KAMPALA – Over 2.8 million people including young (10-19 years), women of reproductive age (15-49 years), sexually active men, refugees, survivors of gender-based violence and persons living with disability in West Nile and Acholi have been empowered in sexual reproductive health, courtesy of Advancing Sexual and Reproductive Health and Rights (ANSWER) Programme.
The four-year programme by the United Nations Population Fund – UNFPA Uganda with funding from The Embassy of the Netherlands in Uganda was aimed to achieve universal access to sexual and reproductive health, realize reproductive rights, and reduce maternal mortality to improve the lives of women, adolescents and youth, enabled by population dynamics, human rights and gender equality.
Speaking at the dissemination of the ANSWER endline evaluation report, Gift Malunga, UNFPA Representative said the ANSWER program has made significant contributions in Acholi and West Nile sub-regions and touched and transformed the lives of tens of thousands of women and girls.
“I am reminded of the story of Akello (a pseudonym), a 13-year-old girl, who showed up at the health facility over bleeding due to unsafe abortion. She was attended to by a young nurse who had received training under the ANSWER Programme on Value Clarification and Attitude Transformation while offering SRH services to adolescents and young people. She treated the Akello without judgment based on her own religious or cultural values, and her life was saved.”
“…or the story of Gloria who dropped out of school at 17 years old and had 2 children. However, with the SRHR knowledge and information gained during the Village Saving Loan Associations formed by the programme, chose to prevent the next pregnancy and return to school.”
She said these stories are representative of tens of thousands that have been impacted and will be impacted by the programme in the years to come due to the heavy investments in health system strengthening for SRH, reproductive health commodity security, community mobilization for SRHR, sexuality education, gender transformation and social norm change and implementation of the DD roadmap.
Ms Malunga noted that the ANSWER Programme’s comprehensive approach addressed the needs of young people from all levels: the school, the health facility, the community and district leadership by equipping young people to make informed choices about sexual and reproductive health and rights in a supportive environment.
Key findings from the endline evaluation
Accordingly, through this programme, the Ministry of Health received reproductive health equipment for HFs and computers for the digitization of the supply chain system to improve the quality of services.
“Allow me to cast a light on Nebbi Hospital, 8 out of 13 maternal deaths that occurred in Nebbi Hospital between July 2020 and June 2021, were due to postpartum hemorrhage and lack of blood for transfusion. Through the ANSWER programme; the Nebbi Blood Bank was set up and I understand the draft FY 2022/23 MPSDR report only 6 maternal deaths have been reported. This is a direct contribution of the programme to the UDHS result of a reduction on the maternal mortality ratio,” said Malunga.
Also, she reported a significant improvement across key SRHR indicators in the Western Nile and Acholi regions and these are paralleled by concurrent improvements in the outcome indicators of the ANSWER Programme, such as the reduction of the institutional maternal mortality ratio (IMMR) at the ANSWER supported health facilities in the two sub-regions by 16.0 percent between 2018 to 2023.
The programme also saw an increase of 134% in the number of new users of modern contraceptives at the ANSWER-supported facilities.
However, she noted that although the programme contributed to increased uptake of family planning, only 40% of sexually active unmarried women aged 15-49 are using modern family planning.
“One key finding in the UDHS that clearly underscores our unfinished business reveals that only 4.5% of the refugees were using any modern method of family planning. As UNFPA we believe in leaving no one behind, and the finding denotes that there is a lot that needs to be done to ensure that this principle is achieved.”
Compared to other sub-regions, West Nile and Acholi are below the national teenage pregnancy rate at 14.6 and 15.3 percent respectively, something Ms Malunga attributed to their programme.
She, however, called on all the stakeholders to join hands – for there is still so much that needs to be done to improve the lives of the young people who form 75 percent of Uganda’s population.
Ambassador of the Kingdom of the Netherlands Embassy – Kavin Boven commended partners and Government and encouraged them to make use of the ANSWER evaluation report to inform programming and policies.
She underscored the role of a collaborative multisector approach as pivotal to strengthening results and accelerating gains in Social and Human Capital Development.
“However, conflicting perspectives and positions on how to address Social and Human development barriers for instance teenage pregnancies, is a key limitation in securing the needed collaborative and effective multisector approach. It is not possible to harmonize views, perspectives, and positions, but as decision-makers and influencers, it is very important that we remain conscious of the unique vulnerabilities and needs of the people we aim to impact and promote inclusive policies and actions, so No One is left behind.”
In her part, Dr Diana Atwine, The Permanent Secretary Ministry of Health commended the UNFPA and the Netherlands Embassy for their collaborative efforts that have been instrumental in advancing Uganda’s development agenda, both at the national and district levels.
“The programme’s impact is tangible, with notable improvements in maternal health services, family planning, and access to SRHR services. Significantly, these achievements resonate with the indicators reported by the Uganda Demographic Health Survey 2022.”
However, she noted that it is imperative to acknowledge that challenges remain, particularly in delivering quality SRH information and services to adolescents and youth, as well as responding effectively to gender-based violence survivors.
“Despite the progress made, the national prevalence of modern contraception use for all women stands at about 30%, with only 4.5% of married refugee women in the West Nile sub-regions utilizing modern contraception. The teenage pregnancy rates in regions where the ANSWER program invested, remain lower than the national average, indicating the need for sustained efforts in bringing these rates even lower. We also need to glean lessons from these regions and scale what is working to keep teenage pregnancies low. Teenage pregnancy rate reduction is a high priority for the Ministry of Health,” she said.
“While the program’s impact may be challenging to quantify comprehensively, I am confident that its lasting effects will endure for years to come. The programme’s impact will be sustained because of the integrated manner it was implemented and designed to be implemented through government structures and systems will ensure the sustainability of gains achieved,” she added.
