Table 5.

Health facility level information and actions taken

Emerging issues	Data collection methods and avenues for information sharing	Actions suggested and taken
Monitoring of women in labour
Limited use of partographs to monitor the progress of labour	Information collected through supportive supervision visits and shared through district review meetings	Training of the health workers on the use of the partograph through mentorship programme and support supervision; training was done by Makerere University and health facilities started budgeting for the printing partographs using their primary health centre fund
Maternal and newborn death high in some health facilities	Data was collected through records review/supportive supervision and shared during quarterly review meetings	Maternal and newborn death audits were recommended; the District reproductive health focal person found that, in one hospital, the nurses did not know how to resuscitate newborns, so it was suggested that this nurse receives a training, which was done by attaching a district mentor at this facility; in another facility, unnecessary augmentation of labour was being performed, leading to foetal distress and stillbirths, so the midwife was given guidance by district mentor about when to augment labour
Care for newborns
Poor care of small infants – neonatal resuscitation and using Kangaroo Mother Care	Data was collected through midterm household surveys and shared in the second quarterly review meetings during second year of implementation	District health officers requested Makerere University to design a mentorship programme focusing on caring for small infants; Makerere University School of Public health mentored the district mentors who in turn scaled-up the skills to other facilities
		District officer in charge of paediatrics proposed putting in place a newborn care corners started at the health facilities; Makerere University School of Public Health brought in a paediatrician on the mentorship team so as to improve newborn care
Resources for providing maternal and newborn services
Stock-out of maternal and newborn essential drugs and supplies	Information collected through supportive supervision visits and shared through district review meetings	Training the health facility managers on proper drug requisitioning during the certificate course on management by Makerere University School of Public Health; however, in some cases, a persistent drug stock-out was brought about by the delay in the delivery of supplies by National Medical Stores – a body that is responsible for the distribution of drugs in all health facilities; nevertheless, facilities that had excess shared with facilities that had inadequate amounts
Four health facilities did not have a placenta pit for disposal of placentas		The sub-county leadership was informed at the sub-county review meeting and they availed funds to construct the placenta pits; the placenta pits were built in all facilities with the support from the sub-county
Some hospitals and health centre IV did not have an ambulance	Data collected through health facility assessment and review meetings	Political leaders to lobby politicians and other stakeholders to buy ambulances; members of parliament in Pallisa district bought four motorised ambulances
		One sub-county bought a motorcycle ambulance
		Fundraising was done and 10 trailers for motorcycle ambulances were purchased
Ambulances have mechanical problems and cannot transport women		Medical superintendent for the hospital was asked to ensure funds allocated for repair of the ambulance during district review meeting and this was done (Pallisa district)
No fuel for the hospital ambulance		The district health officers availed money for fuel for the ambulance from the budget line at district level (Kibuku district)