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.
News and announcements from FHS Uganda
A new collection of research articles in the journal Global Health Action shares findings from the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study in Uganda, led by the Makerere University School of Public Health in Kampala. The team, who are partners in Future Health Systems, used a participatory action research approach to engage different actors to improve maternal and neonatal health outcomes in the districts of Pallisa, Kibuku and Kamuli, in eastern Uganda.
Future Health Systems research in Bangladesh and Uganda is assessing how community empowerment strategies can affect service delivery and community capabilities. In Uganda, FHS partner, Makerere University School of Public Health, has partnered with Kibuku District in Eastern Uganda to develop and test a community and facility score card for maternal and newborn health service delivery. The feasibility study aims at identifying facilitators, barriers and factors that could influence implementation, institutionalization and scale-up of community and facility score cards in Uganda.
Recent FHS Uganda Publications
Tetui M, Coe A-B, Hurtig A-K, Ekirapa-Kiracho E and Kiwanuka SN (2017) Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda, Global Health Action, 10:sup4, 1346038, DOI: 10.1080/16549716.2017.1346038
To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity.
Ekirapa-Kiracho E, Paina L, Kananura RM, Mutebi A, Jane P, Tumuhairwe J, Tetui M and Kiwanuka SN (2017) ‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda, Global Health Action, 10:sup4, 1347311, DOI: 10.1080/16549716.2017.1347311
Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups.
Mutebi A, Kananura RM, Ekirapa-Kiracho E, Bua J, Kiwanuka SN, Nammazi G, Paina L and Tetui M (2017) Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services, Global Health Action, 10:sup4, 1347363, DOI: 10.1080/16549716.2017.1347363
Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. This article aimed to understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda.
Namazzi G, Okuga M, Tetui M, Kananura RM, Kakaire A, Namutamba S, Mutebi A, Kiwanuka SN, Ekirapa-Kiracho E and Waiswa P (2017) Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda, Global Health Action, 10:sup4, 1345495, DOI: 10.1080/16549716.2017.1345495
Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation. This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy.
Kiwanuka SN, Akulume M, Tetui M, Kananura RM, Bua J and Ekirapa-Kiracho E (2017) Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda, Global Health Action, 10:sup4, 1345494, DOI: 10.1080/16549716.2017.1345494
Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda.
Kisakye AN, Kananura RM, Ekirapa-Kiracho E, Bua J, Akulume M, Namazzi G and Kiwanuka SN (2017) Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda, Global Health Action, 10:sup4, 1345496, DOI: 10.1080/16549716.2017.1345496
Support supervision is one of the strategies used to check the quality of services provided at health facilities. From 2013 to 2015, Makerere University School of Public Health strengthened support supervision in the district of Kibuku, Kamuli and Pallisa in Eastern Uganda to improve the quality of maternal and newborn services. This article assesses quality improvements in maternal and newborn care services and practices during this period.