Aligning USAID Funding Targeting Adolescent girls and Young Women; Cues For Local Government Councils In Uganda

SUMMARY:

Local government officials can present over 25 performance indicators below following the use of USAID funds:

1) focus on the poor; 2) improve engagement of the private-for-profit sector; 3) enhance efficiency; 4) strengthen stakeholder coordination; 5) improve service quality; 6) stimulate consumer-based advocacy for better health;  7) programming in maternal; 8) newborn and child health; 9) immunization; 10) family planning and reproductive health; 11) nutrition; 12) health systems strengthening; 13) water/sanitation/hygiene; 14) malaria; breaking cycle of transmission of HIV; 15) pediatric HIV care and treatment; 16) increase in numbers of women attending at least one antenatal care visit with a health care provider; 17) Opportunities for women to deliver their babies with a skilled attendant present will increase; 18) planning meetings on targeted health themes;  19)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues go; 20) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination; 21) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health;  22) existence of strategic plans at different levels of governance reflecting needs of communities;  23) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization;  24) generating disaggregated statistics giving insight into population demographics and;  25) lists or action plans by Village Health Teams.

A PRIMARY SCHOOL IN A RURAL PART IN UGANDA. DOES THE GIRL CHILD HAVE OPPORTUNITY TO WASH HER HANDS AFTER USING THE WASHROOM?  DOES SHE GET A FAIR CHANGE OF SANITARY PADS?

Local governments in Uganda can design systems that promote the health and life of adolescent girls and young women (5-24 years). A mental, sexual and reproductive health plan targeting adolescent girls and young women, can be effective if it is integrated with other activities. At a three percent (3%) population growth by 2025, a young population and a high total fertility rate, Uganda’s high population rate will continue to drive health expenditures upwards. Local Governments in Uganda are entities that can mobilize for action through planning and partnerships. This is captured in the Health Sub-District concept bringing essential health services-especially basic surgical and obstetric care closer to the communities. The attendant staffing, infrastructure, equipment and operating costs become resources for promotion of health. A  comprehensive WHO review of Uganda’s Health System conducted in 2011, found that whereas significant efforts are being implemented to qualitatively and quantitatively improve health in Uganda, more needs to be done to a) focus on the poor; b) improve engagement of the private-for-profit sector; c) enhance efficiency; d) strengthen stakeholder coordination; e) improve service quality; and f) stimulate consumer-based advocacy for better health. At local government level there are opportunities to conduct local health assessment and devise community health improvement plans. These local government entities are in a better position to tap into, say, the USAID funding if a focus on quality of care, service integration, and equity are to become a reality. The generated mechanisms and resources at an initial phase may be costly but these costs are reimbursed under the inbuilt cost of doing the U.S. government’s PEPFAR Business (CODB). The critical fiscal space thus created is an opportunity to increase government expenditure on health.  This will in turn create a standardized service delivery across all local government regions. Uganda has a Maternal mortality ratio of 435/100,000 live births. By end of 2015, Uganda needs to reduce that figure to 131/100,000. Poor access to quality maternal care services, is a significant barrier to improving maternal mortality in Uganda. “HIV/AIDS, malaria and respiratory infections are the top three causes of overall disease burden in terms of Disability-Adjusted-Life-years (DALYs) lost,” (Fiscal Space For Health In Uganda).

THIS SCHOOL IN A RURAL PART OF UGANDA IS A CO-EDUCATION FACILITY. WILL THE GIRL CHILD THINK ABOUT A SANITARY PAD OR HOW EARLY SHE HAS TO RISE FROM BED IN ORDER TO COMPETE FOR WHERE TO SIT IN THAT OVERCROWDED CLASSROOM?

