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Blog

Filtering by Category: maternal health

Community Delivery Center: the answer for safe delivery for women of the Indian Sundarbans?

Future Health Systems

Worldwide, 830 women die daily from preventable causes related to pregnancy and childbirth, and unfortunately one fifth of these women reside in India (UNICEF). Maternal death accounts for highest share of Disability-Adjusted Life Year (DALY) and is more prevalent in rural areas as compared to urban ones. This is demonstrated in areas such as the Sundarbans, where geographically inaccessible terrain makes maternal health service delivery challenging. In the near absence of formal delivery care at the grassroots level, Community Delivery Centers (CDCs) bring basic obstetric care to the doorsteps of hard-to-reach regions of Indian Sundarbans.

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Including marginalised people in ‘people centred health systems’

Future Health Systems

At the upcoming Global Symposium on Health Systems Research, we will be running a participatory session that builds on research from Uganda, Bangladesh and Nepal, entitled Amplifying Marginalised Voices: Towards Meaningful Inclusion in Social Accountability Mechanisms for Health. This session applies an intersectional lens to accountability mechanisms, asking about the inclusion of specific, marginalised categories within communities in mainstream accountability initiatives.

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The 3rd Delay: Prominent and fatal in maternal delivery services, pleas from the frontline

Future Health Systems

Currently, thanks to the sustained campaign by the Ugandan government and development partners, more women deliver in facilities than ever before. However, without concerted efforts to ensure that facilities are well equipped to handle these increased numbers, more women will continue dying to give life.

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Team work key in implementation of Community Score Cards

Future Health Systems

If you watch soccer, you will agree with me that just like a football team working together to set up the perfect shot at goal, every team member has a specific role to play in accomplishing tasks on an initiative that requires joint effort. While it may look like one player scored the goal, that score was made possible by on and off pitch team members’ planning, coordination, and cooperation to get that scorer the ball.

That is what we have observed with the different stakeholders as we implement a study that is testing a community and facility score card for maternal and newborn health service delivery in Kibuku District in Eastern Uganda.

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Not business as usual: make Ugandan health facilities friendly for women with walking disabilities

Future Health Systems

World Health Day has come and gone this year, but nevertheless, it is very important for us to continue to remember our commitments towards health care delivery, such as equitable health systems. Most efforts to improve Maternal and Newborn Health (MNH) outcomes in Uganda have focused on access and quality of care for women in general, paying no attention to special populations such as women with walking disabilities who have a high likelihood of poor MNH outcomes. 

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Community scorecards: addressing the maternal and newborn service related needs of the marginalized?

Future Health Systems

Caroline Namugwere (not real name) is a 27 year old disabled woman and resident of Kibuku District in Eastern Uganda. Her pregnancy experience was laden with challenges right from attending antenatal clinic appointments to delivery. Inquiry into the plight of the marginalised is part of what the Community Score Cards study of Makerere University School of Public Health in partnership with the Future Health Systems Research Consortium intends to explore over the coming months in Kibuku District in Eastern Uganda. Specific to the case of Caroline and other marginalised groups, the following research question is being pursued: To what extent does a community scorecard process incorporate and address the maternal and newborn service related needs of marginalized populations?

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Racing the clock to save mothers and protect newborns in Uganda

Future Health Systems

Stefan Peterson, Chief of Health, UNICEF, highlights the contribution of a maternal and newborn health implementation project in Uganda led by Future Health Systems partner, the Makerere School of Public Health, to improvements in early antenatel care attendance, facility deliveries, newborn care practices, birth preparedness, and awareness of obstetric danger signs.

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Cultivating a positive performance review culture: lessons from the maternal and newborn study in Eastern Uganda

Future Health Systems

Makerere University School of Public Health recently concluded a four-year intervention aimed at sustainably improving maternal and neonatal health outcomes, implemented in the Eastern Ugandan districts of Kamuli, Pallisa and Kibuku. The intervention - the Maternal and Neonatal Implementation for Equitable Systems Study or MANIFEST - employed a participatory action research approach that has been lauded for increasing sustainability chances. This blog post examines lessons learned from the performance review meetings which were part of the approach.

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Ensuring sustainability through working with local resources: lessons from a maternal and newborn study in Eastern Uganda

Future Health Systems

How sustainable is your intervention? If someone wanted to replicate it, how easy would it be? What happens when the study ends? Will the communities be able to continue with this initiative after the implementers have gone? Ayub Kakaire, FHS PIRU Officer for Uganda, blogs about what working on the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study has taught him about how to ensure an intervention is sustainable. 

