By Adara Development
Despite making significant gains in reducing newborn deaths, data shows that Uganda is not on track to reach the Sustainable Development Goal (SDG) for maternal and newborn mortality. Estimates indicate that Uganda will still have 21.9 newborn deaths per 1,000 live births in 2030, rather than the SDG target of 12.
At Adara, we have heard repeatedly that there is a need for new approaches to turn the tide in maternal and newborn health. This has led us to develop AdaraNewborn, our evidence-based, high-impact model with the power to halve newborn deaths and stillbirths across 10 health facilities in Uganda over the next decade. With 25 years of experience working in partnership with Kiwoko Hospital to develop a Centre of Excellence, we are now scaling our programmes to accelerate change across Uganda.
AdaraNewborn spans the continuum of care, improving outcomes across five arms: antenatal care, intrapartum care, inpatient care for small and sick newborns, postnatal care for mother and baby, and follow-up and early intervention. It also utilises a regional ‘hub and spoke’ model that can be replicated nationally and internationally, leveraging recent successes with this approach in Uganda.
What is the AdaraNewborn regional model?
Together with the Uganda Ministry of Health and other implementation partners, we will establish two regional hubs of maternal and newborn care. A regional referral hospital will serve as the Centre of Excellence at the heart of each hub. We will then strengthen surrounding target hospitals and health centres (known as Health Centre IVs) that perform more basic levels of maternal and newborn care.
Through our first hub, we seek to improve the quality of care across Luwero, Nakaseke and Nakasongola districts in Central Uganda. These districts have a combined population of more than one million people. Kiwoko Hospital is in the middle of this hub, acting as a Centre of Excellence and referral facility that can provide higher levels of care. We have already commenced work with two additional AdaraNewborn sites within this hub: Nakaseke and Luwero hospitals. Two more facilities will be added in the coming years.
The second regional hub – comprising five facilities in a separate geographic area – will be selected after close consultation with the Ministry of Health and analysis of national and regional data.
“AdaraNewborn facilities are selected based on high mortality and referral rates into existing AdaraNewborn sites,” says Daniel Kabugo, Adara’s Uganda Country Director. “Because we are working across multiple sites, we can see where the highest risk babies are being referred from and where there is the greatest need.”
We will also invite smaller health centres (known as Health Centre IIIs) to participate in training and skill-building activities to improve survival before and after referral.
How will this model save newborn lives?
AdaraNewborn will improve referral pathways, build collaboration among local facilities and advance local leadership. This will strengthen the health system, leading to better outcomes for mothers and babies. To achieve this, we will focus on four key activities below:
Leadership and governance: We will strengthen leadership and governance within the health system to create sustainable change. Each AdaraNewborn facility will receive a tailored leadership and governance training programme, as well as ongoing support to drive systems-level transformation.
Clinical training: Our team of expert clinicians have developed clinical guidelines and comprehensive training programmes that provide practical guidance for the provision of quality care. We will pair this training with an equipment package and infrastructure upgrades at all AdaraNewborn facilities.
Mentorship: We will provide mentorship through a network of experienced health workers who will model and promote best practices to create resilient systems for ongoing support.
Quality improvement systems: We will implement quality improvement processes to enhance quality of care. We will also develop onboarding processes for new staff to continue implementing these changes, as well as simple education programmes for families.
The model in action
In 2023 we are excited to have begun work with our third AdaraNewborn site, Luwero Hospital. This is a public facility that registers more than 3,500 births each year and needs to refer many of these babies to other health facilities – including Kiwoko – to receive more specialist care. The District Health Officer and Medical Superintendent at Luwero requested this partnership as they see the lives of too many women and newborns being needlessly lost.
“As Luwero Hospital, we have a very busy maternity section,” says Dr Steven Magera, Luwero Hospital’s Medical Superintendent. “We deliver between 350 to 400 babies a month. And as they say, a lot of those babies – maybe 15% of those babies – will require special care, which previously as a hospital we didn’t have. We ended up referring all those babies to Kiwoko, which is quite a distance from Luwero. It’s around 15 kilometres from here. And for every minute you lose, for the baby, it counts. So as a hospital, and as a district, we actually decided to move forward by establishing a neonatal Intensive Care Unit (ICU).”
This year, we will work with Luwero to implement leadership and governance training; carry out needs assessments; roll out clinical training and mentorship; provide biomedical engineering training; and deliver necessary equipment and infrastructure upgrades.
“As we do this work with Luwero, we will monitor where we see large numbers of referrals coming from,” says Daniel Kabugo, Adara’s Uganda Country Director. “Is it from a nearby facility that we can reach out to with our AdaraNewborn package? We will also be able to see how improved maternal and newborn care at Luwero is affecting referrals into Kiwoko Hospital. Is it only the higher-risk babies being referred to Kiwoko, as Luwero becomes equipped to care for less critically sick babies? The benefit of this model is that we can really see progress on a wider scale – it is embedded in the health system. This will ensure change is sustained long after Adara has exited the facility.”
Over the next decade, we plan to reach half a million women and children and prevent over 7,000 deaths. We will impact many more communities by sharing our knowledge and resources – including an AdaraNewborn package – with health facilities and professionals locally and globally.
Through AdaraNewborn, we will strengthen the Ugandan health system and support sustainable systems change. This will save lives now and help reduce maternal and newborn deaths and morbidity into the future.