Monitoring and Evaluation Outcomes Associated With Strategies to Reduce the Third Delay in Uganda, 2011–2016 (N=105 facilities)

% Relative ChangebSig. Levelc
Strategy 1: Ensure facilities have adequate infrastructure to provide EmONC
Total number of EMONC facilities1025150.0N/A
Number of CEmONC facilities717142.9N/A
Number of BEmONC facilities38166.7N/A
Deliveries in EmONC facilities28.2%41.0%45.4***
Hospitals/health center IVs that perform blood transfusionsd56.3%100.0%77.6N/A
Hospitals/health center IVs that have capacity to perform surgery (caesarean-section)d50.0%100.0%100.0N/A
Facilities with electricity57.1%96.2%68.5***
Facilities with water76.2%100.0%31.2N/A
Strategy 2: Ensure sufficient medical supplies and medications
Facilities experiencing no stock-out of oxytocin in the past 12 months56.2%81.9%45.7***
Facilities experiencing no stock-out of magnesium sulfate in the past 12 months47.6%63.8%34.0***
Facilities reporting gentamycin antibiotic currently available90.5%88.6%−2.1NS
Strategy 3: Ensure sufficient trained health care providers at facilities
Facilities reporting at least 1 doctor, nurse, or midwife is on staff100.0%100.0%0.0NS
Health center IIIs that are open 24/7e74.6%82.9%11.1NS
Facilities reporting EmONC lifesaving interventions performed in the past 3 monthsf
    Parenteral antibiotics85.7%92.4%7.8NS
    Parenteral oxytocin69.5%98.1%41.2***
    Parenteral anticonvulsants48.6%34.3%−29.4**
    Manual removal of placenta28.6%54.3%89.9***
    Remove retained products19.0%61.9%225.8***
    Assisted vaginal delivery4.8%10.5%118.8NS
    Newborn resuscitation34.3%87.6%155.4***
Strategy 4: Improve quality of care and ensure care is evidence-based
Facilities with protocols and guidelines available and displayed on EmONC lifesaving interventions
    Postpartum hemorrhage15.2%85.7%463.8***
    Eclampsia or magnesium sulfate use8.6%74.3%764.0***
    Obstetric and newborn complications26.7%61.0%128.5***
    Immediate newborn care30.5%79.0%159.0***
Facilities that report routine practice of partograph33.3%92.4%177.5***
Facilities that report routine practice of AMTSL75.2%96.2%27.9***
Facilities reporting that obstetric patients never share beds35.2%91.4%159.7***
Facilities reporting that women never deliver on the floor85.7%91.4%6.7NS
Strategy 5: Ensure referral capacity to support transfers to higher-level care
Facilities with at least 1 method of communication for referralsg93.3%99.0%6.1**
Facilities that reported having available transportation (motor vehicle or motorcycle)h61.0%59.0%−3.3NS
Strategy 6: Support effective maternal and perinatal health surveillance
Facilities with maternal death reviews performed6.7%32.4%383.6***
Hospital and health center IVs that performed maternal death reviewsd31.3%94.1%200.6***
  • a Baseline period was June 2011 to May 2012; endline period was January to December 2016.

  • b Percentage change calculations are based on unrounded numbers.

  • c Asterisks indicate significance levels calculated with a z-statistic using McNemar's as follows: *** = P<.01, ** = P<.05, NS = not significant. In cases where significance testing is not warranted, this is denoted as N/A.

  • d Hospital and health center IV was n=16 at baseline and n=17 at endline of HFA.

  • e Health center III was n=71 at baseline and n=70 at endline of HFA.

  • f Performance during the previous 3 months preceding the assessment.

  • g Includes facility owned landline, mobile phone, 2-way radio, or individual had a mobile phone.

  • h Includes available and functional motorized vehicle with fuel today and funds generally available.

  • Abbreviations: AMSTL, active management of the third stage of labor; BEmONC, basic emergency obstetric and newborn care; CEmONC, comprehensive emergency obstetric and newborn care; EmONC, emergency obstetric and newborn care; HFA, health facility assessments; N/A, not applicable; NS, not significant; Sig, significance.