This project will provide 2 fully equipped ambulances for a rural Districts in Uganda where maternal and child health services are extremely low serving a population of over 24,330 people. The ambulances will be operated and maintained by Kabambiro Health Centre and Kabuga Health Centre III in Kamwenge District, Uganda. They will be used to provide care and transport for pregnant mothers, children and other community members needing emergency care from rural areas to the health centres. The ambulances will also provide needed transport to and from peripheral health facilities for comprehensive maternal and neonatal care within the Region.
The ambulances will be available for those who need tertiary care for example caesarean section, blood transfusion, neonatal care which are not available at the lower level health facilities. As part of the project we will set up a communications system so that the staff at the lower level health facilities can communicate with the staff at health centres and the ambulance team to dispatch the ambulances in time and ensure the facilities are ready to receive and quickly help any pregnant woman or newborn baby who is referred in.
The current situation
In the calendar year 2018 there were 14,541 deliveries in Kamwenge District the majority of which were in small peripheral health facilities. There were only 1045 caesarean sections done in the District, there were 60 reported maternal deaths and 294 newborn deaths. However, most of the cases go unreported. In line with the Kamwenge District Health Sector Annual Workplan for 2023/24 Financial Year our aim is to reduce the neonatal mortality rate from 60 per 1000.
In addition to the above, there are only 3 health facilities in the district offering caesarean sections, access to these facilities is extremely cumbersome due to lack of quick transportation from the periphery communities. A big contributing factor to these maternal and newborn deaths is delay of
pregnant mothers in reaching the hospital due to lack of a reliable ambulance system. The Maternal Mortality rate in Uganda is 368 per 10,000 Live Births. According to the maternal death audit reviews conducted on these deaths, the major cause of maternal death was delay to reach hospital.
Procurement of an ambulance will address this critical delay through provision of quick means to transport pregnant mothers in urgent need of comprehensive emergency obstetric care from Lower level Health facilities where these services are not available to where these services are available. Through this initiative we aim to reduce the maternal deaths from 60 to less than 10.
Furthermore some of the health workers delay to refer patients in need of tertiary care and when they decide to refer, there is no established ambulance system to transport the patient. Most pregnant mothers referred to the hospital for caesarean sections have to travel by motorcycle for long distances which contributes to poor outcome for the mother or baby or both.
In rural Uganda, It is important to realize that we have very few hospitals. Most of these hospitals are ill equipped and lack sufficient equipment to manage some diseases and emergencies. Its certainly worth noting that, a hospital does not manage emergencies or disasters by itself. There are other pre-hospital factors, which have to be considered. In rural Uganda, a pre-hospital emergency service may not exist, and resources are minimal. Our plan is that, If we can integrate the pre-hospital and hospital resources which are available, we can make an Integrated Emergency Medical Services System which will provide the means to manage daily emergencies and disasters in an organized way, and also provide good quality emergency medical care.
Worse still, the annual health sector performance report for financial year 2017/2018 shows that there are 42,530 health workers employed in the public sector. The staffing is shared between Ministry of Health headquarters, national referral hospitals, three central specialized health institutions, 14 regional referral hospitals, 47 district or general hospitals, 182 level IV health centers, 962 level III health centers and 1321 level II health centers. Most public health facilities have inadequate doctors to offer quality health services to the public. Uganda still has an acute shortage of doctors in the public health service. According to the World Health Organization (WHO), the recommended doctor to patient ratio is 1:1000, which means that Uganda
needs at least 40,000 doctors for its estimated 40 million people. Therefore, the Saving Mothers Ambulance Project means a lot to the people of Kamwenge especially the expecting mothers and their babies.
Provision of the ambulance coupled with intensive community educational campaigns targeting Village Health Teams (VHTs), Change Agents, Community process facilitators, teachers and community leaders who will act as catalyst for change will reach out to the wider community with messages promoting sexual reproductive health and diseases prevention. Through multiplier principle, the trained community trainers will reach out to adolescents, mothers, youth, parents and students in an effort to improve knowledge, skills, attitudes and practices around maternal and child health, reproductive health issues and prevention of diseases in communities.
The project will conduct 10, 1 day orientation meetings for local community stakeholders in 10 different sub counties in Kamwenge District involved in the ambulance project to help them understand how the ambulance will work and help their community, sensitise local stakeholders about the need to increase referral of pregnant mothers and new born children for tertiary care. These meetings will further orient local stakeholders on the referral system and proper communication between the Patient/community leader/Village Health Teams, lower level health unit, the Ambulance team and the referral unit.
To train the stakeholders in proper documentation needed for the project i.e Referral notes, Ambulance register, call logs, health facility registers etc for proper Monitoring and Evaluation of the project and also, strategies to reduce maternal and neonatal mortality, nutrition, malaria and HIV/AIDS prevention.
Goal: To help reduce the number of maternal and neonatal deaths in Kamwenge District by reducing the delay to reach the hospital.
1. Reduce the delay by critically sick patient's especially pregnant mothers and newborn babies to reach hospital by procurement of an ambulance
2. Improve the referral system through training of the health workers and community leaders in hard to reach areas.
3. Improve communication between the rural health units and the referral unit by setting up a communication system (toll free line or radio call).
Expected Project outcomes:
In line with the Kamwenge District Health Sector Annual Work plan for 2023/24 Financial Year our targeted result indicator is to have;
1a. Reduced the neonatal mortality rate from 27 per 1000 Live births in 2019/20 to 18 per 1000 Live births by end of 2024.
The Maternal Mortality rate in Uganda is 368 per 10,000 Live Births. In Kamwenge district there were 43 recorded maternal deaths in the FY 2018/19. According to the maternal death audit reviews conducted on these deaths, the single major cause of maternal death was delay to reach hospital. Procurement of an ambulances will address this critical delay through provision of quick means to transport pregnant mothers in urgent need of comprehensive emergency obstetric care from Lower level Health facilities where these services are not available to Kabuga and Kabambiro health centres where these services are available.
1b. Through this initiative we aim to reduce the maternal deaths from 43 to less than 10.
2. The project will not only target health workers for trainings but will also conduct 10 community 1 day orientation meetings for VHTs (Village Health Teams), health workers and community leaders on ambulance use and referral system and promotion of maternal and child health in target area. The aim of these meetings will be to inform the stakeholders in the community who include the health workers, VHTs, local politicians and community leaders about the availability of the ambulance, how to access and use the ambulance services and when to refer a pregnant mother or newborn baby in need of tertiary care.
3. As part of the project we will set up a communications system so that the staff at the lower level health facilities can communicate with the health centre staff and the ambulance team to dispatch the ambulance in time and ensure the hospital is ready to receive and quickly help any pregnant woman or newborn baby who is referred in.
In addition, The ambulance will also address disease prevention and treatment by providing health education and screening for women and children through health camps in the villages of Kamwenge.
4. The project will promote health education regarding family planning and health screening for cervical and breast cancer, diabetes, and high blood pressure. This will improve the health of the women of child bearing age and improve the success of their pregnancies.