Changing the Trajectory of Uganda’s Future

“Unless the problem of newborn deaths is tackled as top priority, Uganda will not achieve Millennium Development Goals (MDG) 4 and 5 (for child and maternal survival) by 2015,”

– Joaquim Saweka, the World Health Organization Country Representative at the launch event for ‘A Decade of Change for Newborn Survival’.

Each year, 39,000 newborns die within their first 28 days of life, many from preventable causes. This translates to 106 newborn babies dying every day at a rate of 4 deaths per hour. Since 2000, Uganda has made strides towards tackling these unnecessary deaths resulting in an annual mortality decline of 2.2%, which is faster than the regional decline – but this is still not fast enough to achieve MDG 4.

National attention for maternal and child health has been clear and authorized from the highest levels in Uganda but attention and policy change newborn health is comparatively very recent. With the guidance of Uganda’s National Newborn Steering Committee under the Ministry of Health, the now favorable policy environment can and needs to be translated into district-level implementation and high quality services. Policy change and national consensus on strategy cannot guarantee progress for newborn survival without adequate funding for implementation, commitment from district level actors and addressing outstanding gaps in evidence and program integration.

Uganda’s story of addressing newborn survival is documented in a landmark publication entitled ‘Newborn survival in Uganda: A Decade of Change and Future Implications‘. The paper provides a comprehensive analysis of newborn survival in the Ugandan context, examining changes in mortality, coverage of interventions, funding, and contextual factors from 2000-2010. It was published in the public health international journal Health Policy and Planning, along with a series of seven other papers on newborn survival including four other country case studies and a multi-country analysis.

The national launch of ‘A Decade of Change for Newborn Survival’ took place in Kampala on July 27, 2012. The event was attended by Ministry of Health officials, donor agencies and bilateral organizations newborn health researchers, health practitioners, politicians, and stakeholders from various health organisations. Dr. Anthony Mbonye from the Ministry of Health and Dr. Joaquim Saweka from WHO Country Office led the proceedings by applauding the support that the Ministry of Health has received from a number of development partners for maternal, newborn and child health. Reflecting on the findings of the publications and implications for the future of newborn survival, the launch included presentations and a plenary discussion. Click here to view the overview presentation (pdf).

Dr Joaquim Saweka, World Health Organization Country Representative with some of the authors of ‘A Decade of Change for Newborn Survival’. From L-R: Dr Olive Sentumbwe, Prof Gelasius Mukasa, Dr Hanifah Sengendo, Dr Peter Waiswa, Dr Anthony Mbonye, Dr. Joaquim Saweka, Dr Miriam Sentongo, Patrick Aliganyira. 

The event garnered widespread media coverage with two slots on primetime national television news. In addition, short documentary films about newborn survival were aired on television with nationwide coverage. Preceding the event, a series of four articles highlighting the numbers and causes of newborn deaths ran in one of the national daily newspapers. A print newspaper insert with a clear call to action was run on the launch day, distributing nearly 80,000 copies through two main national dailies (The New Vision and The Daily Monitor).

While progress in policies and programs in Uganda has been evident, some challenges remain in addressing newborn survival. For example, the need for integration such as linking family planning services to those of maternal and newborn survival. Also the recent increase in facility births is a notable improvement, but local evidence on how to improve quality of care at health facilities is lacking and poor quality is one of the reasons mothers shy away from delivering in health facilities. There is an urgent need to equip health workers with practical skills as well as knowledge improve care. Local evidence and experience has shown to be invaluable to progress thus far. Dr. Gelasius Mukasa, from the International Baby Food Action Network (IBFAN) and Chairperson of the National Newborn Steering Committee, noted that many young newborn health champions are rising up and increasingly generating local evidence and expertise.

A pivotal commitment made at the launch came from Save the Children who pledged to invest approximately US$. 2.5 million in newborn health programs in Uganda over the next 5 years. Save the Children Director of Programs, Diane Francisco, decreed that the high number of maternal and newborn deaths requires scaling up of existing interventions reach the majority of mothers and children who need them. She advised that this will necessitate increased public-private cooperation in the health sector coupled with the ongoing integration of proven newborn survival interventions into existing health strategies.

The launch concluded with a reminder by Dr Romano Byaruhanga, President of the Association of Obstetricians and Gynaecologists of Uganda, to carry the motto that “Every one child should survive”. If Uganda reaches the targets set in the current Health Sector and Investment Plan and achieves universal coverage of care by 2015, then up to 89% of newborn deaths could be averted. Political commitment and policies are in place to make this happen for Uganda and we must now deliver.

Ugandan mother Shaban Asha Nabulime , center, watches as St. Francis Hospital Nsambya’s Neonatal Unit warden in charge Imacculate Nabwami, right, prepares a kangaroo mother care wrap for Shaban’s preterm baby girl as midwife Juliet Akareut, left, waits to assist. Nsambya Hospital is a private, not-for-profit facility which has been a leader in Uganda in improving newborn survival through initiating programs such as kangaroo mother care and perinatal mortality audit. Photo credit: Ian Hurley/Save the Children.

This post was written by Patrick Aliganyira, Hanifah Sengendo and Kate Kerber for the HNN Blog.

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