UNFPA End of project report -FINAL

1END OF PROJECT REPORT 2015

With an Emphasis on the Immediate Postpartum Period

2 END OF PROJECT REPORT 2015


PROJECT OVERVIEWUganda’s population, estimated at 34.9 million1 is one of the fastest growing in the world. The average Ugandan woman gives birth to 6.2 children. Uganda’s total fertility, maternal mortality, and teenage pregnancy rates remain among the highest in sub-Saharan Africa. More than one million Ugandans are born every year, increasing pressure on the country’s health system.

Despite improvements made in increasing support for family planning, improving access for family planning and scaling up family planning (FP) services, only 26% of women use a modern family planning method and an estimated 34% 2 of women of reproductive age have an unmet need for FP.

The United Nations Population Fund (UNFPA) under its 7th country program supports Jhpiego to increase Uganda’s national capacity to strengthen enabling environments, increase demand for and supply of modern contraceptives, and improve quality family planning services that are free of coercion, discrimination, and violence. Postpartum family planning has been positioned as a key intervention in lowering fertility and mortality rates. The Government of Uganda/UNFPA Country Programme Action Plan (2010 – 2014) sought to address the mounting challenges of rapid population growth. Specifically, efforts were focused on strengthening midwifery training and service delivery systems for skilled attendance.

1 UBOS National Housing and Population Census, 20142 Uganda Costed Implementation plan 2015

UNFPA’s commitment to support and strengthen institutional development and capacities of FP providers in Uganda is reflected in the “Capacity building for family planning providers with an emphasis on the immediate postpartum period project”, a joint effort with the Ministry of Health and Jhpiego. The project was implemented in partnership with 18 midwifery training institutions, and district health offices in 15 target districts over an 18 months period. The project sought to increase access to and utilization of long-acting reversible contraceptives (LARCs), introduce and promote uptake of PPFP, and prepare participating facilities to ably provide FP services.

This project sought to ensure that health workers have the right knowledge and skills and that facilities have the essential equipment to provide FP services, and that district support supervision teams have the skills to monitor and support trained staff as well as the necessary tools to facilitate peer learning and practice at all facilities. Additionally, the project focused on sustainability, through training tutors in 18 midwifery institutions, so that graduating students can join work places with these newly introduced skills.

Initial data suggests that the interventions implemented in this project are improving access to LARCs for Ugandan women. In order to improve access to FP and scale up FP planning services, continued comprehensive interventions that support current and future health care providers and the systems in which they work will be required.


Project deliverables Strengthen the capacity of the 15 districts to provide quality

and timely PPFP services to the population.

Health workers and midwifery graduates will possess improved knowledge and skills in modern family planning methods.

Project Approaches Training providers from the ANC and delivery units in

PPIUD.

Training providers that were from the existing FP units in Implants and Interval IUDs.

Pre-service approach that targeted midwifery teachers, tutors, preceptors and clinical training sites.

80,190 COUPLE YEARS OF PROTECTION

Geographic Location15 districts across Uganda:

Mubende (Central Region)

Katakwi (Eastern Region)

Abim, Amudat, Nakapiripirit, Moroto, Kotido and Kaabong (Karamoja Region)

Oyam, Gulu and Kitgum (Northern Region)

Bundibugyo and Kanungu (Western Region)

Arua and Yumbe (West Nile Region)

THO

USA

ND

160 HealthFacilities reached

15 districts


MUBENDE

YUMBE

ARUA

OYAM

GULU

KATAKWI

KAABONG

MOROTO

NAKAPIRIPIRIT

ABIM

KOTIDO

KITGUM

AMUDAT

BUNDIBUGYO

KANUNGU

REPUBLIC OF SOUTH SUDAN

KENYA

TANZANIA

DEMOCRATIC REPUBLIC OF CONGO

N

S

EW


TABLE OF CONTENTSPROJECT OVERVIEW.. .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ........3Project deliverables..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ...4

