Between 2014 to 2016 the Centre has been implementing projects aimed at strengthening health system interventions for improving care for both the mother and the baby in a network of six hospitals in Busoga region. The projects include the Referral Network study, Regionalizing Maternal and Newborn Care study and Kangaroo Mother Care study. These six hospitals include: Jinja Regional Referral hospital, Buluba, Bugiri, Kamuli Mission, Kamuli government and Iganga Hospitals. These studies were done through three major interventions: (1) Training of health workers to impart skills, (2) Mentorship to sustain the skills, and (3) Catalytic provision of key commodities including equipment and drugs.

Whereas the project achieved significant reduction in facility maternal mortality by 68%, there was insignificant impact on neonatal deaths and stillbirths. Through consultation with stakeholders and analysis of data from death reviews, we learnt that intervening at hospital level may not attain much in reducing stillbirths and neonatal deaths. This is mainly because hospitals are not easily physically accessible to majority of population and often they are highly congested which affects the timeliness and quality of interventions. Hospitals do not function effectively when lower level facilities are not functional; however, functional lower level facilities significantly support processes and outcomes aiming to improve access to timely basic and emergency obstetric care. They also reduce unnecessary referrals thus decongesting hospitals and allowing them to function better.

Cognizant of this linkage, we are now improving the project to a modified maternal newborn scale up extension project (MANeSCALE ext.) which fundamentally draws lessons learnt from early implementation of the original MANeSCALE. Here we will focus on piloting the establishment of a network of facilities – mostly Health Centre IVs and hospitals which collaboratively work to improve care for mothers and babies through improved referral and quality of care for mothers and babies around the time of birth in Central Eastern Uganda.

Study Goal & Objectives
The overall goal of the study is to strengthen a regional network of facilities for improvement of the quality of maternal and newborn care around time of birth in the Central Eastern region of Uganda.

Objectives
To assess factors influencing the implementation of maternal and newborn training and mentorship programs in the regional network of health facilities
To assess the factors influencing implementation of maternal and perinatal death reviews
To explore the role and impact of leadership engagement in maternal and newborn care (MNC)
To measure the effect of a combined package [of MPDR, mentorship, training, provision of catalytic equipment and leadership engagement] on the quality of care for mothers and babies.

Contacts

Principal Investigator: Associate Prof. Peter Waiswa

E-mail: pwaiswa@musph.ac.ug