School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda.
UNICEF, PO Box 2381, Kampala, Uganda.
BMC Health Serv Res. 2023 May 11;23(1):473. doi: 10.1186/s12913-023-09480-x.
Uganda has high maternal, neonatal, and under-five mortality rates. This study documents stakeholder perspectives on best practices in a maternal and newborn health (MNH) quality-improvement programme implemented in the West Nile region of Uganda to improve delivery and utilisation of MNH services.
This exploratory cross-sectional qualitative study, conducted at the end of 2021, captured the perspectives of stakeholders representing the different levels of the healthcare system. Data were collected in four districts through: interviews with key informants working at all levels of the health system; focus group discussions with parents and caretakers and with community health workers; and interviews with individual community members whose lives had been impacted by the MNH programme. The initial content analysis was followed by a deductive synthesis pitched according to the different levels of the health system and the health-systems building blocks.
The findings are summarised according to the health-systems building blocks and an account is given of three of the interventions most valued by participants: (1) data use for evidence-based decision making (with regard to human resources, essential reproductive health commodities, and financing); (2) establishment of special newborn care units and high-dependency maternity units at district hospitals and training of the health workforce (also with reference to other infrastructural improvements such as the provision of water, sanitation and hygiene facilities at health facilities); and (3) community referral of pregnant women through a commercial motorcycle voucher referral system.
The MNH programme in the West Nile region adopted a holistic and system-wide approach to addressing the key bottlenecks in the planning, delivery, and monitoring of quality MNH services. There was general stakeholder appreciation across the board that the interventions had the potential to improve quality of care and newborn and maternal health outcomes. However, as the funding was largely donor-driven, questions about government ownership and sustainability in the context of limited resources remain.
乌干达的孕产妇、新生儿和五岁以下儿童死亡率较高。本研究记录了利益攸关方对乌干达西尼罗地区实施的母婴健康（MNH）质量改进方案中最佳实践的观点，以改善母婴保健服务的提供和利用。
本探索性横断面定性研究于 2021 年底进行，收集了代表医疗保健系统不同层次的利益攸关方的观点。在四个地区通过以下方式收集数据：对在各级卫生系统工作的关键信息员进行访谈；对父母和照顾者以及社区卫生工作者进行焦点小组讨论；对个人社区成员进行访谈，他们的生活受到 MNH 方案的影响。初始内容分析后，根据卫生系统的不同层次和卫生系统构建模块进行演绎综合。
根据卫生系统构建模块总结了研究结果，并介绍了参与者最看重的三个干预措施：（1）数据用于循证决策（涉及人力资源、基本生殖健康商品和融资）；（2）在地区医院建立新生儿特别护理单元和高依赖产妇单位，并培训卫生工作者（也涉及其他基础设施改进，如在卫生设施提供水、卫生和个人卫生设施）；（3）通过商业摩托车代金券转诊系统将孕妇转介到社区。
西尼罗地区的 MNH 方案采取了整体和系统的方法来解决规划、提供和监测优质 MNH 服务方面的关键瓶颈。利益攸关方普遍赞赏这些干预措施有可能改善护理质量以及新生儿和孕产妇的健康结果。然而，由于资金主要来自捐助者，因此在资源有限的情况下，关于政府所有权和可持续性的问题仍然存在。
