Beyond Facility-based Births: Is Uganda Delivering Effective Maternal and Newborn Care? An analysis of the 2022 Demographic Health Survey and 2023 Harmonized Health Facility Assessment Survey

BackgroundMaternal and newborn studies in Uganda have primarily focused on measuring coverage of facility-based birth. However, this is inadequate and tends to overestimate the benefits of services provided to women and newborns if the quality of care in the facilities is not considered. Effective coverage of care addresses this limitation and adjusts for the quality of services. This study aimed to assess the effective coverage of maternal and newborn care in Uganda. MethodsWe analyzed the 2022 Uganda Demographic and Health Survey (DHS) and the 2023 Harmonized Health Facility Assessment (HHFA). We included 5,618 women who had a live birth in the two years preceding the DHS, and we estimated the HHFA readiness indicators for 636 facilities providing childbirth care. Facility readiness was assessed using human resources, equipment, amenities, and drugs and supplies as indicators. We calculated crude coverage as the percentage of facility births. Two effective coverage measures were used: intervention coverage as a percentage of women who received all ten recommended interventions for the most recent birth, and readiness-adjusted coverage as a product of crude coverage and facility readiness using an ecological linking method by region. ResultsAmong the 5,618 women included from the DHS, 85.9% gave birth in a facility; however, only 14.0% reported receiving all ten recommended interventions. Readiness was highest in government hospitals (81.9%), followed by private facilities (58.7%), and lowest in lower government health centers (46.4%). Only 47.8% of women gave birth in a ready health facility. The readiness-adjusted coverage varied across regions, with the lowest readiness in Kampala (40.9%) and the highest in the North-Eastern (61.4%). ConclusionsSignificant gaps exist between crude coverage and effective coverage. The largest gap was in intervention coverage, disproportionately affecting regions and lower-level health centers. There is a need to enhance the capacity of lower-level health centers to deliver quality maternal and newborn care.