The Uganda Rescuer Project

1
The Uganda Rescuer Project

• Establishing linkages with ongoing safe
  motherhood programmes
• Dr. Ismail Ndifuna
• National Program Officer UNFPA Uganda

2
Situational Analysis

• Population 27 Million
• Population Growth rate 3.4 per annum
• TFR 6.7 (UDHS 2006)
• No of children desired 4.7 for women and 5.7 for
  men
• CPR 23.7
• Unmet need for FP 41

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Situational Analysis ctd

• Deliveries in health facilities -41
• Skilled attendance 42
• Unmet need for EmOC 95
• MMR 435/100,000 births (UDHS 2006)
• Fistula prevalence in Uganda is 3 (UDHS 2006)

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Major causes of maternal morbidity and Mortality

• Hemorrhage
• Sepsis
• Obstructed labor (Main cause of Obstetric
  Fistula)
• Hypertension in pregnancy

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Socio-economic causes of Maternal mortality and
morbidity

• The 3 delays
• The delay to make a decision to go to a health
  facility
• The delay to reach a health facility
• The delay to obtain skilled care while at the
  Health facility

6
When do pregnancy complications occur?

• It is now clear that maternal deaths mostly occur
  during the last trimester of the pregnancy
• Every pregnancy is risky. 17 of pregnancy
  declared as risk free during ANC end up with
  complications

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What works in preventing maternal mortality and
morbidity

• FP alone would reduce maternal mortality by
  20-30
• FP combined with Skilled Attendance at Birth and
  EmOC would reduce maternal deaths by over 70

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What is RESCUER?

• RESCUER is an acronym for Rural Extended Services
  and Care for Ultimate Emergency Relief
• RESCUER is a referral mechanism for obstetric
  emergencies

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4 essential elements

• Service providers with the appropriate
  level-specific life saving skills, at village,
  health centre and district hospital levels.
• Appropriately equipped service delivery points
  that are regularly and adequately provided with
  essential drugs and medical supplies.
• Means of communication between the different
  levels of care village, health centre and
  hospital.
• Appropriate transport between different levels of
  care.

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The set up of the RESCUER

• In Iganga District where the pilot RESCUER was
  implemented
• A feasibility study was done
• 12 health units were selected and designated as
  referral units
• The referral units were strengthened (personnel
  Medical equipment and supplies, communication
  system, transport system)

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The set up of the RESCUER (ctd)

• 12 VHF base stations were set-up (one per
  referral health centre)
• 84 Walkie-talkies were provided.
• Two hospital ambulances and the DDHS vehicle were
  mounted with VHF radios
• Since 2 out of the 12 referral units were in Lake
  Victoria, 2 motorboats were included on the
  transport component

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The spirit behind rescuer

• District involvement in identifying sites for
  equipping, identifying health workers, providing
  salary for driver and maintenance costs of the
  ambulance and radio equipment, and general
  political support

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How did RESCUER work?

• The RESCUER system was operated with the base at
  TBA sites
• The apex was at the district hospital maternity
  units.
• A member of the TBA would call health centre on
  Walk-Talkie on recognition of complications
  during labour.
• The Health centre would send an ambulance to
  transport the women to the health centre
• The health centre would manage or call for an
  ambulance from the hospital to transfer the women
  for hospital care if unable to manage

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RESCUER communication Installation
Solar Panel
Antenna
Mast
MATERNITY
Radio
Walkie talkie Charger
Battery
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Cost estimates of establishing RESCUER system in
a District
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Did RESCUER work?

• Overall increase in the number of supervised
  deliveries from 14.7 in 1995 to more than 27 in
  1998 (Iganga district)
• Hospital maternal deaths reduced by 50 between
  1996 and 1998.
• Motivation and job satisfaction among health care
  providers improved
• Increased confidence of the population in the
  health services.
• Following successes of RESCUER, WHO replicated
  the programme in Soroti district

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Challenges to Rescuer

• The growing demand for the RESCUER system soon
  out paced UNFPA ability to fund the system.
  Consequently in the CP 2001-2005 UNFPA only had
  enough funds to cover six districts.
• The number of districts was multiplying by the
  day heavily undermining coverage (from 56 to 80
  now)
• With the discrediting of the TBA RESCUER lost its
  base

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Lessons learnt from RESCUER

• if correctly informed, communities and their
  leaders are willing to meet the cost of health
  care, especially reproductive health care.

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New Initiatives to reduce Maternal Morbidity and
Mortality

• The Road map to reduction Maternal and Neonatal
  morbidity and mortality is in place and provides
  evidence based approaches to reducing maternal
  and neonatal mortality and morbidity

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End

• Thank you