Project Approaches..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ...4

Geographic Location ... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ...4

ACRONYMS.......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ........7STRENGTHENING HEALTH SYSTEMS .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ...... 9Scaling-up Access to LARCs .... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ...9

Enhancing skills for in-service health providers . ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..10

Integrating new skills .. ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..12

Introducing Postpartum Family Planning ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..13

INCREASING FUNCTIONALITY.... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .... 17Equipment and supplies.... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..17

Data collection. ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... . 20

District support supervision ... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..21

AWARENESS AND DEMAND CREATION ...... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ....23Training of VHTs ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... . 23

Provision of Job Aids and Tools ... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... . 24

IMPACT .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ....27LESSONS LEARNED ...... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .... 31GOING FORWARD .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ....33ACKNOWLEDGEMENTS.... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ....34


CPR Contraceptive Prevalence RateCYP Couple Years of ProtectionFP Family PlanningLARC Long Acting and Reversible ContraceptivesMER Monitoring Evaluation and ResearchMMR Maternal Mortality RatioMOH Ministry of HealthPPFP Postpartum Family PlanningPPIUD Postpartum Intrauterine DeviceTFR Total Fertility RateUNFPA United Nations Population FundUSAID United States Aid for International

DevelopmentVHT Village Health Team

ACRONYMS


STRENGTHENING HEALTH SYSTEMSThe project directed efforts to provide technical assistance to build capacities of key systems and strengthened local health institutions in a number of areas.

Trainee in Kodonyo HC II, Moroto district demonstrating Interval IUD insertion..

Scaling-up Access to LARCsJhpiego’ s training targeted health workers from 14 hospitals, 17 health centers IVs, 83 health center IIIs, 46 health center IIs as well as students in pre-service training at 18 midwifery institutions. Jhpiego used three approaches, targeting different categories of health providers:

1. The postpartum family planning approach focuses on health workers working in obstetric and gynecology units providing antenatal care, labor and delivery services and postpartum care. Special emphasis was placed on the Postpartum Interuterine Contraceptive Device (PPIUD).

2. The combined implant and interval intrauterine contraceptive device (IUD) approach targeted providers from existing family planning units who were already competent in counseling and provision of short-acting contraceptives.

3. The pre-service approach focused on midwifery teachers, tutors, preceptors and clinical training sites.


Enhancing skills for in-service health providers

“I have greatly benefited from the PPIUD trainings and my confidence in carrying out IUD insertions has increased.. My colleagues and I have trained other midwives and nurses from Gulu, Kitgum and Oyam districts.. This year alone I have been able to convince over 35 mothers to use the PPIUD family planning method..” Amwine Margaret, Ngai Health Centre III, Oyam

Jhpiego empowers frontline health workers by designing and implementing effective low cost hands-on solutions that strengthen health care

delivery services..

Training health workers currently providing antenatal care, labor and delivery services, and family planning units was one key aim of this project. During the year, these workers were trained in LARCs and PPFP with special emphasis on PPIUD using humanistic models and by gaining supervised practical experience in their workplaces to ensure that they could perform the procedures not only in a classroom, but at their work stations; where they would be serving clients.

Continuous skills development among the health care providers is necessary to equip them with the relevant knowledge and skills to ensure that desired competencies are achieved for them to offer quality PPFP services. In order to motivate health workers to use their updated and new skills, recognition ceremonies were held for district trainers and providers to publicly acknowledge those that excelled in performance and built support for family planning across the 15 target districts.

Jhpiego Country Director Emily Katarikawe recognizing health workers in Katakwi district..


Jhpiego targeted midwifery teachers, tutors, preceptors and clinical training sites. The training sites identified were used for both in-service and pre-service trainings. Additionally, trainees were followed up with support supervision to ensure that knowledge and skills acquired were adequately applied. Before graduation, midwifery students undergo clinical placement and are supervised by midwives who have already been trained by Jhpiego.

