Situational Analysis

Wakiso district still has a high maternal mortality ratio estimated at 584/100,000 live births and a total fertility 6.7, among the highest in the eastern and southern Africa. A review of service statistics from the Ministry of Health showed that only one quarter (25%) of deliveries reportedly take place in the combined Government and PNFP subsidized facilities. More worse still, according to The Demographic health Service (DHS, 2006) more than half of rural births (58%) are delivered at home, and attended to by an inexperienced relative thus, exposing the mother to postnatal bleeding and associated death risks. The DHS (2006) indicates that only 30% of Wakiso district rural women are using contraceptives and attributed this to reasons ranging from reported lack of accessibility, fear of side effects and the reaction of the husband. An assessment conducted by WIRDA (2006) indicate that most of the Government clinic staff had limited knowledge of family planning counseling, client handling, and management of side effects of contraceptives. The WIRDA assessment partially attributed this to service provision by semi-skilled nursing aides in the health units who are the main providers in the health units.

According to the WIRDA (2006) assessment many rural residents marry while still youth. The median age for women is below the age of consent (17.8 years), while men on average marry later, at 22.3 years. First sex also differs, with sexual intercourse for women reported at 16.6 years, as compared to 18.1 years for men, suggesting lack of adequate counseling and appropriate guidance for Uganda young girls. The reasons for above problems have to do more with demand rather supply factors. Although the Ugandan MOH has undertaken massive investment in increasing access to health services both geographically and financially, the reproductive health trend clearly suggests a demand problem. The demand dimension influencing the health seeking behavior of women include women lacking financial and decision making powers in households regarding access to health care, and generally having to seek permission from their husbands before seeking care when they have to travel long distances to the health unit. A combination of time spent at health unit, low level of education, and inability to leave the household for uncertain period of time because of child could all be contributing to women shying from the formal health sector service provision.

By the end of 2009/2010 ,WIRDA will

• Have facilitated 5 community pregnancy monitors in each sub county in 16 sub counties to enable 50,000 projected pregnant mothers attend Antenatal Care (ANC) at least four (4) times during the current pregnancy, and to deliver under clean and safe environment.
• Have facilitated 5 PMWs family planning (FP) counselors in each sub county in 16 Wakiso district sub counties to enable 60,000 FP acceptors to enroll and benefit from modern farming planning methods
• Have monitored, provided support supervision and evaluated the project

Planned Activities for specific goal #1

• Identification of development partners
• Resource mobilization
• Community mobilization
• To orient 5 midwives pregnancy monitors/resource persons into community mobilization skills to enable them mobilize pregnant mothers each sub county in 16 sub counties
• To design, print and distribute 2000 referral cards to the pregnant monitors
  80PMWs/ pregnancy monitors/resource persons to conduct mobilization activities
• 80 PMWs to conduct ANC care to pregnant mothers and integrate PMTCT services
• 80 PMWs to conduct clean and safe deliveries in their clinics

Planned Activities for specific goal #2

• identification of development partners
• Resource mobilization
• Community mobilization
• To conduct refresher training in new FP procedures updates recommended by MOH for 80 PMWs
• To conduct a follow up to 80 trained PMWs in new FP procedures
  80 PMWs to conduct integrated community outreaches on goal oriented ANC, FP, PMTCT and malaria prevention
• Development of IEC materials for family planning promotion (T-shirts, caps and badges)
• 80 PMWs to provide FP contraceptive methods to clients in clinics and community outreaches
• WIRDA to supply affordable FP commodities to project implementers

Planned Activities for specific goal #3

• Conduct baseline survey
• Conduct monthly monitoring and supervision
• Carry out mid-term review of UPMA activities
• Carry out end-tem evaluation