Innovations in maternal and child health: case studies from Uganda

Abstract

Background: Nearly 300 children and 20 mothers die from preventable causes daily, in Uganda. Communities often identify and introduce pragmatic and lasting solutions to such challenging health problems. However, little is known of these solutions beyond their immediate surroundings. If local and pragmatic innovations were scaled-up, they could contribute to better health outcomes for larger populations. In 2017 an open call was made for local examples of community-based solutions that contribute to improving maternal and child health in Uganda. In this article, we describe three top innovative community-based solutions and their contributions to maternal health. Main text: In this study, all innovations were implemented by non-government entities. Two case studies highlight the importance of bringing reproductive health and maternal delivery services closer to populations, through providing accessible shelters and maternity waiting homes in isolated areas. The third case study focuses on bringing obstetric imaging services to lower level rural health facilities, which usually do not provide this service, through task-shifting certain sonography services to midwives. Various health system and policy relevant lessons are highlighted. Conclusions: The described case studies show how delays in access to health care by pregnant women in rural communities can be systematically removed, to improve pregnancy and delivery outcomes. Emphasis should be put on identification, capacity building and research to support the scale up of these community-based health solutions.

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“…[ 70 ] Context—history of innovation and enterprise in a specific people group, alignment with cultural values, existing organizations, active civic participation [ 80 , 86 ] Political context—a changing policy landscape and mandates [ 88 ] Characteristics of the innovator—an insider (from local community, embedded and lived experience), access to different forms of capital (cultural, intellectual, political, social, financial) [ 65 , 80 ] Characteristics of implementers—lacking motivation and drive [ 88 ] Community ownership—self-governance structures to place the community (beneficiaries) in charge of the innovation [ 64 , 65 ] Stage 2: Transfer/diffusion/scale Alignment with existing regime and structures [ 74 , 77 ] Political culture—A lack of willingness of the existing system or government to make allowance for the integration of the innovation or for new actors to play a role [ 69 , 70 ] Partnerships with stakeholders & especially policy makers [ 65 , 74 ] Resource constraints—limitations in funding [ 65 ] Digital formats e.g. applications, mobile phones, online networks [ 64 , 66 , 79 ] Limited evidence on social innovation effectiveness and unintended consequences [ 83 , 85 ] Stage 3: Institutionalisation Political context—encouraging civic engagement and participatory democracy through discussion and deliberation between civil society and state; history of community organizing and social movements; political capacity of government to bring about changes in healthcare [ 86 ] Communication and advocacy—movement building by engaging a range of organizations to engage in the discussion/spread the message [ …”