Examining the quality of maternal and newborn healthcare delivery in an African city – the case of Kampala, Uganda

Project Details


Background: Maternal and Newborn health (MNH) indicators in Uganda remain below national and global targets. This has been attributed to health system bottlenecks that have hindered effective and equitable coverage of life-saving interventions. Urban areas not only harbor vulnerable and marginalized populations, but also experience unique system challenges that limit availability and accessibility to healthcare to all urban residents. Consequently, despite presumed advantages, MNH outcomes remain poor. There’s increasing effort to improve health outcomes in Kampala city through implementation of targeted interventions. However, evidence on how high-quality care can be delivered in Uganda’s urban areas is inadequate to inform planning or policy design for universal and equitable coverage. This study seeks to examine the quality of MNH care delivery in Kampala by: 1) determining the level and patterns of maternal and neonatal mortality and associated factors; 2) exploring how management and governance for health contribute to MNH care delivery and outcomes; 3) assessing pathways to MNH care utilized by women in Kampala; 4) assessing MNH service packages provided in Kampala and the service delivery mechanisms; and 5) evaluating the feasibility and cost of selected MNH interventions/models being implemented in Kampala.
Methodology: An observational cross-sectional design combined with a collective case study design will be used, guided by the complex adaptive systems theory. The study will begin with a comprehensive desk review of literature on MNH and service delivery in urban areas in general and Kampala in particular. Following this, phased data collection will be done using quantitative (health facility assessment and women survey) and qualitative (key informant interviews, in-depth interviews, focus group discussions) methods in line with the study’s objectives. Quantitative data will be analyzed using STATA. Univariate (descriptive), bivariate and multivariate logistic regression analyses will be performed. Other planned techniques include time series analysis and pathway analysis. Thematic analysis will be used for qualitative data using NVIVO. Ethical considerations include ethical approval by Institutional Review Board of the Institute of Tropical Medicine and the Uganda National Council for Science and Technology, administrative clearance from Kampala Capital City Authority and targeted divisions, as well as written informed consent.
Expected results: The research is expected to contribute to urban health policy, service delivery design and implementation research on how to optimize delivery of MNH services to achieve universal coverage and improve outcomes within the urban context. I also expect to derive lessons that can be useful to other urban settings.
Effective start/end date1/01/2131/12/24

IWETO expertise domain

  • B680-public-health


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