Summary

Evidence-based policies and health systems interventions for antenatal care (ePOSIT) – a research project for ANC in Uganda 

Why? In the districts of Mukono and Buikwe, Uganda, 50,000 women give birth every year. Among them, over 200 will die during pregnancy, childbirth, or within 42 days, and over 2,000 will experience that their baby dies after 28 weeks of pregnancy or during the first week of life. Challenges remain in ANC in Uganda, both in women’s use of 4 ANC visits, quality content and continuity of care, outcomes – and data to monitor and guide progress. At the same time Uganda is embarking on a digital transformation of health informatics for ANC, and a doubling of ANC contacts from 4 to 8. Implementation research is needed to support these transformations to ensure feasibility, acceptability, fidelity, and effectiveness of implementation at scale. 

What? In this project, scientists, health, and information technology professionals have the ambition to assist Uganda with better evidence to improve essential services for pregnant women and their babies. Our work will support Uganda in adopting two WHO Guidelines in line with national guidelines and policies: Recommendations on antenatal care for a positive pregnancy experience, and Recommendations on digital interventions for health system strengthening. We will build innovations on the WHO Digital Adaptation Kit for ANC, co-designed with users and stakeholders, and integrated in the national DHIS2 health information systems. 

How? We will work in three domains: First, we will work through a co-design process with users and stakeholders to transform the Ugandan ANC health information system from paper to a digital eRegistry of maternity records in DHIS2 corresponding to the WHO Digital Adaptation Kit for ANC. This system will not only serve as digital health records with clinical decision support for care providers, but also send ANC appointment reminders to women by SMS, and automatically report performance and outcomes to managers. The purpose of introducing such a system is to strengthen both the attendance to ANC, and the quality and continuity of ANC. While undertaking this implementation in Mukono and Buikwe, we will study the factors that can help make such systems feasible, acceptable, effective, and sustainable in a Ugandan setting.  

Second, we will study how the ANC eRegistry, and other contextual factors can help make the transition from 4 to 8 ANC contacts feasible, acceptable, effective, and sustainable in a Ugandan setting – for mothers and their babies, the health care providers, and the health system.  

Third, when there is still a long way to go to secure universal coverage of 4 ANC visits of good quality and continuity of care to all, we do not know how such a change will affect attendance and quality of care. To provide high quality evidence and policy-relevant estimates of effectiveness, i.e. what improvements you get in health outcomes and equity for mothers and their babies for the investment made, we will study the intervention in a cluster-randomized controlled trial.  

Who? The ePOSIT project is a collaboration between the Ugandan Ministry of Health, District Health Offices of Mukono and Buikwe, Makerere University School of Public Health, The Health Information Systems Project (HISP) Uganda, University of Oslo/HISP Global HQ, University of Bergen, King’s College London, and the Norwegian Institute of Public Health. The project is funded by a grant from the Research Council of Norway to the Norwegian Institute of Public Health. 

See the full project description at Cristin for more information about results, researchers, contact information etc.

Project participants

Project leader

Jahn Frederik Alexander Claude Frøen, Global Health, Norwegian Institute of Public Health

Project participants

Aurelia India Neumark, Researc Administrative Support, Norwegian Institute of Public Health
Akuba Kwansima Dolphyne, Global Health, Norwegian Institute of Public Health
Johan Ivar Sæbø, Department for Informatics, University of Oslo
Eleni Zoumpoulia Papadopoulou, Global Health, Norwegian Institute of Public Health
Mahima Venkateswaran, Department of Global Public Health and Primary Care, University of Bergen
Nina Sophie Justnæs, Department for Informatics, University of Oslo
Tara Kelly Dolgner, Researc Administrative Support, Norwegian Institute of Public Health
Eia Elena Skjønsberg, Researc Administrative Support, Norwegian Institute of Public Health
Ane-Marthe Solheim Skar, Global Health, Norwegian Institute of Public Health
Brian O'Donnell, Global Health, Norwegian Institute of Public Health