By Prerna Gopal
Prerna Gopal has undertaken research in Uganda with the assistance of The Family Initiative, as part of a Masters in Public Health at Imperial College, London. We have asked her to write about her main findings and what these imply for future strategies around the world for engaging fathers in maternal and newborn health
According to the report, Fair lives, Healthy Society, by Sir Michael Marmot, overcoming health inequalities around the world must begin by providing to every child a fair and healthy chance in life. This means that every child must have access to good health, nutrition and responsive caregiving at every step. These three essential components of child development require multiple services and interventions such as breastfeeding, maternal immunization, prevention of maternal smoking, alcohol and PMTCT, antenatal and postnatal care, maternal nutrition, and access to family planning and contraception. However, since multiple studies have identified a positive correlation between male involvement and maternal and child health outcomes, male involvement must be at the centre of all the aforementioned health interventions and services.
Given the existing research, the Ugandan government has launched multiple policies and interventions to promote male involvement in the country. However, even with these interventions, male involvement remain low. The failure of various healthcare organisations to facilitate a paradigm shift in gender roles and ensuring equity in healthcare access makes it critical for us to understand the challenges to the implementation of these interventions. This may aid various actors in Uganda and beyond to develop holistic and comprehensive programmes to stimulate greater male participation.
I interviewed multiple stakeholders working within the healthcare system in Uganda and found that the key challenge is dependence on external aid and international work staff. This makes many of the interventions unsustainable. According to a nurse in Kasese,
“It becomes a big challenge sometimes when the programs of organisations that support us phase out.”
International donors who finance these short-term projects tend to withdraw funding once their targets are achieved. Eventually, it results in the relapse of poor health practices and health indicators.
A rural health worker also mentioned that about 40% of the health system in Uganda depends on external aid. This results in a conflict of interest, because the government is answerable to the donors and are bound to invest in the areas of the latter’s interest. Additionally, many donor organisations focus solely on a few regions depending upon their interests while leaving other parts of the country deprived of adequate financial and infrastructural support. He explained that,
“Donor funding depends on how active the health facility is…When people read our data, they appreciate our work and want to support it. People prefer areas of their own interest.”
The opinions of the stakeholders in Uganda emphasise the need for sustainable and home-grown solutions to the low levels of male involvement. There needs to be a shift from dependence on external donors to developing long-term investment schemes and interventions that can provide permanent results. The existing social structure also needs political intervention in the form of adequate fiscal policies and proper allocation of resources to community-level health facilities. Only then can we expect any change in the way men engage with their wives, children and family.
The research is pending publication and is represented in summary form below.Prerna' results
Photo: IAVI. Creative Commons.