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
The Makerere University School of Public Health, has spent the last two years developing a community scorecard for Kibuku district in Uganda. Recent coverage on Ugandan television has highlighted the intervention’s contribution to improvements in maternal and newborn health service delivery, bolstered by the strength of partnerships with community members and officials at local and national levels.
FHS partner Makerere University School of Public Health is undertaking a Community Score Cards study, which is contributing to research on how leaders can work with the community and health workers to improve maternal and newborn health in Kibuku District. The use of the Community Score Card tool – a two-way and ongoing participatory tool for assessment, planning, monitoring and evaluation - aims to improve the performance of facilities and accountability by the different stakeholders who are responsible for improving the performance of facilities.
We are pleased to share two new films, produced by MakSPH, highlighting the research undertaken in Kibuku using the Community Score Card tool.
FHS is pleased to announce the publication of a new supplement in BMC Globalization and Health, titled Innovation in health systems in low- and middle-income countries. There is a growing interest in new technologies and innovative organizational arrangements as a means to improve a health system’s performance. However, only a small proportion of the many investments in innovations have been shown to have an impact on health system performance at scale. The papers in this series, published in Globalization and Health, analyze the factors that enable and constrain the emergence and diffusion of health system innovations. They bring alternative perspectives to this issue, based on diverse local contexts and different types of innovation. The aim is to provide a stronger basis for the formulation of strategies for managing health system change in low- and middle-income countries.
Recent FHS Uganda Publications
Musoke D, Ndejjo R, Biyinzika Lubega G and Ekirapa-Kiracho E (2020) Use of photovoice to explore the potential role of youth in contributing to maternal health in rural Wakiso district, Uganda, Sexual and Reproductive Health Matters, 28:1, 1854152, DOI: 10.1080/26410397.2020.1854152
Despite youth constituting a large portion of the population in Uganda, their involvement in improving maternal health in their communities has been minimal. This paper explores the potential role of youth in contributing to maternal health in rural communities in Wakiso district, Uganda using photovoice. Photovoice was used as a community-based participatory research method among 10 youth (5 males and 5 females) over a period of 5 months. The photos taken by the youth were discussed in monthly meetings, and emerging data was analysed using thematic content analysis. Four themes emerged regarding how youth can contribute to improving maternal health in their communities. These themes were: community health education; advocacy for health improvement; community voluntary work; and being exemplary. The fifth and final theme provides the avenues, including drama and sports, that the youth suggested they could use for conveying messages to the community concerning maternal and general health. Health education on topics such as the importance of delivering at health facilities was emphasised. Regarding advocacy, the youth said they can be involved in reaching out to various stakeholders to raise concerns affecting maternal health. Voluntary work such as construction of energy stoves for pregnant women emerged. The youth also highlighted that they could be exemplary for instance by males accompanying their spouses during antenatal visits. With the need to continuously engage community actors in health initiatives, youth should be considered and supported as important stakeholders so they may engage in activities to improve health within their communities.
Kiracho, E.E., Namuhani, N., Apolot, R.R. et al. (2020) Influence of community scorecards on maternal and newborn health service delivery and utilization, Int J Equity Health 19, 145, https://doi.org/10.1186/s12939-020-01184-6
The community score card (CSC) is a participatory monitoring and evaluation tool that has been employed to strengthen the mutual accountability of health system and community actors. In this paper we describe the influence of the CSC on selected maternal and newborn service delivery and utilization indicators.
Apolot, R.R., Tetui, M., Nyachwo, E.B. et al. (2020) Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District– Uganda, Int J Equity Health 19, 191, https://doi.org/10.1186/s12939-020-01267-4
Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12–19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges.
Between June 2017 and December 2018, Makerere University School of Public Health (MakSPH), in collaboration with Future Health Systems, implemented a Community Scorecard project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku district in Eastern Uganda. This short film highlights some successes from this pilot.
Between 2017 and 2018, the Makerere University School of Public Health (MakSPH), in collaboration with the Future Health Systems Research Consortium, implemented a CSC project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku District, in Eastern Uganda. The implementation was led by stakeholders in the district and comprised of sub county chiefs, Local council chair persons, Health Unit Management Committee chairpersons, Village health team members, community development officers, sub county level councilors and volunteers. This short film is based on the challenges of implementing the project and also explains how these challenges were handled.
FHS partner Makerere University School of Public Health undertook a Community Score Cards study, which contributed to research on how leaders can work with the community and health workers to improve maternal and newborn health in Kibuku District. The use of the Community Score Card tool – a two-way and ongoing participatory tool for assessment, planning, monitoring and evaluation - aims to improve the performance of facilities and accountability by the different stakeholders who are responsible for improving the performance of facilities. This film provides an overview of how to undertake a maternal and newborn community scorecard.