After the promises, time for action on family planning
On a sunny Tuesday morning, a group of civil society organisation activists and professionals from different population and health bodies sit at a breakfast meeting to draw a plan to ensure government follows up on its commitments at the London Summit on Family Planning.
A month ago, President Museveni said his government would increase expenditure on family planning from $3.3m to $5m every year.
“It is upon us to push government to come through with these commitments because a commitment that is not translated into actual expenditure is not a commitment,” says Mariam Nalubega, the Woman MP for Butambala district. “Government has other priorities; if we don’t push it, government will concentrate on other priorities,” she adds.
But how will they hold government to its word and ensure this money is actually provided for and continues to be budgeted for until 2018?
“We recommend the media to follow up on this particular commitment,” says Hasfa Naluyiga, an advocacy coordinator at Reproductive Health Uganda.
“We need to mount pressure from bottom to top. MPs can help by organising the rural grassroots men and women to demand for the commitments to be fulfilled. If the President moves to the villages and hears from the people why they need family planning, he will work to [fulfil] their needs.”
It has worked before; for instance, people have demanded a district status and President Museveni has granted their wishes. The voice of the people, when it is loud and clear, can, after all, force for supply. Take Rukia Nangobi, a 36-year-old mother of 10, for instance. Her first born is 19 while her last is one year old. She was only 16 when she got married and immediately conceived. It wasn’t long after birth that she conceived a second one and was later counting them using her second hand.
“I have never used family planning because I did not know anything about it. When my friends started talking about it, some said it was good while others said it was bad. But now that I have ten children, I want to stop. I am waiting to receive the right information,” Nangobi says.
Nangobi’s family depends on her effort in the garden, where she grows maize, cassava and groundnuts for food at home. In a good season when there is a surplus, she sells it off to buy necessities like salt and soap. Her husband is a boda boda rider who ferries people around the district for a small fee. Her children go to government-aided schools.
The family lives in a modest house in the village of Buwaya, Mayuge district. To Nangobi, anything that will not increase her family size further is welcome.
“I want to use the long-term method because for the injectable of three months, I fear I can forget and get pregnant again. I hear women saying that the implant works for five years, that is the method I want,” Nangobi says.
Sylvia Namabidde Ssinabulya, the Woman MP for Mityana district, says for contraceptives to be provided to women like Nangobi, advocacy must start with MPs. Ssinabulya is also chairperson of Network of African Women Ministers and Parliamentarians.
“I congratulate Uganda because for long we have been trying to get the President committed and now it is our duty to track the budget. We have his commitment and we can now take him on in Parliament and remind him that ‘Mr President, you committed yourself in London’,” Ssinabulya says.
She hopes Parliament’s committees on Social Services and Health can ensure that money promised in London is reflected in the next financial budget and subsequent budgets.
“When the medium-term framework paper comes in April next year, we will ensure that the $5 million is reflected. If the budget reflects things like cars, computers and tea, we will not pass it. This money is for tangible actual commodities and it must be provided for. We have done it before and we can do it again,” Ssinabulya says firmly.
Dr Jotham Musinguzi, the Regional Director for Partners in Population and Development Africa Regional Office (PPD-ARO), says his office is mandated to offer support to stakeholders in making policy and ensuring that the commitments are met.
“We cannot continue putting the job of developing Uganda into the hands of donors. MPs provide oversight to the executive arm, and have to be part of the solution to hold government accountable on its programmes. Ours is to show MPs the issues so they can do their job better,” Musinguzi says.
For starters, PPD-ARO has contracted Dr Moses Muwonge to track the family planning commodities budget. Muwonge says he started tracking the 2010/2011 budget.
“In the 2008/2009 financial year, government allocated Shs 1.5 billion for contraceptives but none was spent because of bureaucracy. When I come in, I get to know the allocation, follow up where the money is, and the requirements of the contraceptive supply plan. I figure out what USAID, UNFPA, DFID and government contributes and follow National Medical Stores to procure and deliver. The aim is to ensure that we spend 100% because we don’t want to get Shs 8 billon and spend only Shs 5 billion,” Muwonge says.
PPD-ARO and Population Secretariat also facilitate MPs with information and evidence to push government into budgeting for the promised funds.
“If the extra $1.7 billion can address demand, then we are happy,” says Dr Betty Kyaddondo, head of Family Health at the Population Secretariat in the ministry of Finance, Planning and Economic Development.
Civil society organisations further want to push for involvement of key donors such as DFID, USAID and UNFPA to increase the budget for commodity supplies. They want to bring in the reproductive health champions and decision makers like the First Lady, Janet Museveni, to keep engaging government to take family planning as a priority.
Abdelylah Lakssir, the international programme officer at PPD-ARO, says it is important to strengthen the role of village health teams in providing family planning services. At a higher level, it is also mandatory to build capacity of health workers at the lower health centres to provide long-term methods.
And most importantly, CSOs want to launch appropriate campaigns that will raise awareness and increase information on the correct and consistent use of family planning.
While it is true that 90% of people have knowledge about contraceptives, women continue to believe in the myths and misconceptions they hear from friends. But only 30% use contraceptives. Back in Mayuge, Rukia Nangobi has her own view about the money the government has committed towards family planning; she says it should go into helping women like her to provide for their children.
Yet if women like her knew and understood the burden of having an unmanageable family, they would not be crying out for help from the government. Dr Jennifer Wanyana, assistant commissioner for Reproductive Health in the ministry of Health, acknowledges inconsistencies in the information that people get.
“Sometimes people don’t have access to platforms on which messages are passed on, like radios,” Wanyana says, adding: “Sometimes they do not understand the language used. Of course their attitude also affects the message where information is provided but people do not take it, the information will not sink. We will do a lot of community sensitisation.”
The ministry also plans to strengthen the institutional capacity of public health facilities and community-based distributors to provide family planning services through staff recruitment, motivation and equipping of health centres.
“Our mandate is to ensure orders are placed, money is found and there is a system that ensures commodities reach the people. Everything must be done according to standards and policies in place,” Wanyana says.