Family planning is crucial to improving health outcomes by increasing birth spacing, delaying first birth and reducing high-risk births—but many women lack access to these services. In Uganda, 3 in 10 married women between the ages of 15 and 49 have an unmet need for family planning (UDHS 2016), while in Kenya, the number is 1 in 7 (KDHS 2022). CHWs are proven to increase the use of contraception—especially where unmet need is high, access is low and geographic and social barriers exist.

Living Goods supports CHWs to offer comprehensive family planning services to women of reproductive age. CHWs provide counselling; facilitate access to a broad range of short-term contraceptive methods including pills, condoms and some injectables; and refer for longer-term and permanent methods. We concluded an external evaluation at the end of 2021 to dig into what was working and what we could do better. Results found that Living Goods-supported CHWs in Uganda enabled a 36% reduction in unmet need for family planning,
compared to the 26% reduction in the control arm. Further, the study found a 26% increase of the modern contraceptive prevalence rate in the intervention areas, but the districts in the control arm reported a two-fold increase (52%).

Beyond the external challenges due to COVID-19 pandemic, the evaluation helped us identify
specific gaps in CHW capacity and knowledge, coverage and reach and commodity access, which affected uptake of family planning services. To improve results, we will be launching
an action plan in Q2 with a focus on the below:

Increasing efficiency of CHW visits: The quality of counseling of a CHW during a client visit
greatly influences outcomes. We are focusing on building the capabilities of CHWs to effectively provide family planning information, handle objections and provide suitable options to users.

Strengthening referrals: In Q1, we started engaging with MSI Reproductive Choices, a
leading provider of family planning services across Uganda, to strengthen referral linkages
for those seeking long-term and permanent methods. MSI is now sharing their outreach schedules within communities and at static sites. This reduces missed opportunities where
referred clients cannot get services at facilities. We are also working with family planning focal persons in the districts to coordinate referrals of clients at health facilities to reduce the number of those bouncing because they can’t access services.

Improving family planning coverage: We conducted a market analysis to understand the potential market, our current coverage and the gaps. This helped us to improve our targeting— from 16 to 21 unique women of reproductive age (WRA) per CHW per month.

Expanding commodity availability: The Uganda MoH recently changed the family planning commodity distribution guidelines; unlike in the past where there were various distribution channels, now commodities must be accessed through only the districts or a central warehouse. We are working with family planning focal persons to ensure commodity requests from CHWs are included in the overall district requisitions to the central warehouse. We hope this will help to stabilize CHW stock levels.