SITUATION ANALYSIS OF SEXUAL AND REPRODUCTIVE HEALTH PARAMETERS AS THEY APPLY TO MARGINALISED IN UGANDA (PRIMARY HEALTH CARE SERVICES)

2012


SEXUAL AND REPRODUCTIVE HEALTH PRIMER
UGANDA PRIMARY HEALTH CARE SERVICES

SOCIO-DEMOGRAPHIC
SITUATION
SEXUAL HEALTH ISSUES
TARGET
SEXUAL-HEALTH RELATED SERVICES in PHC SETTING  (BASIC SERVICES)
REPRODUCTIVE HEALTH ISSUES
TARGET
REPRODUCTIVE HEALTH in PHC
SETTING
HEALTH BENEFIT/
GOAL
POLICY/
RIGHTS ENVIRONMENT/
ROLES OF STAKEHOLDERS
CRIMINALITY/ DANGERS
 OF DENIAL
INFRASTRUCTURE
RESOURCES AND SYSTEMS/ MEASURABLE ASPECT
SEXUAL- REPRODUCTIVE HEALTH ISSUES IN UGANDA
The status and  physical nature of a person
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Services
9.        HIV/
AIDS Services
The status and  nature of  a person’s reproductive organs
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Services
9.        HIV/
AIDS Services
Ensured social and cultural development of the Population
Objective XX of the CoU 1995 mandates Uganda as a state to take all practical measures to ensure the provision of basic medical services to the population.

Collaborative advocacy for funding and implementation
Misdirection of all forms of development

Disrepute
Full package of basic services including outpatient care, STIs management, temporary Family planning methods, ANC, Immunisation, Child Growth Monitoring is available in almost 5 of 10 facilities.

Regular supply of water and electricity, client amenities

Holding routine management meetings


Functioning equipments and chemicals for sterilization or High Level Disinfection

Adequate final disposal system for infectious and sharps waste.






DEMAND BY PREGNANT MOTHER and CHILD
Expectant female whose obstetric and gyneacological needs are higher

Foetus about to be new-born that needs care.
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination

Drug manufacturing and delivery systems to address need for the appropriate paediatric formulations

Ensure early TB diagnosis and treatment

Assess and evaluate cormobidity conditions of malaria, TB and malnutrition

Ensured pharmacovigilance system to expand existing ART to cover all in need.

Improve on treatment strategies to ensure inclusion and eligibility for all.

Reports are disaggregated by sex, ethnicity and race to support routine analysis of potential differences in pharmacokinetics and pharmacodynamics, treatment outcomes and adversity.

Care , support and treatment scale up in various settings and levels

Effectively impacting interventions at programme, facility, community and house-hold levels
Maternal/ new born deaths and near-misses.
-ANC
-PPC
-Immunisation
-Visual Aids
-ANC guidelines
-Essential equipment and supplies
-Medicines for managing pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Equipment/supplied for conducting normal delivery
-Emergency respiratory support for newborns
-Newborn health supportive practices
-Reviews of maternal / child deaths
Partner Notification
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drug provision during labour
Provision of ARV drug to newborn within 72 hours of birth
-Referrals
DEMAND BY HIV+
PREGNANT MOTHER
Expectant female whose obstetric and gyneacological needs are higher

Foetus about to be new-born that needs care.
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination

PMTCT should also be looked at as Prevention of Vertical Transmission in the context of de-stigmatising it.



Maternal/ new born deaths and near-misses.
- HIV testing facilities
-Informed consent policy
-HIV register
-Records for providing HIV results
-Youth friendly HIV testing
-YFS trained provider
-YFS Guidelines
-Care and Support Services (CSS)
-TB diagnosis and treatment
-ART services offered
-ART guidelines
-PMTCT services
-Primary prevention of HIV
-Prevent unintended pregnancies among HIV+
-Use of comprehensive packages
-Comprehensive care of mother/family
-Clinical research on PMTCT and Paediatric treatment.
-Clinical research on treatment issues for women
-Operations research on treatment for women
-operations and implementation research related to PMTCT, including paediatric care, treatment and support.
Discordant couple counselling services
Positive prevention practices
DEMAND BY MALE SPOUSE OF PREGNANT MOTHER
Expectant female whose obstetric and gyneacological needs are higher

Foetus about to be new-born that needs care.
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Spousal escort for expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation

Education on male involvement plans
All services should be provided without discrimination

PMTCT should also be defined as Prevention of Vertical Transmission in the context of de-stigmatising it.



