As Uganda grapples with high maternal and newborn mortality rates, the Kampala Slum Maternal and Newborn Health (MaNe) implementation research project, tested innovative approaches addressing the demand and supply-side barriers affecting care-seeking, effective referral, and provision of quality care for maternal and newborn health in urban slum settings in Kampala City.
The research was intended to provide evidence about the feasibility, replicability, and scalability of selected MNH interventions within an urban setting to address the mismatch between the lived realities of the urban poor and the conventional approaches to improving maternal and newborn health outcomes.
Funded by the United States Agency for International Development (USAID), the MaNe project was a collaboration between Kampala Capital City Authority (KCCA) and Population Services International (PSI) Uganda. The activity was implemented in two of the five administrative divisions of Kampala City (Makindye and Lubaga).
MaNe’s mandates were to harness the public and private facility mix to provide quality and affordable maternal and newborn care services for the urban poor; strengthen referral linkages between public and private health facilities for maternal and newborn health care; and educate mothers, caretakers of newborns, and spouses about appropriate actions on what maternal and newborn health services to seek and from where to access services.
The project’s interventions yielded several positive outcomes. These included increased utilization of quality maternal and newborn health services at private health facilities.
The activity also stimulated improved delivery of respectful and affordable care to mothers and spurred the development of a digital ambulance transportation system to handle maternal emergencies.
Further, the number of mothers attending antenatal services (ANC) increased due to extended operating hours and workdays in KCCA facilities. For example, from no mothers attending ANC in October 2020 to 1,242 mothers attending by August 2021.
The innovation of an uber-like mobile application to improve access to ambulances for pregnant mothers resulted in 1,642 referrals made through the MaNe supported KCCA call and dispatch center, ensuring the safety of these mothers.
The project worked with KCCA to accredit 20 private health facilities, enabling them to provide affordable, quality maternal health care. For example, in Rubaga, a private midwife-led facility was able to reduce the prices of normal delivery for urban poor women from Shs200,000 to Shs120,000 and experienced a 141% increase in the number of pregnant mothers attending ANC.
Additionally, the activity’s collaborative partnership leveraged the support of other civil society stakeholders and the private sector, including UNFPA, USAID Uganda Maternal, and Child Health and Nutrition (MCHN) Activity, Uganda Red Cross, Outbox, White Ribbon Alliance, and MTN Uganda to provide equipment and services.
In his remarks at the project’s learning dissemination event on March 24, 2022, Dr. Charles Olaro, Director of Clinical Services, Ministry of Health, said: “The MaNe project is well aligned to the government priority of universal healthcare including that of maternal and newborn health and this evidence generated will accelerate government efforts towards designing the urban reproductive maternal health policy.”
Dr. Olaro noted that the KCCA-led mentorship, support supervision, and onsite service provisions should continue as it boosts community demand for services, motivates the private sector, and strengthens the linkages between the public and private facilities, which will lead to increased access to quality maternal and newborn health services.
Dr. Daniel Okello Ayen, Principal Investigator on the MaNe project and KCCA’s Director of Public Health and Environment added that: “The project showed us that multi-sectoral collaboration is invaluable in supporting the provision of equitable access to maternal health because of the innovations that arise from each actor.”
The project leaves behind a legacy.
Dr. Yvonne Mugerwa Kidza, MaNe’s Project Director is keen to see the activity’s innovations and tested approaches absorbed by partners at the sub-national, national, and global scale.
She surmises; “The MaNe project tested and has now shared successful innovations in; enabling urban poor access quality and affordable services by leveraging the private sector to get interested in being accredited by KCCA and providing affordable and respectful services for the urban poor; ensuring availability of timely referral transportation for urban poor with MNH emergencies both in accredited private clinics and public facilities; engaging Community Health Workers (CHWs) in working closely with accredited clinics to support appropriate care-seeking and referral and access to post-natal care among urban poor; enabling urban poor women who cannot afford to seek ANC services during regular work hours to access quality services in public facilities.”
She added that these innovations should be absorbed by other partners to maintain the gains accrued in the reduction of maternal and newborn morbidity and mortality among the urban poor. MaNe executed implementation research using systematic and rigorous methods to adopt and integrate evidence-based health interventions into clinical and community settings to improve individual outcomes and benefit population health. The implementation research supported and informed multisectoral collaboration including KCCA policymakers and planners to deliver appropriate and resilient maternal and newborn health services.