@article {MorofS85, author = {Diane Morof and Florina Serbanescu and Mary M. Goodwin and Davidson H. Hamer and Alice R. Asiimwe and Leoda Hamomba and Masuka Musumali and Susanna Binzen and Adeodata Kekitiinwa and Brenda Picho and Frank Kaharuza and Phoebe Monalisa Namukanja and Dan Murokora and Vincent Kamara and Michelle Dynes and Curtis Blanton and Agnes Nalutaaya and Fredrick Luwaga and Michelle M. Schmitz and Jonathan LaBrecque and Claudia Morrissey Conlon and Brian McCarthy and Charlan Kroelinger and Thomas Clark}, editor = {,}, title = {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}, volume = {7}, number = {Supplement 1}, pages = {S85--S103}, year = {2019}, doi = {10.9745/GHSP-D-18-00272}, publisher = {Global Health: Science and Practice}, abstract = {Saving Mothers, Giving Life used 6 strategies to address the third delay{\textemdash}receiving adequate health care after reaching a facility{\textemdash}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{\textemdash}health facility assessments, facility and community surveillance, and population-based mortality studies{\textemdash}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{\textemdash}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{\textquoteright}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.}, URL = {https://www.ghspjournal.org/content/7/Supplement_1/S85}, eprint = {https://www.ghspjournal.org/content/7/Supplement_1/S85.full.pdf}, journal = {Global Health: Science and Practice} }