By Precious Mutoru, Advocacy and Partnerships Coordinator, PSI Uganda
Earlier this month, I spoke with Dr. Livingstone Makanga, Assistant Commissioner Reproductive and Infant Health Division at Uganda’s Ministry of Health (MoH), to talk about sexual and reproductive health needs in his country.
Dr. Makanga’s vast experience gained from working for Uganda’s Ministry of Health (MoH) at district and national levels is evident as he explains plans to improve the country’s sexual and reproductive health outcomes. Although Uganda has witnessed improvements in its modern contraceptive prevalence rate from 17.9% (2006) to 34.8% (2016), the country’s unmet need for contraception remains high at an estimated 32%. Dr. Makanga, while recognizing the achievements made so far, believes there is still a lot that needs to be done.
“We still have a high maternal mortality rate in Uganda, and family planning directly contributes to reduction of maternal mortality,” he intimates. The Ministry has in place a health system development plan that involves multiple sectors of government as well as development partners, including PSI, that are committed to ensuring that every woman in the country has equitable access to the right sexual and reproductive health commodities and services.
Dr. Makanga recognizes the potential of self-care to help attain better sexual and reproductive health outcomes. “Self-care is an innovation that has the potential to cut across all sectors,” he asserts. Already, self-care interventions are being used by diabetics to self-administer insulin and being used to self-test for HIV. For sexual and reproductive health, self-injectable contraceptives can help increase use of modern contraceptives by providing women with an effective and discreet way to meet and manage their contraceptive needs.
In order to reduce access barriers to injectable contraceptives, which remain prescription-only medications in Uganda, since 2017 the Ministry of Health has permitted drug shop operators to provide women with injectable contraceptives without a prescription across 20 districts.
“Drug shops are a critical outlet for sexual and reproductive health commodities in Uganda as that’s where many individuals seek healthcare first. They are located widely around the country and are the first point of access when it comes to reaching the last mile,” explained Dr. Makanga.
In 2015, the National Taskforce on the Accreditation of Drug Shop Operators formed under the leadership of the Ministry of Health to steward the use of evidence to change policies and guidelines, including to enable drug shops to provide injectable contraception. Evidence from the pilot study in 20 districts informs the National Drug Authority’s authorization process and scaling up of the practice to other parts of the country. Since October 2020, when PSI Uganda took over the Secretariat of the Taskforce, the organization has pledged to carry forward the mandate of supporting the reclassification of contraceptives into the over-the-counter medicines’ category.
However, beyond policies and guidelines, Dr. Makanga highlights the critical role to be played by all sectors of society, including cultural and religious leaders, in shaping the community’s acceptance, or lack there-of, of self-injectable contraception. In 2019, the Ministry of Health in collaboration with development partners, particularly the United Nations Population Fund (UNFPA), launched the Family Planning Advocacy Strategy as a critical tool to support demand creation and to increasing public awareness and acceptance of modern contraception. This strategy also provides an opportunity to increase understanding of self-injection among intended users.
“In 2020, we also launched the male engagement strategy to,among other things,combat the idea that family planning is the responsibility of women. When men are informed, they are more likely to permit their spouses and partners to access family planning. It’s time to make self-injectable contraceptives a norm in the country.”
For Dr. Makanga, self-injectable contraception presents several benefits. It cuts down on travel costs and time, as women do not have to frequently visit health service delivery points to collect re-fills, and it grants women their privacy. He also stresses the importance of applying the “method- mix” principle, to provide the potential user/client with all available contraception methods to choose from.
“It’s a basic human right that a woman should be educated about the available methods of contraception and then have her wish addressed. Once she has chosen a method, it should be available. Someone should not be compelled to take a method because another is not there.”
At its core, that is the basis of what Dr. Makanga and his colleagues are working to implement in Uganda.
Banner Image: PATH/Will Boase