Regionalization of health care: Experiences and lessons from the Maternal and Newborn Scale up (MANeSCALE) project in Eastern Uganda

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Uganda still has unacceptably high maternal and neonatal mortality rates. Annually, there are about 85,000 deaths around the time of birth. Of these deaths, 6000 are maternal, 39,000 newborns and 40,000 still births (ref sharpened plan). A critical gap for Uganda is that there’s a policy to implementation gap especially in implementing maternal and newborn interventions at scale mostly in hospitals and district health systems. Substantial gaps in the quality of care exist across the continuum of women’s and children’s health.

Many women and newborns do not receive quality care even when they have contact with the health system, before, during and after pregnancy and childbirth. In addition to this, hospitals and health facilities lack an adequate health information system especially for neonatal health as the MOH is yet to develop them. Emerging evidence suggests that strengthening of individual health units is not sufficient. Models of care that strengthen both hospitals and referring lower level units are needed and hence a regional approach.

This study which started in 2013 and is on-going is being conducted in the East Central (Busoga) region which a population of about 4,000,000 people (approximately 10% of Uganda’s population). This region also includes some islands on Lake Victoria and forested areas. Busoga region has ten districts – Iganga, Mayuge, Bugiri, Kamuli, Kaliro, Namutumba, Namayingo, Luuka, Buyende and Jinja.

This study is conducted in six hospitals and 6 high volume Health Centre IVs in the region. The hospitals include Jinja Regional Referral Hospital, and five general hospitals two of which are private not for profit mission hospitals (Kamuli Mission and St Francis Buluba Hospitals) and 3 District General hospitals (Iganga, Bugiri and Kamuli). All these hospitals provide general preventive, promotional, outpatient curative, maternity, inpatient health services, emergency surgery, blood transfusion, laboratory and other general services. In addition, they receive cases referred from the lower health units. The health Centre IVs include Busesa, Bumanya, Budondo, Kigandalo, Namwendwa and Buyinja.

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