Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda
School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
Kampala Children's Hospital, Kampala, Uganda.
St. Raphael of St. Francis Hospital, Nsambya, Kampala, Uganda.
Show others and affiliations
2015 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, 24271Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities.

OBJECTIVE:

This 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.

DESIGN:

This 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.

RESULTS:

Seventy 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.

CONCLUSION:

Health 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.

Place, publisher, year, edition, pages
2015. Vol. 8, 24271
Keyword [en]
health system strengthening; maternal care; newborn care; neonatal mortality; kangaroo mother care; Uganda
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-251594DOI: 10.3402/gha.v8.24271ISI: 000377758800001PubMedID: 25843496OAI: oai:DiVA.org:uu-251594DiVA: diva2:806749
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2017-12-04Bibliographically approved

Open Access in DiVA

fulltext(618 kB)112 downloads
File information
File name FULLTEXT01.pdfFile size 618 kBChecksum SHA-512
8da31546f100166ebd7f08d8bac09917103b9cd273c55eb3ca932e63f7d683eaca3163833879a6bf694964be361edfb2dcf5e33f93ffb077c4dec78e06bee768
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Peterson, Stefan
By organisation
International Maternal and Child Health (IMCH)
In the same journal
Global Health Action
Public Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar
Total: 112 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 634 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf