Family Planning Services for 5000 Women in Uganda

 During this reporting period, the SAFE initiative continued to support women of reproductive age in fishing communities in Uganda to access quality, affordable and client-centered family planning (FP) information and services. This quarter, the interventions focused on strengthening the capacity of health workers, improving referral linkages between communities and health facilities, and increasing access to FP services through community outreach and facility-based service delivery.

 A key focus during the reporting period was strengthening collaboration between health workers, Community Peer Mobilisers (CPMs), and project staff to ensure that women referred from the community successfully reached health facilities and received the services they needed.

 Summary of Activities

FMP Staff Participation in the ARJC

In June, FMP staff joined over 750 actors and change makers at the Abortion and Reproductive Justice Conference (ARJC) in Nairobi – Kenya. Through plenary sessions and abstract presentations and one on one engagements, the team was provided an opportunity to collaborate, network, share experiences, learn from other actors working in safe abortion care, family planning and sexual and reproductive health, and to reflect on emerging issues affecting safe abortion access and FP service uptake. This strengthened the organization’s technical capacity, exposed staff to innovative and feminist approaches to abortion care and created opportunities for partnership and resource mobilization and also enabled the FMP staff to contribute its own Uganda fishing community experience to the global movement for safe, accessible and dignified abortion care

Quarterly Review Meeting with Health Workers and CPMs

To strengthen coordination between Community Peer Mobilisers and the health workers from the partner health facilities, a quarterly review meeting was conducted. The meeting provided an opportunity to review progress, discuss achievements and challenges, and identify strategies for improving FP referrals and service uptake with particular attention given to the referral process and the importance of ensuring that clients referred for FP services actually reach the facility and receive the services required.

 Capacity Strengthening of Health Workers

Capacity strengthening continued through onsite and virtual support supervision and mentorship of health workers in all 10 partner health facilities to strengthen health worker capacity in delivery of quality post abortion care and long term contraceptives especially IUDs.

2 onsite support supervision visits to each of the 10 partner facilities provided an opportunity to review referral linkages between CPMs and health facilities and to identify facility-level challenges affecting access to comprehensive abortion care and FP services. The mentorship approach allowed project staff to provide practical, on-site support to 30 health worker while responding to specific needs identified at each facility. This support boosted the confidence and skills of the health workers in ensuring that girls and women receive timely, safe and quality care within their communities.

 Community Outreach at Nakiwogo Landing Site

One of the major achievements during the reporting period was the implementation of an FP outreach at Nakiwogo Landing Site. The outreach brought FP information and services closer to women who may otherwise experience challenges accessing facility-based services. Over 400 women were reached and supported with FP information and services during the outreach. The activity demonstrated the importance of taking FP services directly to communities, particularly underserved and mobile populations such as those living and working around landing sites.

Impact

• The interventions implemented during the reporting period contributed to an increase in the number of women accessing FP services across the project-supported facilities and communities.
• A particularly important contribution came from the strengthened community-facility referral mechanism. During the reporting period, 291 clients were accompanied by CPMs to health facilities to access comprehensive abortion care and FP services.
• The accompaniment referral model helped address some of the barriers that clients face between receiving a referral in the community and actually reaching a health facility. CPMs provided practical support, guidance and reassurance to clients throughout the referral process.
• The project also reached more than 400 women through the Nakiwogo Landing Site outreach, providing them with FP information and services and demonstrating the value of community-based approaches in increasing access.

 Key Learning

One of the most significant lessons from this reporting period is that the accompaniment model has introduced a meaningful shift in the decision-making process for women seeking procedures and FP services and provided an effective strategy for improving access to services. The project observed that previously many women who received referrals did not follow through and the gap between being  referred and actually accessing a service was significant, driven by fear of judgment at facilities, lack of information on what to expect, or pressure from partners and family members to abandon the decision or other social and practical barriers. However, when CPMs accompany clients to the facility, the clients successfully access the required services. With CPM accompaniment, women report accessing MA and FP services with greater confidence. Knowing that a trusted peer will be present reduces anxiety and creates a sense of safety. CPMs also serve as a buffer against provider bias, gently advocating for respectful care when needed and helping women articulate their choices clearly.

During the reporting period, 291 clients were accompanied by CPMs to partner health facilities. This experience demonstrated that the CPM's role can extend beyond information provision and referral to actively supporting clients to navigate the health system. In this quarter's feedback sessions, CPMs described the role as one of the most fulfilling parts of their work. "When I sit with a woman through the procedure, I can see her relax. She knows she is not alone," shared by Jemima a CPM. Others noted that accompaniment has deepened their relationship with the women they serve making future follow-up and ongoing engagement more natural and trusted. CPMs also report learning from each facility visit, deepening their own understanding of procedures and post abortion care needs, which in turn makes them more effective health educators at Musawo sessions.

 Story of Change

Mirembe Carol 22years and a resident of Nakiwogo landing site was reached by a CPM and received information about family planning services available at Nakiwogo Health center. Although she was interested in accessing FP services as a young mother of a 3 month old baby girl, she was uncertain about going alone as she feared word would get back to her husband that she was using family planning to avoid getting pregnant again. The CPM reassured her, explained what she could expect at the facility and accompanied her to the health facility where she successfully got counselled by a health worker and was able to make an informed choice about the FP method that best suited her. According to Mirembe “having someone accompany me made it easier for me to go to the health center. I felt no fear and I was supported and able to get the information and service I needed”.

Emerging Issues

Despite the progress made, continued attention is required to ensure that all women referred through community structures successfully access services. The experience at Nakiwogo further highlighted the importance of flexible and community-based approaches for reaching women who may not routinely access health facilities.

 Way Forward

Going forward, the project will continue to strengthen the accompaniment referral model, support CPMs to effectively link women to services, conduct targeted community outreaches, and provide mentorship and support supervision to health workers across the 10 partner facilities.

 The project will also continue documenting client experiences and referral outcomes to generate evidence on effective community-facility linkage models for improving access to family planning and comprehensive abortion care services at the landing sites.