Improving access to skilled attendance at delivery: A policy brief for Uganda

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Study Justification:
– The study aims to address the low proportion of pregnant women delivering from public and private non-profit facilities in Uganda.
– It provides evidence-based policy options to increase access to skilled birth attendance.
– The study involves a priority setting process involving policy makers and stakeholders, ensuring relevance and applicability of the findings.
Highlights:
– The study identifies three policy options that can be adopted independently or in combination to improve access to skilled care during childbirth.
– The options include providing intrapartum care at first level health facilities, implementing maternal waiting shelters, and working with the private-for-profit sector to facilitate deliveries in health facilities.
– The study highlights the importance of a combination of strategies to effectively implement the proposed options.
Recommendations:
– Policy makers should consider providing intrapartum care at first level health facilities to increase access to skilled birth attendance.
– Implementing maternal waiting shelters can also be an effective intervention to improve access to skilled care during childbirth.
– Collaboration with the private-for-profit sector should be encouraged to facilitate deliveries in health facilities.
Key Role Players:
– Ministry of Health: Responsible for implementing and overseeing the recommended policy options.
– Members of Parliament: Play a crucial role in advocating for and supporting the implementation of the recommendations.
– Health Managers: Involved in the planning and coordination of the interventions.
– Researchers: Provide ongoing evaluation and monitoring of the implemented strategies.
– Civil Society Organizations: Contribute to raising awareness and supporting the implementation of the recommendations.
– Professional Organizations: Provide expertise and guidance in implementing the policy options.
– Media: Play a role in disseminating information and raising public awareness.
Cost Items for Planning:
– Infrastructure development for first level health facilities to provide intrapartum care.
– Construction and maintenance of maternal waiting shelters.
– Training and capacity building for health care providers.
– Collaboration and partnership agreements with the private-for-profit sector.
– Monitoring and evaluation activities to assess the effectiveness of the interventions.
– Communication and awareness campaigns to promote the use of skilled birth attendance services.
Note: The actual cost of these items will depend on the specific context and implementation plan.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a study that used the SUPPORT Tools for evidence-informed health policy making. The problem was identified through a priority setting process involving policy makers and stakeholders, and relevant research was reviewed. However, the abstract does not provide specific details about the research methods or the quality of the evidence. To improve the strength of the evidence, the abstract could include more information about the study design, sample size, data collection methods, and any limitations of the research. Additionally, providing references to the specific research studies mentioned in the abstract would allow readers to access and evaluate the evidence themselves.

Objective: This study describes the process of production, findings for a policy brief on Increasing Access to Skilled Birth Attendance, and subsequent use of the report by policy makers and others from the health sector in Uganda. Methods: The methods used to prepare the policy brief use the SUPPORT Tools for evidence-informed health policy making. The problem that this evidence brief addresses was identified through an explicit priority setting process involving policy makers and other stakeholders, further clarification with key informant interviews of relevant policy makers, and review of relevant documents. A working group of national stakeholder representatives and external reviewers commented on and contributed to successive drafts of the report. Research describing the problem, policy options, and implementation considerations was identified by reviewing government documents, routinely collected data, electronic literature searches, contact with key informants, and reviewing the reference lists of relevant documents that were retrieved. Results: The proportion of pregnant women delivering from public and private non-profit facilities was low at 34 percent in 2008/09. The three policy options discussed in the report could be adopted independently or complementary to the other to increase access to skilled care. The Ministry of Health in deliberating to provide intrapartum care at first level health facilities from the second level of care, requested for research evidence to support these decisions. Maternal waiting shelters and working with the private-for-profit sector to facilitate deliveries in health facilities are promising complementary interventions that have been piloted in both the public and private health sector. A combination of strategies is needed to effectively implement the proposed options as discussed further in this article. Conclusions: The policy brief report was used as a background document for two stakeholder dialogue meetings involving members of parliament, policy makers, health managers, researchers, civil society, professional organizations, and the media. Copyright © Cambridge University Press 2013.

The policy brief titled “Improving access to skilled attendance at delivery: A policy brief for Uganda” suggests several strategies to enhance access to maternal health in Uganda. These strategies include:

1. Providing intrapartum care at first-level health facilities: The Ministry of Health should consider offering skilled birth attendance at primary healthcare facilities. This would ensure that women have access to skilled care during childbirth, even in remote or underserved areas.

2. Establishing maternal waiting shelters: Maternal waiting shelters are temporary accommodations near health facilities where pregnant women can stay before their due date. This helps ensure that women can access skilled care during labor and delivery, especially if they live far away from health facilities.

3. Collaborating with the private-for-profit sector: The government should work with private healthcare providers to facilitate deliveries in health facilities. This partnership can help increase the availability of skilled birth attendance and improve access to maternal health services.

These strategies have been piloted in both the public and private health sectors and have shown promise in increasing access to skilled care. It is important to note that a combination of these strategies may be necessary for effective implementation.

The policy brief report was used as a background document for stakeholder dialogue meetings involving members of parliament, policy makers, health managers, researchers, civil society, professional organizations, and the media. This indicates that the recommendations have been considered and discussed by relevant stakeholders.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health in Uganda is to adopt a combination of strategies. These strategies include:

1. Providing intrapartum care at first-level health facilities: The Ministry of Health should consider providing skilled birth attendance at the primary healthcare level, rather than limiting it to higher-level facilities. This would ensure that women have access to skilled care during childbirth, even in remote or underserved areas.

2. Establishing maternal waiting shelters: Maternal waiting shelters are temporary accommodations near health facilities where pregnant women can stay in the weeks leading up to their due date. This helps ensure that women can access skilled care during labor and delivery, especially if they live far away from health facilities.

3. Collaborating with the private-for-profit sector: The government should work with private healthcare providers to facilitate deliveries in health facilities. This partnership can help increase the availability of skilled birth attendance and improve access to maternal health services.

It is important to note that these strategies can be implemented independently or in combination with each other, depending on the specific context and resources available. The policy brief report mentioned in the description provides further details and evidence to support these recommendations.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health in Uganda, a methodology could be developed using the following steps:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the proportion of pregnant women receiving skilled birth attendance, the distance to the nearest health facility, and the availability of maternal waiting shelters.

2. Collect baseline data: Gather data on the current status of the indicators in the target areas. This can be done through surveys, interviews, and data from health facilities and government reports.

3. Develop a simulation model: Create a mathematical or statistical model that simulates the impact of the recommended strategies on the selected indicators. The model should take into account factors such as population size, geographical distribution, and existing healthcare infrastructure.

4. Input data and assumptions: Input the baseline data into the simulation model and make assumptions about the potential impact of each recommendation. For example, assume that providing intrapartum care at first-level health facilities will increase the proportion of pregnant women receiving skilled birth attendance by a certain percentage.

5. Run the simulation: Run the simulation model using the input data and assumptions to estimate the potential impact of the recommendations on the selected indicators. This will provide quantitative estimates of the expected changes in access to maternal health.

6. Analyze the results: Analyze the simulation results to understand the potential benefits and limitations of each recommendation. Identify any trade-offs or unintended consequences that may arise from implementing the strategies.

7. Sensitivity analysis: Conduct sensitivity analysis to test the robustness of the simulation results. This involves varying the input parameters and assumptions to see how sensitive the results are to changes in these factors.

8. Interpret and communicate the findings: Interpret the simulation results and communicate them to policymakers, stakeholders, and other relevant audiences. Present the findings in a clear and concise manner, highlighting the potential impact of the recommendations on improving access to maternal health in Uganda.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data in Uganda.

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