Prime
Improve infant, maternal health service delivery
Elizabeth Nansubuga
The bulk of Uganda’s maternal and infant deaths occur in the postnatal care period within six weeks of child birth, yet this is when women and infants are least likely to obtain the healthcare they need.
According to Uganda Bureau of Statistics (Ubos), only 54 per cent of mothers and 56 per cent of newborns receive postnatal care within two days of delivery. This raises critical concerns about the delivery mechanisms and uptake of postnatal care services in Uganda. The current postnatal care service model is often at birth and at six weeks, with hardly any postnatal care at six days.
Unlike antenatal care services, postnatal care service provision is largely not standardised, has no scheduled days, lacks component of focused postnatal health education, has inadequate or no designated space, excludes individual health assessment, and majorly focuses on the newborns through immunisation services. As such, there are a lot of missed opportunities to curb maternal infant morbidity and mortality. Without doubt, Uganda is at a critical time to examine innovative strategies in a bid to achieve Sustainable Development Goal III targets on maternal and infant health by 2030.
With support from the government, feasibility of group postnatal care service delivery model was piloted in Rakai District. Group based postnatal care involves a blend of focussed group discussions regarding preventive and health-promotional aspects of the postnatal period, that include breastfeeding, postpartum family planning, nutrition, cord care, newborn thermoregulation, recognition of mother – infant danger signs, immunisation, psychosocial health and postpartum depression. Others are financial empowerment and individual mother infant health assessment at each scheduled postnatal care visit.
At least two days are purposively selected at each health facility to provide comprehensive postnatal care. Individual health checks are based on a standardised postnatal care checklist so as to ensure consistency in the content of care.
Mobilisation of mothers is through health workers, village health teams, return date cards and mobile phone call reminders. These group discussions do not only empower mothers, but also give women the confidence, understanding, and support to seek care and advice when needed and to choose healthy behaviours. Ideally, this group care model enables women to receive at least three postnatal care checks in line with recommendations by the World Health Organisation.
Based on a sample of 400 mothers, there is a high preference for the group-based care service model. The service model is associated with higher satisfaction among mothers, improved interaction or relations with health workers, greater sense of social or peer support, shared experiences, empowerment, and greater levels of knowledge regarding postnatal health care. On the upside, mothers also believe that with provision of group-based services, corruption at health facilities will be reduced.
With individual health checks, maternal and infant complications that would otherwise have remained undetected were treated or referred to higher level health facilities. These ranged from women unknowingly presenting with high blood pressure to infants found with cord infections, jaundice, difficulty in breathing, failure to breastfeed, to mention but a few. This period also presents the best opportunity for uptake or resumption of postpartum family planning. Why? Several women believe that they are not at risk of conception before return of their menses. Thus, this postnatal service model enhances the chances of identifying and managing maternal and infant complications in this period.
Overall, group postnatal care offers a high impact alternative to standard postnatal. It has the potential to improve quality, increase timely postnatal care attendance.
Dr Elizabeth Nansubuga is a demographer and lecturer at Makerere University.
