Saving Mothers Giving Life (SMGL): From 2012-2018, with funding from CDC, BU implemented the $16.6 million SMGL Proof of Concept and Project in Kabarol e, Kyenjojo, and Kamwenge districts. The objective was to reduce Maternal Mortality by 50% in the three districts, and to improve access to and utilization of quality obstetric and newborn care services. Key Successes included:
- Built the capacity of health providers in Rwenzori region in various topical areas, including Emergency Obstetric and Newborn Care (EmONC), Long term methods of family planning; Quality Improvement; Infection Control and Prevention; and Maternal and Perinatal Death Surveillance and Response.
- Set up 7 skills labs at HC IVs and hospitals to ensure maternal and newborn skills maintenance. Each received a neo-Natalie, a mama-Natalie, and standard operating procedures to enable health providers at the host unit and those from lower facilities to practice their skills frequently.
- Refurbished and equipped 12 functional operating theatres, 5 neonatal special care units, and 5 maternity wards between 2012 and 2017. Geographical access to Comprehensive Emergency Obstetric Care services increased from 3 to 12 health facilities in the Rwenzori region, leading to a 16% increase in the number of women within 2 hours of accessing emergency obstetric care.
- Over 23,500 health worker encounters (including over 3,700 for EmONC) and 5,000 para-social workers benefitted from pre-and in-service trainings and mentorships in the period 2012 – 2017 to improve knowledge and skills in selected areas for quality service provision.
- Sustainability: The established infrastructure, the skills labs, and the trained regional mentors were resources left in place at project closure to foster sustainability. Districts were also encouraged to incorporate RMNCAH within their annual district budgets to maintain the project gains further.
Strengthening technical and management capacity of District Local Governments for Reproductive, Maternal, New-born, Child, Adolescent Health (RMNCAH), WASH and education services in 10 districts in Western and East Central zones of Uganda (April 2021-June 2022): With funding from UNICEF, BU has supported ten districts (Mubende, Kasese, Kikuube, Isingiro, Ntungamo, Kamwenge, Kyegegwa, Tororo, Kamuli and Namayingo) to improve the quality of maternal and new-born care at primary healthcare level. Facilities implemented at least 3 interventions (labour and delivery care, Kangaroo mother care (KMC) and new-born resuscitation).
- Some districts such as Kasese registered improvement of skilled birth attendance of 93%, from 80% at inception (National target is 89%).
- Best practices from Kasese include continued community dialogue and communication around skilled attendance; discouragement of unskilled attendants at delivery and training/converting Traditional Birth Attendants (TBAs) to VHTs to refer pregnant women to health facilities.
- Provision of KMC to low-birth-weight infants has progressively increased from 58.8% at inception to 91% at closure in at 10 districts, attributed to capacity building of health workers on managing small new-borns;
Consultancy services for Clinical Skills Updates and Mentorship for RMNCAH (March-December 2022):
- BU currently provides consultancy services for Clinical Skills Updates and Mentorship for RMNCAH in the Bunyoro-Tooro (mid-western) region in Uganda funded by the Ministry of Health’s (MoH) Uganda Reproductive, Maternal, and Child Health Services Improvement Project (URMCHIP)/ World Bank.
BU has to date facilitated training in Operative Obstetrics and SAFE anaesthesia;
Updating the skills of Health providers for RMNCAH
Since March 7, 2022 Baylor Uganda has been working Ministry of Health’s (MoH) Uganda Reproductive, Maternal, and Child Health Services Improvement Project (URMCHIP) to provide Consultancy Services for Clinical Skills Updates and mentorship for Reproductive, Maternal, New-born, Child, and Adolescent Health (RMNCAH) in the Mid-Western Region in 17 districts and 2 cities of Tooro and Bunyoro sub-regions.
Working with the health professional associations of Obstetricians and Gynaecologists of Uganda (AOGU), of Anaesthesiologists of Uganda (AAU), Uganda Paediatrics association (UPA), Federation of Uganda Nurses and Midwives (FUNM) and the Uganda Private Midwives association (UPMA), Baylor-Uganda has assembled a pool of 47 master mentors (consisting of Obstetricians, Anaesthesiologists and Paediatricians) and 21 mentor midwives to conduct onsite mentorships for medical officers, anaesthetic officers and midwives to ensure proficiency in providing emergency obstetric and neonatal care.
By the end of June 2022, the mentors had determined the critical health facility gaps and engaged up to 361 providers at 49 sites that provide caesarean section deliveries and 61 mentees at 22 sites providing normal delivery once, to start address their skills gaps for management of the leading causes of death to mothers and their babies
Conclusion and Recommendation
By end of the first round of mentorship it was clear that most of the HC IVs are operating at less than full capacity or not at all because of shortages in critical staff, especially anaesthetists and Medical officers, essential medicines, supplies, equipment, and key infrastructure. If the mentorship exercise is to impact maternal and new-born morbidity and mortality, MoH needs to address the persisting system gaps that are beyond results based financing and current PHC funding.