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
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
Innovation theory has focused on the adoption of new products or services by individuals and their market-driven diffusion to the population at large. However, major health sector innovations typically emerge from negotiations between diverse stakeholders who compete to impose or at least prioritise their preferred version of that innovation. Thus, while many digital health interventions have succeeded in terms of adoption by a substantial number of providers and patients, they have generally failed to gain the level of acceptance required for their integration into national health systems that would promote sustainability and population-wide application. The area of innovation considered here relates to a growing number of success stories that have created considerable enthusiasm among donors, international agencies, and governments for the potential role of ICTs in transforming weak national health information systems in middle and low income countries. This article uses a case study approach to consider the assumptions, institutional as well as technical, underlying this enthusiasm and explores possible ways in which outcomes might be improved.
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.
Tetui M, Hurtig A-K, Ekirpa-Kiracho E, Kiwanuka SN and Coe A-B (2016) Building a competent health manager at district level: a grounded theory study from Eastern Uganda, BMC Health Services Research, 16:665, DOI: 10.1186/s12913-016-1918-0
Health systems in low-income countries are often characterized by poor health outcomes. While many reasons have been advanced to explain the persistently poor outcomes, management of the system has been found to play a key role. According to a WHO framework, the management of health systems is central to its ability to deliver needed health services. In this study, we examined how district managers in a rural setting in Uganda perceived existing approaches to strengthening management so as to provide a pragmatic and synergistic model for improving management capacity building.
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.