There are two documents I hope local government planners can use. One is the Country operational plan guidance document provided by USAID, with focus on eradicating HIV/AIDS. It is a comprehensive tool that local council members in Uganda can find useful as they try to utilize PEPFAR funds in a bid to align money in prevention investments. At the local government level, planned and costed investments are called votes, e.g., providing insecticide-treated mosquito nets to a given number of households. In a bottom-up planning, promoted by decentralization, it is possible to harmonize targets for treatment, prevention and anti-discrimination at Local Council I, II, III, IV, V, Town Council, Municipality, Division and district. There are two outcomes that come to mind. One, it will strengthen an existing local public system that ensures health promotion and prevention of diseases. Two, it will critical forces of change at community level with health promotion and prevention of diseases at the planning core.

A CLASSROOM

The second document is the:The Maternal and Child Survival Program (MCSP). MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. The Program places greater emphasis on key cross-cutting issues such as innovation, e/mHealth, equity, quality, gender, public-private partnerships, and involvement of civil society, community approaches and behavior change interventions. While maintaining focus on the technical high impact interventions, MCSP works toward sustainable scale up to include strengthening the health systems that deliver these interventions. (http://www.mcsprogram.org/). “It is at the heart of improving maternal-newborn health services globally: ensuring care is patient-focused; integrating programs to better serve the needs of mothers and babies; and extending innovative health services to the poorest and most socially vulnerable mothers and babies,” (Bliss, K. 2015). This USAID funding will help local governments mobilize for action through planning and partnerships where a woman in Uganda can seek appropriate counseling and maternal care services in any facility. There will be an increase in number of women attending at least one antenatal care visit with a health care provider. Opportunities for women to deliver their babies with a skilled attendant present will increase.

DO THESE MEN HAVE A PLAN TO PROVIDE THE ADOLESCENT GIRL WITH COMPREHENSIVE SEXUAL AND REPRODUCTIVE HEALTH COUNSELLING AT SCHOOL? THE PROFESSOR WHO IS ALSO A PRESIDENTIAL CANDIDATE IN UGANDA FOR THE 2016 PRESIDENTIAL ELECTIONS IS STANDING IN THE CENTRE WITH TWO TEACHERS. NB. ALL THESE PICTURES BELONG TO THE PRESIDENTIAL CANDIDATE PROFESSOR VENANSIUS BARYAMUREEBA.

The health sector at the district and sub district level in Uganda is governed by a district health management team (DHMT). The DHMT is led by the District Health Officer (DHO) and consists of managers of various health departments in the district. The heads of health sub districts (HC IV managers) are included on the DHMT. The DHMT oversees implementation of health services in the district, ensuring coherence with national policies. A Health Unit Management Committee (HUMC) composed of health staff, civil society and community leaders is charged with linking health facility governance with community needs (http://gov.ug/ministry/ministry-health).

USAID funding into a local government budget plan will cause: 1) planning meetings on targeted health themes including national and district indicators (UBOS, 2010)  2)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues 3) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination 4) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health 5) existence of strategic plans at different levels of governance reflecting needs of communities 6) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization 7) generating disaggregated statistics giving insight into population demographics and 8) lists or action plans by Village Health Teams as a continuum of response who bridge the gap and increase equity in access to health services ( http://www.pathfinder.org/). With the above it is more likely to have information on: voluntary medical male circumcision (VMMC), Test and treat, Viral load, TB/HIV, virology suppression, children health, pregnant women receiving B+, adults on life-saving anti-retro viral treatment, health needs of groups that are higher risk than total population, identified community resources  that support the public health system in promoting health and improving quality of life. A list of themes would be developed, which in turn could be used to assess community health status and community themes. 

Form a team amongst you and check with the US Embassy to see how your local government entity qualifies. A devolved institutionalized public health service is possible in Uganda. Turnock (2015) in “Essentials of Public Health” lists outcomes of deliberate community health improvement plans. I have chosen some points from the long list that I feel would be further outcomes of using USAID funds at a local government level. These are some of the further outcomes: 1) working with policy-makers, promote partnerships, educate, inform, develop policies and plans that support individual and community health efforts and plans 2) Social-community level activity plans 3) Social marketing and targeted media public 4) joint health education programs with schools, churches, Faith-based Organizations, cultural organizations and other entities 5) undertaking health improvement planning e.g., preventive screening, rehabilitation and support programs 6) building coalitions drawing from a wider range of potential human/material resources to improve community health.

