Figures & Tables
Figures
- FIGURE 1
Map of Uganda Showing the Various Phases of SMGL Implementation
Abbreviation: SMGL, Saving Mothers, Giving Life.
- FIGURE 2
Levels of Health Care Service Delivery in Uganda
Source: Northern Uganda Health Integration to Enhance Services (NU-HITES) Assessment Report for Emergency Obstetric Care in Northern Uganda, 2014.
Abbreviations: C-section, cesarean section; HC, health center; IPT, intermittent preventive treatment; PMTCT, prevention of mother-to-child transmission (of HIV).
- FIGURE 3
The WHO Health Systems Framework
- FIGURE 4
Agenda for a Learning Meeting Held for Phase II Facilities in Northern Uganda Involving Facility, District, and Implementing Partner Stakeholders
Abbreviations: LS, learning session; MNCH, maternal, newborn, and child health; MPDR, maternal and perinatal death review; QI, quality improvement.
- FIGURE 5
Health Facility and Community Care Pathway Developed
Abbreviations: PW, pregnant woman; VHT, village health team.
- FIGURE 6
Postpartum and Pregnant Mothers' Experiences With Antenatal Care Services (n=103)
- FIGURE 7
Forms of Community Support to Postpartum and Pregnant Mothers (n=103)
Abbreviation: MNCH, maternal newborn, and child health.
- FIGURE 8
Common Challenges Faced in Implementation of Quality Improvement Strategies (n=125)
- FIGURE 9
Common Challenges Faced by Village Health Teams in Percentages (n=125)
Tables
- TABLE 1.
SMGL Interventions Implemented During Phase 1 and Scaled Up During Phase 2 to Reduce the 3 Delays in Northern Uganda
SMGL Interventions (Phase I) SMGL Intervention Scaled Up to Phase 2 of Northern Uganda Nonbranded SMGL Scale-Up (in Northern Uganda) Increase awareness and seeking care for safe delivery to reduce the first delay √ √ Training of village health teams to encourage birth preparedness and increase demand for facility-based delivery care √ √ Community outreach activities to counsel women, families, local leaders, and community organizations √ √ Distribution of mama kits to incentivize facility-based births X X Community mobilization messages (e.g., radio, billboards, and newspaper articles) and drama skits √ √ Promotion of demand- and supply-side financial incentives to facilitate women seeking, accessing, and using quality care services (e.g., transport and delivery care vouchers, user-fee reductions, and conditional cash transfers) Use of saving groups to save for birth expenses Use of saving groups to save for birth expenses Increase access to quality health care services to reduce the second delay √ √ Upgrade a sufficient number of public and private facilities with appropriate geographical positioning to provide—24 hours a day/7 days a week—clean and safe basic delivery services √ √ Ensure that a minimum of 5 EmONC facilities are providing the recommended lifesaving obstetric interventions 24 hours a day/7 days a week √ √ Hire a sufficient number of skilled birth attendants to consistently provide quality, respectful basic delivery care, diagnosis, and stabilization of complications X X Create a consultative, protocol-driven, quality-assured, and integrated communication/transportation referral system available 24 hours a day/7 days a week that ensures women with complications reach emergency services within 2 hours √ √ Improve quality, appropriate, and respectful care to reduce the third delay √ √ Train health professionals in emergency obstetric care, including obstetric surgeries √ √ Ensure mentoring of newly hired personnel and supportive supervision √ √ Strengthen supply chains for essential supplies and medicines √ √ Ensure implementation of quality effective interventions to prevent and treat obstetric complications √ √ Introduce sound managerial practices utilizing “short-loop” data feedback and response, to ensure reliable delivery of quality essential and emergency maternal and newborn care √ √ Strengthen maternal mortality surveillance in communities and facilities, including timely, no-fault medical death reviews performed in follow-up to every institutional maternal death with cause of death information used for ongoing monitoring and quality improvement √ √ Promote a government-owned health management information system that accurately records every birth, obstetric and newborn complication and treatment provided, and birth outcome at public and private facilities in the district √ √ Abbreviations: EmONC, emergency obstetric and newborn care; SMGL, Saving Mothers, Giving Life.
√, SMGL interventions were implemented.
X, SMGL interventions were not implemented.
- TABLE 2.
Summary of Key Maternal and Newborn Outcomes in National, SMGL, and Unbranded SMGL districts, 2014–2016a
National Unbranded SMGL SMGL 2014 2015 2016 2014 2015 2016 2014 2015 2016 Maternal death Deliveries 862,538 1,122,838 998,162 42,218 47,215 45,721 45,631 49,174 50,521 Maternal deaths 1,071 1,543 1,807 25 50 38 63 60 55 Institutional MMR/100,000 124 137 181 59 106 83 138 122 109 Perinatal death Total births 845,877 936,790 980,574 41,914 46,591 45,629 45,697 48,814 49,855 Total perinatal deaths 27,464 33,589 30,248 1,064 1,476 1,059 1,529 1,628 1267 PNMR/1,000 total births 32.5 35.9 30.8 25.4 31.7 23.2 33.5 33.4 25.4 Predischarge newborn deaths Total live births 825,303 914,387 958,398 41,137 45,740 45,011 44,482 47,455 48,831 Total early newborn deaths 6890 11,186 8,072 287 625 441 314 269 243 ENMR/1,000 live births 8.3 12.2 8.4 7.0 13.7 9.8 7.1 5.7 5.0 Fresh stillbirth Total births 845,877 936,790 980,574 41,914 46,591 45,629 45,697 48,814 49,855 Total fresh stillbirths 12,213 12,531 11,156 496 507 288 720 744 419 FSBR/1,000 total births 14.4 13.4 11.4 11.8 10.9 6.3 15.8 15.2 8.4 Abbreviations: ENMR, early newborn mortality rate; FSBR, fresh stillbirth rate; MMR, maternal mortality ratio; PNMR, perinatal mortality rate; SMGL, Saving Mothers, Giving Life.
↵a Rates are facility based.
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