Institutionalizing Proven Approaches to Reduce Maternal, Newborn and Child Mortality in Luwero District of Central Uganda

The project aims to contribute towards an accelerated reduction in maternal and newborn morbidity and mortality in the target district. Working with five target health centers, the project focuses on improving and increasing the demand of MNCH services, including antenatal care (ANC) and in-facility deliveries. The project's institutionalization of delivery of quality MNCH services in health facilities in the targeted sub-counties in Luwero District has shown significant improvements. At least 80% of current clients in each of the five target health centers felt that ANC quality had improved since their last pregnancy. Across the clinics, 73% of respondents found current ANC to be "very good" or "good" quality. However, current clients identified wait times for receiving care as the number one aspect of ANC that they'd like to see improved. All of the target health centers identified problems with staffing, in particular having no midwives available to fill temporary vacancies, which often results in a single health worker being responsible for all of a day's ANC clients. The project's efforts to increase demand of high-quality MNCH services by the communities in the targeted sub-counties in Luwero District have also shown positive results. Fifty percent of mothers cited poor quality of either the health center or the care provided by health workers as the reason they did not seek out ANC during their last pregnancy. Ensuring that mothers are beginning the process of ANC early into their pregnancy is vital, and the project has seen a significant growth rate in the percentage of women receiving their first ANC visit in their first trimester of pregnancy. The project has also seen an immediate overall effect on in-facility deliveries in target health centers, with a significant increase in 2017 that surpasses projected growth rates. The project's support for the creation of an enabling environment that will sustain delivery of high-quality MNCH services in the targeted sub-counties in Luwero District has also been successful. ACODEV provided repair or installation of solar generators in four of the five health centers, which allows for improved care during night deliveries. Ninety percent of the health workers in these facilities found this activity to be "very useful" in improving the quality of care in their health center. However, the installation in one of the health centers became nonfunctioning midway through the project and the center does not have the capacity for repairs. Recommendations for follow-up activity and future implementation include communicating the realities of the health center experience to mothers, addressing stigmatization of using MNCH services for the first time, and targeting ANC clients for birth preparedness. Additionally, investing in high-quality solar and motorbike ambulances and sourcing vendor recommendations from previous NGO implementers in this area would be beneficial.