Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-26T23:11:53.479Z Has data issue: false hasContentIssue false
  • English
  • Français

IMPROVING ACCESS TO SKILLED ATTENDANCE AT DELIVERY: A POLICY BRIEF FOR UGANDA

Published online by Cambridge University Press:  20 March 2013

Harriet Nabudere ,
Delius Asiimwe  and
Jacinto Amandua
Harriet Nabudere
Affiliation:
Regional East African Community Health (REACH) Policy Initiative, Uganda, and Supporting the Use of Research Evidence (SURE) for Policy in African Health Systems Project, College of Health Sciences, Makerere University
Delius Asiimwe
Affiliation:
Regional East African Community Health (REACH) Policy Initiative, Uganda, and Supporting the Use of Research Evidence (SURE) for Policy in African Health Systems Project, College of Health Sciences, Makerere University
Jacinto Amandua
Affiliation:
Ministry of Health Headquarters
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: This study describes the process of production, findings for a policy brief on Increasing Access to Skilled Birth Attendance, and subsequent use of the report by policy makers and others from the health sector in Uganda.

Methods: The methods used to prepare the policy brief use the SUPPORT Tools for evidence-informed health policy making. The problem that this evidence brief addresses was identified through an explicit priority setting process involving policy makers and other stakeholders, further clarification with key informant interviews of relevant policy makers, and review of relevant documents. A working group of national stakeholder representatives and external reviewers commented on and contributed to successive drafts of the report. Research describing the problem, policy options, and implementation considerations was identified by reviewing government documents, routinely collected data, electronic literature searches, contact with key informants, and reviewing the reference lists of relevant documents that were retrieved.

Results: The proportion of pregnant women delivering from public and private non-profit facilities was low at 34 percent in 2008/09. The three policy options discussed in the report could be adopted independently or complementary to the other to increase access to skilled care. The Ministry of Health in deliberating to provide intrapartum care at first level health facilities from the second level of care, requested for research evidence to support these decisions. Maternal waiting shelters and working with the private-for-profit sector to facilitate deliveries in health facilities are promising complementary interventions that have been piloted in both the public and private health sector. A combination of strategies is needed to effectively implement the proposed options as discussed further in this article.

Conclusions: The policy brief report was used as a background document for two stakeholder dialogue meetings involving members of parliament, policy makers, health managers, researchers, civil society, professional organizations, and the media.

