Baseline Survey Report

178 Pages·2012·3.46 MB·English

UNITED NATIONS JOINT PROGRAMME ON POPULATION

BASELINE SURVEY FOR THE UN JPP

FINAL REPORT

Submitted By:

Funded By:

12th NOVEMBER 2012
Baseline Survey of the UN Joint Programme on Population
FINAL REPORT 2012

ACKNOWLEDGEMENT

This baseline report has been made possible by many people and Partners. First we wish to
thank the funders of the baseline, UK AID. Secondly, we wish to thank UNFPA and all the
JPP partner organisations who greatly contributed to the success of this study. Thirdly we
wish to appreciate the technical contribution and support received from the JPP Technical
team comprising of; Tapiwa Jhamba, Patrick Orotin, Dr. Olive Ssentumbwe, George Ebong,
Dr. Geoffrey Bashobora, among others. We further wish to thank the different line
ministries, departments and Agencies for their cooperation in providing the relevant
information. More appreciation goes to District JPP focal persons, Chief Administrative
Officers, District heads of departments and sub county chiefs who spared their time to
coordinate the study and to provide the requisite information.

We also wish to thank our Consulting team from AH Consulting, notably Dr. Roy Mayega,
Joseph Oriekot, Kenneth Kinyera, Mathias Mulumba, Rashid Kiwanuka, Melody
Niwamanya, Carol Mwebesa, Morgan Mukasa, and others including the dedicated team of
research assistants who made this study a success. Finally, we appreciate the management of
AH Consulting led by Mr. Herbert Rwamibazi for their dedication that made this Baseline
study a success.
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EXECUTIVE SUMMARY

UNFPA in partnership with other UN agencies are implementing a 4 year UKAID funded
GoU/United Nations Joint Programme on Population (UN JPP) intended to contribute
towards accelerating the onset of a beneficial demographic transition in Uganda in line with
the priority of the United Nations Development Assistance Framework (UNDAF) and the
National Development Plan (NDP). The JPP is implemented jointly through ten UN
Agencies, viz; International Labour Organisation (ILO), International Organisation of
Migration (IOM), United Nations Human Settlement Programme (UN-Habitat), World
Health Organisation (WHO), World Food Programme (WFP), United Nations Population
Fund (UNFPA), United Nations Children Fund (UNICEF), United Nations High
Commissioner for Refugees (UNHCR), UN-Women, and UNAIDS and eight government
line ministries, department and agencies.

The JPP focuses on 15 selected districts, 8 of which as dubbed M&E districts for purposes of
demonstrating results and impact. The JPP has four main result areas (Outcome areas) each
with outputs and activities namely; Fertility reduction in line with individual/couple choices
especially among young people; Prepared and protected healthy mothers, children and youth;
Youth and vulnerable groups that have competitive skills and opportunities to participate in
the economy including urban development and; adequately resourced, coordinated and
managed national population programmes. Therefore, UNFPA, the Administrative Agent of
the UN JPP commissioned a study in order to obtain baseline information on the status of
each of the outcome indicators to establish reference points to assess progress towards
achieving intended JPP results at national level and district level (15 JPP districts and
selected M&E districts).

The study was conducted in all the 15 target JPP districts of Arua, Yumbe, Gulu, Oyam,
Kitgum, Kaabong, Abim, Kotido, Moroto, Nakapiripirit, Amudat, Katakwi, Mubende,
Bundibugyo, and Kanungu. Out of the 15 JPP district, the 8 M&E districts selected for the
population based survey were Kotido, Moroto, Gulu, Arua, Mubende, Oyam, Katakwi, and
Yumbe. The study targeted women of age (15-49 years), young people aged 10-24 years, and
youths aged 18-30 years; Local leaders at LCI, LCIII and LCV, religious leaders, health
facilities and district technocrats including; DHOs/DHTs, DCDOs/CDOs, DPOs, DEOs,
DISs, CAOs, and District Planners, & DPPs to mention but a few. A total of 1357 households
were selected randomly out of which, 2372 women aged 15-49years, 2270 youths and young
people aged 10-30 years participated in the study. A total of 217 leaders and 111 health
facility in-charges participated in survey.

