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Background of the Project

Over the past two decades, Uganda has made notable progress in increasing coverage of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) services. Consequently, there has been significant progress toward improving the health of mothers, children, newborns, and adolescents in the country. However, Uganda still ranks among countries with high maternal, newborn and child mortality rates.

Uganda has a population of 41.5 million people and a very high annual growth rate of 3.03% attributed to the high total fertility rate of over six children per woman observed for the last 4 decades against the backdrop of declining mortality rates. Despite recent improvements in Maternal Mortality Rate (MMR), the country still generally has poor RMNCAH indicators. Neonatal Mortality Rate (NMR) has remained stagnant for the last decade though Maternal Mortality Rate (MMR) and child mortality trends show significant reductions. Therefore, the RMNCAH conditions in Uganda still represent a critical public health challenge. 

Mother and Child
Mother and Child (Unsplash Photo)

 Uganda developed the RMNCAH Sharpened Plan in 2013 to enable collective action towards key intervention areas for achieving equitable accelerated improvements in maternal, newborn and child mortality rates in Uganda. The government and development partners are implementing this Plan through several programs and projects. One of which is the Uganda Reproductive, Maternal and Child Health Services Improvement Project (URMCHIP). This project is jointly financed by the Ministry of Health (MoH), the World Bank, the Swedish International Development Agency (SIDA), and the Global Financing Facility.

The objectives of the project are:

  1. To improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target districts; and
  2. to scale up birth and death registration services.

In order to generate evidence for informing policy and management decisions, operational research was included in the RMNCAH Sharpened Plan. Hence, MoH together with the World Bank and SIDA designed and launched the Uganda RMNCAH Operational Research program. The main objectives of the RMNCAH operational research program are: i) to assist Uganda in generating practical and actionable evidence for RMNCAH implementation; and ii) to strengthen the capacity of Ugandan researchers in operational research.

Through extensive stakeholder consultations, led by the Ministry of Health and the RMNCAH operational program’s Advisory Committee, a first set of research questions were identified in 2018, and a call for proposals was issued in March 2019. The program recruited 20 researchers to develop proposals on 11 research topics focusing on seven thematic areas, aligned with the Sharpened Plan, namely:

  1. Stewardship and management;
  2. Financing;
  3. Service delivery;
  4. Human resources for health;
  5. Supply chain management;
  6. Health management information systems and civil registration and vital statistics; and
  7. Demand-side and gender issues.

Following the development of the proposals of the 11 studies, the researchers submitted their protocols to the World Bank for technical review and to the National AIDS Research Council (NARC) for ethics review. They have all received formal approvals, finalised requirements for registeration of their studies with the Uganda National Council for Science and Technology (UNCST), and progressed to the implementation phase of their studies.

MakSPH mandate

Recognizing that timely implementation and completion of these studies requires extensive support from a firm with proven experience in research coordination, the World Bank competitively selected Makerere University School of Public Health (MakSPH) to facilitate their implementation. The specific terms of reference (ToR) for MakSPH are to work with the World Bank and the principal investigators of the studies to design and implement an effective process for facilitating data collection for the respective studies, which will include:

  1. Mobilization, training, and deployment of research assistants during the implementation of the studies;
  2. Alignment of the needs for each research study with the appropriate research assistants in consultation with the principal investigators; and
  3. Provision of the necessary administrative, technical, and logistical support during the implementation of the studies.