Jhpiego trainees demonstrating on the PPIUD..

“Jhpiego employs a holistic approach to capacity building in a sense that it trains the tutors at the school, the health care providers at the health centers and goes on to provide us with equipment and models that enable us to give practical lessons to our students.. Initially we were only taught about family planning in theory and our students only practiced what was taught when they went into the field. We can now offer practical lessons at schools and all midwifery students are required to do a placement in the surrounding health center IIIs and IVs before graduation.. This reinforces their training and confidence at offering family planning services..” Tumwesigye Richard, Tutor, Nyakibale School of Nursing, Rukungiri

Integrating new skills


“Our partnership with Jhpiego and UNFPA has been fundamental in ensuring an increase of highly skilled health workers offering family planning services.. Our hope at the ministry is that this capacity building program is scaled up to all referral hospitals and health centers country-wide, so that we have many more women accessing postpartum family planning..”Dr.. Mihayo Placid, Family planning focal person, MOH

Introducing Postpartum family planning The government of Uganda is dedicated to improving access to and utilization of family planning services. The five-year National Development Plan (2010/11–2014/15) acknowledges that limited access to family planning (FP) services hinders overall development of society in general and women in particular. One of the goals outlined in the plan is to reduce unmet need for family planning by ensuring access to family planning services, especially in rural areas. Jhpiego shares this goal and through this project sought to bring contraceptive methods and other essential FP services closer to the women who need them with particular emphasis on the postpartum period.

Postpartum family planning provides an especially powerful platform for re-positioning FP as a key approach to lowering fertility and mortality. While this project enhanced providers’ skills in all long-acting reversible contraceptives (LARCs), including traditional methods such as implants and interval IUDs, it also introduced the Postpartum IUD (PPIUD) to Uganda. PPIUDs are inserted within 0-48 hours after a woman gives birth. They are cost effective, offering up to 10 years of protection from pregnancy, and can be inserted by a mid-level skilled birth attendant. PPIUDs are the only postpartum FP method for couples requesting a highly effective and reversible yet long-acting method that can be initiated during the immediate postpartum period in lactating women. Training health care workers to insert the PPIUD is the first step in improving access to this intervention.

Raising the profile of PPFP, including PPIUD, within Uganda requires a holistic approach with multiple interventions, such as continued provider training, administrative and political support from supervisors, and demand creation.

A trainer demonstrating on implants insertion


Community Referral

Demand CreationOn-job training

Mentorships

Support supervision

VHTsIn Service Training

Pre-service training, and inclusion for PPFP in training curriculum

Quality Improvement

Technical Skills Development

Data Collection (M&E)

Provision of FP Equipment

Midwifery Institutions

Health Facilities

Jhpiego’s Capacity Building Framework

APPROACHES


Akwiya Consi, is a 30 year old mother of seven, married to a polygamous husband. Over a year ago, her husband who had been living with his second wife came home unexpectedly, and she remembered that she had no protection whatsoever. Knowing that her husband was against family planning, she sneaked away from him and rushed to the health center to talk to a nurse about available contraceptive options. Little did she know he had followed her to see exactly why she had gone to see the nurse. He was very upset and asked her to leave immediately or else he would divorce her if she used any family planning method. Distraught and feeling desperate, she went back home and promised herself to return to the health center after a few days which she didn’t. She discovered she was pregnant a month later and had her 7th baby early 2015.

“During my antenatal trips at Angaya health center III in Gulu, the midwife advised me to try the PPIUD family planning which would offer me protection from unwanted pregnancies and my husband would not know about it.. She counseled me and as soon as i delivered my baby, the PPIUD was inserted.. I am delighted to say that it has not given me any problems and as a farmer, I am now able to work all year round, tend to my crops and sell my produce. I can now afford to take care of my children better..”

MAKING THE CHOICE TO ADOPT A LONG TERM FAMILY PLANNING METHOD AGAINST ALL ODDS..


