MATERNAL HEALTH PROJECT 2010 - 2013

Name of Organization: SICKLECELL ASSOCIATION OF UGANDADate of Submission: 10th/ October / 2012

Reporting period:July – September 2012 District cluster: MUBENDE Sub county: NALUTUNTU

Responsibility / Name / Title / Telephone Number / Email / Signature
Prepared by / Edward Sentamu / Program Officer / 0782963611 /
Reviewed by / Ruth Nankanja Mukiibi / Executive Director / 0712815978 / /

Instructions

  1. Report data on the meetings where the numbers of attended can be obtained. Also include data where individuals receive messages either in small groups or as individual entities.

Section 1

Introduction

Give an overall overview of the reporting period.

Sicklecell Association of Uganda(S.A.U) staff that comprised of Edward Sentamu the program officer and Ruth Mukiibi the Executive Director on 20th/ August/2012 carried out support supervision withtheir twentycommunity Resource persons namely;Nabaweesi J. Frances, B.K Batte, Mulekeai venant, Kalitunsi Herbert, Nampiima Margret, Nagawa Sarah, Mawejje Ahmed,Sebabi Paul, Rugerenjayo John, Mbatudde Teddy, Nansamba Margret, Katende Partrick, Bakaheiha Kalaveri, Nanteza Yudaya, Kibirige Ahamada, Amina Ssonko, Nandawula Harriet, Najjuma Asia, Magala Godfrey, Nakate Sarahand the focal person of Nalutuntu SubcountyMr Amjad Ssebunnya Mubende District. S.A.U staff together with our teamsupervised all the four parishes thatconstitute Nalutuntu Subcountyand these included; Ggambwa, Kyanamugera, Nalutuntu and Kyakatebe. Each parish has five community resource persons who conduct group and individual sensitisation meetings on MSRHR in the communities.

We also facilitated a joint radio talk show on Heart FM 102.3, 6th September 2012 that was conducted by a cluster coordinator Subcounty level Fred Luganda a focal person in Kiganda Subcounty and Mr.Kasozi Deo chairman HUMC Kiganda Health Centre iii/iv who is also reproductive health worker explaining the role of HUMCs at a health facility to the Mubende community.

Table 1: Achievements on the targets for the quarter

Result areas/Objectives / Indicator / Actual achievement (numbers ) / Deviation from plan / Reasons for deviation and remedial action
Result 1:
Awareness and demand / Indicator R1.1: Number of community sensitisation meetings held to disseminate MSRHR information / 166 meetings
Topics
Family Planning, ANCs, Danger signs, Male involvement, Sicklecell and Pregnancy, Post abortion care, Nutrition, HIV/AIDS, Patient rights, STD’s, Postnatal care. / We planned 180 sensitisation meetings / Poor mobilisation skills by our Corps in some parishes like Kyakatebe and Ggambwa. However we have encouraged them to use local leaders for mobilisation as it’s practiced in Kyanamugera parish.
Indicator R1.2: Attendances at community sensitisation meetings (groups) / 2391
Number of Females 1503 and Males 888
Topics
Family Planning, ANCs, Danger signs, Male involvement, Sicklecell and Pregnancy, Post abortion care, Nutrition, HIV/AIDS, Patient rights, STD’s, Postnatal care. / We planned to sensitise 1620 people / Sensitisation meetings were more than those set
Indicator R1.3: Attendances for individual information and dialogue with MHP community resource persons (individuals) / 909
Number of Females 600 and Males 309
Topics
Family Planning, ANCs, Danger signs, Male involvement, Sicklecell and Pregnancy, Post abortion care, Nutrition, HIV/AIDS, Patient rights, STD’s, Postnatal care. / 600 people / Sensitisation meetings were more than those set.
Result 2:
Access and utilisation / Indicator R2.1: Number of outreaches conducted / Response from UHNCO
Indicator R2.2: Number of health facilities supported to conduct MSRH service and information outreaches / Response from UNHCO
Indicator R2.8: Maternal deaths recorded at community level / Response from UNHCO
Result 3: Accountability / Indicator R3.1: Number of health unit management committees sitting at least 4 times a year. / Response from UNHCO
Indicator R3.4: Number of health facilities (Health Centre 3 or 4) with at least one functional feedback/redress mechanism in place (i.e. Complaint desks, suggestion boxes, disciplinary committees, meetings etc). / Response from UNHCO