Descriptive cross-sectional study was used involving a combination of both qualitative and
quantitative techniques to collect data. These included administering survey questionnaires,
conducting FGDs, KIIs, and review of documents. Specifically, Women‘s KAP survey
questionnaire, Youths and Young people questionnaire, Health facility survey questionnaire
and Local leader KAP survey questionnaire were administered to collect data in selected M&
E districts. 16 FGDS were conducted in each M&E district as well. In addition to key
informant interviews with technocrats, the team also reviewed key documents including,
latest MISs (HMIS & EMIS), DDPs, DBFPs, UNDP HDI report 2007, DPAPs, UNPS,
UBOS 2002 Census Report, Statistical abstract 2012, UNFPA-CPAP 2010/14, PP program
reports, and National Population Policy Action Plans among others for indicators at district
and national level. Data was entered in EpiData 3.02 software and exported to STATA for
analysis. Data was analysed using descriptive statistics. Data for most indicators was
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analysed to generate indicators at 2 levels i.e. (i) National vs. 15 JPP district aggregate level
data; and (ii) by individual JPP districts where the indicators apply.

Study findings revealed that Uganda continues to experience unprecedented increase in
population growth. The population growth rate for the 15 JPP districts was 4.6%, slightly
higher than the national average (3.2%). The PGR was highest in Yumbe (7.8%), but lowest
in Kanungu district (2.1%). The factor driving the current trend could be the high Total
Fertility Rate averaging about 6.5%, which is 0.3 percentage points higher than the national
(6.2%). The current HDI for Uganda is 0.446 (UNDP, 2007) (no specific district data) and
the average for the 15 JPP districts was 0.42 according to the UNDP report 2007. The study
further revealed that, the young people‘s dependency ratio stands at nearly 98.8% in the 15
JPP districts though lower than the national average at 91.9%.

In the 15 JPP districts, the contraceptive prevalence rate for currently married women in the
reproductive age group (15-49 years) was 16.5% though lower than the CPR for Uganda
which stood at 26%. Mubende and Bundibugyo district had the highest CPR of 30.7% and
26.8% respectively and this was higher than the CPR for Uganda.

This scenario notwithstanding, the number of new users of modern family planning increased
by 61.9% in the 15 JPP districts, according to the HMIS data for FY 2010/11-2011/12. The
currently married women aged 15-49 years who participated in the UN JPP baseline survey
said that the most preferred contraceptive methods were injectables (6.4%), followed by
implants (4.5%), LAM (2.4%) and the pill (1.7%). The UDHS (2011) puts the national figure
at 14.5 for injectables, 2.7% for implants, 0.2% for LAM and 2.9% for the pill. Estimates
from the JPP baseline found that the CPR for currently married women using any modern
contraceptive method was high in the rural area (24.1%) as compared to the urban areas
(7.7%). 51.4 percent said that they made a joint decision on utilization of any modern
contraceptive method and 34.6% of the married women made an independent decision to use
any modern contraceptive method.

With regards to the stock out of all the 3 most commonly used contraceptive methods (male
condoms, depo-provera and pill), out of the 95 HFs which offered FP services, 66 HFs (59.5
%) did not have stock-outs of all the 3 modern family planning methods in the last 3 months
preceding the survey. Most health facilities did not have stock outs of pills and depo-provera.

Overall, teenage pregnancy rate was high (26.5%) in the 8 M&E districts implying that nearly
27 in every 100 teenagers were pregnant or had given birth. UDHS 2011 put the national
figure at 23.8%. Katakwi district had the highest teenage pregnancy rate (30.3%) as proxied
by the eastern region followed by districts located in Karamoja sub regions (29.7%). This
could be premised on the low levels of awareness of modern family planning methods among
the young people, only 1 in every 100 young people aged 10-24 years (1.3%) had accurate
knowledge on all the 3 most commonly used modern contraceptive methods.

