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Publications

Filtering by Category: MakSPH

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

Future Health Systems

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.

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Maternal and neonatal implementation for equitable systems: A study design paper

Future Health Systems

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.

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Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda

Future Health Systems

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.

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A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda

Future Health Systems

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.

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Building a competent health manager at district level: a grounded theory study from Eastern Uganda

Future Health Systems

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.

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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

Future Health Systems

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.

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Saving money, saving lives: community saving groups lead to improvements in maternal and newborn health care in Uganda

Future Health Systems

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.

Working with health workers to improve maternal health services

Future Health Systems

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.

MANIFEST Issue Brief 9: What a highly effective VHT for maternal and newborn health looks like

Future 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.

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MANIFEST Issue Brief 8: Supporting Local Saving groups improves financial management and their savings

Future Health Systems

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.

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MANIFEST Issue Brief 7: Using integrated strategies can help improve knowledge of maternal & newborn danger signs and service utilization

Future Health Systems

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.

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MANIFEST Issue Brief 5: Mentorship Contributes to Quality Improvement in Maternal and Newborn Care, Health Worker Motivation

Future Health Systems

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.

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MANIFEST Issue Brief 4: Good Practices for District Health Teams to Improve Quality of Service Delivery: Lessons from MANIFEST

Future Health Systems

This MANIFEST Issue Brief shares lessons learned on how to enhance the commitment of district health teams, and presents the findings from quarterly district implementation committee review meeting minutes (four from each district), interviews with nine district health team members and observations made by the research team during the implementation of the project.

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MANIFEST Issue Brief 3: Professionalizing the Cadre of Facility Health Managers

Future Health Systems

Under the decentralized system of governance, health facilities are not only points of delivery but also hold resources that require management. The findings of this issue brief are based on 22 key informant interviews undertaken among health facility managers and select district health team members of three rural districts in Eastern Uganda. Pallisa, Kibuku and Kamuli were the districts in which Makerere University School of Public Health, through the MANIFEST study, intervened to improve management practices among health facility managers among other things.

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MANIFEST Issue Brief 2: Focussed Consistent Supportive Supervision Improves Management and Performance at Facility Level

Future Health Systems

In order to enhance quality of maternal and newborn care, the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study team championed a support supervision programme in Kamuli, Kibuku and Pallisa Districts. This MANIFEST Issue Brief outlines the issue, the MANIFEST experience and the results.

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MANIFEST Research Brief: Improving maternal and newborn health outcomes in Kamuli, Kibuku and Pallisa Districts in Eastern Uganda

Future Health Systems

This MANIFEST Research brief presents some of the key results from the end line survey of the 4-year study which aimed at contributing to the reduction of maternal and neonatal deaths through the use of a participatory action research approach.

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Supporting youth and community capacity through photovoice: Reflections on participatory research on maternal health in Wakiso district, Uganda

Future Health Systems

Musoke, D; Ndejjo, R; Ekirapa-Kiracho, E and George, AS (2016) Supporting youth and community capacity through photovoice: Reflections on participatory research on maternal health in Wakiso district, Uganda, Global Public Health, DOI:10.1080/17441692.2016.1168864

This paper reflects on the experiences of using photovoice to examine maternal health in Wakiso district, Uganda. The project involved 10 youth aged 18–29 years old, who were diverse in education, occupation, and marital status and identified by community leaders with researchers. By taking photos and sharing images and experiences in monthly meetings over five months, youth reported becoming more knowledgeable. They realised that they had common experiences but also reflected on and reinterpreted their circumstances.

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Using photovoice to examine community level barriers affecting maternal health in rural Wakiso district, Uganda

Future Health Systems

Musoke D., Ekirapa-Kiracho E., Ndejjo R. and George A. (2015) Using photovoice to examine community level barriers affecting maternal health in rural Wakiso district, Uganda, Reproductive Health Matters, 23(45):136-47, doi: 10.1016/j.rhm.2015.06.011

Uganda continues to have poor maternal health indicators including a high maternal mortality ratio. This paper explores community level barriers affecting maternal health in rural Wakiso district, Uganda. Using photovoice, a community-based participatory research approach, over a five-month period, ten young community members aged 18-29 years took photographs and analysed them, developing an understanding of the emerging issues and engaging in community dialogue on them. Photovoice's strength is in generating evidence by community members in ways that articulate their perspectives, support local action and allow direct communication with stakeholders.

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