Designed to fail? Revisiting Uganda’s maternal health policies to understand policy design issues underpinning missed targets for reduction of maternal mortality ratio (MMR): 2000-2015

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Mukuru, M, Gorry, J, Kiwanuka, SN, Gibson, L ORCID: https://orcid.org/0000-0002-1220-8680, Musoke, D and Ssengooba, F, 2022. Designed to fail? Revisiting Uganda’s maternal health policies to understand policy design issues underpinning missed targets for reduction of maternal mortality ratio (MMR): 2000-2015. International Journal of Health Policy and Management, 11 (10), pp. 2124-2134. ISSN 2322-5939

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Official URL: https://doi.org/10.34172/ijhpm.2021.127

Abstract

Background: Despite Uganda and other sub-Saharan African countries missing their maternal mortality ratio (MMR) targets for Millennium Development Goal (MDG) 5, limited attention has been paid to policy design in the literature examining the persistence of preventable maternal mortality. This study examined the specific policy interventions designed to reduce maternal deaths in Uganda and identified particular policy design issues that underpinned MDG 5 performance. We suggest a novel prescriptive and analytical (re)conceptualization of policy in terms of its fidelity to ‘3Cs’ (coherence of design, comprehensiveness of coverage and consistency in application) that could have implications for future healthcare programming.

Methods: We conducted a retrospective study. Sixteen Ugandan maternal health policy documents and 21 national programme performance reports were examined, and six key informant interviews conducted with national stakeholders managing maternal health programmes during the reference period 2000-2015. We applied the analytical framework of the ‘three delay model’ combined with a broader literature on ‘policy mixing.’

Results: Despite introducing fourteen separate policy instruments over 15 years with the goal of reducing maternal mortality, by the end of the MDG period in 2015, only 87.5% of the interventions for the three delays were covered with a notable lack of coherence and consistency evident among the instruments. The three delays persisted at the frontline with 70% of deaths by 2014 attributed to failures in referral policies while 67% of maternal deaths were due to inadequacies in healthcare facilities and trained personnel in the same period. By 2015, 37.3% of deaths were due to transportation issues.

Conclusion: The piecemeal introduction of additional policy instruments frequently distorted existing synergies among policies resulting in persistence of the three delays and missed MDG 5 target. Future policy reforms should address the ‘three delays’ but also ensure fidelity of policy design to coherence, comprehensiveness and consistency.

Item Type:	Journal article
Publication Title:	International Journal of Health Policy and Management
Creators:	Mukuru, M., Gorry, J., Kiwanuka, S.N., Gibson, L., Musoke, D. and Ssengooba, F.
Publisher:	Kerman University of Medical Sciences
Date:	October 2022
Volume:	11
Number:	10
ISSN:	2322-5939
Identifiers:	Number Type 10.34172/ijhpm.2021.127 DOI 1791506 Other
Rights:	© 2022 the author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Divisions:	Schools > School of Social Sciences
Record created by:	Jonathan Gallacher
Date Added:	16 Aug 2023 08:16
Last Modified:	16 Aug 2023 08:16
URI:	https://irep.ntu.ac.uk/id/eprint/49568