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Battling uncertainties or a certain doom?: Field notes from Ghoramara, Indian Sundarbans

Future Health Systems

We set out to leave for Ghoramara - one of the islands of the Sagar block of the Indian Sundarbans in the southern part of West Bengal - as a part of the IIHMR University – FHS study on climatic uncertainties and child health. As I sat in the bottom deck of the ferry travelling the hour long journey from Kakdwip to Ghoramara, I began to read the documents shared by the Panchayat on the island. The island, home to a population of 5000 people, is surrounded by rivers from all corners. It has no primary health facility but a sub-centre and ten anganwadi centres. It is popularly called the sinking island because the rising sea levels due to global warming and climatic events had leached a major portion of the island in the last few decades. A report by Centre for Science and Environment stated that over 25 years, Ghoramara’s land mass has been eaten away by the advancing sea – from 9 sq km to just about 4.7 sq km. I wondered what it meant for people living all their lives in a village and watching it gradually leach out.  

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Training health workers in management skills bears fruit

Future Health Systems

Every day, health service leaders face challenges like working with limited resources while delivering results, managing change, and keeping staff motivated. Decentralisation adds to these challenges, as many health workers have both clinical and managerial responsibilities.

However, little attention is paid to leadership and management skills during their health training.

In partnership with the districts, who select the candidates, the Makerere University School of Public Health is training health workers in three areas: planning and management of health services, improving management of logistics and improving management of labor and newborn care.

A six-month distance health services management certificate course, targeting district and health facility managers, caters for the first two thematic areas, the focus for this article. In the first phase, 30 health service delivery personnel were drawn from the three study districts (10 from each), and another 30 are attending the second phase of training. The results have been tremendous, with beneficiaries already registering significant improvements back at their work places.

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Minimising delays for maternal health seeking in Uganda through saving schemes

Future Health Systems

Households and individual community members are being educated and encouraged to join or start financial social networks, like saving groups, which offer financial protection. In addition to the business funds, the networks are advised to have a separate fund to cater for maternal and newborn health needs. Members can access these funds to cater for emergency transport to and from the health facility for pregnant women, mothers and newborns. The fund is also meant to provide funds to cater for birth items. Saving groups are similarly encouraged to enter into partnership with transporters.

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Community health workers encourage women in Uganda to seek skilled care early in pregnancy

Future Health Systems

Deciding to seek care from a skilled health worker by a woman at the time of delivery is highly encouraged in order to improve health outcomes for both mother and baby. When a woman delivers under skilled care, it is easier to detect and attend to any emergences that arise.

Under the community mobilisation and sensitisation component of the study, around 1,691 community health workers (CHWs, also known as village health teams or VHTs), were trained across the three study districts of Kamuli, Pallisa and Kibuku. The training focused on early detection of emergencies, birth preparedness and care for mothers who just delivered and their newborns. During the visits, CHWs provide households with information needed to ensure mothers have a safe delivery and remain healthy with their babies. Two home visits happen during pregnancy and two after delivery.

 

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Tackling negative social cultural norms in Uganda through community dialogues and radio

Future Health Systems

Having knowledge of obstetric danger signs and embracing good birth preparedness practices could enhance maternal and newborn health outcomes. Through the use of communications and media advocacy, the intervention study is tackling social and cultural issues that affect maternal and newborn health negatively. We are using village-level dialogues (once every three months) and radio talk shows (monthly) as well as spot messages (daily). 

During the dialogues, women and men shared sad memories of maternal and newborn illness and death, underlining the grim reality of the situation. They also discussed good and bad practices and made commitments to abandon negative practices and therefore improve maternal and newborn health. “I resolve to stop putting cow dung and other dangerous things on the cord of newborns. After today’s talk I realise why my baby’s cord took that long to heal. I urge fellow women to join a new me,” said Ms Nabirye at a dialogue in Kamuli to thunderous applause from fellow women. Monitoring data shows that, while only 17 per cent of sampled women who had just given birth treated cords with nothing but the appropriate saline water in mid-2013, that percentage had shot to 56% in mid-2014.

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Complexity in practice: Experiences from research to improve maternal health in Uganda

Future Health Systems

Many will already be familiar with the term ‘complex adaptive systems’ (CAS). It’s certainly something we’ve talked about a lot within the Future Health Systems consortium. But it’s a term, and concept and a practice that has taken me some time to fully comprehend and to utilize in my own work. We are implementing a number of implementation research projects in Eastern Uganda, and most of my attention has been focused on the day-to-day operations of these large projects. However, I’ve found CAS tools to help me step back and get a broader picture of our research intervention. Here’s why.

 

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