Factors associated with skilled attendance at delivery in Uganda: Results from a national health facility survey

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Study Justification:
The study aims to address the high maternal mortality ratio in Uganda, which is currently at 435/100,000 live births. Skilled attendance at delivery has been identified as a key intervention to reduce maternal mortality. This study investigates the factors associated with skilled attendance at delivery in Uganda, specifically focusing on the availability and access to essential maternity care and health system factors related to maternal health.
Highlights:
– The study found that the majority of deliveries in Uganda (60.7%) occurred in hospitals, while 39.3% occurred in health centers.
– Factors associated with increased deliveries at health facilities included the availability of running water, electricity, and accommodation for staff.
– Health units providing basic emergency obstetric care (EmOC) had the highest chances of attracting women to deliver there, followed by those providing comprehensive EmOC.
– However, the study also revealed that the majority of health facilities expected to offer basic EmOC were not providing the service, which may explain the high health facility-based maternal ratio in Uganda.
Recommendations:
– Improve the availability and quality of care, particularly emergency obstetric care, in health facilities.
– Ensure that health units have access to electricity, running water, and accommodation for staff.
– Increase the number of health facilities offering basic EmOC services to meet the demand.
Key Role Players:
– Ministry of Health: Responsible for implementing and overseeing the recommended interventions.
– Health facility administrators: Involved in ensuring the availability of essential resources and infrastructure.
– Health workers: Responsible for providing skilled attendance at delivery and implementing quality improvement measures.
Cost Items for Planning Recommendations:
– Infrastructure improvement: Budget for installing and maintaining running water and electricity in health facilities.
– Staff accommodation: Allocate funds for constructing and maintaining staff housing.
– Training and capacity building: Budget for training health workers in emergency obstetric care and quality improvement.
– Equipment and supplies: Allocate funds for procuring and maintaining necessary medical equipment and supplies.
Please note that the cost items provided are general categories and not actual cost estimates. The actual budget will depend on the specific needs and context of each health facility.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a survey covering a large number of districts and health facilities in Uganda, which provides a good representation of the situation. The study also presents specific factors associated with increased deliveries at health facilities. However, the evidence could be strengthened by providing more detailed information on the methodology used in the survey, such as the sampling strategy and data collection methods. Additionally, including statistical measures of association (e.g., confidence intervals) would enhance the robustness of the findings. To improve the evidence, future studies could consider incorporating these suggestions.

Uganda has high maternal mortality ratio of 435/100,000 live births. In order to address this, Uganda has developed a strategy and has prioritized skilled attendance at delivery as a key intervention. Methods: A survey covering 54 districts and 553 health facilities was conducted to determine availability and access to essential maternity care and health system factors related to maternal health. The survey specifically assessed availability of emergency obstetric care (EmOC) signal functions, the state of health infrastructure and availability of basic drugs and supplies. Results: A total of 194,029 deliveries were recorded in the year preceding the survey. Majority, 117,761 (60.7%) occurred in hospitals, while 76,268 (39.3%) occurred in health centers. The following factors were associated with increased deliveries at health facilities; running water, (RR 1.5, P < .001); electricity, (RR 1.4, P < .001) and accommodation for staff, (RR 1.2, P < .002). Health units providing basic EmOC had the highest chances of attracting women to deliver there, (RR 4.0, P < .001) as well as those providing comprehensive EmOC, (RR 3.1, P < .001). Furthermore, the majority of health facilities expected to offer basic EmOC, 349 (97.2%) were not offering the service. This is the likely explanation for the high health facility-based maternal ratio of 671/100,000 live births in Uganda. Conclusions: Improving availability and quality of care especially EmOC; and ensuring that health units have electricity, running water and accommodation for staff could increase skilled attendance at delivery and help achieve the Millennium Development Goals (MDG) target on maternal health in Uganda.

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Based on the information provided, the following innovations can be developed to improve access to maternal health in Uganda:

1. Mobile Clinics: Implement mobile clinics equipped with basic obstetric care facilities to reach remote areas where access to health facilities is limited. These clinics can provide antenatal care, skilled attendance at delivery, and postnatal care, ensuring that women in underserved areas receive essential maternal health services.

2. Telemedicine: Establish telemedicine networks to connect healthcare providers in rural areas with specialists in urban centers. This will enable remote consultations, diagnosis, and treatment of obstetric complications, ensuring that women receive timely and appropriate care, even in areas with limited access to specialized healthcare services.

3. Community Health Workers: Train and deploy community health workers to provide basic maternal health services, including antenatal care, health education, and referrals to health facilities for deliveries. These workers can play a crucial role in reaching women in remote areas and increasing awareness about the importance of skilled attendance at delivery.

