Train 150 AGYW (10-24 Years) on Menstrual Hygiene

Summary:
Given that the population in Buvuma is a fishing community, available data (UBOS 2014) indicates that HIV prevalence in Buvuma islands is as high as 11.5% and is above the national prevalence of 5.5%. According to the Uganda Population HIV Impact Assessment (UPHIA 2020), Uganda’s current national HIV Prevalence is 5.5% among adults aged 15 to 49 years. The prevalence is higher among women at 7.1% compared to men at 3.8%. The African Child and Youth Development Initiative (ACYDI) in partnership with OVCEG and other stakeholders in the HIV affected communities have implemented the Community Led Monitoring (CLM) and MHM project aimed to enhance health service delivery and HIV prevention efforts in 52 isolated islands of Buvuma. The CLM has brought together multi-stakeholders e.g. Adolescent Girls and Young Women (AGYW), men, and boys contributed to strengthening quality, access, and accountability in health service delivery especially on this key performance indicator of Menstrual Hygiene Management (MHM).

Key Achievements:

• The health facilities pledged to continue monitoring the health service deliveries and follow up the progress to ensure that challenges are addressed, and services are improved.
• Enrolled 98 AGYW (10-24 years) into the program
• Sensitized 6 VSLA groups and oriented about the MHM
• Provided psychosocial support and counselling to the HIV affected persons living in fishing areas of Lake Victoria.
• Reached out to 5 health facilities and 50 health workers/stakeholders in Nkata Health Center III, Lubya Health Center III, Buwooya Health Center III, Busamuzi Health Center III, and Lukale Health Center III in Buvuma district who had provided health facility feedback.
• ACYDI and OVCEG presented CLM data that was collected by the CLM Monitors in the DHIS system to the health facilities in Nkata Health Center III, Lubya Health Center III, Buwooya Health Center III, Busamuzi Health Center III, and Lukale Health Center III in Buvuma district.
• The stakeholders agreed to support the health facilities in improving HIV prevention services, including increasing access, reducing stigma, and enhancing health education.

Challenges encountered:

• Lack of life jackets for the team while travelling using boat water transport to go and collect data in the island facilities.
• People move from island to island to seek healthcare and because of the high transport costs, they end up not coming to the facility.
• Some community members expressed frustration with long waiting times at the health facility, which can deter people from seeking services.
• Stockouts and Supply Chain Issues where community members reported frequent stockouts of essential HIV prevention commodities, such as condoms and lubricants.
• Compromised confidentiality and privacy.
• Issues of accessibility especially for the special interest groups such as PWDs since all the 52 islands are scattered making it harder to access health facilities.
• There were inadequate Health Education and awareness on HIV prevention methods, including PrEP and PEP (Post-Exposure Prophylaxis).
• Lack of Youth-Friendly Services and inadequate services for young people where community members expressed concerns that HIV prevention services may not be tailored to the needs of young people, which can create barriers to access.

Lessons Learnt: 

Regular review of actions taken and follow-ups are very important so that commitments by stakeholders are accountable and ensuring that the health facilities are reported back any progress achieved to increase service uptake of HIV prevention services and MHM among AGYW.

Recommendations:

• Provide life jackets to the field staff to ensure safety during the water/island visits.
• Strengthening supply chain management to prevent stockouts and ensure consistent availability of HIV prevention commodities.
• Developing contingency plans for managing stockouts and supply chain disruptions.
• Train peer educators to provide health education and support to young people.
• Increase community outreaches and engagement to promote HIV prevention services and encourage uptake.
• Establish facility feedback mechanisms to ensure that community concerns and suggestions are heard and addressed e.g. suggestion boxes.
• Conduct focused group discussions to ascertain members’ opinions.
• Establish a monitoring and evaluation framework to track progress.