INCREASING FUNCTIONALITY

Equipment and suppliesDuring the course of project implementation, most health facilities were found to be lacking the appropriate tools and equipment to carry out the PPFP services. Jhpeigo together with UNFPA provided equipment (PPIUDs kits, Mama Natalie and Mama U models) to 160 health facilities so that health providers had the required tools to insert PPIUDs and 18 midwifery schools for continuous practice following the training in PPFP, in order to build on their competences and confidence.

Additionally, Jhpiego facilitated health facilities in the targeted districts to bridge stock-outs by tapping into alternative distribution channels.

Director of Programs- Dr Tonny Kapsandui with Mama Natalie model as one of the equipment distributed in Abim, a hard-to-reach district in the Karamoja region..

“Jhpiego has been very instrumental in building capacity of our health workers and has gone ahead to provide the necessary tools required to provide family planning services effectively. Initially due to limited resources, family planning services were only available at the regional referral hospitals and health center IVs but we have now scaled them up to health center IIs with at least one health care provider trained in long-acting and reversible methods hence improving access and uptake of these services.. ” Dr.. Sebudde Stephen, DHO Kanungu..


UNFPA Mama Us and PPIUDs Kits Distribution Matrix

No.. District / School Mama U Complete

Mama U Basic

PPIUD TotalSch RRH Hosp HC IV HC III HC II

1 Abim 2 1 0 0 10 0 9 4 26

2 Amudat 2 1 0 0 10 0 9 4 26

3 Arua 2 1 0 0 20 12 48 2 85

4 Bundibugyo 2 1 0 0 10 8 12 0 33

5 Gulu 2 1 0 15 30 8 18 24 98

6 Kaabong 2 1 0 0 10 4 18 2 37

7 Kanungu 2 1 0 0 10 8 27 2 50

8 Katakwi 2 1 0 0 10 4 9 6 32

9 Kitgum 2 1 0 0 10 0 9 6 28

10 Kotido 2 1 0 0 0 4 18 0 25

11 Moroto 2 1 0 15 0 0 6 12 36

12 Mubende 2 1 0 15 0 8 15 0 41

13 Nakapiripirit 2 1 0 0 0 8 18 2 31

14 Oyam 2 1 0 0 0 4 9 20 36

15 Yumbe 2 1 0 0 10 4 3 16 36

16 Arua School Of Comprehensive Nursing

2 2 10 0 0 0 0 0 14

17 Ibanda School Of Midwifery 2 2 10 0 0 0 0 0 14

18 Jinja School Of Nursing And Midwifery 2 2 10 0 0 0 0 14

19 Kabale School Of Comprehensive Nursing

2 2 10 0 0 0 0 0 14

20 Kagando School Of Nursing And Midwifery

2 2 10 0 0 0 0 0 14

21 Kalongo School Of Midwifery 2 2 10 0 0 0 0 0 14

22 Kamuli School Of Midwifery 2 2 10 0 0 0 0 0 14


No.. District / School Mama U Complete

Mama U Basic

PPIUD TotalSch RRH Hosp HC IV HC III HC II

23 Kibuli School Of Nursing And Midwifery

2 2 10 0 0 0 0 14

24 Lacor School Of Nursing 2 2 10 0 0 0 0 0 14

25 Lira School Of Comprehensive Nursing 2 2 10 0 0 0 0 14

26 Matany School Of Nursing And Midwifery

2 2 10 0 0 0 0 0 14

27 Mulago School Of Nursing And Midwifery

2 2 10 0 0 0 0 0 14

28 Mulago Tutors College 2 2 10 0 0 0 0 14

29 Mutolere School Of Nursing 2 2 10 0 0 0 0 0 14

30 Public Health Nurses College 2 2 10 0 0 0 0 0 14

31 Soroti School Of Comprehensive Nursing

2 2 10 0 0 0 0 0 14

32 Virika School Of Nursing 2 2 10 0 0 0 0 0 14

33 Nyakibale School Of Nursing And Midwifery

2 2 10 0 0 0 0 14

Grand Total 66 51 180 45 130 72 228 100 872755

755 PPIUD kits distributed..


Data collectionJhpiego facilitated the development of an online reporting mechanism using SMS, to enable collection of real time data from health facilities in the project’s target districts. An online web portal was developed through which health care staff can submit weekly reports on FP services provided through text messages. 29 messages were received within the first month of piloting the project. Equipment to facilitate this process is based at Jhpiego and these messages are sent on a weekly basis and will continue to be collected after the project. In future, Plans to enable an interface with the national HMIS will be executed.