REFERENCES:

1. Bliss Katherine (2015). http://www.smartglobalhealth.org/

2. Fiscal Space For Health in Uganda. World Bank Working Paper No. 186 Africa Human Development Series 

3. Government of Uganda, Ministry of Health. http://gov.ug/ministry/ministry-health

4. National Village Health Teams (VHT) Assessment In Uganda. 2015. http://www.pathfinder.org/

5. Statistical Abstract. Ministry of Health. 2010. http://www.ubos.org/

6. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.

7. USAID (2015). Country Operational Plan Guidance 2016 – Draft

8. USAID (2015). http://www.mcsprogram.org/our-work/ 

21st Century USA From a Public health Perspective

The main role of public health in the 21st Century will be to protect us from various diseases or life threatening conditions deriving from: climate change; emerging diseases; bioterrorism; racism; stigma; prejudice; and political dilemmas. Public health practitioners of the 21st Century must be in position to understand the complexities of cultural diversity, e.g.,different generational, economic, professional, ethnic, religious, linguistic background, gender, gender identity, sexual orientation, stereotypes, prejudices, physical status, conscious bias, unconscious bias, structural bias, enjoyment of access to resources, access to opportunities, access to options, safety from violence,  affordability of housing, civil rights, access to food, access to jobs, opportunities for job trainings, access to recreation and readiness to be  a compassionate provider. Many clients and communities face bias and discrimination when they attempt to access health and social services and , as a result, receive fewer services and services of poorer quality (Berthold, T. 2009). In order to provide public health services, government has concrete plans such as enacting laws, enforce laws, provide financial support and oversight to ensure promotion of health, prevention of diseases and instituting a preparedness mechanism.The most important new or expanded roles for public health occupations in the 21st century will include:

1. Strengthening the public health activities framework that is interlinked by a network of federal, state and local public health agencies with emphasis on referral mechanisms and oversight processes.

2. Ensure a reporting mechanism that dovetails into the overarching design where: the contribution of USA to international health-related interventions continues; the legal foundation gives gives primacy for health concerns to states; allows the federal government to promote consistency and minimum standards across the 50 diverse states; and a practical foundation of LHDs serving as the point of contact between communities and the three-tiered government.

3. Shifting mobilization tasks to advocacy entities at community level as a means of having a pulse on changing needs, resource needs and meeting public expectations.

4. Investing in early warning mechanisms for threats from fires to bio-terrorism. There will be need to have a contingency for fire hazards now that the globe is getting warmer. This will mean wildfire-prone geographical zones like Mid-Western and California will have more established fire departments. The quarantine points at border entry points, airports and ports need to be strengthened now that there is more likelihood for bioterrorism, hostility and acts of sabotage against the U.S. or any other nation by terrorists and enemies (www.nytimes.com). 

5. Public health practitioners reaching out to the indigent or marginalized. This will rely on the work of local health agencies. These will in turn report to second tier government levels and different organizations that form the backbone through which the power to protect the public’s health is possible.

6. Providing training and promoting competencies for public health professionals in the 21st century mostly in these areas: conducting essential public health services; legislation; regulation; policies; and the ability to negotiate,  justify public funding for many public health initiatives. For public health to be perceived, such essential services as are relevant: monitoring the health status of the population; diagnosing and investigating problems deemed hazardous to the public’s health; educating the population on health issues; mobilizing communities to act on their own health issues; developing policies; enforcing laws and regulations that protect the public; linking people to health services; ensuring a competent health care workforce; evaluating the effectiveness, access and quality of health services and researching to continue progress and innovation in healthcare (Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett).