Keywords

SkilledAttendanceMaternalUgandaDelivery
Type
POLICIES
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 2 , April 2013 , pp. 207 - 211
Copyright
Copyright © Cambridge University Press 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Lavis, JN, Wilson, MG, Oxman, AD, et al.SUPPORT Tools for evidence-informed health Policymaking (STP) 5: Using research evidence to frame options to address a problem. Health Res Policy Syst. 2009;(Suppl 1):S5.CrossRefGoogle ScholarPubMed
2.Lavis, JN, Wilson, MG, Oxman, AD, Lewin, S, Fretheim, A.SUPPORT Tools for evidence-informed health Policymaking (STP) 4: Using research evidence to clarify a problem. Health Res Policy Syst. 2009;7 (Suppl 1):S4.CrossRefGoogle ScholarPubMed
3.Fretheim, A, Munabi-Babigumira, S, Oxman, AD, Lavis, JN, Lewin, S.SUPPORT Tools for evidence-informed policymaking in health 6: Using research evidence to address how an option will be implemented. Health Res Policy Syst. 2009;(Suppl 1):S5.Google Scholar
4.Supporting the Use of Research Evidence(SURE) in African Health Systems. SURE guides for preparing and using policy briefs: 6. Identifying and addressing barriers to implementing the options. http://www.who.int/evidence/resources/country_reports/africa/en/index5.htmlGoogle Scholar
5.Supporting the Use of Research Evidence(SURE) in African Health Systems. SURE guides for preparing and using policy briefs: 5. Deciding on and describing options to address the problem. http://www.who.int/evidence/resources/country_reports/africa/en/index5.htmlGoogle Scholar
6.UN. United Nations Millenium Development Goals. New York: United Nations; 2000. http://www.un.org/millenniumgoals/maternal.shtml (accessed March 17, 2011).Google Scholar
7.WHO, UNICEF, UNFPA, Bank W. Trends in maternal mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva: World Health Organisation; 2010.Google Scholar
8.UBOS. Uganda demographic and health survey 2006. Kampala: UBOS; 2006.Google Scholar
9.Bhutta Zulfiqar, A, Chopra, M, Axelson, H, et al.Countdown to 2015 decade report (2000–10): Taking stock of maternal, newborn, and child survival. Lancet. 2010;375:2032–2044.CrossRefGoogle ScholarPubMed
10.Ministry of Health. Health sector strategic and investment plan. Kampala: Ministry of Health; 2010.Google Scholar
11.Amandua, J.Concept paper on institutionalizing deliveries at health centre IIs. Kampala: Ministry of Health, Services C; 2011 February 25, 2011.Google Scholar
12.UNFPA. Consensus and concerns. Regional Workshop on Skilled Birth Attendants in South and West Asia. Islamabad, Pakistan: UNFPA; April 19–21, 2004.Google Scholar
13.WHO. Disease and injury country estimates (2004) [database on the Internet]. World Health Organisation. 2009. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html (accessed February 22, 2013).Google Scholar
14.Ministry of Health. Uganda human resources for health policy. Kampala: Ministry of Health; 2006.Google Scholar
15.Kiwanuka, S, Ekirapa, E, Peterson, S, et al.Access to and utilisation of health services for the poor in Uganda: A systematic review of available evidence. Trans R Soc Trop Med Hyg. 2008;102:1067–74.CrossRefGoogle ScholarPubMed
16.Akin, J, Hutchinson, P.Health facility choice and the phenomenon of by-passing. Health Policy Plann. 1999;14:135–151.CrossRefGoogle Scholar
17.Parkhurst, JO, Ssengooba, F.Assessing access barriers to maternal health care: Measuring bypassing to identify health centre needs in rural Uganda. Health Policy Plann. 2009;24:377–384.CrossRefGoogle Scholar
18.Witter, S, Osiga, G.Health service quality and users’ perceptions in West Nile, Uganda. Int J Health Plann Mgmt. 2004;19:195–207.CrossRefGoogle ScholarPubMed
19.AbouZahr, C.Maternal mortality overview. In: Health dimensions of sex and reproduction. Geneva: World Health Organization; 1998.Google Scholar
20.Ministry of Health. The basic package of health services. Kampala: Ministry of Health; 1997.Google Scholar
21.De Brouwere, V, Van Lerberghe, W, editors. Safe motherhood strategies: A review of the evidence. Antwerp: ITG Press; 2001.Google Scholar
22.Berman, P.Organization of ambulatory care provision: A critical determinant of health system performance in developing countries. Bull World Health Organ. 2000;78:791–802.Google ScholarPubMed
23.van Lonkhuijzen, L, Stekelenburg, J, van Roosmalen, J. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries. Cochrane Database of Systematic Reviews [Internet]. 2009. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006759/frame.html (accessed February 22, 2013).CrossRefGoogle Scholar
24.Dudley, L. Do maternity waiting facilities improve maternal and perinatal outcomes in low resource settings? A SUPPORT Summary of a systematic review. 2010. http://www.who.int/evidence/resources/country_reports/africa/en/index5.htmlCrossRefGoogle Scholar
25.Mbonye, AK, Asimwe, JB.Factors associated with skilled attendance at delivery in Uganda: Results from a national health facility survey. Int J Adolesc Med Health. 2010;22:249–255.CrossRefGoogle ScholarPubMed
26.van Lonkhuijzen, L, Stegeman, M, Nyirongo, R, van Roosmalen, J.Use of maternity waiting home in rural Zambia. Afr J Reprod Health. 2003;7:32–6.CrossRefGoogle ScholarPubMed
27.Lee, AC, Lawn, JE, Cousens, S, et al.Linking families and facilities for care at birth: What works to avert intrapartum-related deaths? Int J Gynecol Obstet. 2009;107 (Suppl 1):S65–S85, S86–S88.CrossRefGoogle ScholarPubMed