth do not have adequate or convenient place/ youth corners where they can meet and share their issues, and be served at the health facilities except the one of ogur HC IV, which was not yet launched. Bar is sharing youth corner with the ART Clinic at the moment.
i) According to the DHO Lira, GBV cases are hindered by pilferages of cases, corruption in the process and compromise by parents, including lack of facilitation on the side of the victims and Health workers to follow up and prosecute the cases despite the strong legal instruments in place and improved access to justice. He further noted that there is sometimes limited capacity to handle SRH/R and GBV cases at some facilities.
j) Plan international Uganda and SDS are the two Organization/projects working in the researched sub counties especially Menstrual Hygiene and Dream projects respectively. Notable Hot spots of high sexual activities in Lira are: Corner Kamdini (Teso bar), Kitgum stage, Uhuru bar, Juba Road, Amach market, and Agweng market.
5.0. Major Issues for Advocacy:
The team summarized the major arrears for advocacy as follows
a) Youth corner establishment
b) Understanding the Law on GBV and other rights
c) Health service delivery and system strengthening.
d) Youth livelihood/funds.
I. Transport/service provider for transport provided a very weak taxi for field work which broke down in the field, the whole team stayed in Abunga Centre – Bar s/county until around midnight, until when I called the ED of YPAU to rescue us. Timothy of UYONET also rescued part of the team using their double cabin
II. Refreshment budget was not catered for in the planning, the research team were forced to contribute from their lunch allowances towards the participants refreshment, (An amount ranging from 5000- 8000/= per day)
III. Limited and inadequate time and finances in planning the project led to a lot of struggles during the research.
7.0. Analysis, Conclusions and Recommendations.
The PLA tools used were very instrumental and useful in this research. However, using all the tools made it very difficult in terms of time constraints and application on certain categories of the participants, eg use of Body map was not well received by the mature (men and women) due to shame as aresult of Traditional names of their body parts. Effects of SRH/R & GBV has led to Diseases, Death, early pregnancy, domestic violence, Abortion, Kwashiorkor, defilement, Rape, theft, and fighting.
It is clear and evident enough that Sexual Reproductive Health Risk and Gender based Violence still is a major issue in the arrears visited by the teams. There are many vulnerable groups (girls, boys, disable and women) whose SRH/Gender based rights are still being abused as reflected in the sub counties of Bar, Ogur and Agweng. The DHO further confirmed High risk arrears of GBV and SRH/R comprehensively as in Ogur, Aromo, Bar, Amach and Agweng sub counties. Intervention into such arrears in terms of advocacy by the Network is paramount.
i. Advocacy in the arrears of youth Corners/ youth forums were the adolescent youth issues are freely shared and attended to especially SRH issues
ii. Sensitization of the youth, communities and the Local leaders on the Rights of girls, boys, women and the disability in respect to SRH/GBV.
iii. The Lira youth advocacy network must strengthen its system in order to have the youth issues in the district attended to. There are more opportunities offered by the District youth councilors (male & female) who physically were involved in this field research.
iv. Proper planning and budget must be drawn before such activities have started to avoid the transport challenges experienced by the team, re- evaluation of the current service provider for this project- by Plan and UYONET/FIRD
v. Legal and psychological support is given to the victims of Rape, defilement, GBV who lacks capacity in handling themselves.
vi. More time be given to Network members in preparation for future activities
As a bid to empower communities to analyze and evaluate the delivery of health services, consumers of health services and their providers were tasked to assign scores in respect to health workers’ observing working hours, polite behavior, listening to patients problems and respect for patients privacy . Review of the study results looking at the attitude of staff index (a combination of community scores and service providers) shows, respect of patient’s privacy earned greater scores with half (50%) considering it “very good” or “good”, 17% regarded it fair. Polite behavior of the service providers was ranked second with 83% depicting it as fair and 17% ranking it as “very good or good”. Observing working hours was ranked third with 50% scoring it fair and 17% scoring “very good” or “good”. Listening to patients problems was ranked very poor or poor at 67%, 25% fair and only 8% depicting it “very good” or “good”.
Adherence to working hours was assessed both at facility level and district level. Facility level scores depicted that that level IV faciliies were ranked worst with 67% of the participants ranking it “very poor or poor”, while level III facilities were ranked fair (60%) and 40% poor. Level II facilities were better ranked with half of the participants saying that its fair and the other half regarding it “very good or good”. District level assessment on the other hand regarding observation of working hours point out a poor score for Alebtong and Lira district at sixty percent (60%) and one hundered percent (100%) respectively .
Further analysis was conducted in relation to polite behaviour at facility level and district level. Results show a fair score both at facility level and district level.
Level III facilities excelled in regard to listening to patients problems at 80% “very good or good” . Fifity percent of level II facilities were ranked very good or good while quarter (25%) fair and poor respectively. Level IV performed worst at 67% poor and only 33% ranked very good or good.
Evaluatation of respect of patients privacy across facilities revealed positive score of 60% for level III and 50% for level II facilities. Facilites at level IV rankings performed worst with 67% rakned very poor or poor and 33% ranked very good or good