Uganda has one of the highest population growth rates in the world. Although the total fertility rate has declined from an average of 6.9 births per woman in 2000 to 5.4 births per woman in 2016 (2016 Uganda DHS), it remains among the world’s highest. At the current growth rate, Uganda’s population is expected to double every 20 years and the total population is estimated to reach 100 million by 2050. Only 35% of women in Uganda use modern contraceptive methods, and unmet need for family planning is 28% (2016 Uganda DHS). The burden of unintended pregnancy and its consequences disproportionately fall on poor women and girls, impacting family health and challenging the ability of women and families to manage resources and secure education.
The low rate of family planning uptake and high unmet need for family planning provide an opportunity for community health workers (CHWs) to offer education and care to their communities. The Government of Uganda, through the Investment Case for Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Sharpened Plan for Uganda (2016/17–2019/20), recognizes the important role CHWs (known as Village Health Teams, or VHTs) play in providing treatment and linking communities to health facilities for advanced care.
Intervention: Use of Digital Health Tools to Improve Access to Family Planning
Living Goods uses technology to provide an integrated health package that addresses RMNCAH needs. In particular, Living Goods provides CHWs with digital tools to support CHWs as they diagnose and treat health conditions, improve their reporting, and use data for performance management. In 2017, Living Goods deployed a phased approach to test a comprehensive family planning strategy, which trained and equipped CHWs to provide family planning counseling and short-acting methods including the injectable DMPA-SC (Sayana Press), emergency contraceptive pills (ECPs), combined oral contraceptives (COCs), and the progesterone-only pill (POP) for breastfeeding mothers. The CHWs also referred clients in need of long-acting and permanent methods to identified service delivery points.
The program was implemented in two districts—Wakiso and Mpigi—starting initially with 30 CHWs in each branch and rolling out to all 200 eligible CHWs. CHWs were already using the Smart Health application for maternal and child health services delivery, and Living Goods added family planning workflows in the digital application to support CHWs’ provision of family planning counseling and care. Each CHW received a phone loaded with the Smart Health digital application, which is designed with workflows to standardize client counseling, assessment, and administration protocols for family planning care. This enabled CHWs to accurately educate clients, determine their eligibility for family planning, recommend an appropriate method, and provide follow-up services. The Smart Health app generates task reminders for CHWs to follow up and advise family planning clients, should they experience any side effects. Reminders are also generated for clients who may be due for refills, require follow-up counseling, or have been referred for long-acting methods. This ensures the CHWs’ delivery is efficient and effective.
CHW supervisors also have access to their own supervisor app, where they can see real-time performance data for every CHW and use analytics dashboards to monitor and drive better performance, and ultimately, impact. All the data generated through these mobile health tools is shared with the government and used to inform decision-making for CHW programs at every level.