Plain English summary
Background
Method
Study area and design
Sample size determination and selection
Data collection procedure, management, and analysis
Quantitative data
Qualitative data
Results
Facility health care (supply side) services
Availability of services
HC III
n = 33
|
HC IV
n = 4
|
Hospital
n = 3
|
Total
n = 40 | |||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | |
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
| |
Antenatal registration and counseling | 33 (100.0) | 33 (100.0) | 3 (75.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 39 (97.5) | 40 (100.0) |
Vaccination | 32 (97.0) | 32 (97.0) | 3 (75.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 38 (95.0) | 39 (97.5) |
PMTCT | 33 (100.0) | 32 (97.0) | 3 (75.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 39 (97.5) | 39 (97.5) |
Family planning counseling | 33 (100.0) | 31 (93.9) | 3 (75.0) | 4 (100.0) | 2 (66.7) | 3 (100.0) | 38 (95.0) | 38 (95.0) |
Post-natal health checks for mother and newborn | 32 (97.0) | 28 (84.8) | 3 (75.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 38 (95.0) | 35 (87.5) |
PNC available | 29 (87.9) | 27 (81.8) | 3 (75.0) | 3 (75.0) | 3 (100.0) | 3 (100.0) | 35 (87.5) | 33 (82.5) |
Maternity/ Intra-partum care | 29 (87.9) | 32 (97.0) | 3 (75.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 35 (87.5) | 39 (97.5) |
Abortion services | 10 (30.3) | 1 (3.0) | 3 (75.0) | 0 (0.0) | 2 (66.7) | 0 (0.0) | 15 (37.5) | 1 (2.5) |
Quality assurance systems in place | 25 (75.8) | 13 (39.4) | 3 (75.0) | 3 (75.0) | 2 (66.7) | 3 (100.0) | 30 (75.0) | 19 (47.5) |
Kangaroo Mother Care practice | 9 (27.3) | 22 (66.7) | 2 (50.0) | 3 (75.0) | 1 (33.3) | 1 (33.3) | 12 (30.0) | 26 (65.0) |
Availability of protocols
HC III
n = 33
|
HC IV
n = 4
|
Hospital
n = 3
|
Total
n = 40 | |||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | |
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
| |
Organogram of the health facility staff | 6 (18.2) | 18 (54.5) | 1 (25.0) | 3 (75.0) | 1 (33.3) | 2 (66.7) | 8 (20.0) | 23 (57.5) |
Policy for needle stick injury of patients or staff | 8 (24.2) | 18 (54.5) | 1 (25.0) | 3 (75.0) | 1 (33.3) | 3 (100.0) | 10 (25.0) | 24 (60.0) |
Policy for disposal of sharp equipment | 25 (75.8) | 32 (97.0) | 3 (75.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 31 (77.5) | 39 (97.5) |
Protocol for referral | 9 (27.3) | 22 (66.7) | 0 (0.0) | 4 (100.0) | 1 (33.3) | 2 (66.7) | 10 (25.0) | 28 (70.0) |
Protocol for major haemorrhage | 5 (15.2) | 14 (42.4) | 0 (0.0) | 4 (100.0) | 1 (33.3) | 3 (100.0) | 6 (15.0) | 21 (52.5) |
Protocol for use of partograph | 6 (18.2) | 23 (69.7) | 1 (25.0) | 4 (75.0) | 1 (33.3) | 2 (66.7) | 8 (20.0) | 28 (70.0) |
Poster/leaflets promoting prevention services | 25 (75.8) | 24 (72.7) | 1 (25.0) | 4 (75.0) | 1 (33.3) | 0 (0.0) | 27 (67.5) | 27 (67.5) |
Posters promoting family planning | 25 (75.8) | 24 (72.7) | 2 (50.0) | 4 (100.0) | 1 (33.3) | 0 (0.0) | 28 (70.0) | 28 (70.0) |
Poster promoting nutrition | 13 (39.4) | 23 (69.7) | 2 (50.0) | 3 (75.0) | 2 (66.7) | 2 (66.7) | 17 (42.5) | 28 (70.0) |
