Addressing the third delay in saving mothers, giving life districts in Uganda and Zambia: Ensuring adequate and appropriate facility-based maternal and perinatal health care

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Study Justification:
The study aimed to address the third delay in saving mothers and giving life in Uganda and Zambia. The third delay refers to the delay in receiving appropriate facility-based maternal and perinatal health care. By targeting this delay, the study aimed to reduce deaths related to pregnancy and childbirth.
Highlights:
1. The Saving Mothers, Giving Life (SMGL) initiative increased the proportion of facilities providing emergency obstetric and newborn care (EmONC) in Uganda from 10% to 25% and in Zambia from 6% to 12%.
2. The delivery rate occurring in EmONC facilities increased from 28.2% to 41.0% in Uganda and from 26.0% to 29.1% in Zambia.
3. Nearly all facilities had at least one trained provider on staff by the end of the initiative.
4. Staffing increases allowed a higher proportion of health centers to provide care 24 hours a day/7 days a week.
5. Referral communication improved significantly in both Uganda and Zambia.
6. Data systems to identify and analyze causes of maternal and perinatal deaths were established and strengthened.
Recommendations:
1. Sustain and build upon the improvements in facility infrastructure, equipment, medication, access to skilled staff, and referral mechanisms achieved through the SMGL initiative.
2. Continue efforts to eliminate preventable maternal and perinatal deaths.
3. Strengthen data systems for monitoring and evaluating maternal and perinatal health outcomes.
Key Role Players:
1. Ministry of Health in Uganda and Zambia
2. Health facility administrators and staff
3. Trained providers
4. Community health workers
5. Non-governmental organizations (NGOs) working in maternal and child health
Cost Items for Planning Recommendations:
1. Facility infrastructure improvements
2. Equipment and medication procurement
3. Training and capacity building for health care providers
4. Referral system development and maintenance
5. Data system establishment and maintenance
6. Community engagement and awareness campaigns
7. Monitoring and evaluation activities

Background: Saving Mothers, Giving Life (SMGL) is a 5-year initiative implemented in participating districts in Uganda and Zambia that aimed to reduce deaths related to pregnancy and childbirth by targeting the 3 delays to receiving appropriate care: seeking, reaching, and receiving. Approaches to addressing the third delay included adequate health facility infrastructure, specifically sufficient equipment and medications; trained providers to provide quality evidence-based care; support for referrals to higher-level care; and effective maternal and perinatal death surveillance and response. Methods: SMGL used a mixed-methods approach to describe intervention strategies, outcomes, and health impacts. Programmatic and monitoring and evaluation data-health facility assessments, facility and community surveillance, and population-based mortality studies-were used to document the effectiveness of intervention components. Results: During the SMGL initiative, the proportion of facilities providing emergency obstetric and newborn care (EmONC) increased from 10% to 25% in Uganda and from 6% to 12% in Zambia. Correspondingly, the delivery rate occurring in EmONC facilities increased from 28.2% to 41.0% in Uganda and from 26.0% to 29.1% in Zambia. Nearly all facilities had at least one trained provider on staff by the endline evaluation. Staffing increases allowed a higher proportion of health centers to provide care 24 hours a day/7 days a week by endline-from 74.6% to 82.9% in Uganda and from 64.8% to 95.5% in Zambia. During this period, referral communication improved from 93.3% to 99.0% in Uganda and from 44.6% to 100% in Zambia, and data systems to identify and analyze causes of maternal and perinatal deaths were established and strengthened. Conclusion: SMGL’s approach was associated with improvements in facility infrastructure, equipment, medication, access to skilled staff, and referral mechanisms and led to declines in facility maternal and perinatal mortality rates. Further work is needed to sustain these gains and to eliminate preventable maternal and perinatal deaths.

The publication “Addressing the third delay in saving mothers, giving life districts in Uganda and Zambia: Ensuring adequate and appropriate facility-based maternal and perinatal health care” recommends several key strategies to improve access to maternal health in Uganda and Zambia. These strategies include:

1. Improving health facility infrastructure: This involves enhancing the availability of adequate equipment and medications in health facilities to ensure they are well-equipped to provide maternal and perinatal health care.