Although the current policy interventions emphasize integration of adolescent friendly
reproductive health services in PHC, findings show that out of the 111 health facilities which
participated in the baseline survey, 49 health facilities (44.1%) provided adolescent youth
friendly services. Most health facilities in Arua (64%) and Oyam (57%) provided sexual
reproductive health services for youth. Functional male action groups advocating for SRH
and rights are almost nonexistent, only Mubende had a total of 5 male action groups. Out of
the 15 JPP districts, only 6 districts of Katakwi (25), Bundibugyo (13), Amudat (12),
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Mubende (8), Arua (6) and Oyam (3), had functional young people‘s groups advocating for
SRH and rights.

In the 15 JPP districts, the NER reveals that majority of the primary school going age
(86.9%) are in school while only 15% of the same in secondary are in school. Abim (201%)
and Arua (143.9%) had the highest Net Enrolment Rates at primary level while Kaabong
(33.5) and Abim (31%) had highest NER for secondary level. The completion rates stood at
40% for primary and 18% in secondary overall for the 15 JPP districts.

The study found out that in the 15 JPP districts, on average, 37.5% of the deliveries occurred
in the health facilities. Gulu recorded the highest percentage of deliveries (85.8%) and
Amudat had the lowest (6.5%). Children born with low birth weight averaged about 6.7%
percent in the 15 JPP districts. In Kitgum alone, 15.9% were low birth weights. Few mothers
attended 4th ANC the results showed. The overall percentage increase in number of pregnant
women attending 4th ANC visit was 11.1% in the 15 JPP districts with the highest increase
recorded in Abim district (60.2%).

Youth unemployment still remains a national development challenge. Two out of every three
unemployed persons in Uganda were youths. The JPP baseline survey of youths further
revealed that only 19 in every 100 youths aged 18-30 years (19.3%) accessed skills
development and employment opportunities in the 8 M&E districts and yet no youth
employment action plan was developed and implemented either in the 15 JPP districts or
even at the national level. Notwithstanding, all the 15 JPP districts planned and were
implementing activities in line with some of the priority actions under the 2011 National
employment Policy priority action area. Majority of youth who were members of any
coalition network actively participated in the planning process at the Sub County and district.

At least every JPP district allocated some funds to population issues though the amounts
allocated to and actual expenditures varied per district. The study found out that, on average
30.6% of the districts‘ budgets was allocated to population issues though actual expenditure
dwindled to 23.4%. At national level, of the 175billion shillings received for population
activities in 2011, 146 billion shillings was spent. Generally, most of the expenditure (44%)
was on Basic research, followed by 39% on family planning services.

Out of the 217 leaders who participated in the baseline survey, most of the leaders (71.4%)
were aware, able to identify a population phenomenon. 71% understood the inter-linkages
between population and development concerns, a minimal variability of just 4 percentage
points. Oyam district had the highest number of leaders (65.63%) who could not identify a
population phenomenon and link it to development in their area. 13 out of the 15 JPP districts
(86.7%) used 4 or more authentic socioeconomic, demographic and other data sources to
develop their DDPs although most DDPs were not well referenced.