Summary:

The island communities often face unique challenges in accessing healthcare services due to geographical isolation, limited resources, and inadequate infrastructure. Community-led monitoring can provide valuable insights into the experiences of healthcare users and help identify areas for improvement. Given that the population in Buvuma is a fishing community, available data (UBOS 2014) indicates that HIV prevalence in Buvuma islands is as high as 11.5% and is above the national prevalence of 5.5%. According to the Uganda Population HIV Impact Assessment (UPHIA 2020), Uganda’s current national HIV Prevalence is 5.5% among adults aged 15 to 49 years. The prevalence is higher among women at 7.1% compared to men at 3.8%. The African Child and Youth Development Initiative (ACYDI) in partnership with OVCEG and other stakeholders in the HIV affected communities have implemented the Community Led Monitoring (CLM) aimed to enhance health service delivery and HIV prevention efforts in 52 isolated islands of Buvuma. The CLM has brought together multi-stakeholders e.g. Adolescent Girls and Young Women (AGYW), men, and boys contributed to strengthening quality, access, and accountability in health service delivery especially on this key performance indicator of Menstrual Hygiene Management (MHM).

Key Achievements:

• Data collection was conducted in all the 5 health facilities mapped in Buvuma district.
• All stakeholders actively and adequately participated in the data collection activity.
• 15 FGDs were interviewed across the 5 health facilities mapped.
• 25 Health workers were interviewed across the 5 health facilities mapped.
• 3 Focused groups were interviewed per facility mapped.
• 5 health facilities staff were interviewed per health facility mapped.
• Data collection was successfully done regardless of the little time allocated.
• A total of 75 beneficiaries were interviewed across the 5 health facilities
• A significant number of patients were aware of MHM, HIV, TB, Malaria at the health facilities.
• The duty bearers pledged support in improving HIV prevention services, including increasing access, reducing stigma, and enhancing health education.
• The stakeholders and duty bearers pledged support in improving HIV prevention services, including increasing access, reducing stigma, and enhancing health education.
• The duty bearers pledged to be monitoring the health service deliveries and follow up the progress.

Challenges encountered:

• The inadequate Health Education and awareness where participants expressed a need for more information about HIV prevention methods, including PrEP and PEP (Post-Exposure Prophylaxis).
• Lack of CLM MHM IEC materials e.g. brochures, banners etc. for project visibility
• Lack of life jackets for the staff while travelling using boat water transport to go and collect data in the island facilities like Nkata Health centre III. and Lubya Health centre III.
• Lack of AGYW and Youth-Friendly Services and inadequate services for young people where community members expressed concerns that HIV prevention services may not be tailored to the needs of young people, which can create barriers to access.
• The long distance to the facilities making it inaccessible by the community members, hence very few patients at the facility to be interviewed.
• Most people move from island to island to seek for healthcare and because of the high transport costs, they end up not coming to the facility.

Lessons Learnt:

• Data quality and accuracy was very key where all quantitative and qualitative data was entered into the DHIS system.
• The multi stakeholder approach was used where several CSOs, CBOs and community had participated in activities implementation such as health facilities, boys, men, women, AGYW, CSOs networks, people living with disabilities, female sex workers, women, boys, CLM Monitors at the community, and steering communities from the affected communities.
• The health facility feedback and insights from the staff will inform the MHM and CLM project improvements and to strengthen the service delivery.
• There is need for capacity building of health workers.
• Mult-stake holder approach was very key where different stakeholders participated e.g DHO’s office, Bio stat, steering committee, interviews from different stakeholders (FGDs) where active community participation from the affected persons was very crucial for successful data collection

Recommendations:

• Develop an action plan to implement the recommendations, including timelines, responsible individuals, and resources required.
• Develop targeted AGYW health education programs for specific populations, including young people, AGYW, Boys, men and key populations.
• Establish a monitoring and evaluation framework to track progress and assess the effectiveness of the recommendations.
• Establish community feedback mechanisms to ensure that community concerns and suggestions are heard and addressed.
• Establish youth-friendly clinics or services that cater to the specific needs of young people.
• Implement and enforce strict confidentiality protocols to protect client information.
• Increase community outreaches and engagement to promote MHM and HIV prevention services and encourage uptake.
• Provide life jackets to the team to ensure safety during the island visits.
• Provide training for healthcare providers on stigma reduction, confidentiality, and non-judgmental service delivery.
• Provision of project IEC materials e.g. brochures, banners etc. for project visibility
• Regularly review data to identify trends, challenges, and areas for improvement.
• Strengthen supply chain management to prevent stockouts and ensure consistent availability of HIV prevention commodities.
• Train peer educators to provide health education and support to young people.