Tested Changes to Improve Maternal and Newborn Care
This synthesis of evidence-based changes to improve processes and systems for maternal and newborn care in Uganda was developed for the Ministry of Health by the USAID ASSIST Project as part of its assistance to the PEPFAR-funded Saving Mothers Giving Life (SMGL) initiative.
SMGL was launched in 2012 to accelerate the reduction of maternal and newborn deaths in sub-Saharan African countries, with initial focus on Uganda and Zambia. It was designed to address the three major gaps in health service delivery that are often associated with maternal and newborn deaths.
In Uganda, the Ministry of Health partnered with USAID and CDC to support the implementation of evidence-based, high-impact interventions that had the potential to reduce maternal and newborn mortality in four districts of Western Uganda (Kyenjojo, Kamwenge, Kibaale, and Kabarole) with high maternal mortality rates. USAID ASSIST was one of the implementing partners providing technical assistance to 20 health facilities across continuum of health service delivery system in the four priority districts.
Results of the baseline assessment conducted with ASSIST support identified five major gaps in the process of providing maternal and newborn care that were on the pathway to high mortality rates in the districts. The identified gaps were: i) prolonged and often obstructed labor, ii) postpartum hemorrhage, iii) pregnancy induced hypertension, iv) neonatal sepsis, and v) birth asphyxia.
The interventions to prevent and address these gaps became the focus of ASSIST’s quality improvement efforts in the four SMGL districts. ASSIST supported the sites to address three main improvement aims: 1) improving partograph use for labor monitoring, 2) increasing the application of active management of the third stage of labor, and 3) increasing routine delivery of a complete package of essential newborn care. From January 2012 through May 2014, these 20 teams achieved large gains in compliance with quality standards for key maternal and newborn services.
This document summarizes the most robust and effective changes in improving maternal and newborn care that were tested through an improvement collaborative involving the 20 health facilities in Western Uganda. The change ideas recommended here are backed by data collected over time, which shows improvements in the quality of care provided to mothers and their newborn babies.
Frontline health workers taking care of mothers and their newborn babies are the primary intended users of this change package. Others, like NGOs and projects involved in maternal and newborn care, district health officers supervising health facilities, and Ministry of Health officials working on strategies for improving maternal and newborn health, will find the evidence-based high impact changes described in the document very useful and can adapt them for their work.