The major JPP towns (municipalities) of Gulu, Arua, and Moroto did not have Urban
Physical Development plans at the time of the survey though most Rural Growth Centres and
Town Boards in the JPP districts had just recently finalized Physical Development Plans. The
JPP partners should continue supporting the population programmes at the national and
district level. They should increase on the funding and critically monitor the implementation
of population program activities especially targeting women, young people and youths at the
district and grass-root/village level especially in the rural areas.
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ACRONYMS AND ABBREVIATIONS
AYFS - Adolescent Youths Friendly Services
CAO - Chief Administrative Officer
CDC - Centre for Disease Control
CDO - Community Development Officer
CP - Contraceptive Pill
CPAP - Country Program Action Plan
CPR - Contraceptive Prevalence Rate
DBFPs - District Budget Framework Papers
DCDO - District Community Development Officer
DDP - District Development Plan
DEO - District Education Officer
DH - District Hospital
DHO - District Health Officer
DHT - District Health Team
DIS - District Inspector of Schools
DPO - District Population Officer
DPP - District Physical Planner
DPU - District Planning Unit
EMIS - Education Management Information System
EMP - Emergency Pill
FAL - Functional Adult Literacy
FGD - Focus Group Discussion
FP - Family Planning
FY - Financial Year
GoU - Government of Uganda
HC - Health Centre
HDI - Human Development Index
HF - Health Facility
HHs - Households
HISP - Housing Income Support Program
HMIS - Health Management Information System
HoD - Head of Department
IDPs - Internally Displaced Persons
IGA - Income Generating Activities
ILO - International Labour Organisation
IOM - International Organisation of Migration
JPP - Joint Programme on Population
KAP - Knowledge Attitudes and Practices
KIDP - Karamoja Integrated Development programme
KII - Key Informant Interviews
M&E - Monitoring and Evaluation
MAAIF - Ministry of Agriculture Animal Industry and Fisheries
MAG - Male Action Group
MC - Male Condom
MDG - Millennium Development Goals
MIS - Management Information System
MLHUD - Ministry of Lands, Housing and Urban Development
MoES - Ministry of Education and Sport
MoGLSD Ministry of Gender Labour and Social Development
MoH - Ministry of Health
MoLG - Ministry of Local Government
MWE - Ministry of Water and Environment
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NAADS - National Agricultural Advisory Services
NDP - National Development Plan
NER - Net Enrolment Ratio
NGO - Non Governmental Organisations
NIDI - Netherlands Interdisciplinary Demographic Institute
NUSAF 2 - Second Northern Uganda Social Action Fund Project
PGR - Population Growth Rate
PGR - Population Growth Rate
PI - Population Issue
PLHIA - People living with HIV/AIDS
PO - Probation Officer
POPSEC - Population Secretariat
PPP - Purchasing Power Parity
PRDP - Peace Recovery Development Plan
PWDs - People with Disabilities
RA - Research Assistants
RRH - Regional Referral Hospital
Shs - Shillings
SRH - Sexual Reproductive Health
TBA - Traditional Birth Attendants
TC - Town Council
TFR - Total Fertility Rate
UBOS - Uganda Bureau of Statistics
UDHS - Uganda Demographic Health Survey
UN - United Nations
UNAIDS - The Joint United Nation Programme on HIV/AIDS
UNDAF - United Nations Development Assistance Framework
UNEB - Uganda National Examinations Board
UNFPA - United Nations Population Fund
UN-Habitat - United Nations Human Settlement Programme
UNHCR - United Nations High Commissioner for Refugees
UNHS - Uganda national Household Survey
UNICEF - United Nations Children Fund
UNPS - Uganda National Panel Survey
UPDP - Urban Physical Development Plan
UPFFSP&D - Uganda Parliamentarians Forum on Food Security, Population & Devt
UWOPA - Uganda Women‘s Parliamentary Association
VHT - Village Health Teams
WFP - World Food Programme
WHO - World Health Organisation
YFC - Youths Friendly Corner
YPG - Young People groups

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TABLE OF CONTENTS

ACKNOWLEDGEMENT ......................................................................................................................... i
EXECUTIVE SUMMARY ........................................................................................................................ ii
ACRONYMS AND ABBREVIATIONS .................................................................................................... v

1 INTRODUCTION ........................................................................................................................... 1
1.1 Background ............................................................................................................................. 1
1.2 The four Outcome Components of the JPP ............................................................................. 2
1.3 Objective of the Survey ........................................................................................................... 3
1.4 Scope of work .......................................................................................................................... 3

2 METHODOLOGY ........................................................................................................................... 3
2.1 Study site ................................................................................................................................. 3
2.2 Target population .................................................................................................................... 3
2.3 Study design ............................................................................................................................ 3
2.4 Sample size calculation and selection of households .............................................................. 4
2.5 Data collection methods and tools .......................................................................................... 4
2.5.1 Questionnaires .................................................................................................................... 4
2.5.2 Review of documents ........................................................................................................... 5
2.5.3 Focus Group Discussions ................................................................................................... 6
2.5.4 Key Informants interviews .................................................................................................. 6
2.6 Data processing ...................................................................................................................... 6