2. Training healthcare providers: Providing training to healthcare providers to ensure they have the necessary skills and knowledge to deliver quality evidence-based care to pregnant women and newborns.

3. Strengthening referral systems: Establishing effective referral mechanisms to ensure that pregnant women and newborns who require higher-level care can be promptly and safely transferred to appropriate facilities.

4. Enhancing maternal and perinatal death surveillance and response: Establishing and strengthening data systems to identify and analyze the causes of maternal and perinatal deaths. This information can then be used to inform targeted interventions and improve the quality of care.

The implementation of these strategies during the Saving Mothers, Giving Life (SMGL) initiative resulted in significant improvements in facility infrastructure, access to skilled staff, referral communication, and maternal and perinatal mortality rates.

It is important to note that sustaining these gains and eliminating preventable maternal and perinatal deaths will require ongoing efforts and continued investment in maternal health services.
AI Innovations Description
The recommendation to improve access to maternal health in Uganda and Zambia, as described in the publication “Addressing the third delay in saving mothers, giving life districts in Uganda and Zambia: Ensuring adequate and appropriate facility-based maternal and perinatal health care,” includes the following key strategies:

1. Improve health facility infrastructure: Enhance the availability of adequate equipment and medications in health facilities to ensure that they are well-equipped to provide maternal and perinatal health care.

2. Train healthcare providers: Provide training to healthcare providers to ensure they have the necessary skills and knowledge to deliver quality evidence-based care to pregnant women and newborns.

3. Strengthen referral systems: Establish effective referral mechanisms to ensure that pregnant women and newborns who require higher-level care can be promptly and safely transferred to appropriate facilities.

4. Enhance maternal and perinatal death surveillance and response: Establish and strengthen data systems to identify and analyze the causes of maternal and perinatal deaths. This information can then be used to inform targeted interventions and improve the quality of care.

The implementation of these strategies during the Saving Mothers, Giving Life (SMGL) initiative resulted in significant improvements in facility infrastructure, access to skilled staff, referral communication, and maternal and perinatal mortality rates.

It is important to note that sustaining these gains and eliminating preventable maternal and perinatal deaths will require ongoing efforts and continued investment in maternal health services.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Baseline data collection: Gather data on the current state of maternal health access in the target areas in Uganda and Zambia. This could include information on health facility infrastructure, availability of equipment and medications, healthcare provider training, referral systems, and maternal and perinatal mortality rates.

2. Define indicators: Identify specific indicators that will be used to measure the impact of the recommendations. For example, indicators could include the proportion of facilities with adequate equipment and medications, the percentage of healthcare providers trained in maternal and perinatal care, the effectiveness of referral systems, and changes in maternal and perinatal mortality rates.

3. Intervention implementation: Implement the recommended strategies in the target areas. This could involve improving health facility infrastructure, providing training to healthcare providers, strengthening referral systems, and establishing maternal and perinatal death surveillance and response systems.

4. Data collection during intervention: Collect data on the implementation of the recommendations. This could include monitoring the progress of infrastructure improvements, tracking the number of healthcare providers trained, assessing the effectiveness of referral systems, and documenting changes in maternal and perinatal mortality rates.

5. Data analysis: Analyze the collected data to evaluate the impact of the recommendations. Compare the baseline data with the data collected during the intervention to determine the extent of improvement in access to maternal health. This analysis could involve statistical methods to assess the significance of the changes observed.

6. Interpretation and reporting: Interpret the results of the data analysis and report on the impact of the recommendations. This could involve summarizing the findings, highlighting the improvements in access to maternal health, and identifying any remaining challenges or areas for further improvement.

By following this methodology, it would be possible to simulate the impact of the main recommendations on improving access to maternal health in Uganda and Zambia. The data collected and analyzed would provide valuable insights into the effectiveness of the strategies and inform future efforts to sustain and further improve maternal health services.

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