7. Use of Technology, which will enable complex research to be translated into action in a faster and flexible way. Technology can be used in many other forms as well. One way is establishing a centralized health management information templates that can be used to report for instance compliances to the Healthy 2020 vision and mission. Events in which equity and equality are addressed can be captured at local, state, regional and federal levels. Racial biases are shown to be a part of the social structure of medical practices at both macro and micro levels (Centre for excellence in health care journalism). Use of web-based platforms to share information can help improve on coverage of what works and who is served. Public health will be a means for America to deal with the hot topics that focus on: race, culture, ethnicity, lifestyle, health status and health care in America. This might be the great quest of technology as well. Through technology it will be possible to level the health care playing field. Socioeconomics, individual racism, and institutional racism that represent the three predominant pathways to differential treatment for diseases will be targeted and redress provided. Reporting mechanisms will provide common indicators used to gauge quality of life for women and men irrespective of their gender, sexuality, race and social status.  Compiling reports into a format that can be disseminated to all concerned is another good use of  print technology and the world-wide web. In this format the media can be relied upon to make information available or the applicability of the information by society in form of case reports/studies or any format that is reliable for dissemination. However, newsprint, radio and TV tend to tap into our anxieties focusing on trivia. “The CDC has had to contend with bogus reports of imported banana carrying flesh-eating bacteria, drug addicts placing HIV-infected needles in pay coin-return boxes, virus soaked sponges arriving with the mail,” (Drexler, M. 2010). 

8. Understanding the need for post trauma stress counseling and care arising from the link between terrorism, massacres and resultant traumas, e.g., counseling after separation from loved ones, death and shock,  care after post traumatic stress disease (PTSD), homelessness following destruction of homes or infrastructure and other needs. A global nightmare envelopes the world every time wars, genocides and terrorist attacks occur anywhere in the world. The rallying call that brings together nations ready to do rescue activities is to profess solidarity with the suffering nations. Rescue efforts are made by nations. This was seen after September 11, 2001, in UK, in Uganda, in Tanzania, in Kenya and most recently in the 10th district of Paris where the most recent attacks have occurred. The San Francisco editorial has this to say, “France’s loss is our loss. Its grief is our grief. And its fight to counter the forces of inhumanity is our fight”  (San Francisco Chronicle, Editorial, November 14th, 2015). 

9. The effects of political pronouncements such as the recent debate on mass deportations sends trauma shocks to those who are  not documented yet they many have lived in USA all their life and some are employed. These people may end up not attending social services for fear of being hounded and put on hot lists.

10.  Establishing a structure of international partnership to deal with climate change, neglect, poverty and famine  at a global level which in turn make humans and in some cases livestock vulnerable to influenza, Legionnaires’ disease, Lyme disease, toxic shock syndrome, E. Coli 0157:H7, STDs, Ebola virus, AIDS, severe acute respiratory syndrome (SARS), H1N1 influenza (Drexler, M. 2010). 

11. Understanding the increasing relation of chronic low-level inflammation, wide range of common debilitating disorders, stealth infections, deadly sepsis, how to balance use of antibiotics and inflammatory-quashing steroids. Research findings recommend Mediterranean style diet for those suffering from inflammatory disorders (Sachs J.S., 2007).

In the 21st Century, stigma discrimination, bias and prejudice will be the issues that need addressing. This in turn will clear the way for addressing neglect, poverty and famine. In situations where equality, respect and dignity are promoted, proper protection of life and ensuring individual well-being will be achievable.

REFERENCES:

1. Berthold, T. 2009. Foundations For Community Health Workers. San Francisco, MA: Jossey-Bass.

Centre For Excellence in Health Care Journalism. 2006.

2. Drexler M., 2010. Emerging Epidemics: The Menace of New Infections: H1N1 Flu, SARS, Anthrax, E.Coli.Penguin Books.

3.http://www.nytimes.com/2015/11/15/world/europe/strategy-shift-for-isis-inflicting-terror-in-distant-lands.html?emc=edit_th_20151115&nl=todaysheadlines&nlid=60949333&_r=0

4. Sachs, J.S. 2007. Good germs,Bad Germs: Health and Survival in a Bacterial World. New York, NY: Hill and Wang.

5. SFChronicle.com

6. Turnock, B. J. 2016. Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.