Evaluating the implementation of Bulamu healthcare's maternal and newborn program in Uganda

Maternal and newborn mortality remain critical challenges in Uganda, with rates exceeding global targets. Despite the existence of effective clinical guidelines, such as the World Health Organization's (WHO) Essential Newborn Care (ENC) and Helping Mothers Survive (HMS), implementation gaps persist due to training, resource, and systems-level barriers. Bulamu Healthcare launched a comprehensive maternal and newborn care capacity-strengthening program across eight districts in Uganda to improve clinical outcomes and health system performance. This model works with 104 existing public maternity facilities, which delivered more than 77,000 babies in 2024, and served more than 154,000 mothers and newborns in 2024.

This retrospective evaluation assessed the implementation of Bulamu's maternal and newborn health model using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). The program included clinical training (WHO ENC, HMS) and mentorship, provision of essential supplies, and data-driven quality improvement. Data were collected from Uganda's national District Health Information Software (DHIS2) and Bulamu program monitoring tools from January 2023 to March 2025. Descriptive statistics summarized key implementation and outcome indicators.

Bulamu supported 109 health facilities, exceeding the initial target of 79, and established 12 functional neonatal care units (Reach). All facilities received the full intervention package. Over 250 maternity workers were trained, and 100% of district health workers in supported areas received ENC training (Feasibility). Live births in Bulamu facilities increased by 14% from 2023 to 2024, while maternal deaths decreased by 59% (from 17 to 7) (Effectiveness). The proportion of low-birth-weight newborns receiving kangaroo mother care rose from 54 to 62%, and newborn discharged alive rates improved from 80% to 96.4% (Effectiveness). Facilities demonstrated early signs of sustainability, with at least one trained maternal and newborn provider retained per site and local staff beginning to independently train peers.

Bulamu's integrated approach combining evidence-based interventions with targeted systems support improved care delivery and maternal-newborn outcomes in Bulamu-supported health facilities. Findings highlight the utility of the RE-AIM framework for real-world evaluation and support the value of embedded implementation research in strengthening health systems. Future research should examine cost-effectiveness, sustainability, and context-specific implementation mechanisms to inform scale-up and sustainability.