Availability of lifesaving drugs and equipment
HC III
n = 33
|
HC IV
n = 4
|
Hospital
n = 3
|
Total
n = 40 | |||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | |
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
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n(%)
|
n(%)
|
n(%)
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General equipment | ||||||||
Child health record/vaccination cards | 14 (42.0) | 19 (57.6) | 1 (25.0) | 3 (75.0) | 1 (33.3) | 2 (66.7) | 16 (40.0) | 24 (60.0) |
Blood pressure machine (sphygmomanometer) | 18 (55.0) | 25 (75.8) | 3 (75.0) | 4 (100.0) | 2 (66.7) | 3 (100.0) | 23 (57.5) | 32 (80.0) |
Sterile scissors or blade | 21 (64.0) | 22 (66.7) | 3 (75.0) | 4 (100.0) | 2 (66.7) | 3 (100.0) | 26 (65.0) | 29 (72.5) |
Working adult scale | 18 (55.0) | 29 (87.9) | 3 (75.0) | 4 (100.0) | 3 (100) | 3 (100.0) | 24 (60.0) | 36 (90.0) |
Working watch or timing device | 16 (48.0) | 20 (60.6) | 3 (75.0) | 4 (100.0) | 2 (66.7) | 2 (66.7) | 21 (52.5) | 26 (65.0) |
Room with visual privacy | 29 (88.0) | 26 (78.8) | 3 (75.0) | 3 (75.0) | 3 (100) | 3 (100.0) | 35 (87.5) | 32 (80.0) |
24- h functioning light source | 17 (52.0) | 20 (60.6) | 2 (50.0) | 4 (100.0) | 3 (100) | 3 (100.0) | 22 (55.0) | 27 (67.5) |
Maternal and newborn equipment | ||||||||
Disposable gloves | 30 (91.0) | 26 (78.8) | 1 (25.0) | 3 (75.0) | 3 (100) | 2 (66.7) | 34 (85.0) | 31 (77.5) |
Stethoscope | 22 (67.0) | 26 (78.8) | 3 (75.0) | 3 (75.0) | 2 (66.7) | 2 (66.7) | 27 (67.5) | 31 (77.5) |
Fetal scope | 32 (97.0) | 27 (81.8) | 3 (75.0) | 3 (75.0) | 2 (66.7) | 2 (66.7) | 37 (92.5) | 32 (80.0) |
Working baby scale | 23 (70.0) | 24 (72.7) | 2 (50.0) | 3 (75.0) | 3 (100.0) | 3 (100.0) | 28 (70.0) | 30 (75.0) |
Thermometer | 14 (42.0) | 20 (60.6) | 3 (75.0) | 3 (75.0) | 3 (100.0) | 3 (100.0) | 20 (50.0) | 27 (67.5) |
Intravenous fluids with infusion set | 23 (70.0) | 27 (81.8) | 3 (75.0) | 3 (75.0) | 3 (100.0) | 3 (100.0) | 29 (72.5) | 33 (82.5) |
Manual vacuum aspirator for abortion care | 7 (21.0) | 15 (45.5) | 3 (75.0) | 3 (75.0) | 1 (33.3) | 2 (66.7) | 11 (27.5) | 20 (50.0) |
Speculum | 19 (58.0) | 23 (69.7) | 2 (50.0) | 3 (75.0) | 2 (66.7) | 3 (100.0) | 23 (57.5) | 29 (72.5) |
Aspiration kit | 4 (12.0) | 11 (33.3) | 1 (25.0) | 2 (50.0) | 0 (0.0) | 2 (66.7) | 5 (12.5) | 15 (37.5) |
Oxygen | 6 (18.0) | 6 (18.2) | 1 (25.0) | 3 (75.0) | 1 (33.3) | 2 (66.7) | 9 (22.5) | 11 (27.5) |
Blank partographs | 7 (21.0) | 17 (51.5) | 1 (25.0) | 3 (75.0) | 1 (33.3) | 2 (66.7) | 10 (25.0) | 22 (55.0) |
Vacuum extractor (for vacuum delivery/assisted delivery) | 1 (3.0) | 9 (27.3) | 2 (50.0) | 2 (50.0) | 1 (33.3) | 2 (66.7) | 5 (12.5) | 13 (32.5) |
Newborn suction device | 8 (24.0) | 12 (36.4) | 1 (25.0) | 3 (75.0) | 3 (100.0) | 3 (100.0) | 12 (30.0) | 18 (45.0) |
Newborn resuscitation device/Ambu bag/Mask | 17 (52.0) | 19 (57.6) | 3 (75.0) | 3 (75.0) | 3 (33.3) | 3 (100.0) | 21 (52.5) | 25 (62.5) |
Clamp or umbilical tie | 25 (76.0) | 25 (75.8) | 3 (75.0) | 4 (100.0) | 2 (66.7) | 3 (100.0) | 30 (75.0) | 32 (80.0) |
Gentian violet paint | 9 (27.0) | 7 (21.2) | 1 (25.0) | 1 (25.0) | 2 (66.7) | 1 (33.3) | 12 (30.0) | 9 (22.5) |
