Saving mothers, giving life approach for strengthening health systems to reduce maternal and newborn deaths in 7 scale-up districts in northern Uganda

Background: Uganda's maternal and newborn mortality remains high at 336 maternal deaths per 100,000 live births and 27 newborn deaths per 1,000 live births. The Saving Mothers, Giving Life (SMGL) initiative launched in 2012 by the U.S. government and partners, with funding from the U.S. President's Emergency Plan for AIDS Relief, focused on reducing maternal and newborn deaths in Uganda and Zambia by addressing the 3 major delays associated with maternal and newborn deaths. In Uganda, SMGL was implemented in 2 phases. Phase 1 was a proof-of-concept demonstration in 4 districts of Western Uganda (2012 to 2014). Phase 2 involved scaling up best practices from Phase 1 to new sites in Northern Uganda (2014 to 2017). Program Description: The SMGL project used a systems-strengthening approach with quality improvement (QI) methods applied in targeted facilities with high client volume and high maternal and perinatal deaths. A QI team was formed in each facility to address the building blocks of the World Health Organization's health systems framework. A community component was integrated within the facility-level QI work to create demand for services. Above-site health systems functions were strengthened through engagement with district management teams. Results: The institutional maternal mortality ratio in the intervention facilities decreased by 20%, from 138 to 109 maternal deaths per 100,000 live births between December 2014 and December 2016. The institutional neonatal mortality rate was reduced by 30%, while the fresh stillbirth rate declined by 47% and the perinatal mortality rate by 26%. During this period, over 90% of pregnant women were screened for hypertension and 70% for syphilis during antenatal care services. All women received a uterotonic drug to prevent postpartum hemorrhage during delivery, and about 90% of the women were monitored using a partograph during labor. Conclusions: Identifying barriers at each step of delivering care and strengthening health systems functions using QI teams increase partcipation, resulting in improved care for mothers and newborns.