Bundibugyo Soap Initiative supports uptake of health services during floods and COVID-19
"For instance, the soap initiative has also increased immunizations at this facility"
Bundibugyo District, located in a remote part of south-western Uganda, experienced two floods in a space of six months. The most recent – in May 2020 – destroyed the livelihoods and homes of more than 2,000 people in three sub-counties.
Fortunately, UNICEF was on the ground to provide much-needed emergency relief that included life-saving and other critical measures such as prevention of hygiene-related diseases, psychosocial support, infection prevention and control (IPC) and risk communication and social mobilization. These humanitarian efforts were made possible as a result of generous financial support from UKaid and the United Nations Central Emergency Response Fund (UN CERF).
To further protect affected children and families from contracting hygiene-related diseases, communities received soap and water purification tablets while health facilities were provided with other water, sanitation and hygiene supplies like detergents and handwashing stations for IPC.
As the communities recovered from the floods, health facilities still had numerous stocks of soap. However, the district faced yet another crisis – low uptake of critical health services like immunization, especially measles vaccination, antenatal care, post-natal care and hospital deliveries. And with COVID-19, families were afraid to seek care due to fear of infection.
Dr. Christopher Kiyita, the District Health Officer, mentions that the numbers of children immunized against killer diseases and mothers delivering their babies at health facilities dropped significantly. The health team had to think of ways to attract mothers and caregivers back to the facilities, in order to increase uptake of these vital services.
“We couldn’t sit back and record children and women dying. Mothers were dying in the hands of traditional birth attendants. We had to be innovative and that’s how we came up with providing soap – a small incentive for those that utilized health services, starting with a few health facilities,”
“We also chose an initiative that the district could afford and sustain. Remember, we already had the soap from UNICEF.”
This is how the Bundibugyo Soap Initiative was started.
How does the Bundibugyo Soap Initiative work?
Through radio talk shows and house-to-house drives by the village health teams (VHTs), communities are mobilized and encouraged to visit health facilities for measles vaccination and antenatal, postnatal and child birth services. The use of health facility records is relied on greatly to trace those who miss their appointments. These too are reached.
At the facility, mothers, pregnant women and caregivers are rewarded with soap for seeking the services and are asked to notify others who have not heard of the initiative. The VHTs are also rewarded with soap for mobilizing the communities.
Kakuka Health Centre III is one of the facilities that has introduced the soap initiative. The health team at this facility earmarked Tuesdays for measles vaccination. It is no wonder that several mothers arrive at the facility with babies tied on their backs. Their children are weighed, vaccinated and as they leave, they are given soap.
Among them is Biira Asumin, a 28-year-old mother of twins. Her hands are full, she is carrying her two babies. Asked how she heard about the soap initiative, Asumin confirms that her VHT member told her about it when he came to remind her about her babies’ appointment for their measles vaccination. Her healthy children have not missed any vaccinations and today, they receive protection against measles, a deadly disease.
As she leaves the immunization shade, she is given bars of soap.
“I feel very happy to receive the soap. I will use it to wash my children’s clothes. Now that I have received free soap, I will have some time without buying soap. I will also save the money I could have spent on soap to do other things for my children,”
She promises to tell other parents to bring their children for immunization because they too will get free soap.
Benefits of the soap initiative
According to Charles Ngwabusa, the Medical Clinical Officer at Kakuka Health Centre III, the health facility was performing poorly – with many indicators appearing in category three (low or red). Communities were simply not using the facility. Through VHT mobilization drives and the launch of the soap initiative, the facility’s performance has since improved from category three to category one. “For instance, previously, only 52 per cent of women gave birth at the facility; now the rate has shot to 90 per cent. The soap initiative has also increased immunizations at this facility – for instance, the monthly measles vaccination coverage now stands at 52, above the 42 target, he explains.
Originally piloted in eight health facilities, the initiative has now been scaled up to all facilities.
Ngwabusa shares that the Covid-19 pandemic, which happened at the same time as the floods, motivated communities to wash hands regularly to protect themselves from the disease. But they had no income to buy soap as their livelihoods had been destroyed by the floods. The free soap that was provided as an incentive to use health centre services would also help them promote hygiene in their homes.
“To us, the initiative has delivered results in a very short time – it has attracted people to utilize health services and encouraged IPC practices in households. With soap, we were sure effective handwashing was taking place in homes. A small thing like soap has been very effective and we intend to continue with it. The costs of buying soap have been reflected in the new budgets,”
Initially introduced to protect communities from contracting hygiene-related illnesses after floods, the Bundibugyo Soap Initiative is proving to be a great asset in promoting hand hygiene during the Covid-19 pandemic and has attracted families back to health care services.