Where state capacity is limited, grassroots influencers at the community level can play a vital role in improving sexual and reproductive health outcomes. Drawing on diary entries kept by influencers and health project managers in two sites in Uganda, new research explores the emancipatory potential of such community practices, and the implications for institutionalising these actors on health objectives

Ngutuku, Eliza

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LSE Research Online

Elizabeth Ngutuku May 14th, 2021Ugandan grassroots in uencers are addressing inequities insexual and reproductive health1 comment | 7 sharesEstimated reading time: 5 minutesWhere state capacity is limited, grassroots in uencers at the community level canplay a vital role in improving sexual and reproductive health outcomes. Drawingon diary entries kept by in uencers and health project managers in two sites inUganda, new research explores the emancipatory potential of such communitypractices, and the implications for institutionalising these actors on healthobjectives.Access to Sexual and Reproductive Health and Rights (SRHR) is an important aspect ofreproductive justice, and the state is generally mandated the central role of ensuringaccess to these services. Yet in contexts where state capacity is limited, grassroots non-state actors are often the  rst or the only constituency attending to SRHR needs withincommunities. In Uganda, such actors are often acknowledged as sources of informationand for creating demand for services seeking improved SRHR well-being, but often not fortheir activism.Here I re ect on my experience as one of the coordinators of a subnational community ofa practice that worked with community in uencers in Uganda from 2019-20, in an urbanpoor setting of Kawempe in Kampala and in two parishes in rural Iganga district. Drawingon re exive diaries kept by both the in uencers and the project implementers, I explorehow these in uencers ‘conscientised’ communities and coalesced towards improvedsexual and reproductive health outcomes, and worked with state and local leaders toenhance accountability for SRHR. Such interventions, while small-scale, provide usefullessons for grassroots, place-based struggles for reproductive justice.De ning Uganda’s community in uencersCommunity in uencers are people whose opinion is locally valued. They include cultural,religious, youth and women leaders, teachers, motorcycle (boda-boda) riders, governmentleaders, heads of various associations and grassroots self-help groups. Instead of usingsocial media, they use popular community-based strategies and everyday spaces likefunerals, community events and associations, schools, sports and religious centresamong others. Since these in uencers are not externally created and already havelegitimacy as leaders, they are able to incorporate activism around sexual andreproductive health into their day-to-day activities.How they work: a community of practiceAs part of the decolonial agenda embedded in a larger SET-SRHR project, byforegrounding locally-driven knowledge and solutions, the activism of grassrootsin uencers is not framed by NGOs or the in uencers themselves as usual communityparticipation in an externally conceived project. Instead, it is viewed as a grassrootscommunity of practice, which leverages community knowledge and resources. Thein uencers work horizontally either as a group, or with other members of the community,to address marginalisation from SRHR services, SRHR challenges and associatedinjustices.These in uencers also engage the community on the dominant norms that hinder accessand equity in SRHR. Their capital as members of same community enables them to useinnovative endogenous practices, for instance drawing on community conversationsaround gender-based violence. In Iganga, where boda-boda taxis are a popular means oftransportation, the in uencers worked to shift the identities of the riders, often seen ashaving risky masculinities engaged in negative behaviours in relation to SRHR. The ridersnot only became allies in maternal health by transporting mothers to health centres butwere also, for example, encouraged to re-think the practice involving so-called ‘merry-go-round wives’, which involves the young riders marrying and then sending their wives awaywhen pregnant, before remarrying.In uencers in Iganga, Uganda. Credit: Nascent Research and Development OrganizationIn acknowledging that the quest for reproductive justice issues must be accompanied byeconomic justice, the in uencers also incorporated the importance of secure livelihoodsinto their dialogue with communities and policy actors. This was especially important forwomen and young people who sought a stronger bargaining position in sexual decision-making, and because precarity is viewed as a precursor to gender-based violence andother reproductive health issues. In the Kawempe site, the in uencers went beyondnarrow SRHR boundaries and engaged in other activities, such as cleaning slums, to wardoff disease, but also to re-imagine slums as vibrant and healthy spaces that demandattention.Work also took place in a strategic vertical manner with the state and other actors,including the police, community development leaders, health centres and Local Councilleaders, to link community members with services and ensure seamless