Table 2: Cumulative progress to date (Total numbers since start of the project to the time of current reporting)

Result areas/Objectives / Indicator / Cumulative achievement (numbers ) / Comments
.Result 1:
Awareness and demand / Indicator R1.1: Number of community sensitisation meetings held to disseminate MSRHR information / 363 sensitisation meetings held.
Topics
Family Planning, ANCs, Danger signs, Male involvement, Sicklecell and Pregnancy, Post abortion care, Nutrition, HIV/AIDS, Patient rights, STD’s, Postnatal care / There is an increase in the number of sensitisation meetings due to participation of village chairpersons during mobilisation in some parishes.
Indicator R1.2: Attendances at community sensitisation meetings (groups) / 5014 people
Topics
Family Planning, ANCs, Danger signs, Male involvement, Sicklecell and Pregnancy, Post abortion care, Nutrition, HIV/AIDS, Patient rights, STD’s, Postnatal care. / With good mobilisation the number of participants has increased by 1190 people from the previous attendances.
Indicator R1.3: Attendances for individual information and dialogue with MHP community resource persons (individuals) / 2549 individuals
Topics
Family Planning, ANCs, Danger signs, Male involvement, Sicklecell and Pregnancy, Post abortion care, Nutrition, HIV/AIDS, Patient rights, STD’s, Postnatal care. / Individual sensitisation has also increased by 909 people from the previous visits
Result 2:
Access and utilisation / Indicator R2.1: Number of outreaches conducted / Response from UNHCO
Indicator R2.2: Number of health facilities supported to conduct MSRH service and information outreaches / Response from UNHCO
Indicator R2.8: Maternal deaths recorded at community level / Response from UNHCO
Result 3: Accountability / Indicator R3.1: Number of health unit management committees sitting at least 4 times a year. / Response from UNHCO
Indicator R3.4: Number of health facilities (Health Centre 3 or 4) with at least one functional feedback/redress mechanism in place (i.e. Complaint desks, suggestion boxes, disciplinary committees, meetings etc). / Response from UNHCO

Note: For indicators; R2.2, R3.1 and R3.4; the cumullative will initially increase, once the total maximum number available is reached there will be not cummulatives, instead the the number will remain the same if there are no declines.
Table 3: Mass Media

Type / Number / Topic/Theme
Eg Radio talk shows / 1 / The role of Health Management Committees at Health centres
Radio spot massages
Drama shows etc

This was a joint activity conducted by Kiganda focal person (Fred Luganda) a cluster coordinator at Subcounty level and Chairman HUMC Kiganda Health center iii/iv Mr. Kasozi Deo who is also a reproductive health worker. The main topic was the role of Health Management Committees at Health Centres. It wasconducted on 6th September 2012, Heart FM 102.3 FM Mubende District. Implementing Partners contributed to the facilitation of this radio talk show.

Section 2: Narrative page

Provide a detailed description on how all activities were implemented per result area and what was achieved as a result of implementing the activities.

2.1Result area1: Target communities aware of their rights and demand quality MSRH services

On 6th September implementing partners that is SAU and UNHCO contributed to the facilitation of a joint radio talk show which was conducted on Heart FM 102.3 by the cluster coordinator at Subcounty level Focal person Kiganda Subcounty (Fred Luganda) and Mr. Kasozi Deo Chairman HUMC Kiganda Health center iii/iv, a reproductive health worker in Kiganda Subcounty. The main topic was the roles of HUMC at a health centre. They had 6 phone in calls where one asked why they sale Mama Kits at Health Centres?, another one asked why the Maternal Health project does not reach in other sub counties of Mubende and only cover Kiganda, Nalutuntu and Myanzi?, one man wanted to know if the Chairman HUMC can assist him on his defiled daughter?

The chairman explained to the callers that, Mama kits are not for sale in government health facilities, Maternal Health Project is only implemented in three sub counties this is because of the limited funding from the donors may be an extension of the project we the project will reach out to all the sub counties in Mubende District. About the defiled daughter the chairman HUMC pledged to help the man and gave out his number for contacts.

