In spite of the investments made by the Ugandan Government, the utilisation of maternal health services has remained low, resulting in a high maternal mortality (438 maternal deaths per 100,000 live births). Aiming to reduce poor women’s constraints to the utilisation of services, an intervention consisting of a voucher scheme and health system strengthening was implemented. This paper presents the lessons learnt during the setup and implementation of the intervention in Eastern Uganda, in order to inform the design and scale up of similar future interventions.
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Sustainability of health interventions is a global concern, as program benefits are lost as soon as programs lose donor funding. An assessment of the Uganda Rural Water and Sanitation (RUWASA) project revealed that program gains can be sustained decades later. The authors of this journal article analysed RUWASA implementation to draw sustainability lessons for maternal and child health interventions in Uganda and found that community engagement, contributions, use of structures and ownership of RUWASA was critical for the sustainability of the intervention.
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In this editorial in the International Journal of Public Health, Peter Waiswa, Makerere University School of Public Health, Uganda, says that without significant and sustained building of African research capacity, progress towards achieving development goals and overcoming health challenges will be difficult.
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The concept of clinical mentorship is increasingly becoming important in order to improve the delivery of quality healthcare services. This MANIFEST Progress Brief is based on perspectives of mentors and mentees following a six month mentorship exercise in the districts of Kamuli, Kibuku and Pallisa in eastern Uganda. It outlines the issue, the approach taken, preliminary results, a summary of findings, improvements in clinical care, administrative improvements and challenges.
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This Progress Brief looks at the component of the MANIFEST study that aims to increase financial and physical access to maternal health services by promoting financial preparedness as well as availability of routine and referral transport. It outlines the approach taken, the preliminary findings, the challenges and the lessons learnt.
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This Progress Brief brief highlights implementation experiences from the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study using VHTs to stimulate demand for maternal and newborn health services. It outlines the approach taken, preliminary findings, challenges and lessons learnt.
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This MANIFEST Issue Brief looks at how to increase the use of Partographs to monitor the progress of labour. It explains what a partograph is, and provides practical tips for how to improve partograph use.
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There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets.
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Welcome to the first edition of Showcase, which is débuting at the third Global Symposium on Health Systems Research in Cape Town, South Africa. Showcase is published by the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study to share news and lessons from the study
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Following a range of trainings – on how to use digital cameras, how to approach a picture subject, and getting people’s consent – study participants used the cameras provided to them to capture aspects and situations in their community where youth can contribute to improving maternal health for a period of five months. Monthly meetings were held between the youth and research team to discuss the photos and to identify collectively emerging themes and areas for action.
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This presentation is from workshop in Baltimore in June 2014 on complex adaptive systems (CAS) research methods held at Johns Hopkins University. Agnes Rwashana Semwanga from the Makerere University School for Public Health (MakSPH) introduces the basic concepts of how to create causal loop diagrams (CLDs) as a tool for modelling complex health systems.
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In Eastern Uganda, FHS works on two related research interventions, MANEST and MANIFEST. Both interventions are targeted at improving maternal and newborn health. This video, produced by FHS. describes these interventions in more detail.
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This is a video from the DC Health Systems Board event, Can systems tools deliver for the 'science of delivery'?, which was organised by Future Health Systems as part of its workshop on complex adaptive systems and held at Results for Development in June 2014.
At the event, panellists discussed and debated how systems thinking tools that are designed to tackle issues of complexity can contribute the successful implementation of health system strengthening interventions. The panel showcased some tools and examples, explaining how they had helped them to understand better health systems fluctuations and to anticipate unintended consequences to create more sustainable large-scale interventions.
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The Makerere University School of Public Health (MakSPH) has conducted several maternal health related projects over the years. MakSPH held a Maternal and Newborn Health symposium on May 14, 2014 in Kampala to herald a new beginning in dealing with key stakeholders. This publication recaps the key takeaways from the symposium and captures various views of participants.
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Despite significant investments in health systems research (HSR) capacity development, there is a dearth of information regarding how to assess HSR capacity. An alliance of schools of public health (SPHs) in East and Central Africa developed a tool for the self-assessment of HSR capacity with the aim of producing institutional capacity development plans.
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The role of health systems research (HSR) in informing and guiding national programs and policies has been increasingly recognized. Yet, many universities in sub-Saharan African countries have relatively limited capacity to teach HSR. Seven schools of public health (SPHs) in East and Central Africa undertook an HSR institutional capacity assessment, which included a review of current HSR teaching programs. This study determines the extent to which SPHs are engaged in teaching HSR-relevant courses and assessing their capacities to effectively design and implement HSR curricula whose graduates are equipped to address HSR needs while helping to strengthen public health policy.
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Over the past decade, development assistance for health (DAH) in Uganda has increased dramatically, surpassing the government’s own expenditures on health. Yet primary health care and other priorities identified in Uganda’s health sector strategic plan remain underfunded. Using data available from the Creditor Reporting System (CRS), National Health Accounts (NHA), and government financial reports, the article examines trends in how donors channel DAH and the extent to which DAH is aligned with sector priorities.
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Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country.
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The 'Safe Deliveries' study set up both demand (vouchers for transport and maternal services) and supply-side initiatives (training health workers and provision of essential equipment, drugs and supplies). Findings from the pilot phase and first six months of the one year implementation period saw an upward surge in mothers attending the first postnatal visit.
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Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally.
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