USAID feature the Margaret Pyke Trust’s USHAPE programme: Sexual and reproductive health training in south-west UgandaOctober 4, 2018
On 3 October 2018, USAID featured the Margaret Pyke Trust’s USHAPE programme on its ‘Training Resource Package for Family Planning’ blog. You can read the original article on USAID’s website here, or alternatively below.
We are excited to once again feature USHAPE (Uganda Sexual Health and Pastoral Education) on the Family Planning Training Resource Package website as it begins a new chapter under the management of the Margaret Pyke Trust. The Margaret Pyke Trust is based in the United Kingdom and has around 50 years of history providing sexual and reproductive health services along with implementing research and training for health care workers. They have the broadest range of sexual and reproductive health training courses in the UK for health care staff. In the last few years, the Margaret Pyke Trust have started working internationally to address the need to advance sexual and reproductive health services and trainings in low- to middle-income countries. Taking over the management of USHAPE only seemed natural, since USHAPE was originally created by UK based volunteer doctors. It has been an optimistic transition for USHAPE to come under the Margaret Pyke Trust as there has been a continued effort to increase capacity of USHAPE’s training programs.
In the past few years, we have noted USHAPE’s adaptations of the TRP and its use in pilot training programs at Bwindi Community Hospital and Kisiizi Hospital to build knowledge among family planning service providers and expand the ability of providers to deliver services to the community. The Margaret Pyke Trust funds a full time family planning nurse at Bwindi Community Hospital in order to strengthen and ensure a sustainable future for the current implemented USHAPE program. Moving forward, the Margaret Pyke Trust is finalizing the USHAPE pilot training program into an adaptable and expandable model. The hope is to start replicating the model in different settings, with each institution leading on its implementation of USHAPE. Preparing for this capacity building feat includes thorough monitoring and evaluation to measure the significant impact of contraceptive prevalence rates, family planning uptake, etc. Kat Lloyd, the Program and Operations Manager at Margaret Pyke Trust, commented, “It is a time of reflection and consolidation [for us], and we are hoping that this will prepare us for the [USHAPE] expansion in the coming years.”
Meanwhile, UK based doctors continue to act as short term volunteers at the USHAPE-implemented sites. One of these volunteers and the USHAPE Clinical Lead, Dr. Clare Goodhart, provided us insight on the TRP influence on creating and continuing to update the USHAPE training program: “When we first started developing the USHAPE 'Whole Institution Approach to Family Planning', we were keen not to 'reinvent the wheel'. We searched the internet and were excited to come across the Training Resource Package because it aligns to the guidance of the Family Planning Global Handbook, which we knew needed to be central to our training. Importantly, the TRP makes it clear that you can freely adapt its materials. We were able to pick out the PowerPoint presentation, role plays and case discussions, which are needed to teach the available family planning methods.
"It took quite a lot of work to reduce the TRP materials so they fit into the different levels of USHAPE training, as we needed to build in other modules to address real life scenarios, such as adolescent-friendly contraception, HIV, sexual infection, cervical screening, post abortion care etc. We put a lot of emphasis on counselling and outreach to the community and felt we had to move beyond the suggestions of the TRP to achieve this. We also vary USHAPE training by integrating short films, which helps with the quality of teaching and reduces pressure of the trainers. However, the TRP has been a great starting point for creating USHAPE training and we often return to it when creating outreach materials, refresher training or for the training of trainers. We are keen to continue to work with the John Hopkins team to move family planning training forward worldwide.”
On 3 September 2018, the International Union for Conservation of Nature (IUCN) featured an article written by David Johnson, Chief Executive, Margaret Pyke Trust, coordinator of the Population & Sustainability Network on population growth and the resulting pressure on the environment. You can read the original article on the IUCN’s website here, or alternatively below.
One side effect of running an organisation with population in the name is that every week or so a friend will send me an article or video about population. Almost invariably there is mention of population being a “taboo” topic, or “the elephant in the room”. This is in spite of the fact that I can’t honestly recall ever speaking to a conservationist who disagreed that global population is a critical conservation issue, or was shy to say so. There is no taboo.
Given the United Nations projects that the global population will rise from 7.6 billion today to over 9.7 billion by 2050, this is hardly surprising. But there is something glib about merely stating the challenge. What needs to happen is that we move to consider the actions which form part of the effective response.
Considering health sector data
Evidence-based conservation has become standard practice. This includes the systematic assessment of information when designing conservation projects and determining policy. There is also a growing understanding of the need for cross-sector collaboration. So to move on from the mythical elephant in the room, the first step is to consider relevant health data.
