Championing interventions to improve immunization regimens for unreached and under-immunized children by Care Group Volunteers (CGVs)-Bidi-Bidi refugee settlement
Immunization is a proven strategy for reducing morbidity and mortality among children. Uganda has specifically accomplished greatly on enhancing its routine immunization (RI) system. However, despite the achievements, the coverage is uneven and equity in access to vaccination remains a challenge for children under the age of 5. A large number of children were unimmunized, unreached and under-immunized, due to different circumstances. (Family Health Days program, January 17, 2020 https://doi.org/10.1371/journal.).
Andrua Gloria a CGV in Block 4 Bidi-Bidi refugee settlement followed up Bidal Micheal, a 5 year old boy who had never attended any Immunization, upon probing, Celina Bunia the grandmother said that she feared being embarrassed by the health workers. ‘We came from South Sudan when my grandson was two years old, we had already missed the first Immunization schedule, now I feared going to the Health facility because I thought the nurses would blame me for not bringing the child early for immunization. The CGV counselled the caretaker on the benefits of Immunization and escorted them to the health facility where they were warmly welcomed by the healthworkers who administered the first doze of BCG & HepB and the child finished his fifth visit by 3rd.12.2020. Celina recaps, ‘I am happy that my grandson is now fully immunizaed like other children, thank you Gloria’. A lot more children like Bidal have reportedly benefitted from CGV’s follow ups. Thus, the CGVs are doing all it takes to reach the unreached and under-immunized children in the refugee settlement.
Community group volunteers-CGVs the unsung heros in Promoting healthy behaviours and parenting skills among mothers-Bidi-Bidi refugee settlement
Pregnant women in Koboko tend to have low adherence to antenatal and postnatal care thus contributing to infant and child mortality rates. The Care Group Volunteers have been using care group approach to improve nutrition knowledge among pregnant Lactating Women-PLW and children aged 6-59 months in order to prevent chronic and acute malnutrition among refugees and host communities through behaviour change lessons on early health seeking and good feeding practices to improve uptake of ANC. Nancy, an expectant mother living in village 8 zone 4 Bidibidi Refugee Settlement was found to have never attended any Antenantal care during her 8th month of pregnancy. On a visit by CGVs, she was found staying indoors due to depression after her husband ran away on hearing about her pregnancy. She was offered psychsocial counselling and escorted to Bolomoni Health Center III where she was diagnosed with anemia due to the low blood haemoglobin count of 6.4 below the normal range. The CGV together with the community based facilitator advised her to eat food rich in Iron, improve personal sanitation and hygiene. During the second home visit , the team was impressed with the noticeable change in Nancy’s physical appearance, to supplement her feeding, she was supported with vegetable seedlings for backyard gardening. She exclaimed!,‘I will forever be grateful for how you have saved me from worrying, and I’m now prepared and looking forward to being a mother’.
Climate smart keyhole vegetable gardening-Bidi-Bidi-Yumbe-AFOD and Action Against Hunger (ACF)
Climate change and increased climate variability present new risks and vulnerability for individuals and smallholder farmers in Yumbe, West Nile who depend mainly on rainfed agriculture. With limited options for diversified livelihoods,these communities are more vulnerable to climate risks, with direct negative impacts on household food security and nutritional status. To address this challenge,AFOD rolled out a module on keyhole gardening to 505 care group volunteers (55 Male and 450 Female) across the four zones in Bidi Bidi refugee settlement to help improve food diversity by ensuring constant production of vegetables throughout the year with smart planting techniques which reserve water during drought conditions.
A keyhole garden is a circular raised garden bed with a compost basket at the center and a keyhole-shaped path that allows access to the entire garden. The compost basket can be fed throughout the season and will continually break down and deliver nutrients to the bed for the duration, as will the chunky bits of organic matter you add to the layers of the bed as you build it.
Joseph, a CGV in Igamara v.5 zone 4, testifies that the introduction of the module greatly improved his livelihood after being provided with seeds of tomatoes, sukuma wiki, carrots and onions which he planted in the set key hole gardens. He further adds that the fathers in his neighbourhood have greatly appreciated the knowledge shared and this has made them adopt keyhole gardening which is improving the diets in their homes. “There is likely to be an end to malnutrition in the settlement in the following years, so AFOD should continue to support us for the next five years,”says excited Joseph.
The module has been appreciated by most of the CGVs with the following statements recorded. “We would love to thank AFOD for the support they have given us especially during this pandemic. We are now able to have a balanced diet in our homes with vegtables at our disposal,” one CGV applauded. To ensure sustainability, we advise the CGVs to keep seeds for the next planting season. Monthly field visits are usually conducted to followup on compliance.
