Uganda Adapts Checklists

Provider tools introduced to facilitate client screening.

Family Health Research: 2007, Vol. 1, Issue 3

The Ministry of Health (MOH) is promoting the use of four simple checklists to improve women's access to contraception in Uganda. Adapted from similar tools developed and tested by FHI (see Pregnancy Checklist for Providers), these checklists help family planning providers determine whether clients are eligible to use various contraceptive methods.

Modern contraceptive methods are generally safe and effective for use by most women, including those who have not given birth, those who want to space births, those living with HIV, or those at risk of HIV infection. But some methods are not suitable for women with medical conditions such as genital cancer, high blood pressure, or current pelvic inflammatory disease. A woman who wants to initiate family planning must be screened for these medical conditions to determine whether she is an appropriate candidate for a particular method.

In the past, such screening usually involved laboratory tests and physical examinations. But current World Health Organization (WHO) recommendations state that tests and examinations do not contribute substantially to the safe and effective use of hormonal contraception. For a woman with a known condition, a self-reported medical history using a simple checklist is all that is needed to determine whether she is medically eligible to use a hormonal method. A similar checklist can help providers screen candidates for an intrauterine device (IUD), but a pelvic examination is also required.

Evidence-based tools

Three of the four FHI checklists were developed to help providers determine quickly and with confidence whether a client may safely use a particular method. The methods addressed are IUDs, injectable depot-medroxyprogesterone acetate (DMPA), and combined oral contraceptives.

The fourth checklist enables family planning providers to be reasonably sure a client is not pregnant before providing her with a contraceptive method (see Pregnancy Checklist for Providers). It also can be used by health care providers who need to rule out pregnancy in a client before she begins a medical regimen.

The four checklists are based on the most current scientific research on safe contraceptive use, as recommended by the 2004 WHO guidelines for Medical Eligibility Criteria for Contraceptive Use.

Using checklists in Uganda

After working with FHI to adapt the checklists to the Ugandan context, the MOH endorsed them and printed 20,000 copies with its logo. Since then, the Ugandan checklists have been widely used by family planning providers and trainers. The MOH, with support from FHI, held a series of continuing medical education workshops in 2005 and 2006 to update provider skills and to disseminate the checklists.

Partners of the MOH and FHI report that the checklists are useful to community-based family planning workers, helping them safely screen potential clients for hormonal contraceptives.

To encourage their sustained use, the checklists have been introduced into nurse-midwife training courses. Family planning tutors and principals in nurse-midwife training schools in Mulago, Nsambya, Rubaga, and Mengo received training on the checklists, and they were given sufficient copies for all final-year students and their school libraries.

Please contact FHI or the MOH's Reproductive Health Division to request technical assistance, copies of the checklists in various languages, and the Checklist Training and Reference Guides.