Uptake of reproductive, maternal and child health services during the first year of the COVID-19 pandemic in Uganda: A mixed methods study

Simon P S Kibira; Emily Evens; Lilian Giibwa; Doreen Tuhebwe; Andres Martinez; Rogers Kagimu; Charles Olaro; Frederick Mubiru; Samantha Archie; Rawlance Ndejjo; Noel Namuhani; Martha Akulume; Sarah Nabukeera; Rhoda K Wanyenze; Fredrick E Makumbi

doi:10.1371/journal.pgph.0001619

Uptake of reproductive, maternal and child health services during the first year of the COVID-19 pandemic in Uganda: A mixed methods study

PLOS Glob Public Health. 2023 Apr 20;3(4):e0001619. doi: 10.1371/journal.pgph.0001619. eCollection 2023.

Authors

Affiliations

¹ Department of Community Health and Behavioural Science, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
² Health Services Research Division, FHI 360., Durham, NC, United States of America.
³ Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
⁵ Behavioral, Epidemiological and Clinical Sciences Division, FHI 360., Durham, NC, United States of America.
⁶ Department of Planning, Financing and Policy, Division of Health Information Management, Ministry of Health, Kampala, Uganda.
⁷ Directorate of Clinical Services, Curative, Ministry of Health, Kampala, Uganda.
⁸ Research Utilization Department, FHI 360., Durham, NC, United States of America.
⁹ Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Abstract

Use of reproductive health (RH), maternal, newborn and child health (MNCH) services in Uganda is suboptimal. Reasons for this are complex; however, service-delivery factors such as availability, quality, staffing, and supplies, contribute substantially to low uptake. The COVID-19 pandemic threatened to exacerbate existing challenges to delivery and use of high-quality RH and MNCH services. We conducted a mixed methods study, combining secondary analysis of routine electronic health management information system (eHMIS) data with exploratory key informant interviews (KII) to examine changes in health service uptake over the course of the pandemic and to understand service delivery adaptations implemented in response. We analyzed eHMIS data for four services (family planning, facility-based deliveries, antenatal visits, and immunization for children by one year), comparing them across four time periods: pre-COVID-19, partial lockdown, total lockdown and post lockdown. Additionally, KIIs were used to document adaptations made for continuity of health services. Use of services declined substantially during total lockdown; however, rebounded quickly to earlier observed levels, during the post lockdown for all four services, especially for immunization for children by one year. KIIs identified several health services delivery adaptations. At the community level, these included: community outreaches, training some mothers as community liaisons to encourage others to seek health services, and support from local leaders to create call centers to facilitate clients transport during travel restrictions. Health facilities creatively used space to accommodate social distancing and shifted providers' roles. District leadership reassigned health workers to facilities closest to their homes, provided vehicle passes to staff, and ambulances to transport pregnant women in critical need. WhatsApp groups facilitated communication at district level and enabled redistribution of supplies. Ministry of Health produced critical guidelines for continuity of health services. Implementing partners provided and redistributed commodities and personal protective equipment, and provided technical support, training and transport.

Copyright: © 2023 Kibira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This research was funded under the Grant funded by Family Health International (FHI) under Cooperative Agreement/Grant no 7200AA19CA00041 funded by United States Agency for International Development (USAID). The content of this paper does not necessarily reflect the views, analysis of policies of FHI 360 or USAID, nor does any mention of trade names, commercial products, or organizations imply endorsement by FHI 360 or USAID. RKW. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.