In Uganda, R4S is engaged in eight activities: 1) a mixed methods study to advance understanding of self-care, 2) assessment of opportunities for integrating FP into existing and emerging HIV self-care strategies, 3) the assessment of HIP implementation with respect to scale, quality, reach and cost, 4) supporting a country equity group, 5) a study to understand the impact of COVID-19 on the ability of women to access FP care and products in Uganda 6) capturing COVID-19’s impact on FP service delivery and use through an interactive voice platform, 7) capturing COVID-19 adaptations to FP programs through a qualitative approach, and 4) supporting the development of a family planning research and learning agenda (RLA). These activities are part of the R4S portfolios below.  

Self-Care Portfolio

R4S’ Self-Care Portfolio includes activities aimed at deepening understanding of self-care through a people-centered approach. Countries increasingly seek to integrate self-care into FP policies and programs. But there is little evidence available to create an enabling environment for self-care programming, despite the growing appreciation that self-care is a culturally relative concept. R4S has designed and implemented studies to capture attitudes, preferences and intentions regarding FP self-care from women, men and providers. 

1. R4S is conducting this mixed-method study in Nepal, Niger, and Uganda is to advance understanding of self-care among potential end-users and providers and identify opportunities and barriers for advancing self-care programming. R4S has consulted with the Self-Care Trailblazers Group (SCTG) to ensure that the work complements global and country priorities, and with the MOH and other stakeholders in each country on needs and priorities related to advancing self-care. The study was conducted in 2022-early 2023. Country dissemination in Nepal took place in June and July 2023.  

FP/HIV Integration Portfolio

This portfolio groups together activities examining if and how other self-care health platforms can serve as vehicles for reaching sub-groups of the “most left behind” (for example, people living with HIV) and thereby open more channels for women to access FP and within a context that caters to their specific needs/realities. R4S works very closely with national partners and stakeholders so that the study designs produce quality and applicable results.

2. As part of the FP/HIV Integration Portfolio, R4S worked with the MOH and the Uganda USAID mission to design a landscape analysis to better understand if, how and where FP services have been integrated into the roll-out of the current HIV differentiated delivery model (DSDM) policy. The study was completed in February 2023, with dissemination to the MOH in May, and to a wider stakeholder audience in July.

HIPs Portfolio

Includes activities that assess multiple service delivery practices to inform programmatic decisions for scale-up – either vertically into local or national health systems and policies, or horizontally to new geographies or groups.  Knowledge generated can facilitate advocacy efforts for the adoption and sustainability of interventions that are proven to enhance the impact of FP programs and investment of resources to address equitable access to services among traditionally underserved populations or groups. 

3. This activity, part of the HIPs Portfolio, evaluates the scale, quality of implementation, reach, cost and cost-effectiveness in Mozambique, Nepal, and Uganda. Four service delivery HIPs have been identified as the study focus: immediate postpartum family planning (IPPFP), community health workers (CHWs), pharmacies and drug shops (PDS), and Post Abortion FP (PAFP). The approach for this study includes: 1) development and implementation of a replicable methodology to establish a baseline for scale, reach, and quality, involving a review of the selected indicators as well as additional data collection through interviews with managing authorities; 2) collecting information about required resources and assigning unit costs via interviews with managing authorities; and 3) conducting readiness assessments at the service delivery level to assess adherence to the core components. Analyses of the data will also examine aspects of equity, efficiency, and economies of scope/scale. Study results will be used by governments (MOH, TWGs), donors, and implementers to inform program design, scale-up, monitoring, and to inform the framing of the HIPs evaluated in terms of health system costs (and cost-savings) and their effectiveness to increase FP provision overall. Four briefs have been produced to provide details on the first part of this study:  

Equity Portfolio

This portfolio seeks to advance the inclusion and measurement of equity considerations in FP program design, implementation, and monitoring. It brings together country-level efforts to define and measure equity in FP and identify strategies for monitoring when, where and how inequities shift, and global-level efforts to establish the FP/RH Equity Working Group to serve as a hub for thought leadership and knowledge sharing between national, regional, and global-level actors.  

