Saving Mothers, Giving Life: A Systems Approach to Reducing Maternal and Perinatal Deaths in Uganda and Zambia

Abstract

The 5-year public-private partnership boldly addressed maternal mortality in Uganda and Zambia using a systems approach at the district level to avoid delays in women seeking, reaching, and receiving timely, quality services. This supplement provides details on the Saving Mothers, Giving Life partnership and approach, including the model, impact, costs, and sustainability.

Postnatal care services in rural Zambia: a qualitative exploration of user, provider, and community perspectives on quality of care

“…They also offered guidance and instructions to pregnant women regarding use of MWHs, decision-making process regarding childbirth preparedness and place of delivery and the importance of attending PNC visits. SMGL phase 1 (2012–2013) project results showed a 31% increase in access to and coverage of emergency obstetric and newborn care (EmONC), a 44% increase in the number of women delivering in health facilities, a 41% reductions in mothers dying across target districts, a 38% decline in health facility maternal mortality, and a 36% decrease in total stillbirths in the facility along with a decrease in perinatal mortality [ 32 ].…”

Access to care solutions in healthcare for obstetric care in Africa: A systematic review

“…In Uganda there was a 258% increase in facility deliveries supported by transportation vouchers. In Zambia,there was a 31% increase in health facilities with available transportation [58] mAccess program: an interactive and personalized 2-way SMS messaging to increase maternal and child health service utilization along with SMS messaging for identification of motorcycle transport to health facilities [61] Acceptance of the mAccess innovation throughout pregnancy and childbirth; assistance in overcoming some health system barriers [61] mAccess program: Provision of 2-way text messaging to increase maternal and child health service utilization and identify motorcycle transport for maternal emergencies [62] 5-times increased odds of 4 ANC visits; 3 times higher odds of travel time of 30-60 minutes to a health facility; 4 times higher odds of at least 4 PNC visits; no differences in miscarriage or stillbirth rates [62] SMGL program: Transportation-specific interventions included development and strengthening of systems for communication, referral, and transportation available 24/7 [64] 44% reduction in both facility and district wide MMR in Uganda, and a 38% decrease in facility and a 41% decline in districtwide MMR in Zambia [64] Free transportation and installation of radio system to link hospitals and referral vehicles [66] Increased hospital utilization for maternal complications; decrease in case fatality rate by half; cost of intervention was $74,836 USD [66] Referral system development with ambulances and radios; policy and advocacy efforts [67] Increased proportion of facility births; no significant change in institutional births; increase facility use for complications; case fatality rate decreased from 2.9% to 1.6% [67] Community capacity building and engagement to develop emergency transportation plans [69] Increase in number of villages with community plans for maternal health emergency transportation [69] SMGL program: Transportation-specific interventions included expansion of motorized transportation to emergency obstetric and newborn care (EmONC) through transportation vouchers for motorcycle taxis and a coordinated ambulance service [70] Decrease in estimated travel time to EmONC facilities; increase in proportion of EmONC and comprehensive EmONC (CEmONC) facilities within 2 hours by 18% and 37%, respectively, from baseline; further increases in EmONC and CEmONC facility use occurred if 4-wheeled vehicles could be used (14% and 31%) [70] Issue of 18 dedicated vehicles for interfacility transport for maternal health emergencies [71] Decrease in maternal mortality rate from 279/100,000 to 152/100,000; decrease in dispatch interval for referrals from 32.01 to 22.47 minutes; increase in number of vehicles dispatched within 1 hour [71] (Continued )…”

“…In Zambia,there was a 31% increase in health facilities with available transportation. Renovation and construction of maternity waiting homes resulted in a 69% increase in facilities associated with maternity waiting homes [58] SMGL program: Facility infrastructure-specific interventions included improvement of safe facilities and hospitals for deliveries; supplies and provision of basic and emergency obstetric services [64] 44% reduction in both facility and district wide MMR in Uganda, and a 38% decrease in facility and a 41% decline in districtwide MMR in Zambia [64] Facility infrastructure improvements [67] Increased proportion of facility births; no significant change in institutional births; increase facility use for complications; case fatality rate decreased from 2.9% to 1.6% [67] SMGL program: Facility infrastructure-specific interventions included improving the availability and distribution of EmONC services [70] Decrease in estimated travel time to EmONC facilities; increase in proportion of EmONC and comprehensive CEmONC facilities within 2 hours by 18% and 37%, respectively, from baseline; further increases in EmONC and CEmONC facility use occurred if 4-wheeled vehicles could be used (14% and 31%) [70] A multifaceted approach, which included health information system strengthening, improvement of health center infrastructure and supplies [82] Increased facility-based deliveries from 7.3% to 35.6%; increased receipt of ANC components and SBA attendance at delivery; no difference in coverage of 4 ANC visits or PNC visits [82] https://doi.org/10.1371/journal.pone.0252583.t002…”

Saving Mothers, Giving Life: Don’t Neglect the Health Systems Element

“…The SMGL initiative was clearly conceived as an HSS initiative, using a “systems approach, focused at the health district level” 1 and addressing 5 elements of the health system in an integrated manner. This systems approach was designed to “create a highly visible, bold initiative that would galvanize global action and financial support” 2 and demonstrate that such an initiative “could achieve impressive results in a short time.” 1 …”

“…SMGL implementation at a district level relied on multiple partners, including teams of Ugandan and Zambian government medical and local civic leaders as well as “equally dedicated and talented U.S. government teams.” 1 This approach was reported to have enabled 1 :…”