Maternal/ new born deaths and near-misses
-Facilitation and acceptance of accompaniment by spouse

-Informed consent policy
-HIV register
-Records for providing HIV results
-Youth friendly HIV testing
-YFS trained provider
-YFS Guidelines
-Care and Support Services (CSS)
-TB diagnosis and treatment
-ART services offered
-ART guidelines
-PMTCT services
-Primary prevention of HIV
-Prevent unintended pregnancies among HIV+
-Use of comprehensive packages
-Comprehensive care of mother/family
-Clinical research on PMTCT and Paediatric treatment.
-Clinical research on treatment issues for women
-Operations research on treatment for women
-operations and implementation research related to PMTCT, including paediatric care, treatment and support.
Discordant couple counselling services
Positive prevention practices
DEMAND BY FEMALE SPOUSE OF PREGNANT MOTHER
Expectant female whose obstetric and gyneacological needs are higher

Foetus about to be new-born that needs care.
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Spousal escort for expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation

Education on Spousal involvement plans
All services should be provided without discrimination
Maternal/ new born deaths and near-misses
-Routine cervical examination for cancer and STIs.
-Family planning information, education and communication

-Informed consent policy
HPV Immunisation
-HIV register
-Records for providing HIV results
-Youth friendly HIV testing
-SMF trained provider
-SMF Guidelines
-Care and Support Services (CSS)
-TB diagnosis and treatment
-ART services offered
-ART guidelines
-PMTCT services
-Primary prevention of HIV
-Prevent unintended pregnancies among HIV+
-Use of comprehensive packages
-Comprehensive care of mother/family
-Clinical research on PMTCT and Paediatric treatment.
-Clinical research on treatment issues for women
-Operations research on treatment for women
-operations and implementation research related to PMTCT, including paediatric care, treatment and support.
Discordant couple counselling services
Positive prevention practices
DEMAND BY
BELOW 18 YEAR OLD FEMALE
Adolescent with sexual needs that need addressing through dialogue to reduce experimenting hazards
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Teenage friendly Sexual-reproductive health services
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation

Education on Spousal involvement plans
All services should be provided without discrimination
Risk of infection due to peer pressure and experimenting
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
Teenage friendly services
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
-YFS Services
-Referral
DEMAND
BY  ABOVE 18 YEAR OLD FEMALE
Teenage needs, emotional stability counselling and sexual  health education
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Teenage friendly Sexual-reproductive health services
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination

Drug manufacturing and delivery systems to address need for the appropriate paediatric formulations

Ensure early TB diagnosis and treatment

Assess and evaluate cormobidity conditions of malaria, TB and malnutrition

Ensured pharmacovigilance system to expand existing ART to cover all in need.

Improve on treatment strategies to ensure inclusion and eligibility for all.

Reports are disaggregated by sex, ethnicity and race to support routine analysis of potential differences in pharmacokinetics and pharmacodynamics, treatment outcomes and adversity.

Care , support and treatment scale up in various settings and levels

Effectively impacting interventions at programme, facility, community and house-hold levels
Teenage health un-met needs
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Teenage-Health Friendly services
-Prophylactic ARV drugs and their importance in checking HIV transmission.
DEMAND
BY ABOVE 18 YEAR OLD MALE
Teenage needs, emotional stability counselling and sexual  health education
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination

Drug manufacturing and delivery systems to address need for the appropriate paediatric formulations

Ensure early TB diagnosis and treatment

Assess and evaluate cormobidity conditions of malaria, TB and malnutrition

Ensured pharmacovigilance system to expand existing ART to cover all in need.

Improve on treatment strategies to ensure inclusion and eligibility for all.

Reports are disaggregated by sex, ethnicity and race to support routine analysis of potential differences in pharmacokinetics and pharmacodynamics, treatment outcomes and adversity.

Care , support and treatment scale up in various settings and levels

Effectively impacting interventions at programme, facility, community and house-hold levels
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Medical male circumcision and its importance
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
DEMAND BY
BELOW 14 YEAR OLD
MALE
Teenage needs, emotional stability counselling and sexual  health education
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Teenage sexual health needs
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination.

Drug manufacturing and delivery systems to address need for the appropriate paediatric formulations

Ensure early TB diagnosis and treatment

Assess and evaluate cormobidity conditions of malaria, TB and malnutrition

Ensured pharmacovigilance system to expand existing ART to cover all in need.