3 RESULTS OF THE UN JPP BASELINE SURVEY ......................................................................... 7
3.1. Indicator 1: Population Growth Rate .......................................................................................... 7
3.2. Indicator 2: Human Development Index ..................................................................................... 8
3.3. Indicator 3: Young age Dependency Ratio ................................................................................ 10
3.4. Indicator 4: Total Fertility Rate (TFR) ..................................................................................... 13
3.5. Indicator 5: Contraceptive prevalence rate (Married women aged 15-49) .............................. 15
3.6. Indicator 6: Teenage pregnancy rate ........................................................................................ 22
3.7. Indicator 7: Percentage of young people with accurate information on FP ............................. 24
3.8. Indicator 8: No. of HCIIIs, HCIVs and Hospitals providing AYFS in target districts .............. 26
3.10. Indicator 9: Percentage increase in number of new users of Family Planning ...................... 28
3.11. Indicator 10: Proportion of HFs without stock-outs of 3 most commonly used Contraceptive
Methods ............................................................................................................................................ 30
3.12. Indicator 11: No. of functional male action groups advocating for SRH and rights .............. 31
3.13. Indicator 12: No. of functional YPGs advocating for SRH & Rights ...................................... 33
3.14. Indicator 14: Percentage of pregnant women with anemia .................................................... 34
3. 15. Indicator 13: Net enrolment ratio in both primary and secondary, by sex ............................ 35
3.16. Indicator 15: Completion rates for boys/girls in school.......................................................... 37
3.17. Indicator 16: Drop-out rate for boys/girls in school ............................................................... 39
3.18. Indicator 17: Percentage deliveries occurring in health facilities .......................................... 42
3.19. Indicator 18: Percentage births attended by midwife or other skilled attendant .................... 43
3.20. Indicator 19: Percentage of low birth weight in health facilities ............................................ 45
3.21. Indicator 20: Percentage increase in number of pregnant women attending 4th ANC visit ... 47
3.22. Indicator 21: Proportion of youths among the unemployed .................................................... 49
3.23. Indicator 22: Proportion of youth employment action plans implemented ............................. 50
3.24. Indicator 23: Percentage of youth accessing skills development and employment
opportunities ..................................................................................................................................... 54
3.25. Indicator 24: Amount of financial resources mobilized for the population programme ......... 57
3.26. Indicator 25: Number of key sector and district policies and plans that mainstream youth
issues ................................................................................................................................................. 58
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3.27. Indicator 26: Proportion of target districts allocating and disbursing funds to population
issues ................................................................................................................................................. 59
3.28. Indicator 27: Percent of leaders that are aware and understand the inter-linkages between
population and development concerns ............................................................................................. 63
3.29. Indicator 28: Proportion of youth coalitions, networks and councils that are actively involved
in formulation of sub county/district development plans .................................................................. 64
3.30. Indicator 29: Proportion of DDPs developed based on socioeconomic, demographic and
other data sources ............................................................................................................................ 69
3.31. Indicator 30: Number of urban physical development plans addressing the needs of youth and
vulnerable groups ............................................................................................................................. 71

4 CONCLUSION AND RECOMMENDATIONS ............................................................................. 77

5 REFERENCES AND DOCUMENTS FOR REVIEW .................................................................... 80

6 APPENDICES: ............................................................................................................................. 82
Appendix 1: Summary JPP M&E Indicator Matrix and status base for reporting on the Indicators
.......................................................................................................................................................... 82
Appendix 2: Indicator 31: Number of sector and district policies and plans that mainstream youth
issues ............................................................................................................................................... 125
Appendix 3: Status of health facilities in regards to Adolescents friendly services ....................... 160