On 20th August 2012, SAU carried out supervision on MSRHR in the four parishes of Nalutuntu Subcounty Mubende District. We moved with our Focal Person (Amjad Ssebunya) and started with Ggambwa parish where we met the five CORPS in that parish headed by Ms. Mbatudde Teddy. They informed us that with the introduction of an outreach in Kyatalegerwa village by Myanzi HC iii with a Maternal Health services many women were now referred to Myanzi HCiii and Kasanda HC iii. It was therefore recommended that if Dr Kizito of Myanzi HCiii (0782390253) can be influenced to support more outreaches in all Ggabwa villages then maternal mortality will reduce in Ggabwa parish.

Through our supervision Mr Ruberegyeyo John was told by Ms Amina a pregnant mother of Ggabwa that,”It is very important to give birth in a Health Center than going to a TBA (Nnalongo)”. This was a sign of a positive change among the communities in Ggambwa parish.

Ms Mbabtudde a community resource person was thanked by Ms. Nalubega Prossy a Sicklecell patient care giver that she had lost hope that Sicklecell women can never give birth and also children can never grow like any other normal person. This a sign of appositive change to the community that Sicklecell women can also deliver babies and grow like any other human being.

Mr. Mawejje Ahamed a CORP testified that in Kisalarwe village apregnant woman suffering from Sicklecell disease was advised by him that it is important for a woman in your condition to give birth in a Health Centre and later referred her to Myanzi Health centre iii where she delivered from with the help of a skilled midwife.This is an indicator to show that the community is now aware that women with Sicklecell disease are supposed to deliver from a health facility under the supervision of a skilled health worker yet before this project she was thinking of a TBA.

Community resource persons thanked the project for supporting them with the bicycles which eased their movements when carrying out mobilisation for both individual and group sensitisation meetings.

The community in Ggambwa parish have now appreciated the importance of testing for HIV/AIDS during pregnancy and Sicklecell testing before giving birth according to Mr. Magala Godfrey aCORP in Ggambwa parish.

Ms. Mbatudde (0777504278) a CORP also provides Family planning services to the women in Ggambwa parish, the turn up was excellent and said that the attitude towards family planning has changed because even men accompany their wives to her home for family planning services. Whoever gets this service is recorded in a black book. This indicates that the community can now demand and access for quality family planning services.

Kyanamugera parish, CORPS normally make referrals to Kiganda Health Center iii which is near this parish and it has reduced the number women dying in this parish for example they always make sure they follow up all the pregnant women in this parish and encourage them to go for Antenatal care which is provided by Kyanamugera Health centre ii conducted by Midwife Ruth Nabankema (0775263337).

Having a good relationship with our local leaders especially chairpersons in our villages had eased our work, Mr Edward Muhirwe a Chairman in Kasana Village (0750765004) has done great work during mobilisation exercise to conduct community sensitisation meetings on Maternal Sexual and Reproductive Health Rights. With the support of Chairpersons, participants for group sensitisation meetings are many and this increases the awareness and thus demand for MSRHR services.

Women and children indentified with Sicklecell disease symptoms are referred to Hospitals for Sicklecell test and delivering in health facilities. For example Ms. Nandawula Harriet a CORP identified a young girl by the names of Nakato a daughter to Mr. Muhirwe Edward a chairman in Kasana village with symptoms of Sicklecell disease and advised him to take her for a Sicklecell test, results showed that the girl was suffering from Sicklecell disease and was advised proper management of Sicklecell disease.

There is still a big challenge of domestic violence in Kyanamugera parish, this is due to male dominance where a man comes back home expecting to find food and yet the mother has gone to Hospital for ANC by the time she comes back the husband is already filled with anger and thus beating up this expecting mother. TheCommunity Resource Personshave sensitized the community about the dangers of domestic violence but it still exists.

There is a positive change in the attitude of males towards their responsibilities as fathers although they claim that they are hindered by poverty to fulfil all the responsibilities. For example Mrs. Nakintu Cissy (0781867521)a resident in Kyanamugerawith an eight months the baby died in the womb and stayed with this dead baby for a week when Ms. Nandawula Harriet a CORP intervened, the woman told her that the husband has not yet given her transport to go to Mityana Hospital not until our CORP persisted that the husband finally gave his wife money for transport and was accompanied by Ms. Nandawula Harriet and was on ARVS.