District support supervisionJhpiego trained members of the district support supervision team, including trainers of trainers, to mentor service providers and conduct supportive supervision visits to ensure that current and future health care providers attain the desired competencies that ultimately improve access to and utilization of PPFP services.

To ensure mainstreaming PPFP in district health plans Jhpiego trained district leaders in order for them to appreciate PPFP as a new service that could improve the lives of women and families. Support from district leadership is necessary to ensure that PPFP supplies are included in supply requests from the National Medical Stores (NMS), are included in district and national data collections, and that services are monitored during support supervision visits to facilities.

.

Health provider demonstrating Implant insertion at a mentorship workshop in Kotido district..

160 Health Facilities reached

15 districts

4 Regional Referral Hospitals, 10 Hospitals, 17 HC IVs, 83 HC IIIs and 46 HC IIs

“My first encounter with Jhpiego’s clinical training on PPIUD was last year and it has been very good for me and my colleagues.. We have gone on to mentor other providers in health centers in Arua and constantly supervise them to ensure they are providing these services effectively. We hope that next time we can target VHTs in order to reach more women in communities who are not able to come to the health centers..” Jane Angucia, Nursing officer, Arua Regional Referral Hospital (DToT)


AWARENESS AND DEMAND CREATION

Training of VHTsOver the last year, Jhpiego strengthened systems in order to link family planning services with consumer demand. We are aware that even with well-trained providers, a lack of informed client demand for PPIUD can undermine a PPIUD program. To this end, Jhpiego trained VHTs, composed of two women and two men from each project district, to provide information on PPIUD and linkage services and to encourage male involvement in family planning decisions.

158 VHTs trained in PPFP Advocacy and linking to service delivery points!


Provision of Job Aids and Tools In addition to training health care providers, Jhpiego supplies them with job aids and other informational and educational resources to support service provision and assist with counseling women and their partners on PPIUD. These resources include: The Postpartum Intrauterine Contraceptive Device (PPIUD) Services: A reference Manual for Providers (Jhpiego 2010); Performance standards for establishing and managing PPIUD clinical services (included in the manual); PPIUD insertion kits and Copper T 380A IUDs in sterile packages as well as anatomic models (Mama U) for practicing PPIUD insertion.


IMPACTDuring the course of the project, Jhpiego’s training targeted health workers from 18 hospitals and 20 level-four health centers, as well as students in pre-service training at 18 midwifery institutions.

A look at performance of districts/facilities showing promising trends, especially in PPIUD uptake.

Number of health workers trained under specific FP skills by Jhpiego

Skills Trained In No Of People Trained

MNH BEmONC 32

Effective teaching skills 42

Clinical training skills 44

Implants 120

PPFP (Emphasis on PPIUD updates & Insertion)

439

Interval IUD 72

General FP updates, PPFP counseling, advocacy and linkage facilitation to SDPs

158 VHT Members

District leaders in PPFP advocacy, sensitization and resource mobilization

34

TOTAL 941


2015

13350

5170

694

46954

4785

15181

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

Jadelle Implanon Interval_IUD PPIUD Injectable Pills Comdom

Contraceptives use by method (Oct 2014 – Oct 2015)


Family planning service uptake for Jhpiego project target districts by method (Oct 2014 - Oct 2015)


• Male involvement is a critical issue that needs to be handled perhaps at household level especially in communities where cultures prohibit use of family planning methods.

