Uganda has high maternal mortality ratio of 435/100,000 live births. In order to address this, Uganda has developed a strategy and has prioritized skilled attendance at delivery as a key intervention.
Methods: A survey covering 54 districts and 553 health facilities was conducted to determine availability and access to essential maternity care and health system factors related to maternal health. The survey specifically assessed availability of emergency obstetric care (EmOC) signal functions, the state of health infrastructure and availability of basic drugs and supplies.
Results: A total of 194,029 deliveries were recorded in the year preceding the survey. Majority, 117,761 (60.7%) occurred in hospitals, while 76,268 (39.3%) occurred in health centers. The following factors were associated with increased deliveries at health facilities; running water, (RR 1.5, P < .001); electricity, (RR 1.4, P < .001) and accommodation for staff, (RR 1.2, P < .002). Health units providing basic EmOC had the highest chances of attracting women to deliver there, (RR 4.0, P < .001) as well as those providing comprehensive EmOC, (RR 3.1, P < .001). Furthermore, the majority of health facilities expected to offer basic EmOC, 349 (97.2%) were not offering the service. This is the likely explanation for the high health facility-based maternal ratio of 671/100,000 live births in Uganda.
Conclusions: Improving availability and quality of care especially EmOC; and ensuring that health units have electricity, running water and accommodation for staff could increase skilled attendance at delivery and help achieve the Millennium Development Goals (MDG) target on maternal health in Uganda.