A consortium of Rotary Clubs in US and Uganda is teaming up to provide badly needed MCH equipment, support services, and clinical training to 63 public hospitals and maternity centres in 6 local government districts serving the poor in rural Uganda. These facilities provide the full range of women's health services, including maternity, C-sections, perinatal care, and family planning counseling, to 105,000 maternity patients annually. To reach this target group, Rotary will partner with Bulamu Healthcare International, a US non-profit & Ugandan NGO that has Memorandums of Understanding (MOUs) in place to provide medical services and management systems to 12 partner districts in Uganda that operate 347 health facilities treating 3.3 million patients each year. Together these districts account for 11% of the public healthcare facilities in Uganda and serve 17% of the country's population of 47 million. (See Exhibit 1: Bulamu Partner District Map, and Exhibit 2: Bulamu Partner District Data.)
The Bulamu partner districts are providing a demonstration project for the Ministry of Health (MOH) to show what can be accomplished by introducing private-sector solutions to address endemic problems while strengthening the public health system. The 6 target MCH districts fall below average in a composite of 12 MCH-related performance factors that are used by the MOH in its annual District League Table ranking of all 140 districts on their level of patient care. The goal is that after the implementation of this MCH initiative, the target districts will become MCH Model Districts, justifying funding from public agency and private foundations to extend these programs across all public health facilities in Uganda.
The Need: According to WHO data, Uganda is underperforming the global average in these key MCH metrics:
• Maternal mortality was recently 375 per 100,000 live births, 78% above the global average.
• Neonatal mortality was 20 per 1000 births, 18% above the global average.
• Under-5 mortality was 46 per 1000 births, 21% above the global average.
• Births attended by skilled health personnel was at 74% versus the global average of 83%.
These statistics include 6,232 public and private health facilities in Uganda, of which 3,194 are MOH-funded and focus on serving the poor. During the 6 years Bulamu has been providing healthcare programs in partnership with 22 different local government districts throughout the country, it has identified the most common failures in patient care and developed with MOH authorization a suite of programs that address those issues cost-effectively by implementing them entirely through local personnel. By building on Bulamu's existing MOU partnerships, distribution network, and Core Team of licensed clinicians who are paid based on days worked, Rotary funds will be leveraged and have nationwide impact that could not be achieved on its own. In a previous Global Grant (GG2127364), Bulamu teamed with 5 US & UG Rotary Clubs to provide vital signs equipment and training to 125 health facilities treating 1.1 million patients per year.
The Program: While Bulamu's previous healthcare programs have extended horizontally across the full range of medical diagnoses, surgical cases, and facility management challenges, this program focuses vertically on a single clinical area, maternal and child health. In its 6 years of operations, Bulamu has observed consistent gaps in MCH care and identified particularly pressing needs in 5 MCH areas where modest funding can have dramatic impact:
(1) Essential Surgical Supplies: Stockouts of essential surgical supplies needed to keep operating rooms open and performing C-sections (e.g., sutures, needles, gloves, etc.) Our survey found that district-level operating rooms are dark 50% of the time for lack of inexpensive supplies.
(2) Emergency Transport: Unavailability of ambulances to transport mothers with obstructed labor to the nearest surgery center for a C-section, even though local vehicle services will transport patients for $27 per trip!
(3) Maternity Treatment Forms: Lack of hardcopy treatment forms for expectant mothers to have access to their pregnancy, maternity, and post-natal data, since no digital records are available, with copy for the health facility to maintain its own proper records.
(4) Hospital Equipment; Basic equipment needed for C-sections and neonatal care (incubators, autoclaves, suction machines, etc.) at maternity centers and community hospitals. One district hospital's OR was dark for 11 years for lack of $5,000 in basic surgery room equipment!
(5) MCH Clinical Training. Need for staff training (nurses, midwives, doctors) using WHO-approved curriculum for Essential Newborn Care (ENC), a set of disciplines that incorporate APGAR, Helping Babies Breathe (newborn resuscitation), and perinatal care.
The breakdown of cost between the 5 program elements and 6 participating districts can be found in Exhibit 3: Rotary MCH Grant Program Costs.
Shared Funding. The entire project described above will cost $308,000 over the first 12 months. Bulamu has agreed to provide the needed surgical supplies, emergency transports, and treatment forms that will cost $108,200. These are standard elements in the Health Center Excellence (HCE) Program, Bulamu's hospital/clinic management system that is installed in every partner district following the completion of its direct patient treatment programs (explained below.) What Rotary must contribute, since it is outside Bulamu's normal budget, is the $200,000 for capital equipment essential for maternity centres and hospitals to perform their MCH roles and the clinical staff training necessary to ensure safe deliveries and improve perinatal care. The Rotary portion is a one-time, front-end investment, whereas the Bulamu portion is ongoing and will continue to be covered in its annual operating budget.
Objectives: This MCH Initiative is designed to close five operational gaps that were identified with ground-level observations as currently hurting MCH care across the MOH network of 2,194 facilities. The program objective is to raise the standard of maternal and child care by achieving demonstrated progress at the partner MCH districts, as shown by these metrics:
1. Increase the number of women receiving antenatal care and the frequency of their visits.
2. Reduce the maternal and neonatal mortality rates vs. Uganda national averages and previous trends (e.g., fresh stillbirths.)
3. Increase the rate of births being covered by skilled health personnel.
4. Increase the rate of newborns needing resuscitation who successfully survive.
5. Reduce surgery theatre down days due to lack of equipment or supplies.
6. Improve access to Caesarian deliveries within partner districts by increasing the number of emergency transport trips.
7. Increase the total number of deliveries in public health facilities, reflecting an increase in patient confidence in the quality of care that will be provided.
8. Increase the number of clinicians trained in WHO's Essential Neonatal Care (ENC) disciplines.