Quality of Care in Uganda

A national roadmap and implementation guidelines were developed to improve the quality of RMNCAH services, including family planning in the country. Beginning in 2017, the WHO standards for improving quality of maternal and newborn care in health facilities have been adapted and learning sites have been oriented on the implementation of the national package of QI interventions. The adaptation of the WHO standards for improving quality of care for children and young adolescents in health facilities was finalized in 2022, and the process to adapt the standards for improving quality of care for small and sick newborn in health facilities has commenced. The National Quality of Care Framework & Strategic Plan (2021-2025) was developed in 2021 to support the implementation of MNH QoC initiative at national, district and facility level.

In 2017, starting with six districts and eighteen learning sites, quality of care MNH interventions were scaled up by ten folds with partner support, to more than 60 districts and 200 plus health facilities in 2022. The scale-up is being made possible by the high level political will to improve RMNCAH care, a positive legislative environment and continuous support from partners such as CHAI, UNICEF, USAID, UNFPA, Jhpiego, Rotary, World Bank. To ensure healthcare workers are capacitated on MNH quality of care, Uganda established a national RMNCAH mentorship program; trainings and district led supportive supervision are conducted regularly in the eighteen learning districts. Projects and initiatives focusing on improving WASH services, family planning, pediatric and newborn care are being implemented across the country with partner support. Mentorship packages for child health, Integrated Management of Neonatal and Childhood Illness (IMNCI), integrated family planning, adolescent health, QI, MPDSR, MNCH QoC standards and IPC were developed and are being adopted by health facilities. With support of WHO, Makerere University  School of Public Health and Uganda Private Midwives Association spearheaded the Maternal and Newborn Health Quality of Care baseline assessment, using the adopted MNH QoC assessment tool.

A set of quality indicators for reproductive, maternal, newborn and child health were agreed to be reported upon, data on selected MNH indicators are routinely collected in the national HMIS system and analysis and QoC assessments are regularly conducted. A national QI database has been established which captures the core MNH QoC process indicators. With the support of WHO, the USAID HYBRID HIV Database was modified to enable reporting of data on experience of care and WASH indicators in 2022. These indicators are yet to be included in DHIS2.

Uganda has established mechanisms to engage communities in quality MNH initiatives such as community dialogues and health committees. The Ministry of Health developed Community Dialogue Guidelines  for community discussions on the findings of QoC MNH assessments. Guidelines for engaging Health Unit Management Committees (HUMCs) were also developed to systemize the approach of raising concerns from the community level to healthcare workers and local counsellors. For example, village counsellors representing local communities also meet monthly to discuss health and development priorities and key issues are conveyed to the district council for further consideration and planning.

Uganda has been advancing the documentation and sharing of lessons learned, progress and challenges at national level. Makerere School of Public Health was identified to facilitate the documentation of lessons learned and exchanges among practitioners, learning districts, decision-makers, and academics in the country. Innovative solutions have been developed to share learning from district-based activities across health facilities, such as WhatsApp platforms for each learning district. Peer-to-peer Maternal and Newborn Health quality of care learning sessions have been incorporated into district performance reviews in learning districts. In 2021, the Makerere University School of Public Health piloted a system to strengthen MNH quality of care data collection and management at the facility level and established a community of practice, which include the systematic reporting of case stories from the field. This will form the basis of a national learning network across learning sites.

Moving forward, maternal, newborn health and family planning scaled up to further health facilities and districts is the priority. Accountability for MPDSR needs to be strengthened at national level, this includes the establishment of a culture of learning and knowledge sharing. The engagement of the private sector in the delivery of quality MNCH services is high on the agenda at national level for 2023, with the aim for collaboration between the public and private sector to improve the quality of MNH services.

Photo: A mother and her child in Molo village, Tororo district, in 2013. ¬©UNICEF/Nakibuuka

The first National Forum on Quality of Care for Maternal and Newborn Health took place in May 2022, which aimed to review the status of implementation in the learning districts, reflect on key challenges encountered and discuss the most promising innovative solutions. This National QoC Forum was officiated by the Minister of State for Health, Hon. Margaret Muhanga Mugisa, and brought together MNH partners and stakeholders, including frontline health workers and quality of care teams from learning facilities and districts, to discuss and reflect on the progress, challenges and lessons learned in implementing the MNH Quality of Care initiatives at the national, district and facility level.

In relation to the National Quality of Care Forum, a webinar was conducted and led by Dr Elizabeth Namagala, Quality Improvement Advisor at the Ministry of Health, Uganda. This aimed to summarize the National Forum discussions and to share positive experiences, challenges, practical solutions and lessons learned by Uganda in implementing and scaling up quality of care for MNH.