Seizing opportunities: the Uganda experience 

The Uganda Country Office 
and Marilen J. Danguilan 


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Sector Wide Approaches 

● SWAps replace the inefficiency of project-based funding 
● All donors pool their resources and participate in a joint process with the MOH to determine priorities for the sector. 


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Influencing the process 

● To ensure that maternal mortality reduction be a priority 
● Conduct a needs assessment on EmOC using the UN Process Indicators 
● Use the results for advocacy


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The UN Process Indicators 

Tell us about changes in: 

● access 
● utilization 
● quality of emergency obstetric care services (EmOC)


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The UN Process Indicators 

Answer these questions: 

  Are there enough facilities providing EmOC? 
  Are they well distributed? 
  Are enough women using these facilities?


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The UN Process Indicators 

Answer these questions: 

  Are the right women using these facilities? 
  Are enough critical services being provided? 
  Is the quality of the services adequate?


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UNICEF and AMDD 

● Needs assessments require technical support and funds 
● UNICEF requested AMDD's assistance 


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Needs Assessment on EmOC 

197 health facilities in 19 out of the 56 districts were assessed using the UN Process Indicators


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Availability 
19 Districts (pop: 9.3 M) 

CemOC 
  Minimum Required: 19
  19 Districts: 23
  Gap: +4 

BemOC 
  Minimum Required: 76
  19 Districts: 18
  Gap: -56 


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Signal functions 

Of the 36 Health Center IVs, only 2 offered all the signal functions of comprehensive EmOC.


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Signal functions 

Of the 129 Health Center IIIs, only 5 offered the full range of signal functions of basic EmOC.


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Availability 

There are enough facilities but many facilities are not functioning. 


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Proportion of births in EmOC facilities 

5 per cent of women in Uganda give birth in EmOC facilities. 
(minimum required is 15 per cent.) 


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Met Need

The met need for EmOC is 5 per cent. 
The met need should be 100 per cent. 


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C-Sections as a Percentage of Births 

● Only 1.02 per cent received a C-section. 
● This is below 5% -- the minimum rate of C-sections that should take place in the districts.


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Case Fatality Rate 

Case fatality rate is more than 1 per cent. 
Deaths in health facilities should be less than 1 per cent.


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Response 

MOH and development partners agreed that an important first step is to improve facility-based deliveries and address EmOC. 


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Hard data and priorities 

● Powerful advocacy tool to put maternal mortality reduction in the agenda. 
● Enabled MOH to prioritize on key interventions 
● Engaged donors


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Opportunities 

● High level political support 
● Decentralization of health system 
● Mid-term review of the Health Sector Strategic Plan