Empowering refugees through backyard gardening-Palorinya refugee settlement
AFOD in consortium with Palm Corps through complementary activities on backyard gardening have established vegetable demonstration sites at all the food distribution points with the aim of ensuring small holder farmers and individuals learn and replicate backyard gardening. Below are testimonies of beneficiaries who have benefitted from the project:
| “The south Sudan war had a far reaching impact in my life. I lost my resources including my only motorbike. However, this year, I experienced a turning point in my life when I learnt about AFOD and PALM Corps initiative in promoting backyard gardening to improve the nutritional status of the beneficiaries” Likambo narrates. “I joined the PIPILET farmer group where I received seeds and training on establishment and management of Kitchen gardens. “I silently got motivated and thought to myself, this could be a life changing opportunity for me and my family”, Likambo explained. With the knowledge acquired, I utilized a small portion of my land to grow a variety of vegetables including; eggplants, tomatoes, onions, and Sukuma wiki (collards). “My Kitchen garden is now like my motorbike. From the vegetables produced, I can now buy more food, meet household needs and even buy clothes for my wife and children” When asked about his plan for the next season, Mr. Likambo said, “I intend to increase on the amount of vegetables grown by using 60 by 60 meters of land so that my family can have enough food to feed on and money for sustenance.”. | Agnes Aber, a 26 years old refugee from South Sudan, lives with her 1-year old daughter in Base camp zone of Palorinya refugee settlement. Aber was selected to be a nutrition mentor by the farmer group members of Iboa village Farmer groups were provided with a variety of vegetable seeds including tomatoes, collards (Sukuma wiki), carrots, onions and egg plants. Members were taught about the benefits of vegetables and how to grow them. “For a long time, I have struggled with inadequate food and recurring body rashes on my daughter Becky due to reduction in ration quantity. Through AFOD/Palm Corps, I learnt that vegetables provide micronutrients that protect our bodies from diseases which motivated me to establish a kitchen garden at my home. Within one month, I was already enjoying vegetables from my kitchen garden and I eventually noticed a change on my baby’s skin, which I attribute to the vegetables”. I encourage others to establish kitchen /backyard gardens on their compounds which does not require much land so as to improve their household nutritional status.” | Justine Nyarakajo, a 36 years old South Sudanese Refugee from Palorinya settlement living in Zone II-Morobi narrates how he has reaped big from vegetable gardening “I was a business man selling general merchandise worth UGX. 4,000,000 which I lost during the South Sudan war. I lost my livelihood when I moved with my six family members on foot to Uganda. Life was harder than never before. I frequently experienced food shortage as we entirely depended on the ration from World Food Programme”. When I heard from the Refugee Welfare Committees about support from PALM Corp, AFOD and WFP partnership, I decided to join the group (God Blessed Us Farmer Group) of Idiwa Village, Zone II-Morobi. To me, it was a life changing move as it enabled me to gain practical knowledge through the training and sensitization sessions on the importance of kitchen gardening, and skills of managing it”. I took up these lessons and applied them in my own home. I started to raise money to buy basic vegetable seeds which I grew and sold at Konyokonyo market. I used the profit for paying children school fees, buying medicine and food. Today, l have reaped a fortune from vegetable growing that has made my life much better.” So far, Justine has inspired four group members who have learnt from his home and have replicated vegetable production. Justine hopes to start up goat rearing by the end of 2021. |
Giving hope to those in denial of HIV status
AFOD Uganda with funding from Infectious Disease Institute plays a unique role in the fight against HIV/AIDS in Adjumani District-West Nile Region-Uganda. Our community based approaches of; door to door home based counseling and refill of stable clients are helping to increase the number of HIV clients enrolled and retained in care and increased adherence to treatment leading to non-suppressed clients able to suppress.
In our psychosocial support follow up, a client shares her story, “I am Kinyaa Margret, 35yrs old from Melijo village, Adjumani District. In 2012, I tested HIV positive from Adjumani mission health center but denied the results simply because l didn’t believe it was true. I later decided to carry out another test in Adjumani Hospital thinking maybe the earlier test from the health center was not correct. Unfortunately from the hospital too, the results was confirmed to be positive. “I felt sad to know that I was HIV positive, I didn’t expect it” Says Margret”.
Being married, the hardest part was how to break the news to my husband, guilt engulfed me as l was eager to know his reaction. I finally decided to open up to my husband who later took an HIV test and the result was negative. I wondered how that was possible but it made me happy knowing he was negative. I asked how he felt about my results, he simply said, “There is nothing I can do about it because whether you are positive or negative, we will still die at some point in life”
After sometime, l was visited by a young lady from AFOD Uganda who was following up HIV clients in the communities. On sharing my plight with her, she explained to me about HIV/AIDS and shared messages on discordant couples. I was counselled together with my husband, we both came to understand that discordant couples exist and we were taught how to maintain and protect each other. I started taking ARVs and l was encouraged to accept my situation. With time I opened up to all my family members about my status and they understood my condition and this made me happy, “until now no one segregates against me in the family, we all live normally”. Adds Margret.
