2019 will be a year of new possibilities for the people of Rakai and Kyotera. Over the past fifteen years we have built an innovative model based on strong partnerships with local government and the rural communities we serve. We are often asked why we have chosen to limit our work to Uganda, and to just two rural districts of a half million people. Most international development organizations have a much broader scope, working in many countries, possessing resources we can only dream about. Sometimes ‘small is beautiful’. Only by staying focused on our local communities, can we build the strong and trusting relationships that allow us to tackle complex problems, like lack of access to quality maternal and newborn care, keeping young women in school through comprehensive sexual and reproductive health education, and building primary schools equipped to educate and care for 5000 children. Sustainable development cannot be fostered on people by ‘outsiders.’ Rather, it will only come when people join together to create solutions from the ground up, brick by brick.
This year we will launch several innovative partnerships that will expand on the progress that we have made to improve the health of our communities.
Mama Rescue: Transportation That Saves Lives
Every year 7,000 women die in Uganda due to entirely treatable complications of pregnancy and childbirth. This silent tragedy is compounded by the fact that 45,000 babies every year. Over the last three decades, Uganda has had a sub-optimal reduction in maternal mortality with the current maternal mortality ratio standing at 336 deaths per 100,000 live births . The risk of a mother dying in Uganda is 14 times the risk in the US and almost 50 times the risk of a mother dying in Canada. At least 75% of these deaths can be attributed to one or a combination of three types of delay:
The delay in the decision to seek skilled maternity and newborn care
The delay in accessing skilled maternity and newborn care once the decision is made
The delay to receive quality care once reaching a health facility
The first two of these delays are often related to transportation. Rakai and Kyotera Districts are entirely rural. The roads and transportation infrastructure are extremely underdeveloped. Over 90% of our population live in remote villages, often many miles from a health facility staffed by a skilled birth attendant. With the exception of the one paved road that connects Rakai to Masaka, all others are poor dirt roads and for many communities completely lacking. Our region of Uganda has two rainy seasons, each of which is two to three months in duration. During these periods of heavy storms, our already poor roads may become slippery or are washed away and become impassable. In our districts of 518,006 people, there are only two ambulances, often lacking petrol to make referrals. All of these factors conspire to increase the delays of laboring mothers in reaching health facilities where our BAMA Program has worked diligently and successfully over the past four years to improve the quality of care.
Mama Rescue is a mobile-phone platform providing transport for laboring mothers in rural areas, through transport vouchers enabling women to be transported to deliver in health centers, received after attending four antenatal care appointments. By coordinating transport from home to health center, logistics, and communication between facilities, Mama Rescue aims to reduce delays associated with childbirth, thereby mitigating risks related to maternal and newborn mortality and morbidity, and increasing mothers’ and midwives’ confidence in the health system. Once fully implemented Mama Rescue will provide:
Facility-Based Delivery: Mama Rescue provides transport vouchers to women enrolled in the system after they log four antenatal care visits. These vouchers guarantee them free transport by boda boda (motorcycle taxi) from home to a health center, for delivery with a midwife. Our Babies and Mothers Alive Program has documented that if mothers attend ANC visit #4 the likelihood that they will deliver in one of our partnering health facilities reaches 81%
Rapid Emergency Response: Midwives at health centers can use their simple mobile phones to request emergency transport, using an automatic dispatch system. Local taxi drivers are alerted, and one is selected based on response time. Upon transporting the woman to the receiving facility, the driver is paid immediately with mobile money.
Communication of Critical Information: Referring midwives use Mama Rescue menus on their phones to send clinical information to the hospital, ahead of the woman’s arrival. This enables the hospital midwives to prepare for the admission and reduces the wait time for services such as surgical procedures and blood transfusions.
We are actively seeking funding to launch this innovative program this year.
Saving Brains/ Mama Ambassadors Program
Dr Eleanor Nakintu, BAMA Program Clinical Director with a Papa Ambassador and his baby
Uganda has one of the highest rates of adolescent pregnancy in Africa, with about 20% of young women becoming pregnant before the age of nineteen. A study completed at Makerere University in 2011 found that only 5% of pregnant adolescents stay in school during pregnancy and 25% rejoin after giving birth. With the support of Grand Challenges Canada, the Saving Brains/Mama Ambassador Program (MAP) is an initiative of Brick by Brick Uganda’s Babies and Mothers Alive (BAMA) Program to improve support for the 2,000 adolescent mothers who give birth each year in Uganda’s Rakai and Kyotera Districts. Through use of the BAMA Program’s existing community midwives and model mothers and fathers, Mama and Papa Ambassadors, the project will specifically identify, track, and provide both institutional and monthly peer-group support for adolescent mothers at Rakai Hospital to improve their well-being and stimulate their infants’ early brain development. Midwives and Mama Ambassadors will be trained in adolescent-friendly reproductive health care and we will establish adolescent health clinics for the first time in our districts. We will also establish newborn intensive care units at our two district hospitals.
Partnering with Knowledge for Children
Our students reading at their new school library.
Over the past fifteen years, we have partnered with local communities to rebuild nine Universal Primary Education (UPE) Schools serving 4000 students. In 2019, we will work with Knowledge for Children, a Dutch-funded NGO, that works with UPE schools to improve the quality of education, improve literacy and build a culture of reading amongst our children. Like Brick by Brick, whose partnering communities invest 25% of the costs of all construction projects, Knowledge for Children practices a co-funding model to ensure full engagement and sustainability. We will pilot this project in four schools beginning in February.
2019 will be an exciting year of innovation. You can follow our progress here throughout the year. We thank you as always for being a partner in our work.