Dextrose saline/ORS | 20 (61.0) | 25 (75.8) | 2 (50.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 25 (62.5) | 32 (80.0) |
Nasogastric tubes 20 ml syringes | 6 (18.0) | 5 (15.2) | 2 (50.0) | 2 (50.0) | 1 (33.3) | 2 (66.7) | 9 (22.5) | 9 (22.5) |
Binders for Kangaroo Mother Care | 1 (3.0) | 3 (9.1) | 0 (0.0) | 1 (25.0) | 0 (0.0) | 0 (0.0) | 1 (2.5) | 4 (10.0) |
Blanket to wrap newborn | 1 (3.0) | 6 (18.2) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (33.3) | 1 (2.5) | 7 (17.5) |
Baby warmer or heat lamp | 0 (0.0) | 1 (3.0) | 0 (0.0) | 1 (25.0) | 0 (0.0) | 1 (33.3) | 1 (2.5) | 3 (7.5) |
HC III
n = 33
|
HC IV
n = 4
|
Hospital
n = 3
|
Total
n = 40 | |||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | |
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
| |
Pregnancy test kits | 11 (33.3) | 22 (66.7) | 3 (75.0) | 3 (75.0) | 1 (33.3) | 0 (0.0) | 15 (37.5) | 25 (62.5) |
Proteinuria | 16 (48.5) | 24 (72.7) | 1 (25.0) | 3 (75.0) | 2 (66.7) | 0 (0.0) | 19 (47.5) | 27 (67.5) |
Rapid test for malaria | 19 (57.6) | 32 (97.0) | 3 (75.0) | 4 (100.0) | 3 (100.0) | 0 (0.0) | 25 (62.5) | 36 (90.0) |
HIV rapid tests | 21 (63.6) | 30 (90.9) | 1 (25.0) | 4 (100.0) | 3 (100.0) | 3 (100.0) | 25 (62.5) | 37 (92.5) |
Syphilis RPR syphilis tests | 4 (12.1) | 27 (81.8) | 2 (50.0) | 4 (100.0) | 1 (33.3) | 3 (100.0) | 7 (17.5) | 34 (85.0) |
Syphilis rapid tests | 4 (12.1) | 27 (81.8) | 3 (75.0) | 4 (100.0) | 1 (33.3) | 3 (100.0) | 8 (20) | 34 (85.0) |
Anaemia tests | 9 (27.3) | 16 (48.5) | 4 (100.0) | 2 (50.0) | 2 (66.7) | 2 (66.7) | 15 (37.5) | 20 (50.0) |
HC III
n = 33
|
HC IV
n = 4
|
Hospital
n = 3
|
Total
n = 40 | |||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | Baseline | Follow-up | |
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
| |
Sulphadoxine Pyrimethamine for IPTp | 27 (81.8) | 30 (90.9) | 4 (100.0) | 2 (50.0) | 1 (33.3) | 3 (100.0) | 32 (80.0) | 35 (87.5) |
Vitamin A | 30 (90.9) | 31 (93.9) | 4 (100.0) | 3 (75.0) | 3 (100) | 3 (100.0) | 37 (92.5) | 37 (92.5) |
Ferrous Sulphate | 14 (42.4) | 19 (57.6) | 3 (75.0) | 2 (50.0) | 2 (66.7) | 2 (66.7) | 19 (47.5) | 23 (57.5) |
Folic Acid | 16 (48.5) | 23 (69.7) | 2 (50.0) | 2 (50.0) | 2 (66.7) | 2 (66.7) | 20 (50.0) | 27 (67.5) |
Combined ferrous/folate | 9 (27.3) | 19 (57.6) | 4 (100.0) | 2 (50.0) | 2 (66.7) | 2 (66.7) | 15 (37.5) | 23 (57.5) |
Benzyl penicillin | 15 (45.5) | 13 (39.4) | 2 (50.0) | 2 (50.0) | 3 (100) | 3 (100.0) | 20 (50.0) | 18 (45.0) |
Diazepam (IM or IV) | 28 (84.8) | 15 (45.5) | 2 (50.0) | 4 (100.0) | 3 (100) | 3 (100.0) | 33 (82.5) | 22 (55.0) |
Mebendazole | 29 (87.9) | 19 (57.6) | 4 (100.0) | 3 (75.0) | 3 (100) | 2 (66.7) | 36 (90.0) | 24 (60.0) |
Amoxicillin | 12 (36.4) | 21 (63.6) | 1 (25.0) | 3 (75.0) | 1 (33.3) | 2 (66.7) | 14 (35.0) | 26 (65.0) |
Penicilin or ampicillin | 10 (30.3) | 21 (63.6) | 3 (75.0) | 3 (75.0) | 1 (33.3) | 2 (66.7) | 14 (35.0) | 26 (65.0) |
Cotrimoxizole | 26 (78.8) | 28 (84.8) | 3 (75.0) | 4 (100.0) | 3 (100) | 3 (100.0) | 32 (80.0) | 35 (87.5) |
Tetracycline ointment or silver nitrate eye drops | 20 (60.6) | 26 (78.8) | 2 (50.0) | 4 (100.0) | 2 (66.7) | 2 (66.7) | 24 (60.0) | 32 (80.0) |
