This article explores how USAID’s Advancing Partners & Communities (APC) project, led by FHI 360 in Uganda (July 2014 to July 2019), implemented a multisectoral approach to family planning. APC found that helping district leaders appreciate the evidence creates ownership of problems and commitment to solutions, and that multisectoral partnerships are both possible and powerful.
Why does working with non-health stakeholders matter?
Efforts to expand ownership of family planning (FP) programs to other sectors and to share resources and services have been challenging. The World Health Organization (WHO) notes that barriers to multisectoral and intersectoral action include lack of political will or commitment, lack of resources and coordination, and entrenched siloed thinking. However, WHO also asserts that a systematic multisectoral approach to FP can help address conflicting interests among sectors, power imbalances, and competition for resources. At the community level, providing political, religious, and cultural leaders with information about the importance of FP, and building the capacity of technical leaders to coordinate and structure multisectoral approaches, will help increase uptake of available services.In Uganda, for many years the government has addressed FP as a high priority and committed itself to meeting the ambitious national goal of 50% modern contraceptive use by 2020. The total fertility rate (TFR) in Uganda, however, remains high at 5.4 children per woman—among the highest in the world (DHS Program STATcompiler). This rate is driven by various factors, including high percentages of unintended and teenage pregnancies, which average over 25% in various regions of the country. The modern contraceptive prevalence rate (mCPR) has grown significantly (up to 35%, from 18.2% in 2001), but at current growth rates in mCPR, the country will not meet its FP2020 goals. Therefore, much work remains to be done.
The Government of Uganda has recognized that increasing uptake of FP services requires addressing an array of underlying determinants, many of which lie beyond the health sector. The government, together with FP stakeholders, determined that one strategic priority in the 2015–2020 Uganda Family Planning Costed Implementation Plan (CIP) was to “mainstream implementation of family planning policy, interventions, and delivery of services in multisectoral domains to facilitate a holistic contribution to social and economic transformation” (CIP Strategic Priority Number 4). The multisectoral nature of the CIP and the roles of different institutions are clearly defined, with the Office of the Prime Minister coordinating implementation of the CIP with assistance from the National Population Council. This underlines the need for all FP programs to effectively engage other sectors and stakeholders who may influence both the quality of and the demand for services.
The multisectoral approach also aligns well with USAID’s new strategic direction, the Journey to Self-Reliance, which emphasizes cross-sectoral approaches, including engaging with the private sector.
How did APC engage with non-health stakeholders?
The APC project in Uganda worked in five high-fertility (hot spot) districts (Figure 1) to address teenage pregnancy and barriers to uptake of FP. The project started by exploring social norms to identify factors that drive high fertility, teenage pregnancy, and low contraceptive use. Given the multidimensional nature of the factors identified―including economic, religious, and cultural factors; quality and access to FP services; and gender issues―the project applied a multisectoral approach at the district level to build ownership across sectors. Through partnership with the National Population Council, APC conducted a landscape analysis using FHI 360’s SCALE+ methodology (Figure 2) to identify stakeholders that would support FP interventions.