Educate women and empower midwives to increase skilled birth attendance and health facility delivery.
We are a midwifery-centred maternal health charity, working in Uganda, registered in the UK in 2017. Our primary objective is to improve the availability and quality of healthcare for expectant mothers and their babies, in Hoima and Kikuube districts (see map), surrounding Hoima town, in Bunyoro sub-region, Uganda. Skilled birth attendance and delivery in a health facility reduce the risks of harm to both mother and baby. The World Health Organization (WHO) concludes that skilled attendance during childbirth is “the single most important factor in preventing maternal deaths”. We target the three delays described as contributing to adverse outcomes in pregnancy and childbirth: the woman, and her family’s, decision to seek care; economic and physical accessibility of care; and the quality of the care available once accessed. We aim to enhance access to quality healthcare, skilled medical staff, medical resources and comprehensive referral services, thereby increasing skilled birth attendance and health facility delivery, so decreasing serious pregnancy complications. This closely aligns with the United Nations’ Sustainable Development Goals, as well as priorities from the WHO, Ugandan government and the Hoima District Development Plan.
Despite a 50% improvement since 1990, Uganda’s maternal mortality ratio (MMR, maternal deaths per 100,000 live births) is estimated to be 375; approximately 50 times higher than in the UK (The World Bank, modelled estimates, 2017). Maternal health in Uganda lags behind both national and international targets, and is negatively impacted by marked poverty levels; geographical inaccessibility; lack of transport; and gender inequality. In Bunyoro sub-region where we work the percentage of births that took place in a health facility (57%) and/or were assisted by a skilled provider (58%) were the second-lowest in 2016 (Uganda Bureau of Statistics). During the financial year 2019/20, Hoima Regional Referral Hospital had both the second highest MMR (611) and rate of fresh stillbirths per 1000 births (37) amongst the regional referral hospitals (consistent with previous years); and in Hoima district 51 maternal deaths were reported (second highest) (Ministry of Health, Uganda). These data highlight the critical importance of our work in the particular area in which we are based.
- Comprehensive health education of women and their families throughout pregnancy;
- Improving physical and economic access to skilled birth attendance and health facility delivery, through the establishment of remote maternity facilities and outreach antenatal clinics, together with the provision of reliable emergency transportation;
- Providing safe, high quality maternal healthcare at our facilities, achieved through both formal and bedside clinical education of the midwives, clinical officers, doctors and health support workers, coupled with reliable supply of resources;
- Ensuring sustainability of our maternal healthcare services through close collaboration with our Ugandan colleagues.
- Place women and their families at the centre of our focus;
- Empower and promote the advocacy of the local Ugandan midwives;
- Work with our Ugandan colleagues to establish locally run and led sustainable maternal healthcare facilities;
- Remunerate local staff and suppliers fairly and in line with local rates, to ensure retention of well trained, committed staff as well as sustainability of our services.
Hoima is the municipal town in the Western Region of Uganda, and is three hours north west of the capital city, Kampala. The MAMA Trustees first became involved in healthcare in Hoima town through the regional referral hospital (HRRH or ‘Boma’) and then developed a relationship with Azur Health Centre IV, with whom we still work closely.
MAMA’s first maternity clinic was established in Runga in February 2017, after we had been involved with holding outreach antenatal clinics in the village since 2012. Runga is a small fishing village in on the shore of Lake Albert, bordering the Democratic Republic of Congo. The clinic’s monthly running are funded through regular personal donations to MAMA, and the Shalimar Trust.