Pregnancy mapping to improve access to health services
The project in brief
United Nations Population Fund (UNFPA)
March 2019-December 2019.
It is expected that the project will be renewed in 2020 in both settlements and nearby host communities. The Moyo district local government and VHTs will continue the mapping every quarter in nearby host communities, and the Sexual and Reproductive Health (SRH) Sector Sub-Working Group partners are discussing how to carry out the project in Palorinya settlement in 2020 through resource sharing.
Pregnancy mapping was conducted in refugee settlements and host communities to provide partners with real-time location-based data to improve women’s access to maternal health services.
The purpose of the project is to conduct pregnancy mapping and tracking in order to take a census of all pregnant mothers within the settlement and two nearby host community parishes. The improved access is expected to reduce maternal and infant morbidity and mortality.
The mapping exercise was low-cost and community driven.
It applied Geographical Information Systems (GIS) to collect health-related data on pregnant women and ease follow up during pregnancy and after birth. Information collected included biographical information of the mother, ANC attendance, next of kin, behavioural characteristics of the previous pregnancy, and GIS information of the homestead for ease of follow up. SMS messages were sent for reminding patients about appointments and health workers traced mothers who have skipped their appointments.
The mapping will inform planning and interventions for 2020 in order to improve maternal health outcomes and meet the immediate needs of both refugee and host communities through the humanitarian-development nexus.
Specific objectives of the intervention included:
(1) Map all pregnant mothers within Palorinya refugee settlement and two parishes in the host community;
(2) Conduct a basic risk screening and assessment of pregnant mothers in the community and appropriate referral accordingly;
(3) Issue mapping cards with unique identifiers to pregnant mothers to enable the tracking of access to antenatal care (ANC), postnatal care (PNC), labour and ambulance services;
(4) Compare the number of mapped mothers with the estimates of the local districts.
Funding was provided by UNFPA and from the Central Emergency Response Fund (CERF). UNFPA, partners and District Local Government (DLG) of Moyo regularly participate in a Sexual and Reproductive Health Sector Sub-Working Group (SRHWG) and agreed to conduct the mapping by sharing resources and capacity.
- Lutheran World Foundation (LWF Uganda)
- Medical Team International (MTI Uganda)
- Infectious Diseases Institute (IDI Uganda)
- Village Health Teams (VHTs) – Moyo and Obongi Districts (Uganda)
- District Local Government – Moyo and Obongi Districts (Uganda)
- UNFPA Uganda
Challenges and how they were overcome
Using mapping technology (GIS) to map pregnant mothers in rural and hard-to-reach areas was challenging due to little or no network coverage and intermittent power for charging mobile devices. More robust data collection methods are needed, as the recorded number of pregnant women did not meet the district estimates based on population crude birth rate calculations.
Partners overcame challenges by carefully planning and collaborating during the Sexual and Reproductive Health working group meetings and utilizing already existing community structures for conducting the mapping, such as Village Health Teams (VHTs). Partners worked together to train and support a group of 20 VHTs in data collection methods. The VHTs will continue to work with midwives at their nearest health facility to ease referrals and enhance follow up by the midwives in the community. Over time, the sensitization provided by the VHTs may encourage mothers to self-report their pregnancies earlier and the recorded number of pregnant women may more closely reflect estimations.
Results of the Good Practice
- The mapping identified 894 pregnant women, educated mapped mothers about the benefits of timely ANC and nearly half were flagged as high-risk groups for closer follow up and referred to appropriate levels of care.
- Between March 2019 and October 2019, the number of pregnant mothers who did not visit a health facility for ANC reduced by almost a third, from 112 to 80.
- The mapping informs sector partners on gaps in health services provision.
- The data summary sheet and GIS coordinates of mapped pregnant mothers were shared with partners such as UNICEF and WFP for nutritional follow up, vaccination etc.
How the project meets the GCR Objectives
Objective 1: Ease the pressures on host countries
The good practice of pregnancy mapping eases pressures on host countries by providing more accurate data about currently pregnant women on an ongoing basis to partners and service providers in the sector. This enables partners to provide better maternal health services, including following up on missed ANC appointments, sensitizing mothers on information related to their pregnancy and the importance of having a skilled birth attendant deliver their baby, among others. The mapping also improves follow up and flagging any potential complications from birth prior to delivery, particularly for high-risk pregnancies, such as for young adolescents or women carrying their fifth or higher pregnancy. The mapping strengthens the humanitarian-development nexus as it is jointly conducted across both settlements and host communities while being low-cost and community driven. By reducing complications and encouraging regular attendance of ANC, the project eases pressures on the host country’s health service providers to manage late-stage pregnancy and delivery complications. Furthermore, it provides real-time data to the host country government and sector working groups for better planning of interventions.
Objective 2: Enhance refugee self-reliance
Pregnancy mapping enhances refugee self-reliance by improving refugees’ access to maternal health services, reinforcing the benefits of (1) attending at least one ANC appointment prior to delivery, and (2) delivering at a health facility with a skilled birth attendant. Refugees also receive information about their pregnancy, nutritional advice, and family planning methods, particularly after delivery during postnatal care. The intervention is especially important in mapping young adolescents and educating them about how to have a healthy pregnancy early on in their lives, which has the potential to inform them on how to manage their future pregnancies.
The project was implemented across both settlement and host communities to strengthen the humanitarian-development nexus, and the DLG will absorb the intervention through VHTs in host communities on a quarterly basis. Discussions are currently ongoing for sustaining the project in the settlement. The findings were shared with all sector partners and inform the planning of interventions to better meet the identified gaps in service delivery.
Maiken Jacobsen, Programme Delivery and Coordination Specialist, UNFPA