Bulamu’s Maternal and Child Health

As Bulamu’s programs have evolved for the COVID-19 era, through our district partnerships, we observed gaps in the public healthcare system that have an especially detrimental impact on pregnant women and their newborns. Facilities have shortages of essential medicines and health supplies. Operating theaters are dark 50-60% of the time due to lack of basic surgical supplies, and sometimes delivery rooms are dark due to the same problem. Uganda’s MOH does not maintain digital or hard-copy patient records and patient forms to record antenatal, delivery, and postnatal care, so the caregiving process suffers and data are supplied only sporadically or not at all. The pandemic has also worsened MCH outcomes in many countries around the world. In Uganda, neonatal deaths in government facilities increased by 13% and maternal deaths in public health facilities increased by 7.6% in 2019-20 from the year before. (Uganda MOH, Annual Health Sector Performance Report, 2019/20)

Since COVID-19 began, Bulamu’s team has observed that our programs often serve a majority of MCH patients, helping them to survive and return to good health in the face of these serious health system challenges. In 2020, Bulamu’s CST and surgery programs helped 4,903 patients to give birth safely, including by providing C-sections for 472 women. In the second quarter of 2021, we began to provide 4 larger health centers with essential surgical supplies which resulted in more than 300 surgeries, including more than 100 C-section patients supported, in the program’s first 3 months. The HCE program, with its focus on systems strengthening, improves MCH outcomes by increasing patient confidence and attendance, by ensuring more functioning operation theaters and improving access to C-sections at appropriate facilities.

As a result, in 2021 Bulamu identified Maternal & Child Health as a vertical area where our cost-effective programs already are making a significant impact on patient care and where we now focus on continuously improving our results at scale. Bulamu’s MCH program thus builds on our established partnerships with 11 districts in Uganda, in order to implement Standard of Care MCH practices in their more than 250 health facilities over time.

Program Features and Impact

Bulamu’s MCH program addresses four systemic shortcomings:

1. Emergency Transportation. Expectant mothers with obstructed labor have an emergency need for transport to the nearest surgery center to avoid a catastrophic outcome. Since ambulances are often unavailable, we have arranged local transport companies to be on call when needed in partner districts. In 2021, we organized transportation for more than 500 patients, about half pregnant women, at an average cost of $26 per patient.
2. Essential Surgical Supplies. We are enabling the functioning of operation theaters in our partner districts by supplying inexpensive essential surgical supplies like sutures, needles, gloves, gauze, cotton, etc., so that C-sections and other surgeries can be performed when needed.
3. MCH Equipment. We identified items that are needed for conducting C-section surgeries safely, such as suction devices, autoclaves, fetal doppler scopes, incubators, etc. We are now doing needs assessments at our partner facilities to identify missing equipment and the cost of filling those gaps.
4. Patient Treatment Forms. We developed 5 new maternity forms for clinicians to record key data and observations during each patient visit: 3 of these forms are on folded card stock that the expecting or new mother brings with her for the 8 antenatal, 3 postnatal, and multiple family planning visits. The other 2 forms record critical patient information during the delivery or C-section.

C-sections often protect both the mother and her baby’s health. Bulamu works to ensure that C-sections are always available in our partner districts, avoiding catastrophic negative health outcomes that too many women around the world still have to face.

Bulamu’s MCH program is an exceptionally cost-effective way to improve care for thousands of Ugandan mothers and babies living in poverty. This program will help our partners become model MCH districts for cost-effective care in Uganda, with the goals of increasing MCH services provided by trained staff at properly equipped facilities and reducing maternal and neonatal mortality.