Kananura RM, Ekirapa-Kiracho E, Paina L, Bumba A, Mulekwa G, Nakiganda-Busiku D, Oo HNL, Kiwanuka SN, George A and Peters DH (2017) Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda, Health Research Policy and Systems, 15(Suppl 2):107, DOI: 10.1186/s12961-017-0274-9
The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda.
Morgan R, Tetui M, Kananura RM Ekirapa-Kiracho E and George AS (2017) Gender dynamics affecting maternal health and health care access and use in Uganda, Health Policy and Planning, Volume 32, Issue supplement 5, pp z13 - v21, doi: 10.1093/heapol/czx011
Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women’s access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women’s lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women’s lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women’s workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women’s attitudes and behaviour during pregnancy, men’s attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term.
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.
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.
Ajeani J, Ayiasi RM, Tetui M, Ekirapa-Kiracho E, Namazzi G, Kananura RM, Kiwanuka SN and Beyeza-Kashesya J (2017) A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons, Global Health Action, 10:sup4, 1345497
There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model.
Kananura RM, Tetui M, Bua J, Ekirapa-Kiracho E, Mutebi A, Namazzi G, Kiwanuka SN and Waiswa P (2017) Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study, Global Health Action, 10:sup4, 1362826, DOI: 10.1080/16549716.2017.1362826
Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization. This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda.
Ekirapa-Kiracho E, Kananura RM, Tetui M, Namazzi G, Mutebi A, George A, Paina L, Waiswa P, Bumba A, Mulekwa G, Nakiganda-Busiku D, Lyagoba M, Naiga H, Putan M, Kulwenza A, Ajeani J, Kakaire-Kirunda A, Makumbi F, Atuyambe L, Okui O and Kiwanuka SN (2017) Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts, Global Health Action, 10:sup4, 1363506, DOI: 10.1080/16549716.2017.1363506
The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices.
Ekirapa-Kiracho E, Tetui M, Bua J, Kananura RM, Waiswa P, Makumbi F, Atuyambe L, Ajeani J, George A, Mutebi A, Kakaire A, Namazzi G, Paina L and Kiwanuka SN (2017) Maternal and neonatal implementation for equitable systems: A study design paper, Global Health Action, 10:sup4, 1359924, DOI: 10.1080/16549716.2017.1346925
Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach.
George A, Tetui M, Pariyo GW and Peterson SS (2017) Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda, Global Health Action, 10:sup4, 1359924, DOI: 10.1080/16549716.2017.1359924
This editorial provides an overview of the Global Health Action MANIFEST special issue. The special issue covers 10 papers whose main purpose is to share findings from a maternal and neonatal health intervention in Uganda. The MANIFEST intervention 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.
Kananura RM, Wamala R, Ekirapa-Kiracho E, Tetui M, Kiwanuka SN, Waiswa P and Atuhaire LK (2017) A structural equation analysis on the relationship between maternal health services utilization and newborn health, BMC Pregnancy and Childbirth, 17:98, DOI: 10.1186/s12884-017-1289-5
Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors.
Vadrevu L and Kanjilal B (2016) Measuring spatial equity and access to maternal health services using enhanced two step floating catchment area method (E2SFCA) – a case study of the Indian Sundarbans, International Journal for Equity in Health, 15: 87, doi:10.1186/s12939-016-0376-y
Inaccessibility due to terrain and lack of transport leaves mothers travelling for long hours before reaching a facility to deliver a child. In the present article we analyzed the issue of spatial inaccessibility and inequity of maternal health services in the Indian Sundarbans where complex topography and repeated climatic adversities make access to health services very difficult.
Ekirapa-Kiracho E, Namazzi G, Tetui M, Mutebi A, Waiswa P, Oo H, Peters DH and George AS (2016) Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda, BMC Health Services Research, 16:1864, DOI: 10.1186/s12913-016-1864-x
Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda.
Paina L, Vadrevu L, Hanifi SMMA, Akuze J, Rieder R, Chan KS and Peters DH (2016) What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda, BMC Health Services Research, 16:1861, DOI: 10.1186/s12913-016-1861-0
While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.
Future Health Systems (FHS) work on maternal and newborn health in the poorest
districts of eastern Uganda has contributed to a story of community empowerment where people have learnt to prioritise, prepare and save money for childbirth. This increases the likelihood of delivery in a health facility, and therefore the chances of a healthy pregnancy and safe childbirth under skilled care.
Poor quality of maternal and newborn health services in Uganda have resulted in low maternal health service utilisation and high newborn mortality rates, both at home and at health facilities. The support Future Health Systems (FHS) provided to health workers to improve maternal health service delivery illustrates how a package of interventions that equips health workers with the necessary knowledge, skills and equipment, supplies and other non-financial incentives can improve the quality of maternal and newborn health service delivery.
The objective of this brief is to introduce the Photovoice method, highlight how it helped capture the voices of mothers in the Sundarbans, and demonstrate how the method can bridge the gap between communities and local decision-makers.
Vadrevu L and Kanjilal B (2016) Measuring spatial equity and access to maternal health services using enhanced two step floating catchment area method (E2SFCA) – a case study of the Indian Sundarbans, International Journal for Equity in Health, 15:87, DOI: 10.1186/s12939-016-0376-y
Inaccessibility due to terrain and lack of transport leaves mothers travelling for long hours before reaching a facility to deliver a child. This article analyzes the issue of spatial inaccessibility and inequity of maternal health services in the Indian Sundarbans where complex topography and repeated climatic adversities make access to health services very difficult.