By Population Services International Uganda and Kampala Capital City Authority
Uganda’s high maternal mortality ratio of 336 deaths per 100,000 live births and the perinatal mortality rate of 43 deaths per 1000 live births are a significant concern in Uganda.1 The maternal mortality ratio and neonatal mortality rate far exceed the global targets of 70 deaths per 100,000 live births and 12 deaths per 1000 live births respectively, set in the 2030 Sustainable Development Goals (SDGs).2, 3 Access to and receipt of quality antenatal care (ANC), delivery, and postnatal care (PNC) are critical to reduce maternal and neonatal deaths.4 In poor urban settings, women and children are particularly vulnerable to adverse health outcomes due to limited access and availability of resources and poor-quality care.5
To address these issues, Population Services International (PSI), in partnership with Kampala City Council Authority (KCCA)—the governmental body that oversees the provision and supervision of health services in Kampala—with funding from the United States Agency for International Development (USAID), launched the Kampala Slum Maternal and Newborn Health (MaNe) project in 2018. Using an implementation research framework, the goal of MaNe was to improve MNH outcomes for people living in Kampala slums by developing and evaluating interventions that addressed supply- and demand-side barriers to care seeking and to generate evidence on effective and feasible solutions to improve the quality of MNH services for the urban poor.
Findings from the formative research phase revealed that despite limited availability, overcrowding, long wait times, and resource shortages, public healthcare facilities were the main source of MNH care for the urban poor primarily because services were supposed to be free. Women reported, however, that care at public facilities was not always free. In some cases, patients found themselves responsible for paying for medical supplies or having to make informal payments to providers before they could receive a service. Women expressed interest in private healthcare options as they perceived the services to be of higher quality (specifically in regard to cleanliness, timeliness, and respectful treatment by providers); but for most, the cost was a prohibiting factor. Many women stated that they would be willing to pay a reasonable fee for private healthcare but wanted assurances that they would in fact receive quality MNH services.