What I Learnt About MNH Service Delivery in Rural Uganda Before COVID-19

Team Leader MNCH-Dr. Peter Waiswa (Left) poses for a photo with article author Ben Wendel at the School of Public Health, College of Health Sciences, Makerere University, Kampala Uganda.

BY BEN WENDEL | In March 2020, I got the chance to work with Prof. Waiswa and Dr. Kizito on the Centre of Excellence for Maternal Newborn and Child Health’s COMONETH project. It was incepted in 2017 and is based in Eastern Uganda’s Luuka district. Luuka district is one of 112 districts located in the south eastern region of Uganda and is projected to have about 260,000 residents, according to a 2018 census. Like other districts, Luuka is struggling with a high neonatal and maternal mortality rates. COMONETH aimed to plan and implement a district wide intervention to increase healthcare capacities, improve maternal and newborn health and reduce mortality. The interventions included promotion of evidence-based practices in ante-natal and post-natal care. COMONETH also revitalized and improved access to emergency obstetric services by offering Cesarean sections and extended maternal health care at Luuka’s Level IV Health Center in Kiyunga.

Emergency obstetric services occupy an important position in maternal and neonatal healthcare and are integral to achieving COMONETH’s overarching goal of reducing maternal and neonatal mortality. Cesarean sections or C-sections are one of the most widely practiced emergency obstetric procedures and surgically deliver a baby if there are factors prohibiting vaginal birth or if complications arise intrapartum. Complications during birth are associated with a high maternal and newborn mortality. Before COMONETH a lot of mothers were not able to receive quality emergency obstetric services. Luuka is a rural district, roads are unpaved and there is no public transportation system. Before the initiation of COMONETH, emergency services were not available in Luuka and mothers regularly had to be referred to Iganga General Hospital 26km away for treatment.

I was interested to find out what mothers’ experience of care in a rural health center like the Kiyunga health center would be like. To really provide a benefit to mothers, the quality of care provided at the health center would have to be comparable to other health facilities. I wanted to investigate this question and get a deeper understanding of the maternal healthcare situation in Kiyunga. Under the supervision of Dr. Felix Kizito, I used the WHO’s Quality of care framework to write a report about the quality of care of emergency obstetric services in Kiyunga.

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