Ibingira Charles, Byamugisha Josaphat, Rutebemberwa Elizeus, Atuyambe Lynn, Mugahi Richard, Odongo Emmanuel
School of Biomedical Sciences, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda.
Health Res Policy Syst. 2025 Apr 8;23(1):46. doi: 10.1186/s12961-025-01302-2.
Despite many improvements in maternal, newborn, sexual, and reproductive health (RMNCAH) in sub-Saharan Africa, the overall progress remains inadequate and uneven. Some of the reasons for this include fragmented healthcare systems, gaps in evidence-based policy, inadequate investment and funding for health, and weaknesses in policy dissemination and implementation. Current stakeholder views on RMNCAH policy formulation and policy implementation in Uganda has not been exhaustively studied to help inform adjustments in policy formulation approaches and implementation strategies. The objective was to conduct a situation analysis to identify gaps in RMNCAH policies and guidelines formulation, dissemination, and implementation in Uganda to be able to recommend strategies to address these gaps, and catalyse policy formulation and implementation.
This was an exploratory qualitative study conducted among RMNCAH stakeholders at central level and four district local governments in Uganda. Data were collected through review of RMNCAH policies and guideline documents using a document review guide, two guided small-group discussions (SGDs) with central government stakeholders and partners, four SGDs with district health teams (DHTs), eight key informant interviews (KIIs), and four focus group discussions (FGDs) with women 20-35 years of age. The interviews and group discussions were conducted using pretested interview guides, audio-recorded and transcribed verbatim. The transcripts were analysed by thematic analysis using open code software.
It was established that the policy and guideline documents addressing most of RMNCAH components existed. However, the indicators have not improved adequately to meet the international targets. The main policy implementation gaps reported revolved around policy leadership and coordination such as weaknesses in district and facility leadership and management, insufficient monitoring and evaluation, inadequate community engagement in policy formulation and implementation, inadequate policy and guidelines dissemination, limited multisectoral approach, and insufficient resource allocation to implement the policies and guidelines.
Policies and guidelines covering all RMNCAH components are in place, but implementing and translating these into improved indicators has been the major challenge. A strategic framework should be developed to test interventions to address these gaps to catalyse policy implementation in selected districts and later be rolled out to cover the whole country to cause wholesome policy impact.
尽管撒哈拉以南非洲地区在孕产妇、新生儿、性健康和生殖健康（RMNCAH）方面取得了许多进展，但总体进展仍然不足且不均衡。造成这种情况的一些原因包括医疗保健系统碎片化、循证政策存在差距、对卫生的投资和资金不足以及政策传播与实施方面的薄弱环节。目前尚未对乌干达利益相关者关于RMNCAH政策制定和政策实施的观点进行详尽研究，以帮助为政策制定方法和实施策略的调整提供信息。目的是进行一次情况分析，以确定乌干达RMNCAH政策及指南在制定、传播和实施方面的差距，从而能够推荐解决这些差距的策略，并促进政策制定和实施。
这是一项在乌干达中央层面以及四个地区地方政府的RMNCAH利益相关者中开展的探索性定性研究。通过使用文件审查指南审查RMNCAH政策和指南文件、与中央政府利益相关者及合作伙伴进行两次有引导的小组讨论（SGD）、与地区卫生团队（DHT）进行四次SGD、进行八次关键 informant 访谈（KII）以及与20至35岁女性进行四次焦点小组讨论（FGD）来收集数据。访谈和小组讨论使用预先测试的访谈指南进行，进行录音并逐字转录。使用开放代码软件通过主题分析对转录本进行分析。
已确定存在涉及大多数RMNCAH组成部分的政策和指南文件。然而，各项指标尚未充分改善以达到国际目标。报告的主要政策实施差距围绕政策领导与协调，例如地区和机构领导与管理薄弱、监测和评估不足、社区在政策制定和实施中的参与不足、政策和指南传播不足、多部门方法有限以及实施政策和指南的资源分配不足。
涵盖所有RMNCAH组成部分的政策和指南已经到位，但将这些政策和指南实施并转化为更好的指标一直是主要挑战。应制定一个战略框架来测试解决这些差距的干预措施，以促进选定地区的政策实施，随后推广至全国以产生全面的政策影响。