Because of my determination to live a more healthy life, AFOD enrolled me as an expert client in Bira health center where l look out for fellow HIV positive clients and encourage them to regularly take their ARVs, do follow ups for those who stopped coming for treatment and most of all sensitize others on how to live positively in the communities for a better life. I would like to give hope to other HIV positives clients that being positive isn’t the end of the road for anyone. “It is just another life of taking your drugs promptly and living normally like any other human being, I am a mother, wife and still continue taking care of my family needs as expected”. Caption below is Margret at her home preparing local brew for sale.
Teenage pregnancy a growing vice in Moyo and Adjumani District-West Nile Region
Caption: AFOD Project Assistant in a follow up visit with Rose
Rose aged (15) is a primary seven dropout now a teenage mother to a two weeks old baby boy Aron from Palida village, Ayiro parish, Metu Sub County in Moyo District, She narrates her story, “I live with my mother who is a single parent and due to frustration, she resorted to Alcoholism which became a habit. This caused me a lot of trauma and anger towards my mother for always drinking. I felt that I was the main cause of mother’s drinking, I was constantly worried about the situation at home and feared inviting my friends to our home out of fear of being embarrassed by a drunk mother, I felt confused and wondered if other families were like ours”.
Mother provided no support towards my education and other basic needs as all the little money she would get would be spent on Alcohol”. Due to lack of financial support from my mother, I gave into the endless advances from Justine, a 17 year old student in senior two. I was convinced that he would provide all my basic needs as he had promised to share with me some of his pocket facilitation to help me meet my needs. One day he invited me to attend a night social event which he used as a bait that resulted into my pregnancy. Afraid of the repercussion from mother, I wanted to flee home but was also scared of being homeless. My peers advised me to abort the baby but I took a decision to keep the pregnancy. To my surprise, when mother got to know about it, she didn’t care.
During an outreach session organized for Adolescent change champions by AFOD, I gathered courage to attend and after the session, the project assistant of AFOD called me aside and inquired whether I have been attending ANC services to which I said no due to lack of proper clothing (maternity wear). He advised that as an expectant mother, I needed to attend ANC services (HIV testing, MUAC etc.) at the nearest health facility since such services are offered free of charge. He referred me to Metu health Centre III on the 15th October 2020 where I was offered ANC services.
On a follow up visit by the project assistant, she shared, “If I could be supported, I have much interest to go back to school because I have been performing well in class”.
Just like Rose, there are thousands of teenage girls in Moyo and Adjumani who get pregnant, drop out of school and lead a hard life. This intervention is targeting multiple actors to create synergy and address varying ASRH needs of both the host and refugees communities by seeking to strengthen access to reproductive health information and services in schools, ensure effective coordination between the health and education sectors, working with civil society human rights organizations, police and justice system, families, men, boys, women and girls, religious and cultural leaders to address SGBV and teenage pregnancies which is a growing vice in West Nile.
The sad story of teenage Pregnancy-Ayiri Refugee camp Adjumani District.
Kiden is an 18-year-old south Sudanese national living in Ayiri II refugee settlement, Ukusijoni sub county-Adjumani district. Kiden recaps, “In September 2020 my boyfriend invited me to his place and demanded to have unprotected sex which resulted into my pregnancy. Weeks later, I started feeling nausea, fever and poor appetite which drew the attention of my mother. A medical examination confirmed I was pregnant. All my fears set in, I was made to feel I didn’t belong, I was told a lot of things; “You won’t be able to finish school; You’ll never be able to support yourself; You’ve ruined your life; how could you let this happen?” I had so much regret, home was not the best place to live and thoughts of running away kept haunting me since my boyfriend had also run away from the refugee camp in fear of being arrested, with no support or anyone to turn to, I had to face the world alone.
In April 2021, 8 months into my pregnancy, AFOD team and a health worker came to our home, I thought they had come to arrest me only to realize the team were identifying and following up cases of sexual gender based violence and teenage pregnancies in my community. They counselled me about the importance of ANC services; I developed skills to cope with the challenges of single parenthood and received encouragement to breast feed and go back to school to complete my education. This gave me hope and I felt like a person again, with the information and skills acquired, I am now able to prevent unwanted pregnancy and confront stigma head on. Suddenly my family members have started to accept me as I am. If it were not for AFOD, I could not have attended ANC and given birth to a bouncing baby boy who is 4 months and weighs 8 kg”. There are thousands of such girls who get pregnant because of lack of family planning information and drop out of school. With lack of skills, they are exposed to more vulnerabilities, therefore, investment in efforts to provide reproductive health information as well as provision of livelihood opportunities for such girls and young mothers through a deliberate effort to provide access to relevant transferable vocational skills training can add value to their lives.
