Health Policy Planning and Management (HPPM) Department

The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study is a partnership of the Makerere University College of Health Sciences School of Public Health and the districts of Kamuli, Pallisa and Kibuku in Eastern Uganda. MANIFEST is building on work done by the Uganda Newborn Study (UNEST) conducted in Iganga and Mayuge districts that involved use of community health workers and the Safe Deliveries Study in the districts of Kamuli, Buyende and Pallisa that used a voucher scheme to increase access to maternal and newborn care services. Both interventions were successful in increasing utilization of health facility delivery and newborn care services.

However scale up and sustainability became a challenge beyond the pilot districts. Therefore MANIFEST is attempting to generate evidence that can contribute to solving barriers to successful scale up of these successful interventions in Kamuli, Pallisa and Kibuku Districts by investigating mechanisms of mobilizing and using locally available resources in a sustainable manner for improving access to quality maternal and newborn health care using existing structures.

Our community mobilization strategies support locally organized, financed and monitored transport systems, rather than rely on vouchers that are externally initiated and funded.

Project/Study Design & Setting
We have employed an action type research method that promotes the use of local experiences and locally available management structures (e.g. district health management teams, village health teams, community service organizations, and local council leaders).

Results
Preliminary results show that there have been significant changes in the maternal and newborn care practices as a result of home visits; Community Dialogue meetings and radio talk shows/spots.

Up to 25,966 pregnant women and 11,752 newly delivered women were registered and visited by the 1691 VHTs that we trained in the three districts. A total of 40,553 people attended community dialogue meetings of which 49% were male. Our target is to reach 37,997 people through dialogue meetings and so far we have reached 56,156, way above the target.
Facility deliveries have improved by 16% and ANC 4th attendance has increased by 25%.
The VHT reports indicate that 11, 999 women saved for maternal and newborn care and 3,213 were transported to the health facility.

So far, 60/90 health facility managers and 2/3 DHOs (Kamuli and Pallisa) completed management training. As a result there has been marked improvement in the management of health facilities and services at district level.
At facility level, the use of partographs to monitor labour progression has greatly improved owing to the regular support supervision and mentoring visits.

Practical obstetric and newborn care skills have equally been boosted following refresher training for health workers coupled with support supervision and mentorship sessions.

Team Leader: Dr Elizabeth Ekirapa-Kiracho
Co-leads: Dr Peter Waiswa, Dr Suzanne Kiwanuka
Funder/s: Comic Relief
Collaborating Institutions:

  • Makerere University School of Public Health,
  • Future Health Systems Research Consortium,
  • Kamuli District,
  • Pallisa District and
  • Kibuka District.

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