Corticosteroids (for preterm labour) | 8 (24.2) | 10 (30.3) | 1 (25.0) | 1 (25.0) | 1 (33.3) | 1 (33.3) | 10 (25.0) | 12 (30.0) |
Ergometrine (oral or injectable) | 3 (9.1) | 5 (15.2) | 2 (50.0) | 1 (25.0) | 1 (33.3) | 1 (33.3) | 6 (15.0) | 7 (17.5) |
Oxytocin | 10 (30.3) | 27 (81.8) | 3 (75.0) | 4 (100.0) | 3 (100) | 2 (66.7) | 16 (40.0) | 33 (82.5) |
Misoprostol | 8 (24.2) | 2 (6.1) | 1 (25.0) | 3 (75.0) | 2 (66.7) | 1 (33.3) | 11 (27.5) | 6 (15.0) |
IV Ampicillin | 9 (27.3) | 3 (9.1) | 2 (50.0) | 1 (25.0) | 1 (33.3) | 2 (66.7) | 12 (30.0) | 6 (15.0) |
IV Gentamycin | 8 (24.2) | 1 (3.0) | 1 (25.0) | 2 (50.0) | 2 (66.7) | 1 (33.3) | 11 (27.5) | 4 (10.0) |
IV Metronidazole | 5 (15.2) | 0.0 | 1 (25.0) | 2 (50.0) | 1 (33.3) | 2 (66.7) | 7 (17.5) | 4 (10.0) |
Local anaesthetics (such as lidocaine) | 22 (66.7) | 4 (12.1) | 2 (50.0) | 4 (100.0) | 3 (100) | 2 (66.7) | 27 (67.5) | 10 (25.0) |
Zinc tablets | 20 (60.6) | 4 (12.1) | 2 (50.0) | 2 (50.0) | 2 (66.7) | 2 (66.7) | 24 (60.0) | 8 (20.0) |
Nevirapine | 21 (63.6) | 3 (9.1) | 2 (50.0) | 4 (100.0) | 3 (100) | 1 (33.3) | 26 (65.0) | 8 (20.0) |
Magnesium Sulphate (IV or IM) | 9 (27.3) | 2 (6.1) | (0.0) | 2 (50.0) | 2 (66.7) | 1 (33.3) | 11 (27.5) | 5 (12.5) |
“First and foremost some supplies such as gloves are always missing, and these things hinder mothers from coming to us because we ask them for three pairs of gloves. One pair is for the first examination, the second pair for the second examination, and the third for handling delivery and each pair is 1000/= it is too much for the mothers. You find that they give us 100 or 200 pairs of gloves and they are supplied to the center even in the outpatient department they need it and here in maternity, we need it so the supply is really low. Even the drugs are in most cases in shortage, for example, oxytocin, it is the same with magnesium for mothers with Pre Eclamptic Toxemia (PET).” Health center III, Kamuli district.
“............ the challenge we are having now is that there is always stock out of drugs and other essential equipment needed for maternal and newborn care. For example, we have not been having syphilis reagents for last 12 months. We also don’t have newborn equipment like bulb syringes for newborn resuscitation” HC III, Kibuku district.
“……now sometimes if a mother comes when she in antepartum hemorrhage (APH), sometimes we don’t have blood so by the time when you refer her sometimes she can reach there when she is in a very critical condition.” Health center IV, Kamuli district.
Referral transport
“ We have a challenge of transportation of mothers. A mother may come here with complication and you need to refer her to hospital. From here we have that small ambulance (that tri-cycle), but it is not readily available you may call him [transporter] when he is 20 kilometers away and yet you have an emergency. Because of that, you may end up taking [transporting] this mother on a motorcycle to Kamuli [hospital]. So, referral system is still a challenge.” Health center III, Kamuli district.
