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According to reproductive health experts in Uganda, 6000 Ugandan women die every year from preventable pregnancy and child birth related complications. Yet, if women could only deliver under skilled care, about 80 percent of these deaths could be prevented. The reasons for not delivering in a health facility are several. But the main ones in Uganda include financial limitations, long distances to health facilities coupled with lack of access to transport facilities, lack of decision making power among women, inability to afford the medical supplies that are often compulsory at health facilities, rude unmotivated health workers and preference for traditional child birth settings.


FHS Phase 1

To address these issues, in Phase 1 FHS Uganda set up a 'Safe Deliveries Project' that established both demand (vouchers for transport and maternal services) and supply-side initiatives (training health workers and provision of essential equipment, drugs and supplies).

To implement the intervention, vouchers and registers for the vouchers were distributed to participating 22 health facilities in the districts of Kamuli and Pallisa. Drugs, supplies and equipments were procured and distributed to all participating health facilities to supplement the requirements for safe, clean deliveries. In addition, payments were made to transporters once every two weeks after they had submitted their transport vouchers. Health units also received payments once a month according to the number of service vouchers collected during that period.

The pilot phase was for 3 months from December 2009 to February 2010. And by the end of the pilot only conducted in Kamuli District, health facilities were already overwhelmed by the surge in numbers seeking maternal services. The number of number of facility deliveries was less than 200 per month but this increased to more than 500 per month. 

FHS Phase 2

Following the success of the Safe Deliveries Project, the second phase of FHS Uganda will focus on developing on a more sustainable mechanism of financing and managing the project so that the gains can be sustained. In particular:

  • The team will explore different methods of mobilizing community resources for maternal and newborn health.  To address some of the challenges found in implementing the voucher study, they will introduce the use of community health workers, who will also provide health education and promotion about maternal and newborn health through home visits. This work will be done in Buyende, Kamuli and Iganga districts using a quasi-experimental design.
  • In Pallisa, the team will use action research methods to test different approaches for mobilizing financial, social and human resources that exist within the community for improving maternal and newborn health. 

FHS Partners

Makerere University School of Public Health

Makerere University School of Public Health

News and announcements from FHS Uganda

FHS at the Fourth Global Symposium on Health Systems Research, 14-18 November 2016

Future Health Systems members are excited to be contributing to the Fourth Global Symposium on Health Systems Research, which will be held in Vancouver, Canada, from 14 to 18 November.

Recent FHS Uganda Publications

FHS Key Message Brief 3: Unlocking community capability: key to more responsive, resilient and equitable health systems

In Future Health Systems, we focused on communities as active service delivery participants across a wide variety of contexts. In this brief, we reflect on the process of unlocking community capabilities, the key actors involved, and the productive tensions within community partnerships forged to build more responsive, resilient and equitable health systems.

Makerere University School of Public health in collaboration with Ministry of Health and the three districts of Kamuli, Pallisa and Kibuku designed and implemented a four year (2012-2015) maternal and newborn study (MANIFEST) that aimed at improving access to institutionalized deliveries. One of the study components was community mobilization through use of Village Health Teams (VHTs), essentially community health workers. The VHTs were trained for five days and supervised by district level health workers and district health team (DHT) members with support from external trainers following a training of trainers (TOT). The VHTs effectively sensitized communities and improved awareness on birth preparedness, knowledge of danger signs and health facility service utilization. This brief therefore highlights the key characteristics of a good performing VHT based on observations of VHT performances over three years of implementation.

Women in resource constrained settings often fail to seek care because of inadequate money, even though they often belong to small financial social networks where they save to help each other during funerals, buy meat during festive days, and contribute to wedding preparations among many other things. The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study implemented in the districts of Kamuli, Kibuku and Pallisa exploited this opportunity by encouraging households to join existing financial social networks where households can save money, such as women’s saving groups, burial groups and financial circles, for maternal health. This Issue Brief outlines the key messages and recommendations from MANIFEST's experience.

Reducing maternal and newborn deaths has been a key goal for the Government of Uganda. Focus has been put on increasing access to reproductive health services including antenatal care and skilled birth attendance. Reducing maternal and newborn deaths cannot be solely achieved through increasing access to reproductive health services and skilled birth attendance. 

This brief shares key findings under the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study in both the intervention and control area. Integrated strategies were implemented to reduce maternal and newborn deaths in the districts of Kamuli, Kibuku and Pallisa, in Eastern Uganda.

Recognising and rewarding the best performing health workers and facilities as a way of motivating them was one of the activities under the Health Systems Strengthening component of the MANIFEST Study. This Issues Brief shares the key lessons learned from the MANIFEST experience.

Mentorship is deliberate pairing of a more skilled or experienced person with a lesser skilled or inexperienced one, with the agreed-upon goal of having the less experienced person to grow and develop specific competencies. Here, the more experienced (Mentor) guides the less experienced (Mentee) in the development of specific professional knowledge and skills which will promote personal and professional development of the mentee. This Brief is based on lessons learned from mentors and mentees following a one year mentorship exercise in three districts in Eastern Uganda.