Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

Abstract

BackgroundIn Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities.ObjectiveThis paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme.DesignThis health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening.ResultsSeventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs.ConclusionHealth system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities.

Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda

“…The MANIFEST approach demonstrated that it is possible to have positive and collegial relationships between health workers and supervisors. The changes in the use of support supervision in improving the quality of maternal and newborn care services has also been reported by other studies conducted in low-income countries [10,12–14]. …”

“…Available evidence highlights the importance of support supervision in strengthening relationships within the system, identification and resolution of problems, optimizing the allocation of resources, motivating health workers, promoting the use of standard procedures, and teamwork [10,11]. Support supervision also provides opportunities for regular feedback and therefore promotes skill building through appropriate strategies, such as training and mentorships [12,13].…”

Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda

“…The predominant ethnic group in the HDSS is the Basoga, a bantu-speaking group which make up 8% of Uganda’s population. The HDSS is served by one 100-bed hospital and at least 19 government-run and private-sector health centres [17]. A rising proportion of women in the Central East region, over two-thirds, deliver at health facilities [18].…”

Observation study showed that the continuity of skin‐to‐skin contact with low‐birthweight infants in Uganda was suboptimal

“…Prolonged direct SSC between infants and caregivers is the cornerstone of KMC . Most studies of KMC have taken place in dedicated KMC wards , where staff were trained to care for both newborn infants and post‐partum women. Intermittent SSC may occur in the absence of a KMC ward or where adequate space to practice continuous SSC does not exist or is not used.…”