RT Journal Article SR Electronic T1 Addressing the Third Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Ensuring Adequate and Appropriate Facility-Based Maternal and Perinatal Health Care JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP S85 OP S103 DO 10.9745/GHSP-D-18-00272 VO 7 IS Supplement 1 A1 Diane Morof A1 Florina Serbanescu A1 Mary M. Goodwin A1 Davidson H. Hamer A1 Alice R. Asiimwe A1 Leoda Hamomba A1 Masuka Musumali A1 Susanna Binzen A1 Adeodata Kekitiinwa A1 Brenda Picho A1 Frank Kaharuza A1 Phoebe Monalisa Namukanja A1 Dan Murokora A1 Vincent Kamara A1 Michelle Dynes A1 Curtis Blanton A1 Agnes Nalutaaya A1 Fredrick Luwaga A1 Michelle M. Schmitz A1 Jonathan LaBrecque A1 Claudia Morrissey Conlon A1 Brian McCarthy A1 Charlan Kroelinger A1 Thomas Clark A1 , YR 2019 UL http://www.ghspjournal.org/content/7/Supplement_1/S85.abstract AB Saving Mothers, Giving Life used 6 strategies to address the third delay—receiving adequate health care after reaching a facility—in maternal and newborn health care. The intervention approaches can be adapted in low-resource settings to improve facility-based care and reduce maternal and perinatal mortality.Background:Saving Mothers, Giving Life (SMGL) is a 5-year initiative implemented in participating districts in Uganda and Zambia that aimed to reduce deaths related to pregnancy and childbirth by targeting the 3 delays to receiving appropriate care: seeking, reaching, and receiving. Approaches to addressing the third delay included adequate health facility infrastructure, specifically sufficient equipment and medications; trained providers to provide quality evidence-based care; support for referrals to higher-level care; and effective maternal and perinatal death surveillance and response.Methods:SMGL used a mixed-methods approach to describe intervention strategies, outcomes, and health impacts. Programmatic and monitoring and evaluation data—health facility assessments, facility and community surveillance, and population-based mortality studies—were used to document the effectiveness of intervention components.Results:During the SMGL initiative, the proportion of facilities providing emergency obstetric and newborn care (EmONC) increased from 10% to 25% in Uganda and from 6% to 12% in Zambia. Correspondingly, the delivery rate occurring in EmONC facilities increased from 28.2% to 41.0% in Uganda and from 26.0% to 29.1% in Zambia. Nearly all facilities had at least one trained provider on staff by the endline evaluation. Staffing increases allowed a higher proportion of health centers to provide care 24 hours a day/7 days a week by endline—from 74.6% to 82.9% in Uganda and from 64.8% to 95.5% in Zambia. During this period, referral communication improved from 93.3% to 99.0% in Uganda and from 44.6% to 100% in Zambia, and data systems to identify and analyze causes of maternal and perinatal deaths were established and strengthened.Conclusion:SMGL's approach was associated with improvements in facility infrastructure, equipment, medication, access to skilled staff, and referral mechanisms and led to declines in facility maternal and perinatal mortality rates. Further work is needed to sustain these gains and to eliminate preventable maternal and perinatal deaths.