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Mothers and Children First:
                The case of Uganda


                   Peter Lochoro MBChB, MSc
                     Country Representative
               Doctors with Africa CUAMM, Uganda


Prima le mamme e i bambini   15 dicembre 2012   II caso Uganda
Uganda – Oyam District




 Prima le mamme e i bambini   15 dicembre 2012   II caso Uganda
PL1
Diapositiva 3

PL1         Explain the diagram and the Italian version
            Peter Lochoro CUAMM Uganda; 15/12/2012
PL2
              Signal Functions for Emergency Obstetric
                and Neonatal Care, Oyam District

                                                                       Aber Hospital is the only
                                                                    health unit which provides all 9
                                                                    signal functions. Therefore it is
                                                                    qualified as comprehensive
                                                                    emergency obstetric care
                                                                    (CEmOC)

                                                                        None of the health centres
                                                                    provide all 7 signal functions
                                                                    to qualify as Basic Emergency
                                                                    Obstetric Care (EmOC)

                                                                        The most missing signal
                                                                    function is “Assisted vaginal
                                                                    delivery (i.e. use of vacuum
                                                                    extraction, forceps)
                       Instrument used:
         Need assessment of emergency and neonatal care,
                 Columbia University, AMDD 2011.


      Prima le mamme e i bambini    15 dicembre 2012       II caso Uganda
Diapositiva 4

PL2         Need to explain HC 1-6 and diagram
            Peter Lochoro CUAMM Uganda; 15/12/2012
Quality of maternal and neonatal
        care, Aber Hospital


  .




Instrument used: Assessment tool for the quality of hospital care for mothers, newborn and child, WHO 2009.

 Prima le mamme e i bambini       15 dicembre 2012        II caso Uganda
Quality of maternal and neonatal
      care, Aber Hospital
          Substantial improvements necessary to prevent
   serious risk to the health of mothers and new borns.`
Issues: Sick newborn care, nursery, Guidelines,
   protocols, auditing:
          Improvements necessary to avoid risks for the
   health of mothers and new born
Issues: 1. Organisation: Infrastructure, equipment,
   supplies, laboratory, access, HIS. 2. Clinical: Maternal
   care (normal delivery and obstetric complications)
   Neonatal care (routine), Mothers and newborn follow-
   up
         Improvements necessary to mininmize potential
   risks for the health of mothers and new born
Issues: Drugs availability
Prima le mamme e i bambini   15 dicembre 2012   II caso Uganda
Equity Aber Hospital, Oyam
                    District


                                                         77% of women who
                                                     delivered at Aber Hospital
                                                     belong to the richest
                                                     quintile, while none
                                                     belong to the poorest
                                                     quintile

                                                         40% of women who
                                                     delivered at health centres
                                                     belong to the richest
                                                     quintile, while 10% belong
                                                     to the poorest quintile


                                                      Instrument used: Proxy Wealth Index,
                                                           Demographic Health Survey
                                                                  Uganda 2006.

Prima le mamme e i bambini   15 dicembre 2012   II caso Uganda
Indicators of Emergency Obstetric
care, Oyam District


                                                                 Acceptable
  Indicator
                                                                  standard    Oyam

  1a. Number of cEmONC facilities                                    1          1
  1b. Number of bEmONC facilities                                    3          0
  2. Proportion of all births in EmONC facility                   None set    12.4%
  3. Population based caesarean section rate                       5-15%      2.4%
  4. Direct obstetric case fatality rate in EmONC
                                                                    <1%       1.5%
  facility
  5. Intrapartum and very early neonatal death rate
                                                                  None set    2.8%
  in EmNOC facility
  6. Proportion of maternal deaths due to indirect
                                                                  None set    33.3%
  causes in EmONC facility

Prima le mamme e i bambini   15 dicembre 2012   II caso Uganda
Conclusion
• The project is beginning to get results
• Now we are more knowledgeable about the gaps in
  quality, equity, coverage and we have a basis for specific
  actions for improvement
• Gaps in Signal functions for EmONC persist and we
  need to address them; esp. assisted vaginal del, use of
  anticonvulsant, to get HC IV fully functional
• Quality gaps are mainly in Sick newborn care, nursery,
  Guidelines, protocols, auditing:
• We are not yet serving the people we intend to reach



 Prima le mamme e i bambini   15 dicembre 2012   II caso Uganda

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Il caso Uganda - Prima le mamme e i bambini - Medici con l’Africa Cuamm

  • 1. Mothers and Children First: The case of Uganda Peter Lochoro MBChB, MSc Country Representative Doctors with Africa CUAMM, Uganda Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda
  • 2. Uganda – Oyam District Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda
  • 3. PL1
  • 4. Diapositiva 3 PL1 Explain the diagram and the Italian version Peter Lochoro CUAMM Uganda; 15/12/2012
  • 5. PL2 Signal Functions for Emergency Obstetric and Neonatal Care, Oyam District Aber Hospital is the only health unit which provides all 9 signal functions. Therefore it is qualified as comprehensive emergency obstetric care (CEmOC) None of the health centres provide all 7 signal functions to qualify as Basic Emergency Obstetric Care (EmOC) The most missing signal function is “Assisted vaginal delivery (i.e. use of vacuum extraction, forceps) Instrument used: Need assessment of emergency and neonatal care, Columbia University, AMDD 2011. Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda
  • 6. Diapositiva 4 PL2 Need to explain HC 1-6 and diagram Peter Lochoro CUAMM Uganda; 15/12/2012
  • 7. Quality of maternal and neonatal care, Aber Hospital . Instrument used: Assessment tool for the quality of hospital care for mothers, newborn and child, WHO 2009. Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda
  • 8. Quality of maternal and neonatal care, Aber Hospital Substantial improvements necessary to prevent serious risk to the health of mothers and new borns.` Issues: Sick newborn care, nursery, Guidelines, protocols, auditing: Improvements necessary to avoid risks for the health of mothers and new born Issues: 1. Organisation: Infrastructure, equipment, supplies, laboratory, access, HIS. 2. Clinical: Maternal care (normal delivery and obstetric complications) Neonatal care (routine), Mothers and newborn follow- up Improvements necessary to mininmize potential risks for the health of mothers and new born Issues: Drugs availability Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda
  • 9. Equity Aber Hospital, Oyam District 77% of women who delivered at Aber Hospital belong to the richest quintile, while none belong to the poorest quintile 40% of women who delivered at health centres belong to the richest quintile, while 10% belong to the poorest quintile Instrument used: Proxy Wealth Index, Demographic Health Survey Uganda 2006. Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda
  • 10. Indicators of Emergency Obstetric care, Oyam District Acceptable Indicator standard Oyam 1a. Number of cEmONC facilities 1 1 1b. Number of bEmONC facilities 3 0 2. Proportion of all births in EmONC facility None set 12.4% 3. Population based caesarean section rate 5-15% 2.4% 4. Direct obstetric case fatality rate in EmONC <1% 1.5% facility 5. Intrapartum and very early neonatal death rate None set 2.8% in EmNOC facility 6. Proportion of maternal deaths due to indirect None set 33.3% causes in EmONC facility Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda
  • 11. Conclusion • The project is beginning to get results • Now we are more knowledgeable about the gaps in quality, equity, coverage and we have a basis for specific actions for improvement • Gaps in Signal functions for EmONC persist and we need to address them; esp. assisted vaginal del, use of anticonvulsant, to get HC IV fully functional • Quality gaps are mainly in Sick newborn care, nursery, Guidelines, protocols, auditing: • We are not yet serving the people we intend to reach Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda