title: Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda.
abstract: Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda.
  
  
  
  A participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered.
  
  
  
  Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs. However saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women's access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health teams and savings groups functioned required regular supervision, review meetings and payment for supervisors to visit.
  
  
  
  This participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare. Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced.
authors.affiliation: Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, Kampala, Uganda. Ekky@musph.ac.ug.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ekirapa-Kiracho
authors.affiliation: Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, Kampala, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Namazzi
authors.affiliation: Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, Kampala, Uganda.|Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Moses
authors.initials: M
authors.lastname: Tetui
authors.affiliation: Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, Kampala, Uganda.
authors.forename: Aloysius
authors.initials: A
authors.lastname: Mutebi
authors.affiliation: Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, Kampala, Uganda.|Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Htet
authors.initials: H
authors.lastname: Oo
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Peters
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.|South African Research Chair, School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors.forename: Asha S
authors.initials: AS
authors.lastname: George
mesh_terms: D000328:Adult; D001107:Architectural Accessibility; D003695:Delivery of Health Care; D005260:Female; D017144:Focus Groups; D006268:Health Facilities; D006302:Health Services Research; D006792:House Calls; D006801:Humans; D007223:Infant; D000068104:Infant Health; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D000068097:Maternal Health; D011247:Pregnancy; D011295:Prenatal Care; D058996:Quality Improvement; D012424:Rural Population; D014454:Uganda