Implementing the skilled birth attendance strategy in Uganda: a policy analysis

Area of Science:

• Public Health
• Health Policy
• Maternal Health

Background:

• Uganda implemented skilled attendance at birth strategy to reduce maternal mortality, a key target of the 5th Millennium Development Goal.
• Despite improved facility delivery rates, maternal mortality rates remained high, necessitating an analysis of policy implementation.

Purpose of the Study:

• To analyze the strategies and bottlenecks experienced during the rollout of Uganda's skilled birth attendance policy.
• To provide lessons for decision-makers on improving maternity care in low-resource countries.

Main Methods:

• Case study utilizing document review and in-depth interviews with key informants.
• Data collection and analysis guided by the Walt and Gilson health policy triangle.

Main Results:

• The policy had strong political commitment and stakeholder support, with efforts to increase skilled health workers and improve emergency obstetric care infrastructure.
• Challenges included slow health worker recruitment due to restrictive norms, inadequate midwifery skills in newly trained cadres, and infrastructure expansion outpacing resources, leaving facilities non-functional.

Conclusions:

• Uganda's policy increased access to obstetric care but faced significant human resource and infrastructural capacity challenges for quality care.
• Policy implementation revealed complex issues and unintended consequences, highlighting the need for further evaluation to improve skilled birth attendance.