CHALLENGE

Every day, around 300 children and 20 women die in Uganda, especially around the time of delivery. Although well-established medical care exists to prevent these deaths, most women and children in remote and hard-to-reach areas cannot access this care. Many women thus suffer severe illness including maternal and neonatal infections, obstetric fistula, and even death after giving birth in unsafe conditions.

The leading causes of maternal death in Uganda include pre-existing medical conditions accelerated by pregnancy like diabetes, malaria, HIV, and obesity (28%), bleeding (27%), eclampsia (14%), sepsis (11%), obstructed labour (9%), unsafe abortion (8%) and blood clots (3%). Addressing these causes of maternal and infant death as well as pre-existing medical conditions, requires good antenatal care, consistent monitoring, and access to emergency obstetric care, all of which are provided by the Mothers’ Waiting Hostel in the remote Bwindi forest area.

INTERVENTION

In 2008, the Bwindi Community Hospital (BCH) established a Mothers’ Waiting Hostel (MWH) with the aim of increasing institutional deliveries; reducing obstetric delays; and improving maternal and perinatal outcomes in the region. The hostel was fully integrated into the hospital, so that all existing services could be accessible to pregnant women in the hostel including medical care, surgery, community outreach, the insurance program, and mental health services.

High-risk mothers, living in hard-to-reach areas are identified through the hospital’s community nurse team, which regularly visits all villages in its catchment area, and through antenatal clinics. These women are then encouraged to come and stay in the hostel for up to a month before delivery, depending on the severity of their risk. The hostel has a capacity of about 40 mothers. If a mother chooses to come to the hostel, she pays a one-time fee of 2,000 shillings for her entire stay if she is covered under the community insurance scheme or if she is not, 5,000 shillings (approx. USD 1.35) for her entire stay.

Daily monitoring of the mothers is done by midwives.  If mothers have any concerns, midwives are available at any time for questions and counselling. Supervised deliveries, antenatal services, emergency obstetric care, and education services are provided to the mothers.

From 2008 – 2017, the maternal waiting hostel contributed to a fourfold increase in the utilization of delivery services at Bwindi Community Hospital; and a 10.5% increase in access to delivery services by mothers from the most remote areas like Mpungu sub county.

On averages of 150 deliveries are conducted per month, of which 50% of mothers utilize the waiting hostel.

At the hostel, women also access social support, and education. The hospital also has an active nutritional program utilizing demonstration gardens and weekly cooking classes, where mothers learn about nutritious and balanced meals to feed their children and families. By accessing the hostel, more babies are born healthy and the mothers return home with better knowledge about family planning, nutrition, and how to take care of their babies.

CASE INSIGHTS

It is possible to improve maternal and child health outcomes in remote areas using a socially acceptable model of a waiting home for pregnant women in remote areas. Waiting homes for pregnant women with obstetric problems are recommended by the World Health Organization and the Uganda government, although very few of them exist in Uganda. The waiting home can be a basis for health education for the mothers to improve the well-being of the new born children by providing information on appropriate Nutrition, immunisation, family planning and water, sanitation and hygiene. After the initial cost of building the hostel, the other costs are small. It is possible to maintain the hostel using existing hospital staff, and patients make a small financial contribution to their stay.