Improve on treatment strategies to ensure inclusion and eligibility for all.

Reports are disaggregated by sex, ethnicity and race to support routine analysis of potential differences in pharmacokinetics and pharmacodynamics, treatment outcomes and adversity.

Care , support and treatment scale up in various settings and levels

Effectively impacting interventions at programme, facility, community and house-hold levels
Teenage sexual health un-met needs
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Teenage health friendly services
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND
BY 18 YEAR OLD MALE
Teenage needs, emotional stability counselling and sexual  health education
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Teenage sexual health needs
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination.

Drug manufacturing and delivery systems to address need for the appropriate paediatric formulations

Ensure early TB diagnosis and treatment

Assess and evaluate cormobidity conditions of malaria, TB and malnutrition

Ensured pharmacovigilance system to expand existing ART to cover all in need.

Improve on treatment strategies to ensure inclusion and eligibility for all.

Reports are disaggregated by sex, ethnicity and race to support routine analysis of potential differences in pharmacokinetics and pharmacodynamics, treatment outcomes and adversity.

Care , support and treatment scale up in various settings and levels

Effectively impacting interventions at programme, facility, community and house-hold levels such as male involvement
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Medical Male Circumcision
-Sexuality and orientation
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Equipment/supplied for conducting normal delivery
-Emergency respiratory support for newborns
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
DEMAND BY  ABOVE 18 AUTISTIC
DISABLED
MALE
Disabled person whose sexual health needs consider disability conditions
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Disability Person Sexual health needs
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Disability, Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Disability friendly services (DFS)
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY  ABOVE 18 DYSLEXIC
DISABLED
Disabled person whose sexual health needs consider disability conditions
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Disability, Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Disability friendly services (DFS)
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY  ABOVE 18 VISUALLY IMPAIRED
DISABLED
Disabled person whose sexual health needs consider disability conditions
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Disability, Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Disability friendly services (DFS)
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY HEARING IMPAIRED
DISABLED
Disabled person whose sexual health needs consider disability conditions
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Disability, Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Disability friendly services (DFS)
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY
DISABLED
FEMALE ABOVE 18 YEARS
Disabled person whose sexual health needs consider disability conditions
1)       Facility-Infrastructure
2)       Resources
3)       Systems
4)       Child Health Services
5)       Family Planning Services
6)       Maternal Health Services
7)       STI and Tuberculosis Services
8)       Malaria Service
9)       HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Disability, Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Disability friendly services (DFS)
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY FEMALE SEX-WORKER
Child bearing and maternal health needs to be addressed
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Expectant Mother with enlarged uterus proceeding to term
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
Sex-worker friendly services
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY MALE SEX-WORKER
Person who depends on sex with same sex or different gender person
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Sex as an income generating activity
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Friendly services
All services should be provided without discrimination
Misdiagnosed STIs and sexual health status
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
Sex-worker friendly services
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY NON SEXUALLY ACTIVE  GAY MALE
Closeted life, attraction for same sex, coming out  issues
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Male-Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Desire for sexual satisfaction with same sex
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Health Indicators relevant to sexual minorities:

Weight issues

Obesity

Tobacco use

Substance use

Responsible sexual behaviour

Mental health

Injury

Violence

Access to care

Burden of STIs
All services should be provided without discrimination
Stress
Discrimination
Preparatory Information, Education and Communication around:-
-Health, empowerment, legal and psycho-social issues
-Life events/experiences
-stage of life
-disclosure issues
-motivations and expressions for same sex practices
-Adolescent health
-Exploration of Knowledge, attitudes and skills
-Depathologisation of homosexuality
-Medical Male Circumcision
-Sexuality and orientation
-Pregnancy and conceiving
-HIV/STIs transmission
-HPV
-HSV
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Starting a family
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
DEMAND BY  NON SEXUALLY ACTIVE LESBIAN
Closeted life, attraction for same sex, coming out  issues
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Sexual/
reproductive health expectations
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Non-discriminative services
All services should be provided without discrimination.

Provide environment for understanding the complexity and multidimensionality of  gender and sexual orientation .