Gladys an Advocate against SGBV and teenage pregnancy-Logoba HC111-Moyo District
Anzoa Gladys can’t hold back her joy as she recalls growing up as a shy girl and never imagined she would ever communicate effectively to people both young and old. “After being trained by AFOD, I was elected the chairperson of the adolescent change champions in Logoba Sub-county, Moyo District. As a leader, I had to move to the community, including churches and mosques to mobilize adolescents in the fight against early marriages, teenage pregnancy and SGBV. This is no simple task given the fact that it requires effective communication to influence a patriarchal society with strong cultural beliefs that value male supremacy and women’s subordination, but because of the need to fight cases of teenage pregnancy in our community made worst by school closure and lock down, I needed to take action. My work involves mobilization during outreaches and community dialogues, moving from home to home looking out for teenage mothers, giving them hope; sharing information on HIV/AIDS which knows no boundaries with everyone at risk of infection; identification and referral of Sexual Gender Based Violence (SGBV) victims; sensitizing parents on the need to report and respond to sexual gender based violence against girls. My effort is yielding fruits as evidenced by a greater reduction on social acceptability of sexual gender based violence against girls and reduction in forced marriage in the Sub County”.
Health workers training boost uptake of reproductive health services by Adolescents-Idiwa HC111-Itula Sub County Obongi District
Kaahwa Scovia, is a midwife in Idiwa HCIII-Itula Sub-county Obongi district and a focal point person in charge Reproductive health. She shares her experience on the impact of health workers training on reproductive health service uptake provided by AFOD and ViiV health care foundation. “I am delighted with AFOD’s contribution towards provision of friendly adolescent sexual reproductive health services because my aspiration is to see a community free of sexual gender based violence. Before AFOD came in, Health workers in Idiwa HC111 had challenges communicating effectively with adolescents, conducting outreaches due poor mobilization and lack of transport to reach out to the communities, yet cases of teenage pregnancies and forced early marriages were rampant. Our training on provision of friendly Adolescent reproductive health services in a stigma free environment has contributed to an increase in the number of Adolescent accessing reproductive health services at the health facility. In addition, the change champions were trained from each village to offer counselling services, identify and refer teenage pregnant girls and SGBV cases to the health facilities” which has complemented our work. Evidence from the 1st ANC register show that during the previous year 2020, we had high teenage pregnancy cases ranging from 200 and above compounded by Covid-19 pandemic and lock down restrictions but this has substantially reduced to less than 12 on average this year,” she added. She therefore appealed to AFOD and ViiV to extend Reproductive Health services to other sub counties where such cases have become high.
Story title: Walk a mile in the lives of refugees
Alliance Forum for Development (AFOD) Uganda in partnership with Adjumani District Local Government (ADLG) is implementing livelihood activities in four FDPs of Maaji 2&3, Mungula and Ayilo 1. The beneficiaries of the project are both Refugee and host community. AFOD with the help of Office of Prime Minister (OPM) and Local Council 1 identified landlords and entered in to agreement with landlords who offered land for cultivation for the group for a period of 5-10 years and in return, AFOD provided tree seedlings planted by the group members’ plant and maintained the trees for the landlord. The aim of the project is to build household/community assets through livelihoods to meet food consumption gaps and enhanced household income.
I am Zakaria Sobasio a 51-year-old South Sudanese refugee living in Majji 3. I am the Chairperson of Hadia Farmer Group.
“Before, getting land for Cultivation as well as agricultural inputs was our biggest challenge. When AFOD team came to Majji 3 FDP, we were mobilized and requested to form groups.
We gathered ourselves and formed Hadia Farmer Group last year 2021, we are 30 in number comprising of 20 refugees and 10 nationals. With 17 Females and 13 Males.
AFOD supported us by renting land, which is over 10 acres. They did the 1st and 2nd ploughing for us, provided us with garden tools like hand hoes, plangas and seeds like Maize, Soya bean and cassava stalk that we planted.
The project has created unity between the refugee and host communities, since both communities have been integrated in the group and this has made us to learn a lot from each other.
Last year we planted beans but due to prolonged drought we were not able to get a good harvest but as you can see this year, the plants are doing well and we are expecting some good yield. I expect to use part of the money for school fees, family upkeep and save in the VSLA group. I advise more refugees to join the group so as to benefit from this impactful project initiated by AFOD.