Ethiopian health team benchmarks Uganda's PLA
“Disability is not inability,” Balidawa said. “From our savings, we make money to support personal businesses like restaurants and grain stores, which improves our lives.”
Health officials from Ethiopia with Persons With Disability (PWDs) and members of Balitwewunya PWDs group, officials from Amref Health Africa Uganda and officials from Medical Research Centre. This was during their visit to Balitwewunya PWDs group in Luuka district last week. (Credit: Lawrence Mulondo)
Lawrence Mulondo
Journalist @New Vision
Margaret Mugisa, the project manager for the Missing Billion project remarks during a meeting with Luuka district officials last week. (Credit: Lawrence Mulondo) Persons With Disability (PWDs) of Balitwewunya PWDs group in Luuka district act a skit about transformation in their access to health care services in the district. This was during a visit by Ethiopian health officials last week. (Credit: Lawrence Mulondo)
A delegation of Ethiopian Ministry of Health officials and various development organizations have spent a week in Uganda, benchmarking the country's successful implementation of the Participatory Learning and Action (PLA) approach.
This method has proven to be effective in improving maternal and child health, as well as supporting persons with disabilities (PWDs) in accessing essential healthcare and uplifting their livelihoods.
The Ethiopian officials, hosted by Amref Health Africa Uganda, met with counterparts from Uganda’s Ministry of Health, specifically the Community Engagement Department.
They also visited communities in Luuka District, where the PLA approach is actively being implemented.
The PLAC approach empowers community groups to identify challenges they face, particularly those that hinder access to healthcare, and develop local solutions to address these barriers.
Empowering communities through PLA
In 2023, Amref Health Africa Uganda, in partnership with the Medical Research Council (MRC) and Makerere University, and with support from the London School of Hygiene and Tropical Medicine, began implementing PLA in Luuka District under the Missing Billion Study.
This research initiative focuses on improving healthcare access for persons with disabilities, who represent 12% of the population in Luuka.
Margaret Mugisa, the project manager for the Missing Billion project, explained that the PLA approach is being utilized in Ethiopia to enhance maternal, newborn, and child health.
“Ethiopia’s team, led by Amref Health Africa Ethiopia, is here to learn from Uganda’s 11 years of experience in implementing this approach,” she said.
Mugisa emphasized the importance of community involvement at all levels—from the national ministry to the village level—in ensuring the sustainability and success of the project.
In Luuka, the project is helping previously marginalized groups access health services.
How PLA works
The PLA approach is implemented in four phases, each consisting of meetings designed to identify and address healthcare barriers.
A total of 11 meetings are held within the organized community groups, which consist of persons with disabilities, their caretakers, and well-wishers.
"For this project, we have 50 groups of persons with disabilities, each with 35 members—both men and women—along with a few caretakers,” Mugisa explained.
The groups use these meetings to discuss local challenges, devise solutions, and then implement and evaluate their efforts over a three-to-six-month period.
While the current focus in Luuka is on persons with disabilities, the team from Ethiopia also learned from Uganda’s previous successes in maternal, newborn, and child health. The overall goal of the approach remains the same: identify healthcare barriers, find locally-driven solutions, implement them, and evaluate their effectiveness.
Overcoming barriers to healthcare access
Mugisa further elaborated that the PLA approach has had significant success in addressing healthcare barriers faced by persons with disabilities in Luuka. Some identified challenges include physical, emotional, and visual impairments, as well as poverty. The inability to afford transport to healthcare facilities or face stigmatization from health workers also hindered access.
To tackle poverty, some groups started Village Savings and Loan Associations (VSLAs), pooling their resources to afford healthcare and income-generating activities. These activities, such as bricklaying and farming, have enabled them to raise money for medical expenses.
“When a solution doesn’t work, the group returns to the drawing board to re-assess and try another approach,” Mugisa said, emphasizing the iterative nature of the PLAC process.
Impact on local Communities
The Ethiopian delegation visited local groups, such as the Balitwewunya Persons with Disabilities (PWDs) group in Kiloba village. Wilson Balidawa, the group chairperson, shared how the group has benefited from savings and income-generating activities like bricklaying and farming.
These activities have helped members overcome poverty, making it easier to access healthcare and other services.
“Disability is not inability,” Balidawa said. “From our savings, we make money to support personal businesses like restaurants and grain stores, which improves our lives.”
On behalf of the visiting delegation, Dr. Agumaise from Amref Health Africa Ethiopia explained their ongoing implementation of the PLA approach for maternal and child health in Ethiopia.
“We came to Uganda to learn how the PLA approach has been effectively planned for sustainability and greater impact,” he said.
Despite the differences in focus—Uganda’s approach is centred on disability, while Ethiopia is focusing on maternal and child health—both share the same underlying principles of community involvement and locally-driven solutions.
Local leaders speak out
Local leaders in Luuka praised the PLA approach for empowering persons with disabilities. Kwegemya Mwajuma, a senior probation officer and focal person for disabled and elderly persons, highlighted the increase in healthcare-seeking behaviour among persons with disabilities following sensitization efforts by the project.
“Many were hiding or not attending medical outreaches before. Now, more people are coming forward to demand health services,” she said.
Hamis Bikadho, the Deputy Community Development Officer in Luuka, emphasized that the groups formed under PLA have made it easier for the government to reach PWDs with social programs, such as the Parish Development Model and the National Special Grant for Persons with Disabilities.
Real-life impact on individuals
Susan Namwase, a person with a disability from Buwologoma Central, shared how borrowing from her group enabled her to start a roadside food stall. “I use the income to pay school fees for my children and cover their medical expenses,” she said.
Fagil Kyagira, a facilitator for the Balitwewunya PWDs group, explained how health workers once feared treating people with albinism due to myths and misconceptions. However, consistent training has improved their relationships with health workers, allowing them to access treatment with dignity.