The Convention on Biological Diversity (CBD), the United Nations Environment Programme (UNEP) and the World Health Organization (WHO) did exactly that in their 2015 joint report “Connecting global priorities: biodiversity and human health: a state of knowledge review”. They acknowledge that population growth places increased demands on healthcare systems and can greatly increase pressures on natural resources. Most importantly, they acknowledge that population growth could be moderated by greater investments in family planning programmes.
They also explain that greater investment in the education of girls and women and improved access to and awareness of contraception would “not only improve human health and well-being directly, it would also help slow and reverse trends among countries with the highest projected growth rates and concomitant pressures on ecosystems”.
In reaching their conclusions the CBD, UNEP and WHO relied on fertility and other reproductive health data. In the health sector that is elementary. It needs to become standard in conservation too. At the Trust I lead, we are working with an increasing number of conservation organisations which are considering not only population data, but also the evidence of how small improvements in family planning have significant changes on fertility rates, and consequently long-term population size and environmental pressures.
Accepting that barriers to family planning are conservation issues
At the national policy level, there is often acceptance that population is a key conservation challenge. Nigeria’s National Biodiversity Strategy and Action Plan (NBSAP), for instance, highlights high population growth as the first cause of biodiversity loss. Tanzania’s NBSAP states, “Human activities due to rapidly growing population have been one of the major causes of habitat loss and degradation resulting into biodiversity decline in Tanzania.” Nigeria and Tanzania are not alone in making such statements. Many developing nations, with relatively poor healthcare provision and higher fertility rates as a result, make this connection in their NBSAPs.
Poor rural communities often depend most directly on natural resources for their livelihoods, food, water, shelter and cultural practices. When localised human pressures on ecosystems exceed critical tipping points, both community health and environmental health suffer. Poor rural communities in developing nations also face the greatest barriers to the use of and access to reproductive health services.
This is why these areas are such a focus for health advocates. Barriers to family planning prevent women from choosing freely when and whether to have children, threaten family health, create challenges for girls who want to complete their education, and lead to higher levels of fertility and more rapid rates of population growth. These are issues which also directly impact on conservation, and there is often an overlap in areas with the greatest need for better reproductive health services and for conservation. Supporting policy developments that will improve reproductive health services is therefore something conservation organisations should consider including in their strategic priorities.
Conservation organisations can’t provide clinical services. Similarly, family planning nurses can’t implement conservation activities. But this does not mean family planning should be seen as solely a health issue. Conservationists are familiar with overlapping concerns. For example, we are confident to promote renewable energy as part of the response to the environmental threats of climate change, or to advocate for better public transport to improve air quality. These are not merely “energy” or “transport” issues. Conservation organisations do not need to run windfarms or provide train services to promote them as relevant to the environment.
Barriers to family planning increase pressures on ecosystems as well as families. Therefore, as a sector, we should find it as easy to promote universal access to family planning as we do renewable energy. After all, the Sustainable Development Goals call for both.
Some conservation and reproductive health organisations have already successfully joined forces. There is a growing movement of community-based Population, Health and Environment programmes which take a holistic approach to interconnected issues of poor health, family planning needs, food insecurity, poverty, and unsustainable use of natural resources. Project data shows this approach leads to greater uptake of family planning, better health and gender relations, and increased support for and participation in conservation activities by local communities. Such a multisector approach can also be more cost-effective, and generate more sustainable results.
The Inter-governmental Panel on Climate Change affirmed in a 2014 report that family planning can play a role in reducing climate change vulnerability and is a potential adaptation strategy. The book Drawdown: the most comprehensive plan ever proposed to reverse global warming, details the top 100 solutions that have the greatest potential to reduce emissions or sequester carbon from the atmosphere. Educating girls ranks sixth and family planning ranks seventh. The integration of family planning into conservation and climate change thinking has begun; we need this to become the norm.
The Margaret Pyke Trust has, from its inception, been at the forefront of developments in contraception. In the 1960s that meant opening and running what soon became the world’s busiest family planning clinic. Today, the Trust is likely the only IUCN Member to have 50 years’ family planning expertise. One of our strategic priorities is working with conservation organisations in developing countries to integrate family planning into conservation programmes. We do this because we believe all girls and women have the right to choose freely whether and when to have children, and how many. We also do this because we question whether many traditional conservation projects can have long term sustainable results if they don’t.
On World Population Day in July 2019 we will be promoting the growing collective of visionary conservation organisations which are integrating family planning into their conservation activities by making appropriate partnerships, or supporting policy changes which will make this easier. The Trust is keen to work with other IUCN Members, as well as other conservation organisations worldwide, who understand that it is time we stopped talking about population growth and started to take action to remove barriers to family planning as an integral part of conservation policy.
On 30 August 2018 Sandra Jordan, FP2020’s Senior Advisor, Rights & Empowerment wrote about FP2020’s support of the current work of the Population & Sustainability Network at the intersection of population, conservation and reproductive health. You can read the original article on the FP2020 website here, or alternatively below.
