increased access to disability friendly maternal services

Despite Uganda’s Constitutional acknowledgment of the rights of persons with disabilities and substantial policy provision, persons with disability still struggle to access health services. Disability in any of its manifestations restricts the ability of individuals to participate in what is considered “normal” in their everyday societies. Women With Disabilities want to receive institutional maternal healthcare, but they often find it difficult to travel to access skilled care. Other health service barriers they encounter include inappropriate physical health infrastructure and healthcare providers’ insensitivity, lack of knowledge about their maternity care needs, and negative attitudes towards them. Frequently the needs of disabled women are poorly understood. Studies report that able-bodied persons hold the perception that WWD should be asexual and hence childless; and when they do have children they are often judged to be unable to care for their offspring. Moreover, in Uganda, persons with disability are often not valued as marriage partners because of the extra social and economic burden they pose and the perception that they cannot contribute economically to household incomes. However, persons with disabilities do strongly defend and exercise their reproductive rights despite their social and environmental constraints; currently the fertility rate of women with disabilities in Uganda is 6.3% as compared to the general population which is at 5.4%. Many disabled women perceive having children as an investment for the future in terms of social support and labor provided by grown children. Therefore, the project will accelerate equitable access to maternal health services by WWD in Kamuli district,Uganda.

Studies reveal that the maternal health seeking behavior among women with disabilities is influenced by parity; WGDs visit traditional birth attendants mostly during pregnancy due to long distance and lack of information and bad attitudes by service providers and community members. There is therefore need to raise awareness on pregnancy management among the disabled by carrying out more outreaches and routine check-up for women with disability in the community. There is need to include provision of user friendly maternal facilities, training health workers in customer care to improve their attitude and skills, provide advanced screening equipment at the health centres and regular training of midwives/nurses in handling women with disability so as to attract more women to the health facilities (literature from Maternal Health Care Seeking Behavior of PeriUrban Women With Disability in Uganda: a Community Based Study by research square

Objective 1: To strengthen community-facility linkages at all levels of the health care system.

Output: Improved accessibility to maternal and neonatal health services by 60 WWDs, increased knowledge, awareness, attitudes, and practices about health issues that affect new born children for and WWDs

The objective will be achieved through the following activities

• Support VHTs & other community structures to mobilize communities with focus on mothers with disabilities for health service utilization including Maternal, Neonatal and Child Health, PMTCT (Option B+), ART, tracking adherence of mothers on antenatal visits and mobilizing WWDs to promote Nutrition & Food security and ECD through innovative interventions.
• Conduct a baseline survey on accessibility of maternal and neonatal health services to WWDs and project endline evaluation.
• Identify malnourished pregnant mothers with disabilities & children through community structures and refer them to health facilities for specialized treatment and nutrition supplements.

• Work with Peer Educators among KP to reach out to their peers with prevention interventions and referrals for health services
• Work with PLHIV structures to improve coordination and advocacy for quality WWDs services to improve adherence.
• Work with district leadership with focus on disability council and health department & community structures to ensure that children for persons with disabilities new born children receive community care without exclusion.
•  Provide adjustable examination and delivery beds

Objective 2: To promote adoption of positive health behavior, increased demand, access and continuous utilization of maternal health services

Output: SBCC interventions and other interventions to redress gender and socio-cultural barriers to adoption of disability friendly positive health behaviors delivered

• Promote health seeking behaviors for services with utilization of breast feeding, nutrition, retention in PMTCT programs and adherence to HIV/AIDS treatment, among others.
• Mentor & support VHTs & other community level outreach workers & /or CDOs to implement SBCC activities with support from Child Health Foundation.
• Organize, facilitate & supervise community outreach activities.
• Conduct Community mobilization and awareness campaigns in the project implementation area targeting the public
• Organize community dialogues to address barriers & promote adoption of disability positive health seeking behavior.
• Form & support psychosocial groups geared towards MWDs

The executive director has life experience given the fact that she is a person living with disability and she has implemented projects on disability inclusion before inclusive of the "Putting Persons with Disabilities at the Centre of Humanitarian Preparedness and Response: Building and strengthening capacities in the field of inclusive humanitarian action and inclusive disaster preparedness through active involvement of persons with disabilities" a project which was implemented seven years ago before the current one.

Kabaale Glibert (project lead) is a graduate with bachelor of mass communication has experience from ABH project as an advocacy coordinator, from RHITES-EC as project officer and from integrated disabled women activities as Gender, advocacy and communications officer and he has real feel of the life that PWDs experience.

Babirye Annet Luwambo is our programs manager and also a person with disability. She is a gender expert with experience in disability interventions. she has a bachelor of gender studies.

Julius Mulinda is the MEAL manager with a masters in statistics from makerere university and a postgraduate diploma in monitoring and evaluation from Uganda management institute.

Kumbuga Yusuf is our programs officer with a masters of public health, Bachelor of social work and postgraduate diploma in special needs psychology.

The finance manager (Sarah Babirye) has a bachelor of Accounting and finance and a postgraduate diploma in ACCA. The project team will be guided further by the district health team inclusive of the district health officer and the assistant district health officer who is in charge of maternal and child health in the district. The ADHO will be engaged by the project team and will also engage team from planning, during implementation, assessments and evaluations. 

