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The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities : the role of absenteeism

Ackers, HL; Ionnou, E; Ackers-Johnson, J

Authors

E Ionnou

J Ackers-Johnson



Abstract

Maternal mortality in low and middle income countries (LMICs) continues to remain high. The Ugandan Ministry of Health’s Strategic Plan suggests that little, if any, progress has been made in Uganda in terms of improvements in Maternal Health (Millennium Development Goal 5) and, more specifically, in reducing maternal mortality (MOH, 2010:43). Furthermore, the UNDP report on the MDGs describes Uganda’s progress as ‘stagnant’ (2013: iii).
The importance of understanding the impact of delays on maternal and neonatal outcomes in low resource settings has been established for some time. Indeed, the ‘3-delays’ model has exposed the need for holistic multi-disciplinary approaches focused on systems change as much as clinical input. The model exposes the contribution of social factors shaping individual agency and care seeking behaviour. It also identifies complex access issues which, when combined with the lack of timely and adequate care at referral facilities, contributes to extensive and damaging delays. It would be hard to find a piece of research on this topic that does not reference human resource factors or ‘staff shortages’ as a key component of this ‘puzzle’. Having said that, it is rare indeed to see these human resource factors explored in any detail. In the absence of detailed critique (implicit) ‘common sense’ presumptions prevail: namely that the economic conditions at national level lead to inadequacies in the supply of suitably qualified health professionals exacerbated by losses to international emigration.
Eight years’ experience of action-research interventions in Uganda combining a range of methods have lead us to a rather stark conclusion: the single most important factor contributing to delays and associated adverse outcomes for mothers and babies in Uganda is the failure of doctors to be present at work during contracted hours. Failure to acknowledge and respond to this sensitive problem will ultimately undermine all other interventions including professional voluntarism which relies on local ‘co-presence’ to be effective (author ref, 2014). Important steps forward could be achieved within the current resource framework, if the political will existed. International NGOS have exacerbated this problem encouraging forms of internal ‘brain drain’ particularly among doctors. Arguably the system as it is rewards doctors for non-compliance resulting in massive resource inefficiencies.

Citation

Ackers, H., Ionnou, E., & Ackers-Johnson, J. (2016). The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities : the role of absenteeism. Health Policy and Planning, 31(9), 1152-1161. https://doi.org/10.1093/heapol/czw046

Journal Article Type Article
Acceptance Date Mar 28, 2016
Online Publication Date May 3, 2016
Publication Date May 3, 2016
Deposit Date Apr 12, 2016
Publicly Available Date May 9, 2016
Journal Health Policy and Planning
Print ISSN 0268-1080
Electronic ISSN 1460-2237
Publisher Oxford University Press
Volume 31
Issue 9
Pages 1152-1161
DOI https://doi.org/10.1093/heapol/czw046
Publisher URL http://dx.doi.org/10.1093/heapol/czw046
Related Public URLs http://heapol.oxfordjournals.org/