Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity in Uganda

Dr. Olive Sentumbwe-Mugisa Family Health and Population, WHO

Demographic Characteristics
Total Population
Population growth rate Doubling time Life expectancy at birth HIV Seroprevalence Infant mortality rate Under 5 mortality rate Maternal mortality ratio

33 million
3.2% 21 years 48 yrs 6.2% 76/1000 L.B. 145/1000 L.B. 435/100,000 L.B.

Low Status of Women

Low completion of secondary education Limited Access to Economic Opportunities
Land ownership Engaged in formal sector employment 7% 20%

Limited Control over Economic Proceeds Limited Participation in Governance

Women Ministers Women Perm. Secretaries -------% 19.4%

Female parliamentarians

33?%

TRENDS OF THE REPRODUCTIVE HEALTH INDICATORS IN UGANDA

1987
TF R UNMET FP CPR DELIVERIES(skilled) ADOL PREG. MMR 7.3 33% 5% 37% 44% 527

1995
6.9 29% 15% 38% 43% 506

2000
6.9 35% 23% 38% 32% 505

2005
6.7 40.6 23.7 41 32 435

IMR
Neonatal

122
-

81
-

88
33/1000

77
29

Persistently High Maternal Mortality Ratios

Inadequate national commitment and financial support

Poor co-ordination amongst partners Weak health systems characterised by poor functioning health systems, with weak referrals systems and poor logistics for management

Inadequate access to, and availability of quality skilled care

Weak national human resource development and management and unclear policies concerning practice regulation

Inadequate community involvement and harmful sociocultural beliefs and practices

Every Pregnancy carries a risk

Need for a skilled attendant

At all levels of the health care delivery system:

Community
Primary Health Care Levels

Referral levels

Global Response
1987 - Launch of the Safe Motherhood Initiative
1997 - Review of the Safe Motherhood Initiative
10 Main Messages

2000 - MDGs

2004 - The African Road Map

2006 - Presidents letter to the MoH 2006 - Uganda Road Map

The Road Map Vision

To have women in Uganda go through pregnancy, childbirth and postpartum period safely, and their babies born alive and healthy.

The Goal of the Road Map

The overall goal is to accelerate the reduction of maternal and neonatal morbidity and mortality in Uganda and help the country achieve the MDGs.

Specific Objectives
To increase the availability, accessibility and utilization of quality skilled care during pregnancy, childbirth and postnatal period at all levels of the health care delivery system. To promote and support appropriate health seeking behaviour among pregnant women, their families and the community. To strengthen family planning information and service provision for women/men/couples who want to space or limit their childbearing thus preventing unwanted and/or untimely pregnancies that increase the risk of a maternal death

Strategy 1
Improving legal and policy environment for effective formulation and implementation of maternal and newborn health programmes: (i) Developing, reviewing and updating policies, guidelines and protocols that enable health professionals use their skills (ii) Ensuring adequate and appropriate staffing at the health facility to provide the

Strategy 2
Improving the availability of, access to, and utilization of quality Maternal and Newborn Care Services, particularly at sub-counties: Provide Skilled Attendance at Births Scaling up Emergency Obstetric Care, Goal oriented ANC, Neonatal and Postnatal care and PMTCT services, particularly at sub county levels Increasing access to accurate and quality Family Planning information and services Establishing an appropriate and effective referral system Strengthening of youth friendly sexual and reproductive health services

Strategy 3
Strengthening human resources and building capacity to provide quality maternal and newborn skilled health care: Build the capacity of training institutions and service providers for key maternal and newborn health interventions

Strategy 4
Advocating for increased resource allocation for maternal and newborn health care Review resource allocations and mechanism to improve accountability at all levels Strengthen the capacity of districts to prioritise maternal and newborn health in their Development and Annual Implementation Plans

Strategy 5
Strengthening Coordination and Management of Maternal and Newborn Health Care Services: Improve multi sectoral partnership, collaboration and coordination between and among all stakeholders Promote effective public/private partnership

Strategy 6
Empowering communities to ensure a continuum of care between the household and the health care facility Empower communities to create demand for maternal and newborn health services Strengthen the capacity of health planning teams and health facilities to manage Maternal and Newborn Health Services

Strategy 7

Strengthening monitoring and evaluation mechanisms for better decision making and service delivery of Maternal and Newborn Health Services

Improve accessibility and utilization of quality data and information for planning and management of maternal and newborn health programmes Review the Health Management Information System (HMIS) to capture all essential information on Maternal and Newborn Health Strengthen MOH and Local Government capacity for monitoring and evaluation

Strategy 7 cont..
Providing technical/ facilitative support supervision to enhance quality of care Institutionalizing maternal and newborn death audits and reviews Establishing a Monitoring and Evaluation System for the Road Map

Guiding Principles
Evidence-based

Health systems support

Complementarities

Partnership
Division of labour

Guiding principles cont.

Appropriateness and relevance

Transparency and accountability

Equity and accessibility

Phased planning and implementation

Human rights based and gender responsive

Institutional Framework
To be executed through the various line ministries National institutions-academic Civil society Professional bodies Cultural and faith based institutions NGOs and CBOs

Multi sectoral Response

Multi sectoral Technical working Group
Monitor policy development and implementation

Ministry of Health
Coordinate implementation Together with Ministry of local government

The Road Map is in line with the Goals and objectives of the PEAP-MoF

Thank you for listening