Conundrum of Health Access in Acholiland

I have recently had the opportunity to tag along to a spate of field activities related to the RHITES Project. GWED-G is part of a USAID-funded health coalition tackling access issues to health care services in the Northern Region – namely the Acholi Sub-region of Uganda. This project is in its 3rd year and looks to improve a series of important health measures including HIV/AIDS, tuberculosis, malaria, maternal and infant mortality, antenatal care, family planning, sexual and gender based violence, and hygiene.

GWED-G’s role in the project is to leverage its extensive community structures and contacts to mobilize communities and spark behavioural change: to increase rural community members’ health-seeking behaviours. This means increasing communities’ awareness of health services and where to access them, and most importantly to encourage people to actively seek out these services.

There are a variety of event types that GWED-G hosts to cultivate attitudinal and behavioural changes when it comes to health.

Youth Pageants

One such event is the Youth Pageant. Depending on budgeting constraints for each quarter, these events are aimed at youth, but adults often attend as well. Typically, there is hiring of a music sound system to attract community members deep in the villages where members are spread out. Sometimes, the event will centre on a sports competition, which is always football, where the winning team is awarded a goat for slaughter.

My role on these visits was to monitor the activities and comment on how things are done, as well as make recommendations for improvement. Believe it or not, this is quite important because in a country like Uganda, there can be a tendency to mislead supervisors and donors on how events actually unfolded and how money was spent.

We headed off for a Youth Pageant one blistering afternoon down the red dirt roads towards Patiko sub-county. The roads were in terrible condition having been severely worn down by unusually long and heavy rains last season. What normally takes an hour took us double and we headed down a trail that led to an opening in the 2-metre tall grass where there was a few massive mango trees and a group of women, children and a handful of men gathered to receive services.

 

Bringing Services to Communities

All RHITES Project events are accompanied by service delivery, meaning our team also provides a health care service while doing things like community awareness or dialogue sessions. This is to tangibly demonstrate the types of FREE services available at health facilities, as well as check-up on community members’ health to provide further guidance should there be any issue.

During this visit, services provided included on-the-spot malaria testing and treatment, blood pressure testing, and condom distribution. Malaria is still a major killer in the area – Uganda has the 6th highest death rate from malaria in Africa[i], and UNICEF states that every two minutes a child under 5 years dies of malaria, most deaths occurring in sub-Saharan Africa[ii]. There was also a recent malaria outbreak in the area of Gulu District. Out of over 200 community members that were tested during this event, almost 70% of them tested positive for malaria. The overwhelming majority of those in attendance were women with babies and infants, and school-aged children. All those who tested positive received treatment.

 Community Dialogue for Sharing Information

Youth Pageants use a community dialogue approach to share important information to rural community members. The dialogue approach is useful to better understand certain phenomena, like why community members are resistant to accessing services. In Patalira village, we learned that potential reasons for the high prevalence of malaria is due to misuse of nets. In this community, the government had done mosquito net distribution more than 2 years ago. However, many of the nets have since been put to use to tie up goats, used to catch fish in nearby streams, as well as to mark the boundaries of people’s vegetable gardens.

Another thing we learned was that for families that do have in-tact nets, often it is the men who will keep the net to themselves. In Acholi culture, polygamy is commonplace, and in the villages, the compounds are usually set up so that each wife will have her own hut, and the man of the household will sleep alone and call upon whatever wife to accompany him at his choosing. This means that women and children are left unprotected.

 

The Role of Men is the Key to Access & Improving Health

I also noticed at this event that there were very few men around, which my team didn’t seem to notice or be too concerned about. At the beginning of the event, there was a handful of men lingering about; yet once the “education” portion begun, they made a beeline for the exit trail. This meant that only the women and children ended up getting the actual information about proper net use practices, and the need to ensure children and women also get protection. My team brushed this off and explained that men were “stubborn” and not interested in health.

This is yet another example of the staunch patriarchal nature of Acholi culture engrained in the northern parts of this country. As men often control household decision making, this also means that they heavily influence women’s and children’s ability to access health services. This speaks to the need to work even harder to transform ideas about gender, and to broaden the acceptance of allowing women and children to access health services.

For now, I am determined to work with the project team to chip away at the question of how can we get men invested in their own health and the health of their families? How can we get men to come to the table? These are urgent questions and I will be working hard at tackling because what is at stake is the lives of women and children throughout rural communities in the north.

[i] https://health.go.ug/programs/national-malaria-control-program

[ii] https://data.unicef.org/topic/child-health/malaria/