Evidence-based policies and health systems interventions for antenatal care (ePosit)
Evidence-based policies and health systems interventions for antenatal care (ePOSIT) – a research project for ANC in Uganda
About the project
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Project period: 01.08.2021 - 30.07.2026 (Active)
- Coordinating Institution: Global Health
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Project Manager:
- Jahn Frederik Frøen, Global Health
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Project Participants:
- Aurelia India Neumark, Researc Administrative Support
- Johan Ivar Sæbø, Department for Informatics
- Eleni Papadopoulou, Global Health
- Mahima Venkateswaran, Department of Global Public Health and Primary Care
- Ane-Marthe Solheim Skar, Global Health
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.
The ePOSIT project aims to provide Uganda with better evidence to enhance care for pregnant women and their babies. We will support the adoption of 2 WHO guidelines in line with national policies:
- Recommendations on antenatal care (ANC) for a positive pregnancy experience
- Recommendations on digital interventions for health system strengthening
Our work will build on the WHO Digital Adaptation Kit (DAK) for ANC, co-designed with users and stakeholders, and integrated into Uganda’s national DHIS2 health information system.
Why?
In a typical district in Uganda, 50,000 women give birth each year. Tragically, over 200 will die due to complications during pregnancy, childbirth, or shortly after, while more than 2,000 babies will die either late in pregnancy or within the first week of life. Significant challenges persist in ANC, including limited access to the WHO-recommended 4 ANC visits, inconsistent quality, and gaps in continuity of care. Moreover, the data needed to track and improve outcomes remains inadequate.
At the same time, Uganda is undergoing a digital transformation in health informatics, including doubling ANC visits from 4 to 8. Research is essential to ensure that this shift is feasible, acceptable, and impactful at scale.
How?
We will work across 3 key domains:
Domain 1: Digitizing the ANC system
Through a co-design process with users and stakeholders, we will transform Uganda’s ANC records from paper-based to a digital eRegistry in DHIS2, aligned with the WHO DAK for ANC. This system will serve as:
- A digital health record with clinical decision support for providers
- A platform for SMS appointment reminders for women
- An automated reporting tool for managers to monitor performance and outcomes
By introducing this system in Mukono district, we aim to improve both ANC attendance and the quality of care. Alongside implementation, we will study its feasibility, acceptability, and sustainability in the Ugandan context.
Domain 2: Supporting the transition to 8 ANC visits
We will examine how the ANC eRegistry and other factors can support Uganda’s shift from 4 to 8 ANC contacts. Our focus will be on ensuring this transition benefits mothers, babies, healthcare providers, and the health system.
Domain 3: Evaluating impact through a cluster-randomized trial
While universal coverage of 4 high-quality ANC visits is still a goal, the shift to 8 visits raises questions about its impact on attendance and care quality. We will conduct a cluster-randomized controlled trial to provide robust evidence on health outcomes, equity, and the value of the investment.
Who?
The ePOSIT project brings together the Ugandan Ministry of Health, the District Health Offices of Mukono, Makerere University School of Public Health, HISP Uganda, University of Oslo, the University of Bergen, King’s College London, and the Norwegian Institute of Public Health. The project is funded by the Research Council of Norway through a grant to the Norwegian Institute of Public Health.
As of February 2026, 34 health facilities are using the ANC eRegistry, with health workers leveraging the digital platform to enhance clinical decision-making and streamline antenatal care services.
To date, more than 10,000 new pregnancies have been registered in the eRegistry, generating comprehensive digital client records.
The ePOSIT project continues to drive innovation in maternal healthcare, strengthening Uganda’s health system through digital transformation.