“One problem is transport, sometimes the doctor might not be there or an anesthesia nurse might not be there so you want to refer that patient to another hospital but there is no transport. For example, we had a lady who was transferred from a clinic and we had no transport, that lady’s husband had to go and look for public means and he failed until morning when we went to Pallisa [town]. So, suppose we had that delivery I think that woman would have died, but God helped us and we got transport in the morning and they went and the mother was operated from there [regional hospital].” Hospital, Pallisa district.
Space in Maternity Wards
“ We have very small space as you can see. Labor ward has only two beds. Last night I had three mothers and one had to deliver from the floor due to the limited number of the beds here. For example, one mother came during the day, she was in false labor, and we kept her because we could not tell her to go home because she had signs that maybe she could start the true labor. Another one came she was in real labor, we admitted her, then the third one came, she was also in true labor we also admitted. Then it was around 1:00 Am in the night and on examining them, they were all fully in labor, remember we have only two beds, so one had to deliver from the floor!” Health center III, Pallisa district.
“We don’t have enough space for delivering mothers. When you get another delivering mother you will not have where to put her. Because of that, you will have to discharge the first one who has just delivered; yet, you should monitor this mother who has delivered for at least 12 hours. But, because they are many, they are uncomfortable; the room is too small they request for discharge to go home.” Health center III, Kibuku district.
Availability of qualified staff
Baseline | Follow-up | |||
---|---|---|---|---|
Number | Percent | Number | Percent | |
Overall | 40 | 100.0 | 40 | 100.0 |
Registered midwives | ||||
None | 31 | 77.5 | 23 | 57.5 |
One | 6 | 15.0 | 10 | 25.0 |
Two | 3 | 7.5 | 3 | 7.5 |
at least three | 0 | 0.0 | 4 | 10.0 |
Enrolled Nurse | ||||
None | 12 | 30.0 | 4 | 10.0 |
One | 13 | 32.5 | 2 | 5.0 |
Two | 8 | 20.0 | 6 | 15.0 |
At least three | 7 | 17.5 | 28 | 70.0 |
Clinician | ||||
None | 25 | 62.5 | 5 | 12.5 |
One | 11 | 27.5 | 13 | 32.5 |
Two | 2 | 5.0 | 16 | 40.0 |
At least three | 2 | 5.0 | 6 | 15.0 |
Registered Nurse | ||||
None | 28 | 70.0 | 9 | 22.5 |
One | 9 | 22.5 | 22 | 55.0 |
Two | 3 | 7.5 | 6 | 15.0 |
At least three | 0 | 0.0 | 3 | 7.5 |
Nursing Assistants | ||||
None | 16 | 40.0 | 3 | 7.5 |
One | 15 | 37.5 | 15 | 37.5 |
Two | 6 | 15.0 | 10 | 25.0 |
At least three | 3 | 7.5 | 12 | 30.0 |
“...you see the community think we are rude, but it is the nature of our work. For example, at this facility, we are only two health workers (in-charge and midwife). The midwife works day and night. There is a lot of work. Seeing pregnant women who have come for ANC, Immunization, and deliveries by one person without rest! ... hmmm... We are also human beings who need rest.” Health center III, Pallisa district.
“… understaffing is a big challenge. If we were many, you cannot work at night and throughout the day. By now I would be at home resting, waiting for night duty but now I am here because I cannot leave those mothers unattended to. Sometimes you are not on time, for example, when I went after night duty; I first had to go home in the morning to freshen up and also take some breakfast before coming back here. By the time you come back you find that these mothers have sat for long hours waiting for you here, which is a very big problem” Health center III, Kamuli district.
“............the challenge we are having now is that the facility does not have the midwife. We are improvising by using the Nursing Assistant who is not trained to do that work. ” HC III staff, Pallisa.
“The first challenge we have is that we lack enough health workers. For example, in this facility, the number of clients has increased but I am the only midwife who works on this increased number. Because of that, we end up delegating to the nursing assistants who we always work with to cover us in case we are not available at the health center.” Health center III, Kibuku district.
Demand-side influences on maternal and newborn care
Facility health care services
“……. we have a problem in this community, health workers are only available on Monday, Tuesday and Wednesday. The other remaining days of the week, when you go you will not find the health workers and yet you are in labor. So, we end up delivering from home since we know that most of the times the health workers are not always there.” Women FGD kibuku district.