Exploration of coping skills
Stress
Discrimination
Preparatory Information, Education and Communication around:-
-Medical Male Circumcision
-Sexuality and orientation
-Pregnancy and conceiving
-HIV/STIs transmission
-HPV
-HSV
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Starting a family
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Choice of surrogacy
-Choice of siring partner
-Hormonal replacement
-Prophylactic ARV drugs and their importance in checking HIV transmission.
DEMAND BY FEMALE TO MALE TRANSGENDER
attraction for same sex, coming out  issues
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Sexual/
reproductive health expectations
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
None
Discriminative
services
All services should be provided without discrimination
Stress
Discrimination
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
Hormonal replacement
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY MALE TO FEMALE TRANSGENDER
attraction for same sex, coming out  issues
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Sexual/
reproductive health expectations
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Same sex –friendly services
All services should be provided without discrimination
Stress
Discrimination
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Hormonal replacement
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY INTERSEX
Sexual/genital health  status
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Intersex person desiring to have or not have children
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Same sex
Friendly
services
All services should be provided without discrimination
Stress
Discrimination
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-Vaginal/Penile growth and development
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Hormonal replacement
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY GAY DISABLED MALE
Sexual-genital health needs
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Same sex loving person probably in the closet and with low self esteem
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Same sex and Disability friendly
Services
All services should be provided without discrimination
Stress
Discrimination
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
Same sex/Disability friendly services
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY LESBIAN DISABLED FEMALE
Sexual-genital health needs
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Same sex loving person probably in the closet and with low self esteem
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
None discrimination services
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
Same sex/Disability friendly services
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY  DISBALED TRANSGENDER (FTM)
Sexual/
Genital health needs
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Same sex loving person probably in the closet and with low self esteem
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Non
discriminative
services
All services should be provided without discrimination
Maternal/ new born deaths and near-misses.
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY DISBALED TRANSGENDER (MTF)
Sexual /
Genital
Heath needs
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Same sex loving person probably in the closet and with low self esteem
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Non
Discriminative
services
All services should be provided without discrimination
Stress
Discrimination
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.
-Sexuality and orientation information, education and communication
DEMAND BY POST MENOPAUSAL
FEMALE
Female whose obstetric and gyneacological needs should be addressed side by side with post menopausal issues/
anxieties

Ability to enjoy sexual intercourse with no procreation
Should be done safely without HIV/STI transmission
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services should include safer sex practices for Post  menopausal females
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services

Issues around libido, sexual function and hormonal replacement

Menopausal
status
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Counselling for safer sex practices
All services should be provided without discrimination
Safer sex practices advice reduces on risky behaviour.
Preparatory Information, Education and Communication around:-
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
Continued protective family planning methods
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Maternal / child Health
-Pre/Post HIV test counselling
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.


DEMAND BY
SPOUSE OF POST MENOPAUSAL
FEMALE
Sexual needs of spouse and child-bearing status
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Issues around libido, sexual function and hormonal replacement
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services
Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Safer sex practices advice reduces on risky behaviour.

Point out child-bearing needs and gauge expectations. Counsel around this.
Preparatory Information, Education and Communication around:-
-Pregnancy and conceiving
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Managing STIs
-ANC registers
Infection Control
-Newborn health supportive practices
-Maternal / child Health
-Pre/Post HIV test counselling
-Infant feeding practices
-Family Planning
-Prophylactic ARV drugs and their importance in checking HIV transmission.










DEMAND BY THE SENIOR PERSON (AGED/
ELDERLY)
Issues of child-bearing and obstetric health
1.        Facility-Infrastructure
2.        Resources
3.        Systems
4.        Child Health Services
5.        Family Planning Services
6.        Maternal Health Services
7.        STI and Tuberculosis Services
8.        Malaria Service
9.        HIV/
AIDS Services
Issues around libido, sexual function and hormonal replacement
1. Health Services
2. Family Planning Services
3. Maternal Health Services
4. STI and Tuberculosis Services
5. Malaria
Services
6. HIV/AIDS
Services


Normal delivery under trained/
qualified observation
All services should be provided without discrimination
Immuno-suppression, neuropathy and various other old age (geriatric) related illnesses are nearly missed as old age related issues and not HIV related.
Preparatory Information, Education and Communication around:-
-HIV/STIs transmission
-Vaginal/Penile hygiene
-PPC
-Immunisation and its importance to health
-Visual Aid messages
- Key messages in ANC guidelines
-Signs of pregnancy complications
-Managing STIs
-ANC registers
Infection Control
-Elderly health supportive practices
-Pre/Post HIV test counselling
-Infant feeding practices
-Prophylactic ARV drugs and their importance in checking HIV transmission.


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