Blog post by Jan Kumar, EngenderHealth/RESPOND Project
The planets have aligned in Uganda over the past few weeks for a significant shift in the country’s national family planning (FP) program that sets it on a new and ground-breaking course. From July 28-30, 2014, the Ugandan Ministry of Health (MOH)—with support from the United Nations Population Fund (UNFPA)—hosted an event titled “Accelerating social and economic transformation through universal access to voluntary family planning.” President Museveni used this opportunity to accelerate the government’s commitment to FP2020 and to voice his endorsement for FP as a means to improve maternal health, reduce poverty, and support social and economic development. The meeting paved the way for the promotion of equitable access to a wide range of quality FP services that ensure full, free, and informed choice, as well as the protection and fulfillment of human rights for all Ugandan women and couples who wish to space or limit their childbearing.
Just two weeks later, EngenderHealth co-sponsored a meeting with the MOH called Voluntary Family Planning: A Matter of Choice and Rights to field-test two new resources, Checkpoints for Choice (co-funded by the Hewlett Foundation and USAID under EngenderHealth’s RESPOND Project) and the Voluntary, Rights-Based Family Planning Framework Users’ Guide (funded by the Bill and Melinda Gates Foundation [BMGF]). The meeting engaged policy makers, service providers, representatives of human rights groups, community organizations, and technical assistance agencies. The timing of this event coincided with the Ugandan government’s engagement in finalizing its Costed Implementation Plan (CIP) for its commitment to FP2020.
The CIP includes a rights-based component FP that had yet to be defined. The content of the workshop was directly relevant. It clarified key rights-related concepts; identified the human rights that apply to FP programs; introduced a conceptual framework for voluntary FP programs that respect, protect, and fulfill human rights; and offered guidance for transforming abstract rights concepts into practical, programmatic action steps. Facilitated exercises and group work enabled government officials to formulate activities and program monitoring indicators to incorporate into their national plan. EngenderHealth staff and partners from the USAID-funded Fistula Care+ Project/ Uganda and the BMGF-funded Implants Initiative also developed action, monitoring, and evaluation plans that they will incorporate into their respective annual workplans.
The workshop benefited greatly from the active engagement and dynamic leadership of Dr. Zainab Akol, Principal Medical Officer for Family Planning FP and Reproductive Health (RH) within the MOH. “It is vital to me,” she said, “as the lead person for FP in Uganda, to serve as an advocate for rights and choice issues (in FP) as well as train other advocates. We will review all national standards including training materials.” High-level government commitment to rights-based FP was further demonstrated by the participation of two members of Parliament and several district health officers, as well as the supportive comments of Dr. Collins Tusingwire, Assistant Commissioner of RH in the MOH.
Importantly what emerged from the meeting is that much can be done to strengthen contraceptive choice and human rights in FP programs by doing ongoing activities differently, as opposed to doing more that would require additional resources. For example:
- Sharing workshop content with the Maternal and Child Health Technical Working Group at an upcoming meeting;
- Making FP choice and rights an agenda item in every FP forum, including at District Health Officer meetings;
- Orienting supervisors as advocates for choice and rights;
- Incorporating choice and rights into capacity-building, supervision, monitoring, and quality assurance;
- Building choice and rights into performance expectations and motivation mechanisms;
- Reviewing FP policies, strategies, guidelines, and training materials to ensure their compliance with a rights-based approach; and
- Addressing contraceptive security issues to ensure the availability of FP commodities and supplies at all service delivery levels.
In addition, Dr. Akol proposed seeking additional resources to support the development and conduct of a research agenda to demonstrate the “so what” of incorporating a rights-based approach into FP and other health programs. While there is some global evidence of the value added by taking a human rights approach to FP and other healthcare programs, it is scant. A more robust body of evidence would go a long way to marshal donor and government support for taking this approach.
Uganda is well poised to be a global leader in demonstrating the rights-based approach in action and to generate evidence that it can be a low-cost, high-impact game changer. We will follow their experience and results with keen interest.