4. Public-Private Partnerships: Foster partnerships between the government and private healthcare providers to expand access to maternal health services. This can involve subsidizing services in private facilities, improving the quality of care through training and accreditation programs, and leveraging the existing infrastructure and expertise of private providers to reach more women in need.

5. Maternal Health Vouchers: Introduce a voucher system that provides pregnant women with access to a package of essential maternal health services. These vouchers can be distributed to vulnerable populations, such as low-income women or those living in remote areas, and can be redeemed at accredited health facilities, ensuring that women receive quality care without financial barriers.

By implementing these innovations, Uganda can improve access to maternal health services, reduce maternal mortality rates, and achieve the Millennium Development Goals (MDGs) target on maternal health. These strategies address the specific challenges identified in the survey, such as limited infrastructure, lack of skilled healthcare providers, and low awareness about the importance of facility-based deliveries.
AI Innovations Description
Based on the information provided, the following recommendation can be developed into an innovation to improve access to maternal health in Uganda:

Innovation Recommendation: Implement a comprehensive infrastructure improvement program to increase the availability and quality of emergency obstetric care (EmOC) in health facilities across Uganda.

Description: The survey conducted in Uganda highlighted several factors associated with increased deliveries at health facilities, including the availability of running water, electricity, and accommodation for staff. Additionally, health units providing basic EmOC had the highest chances of attracting women to deliver there. However, the majority of health facilities expected to offer basic EmOC were not providing the service.

To address these challenges and improve access to maternal health, it is recommended to implement a comprehensive infrastructure improvement program. This program should focus on the following key areas:

1. Infrastructure Upgrades: Upgrade health facilities to ensure they have access to running water, electricity, and adequate accommodation for staff. This will create a conducive environment for safe deliveries and improve the overall quality of care.

2. EmOC Provision: Ensure that health facilities, especially those expected to offer basic EmOC, are equipped and staffed to provide these services. This includes training healthcare providers, procuring necessary equipment and supplies, and establishing protocols for emergency obstetric care.

3. Capacity Building: Provide training and support to healthcare providers to enhance their skills in providing maternal health services. This can include training on EmOC, emergency preparedness, and management of obstetric complications.

4. Awareness and Education: Conduct awareness campaigns to educate communities about the importance of skilled attendance at delivery and the availability of improved maternal health services. This can help increase demand for facility-based deliveries and encourage women to seek care at health facilities.

By implementing this comprehensive infrastructure improvement program, Uganda can improve access to maternal health services, increase the number of deliveries at health facilities, and ultimately reduce maternal mortality rates. This innovation aligns with the country’s strategy of prioritizing skilled attendance at delivery as a key intervention to address the high maternal mortality ratio.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health in Uganda, the following methodology can be used:

1. Data Collection: Collect data on the current state of health facilities in Uganda, including the availability of running water, electricity, accommodation for staff, and the provision of emergency obstetric care (EmOC) services. This can be done through surveys, interviews, and site visits to health facilities.

2. Baseline Assessment: Determine the baseline levels of skilled attendance at delivery and maternal mortality rates in Uganda. This can be obtained from existing data sources such as national health surveys and reports.

3. Infrastructure Improvement Program: Implement the recommended infrastructure improvement program, which includes upgrading health facilities, providing EmOC services, capacity building for healthcare providers, and conducting awareness campaigns.

4. Monitoring and Evaluation: Continuously monitor and evaluate the progress of the infrastructure improvement program. This can involve tracking the implementation of infrastructure upgrades, the availability and utilization of EmOC services, the training of healthcare providers, and the impact of awareness campaigns on increasing facility-based deliveries.

5. Data Analysis: Analyze the collected data to assess the impact of the infrastructure improvement program on access to maternal health services. This can involve comparing the baseline levels of skilled attendance at delivery and maternal mortality rates with the post-intervention data.

6. Statistical Analysis: Conduct statistical analysis to determine the significance of the changes observed. This can include calculating relative risks, p-values, and confidence intervals to assess the association between the implemented interventions and the outcomes.

7. Interpretation of Results: Interpret the results of the analysis to understand the effectiveness of the infrastructure improvement program in improving access to maternal health services in Uganda. This can involve identifying any significant changes in skilled attendance at delivery rates, reduction in maternal mortality rates, and improvements in the availability and utilization of EmOC services.

By following this methodology, policymakers and healthcare professionals can gain insights into the impact of the recommended interventions on improving access to maternal health in Uganda. This information can guide future decision-making and resource allocation to further enhance maternal health services in the country.

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