4. R4S supported Uganda to establish a country equity group and continues to support its operation. This is part of the Equity portfolio, which builds upon the country-level equity analyses and discussions that were part of the RLAs in four countries (Nepal, Malawi, Niger, and Uganda). The country equity groups work to define, measure and monitor equity in family planning. R4S partner Makerere University assists Uganda in the equity analysis and dissemination of findings. The national working group in Uganda selected key indicators from existing data sources in the country and completed analyses. R4S shared analysis findings with the Uganda national Equity Steering Committee which welcomed the results and provided guidance for further refinement. 

COVID-19 Portfolio

The COVID-19 Portfolio was developed in response to the COVID-19 pandemic. R4S designed and implemented studies aimed at capturing the pandemic’s impact on FP service delivery and use, as well as documenting and disseminating the lessons learned from program adaptations. Knowledge generated can be used to support mitigation strategies for COVID-19 and future epidemics and emergencies.  

5. As part of the activities under the COVID-19 Portfolio, R4S conducted a study to understand the impact of COVID-19 on the ability of women to access FP care and products in Uganda. R4S abstracted key indicators from DHIS2 to examine trends in FP/RH and MNCH service uptake, supplies before, during and after country lockdown restrictions. R4S also conducted key informant interviews (KII) with health facility staff, implementing partners (IPs), and district and regional government officials to explore the challenges to service provision during lockdowns, availability of supplies and commodities, and adaptations to continue service delivery to end-users, and reviewed key program documents used by IPs. Results from this study were published in the PLOS Global Public Health journal in April 2023, found here

6. In 2020 R4S began systematically documenting adaptations across eight FP programs in Nigeria, Kenya, Uganda, Zimbabwe and India using a qualitative approach. An Excel documentation tool captured a total of 64 adaptations over a six-month period. An interactive site was developed to showcase adaptations and experiences of eight family planning programs in five countries. Since its launch, the interactive site has received nearly 900 views from at least 37 countries. 

7. To assess the impact of COVID-19 on FP service delivery and use, R4S worked with Viamo to leverage their 3-2-1 Interactive Voice Response (IVR) platform to deploy a panel survey efficiently and safely with women in Nepal, Niger, Malawi, and Uganda. Women who accessed content via their mobile phone on any topic through the 3-2-1 service were recruited for a brief survey. For those completing the survey, and eligible for a panel survey, they were re-contacted through a series of outbound surveys.   This allowed for the documentation of FP access and use over time among the same women, as well as an assessment of barriers to care. Results are presented in this dashboard – COVID-19 Dashboard and summarized in this blog: What Did We Learn? Women’s Experiences with Family Planning Access and Use During the COVID-19 Pandemic.

Country FP Research and Learning Agendas 

This activity supports countries to develop family planning research and learning agendas (RLAs) that will help them meet their national FP program goals.  It also helps to identify research questions that R4S can answer and programmatic and policy areas for which R4S can help produce, synthesize, or apply evidence to improve outcomes. 

8. R4S supported the development of the FP research and learning agenda in Uganda, among other countries, via a multi-phase process that involved the review and analysis of data, consultation with local experts, and convening stakeholders to define concrete questions to guide family planning research and ultimately programming. The FPRLA for Uganda was approved by the MOH in March 2021 and shared broadly with partners. It has been uploaded on the MoH Knowledge Portal and has been referenced in the country’s costed implementation plan. R4S partner Makerere University supports the MOH in continued dissemination efforts. As part of these efforts, the Makerere team disseminated the FPRLA to students at the concept or proposal development stages of their research projects to encourage alignment with the FPRLA research questions.  Details about the overall RLA process, country context, and main takeaways is found here: FP Research and Learning Agendas, and summarized in this blog: Towards 2030 and Beyond.

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