page 1 Are public health facilities ready to provide IUCD services? A survey of public facilities in Uganda Authors: R. Twesigye, Peter Buyungo and H. Kaula Research Department

 Uganda Poor Maternal Health Numbers page 2 Why Family planning in Uganda? Total Fertility Rate – Third highest in the world 438 deaths per 100,000 (MMR) - Way off 2015 UN MDG target of 131 Source: UDHS,

Contraceptive use in Uganda Spacing and limiting births reduces the risk of maternal mortality Uganda Family planning unmet need is at 34% Total demand for family planning is at 64.3% 64.3% 34%

Use of modern FP methods among married women in Uganda, UDHS 2011 CPR method mix is currently dominated by short term methods

Use of Modern FP methods among women (15-19yrs) in Program area, Uganda (n=2040, 1510),

Rationale To reduce the high TFR and MMR improved access to a wide range of modern FP methods including long acting and reversible contraceptive (LARCs) like IUCDs that are most effective

Public health facilities (PHFs) are a key source of modern contraception 47% of current users One of the tenets of good FP is to ensure ‘choice’ – any source must be ready to offer this choice Why Public Health facilities?

Research conducted A study was conducted in 2013 to establish the level of readiness of PHFs to provide IUCDs services so as to guide interventions to improve their capacity Study Specifically aimed at assessing – Availability of IUCDs – Availability of a provider trained to insert IUCDs – Availability of functioning equipment for inserting IUCDs – Availability of required supplies for IUCD insertion in PHFs

Methodology Sampling: 30 districts representative of all regions All public health facilities eligible to provide IUCDs (i.e level III and above) 356 facilities were surveyed Respondents: in – charges of family planning sections Methods: Face to face structured interviews and observations Fieldwork: November 2013 page 9

KEY FINDINGS page 10

Outlet characteristics

Family planning services available (%) n=356

IUDs in stock page 13

Staff trained page 14

Equipment page 15 Instrument tray and trolley; Examination couch; Tenaculum / Vulselum; Uetrine sound; Long scissors for cutting IUCD string; Sponge holding forceps; Kidney dish; Gallipots; Autoclave / sterilizer; Speculum sims cusco

Supplies page 16 Jik / chlorine for decontamination; Surgical gloves; Disposable gloves; cotton; Gauze; Surgical blades; Plaster (adhesive elastoplasts); Color coded waste bins; Safety box for disposal of sharps

Overall service readiness page 17

Conclusions Opportunity exists – since two thirds of facilities have trained providers Significant gaps are evident at HC III level hence a need to focus interventions to this level. Components that require improvement are: – Equipment, stocks and supplies page 18

Recommendations A total market approach harnessing public and private sectors resources will be key in covering unmet need for FP in Uganda Non government agencies will be required to support PHFs; – to acquire complete sets of equipment; – to strengthen their forecasting and procurement systems so as to ensure reduced cases of stock out of essential supplies for provision of IUDs

Acknowledgements Ministry of Health District Health Officers in the study districts Health Facility – In – charges Study respondents Makerere University, Kampala Department for Social Work and Social Administration (SWSA) MUREC & UNCST Illustrations - page 20

Thank you! PAGE 21