Kampala has a population of 1.5 million people. 1.2 million are urban poor or residents of informal settlements. While the private health care sector in Kampala constitutes 98% of all health facilities, the provision of maternal and neonatal health (MNH) services is primarily shouldered by public health facilities. Public facilities are thus congested beyond the numbers they are designed to handle, a situation which compromises the quality of care. Women perceive services at private facilities to be of higher quality in terms of cleanliness, care, and timeliness. However, urban poor women were concerned by lack of regulatory control on standards and pricing at these facilities. In addition, women were concerned that these facilities lacked the skills to manage obstetric and newborn complications when they arise, because they often witness cases being referred to national referral hospitals rather than being treated.
To address these issues, Population Services International (PSI) Uganda and Kampala Capital City Authority (KCCA) which is the governing body of the capital city, received funding from USAID in 2018 to develop and test innovative interventions to address barriers that affect access to quality MNH care for urban poor. The Kampala Slum Maternal and Newborn Health (MaNe) project used an implementation research and human-centered design (HCD) approach to test interventions that were co-designed with stakeholders such as the Ugandan Ministry of Health (MOH), development partners, and members of the resident urban slum communities. The first step of the MaNe project was to conduct formative research to better understand the supply and demand barriers affecting care seeking, referral, and the provision of equitable and quality private MNH care. The findings from this study highlighted the lack of readiness and commitment by private proprietors to invest in MNH; lack of essential MNH infrastructure, supplies, drugs, and commodities; and high MNH service costs for the urban poor. The findings also indicated that women were willing to pay a reasonable fee for care in private facilities if they were reassured that the services would be high quality.