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List of Tables

Table 1: Sample size ............................................................................................................................... 4
Table 2: Total Population and Population growth rates per JPP district .............................................. 7
Table 3: Young age dependency ratio per JPP district in year 2012 ................................................... 11
Table 4: Total Fertility Rate ................................................................................................................. 13
Table 5: Contraceptive prevalence rate for married women using any modern FP method ................ 15
Table 6: CPR Modern Methods for Married Women 15-49 KAP Survey ............................................. 16
Table 7: Percentage distribution of currently married women aged 15-49 years by contraceptive
method used in rural areas ................................................................................................................... 17
Table 8: Percentage distribution of currently married women aged 15-49 years by contraceptive
method used in urban areas .................................................................................................................. 17
Table 9: Percentage distribution of currently married women aged 15-49 years by contraceptive
method used .......................................................................................................................................... 18
Table 10: Reasons why woman or partner is not using contraceptive method..................................... 20
Table 11: Teenage Pregnancy Rate ...................................................................................................... 22
Table 12: Percentage of young people (10-24years) with accurate information on modern FP ......... 24
Table 13: Number of health facilities providing adolescent youth friendly services ............................ 26
Table 14: Percentage increase in number of new users of FP in target districts ................................. 29
Table 15: Proportion of HFs without stock-outs of 3 most commonly used CM .................................. 30
Table 16: Number of functional MAGs with SRH advocacy ................................................................. 32
Table 17: Number of functional Young People groups advocating for SRH and rights ....................... 33
Table 18: Net Enrolment Ratio in both primary and secondary, by sex ............................................... 36
Table 19: Completion rates for boys and girls in primary and secondary education .......................... 38
Table 20: Drop-out rates for boys and girls in 15 JPP districts for year 2011 .................................... 40
Table 21: Main reason for dropping out of school 8 M&E districts .................................................... 41
Table 22: Percentage of deliveries occurring in health facilities ......................................................... 42
Table 23: Percentage births attended by midwife or other skilled attendant ....................................... 44
Table 24: Percentage of low birth weight in health facilities ............................................................... 45
Table 25: Percentage increase in number of pregnant women attending 4th ANC visit ...................... 48
Table 26: Proportion of youth among the unemployed 2011/12 .......................................................... 50
Table 27: Percentage of youth accessing skills development and employment opportunities .............. 54
Table 28: Type of training received to enhance skills development among youth ............................... 55
Table 29: Youth 18-30 with access to employment opportunities ......................................................... 55
Table 30: Proportion of youth accessing skills development and employment opportunities .............. 56
Table 31: Summary of Financial Resources mobilized & Spent on Population activities by Source and
activity (Ugx Billion) ............................................................................................................................. 58
Table 32: No of District Plans that mainstream youth issues ............................................................... 59
Table 33: Assessment form used to determine budgets and expenditure on population issues ............ 60
Table 34: Critical population issues assessed per sector and sub-sector in DDPs in JPP district ...... 60
Table 35: Proportion of target districts allocating and disbursing funds to population issues ........... 62
Table 36: Leader‟s awareness and ability to link population characteristics to development ............. 63
Table 37: How youths councils are involved in the formulation of sub-county/DDPs in Mubende
District. ................................................................................................................................................. 65
Table 38: Proportion of Youth Networks that participated in formulation of S/C plans and DDPs .... 67
Table 39: Youth Coalitions that participated in formulation of the S/C and DDPs ............................. 68
Table 40: Proportion of DDPs developed based on socioeconomic, demographic data sources ........ 70
Table 41: No. of physical development plans addressing the needs of youth and vulnerable groups .. 71
Table 42: Summary JPP M&E Indicator Matrix and status base for reporting on the Indicators ...... 82
Table 43: Promotion of youth employment in Arua district ................................................................. 91
Table 44: Promotion of youth employment in Yumbe district ............................................................... 93
Table 45: Promotion of youth employment in Gulu district ................................................................. 95
Table 46: Promotion of youth employment in Kitgum district .............................................................. 97
Table 47: Promotion of youth employment in Oyam district ................................................................ 99
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