Programs - Community Outreach

The community outreach programme is one of the strategic programmes of HEPS Uganda that empowers health care consumers to demand for their health rights and exercise their health responsibilities. Health is not a preserve of health care providers, health is also an every day experience influenced by the choices individuals make.

HEPS-Uganda targets communities to empower health care consumers, especially the poor and vulnerable, with information that will enable them to know and demand for their health rights and exercise their health responsibilities including rational use of medicines.

HEPS-Uganda works with grass root community leaders to increase their capacity and knowledge and be able to impart this knowledge about health rights and health responsibilities to their local community members using the ToTs (Trainer of Trainers). These leaders commonly known as community trainers are key change agents in the local communities.

Community Outreach Objective

To educate and empower health consumers, especially the poor and vulnerable, by dissemination of information on health rights and responsibilities, including rational use of medicines (RUM).

The geographical coverage of the community outreach programme:

• Central Uganda - Kiboga district and Kawempe Division of Kampala district
• Eastern region - Pallisa and Budaka districts
• Western region - Mbarara and Kamwenge districts
• Northern region - Lira district

Components of the Community Outreach Programme

The community outreach programme has two other components namely:

1. School Outreach
2. Complaints and Counselling Desk

School Outreach Component

The objective of school outreach is to educate, empower and enable, health care consumers in secondary school and institutions of higher learning to know and demand for their health rights and be able to exercise their health responsibilities with emphasis on access to essential medicines and rational use of medicines (RUM).

HEPS – Uganda works with school and club leaders in secondary and tertiary institutions to increase their capacity and knowledge and be able to impart this knowledge about health rights and health responsibilities to their fellow students and teachers using the ToTs (Trainer of Trainers) technique. In this case, the school and club leaders are the key change agents in the school communities.

C & C Component

From the study of the Uganda Human Rights Commission (UHRC) the following rights were listed as the most abused:

• The right to access drugs,
• The right to food (including drinking water),
• The right to dignity of the person,
• The right to prompt treatment (except in private health facilities),
• The right to treatment with or without pay,
• The right to treatment in emergency situations; and
• The right to optimal care/holistic treatment.

According to the research of the UHRC the biggest obstacle to the realisation of health rights is the rampant absence of drugs especially in the public health facilities. Where the drugs were available (mostly private health facilities) the prices were beyond the reach of most patients.

The violation of these rights is not properly addressed in Uganda. The situation is made worse by the absence of a feedback mechanism between health consumers, health providers and policy makers. Also lacking is a redress mechanism between health providers and consumers. Through the HEPS Health Counselling & Complaints Desk (C&C Desk), health consumers can voice their complaints and/or suggest improvements to the health services they are rendered (health providers). The C&C Desk has a complaints handling procedure and serves as a feedback mechanism to dialog with central government, local policymakers and health providers to improve health care.

Methodology

HEPS uses two methodologies for community outreach and these include:

1. Community empowerment methodology

To increase health awareness and community participation, HEPS-Uganda uses trained community trainers to be agents of change. A series of carefully planned training activities that reinforce each other in dissemination of health messages and training of the target group in the community are used.

HEPS-Uganda has developed and tested community empowerment training materials with easy to read and understand messages. These materials include a facilitator’s guide (for HEPS facilitator), a trainer’s guide (for Community Leaders) and Education Materials. The Trainer’s Guide and Education Materials have been translated into three local languages namely Lugwere, Runyankore and Luo.

2. Community participatory methodology

The Participatory Rural Appraisal (PRA) approach is also used to increase health awareness and community participation in identifying and addressing barriers to access. Several techniques of the PRA are employed, such as case studies, brainstorming and group discussions, ranking and scoring, spider ranking, role play, stepping stones/ wheel chart among others.

This methodology has proved to be effective in working with the community and encouraging participation in identifying problems within the community and suggesting solutions and interventions to address the problems.

This methodology has been implemented in:

• Kamwenge district under the project, “Community Empowerment and Participation on Maternal Health”
• Kamwenge and Kiboga Districts under the project, “Consolidating participatory approach to increase community participation in prevention of parent to child HIV/AIDS transmission”.

Messages

The community training materials are designed around health rights and health responsibilities the rational use of medicines. Right to health is an entitlement to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realization of the highest standard of health. Each of these messages has been shaped in an easy to understand, drawing-based discussion. The education materials enable community members to discuss / debate the health rights based on the pictures.

The health rights of health consumers are:

1. Right to Health Care

2. Right to Access Essential Medicines

3. Right to Access Information

4. Right to Choose

5. Right to Privacy and Confidentiality

6. Right to be treated with respect

7. Right to complaint and redress

Maternal health rights

1. Right to health care

· As a health care consumer you have the right to the best quality of appropriate health care (affordable and accessible) irrespective of your social-economic (sex, disability, age, religion, ethnicity, etc) background.

2. Right to access essential medicine

· The right to health includes the right to goods and services. Therefore one has the right to access essential medicines.

3. Right to access information

· You have the right to full knowledge of your health status, the treatment procedures/options available, their benefits, risks and consequences of each option.

4. Right to choose

· As a health care consumer you have the right to become an active partner in your own health care.

5. Right to participation and representation

· You have the right to participate in any decision affecting your personal health and treatment and your voice to be heard at all levels of decision-making.

6. Right to respect for human dignity

· You have the right to be respected and treated with dignity while accessing health care irrespective of your background.

7. Right to privacy and confidentiality

· Your right to privacy and confidentiality while accessing health care service must be respected.

8. Right to complaint and redress

· If you are not satisfied about the manner in which you have been treated you have a right to lay a complaint and get redress according to prescribed procedure.

The health responsibilities of health consumers are:

Responsibilities are the duties and obligations of the health care consumer in ensuring his/her own well being and the well being of those under his/her care.

1. Be extra careful with use of medicine during pregnancy

2. Get your medicines from a qualified health provider

3. Ask the health provider which medicines you get

4. Always ask your health provider to give you your medical form

5. Buy medicines at the right price

6. Take your medicines at the right time

7. Always complete the prescribed dose

8. Store your medicines at the right place

Maternal health responsibilities

1. Personal responsibility of expectant mothers

It is your responsibility to:

- To care for, protect and promote your own Health and that of your baby

- Attend antenatal clinic at least 4 times while pregnant

- Seek skilled medical attendance at birth

Personal responsibility also includes the rational use of medicine (RUM);

- Be careful with medicines when you are pregnant

- Ask the health provider which medicines you get

- Always asks for your medical forms when visiting a health provider

- Buy your medicines at the right price

- Take your medicines at the right time

- Get your medicines at a trained health provider

- Always complete the dose

- Store your medicines in the right place

1. Responsibilities of partners (husbands)

- Support the expectant mothers financially, emotionally etc

- Encourage expectant mothers to attend ANC

- Ensure that your partner seeks skilled medical attendance at birth

1. Community responsibilities

- Make community maternal health concerns a priority

- Advocate for increase in district health budgets especially for EmOC and mama kits

1. Health worker responsibility

These are duty bearers since they are the providers of health services

- respect the dignity of expectant mothers

- Be available when needed

- Observe equity – no discrimination

- Be culturally appropriate

1. Honesty and collaboration

All parties/stakeholders have a responsibility to cooperate and collaborate honestly in order to improve the health of expectant mothers and achieve better pregnancy outcomes.