A case study from Mugalama Sub-county, Uganda
This project was delivered with Rural Aid Foundation in Mugalama Sub-county, Uganda, with the aim of improving access to sexual and reproductive health services and rights among adolescent girls and young women.
In 2020, Rural Aid Foundation established a rural women health information and skills centre that trains 80 Adolescent girls and young women (AGYW) in making reusable sanitary pads annually. This project integrated a harm reduction model and sexual reproductive health and rights training in the centre activities to build a movement of Community Link Ambassadors (CLAs) to sensitize rural women on sexual reproductive health rights and services. This includes access to, and use of, misoprostol to treat postpartum hemorrhage for women that deliver or obtain unsafe abortions from traditional birth attendants in Mugalama subcounty.
The women and girls that graduate from the centre work as village ambassadors to reach their peers with sexual reproductive health and rights information and services through door-to-door visits, community outreach, sensitization meetings, health camps and radio talk shows. Health workers; traditional birth attendants; local leaders and justice actors were trained in using the harm reduction model to improve access to sexual reproductive health information and services including post abortion care, as well as preventing unsafe abortion among ethnic minority women. The Harm Reduction Model is an evidence-based public health and human rights framework originally developed to curb the spread of HIV/AIDs and later re- conceptualized by Iniciativas Sanitarias- a Uruguayan organization to prevent unsafe abortion in situations where policies and practices prohibit, stigmatize abortion.
As well as directly engaging 1508 women during the second phase of this project, 548 women were involved in phase one. Because of the innovative combination of face-to-face community engagement and radio shows, the project was able to reach an audience of more than 100,000.
Key stakeholders included:
Rural Aid Foundation (RAFO) is a women and youth centered non-profit organization whose mandate is to advance and advocate for health, digital rights and economic empowerment among vulnerable persons in Uganda. RAFO was founded by children borne as a result of intermarriages between Ugandans and refugees who fled the Rwanda Genocide. RAFO was founded initially as a community based organization and later registered as a nonprofit organization to advocate for and advance health, digital rights and economic rights and empowerment among vulnerable rural women including refugees, persons with disabilities, sexual and ethnic minority groups, sex workers, adolescent girls, women and children.
Their work is in three broad programmes; Health and Health Determinants, Digital rights and Economic Empowerment. RAFO has offices in Kibaale district in Bunyoro sub region in Western Uganda. They achieve this mandate through a human rights and community driven approach that guide direct implementation for service delivery, advocacy, research, and community empowerment in health, digital and technology rights and economic empowerment.
Before the start of the project activities, a baseline rapid assessment survey was conducted to establish the initial values of the outcome indicators. This was conducted before the start of the first engagements with the village women ambassadors, Traditional Birth Attendants (TBAs) and health service providers. The communities were assessed to establish their level of knowledge on sexual reproductive health services and rights before they were sensitized by the ambassadors through village sensitization meetings and home visits. Our project was also selected as part of the Global women empowerment projects by Global Health Corps and a documentary of the project’s impact was done by Global Health Corps. The documentary will be featured in the Global Health Corps impact report which will be published via the link here. You can see our rural women ambassadors in this video.
After implementing all the activities, Rural Aid Foundation mobilized 46 stakeholders including male community members and 39 community female members (5 TBAs, 6 health workers, 20 ambassadors, and 8 community members) for focus interviews and focus group discussions to establish the extent to which project results were attained. These were randomly selected from those that were engaged in the project in the second phase of the project from the four parishes of Mugarama sub county including Mugarama, Imara, Kituuma and Kyezimbira. The community members were those that we mainly engaged during health camps and those reached by women ambassadors during the implementation of the activities such as sensitizations, home visits and others.
After conducting the field and documenting the success stories RAFO hired a consultant to develop a project documentary showing the project results, lessons and recommendations. They felt that video was the best way to share with partners the achievements of the project. The video is available below.
Discover more about this project and others like it through our Project Fact Files
As an ambassador, I learnt that when a women or child is raped, the first thing is to take them to the hospital to get medicine called PEP within 72 hours such that even if the person who raped that girl is HIV positive, the child will remain safe provided that medicine is given within those 72 hours or 3 days.
Woman ambassador from Kyezimbira sub county.
Harm reduction is one thing I really appreciated and how to use it in my day today work here at the hospital. Some women come with many problems for example, the women are young, she has a one-year-old baby, she is pregnant and HIV positive! These are many health issues, before, I would first ask them so many things such as why are you not using family planning? Why did you get married at that age? At time I would not want to help some women because they I thought they were just negligent about their life. After learning about their rights and the principles on harm reduction, I learnt not to judge or discriminate women but to focus on addressing their health needs.
Health worker at Mugarama Health Centre III
My name is WK* from Mugarama church of Uganda, I want to thank Rural Aid Foundation because they came to our sub county and held suessions raising awareness of sexual violence, how to prevent unsafe abortions, and testing for HIV and we have realized that Rural Aid Foundation is helping us as community leaders because they are doing part of our work to ensure women and girls remain healthy. Rural Aid Foundation brought health services closer through the health camps. Thank you.
* Names have been adjusted to protect participant's privacy
My name is AB*, the local council one chairperson of Mugarama village and I am a member of the health unit management committee for Mugarama health center III. Rural Aid recruited and trained 80 adolescent women and girls and trained them on HIV prevention, sexual violence, rape and how to identify an report some of these case. After training them, they were supported to go to their villages to sensitize our people and also identify some of these cases. So far, we I have received a number of sexual and domestic violence cases that I have handled and resolved while others have been sent to police and CDO’s office (Community Development officer). The number of cases has reduced in my village. I am happy that the girl the girls that were trained are supporting women in the community as you can see may women are now turning up to receive health care services. This was not the case previously.
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