What is the big aim?
Healthier women and children in urban slum areas in Kampala – contributing to the effort to reach millennium development goals 4 and 5 in Uganda.
What is the specific problem that we are trying to address?
Lack of access to basic health information and preventative health services – even when these services exist.
A major reason for much of the ill health and premature death of young children and pregnant women stems from their not accessing simple preventative and basic primary care services or not knowing about simple things they can do themselves. Really simple things; like vaccines, bednets to prevent mosquito bites, antenatal care for pregnant women, knowing where to go if your child is sick,
Most of these services are provided at affordable cost or free either by the government, or by NGOs within a short travelling distance. And organisations like UNICEF and the Uganda Ministry of Health produce lots of health information about things families can do to keep themselves healthy. However poor people in the slums cannot access these services and don’t know the information that can keep them healthy.
This is because they don’t know that services exist at all, because they don’t know what to expect when they get there and it’s a overwhelming and frightening to go, because it’s not the socially normal thing for men to pay (small amounts) for healthcare for their children and several other reasons.
The result is that – even though these services are available within the locality and are often sometimes even free of charge – poor women and children do not access them.
How are we going to address this problem?
We don’t believe the answer to this problem is to set up another clinic – the clinics exist but people can’t access them. Nor do we just produce more educational materials – these already exist but people don’t know about them. We are going to work with what is already there, to make it work better and improve access to things that already exist by training and supporting peer educators in the community.
Unlike a stable rural community, there are lots of people moving in and out of a slum. And not all residents in a slum community will know each other or their neighbours (a little bit like cities in the UK!). There is little formal social infastructure (that is, things like rotary club, parent teachers association etc.) in the slums. But something that does exist is the local church. The local church is full of people, who are linked in to other social networks around the slum. It has the potential to bring transformation to the whole slum!
1. Training of peer educators – men and women from the slum will be trained about simple health messages. With lots of discussion and emphasis on both understanding the issue for themselves, and on how to simply communicate key messages to friends and neighborrs.
2. Supporting these peer educators to work as health volunteers – the trained women will then be encouraged and supported to share their learning with their friends and neighbours and to provide practical help to their neighbours who need health advice or need to go to a health clinic. We will give these women a small amount of phone credit each month to keep in touch with the project and with health facilities, and could reimburse small travel expenses if they went to accompany a friend to a health visit.
3. Mapping of health facilities – we will map what health provision is available in the slum and share this information with local people through our women’s group network. And we will build links with a couple of clinics (the government ones or most affordable ones) in order to help them better serve the poor population around them.
Our ethos and values in this project emphasise the importance of cooperation and collaboration. We want to improve what is already there by empowering poor people to access information and services, not duplicate anything. We are strongly directed by our local working group in Kampala. This group involves churches, clinics, public health people and the Kampala Capital City Authority (local government). We are also working with the government Village Health Team structure.
Why is that a good way of addressing the problem?
We think that this will prevent duplication and waste of money by helping poor people to access services that already exist.
Too often the poorest are the ones who are ‘missed’ from available services because they are also the ones with the least education and who are least empowered to seek medical help.
We think this will have a greater impact than on building one more facility in a city with plenty of NGOs and many that work on health.
This is sensitive to social dynamics within slum areas, and is working closely with churches and church members – who know their locality much better than we do.
This project is driven by Ugandans through our local working group and is in response to a need identified by church leaders. In the UK we are providing some public health technical expertise and funding.
How will know if we’ve succeeded?
The current programme is a 3-year pilot scheme. It will be monitored by measuring health status across two slums before and after. And we will ask communities and trained peer educator women what they thought of the programme.
So far, there is little evidence about what works in urban poor communities (in contrast to community health programmes in rural poor communities). We have helped design this project – in conjunction with the local working group – in accordance with our best knowledge of what might work given our public health knowledge.
But this is quite a new field. And we are not certain that our approach will work. The current programme is a 3-year pilot. We believe it is vitally important to monitor this closely so we know if it works and whether we should do it again.
In November 2011 we did a baseline survey of health status, using a quasi-random cluster model. We asked randomly-selected households about the health status of women and children in the house. These households were not connected to the churches at all. In three years time we will repeat the survey and see if anything has changed. For this project to succeed the health information and behaviour change need to get beyond the people who come to church and into the whole slum community.
We will also ask the people involved what they thought of the project and if it met their needs and expectations (participatory qualitative review).
Is this a good use of money?
This is a good use of money because we are not setting up or duplicating services. We providing training and linking people into existing services. Our model is a low-cost model, using church halls to run training programmes and using volunteers to do the work of reaching out to their community.
At the end of the day the success of this project is dependent on the people in the communities themselves, the money required is small, it’s necessary to train and empower these women, but it’s not sufficient. This project requires passion and dedication from the peer educators to serve their community. From conversations with church leaders and women in these communities we think this already exists. We just need a small amount of money to equip these passionate women and allow them to be effective change makers in their own communities.