CORPS in kyanamugera recommended if possible they can extend an outreach in nearby villages like Kasana LC , Kibonwa LC and Nkandwa LC for accessibility of maternal services by the community.

2.2Result 2: Good access to and high utilization of MSRH services in target communities

Response from UNHCO

2.3Result 3: Key duty bearers held accountable for delivery of MSRH services in target areas

Response from UNHCO

2.4. Advocacy progress: report on the indicators below using the questions;

  • Is there evidence and signs of enhanced advocacy effectiveness and opportunity?

The Community can now identify the relationship between Sicklecell disease and Maternal Health this was found out during the supervision exercise when Mr. Mawejje Ahmed a CORP testified that a pregnant woman in kisalarwe village a patient with Sicklecell disease after being sensitised she knew the dangers of delivering from a TBA, for a woman in her condition had to deliver in a health facility under a skilled health worker she delivered from Myanzi Health centre iii.

It was also evidenced in Kyanamugera parish where we visited a pregnant woman with HIV/AIDS and a dead foetus. Our CORPS operating in that parish have following her and encouraging her to go to a health facility for services but the husband had refused to provide transport for her but with our intervention we also intervened in this case

  • What change has there been and how did it come about?

In the previous quarter people were failing to integrate Sicklecell disease to Maternal Health but through the retraining of the Community Resource Persons on this aspect, it has been evidenced that the Nalutuntu community is now aware of the integration of Sicklecell disease and Maternal Health this has been achieved through the group and individual sensitization meetings of the Community Resource Persons.

  • What was the role of the MH project in securing this outcome?

MHP’s role was retraining the Community Resource Persons on the linkage between Sicklecell disease and Maternal Sexual and Reproductive HealthRights where we taught them that a pregnant Sicklecell woman MUST deliver in a health facility, attending Antenatal care MUST be more than 4 timesMUST attend 2 clinics that is the Sicklecell clinic and the usual clinic. It was from this knowledge which they acquired and had to incorporate Sicklecell disease during their Maternal Sexual and Reproductive Health sensitization meetings.

  • What change has there been in the focal institutions (at community, district or national level) for the MH project and how did it come about?

At District level the District Health Officer in Mubende promised that very soon a health center iii in Nalutuntu will be completed by the Prime Minister’s office attached a confirmation email from him to SAU after receiving our last quarter report. We have achieved this through continuous lobbying at the district from SAU and our Focal person Mr. Amjad Ssebunya.

At National Level SAU with our CSO’s participated in Budget advocacy to correct the health workers crisis in Uganda, we mobilized the masses and pressured the MPs to pass the Budget with 39.2 Billion Uganda shillings but only passed 6.5 billion where 3 Billion will work on the recruitment of 6172 health workers and 3.5 will work on increasing Doctors salary at Health center iv.

  • What was the role of MHP in securing this outcome?

Through the proper coordination of the MHP secretariat SAU has been actively participating in all the advocacy campaigns such as press conferences, Breakfast meetings with MPs, giving out stickers to MPs on the date of passing the budget and mobilizing our communities to send messages to their area MPs .

2.4.1 Signs of positive change in key audiences' at national and district levels in support of actions geared towards improving maternal health.

SAU has participated in the advocacy meetings with members of Parliament to influence the Health Budget of 39.2 billion to increase on the recruitment of Health workers and their salaries however Government passed 6.5 Billion specifically to recruit and increase the salary of Health workers at Health centre iv from 1.2 Million to 2.5 Million. This was achieved through the press conferences organised by the Secretariat, Breakfast meetings with Members of Parliament, mobilising our communities to text messages to their respective MPs telling them that do not pass the Budget without 39.2 billion its now or never, giving out stickers to MPs on the day of passing the budget.

2.4.2 Signs of positive change at district level with actions that respond to maternal health needs of communities

SAU has engaged the District Health Officer Mubende district in the activities that take place in Nalutuntu Subcounty and he is very appreciative what is done in the Subcounty and promised that they will complete with construction of the Health Center iii in Kyakasengula Nalutuntu Subcounty. Attached is an email from the DHO appreciating the Maternal Health Project.