FLEP is a strong organization with functional organization systems to support delivery of evidence based advocacy and rights and quality integrated health services to the communities of East Central Uganda.
FLEP supports activities aimed at increasing access to, coverage of and utilization of quality and comprehensive HIV&AIDS and TB prevention, care and treatment services to communities in East Central Uganda. The program targets increased uptake of HIV counseling and testing (HCT); promotion of HIV prevention with positives through sexual and other behavioral risk prevention; abstinence and/or being faithful; provision of Septrin prophylaxis for positives and referral for antiretroviral therapy (ART) services including safe male circumcision (SMC) HIV counseling and testing (HCT) services are conducted using both static and outreach based approaches with more focus to target Most-at-risk populations (MARPs) living at fishing communities/islands around Lake Victoria and Lake Kyoga. ‘Community camping’ and door to door’ models constitute our approaches to provision of HCT through outreaches. A team of counselors camps within the community, and then moves from home to home with the aid of village health team (VHT) to provide home based HCT to targeted groups. Cognizant of the fact that married and/or cohabiting couples account for a high percentage of new HIV infections and yet few couples know their HIV status, couple HIV counseling and testing (CHCT) is promoted. Specific CHCT activities are conducted and couples receiving CHCT are awarded certificates in recognition of their active participation in CHCT activities. Risk reduction counseling through provision of targeted abstinence and/or being faithful messages is provided by peer educators to appropriate groups. Youth peer educators (YPE) target peers in-school and out-of-school, and ‘role model couples’ and religious leaders are utilized to target couples with couple fidelity sessions. Beach management units (BMUs) target fisher folks with condom education and distribution.
When FLEP was founded in 1986, delivery of family planning (FP) services was the core intervention area for the program. FLEP was among the first organizations in Uganda to run a community based distribution (CBD) program for FP commodities/services. This history provides FLEP a rich experience in supporting couples to have manageable family sizes and thus contribute to the reduction of high fertility rates in program communities and Uganda at large. FLEP provides a full range of FP services including long-acting and permanent methods (LAPM) and short-acting methods for family planning. There are 2 voluntary surgical contraception clinics (VSC) with adequately equipped theatres for conducting female and male sterilization procedures. Village health team (VHTs) constitute the backbone of the FP program by providing appropriate information and/or services and conduct referral for couples or individuals to the 52 program health centres for appropriate family planning services. VHTs register all women in reproductive age (15-49 years) within their catchments to enable them map households with target groups that are eligible for family planning interventions. It’s against this information that targeted FP couple counseling sessions are conducted to households. There are Moslem VHTs that target Moslem couples with FP education sessions during Friday ‘Juma’ prayers. This activity is implemented with support from the respective District Uganda Moslem Supreme Council (UMSC) offices. The moon beads cycle a family planning option that suits the teachings of the Islamic faith that forbids modern contraceptive use is promoted. VHTs therefore distribute female and male condoms, oral contraceptives and moon beads cycles and refer clients for injectables, and long-acting and permanent methods to either of the 52 program health centres. Additionally, targeted FP outreach sessions are conducted to hard-to-reach communities including islands of Lake Victoria to increase FP service accessibility, coverage and utilization. The family planning program has contributed to an improvement in the lives of communities. An evaluation of one of the FP programs in Kamuli district showed that contraceptive prevalence rate (CPR) had risen from 28.4% (2007) to 52.2% in 2009. This CPR in program catchments doubled Kamuli district CPR (23%) and the National average of 24%. Additionally, there are two community feeder roads in Nabwigulu sub county Kamuli district and Bumanya sub county Kaliro district respectively, along which FP clients live, which have been re-named by the community as “family planning streets” . In these two communities each with an average of 70 households, over half of the households are clients for permanent contraception.