referralpathways. At the health centres, the in uencers engaged with health workers to provideSRHR services to young people, who are often seen as asexual and often excluded fromservices. In addition, young people’s SRHR is often only considered when they suffer fromsexual and reproductive health issues and diseases with less attention to their overallSRHR well-being.A community ‘do shop’ in Kawempe, Uganda. Credit: Nascent Research and DevelopmentOrganizationThe in uencers also worked with district leaders, such as the police, to address cases ofgender-based violence. For example, in Iganga, they worked with the police in charge offamily issues, who are often not seen as allies in addressing gender-based violence. Aparticular policewoman with whom they worked became known, and repositioned withinthe community, as ‘mama’ (mother) police, and so transformed her into ally in terms ofher community image.Critical re exivity: ‘do-shops’ as an emergent spaceAs part of their leadership, the in uencers participate in training and experience-sharingonce a month. Such a deliberative space is called a ‘do shop’, where practical lessons aretaught through interactions with master trainers and the grassroots-supportingorganisation Nascent Research and Development Organization. Re-imagining a space asa do-shop affords transformative value by acknowledging community agency andknowledge and drawing from a locally generated and embedded curriculum, organised toaccommodate the context within which the in uencers work. In addition, theseencounters are seen as alternative spaces for such validation and making visible theircommunity’s collective SRHR experiences.A community ‘do shop’ in Kawempe, Uganda. Credit: Nascent Research and DevelopmentOrganizationBecause a community is a contested out t with embedded inequalities, bringing togetherin this re exive space diverse leaders, including the external catalysers, youth, women,men and political leaders and people with disabilities, enables them to engage the class,generational, gender power ableist, expert and other power relations that in uence SRHR.Such critical re exivity and disruption of personal and collective norms is therefore aform of change. As scholars have noted, emancipatory politics takes place when a spaceis provided for people often excluded to articulate their needs and interests.Lessons learnt from community innovationBy linking their activities in the community around the do-shop model, this way of workingwith, and enhancing the capacity of, grassroot in uencers is an innovative way ofenhancing reproductive justice. The local district governments in the two sites are alreadyworking on institutionalising the in uencers (like the Village Health Teams and othervolunteers) in health service delivery, to enable them to work with the state and other non-state actors to provide information.But what would be the implications of institutionalising these community  gures? I re ecton the following:• There is a danger that these in uencer actors become another cog in the policysystem, replacing currently limited provision and allowing the state to renege on itsresponsibilities for adequate service provision, such that in uencers are forced to losetheir critical engagement with the state. Such adoption should therefore not hollow outtheir emancipatory potential.• For marginalised communities, information on services is an important  rst step.There is, however, a need for awareness that reproductive injustice is not just aninformation de cit issue. These in uencers should therefore continue acting asinterlocutors for the state while engaging economic and social relational SRHR inequitiesin their contexts.• The role of intermediaries like NGOs is important in grassroot organising. However,there is a need to ensure that the SRHR vision for the community is maintained. Advocacyand activism should not be professionalised by external actors, who often have their ownproject-centred approach that may not provide space for questioning the status quo.• There is need for continued vigilance and strategic manoeuvring that goes beyond theinstrumentalism of working with the state. The state, and especially the Ugandan state, isnot always an ally in ensuring reproductive justice. This has been the case for youth withdrug-related issues and commercial sex-workers or those seeking post-abortion care,who have been reportedly criminalised. Indeed, since 2021 was an election year, somepolitical leaders felt threatened by the in uencers’ popularity and, when confronted thisway, the latter tended to minimise and de-politicise their work.Photo: a community ‘do shop’ in Kawempe, Uganda. Credit: Nascent Research andDevelopment Organization.About the authorElizabeth Ngutuku is a Research O cer at the LSE Firoz Lalji Centre for Africa with aPhD in Development Studies from the International Institute of Social Studies ofErasmus University Rotterdam. Her work investigates young people’s experience ofpoverty, vulnerability, citizenship claims and sexual and reproductive health.Elizabeth Ngutuku

Ugandan grassroots influencers are addressing inequities in sexual and reproductive health

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Ugandan grassroots influencers are addressing inequities in sexual and reproductive health

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