The project will focus on community systems strengthening approach by mentoring peers on related work and engaging health workers using MoH approved standard to provide ongoing mentor-ship and supportive supervision. These processes will allow skills to be transferred and consolidated among the community workers, thereby enhancing their competencies to render services beyond the project life and ensure full participation in lower local government work plan processes and integration of community innovations to improve access to maternal health services by women with disabilities. Engaging community members, health workers and VHTs as volunteers through training, supervision and career development especially VHTs who are already remunerated and supported by government will leverage costs, bring services closer and enable the project to benefit from the intimate knowledge the VHTs have of their communities. These structures will continue to support communities, follow-up of clients and link the women with disabilities to the health centres beyond the project life. The use of “Support groups’ model” at community level, led and run by peers will continue to promote adherence, provide psycho social support, nutrition counselling and delivery planning and maternal health relevant for HIV+ women and adolescent girls and young women with disabilities beyond the project life. Therefore the project seeks guidance and financial support.

The proposed project seeks to work with existing community structures inclusive of the Village health teams, linkage facilitators and expert clients who have experience in ART which will strengthen the health system and also enable effective sustainability. Furthermore the project is targeting last mile women with disabilities and Living with HIV, Adolescent Girls and Young Women with Disabilities and HIV, Children with Disabilities children of women with disabilities and Family members of women and girls with disabilities who live deep in villages since they have been left behind.

The project will be implemented in hard-to-reach and remote sub counties of Kamuli District, with poor road network, and limited involvement of women and Adolescent Girls and young women with Disabilities in accessing health services esulting from social norms attached to gender, disability and HIV/AIDS, low levels of education and poverty among others. Traditional beliefs and cultural attitudes, especially as regards women’s roles and status in society remain strong, roles and the division of labour are still clearly gendered and social norms make it more difficult for women with disabilities to effectively access and enjoy maternal and neonatal health services so the project will bridege the gap in Buwenge subcounty and Buyengo sub county.

The collaboration with local partners inclusive of the district local government, local disability women’s groups and other groups for persons with disabilities will enable smooth and effective implementation.

For sustainability and continuity, the project will train stakeholders on inclusive health service delivery and sign language skills. It will also appreciate VHTs who will remain in the community even after project life.

The project is directly targeting 60 women/adolescent girls and young women with disabilities who are pregnant; have children below one year, or living with HIV/AIDS.

In addition, the project will be implemented in strict adherence to COVID19 guidelines as set by the world health organisation and each activity will have an assigned individual to observe standard operating procedures (SOPs)

We hope to establish networks in form of psycho social groups for sustainability purposes and also register them as CBOs for further support

Performance indicator

Indicator definition

MOV

Data source

Frequency of data collection

GOAL: increase access to disability friendly maternal health services to women and girls in  district

Outcome 1.0 strengthening community facility linkages at all levels of the healthcare system.

1.1 Number of linkage facilitators  following up on clients/women with disabilities

Linkage facilitators will be members of the community who will act as a link between the community and health centers.

List of locums

HMIS, monthly reports

Monthly

1.2 Number of women with disabilities and adolescent girls and young women, vulnerable children linked to facilities for maternal health care and and HIV treatment services

Women with disabilities who live in the community and pregnant or have children less than one year will be identified and linked for health services

HMIS Registe

HMIS

Monthly

1.3 Number of WWDs who are pregnant and survivors of GBV referred/ linked to a health facility for a GBV services.

Registration forms for GBV services

Referral notes

Monthly

1.4 Proportion of key populations referred for maternal health services

Key populations will be women with disabilities, adolescent girls and young women with disabilities and HIV/AIDS

Antenatal and postnatal register

HMIS

Monthly

Outcome 2.0 Promoting adoption of positive health behaviors, increased demand, access and continuous utilization of health services.

2.3 Number of community awareness radio talk shows, spot messages and social media reach.

Talk show reports

Quarterly activity reports

Attendance lists

Activity photos

Monthly

2.4 Number of community dialogues, small groups meetings on promotion of positive health behavior and practices.

Progress with the action plan

Activity reports and attendance lists

Monthly

2.6 Number of members for psychosocial groups

Monthly

EID-Uganda wishes to implement a project on accelerating access to disability friendly maternal health care services in Kamuli district.

The overall project goal is to increase access to disability friendly maternal health services to women and girls in Kamuli district. The project will further seek to expand and strengthen local level approaches and improve access to services and information on maternal health and rights including Vaccination, Nutrition care and support and HIV/AIDS linkages for Women and Adolescent girls and young women with Disabilities and HIV AIDS.

The project will focus on community systems strengthening approach by mentoring peers on related work and engaging health workers using MoH approved standard to provide ongoing mentorship and supportive supervision. These processes will allow skills to be transferred and consolidated among the community workers, thereby enhancing their competencies to render services beyond the project life and ensure full participation in lower local government work plan processes and integration of community innovations to improve access to maternal health services by women with disabilities.

Engaging community members, health workers and VHTs as volunteers through training, supervision and career development especially VHTs who are already remunerated and supported by government will leverage costs, bring services closer and enable the project to benefit from the intimate knowledge the VHTs have of their communities. These structures will continue to support communities, follow-up of clients and link the women with disabilities to the health centres beyond the project life. The use of “Support groups’ model” at community level, led and run by peers will continue to promote adherence, provide psychosocial support, nutrition counselling and delivery planning and maternal health relevant for HIV+ women and adolescent girls and young women with disabilities beyond the project life

Health management information system (HMIS) registers, Referral books and other record keeping books used by ministry of health

we have been working with community structures for mobilization and working with health centers for service delivery

we currently support PWDs access maternal and other health services by building the capacity of the existing community health structures through training and other forms of empowerment and PWDs appreciate because they had been excluded before our interventions.

through continuous lobbying and advocacy from both donors and the government

we hope to receive some funding from Germany