OBJECTIVE
To improve the reproductive health (RH) conditions in the district and to discard the harmful practice of female genital cutting (FGC) while promoting the cultural values to the community.

BACKGROUND
The Reproductive, Educative and Community Health (REACH) project was spearheaded by the UNPFA, Kampala Office and is aimed at supporting community efforts to discard the practice of FGC.

The REACH programme attempts to detach the practice of cutting the genitals of girls and women from the cultural value of initiation, through a consultative and persuasive process using key change agents within the community.

SCOPE
The main focus is on addressing the issue of FGC and a poor RH care and delivery system.

MAIN ACTIVITIES
Some of the activities the REACH carries out are seminars targeting conservative groups and potential change agents, workshops for educating Trained Birth Attendants (TBAs) and peer educators, and awareness speeches to target audiences. It also renovated some health units equipping them with basic maternal and child health (MCH/FP) kits to strengthen the RH services.

Cultural Day was proposed as an advocacy strategy to strengthen the sense within the community that positive cultural values can be promoted while negative cultural practices can be changed or replaced as a socially sanctioned demonstration event. This would convince the community to discard the FGC practice and replace it with more symbolic rituals such as giving the girl a cow, goat or bracelets after the rituals of feasting and dancing to mark the passage from girlhood to womanhood.

MANAGEMENT FEATURES

Strategy

• Pre-intervention assessment was carried out which helped develop appropriate measures to best address the problems.
• Organised sensitisation seminars were carried out with advocacy activities aimed at conservative groups and key change agents.
• Organised Training Workshops for TBAs and peer educators to increase their awareness about the associated risks of the practice.
• Rehabilitated and equipped health units and the maternity wing of the hospital to strengthen RH services.

• Established District Population (DP) coordination structure and introduced District Cultural Day which comprised all stakeholders.
• Used information, education and communication (IEC) materials to create awareness on FGC.

Capacity-Building

• Build coalition between project management and elders, clan leaders, and network among education institutions, religious groups, politicians, and health professionals.
• Train TBAs to enhance their RH technical skills and to increase their awareness about the associated risks of the practice.

Mobilising Resources

• Workshops brought together the most conservative groups to share information on RH and the harmful aspects of the practice
• The cultural day
• IEC materials on FGC
• Youth sensitisation through seminars

Managerial Leadership

• Oversee the overall implementation of the programme
• Ascertain progress and advise on implementation
• Assess the programme’s performance, evaluate the impact, and assess the relevance, sustainability, and replicability of the REACH concept as a model.

EVALUATION FINDINGS

• An evaluation conducted in 1997 concluded that the project had made a significant impact and brought about a positive change in FGC perceptions among men, women, and school adolescents/teenagers.
• The project attracted the active participation and support of important partners including political, government, traditional, and community leaders in the district.
• Training TBAs and equipping them with TBA kits have improved their service delivery skills and performance.
• However, the impact was less obvious on out-of-school adolescents and drop-outs because they were not directly targeted in the pilot phase.
• The independent evaluation suggested that not only is it possible and feasible to replicate the REACH model, it is also likely that a positive outcome will be achieved in a reasonably short period of time on such sensitive issues.