Family Planning in Urban Slums
Voluntary Family Planning for low income women and men in Kampala's Kawempe urban slums, to reduce environmental destruction and poverty.
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Growth (have moved past the very first activities; working toward the next level of expansion)
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1. Founding story: Share a story about the "Aha!" moment that led the founder(s) to get started or the story of how you saw the potential for this project to succeed.
Kawempe Home Care (KHC) is a not for profit community based organisation established in 2007 which provides comprehensive holistic care to people with HIV/AIDS, Tuberculosis and Cancer in Kawempe division, Kampala district and Nangabo Sub County, Wakiso district in Uganda.
KHC offers medical services, psycho-social support, legal aid and income generating activities. The services in our medical department are HIV testing and counselling, HIV and TB treatment, prevention of mother to child transmission and early diagnosis, vaccination, cancer screening, family planning services, pain and symptom control as well as home based care.
This is an integrated approach where we see the benefits for human and natural life to flourish together.
2. The problem: What problem are you helping to solve?
Population growth is a key cause of habitat encroachment and destruction, and a major cause is unmet need for family planning services which lead to higher family size then is desired. The IPCC recommend that smaller families help individuals and communities cope with the demands for land, space, food, healthcare and educational opportunities; which has the double benefit of reducing pressure on the surrounding eco-system, as well as alleviating multiple dimensions of poverty.
3. Your solution: How are you working to solve this problem? Share your specific approach.
Kawempe Home Care seeks to strengthen and extend the existing family planning program through the present project proposal. The current offer at KHC clinic consists of counseling and care by clinical team for patients receiving HIV care and women in the community who are approached by 12 community volunteers.
The evidence from Guinea shows that Family Planning education and services can be provided to girls and women of reproductive age in beauty salons (The Guardian 2016). The saloons provide an opportunity to get the undivided attention of women while they spend 2-6 hours plaiting/treating their hair. The KHC health workers and volunteers will work together to train 30 more hairdressers this year. The hairdressers will provide education of full range of methods, and are able to dispense contraceptive pills; as well as refer to KHC community volunteers for condoms and injectables, and on to clinicians at the KHC facility for Long Acting Methods such as IUD and implants, and for onward referrals to the government facilities for sterilization. When women are able to choose a smaller family size, they do so, and this is good for the health of communities and eco-systems.
4. Innovation: How are you innovating or using unique approaches to solve the problem?
Our unique approach to strengthening biodiversity in the urban environment, through the method of family planning education and service provision is born out of conversations within the team, community members as well as research from Inter governmental Panel on Climate Change, and the World Health Organisations ecological framework which recognizes that there are social and environmental determinants of health. This has inspired us to take up as this creative conservation efforts, as they intersect both with our stated vision and mission of a healthful sustainable community. Even one of our board members, Aloysius Byaruhanga has written an academic paper in 2012 about the effect of human population on the natural environment in Kampala.
5. Collaboration: How does your initiative seek to bring key players together to preserve biodiversity?
We at Kawempe Home Care are committed to collaboration. Currently we do this by working with partners, donors, volunteers, staff, clients and others in the health sector address human need. In the future we want to make more advocacy and communications about the close relationship between human and eco-system health, and encourage stakeholders to be proactive in protecting biodiversity and reducing human poverty and ill health. We are open to working with other partners to share these messages, and become part of integrated solutions to sustainable development.
6. Impact: how has your project made a difference so far — in terms of both business outputs and social impact? How do you plan on measuring progress?
Whilst KHC has always provided condoms as part of counselling for HIV, and for our HIV positive clients to prevent transmission of HIV, the family planning project really started in June 2019, with the training of 9 volunteers and 33 community hairdressers. Between June and December 2019 427 new women were referred by the trained hair dressers (mostly for pills and injectables) and 162 women were referred by their male partners who were sensitized by our outreach reach about the benefits of, and access to family planning by KHC. As of February 2020 we have trained 12 new community volunteers in family planning counselling and service provision, as well as HIV and TB home based care (our key areas of work at KHC). Taking last month (January 2020), 251 women have been prescribed with contraceptives (not including condoms), including 76 new clients and 175 revisiting women.
7. Growth strategies: what are your main strategies for scaling your impact?
Our growth strategy for this project will follow the trajectory of our organisation. The plan for this is to increase geographic spread, increase numbers of families provided with holistic care, and increase man power to enable all women and couples in Kampala to space, time, and limit their families in the way that they choose. We will also share learning about our delivery model with other Sexual and Reproductive Health Providers in order that the methods and conversations had with potential service users are consistent, high quality and rights based; and enabling them to understand how the environment and biodiversity should also be part of the conversations, as well as health and poverty reduction.
8. Creating shared value: How does your initiative create value for society? Or different stakeholders?
Delaying the age of first births and extending the spaces between births have played a role in reducing fertility levels in many countries, and this is how we will create value for society in Kampala, Uganda. Using modern family planning to facilitate this change also has positive health consequences and protects the local ecosystem from population pressure. In contrast, short birth intervals (of less than 2 years) can lead to harmful outcomes for both new-born infants and their mothers, such as preterm birth, low birth weight, and death; as well as lead to inter-generational poverty and puts families at risk of living in areas that are more susceptible to climate change shocks.
9. Financial sustainability plan: can you tell us about your plan to fund your project and how that plan will be sustainable in the short, medium, and long term?
Our financial sustainability comes from the variety of small and large donors for our organisation, from individual 'friends of' to large donors such as USAID and Uganda's Ministry of Health. We also have income generating activities such as making bags and jewellery which are sold both nationally and internationally by ambassadors.
10. Team: what is the current composition of your current team (types of roles, qualifications, full-time vs. part-time, board members, etc.), and how do you plan to evolve the team’s composition as the project grows?
Our family planning team is comprised of all our clinical staff (8) who are trained to provide Long Acting Methods, our counselors who counsel for HIV testing and family planning (6), our community volunteers (12) and our 33 hair dressers. As the project expands we will provide greater allocation of clinical time in order to promptly meet need for long acting methods, as well as provide the supervision to community volunteers and hairdressers.
11. How did you hear about this challenge?