Transforming adolescent sexual reproductive health and family planning services in Uganda

Uganda faces a critical challenge with the highest teenage pregnancy rate in East Africa at 24% (UDHS 2023). Misconceptions about family planning, lack of information on comprehensive sexual and reproductive health and family planning (SRH/FP) services, and unequal gender dynamics contribute to this alarming statistic.

Despite favourable national policies for SRH/FP, including the National Family Planning Costed Implementation Plan II and the National Development Pan III (NDP III), gaps in implementation persist, especially at the district level where authorities struggle with inadequate resources. The NDP III aims to increase access to SRH and rights with a particular focus on family planning services and harmonised information through the Human Capital Development programme. But this is poorly planned for and implemented.

Through the UK aid-funded Women’s Integrated Sexual Health (WISH) programme, Options has been working with Kaliro and Bugiri districts to improve strategic planning and budgeting for SRH/FP services and to address the specific needs of adolescents.

“We have supported these districts to achieve significant shifts in their enabling environment, which in turn has impacted service delivery.”

The In-Charge at Health Centre III in Bugiri District

Here, we outline our three strategies to achieve this:

1. Building partnerships

In 2019, at the start of the WISH programme, Options worked with civil society organisations (CSOs) and the district community development office to establish sub-national accountability mechanisms (SNAMs) in Bugiri and Kaliro districts. These were led by the Multi Community Based Development Initiative (MUCOBADI) and the Uganda Development and Health Associates (UDHA) respectively. We provided the SNAMs with tools and skills to monitor community-based service delivery using scorecards, budget monitoring and quality improvement support supervision tools. Using these tools, the SNAMSs have held the districts’ technical and political leaders to account for their commitments to improving their districts’ planning and fund allocations for SRH/FP.

As a result of our work with the SNAMs, district workplans and FP costed implementation plans (DCIPs) have been brought together and the workplans now include three strategic SRH/FP interventions; community-based family planning outreaches, school health outreaches and youth targeted outreaches.

These interventions were financed through either the primary health care grant or results-based financing. The SNAMs now have the knowledge and tools to track budget allocations, disbursement and use of funds, and use this evidence to advocate for SRH/FP services to be prioritised beyond the life of the WISH programme.

2. Improved budget allocation to meet SRH/FP needs for adolescents

By aligning district workplans with the DCIPs, the local government health facility in-charges and district health officers for the two districts, had a better understanding of outreach activities aimed at reaching teenagers at school and in the community. This led to substantial budget increases. Budget for interventions targeted at adolescents increased by 447% in Bugiri and over 1000% in Kaliro between 2022 and 2023.

More money for adolescent health meant that health facilities could plan for additional interventions that directly contributed to positive FP/SRH outcomes amongst teenagers. Some facilities integrated FP within other maternal, neonatal and child health outreaches to address the needs of adolescents in the remote areas.

3. Strengthening sustainability

To make sure this approach is sustainable, Options established technical back-stopping teams that supported the districts in planning and budgeting after the WISH programme came to an end. These teams were made up of a group of health facility in-charges, district biostatisticians, and a district health officer who helped health facilities in completing their annual workplans for FY 2023/24 using the HMIS 001. This team will ensure sustainable technical support to health facilities during development of annual workplans and therefore ensure quality, evidence-based planning and budgeting at the facility level.

The work at the sub-national level provides an opportunity to improve SRH/FP outcomes amongst adolescents. The Ministry of Health and SRH/FP partners, including the donor community, must continue to support the districts and sub-national actors in advocating and planning for SRH/FP programmes. Options’ impactful interventions in Bugiri and Kaliro districts shows how targeted support can lead to meaningful changes in the SRH/FP landscape.