• There’s a need to have all training resources ready before commencement of the actual training. Training manuals and references for the participants are crucial and greatly improves the quality of the training and facilitates learning and or transfer of knowledge and skills.

• There is a big disparity between FP knowledge and skills required to provide services by health workers – therefore regular Continuing Medical Education (CME) is critical especially for pre-service health tutors.

• Health providers who are competent in a particular skill should have the necessary supplies and equipment for them to effectively provide the services.

• To get a critical mass of health providers trained in postpartum family planning, it is essential to train district trainers to cascade trainings together with targeting the pre-service training institutions.

LESSONS LEARNED• Mentorship and supportive supervision for health workers

on PPFP is critical in ensuring the desired competencies are acquired but also to influence their attitudes in a positive manner.

• Involving the community, through training of VHTs to mobilize and promote postpartum family planning uptake in the communities is critical for demand creation for PPFP service uptake especially in the Karamoja region.

694 women provided with PPIUD services

across the 15 targeted districts..


Family planning has potential to reduce deaths and improve health of women and their families by reducing maternal and under-five mortality in several countries including Uganda. For the past five decades gains in these areas have been made; however, family planning (FP) uptake has been low in Uganda.

Uganda continues to have a large unmet need for comprehensive FP services. Jhpiego has been privileged to be among the champions promoting FP, especially Long-term Reversible Contraceptives (LARCs) and Postpartum Family Planning (PPFP). We have registered many achievements: 15365 women have received implants; 5170 interval IUDs; 4785 pills; 694 PPIUDs in a period of one year.

Through strategic partnerships with local governments, the Ugandan Ministry of Health, and other family planning stakeholders, Jhpiego expanded its collaboration with district governments, health facilities, midwifery Institutions, and communities to introduce new synergies and good practices for scaling up family planning services. We are grateful to United Nations Population Fund (UNFPA) for providing technical support and financial resources which enabled us to provide these critical services to women and families.

For the future, Jhpiego seeks to:1. Strengthen more health facilities in Uganda to provide FP

services especially PPFP;2. Partner with the United Nations Population Fund, Ugandan

Ministry of Health and district health officers to train a critical mass of midwives to deliver quality PPFP services;

3. Mobilize communities and individuals to demand and utilize PPFP services;

4. Scale up FP services uptake for adolescents and youths as guided by the most recent World Health Organization’s medical eligibility criteria.

We are poised to become the family planning lead partner for MOH, and Jhpiego will draw upon its knowledge and expertise in FP to build capacity for LARCs and PPFP.. Together with key partners, including the Uganda Ministry of Health, Jhpiego will seek to address the unmet need for spacing and limiting pregnancies among Ugandan women.

GOING FORWARD


Jhpiego Uganda would like to thank all the individuals and teams for their commitment, their innovative ideas and their hard work to make this project a success. Special thanks go to our development partners, implementing partners – both institutions and individuals working with us to achieve our mutual goals. Many thanks to our vital partners, the Government of Uganda through the Ministry of Health, UNFPA and the Johns Hopkins University Bloomberg School of Public Health – Center for Communication Programs.Thank you to the individuals who agreed to share their personal stories and photographs for publication.

Photographs KATE HOLT, JOHN SPANGLER, GUIDO DIGEMANES

Booklet Editor BRENDA KABAGWERI

Design Special RACHEL KANYANA

ACKNOWLEDGEMENTS

Jhpiego—an affiliate of Johns Hopkins UniversityPlot 36, Lower Naguru, East road Kampala, UgandaTel: 0312 202 937 Cell: 0785 999 848www.jhpiego.orgwww.facebook.com/Jhpiego

UNFPA End of project report -FINAL

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