Understanding the delicate balance between human populations and environmental concerns has long been a challenge; finding solutions and common ground has been even more difficult.
Evidence shows programs that address women’s needs for sexual and reproductive health that also support environmental efforts can improve the ecosystem, reduce vulnerability, and enhance resilience to climate change. Population-related policies, including offering voluntary rights-based family planning services and improved education for women and girls, are important factors for addressing climate response options, benefitting both human well-being and environmental issues and helping governments meet the Sustainable Development Goals.
In an effort to support such policies, FP2020 is taking an active role in leading important discussions around family planning and environmental sustainability.
We are working with David Johnson, chief executive officer of the UK-based Margaret Pyke Trust, which runs the Population & Sustainability Network, and has promoted reproductive health and rights as an integral element of sustainable development for nearly 50 years. David has launched a new advocacy effort to amplify coordination and collaboration between environmentalists and conservationists, believing the partnership can lead both groups to lasting solutions. If he’s right, and we strongly suspect he is, overlapping goals for healthier communities and healthier planets may be in reach. We are working with David to promote an upcoming report that makes the case for population-health-environment advocacy, research, and action along with calls to action for donors and implementers.
FP2020 is hosting a series of webinars to explore links, approaches, and solutions to population and environmental issues. The first, which showcased the work of co-sponsors Population Reference Bureau and the Public Health Institute, explored how the family planning community can form partnerships with multilateral institutions, including the UN’s Green Climate Fund and the Adaptation Fund, which support activities and programs to help vulnerable populations adapt to climate change impacts. Creating successful partnerships with these investment frameworks could contribute to both improved health and environments.
In coming months, FP2020 will share emerging research on how increased use of family planning can strengthen or accelerate a transition to environmental sustainability. We will work with our Focal Points in country to build cross-country conversations and share new findings, approaches, and campaigns from our partners.
Stay tuned for more from us on this important issue!
Women in the communities around Bwindi Impenetrable Forest in south-west Uganda have, on average, eight children. This is two more than they report they would ideally like to have. Network coordinator, the Margaret Pyke Trust, is working to support the local hospital, Bwindi Community Hospital, to address this through the delivery of its USHAPE training programme.
USHAPE (Uganda Sexual Health and Public Education) is a family planning training methodology which has been developed by the Margaret Pyke Trust, and a collective of clinicians in Uganda and the UK. At Bwindi Community Hospital, USHAPE is being implemented by a family planning training nurse funded by the Trust.
The training is being delivered at three different levels. The first level provides basic family planning information to all staff, regardless of their roles. Everyone at a healthcare facility should understand the fundamental importance of family planning, why family and community health are dependent on its provision, and why it is important to the hospital as a whole. Both clinical and non-clinical staff benefit from this training, as everyone has a role to play in ensuring family planning is available to all who seek it. For instance, a security guard might not realise why a young person is loitering by the gates, too nervous to enter, they should be welcoming. Similarly, a finance manager might not realise that investing in family planning services has life-saving and cost-saving benefits in the long-run, so they might not prioritise family planning in their work without knowing this.
The second level is delivered through skills training provided to healthcare workers, which combines theory-based and practical lessons on a range of topics, including reproductive anatomy and physiology, condoms, IUDs, contraceptive implants and injections, and oral contraceptives, in addition to cervical screening techniques, STIs, and counselling.
The third level, “train the trainers”, ensures the hospital has a large enough cohort of trainers to ensure training is embedded, and staff are monitored and supported to ensure the delivery of comprehensive family planning services.
Alongside this, the family planning training nurse is also conducting outreach in the remote and rural areas surrounding the hospital, to increase awareness of the importance of family planning and to provide information about how individuals can access services.
Kathryn Lloyd, the Trust’s Programmes & Operations Manager explained, “We are delighted the Trust is able to support Bwindi Community Hospital to fully embed USHAPE over the next three years. In the coming months I will be at Bwindi Community Hospital, working with them and others to expand this model with neighbouring hospitals. It’s an exciting time in the history of USHAPE”.
On 18 June 2018 Devex, the leading media platform for the global development community, published a lengthy piece on the work of the Population & Sustainability Network.
In Sophie Edwards’ article she wrote about not only the policy work of recent Network member, the Cheetah Conservation Fund, and Network coordinator, the Margaret Pyke Trust, but also more broadly on the Population Health & Environment conservation model, and the appointment by the Trust of Robert Engelman. Robert is a renowned environmental and demography expert, and his substantial experience gained at the United Nations Population Fund, PAI, Population Institute, and Worldwatch Institute will only further enhance the ability of the Trust and wider Population & Sustainability Network to advance the Population, Health & Environment agenda.
The full Devex article can be accessed here.