“The health workers at our facilities are rude and they always neglect us. The Traditional Birth Attendants have good care other than going to the government hospitals and suffer from there.” FGD women Kamuli district.
Geographical, social and economic factors
Transport system
“Most women deliver from home like he has said and what brings that is the long distance (about 8–10 Kms to the health facilities).” Female FGD Pallisa district.
“The reason as to why women are delivering from home is because of the long distance to the health facilities. If a woman starts experiencing labor pains, it might be hard for the man to get transport at that time and maybe the time he gets a bicycle the woman might have reached a stage that she cannot even sit on the bicycle. So, at the end, they have to pick those old women and that is still happening in this place; those who have ever conducted deliveries to come and help to deliver.” FGD Male, Pallisa district.
“………. very few women who deliver from the facility, though many would wish to deliver from the facility but because of the long distance……… those who try to go and deliver from the health facility at times end up delivering on the way because of the long distance that they move and if people who attend to her at that don’t have the skills to deliver a woman, then the baby can even die from there.” Female FGD, Kibuku district.
“….the challenge is that sometimes they [women] do not reach there [health facility] on time due to the poor transportation system in this village and the poor roads. So, by the time they reach, the babies are at a high risk of dying.” FGD men, Kamuli district.
“The main difficulty that we mothers face when we are going to deliver is the long distance to the Health Centers and the poor transport system. So, by the time the mothers reach, they are usually in critical conditions.” FGD women, Kamuli district.
“Distance and lack of transport to take you to the health facility are some of the reasons why women give birth at home. Also, labor pains may start during the night and sometimes it might have rained, which is so hard for you to reach a health facility. So, if you get someone to help you deliver the baby then someone would prefer delivering at home than risking going to the hospital.” FGD women, Kibuku.
Access to information
“…people in this community have not yet realized the importance of delivering from the health facility. So there is limited information on skilled deliveries.” FGD men, Kamuli district.
“People lack knowledge and information on safe, skilled deliveries and need to be healthy educated.” FGD women, Kamuli district.
“…. The biggest challenge is that there are no outreaches that come from the health facilities to health educate our women and reduce maternal and newborn deaths. So, you find that the number of maternal and newborn deaths is just increasing instead of reducing due to lack of knowledge. So, it would be good if only the Government came up with a program to health educate people about the many risks of delivering from home and also bringing services nearer to the people.” FGD men, Pallisa district.
Poverty and access to finances
“The health center that we have around is 5 kms away and it is private so services in that facility are expensive. Right now, if you take a woman to deliver from there and then she gives birth to a baby boy they will charge you 40,000/− and if it is a baby girl, you pay 50,000/− that is why when a woman starts getting labor pains a person starts pretending until the woman delivers from home.” FGD Men Pallisa.
“Sometimes you may get a mother who comes with complications and yet during ANC, you told her that due to for instance, certain complications, she will not deliver from here (Health center III) but because the mother does not have money, she comes back only to check on her passport book you had referred her (to the hospital) but the mother insisted on coming back because she did not have the money to go to where you referred her. So, we end up paying the transport for such a mother because the mother may end up dying from here and you are the one to be blamed.” Health facility III, Kamuli district.
“What stops us from going to other medical centers is because of our low incomes, the poor transport. We usually use boda-bodas (motorcycles) which usually charge expensively for example, they may charge us around 20,000/= for hire of their motorcycle because they know you are in need and don’t have many options, hence they hike the charges when they know that we don’t have any other option but to use them.” FGD women, Kibuku district.
Traditional birth attendants’ services
“Someone would desire to reach those other Health Centre’s but because of the poor transport and the bad roads, they chose to opt for the nearby services even when they are inadequate and the mothers’ lives are unsafe.” FGD Women, Pallisa district.
“… she (TBA) was near my home and so I decided to use her than going to the health center.” FGD women, Pallisa district.
“The TBAs have good care other than going to the government hospitals and suffer from there. Also, the distance from your home to the TBAs may be near so you save money for transport and get good care from her.” FGD women, Kamuli district.
“We give birth at Ruth’s, Adiye and Kayendeke homes (TBAs). They are not trained, but the community trusts them and it is the reason why we prefer delivering from there.” Women FGD, Pallisa district.
“When the time for delivery reaches, we call the TBA to help because we will not spend much, and if we have to give anything, it could be just a small chicken and things end there. So, they [women] deliver from TBAs because there is not much disturbance than it would be if they are to deliver from the health facility.” FGB men Kibuku district.