The behaviour change communication (BCC) programs are intended to increase knowledge of the available health services and how to access them, stimulate community dialogue on the services hence create demand for services. VHTs utilize the traditional client-provider interpersonal communication strategy to reach targeted groups with appropriate health information education and communication (IEC) through door to door campaigns. Forum theatres that include puppetry and drama shows are utilized to reinforce the home visits conducted by VHTs. Forum theatre is interactive and passes messages utilizing drama as a channel of communication and involves the audience actually participating so that they take part in discussing the issues as well as finding solutions. Networks of satisfied clients especially for family planning are utilized to provide correct information to demystify myths and misconceptions about services, link clients to service providers and follow-up to peers for continued service use. In addition, there are 564 community owned resource persons including youth peer educators in-school and out-of-school, role model couples, beach management units, religious leaders, people living with HIV&AIDS, teachers, and OVC volunteer team, each targeting specific program target groups with appropriate health information and/or services. Utilizing church ministry structures has contributed greatly to the success of program BCC programs. Some church ministers (reverends, clergy, lay reader) are satisfied service users which enables them to mobilize their congregation for program health activities.
FLEP targets both out-of-school and in-school young people (10-24 years), with greater emphasis on reaching out-of-school youth who are most at risk due to their limited access to adolescent sexual reproductive health information and services. Youth peer educators (YPEs) engage young people and communities in dialogue and discussion about the health and social problems associated with adolescent pregnancy and illegal abortion, in order to create a supportive environment for behaviour change among adolescents to discourage early sex and marriage, to use contraception when sex is initiated, and seek health services when complications arise. There are youth clubs that enhance sustainable provision of adolescent health information and services at community level. Youth clubs are equipped with IEC/BCC and life skills messages for young people.
Over 90% of FLEP 52 health centres are rural based and serve hard-to-reach communities. All these facilities receive the primary health care (PHC) conditional grant from ministry of health government of Uganda. Additionally, program health centres are facilitated with drugs/medicines from the Uganda Protestant Medical Bureau (UPMB). This enables these sites to provide appropriate curative care to children and adults within their catchments. Each health centre has a health unit management committee (HUMC) that provides checks and balances and oversees service delivery at the respective sites. Each health centre has a minimum of 6 VHTs attached to it to facilitate client referral and follow-up for further appropriate care. FLEP utilizes a model of quality of care monitors locally known as ‘gampe agents’ to initiate and manage the client-feedback system for improved quality of care. Gampe agents conduct mystery client sessions, client-exit counseling and client concern sessions to collect information on community perception for services provided. Gampe agents’ timely feedback to health unit management committees (HUMCs) ensures delivery of client-centered services and enhances quality of care. The yellow star assessment framework is utilized to assess program health centres to enhance quality improvement.
FLEPs’ advocacy mandate is purposed to deliver improved quality, accessibility, and availability of health and social services in the catchment districts. Guided by our advocacy strategy which aims at fostering citizen’s demand and enhancing the capacity of CBOs to advocate for improved responsiveness and accountability by decision-makers and service providers. In partnership with 11 established district local government structures, FLEP seeks to advocate for policy implementation, review and change as a means of fostering sustainability. This is because the local governments have a clear mandate as outlined in the Ugandan Constitution, the Local Government Act (cap 243), the Decentralization Policy and Strategic Framework (DPSF), the Local Government Sector Investment Plan (LOGSIP), the Public sector Management Strategic Investment Plan (PSM-SIP) and the National Development Plan (NDP). FLEP mobilizes and empowers vulnerable communities and amplify the voice of citizens as active agents of change for better health services in East Central communities. Our implementing teams utilize multiple integrated community interventions and communication strategies including interactive dialogue sessions, advocacy forums, radio talk shows, media engagements to mobilize and empower community members, leaders, and grassroots groups to engage in advocacy and social accountability activities with public officials and private-sector entities, including service providers. Central to these efforts is increasing citizen knowledge and awareness of their rights and responsibilities related to health and social services and enhancing their ability to identify, articulate, and take advocacy actions relative to their needs. Our advocacy interventions are informed by the overriding need to have accessible and quality health and social services for citizens within the East Central districts. FLEP believes that if citizens are empowered to demand for better health and social services, districts would be more responsive to their needs and this would provide a foundation for improved availability, accessibility and utilization of health and social services for the citizens.