27 research outputs found
PHS44 Cost Of Patient Care At Different Stages Of Treatment Within The Public Health Model Of Hiv Care; Analysis From An Urban Hiv Centre In Uganda
Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda
Background:
Community capacities and resources must be harnessed to complement supply side initiatives
addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and
lessons learnt from working with communities to improve maternal and newborn health in rural Uganda.
Methods: A participatory action research project was supported from 2012 to 2015 in three eastern districts. This
project involved working with households, saving groups, sub county and district leaders, transporters and village
health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to
address these issues, taking action and learning from action in a cyclical manner. This paper draws from project
experience and documentation, as well as thematic analysis of 20 interviews with community and district
stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had
recently delivered.
Results:
Women and men reported increased awareness about birth preparedness, improved newborn care
practices and more male involvement in maternal and newborn health. However, additional direct communication
strategies were required to reach more men beyond the minority who attended community dialogues and home
visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport
costs, purchase other items needed for birth and other routine household needs.
However saving groups required significant support to improve income generation, management and trust among
members. Linkages between savings groups and transport providers improved women’s access to health facilities at
reduced cost. Although village health teams were a key resource for providing information, their efforts were
constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring
that the village health teams and savings groups functioned required regular supervision, review meetings and
payment for supervisors to visit.
Conclusions:
This participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare. Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced
Influence of Birth Preparedness, Decision-Making on Location of Birth and Assistance by Skilled Birth Attendants among Women in South-Western Uganda
Introduction: Assistance by skilled birth attendants (SBAs) during childbirth is one of the strategies aimed at reducing maternal morbidity and mortality in low-income countries. However, the relationship between birth preparedness and decision-making on location of birth and assistance by skilled birth attendants in this context is not well studied. The aim of this study was to assess the influence of birth preparedness practices and decision-making and assistance by SBAs among women in south-western Uganda
Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda
The future of financing for HIV services in Uganda and the wider sub-Saharan Africa region: should we ask patients to contribute to the cost of their care?
Male partners’ perceptions of maternal near miss obstetric morbidity experienced by their spouses
Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda
BACKGROUND: Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context. METHODS: This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes. RESULTS: Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care. CONCLUSION: In this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities